How does macroeconomics factors affect smes in tanzania

How does macroeconomics factors affect smes in tanzania Essay one talked about how macroeconomics factors such as inflation, monetary policy, taxation and international trade affect the economy of Tanzania as a whole. As stated in essay one, this essay will discuss about how these microeconomics factors affect the small and medium enterprises (SMEs) or occasionally known as micro, small and medium enterprises (MSMEs) in Tanzania. In Tanzania (SME Development Policy, 2002), it is at present increasingly recognized that SMEs play an important job in employment contribution, income generation and stimulation of growth in both rural and urban sectors. SMEs can easily be set up given that their requirements in terms of capital, technology, management, etc. are not as demanding compared to large enterprises. SME Development Policy (2002) wrote different countries use different measures of size according to their development level. In the perspective of Tanzania, micro enterprises are those employing up to 4 employees or utilizing capital amounting up to Tshs.5 million. Small enterprises are those that are employing between 5 and 49 employees or with capital investment amounting from Tshs.5 million to Tshs.200 million. Medium enterprises are those employing between 50 and 99 employees or utilize capital investment amounting from Tshs.200 million to Tshs.800 million. The above information can be summarized using the table below: In 2002, the Government of Tanzania (quoted by Aikaeli, 2007) stated that it is estimated that about a third of the GDP originates from the SME sector and employs approximately 20% of the Tanzanian work force. This data shows that SME sector plays a significant role in the economy. According to Morwa (2006), following the privatization drive and the civil and public service reforms which began to take place in the early 1990s in Tanzania, the country observed a considerable increase in the number of SMEs over the last one decade. SME Development Policy (2002) argued that due to the existence of a number of restrictions hindering the development of Tanzania SME sector such as unfavorable legal and regulatory framework, undeveloped infrastructure, poor business development services, limited access of SMEs to finance, ineffective and poorly coordinated institutional support framework etc., the full potential of this sector has yet to be tapped. The anticipated result is to have a considerably increased contribution of the SME sector to economic development of Tanzania. Monetary policy and its contribution to the SMEs in Tanzania: As described in essay one, the Bank of Tanzania is the central bank of Tanzania and in 1995, according to Wikipedia (2010) the bank had one single main objective, which was monetary policy. One of the problems that SMEs in Tanzania face is limited access to finance. The government decided to set up the following schemes to tackle with this problem: Small and Medium Enterprise Credit Guarantee Scheme (SME-CGS): According to BOT (2010), this scheme was set up by the government during the financial year 2004/5. It is executed by the Bank of Tanzania (BOT) in alliance with Financial Institutions. SME-CGS is devised to promote and support SMEs by building up an enabling environment for expansion and making possible access to financial resources, thus speeding up economic growth and job creation. Economic Empowerment Programme (J.K. Fund): In the financial year 2006/7, the government kept aside about Tshs.21 billion. Mkukuta (2008) stated that the motive of the fund is to offer special consideration loans through normal banking practices to empower SMEs, and especially those that are in the rural and urban areas. The execution of the programme is categorized into two phases. The first phase was assigned Tshs.10.5 billion, which were issued under Credit Guarantee Scheme. The CRDB and NMB banks were selected to partake in the first phase. The second phase was also assigned with Tshs.10.5 billion, which were issued to banks and non-bank financial institutions to offer loans mostly to districts that CRDB and NMB banks were not able to cover during the first phase. According to Mkukuta (2008), as of 30th September 2008, loans worth of Tshs.39 billion were issued from the first phase allocation, whereby the CRDB bank issued about Tshs.22.8 billion and 26,384 entrepreneurs profited from this. NMB bank issued about Tshs.16.2 billion and 21,955 entrepreneurs profited from this. In total, the number of entrepreneurs that profited was 48,370. Mwananchi Empowerment Fund: This scheme was commenced in January 2008. According to Mkukuta (2008), since it was launched with limited capital resources of about Tshs.400 million, the government decided to launch the scheme in five regions in the first phase and carry on with other regions subject to the availability of funds. The first phase regions included Lindi, Mtwara, Manyara, Singida and Rukwa. A Memorandum of Understanding (MOU) has been signed between the CRDB Bank and the National Economic Empowerment Council (NEEC), whereby NEEC had agreed to deposit about Tshs.400 million to the CRDB Bank as cash guarantee. The scheme seeks to empower Tanzania citizens to access capital and loans and take part in the economic activities of the country. The following are the objectives of the Fund as given by Mkukuta (2008): Widen investment knowledge among Tanzanians Enhance employment opportunities Offer a connection among institutions, companies and corporations that are registered under the Economic Empowerment Act by bringing coordination in their activities, counseling and developing them Offer loans to private individuals, corporations and institutions under credit guarantee scheme or non-guarantee scheme. Mkukuta (2008) concluded that until 30th September 2008, a total loan worth Tshs.143,770,000 has been issued to two of the first phase regions; Lindi and Mtwara. CRDB BANK LTD TANZANIA: Masuke (2010) stated in his presentation that CRDB Bank is a private commercial bank that was set up in July 1996. CRDB Bank is one of the banks in Tanzania that cannot escape doing and expanding business with the SMEs sector. This is because of the intense competition for the small corporate market. Because of this predicament, CRDB Bank has been compelled to adjust their traditional banking philosophy and practice and seek out methodologies of dealing with the crisis built-in in financing of SMEs in Tanzania. According to CRDB Bank (Masuke, 2010), SMEs are those with: Number of staff between 1 and 100 in the midst of them are relatives of the entrepreneur Capital investment of between Tshs.5 million to Tshs.800 million Requirement of businesses loan amounting Tshs.1 million to Tshs.100 million Annual sales turnover of Tshs.20 million to Tshs.500 million One of the problems faced by SMEs is getting finance from banks. CRDB Bank carried out a survey to uncover what was hampering SMEs from accessing finance. Masuke (2010) wrote that the following were the results: SMEs sector is viewed as a high risk and costly to finance SMEs have poor auditing and accounting framework Lack of enough guarantee schemes to back-up financing SMEs Inadequate knowledge of business operations Failure of borrowers to organize and present applications/business plan that meets the banks requirements. Failure of SMEs to fulfill collateral requirements. According to Masuke (2010), the following are the initiatives that CRDB Bank took to support SMEs: Devise modified products for SMEs: The bank developed two credit products for SMEs: working capital loan and investment loan. The repayment style developed is by installments. In working capital loan, the minimum repayment period was developed to be 3months and the maximum 12months while in investment loan, the minimum repayment period is 12months and the maximum 60months. Capacity building for CRDB staff and SME customers: In building capacity for CRDB staff, the bank had to hire new staffs who specially deal with SMEs. Furthermore, all employed staffs had to go through an intensive training. In building capacity for SMEs, the bank offers free business and loan management training to SMEs. In addition, after training the trainees are provided with booklet called SME Toolkit, which can be used as a reference. Increase the range of collaterals accepted by the bank: Before CRDB Bank implemented the SMEs concept, it used to call for just traditional collateral. But now, the bank has broadened the range of acceptable collaterals to include non-traditional collaterals e.g. Residential License, properties with offer letters, used motor vehicles and machines etc. Introduction of customer relationship concept at branch level: The bank extended the relationship concept to branch level, which can allow the bank to build a strong relationship with its SMEs. The SME concept was executed as a project in 2005. Since then, the project has been a hit with remarkable growth in terms of portfolio and number of customers. International trade and SMEs: Tanzanias ability to face global economic challenges depends on the stage of development of its SMEs. According to OECD Bologna conference (2000), there are four requirements for development of competitive SMEs that meet the criteria to get involved in cross-border business: Provision of effective business support services Availability of long-term finance Availability of a good state of information and communication technology infrastructure Existence of appropriate social capital The following are the strategies that SMEs can adopt when involving in international activities (Young, 1987): Exporting Foreign direct investments (FDI) Strategic alliance Joint ventures Licensing, etc. According to Saiguran (2007), some of the problems that SMEs in Tanzania face include: Lack of appropriate information, knowledge and skills Challenge of small and competitive domestic market Inadequate and inefficient infrastructural facilities Multiplicity of taxes The following are some of the initiatives that were set up in order to promote international trade in Tanzania: The Board of External Trade (BET): This scheme was set up in 1978. The scheme is responsible for: International markets searching Synchronizing foreign businesses requiring to trade in Tanzania Sorting out and helping out involvement in overseas trade fairs, exhibitions, and missions Carrying out Research and Development on external trade According to BET (2007), since the time the scheme was set up, it has been synchronizing and carrying out training programmes in all areas of international trade, holding specialized exhibitions and carrying out market research. Mini-Tiger Plan 2020: this scheme is fed into the National Strategy for Growth and Reduction of Poverty (NSGRP). According to Aikaeli (2007), this scheme is responsible for: Promote competitiveness of Tanzanian products on the global markets Promote exports Create special economic zones. The zones that were created included: Tanzania Export Processing Zones, which was set up by the parliament Act of 2002 and Zanzibar Free Trade Economic Zones Authority (ZFTEZA), which was created in 1992 SMEs Export Credit Guarantee Scheme: this scheme was set up in 2003 by the government of Tanzania through the central bank. The aim of the scheme is to facilitate export trade. According to BOT (2006), the scheme is geared to support SMEs in line with the National SMEs Development Policy. In order to assist the mentioned above scheme in minimizing problems that are affect by SMEs in relation to international trade, the government in collaboration with private non-governmental organization (NGOs) organizes workshops and seminars to sensitize and educate people on how to cope with the existing global challenges. For example, SMEs Competitive Facility (SCF) of Tanzania organized a course with jingle Track IT, Trace IT Tanzania: Competitiveness for Tanzania. According to SCF (2006), SCF grants opportunity for businesses that desire to build up or add to their ability to trade and export. Regardless of all the problems that SMEs face in Tanzania in relation to international trade (Aikaeli, 2007), SMEs still have the potential to effectively compete and gain the benefits of the rapid expending international trade. AMKA: DAR-ES-SALAAM, TANZANIA Tomesen and Gibson (1998) stated that AMKA is a Swahili word meaning awareness or awaken. It is an NGO in Tanzania which specializes in export and marketing-oriented business development services (BDS) to Tanzania SMEs. AMKA was founded in 1994. Its main goal is to: Increase the incomes and numbers of Tanzanians (employees and/or producers) involved in exportsà ¢Ã¢â€š ¬Ã‚ ¦ [And] increase the value of agricultural output in Tanzania via exportsà ¢Ã¢â€š ¬Ã‚ ¦. (Tomesen and Gibson, 1998) In other words, Tomesen and Gibson (1998) wrote AMKAs export/market-focuses technique is to improve business performance by increasing efficiency and turnover through improved access to new markets (domestic and foreign). In quest of the goal, AMKA carries out a variety of activities that target the SME sector. These create a balancing market/export-focused portfolio of services and can basically be categorized into two groups: Training and advisory services providing training in small business development skills and business planning for export. Trade promotion and intermediary services AMKA acts as an agent between producers and customers. It offers market information on export, assist producers who need export facilities and eases the connection between the producers and alternative trade organizations, which are the customers. AMKA also helps producers and intermediary organizations to take part in trade fairs and offer ethical and quality standard audits of producers for external customers and carries out market research AMKAs key income source is the Department for International Development (DFID). In 1994, it endorsed a 4 year funding of $557,053, which was to assist in forming the organization (AMKA). Nevertheless, the awareness strategy of lessening reliance on one donor has been successful. Reliance on DFID funding has lessened from 94% in 1994/5 to 40% IN 1997/8. Important funds from other donors began to enter into the organization. The percentage of internally generated funds has risen from 5% in 1994/95 to 41% in 1997/98. According to Tomesen and Gibson (1998), AMKA successfully serves two groups of customers: SMEs in Tanzania Overseas customers These customers are mainly in two sectors: food-processing and handicraft production. The customer base is extremely different in terms of the organization structure, the number of employees, their activities and main products. The customer enterprises size ranges from 4 to 446 employees. Customer enterprises have a range of structures of ownership, which include: producer groups (groups of self-employed people), co-operative societies, privately limited companies, parastatals, and associations. Originally, AMKAs focus was to develop intermediaries (co-operatives and associations) who could, in turn, deliver services to producers. Nevertheless, AMKA has shifted deliberately towards to offering more services to producers itself directly mainly because of the weakness of these intermediaries and the complexity in increasing their ability. In general, Tomesen and Gibson (1998) concluded that it is obvious that AMKA has had a positive impact on the economy of Tanzania in general and on producers, SMEs in particular. Because of AMKA, some businesses were rescued; others, for the first time, were introduced to exports, or had export sales increased. Effects of Inflation on SMEs in Tanzania: As described in the first essay, Thompson and Vane (1979) argued that inflation can be caused by a simultaneous fall in the value of money. Inflation had continuously pressure Bank of Tanzania in the year 2009-10 due to its double digit and is expected to remain the same due to government expenditure ahead of October elections, the anticipated dry weather and the deteriorating of the shilling. The rate of inflation affects SMEs access to finance. As described in essay one, a high rate of inflation restricts SMEs from access to finance from the banks and other financial institutions while a low rate of inflation widens the SMEs chances of accessing funds. Because of this, inflation is considered as one of the factors that get in the way of the growth of SMEs in Tanzania, in a way that it puts off investors. Investors prefer to invest in countries where currencies are stable and rates of inflation are low. In order to help the SMEs sector, the central bank of Tanzania has set up a chain of strict fiscal measures to control inflation. Professor Benno Ndulu, the governor of the Bank of Tanzania (cited by Emerging Markets Business News, 2010), in an exclusive interview in Dar es Salaam said his institution was acting quickly and resolutely to turn around the rising rate of inflation. He said the bank would remain alert against the risk of higher food and fuel prices firing up the inflations upward spiral. He continued to say that increasing inflation was a worldwide happening and that the Bank was working round the clock to have power over money liquidity in the economy as one of the measures to deal with the problem. As an economics expert, Prof. Ndulu suggested that Tanzania as a nation requires to produce more food for its rapidly increasing population to trim down reliance on costly imported food products, which add up to inflationary pressures. He challenged regulators such as the Energy and Water Utilities Regulatory Authority (EWURA) and others to make certain that when prices of fuel at the global market dro p, such positive changes should be experienced by Tanzania too. The Bank of Tanzania also controls the growth of money in order to control inflation. According to Ballali (2004), controlling the growth of money enables the bank to have influence over the rates of inflation. In controlling the growth of money, the bank targets broad money, M2, which is currency in circulation outside banks, and total deposits detained by commercial banks, not including foreign currency deposits. BANK OF TANZANIA (BOT): The Bank of Tanzania is responsible for controlling the rate of inflation. Ballali (2004) wrote the objective of monetary policy is to attain a low and stable rate of inflation, which has a link with the key objective of the Bank of Tanzania, which is price stability. Therefore, the bank has an obligation of making sure that it sets up monetary conditions that are in agreement with low and stable inflation. According to Ballali (2004), the focus of the Bank of Tanzania is on the Consumer Price Index (CPI), which it uses to determine inflation. The rate of change in the overall CPI is known as the headline inflation rate. The inflation rate, not including food prices is regularly known as the non-food inflation rate. Non-food inflation rate is used to calculate price movements, which are mostly influenced by policy factors, but can also be often affected by external factors. The Bank of Tanzania also keeps an eye on food prices and their index. This is for the reason that food prices are occasionally influenced by non-monetary factors like drought and floods, which can have an effect on inflation significantly in spite of the attitude of monetary policy. The rate of change in food price index is known as the food inflation rate. Ballali (2004) stated that by controlling the growth of money supply, Central Banks have influence over inflation. The Bank of Tanzania targets broad money, M2, which is described as currency in circulation outside banks, and total deposits detained by commercial banks, not including foreign currency deposits. M2 is selected for the reason that it is the monetary aggregate that is estimated to have closest relationship with the rate of inflation. Central Banks usually have influence over reserve money (base money, or central bank money), as stated by Ballali (2004) which is directly connected to money supply in order to control the growth of M2. Reserve money is described as the liabilities of a Central Bank, which consist of currency detained outside banks and banks reserves detained by the Central Bank. Taxation and its effect on SMEs: According to Mittah (2009), there are two classifications of SMEs: SMEs formal these are potential taxpayers who comply with the tax laws, are well structured and keeps records SMEs informal these are not well structured and have complexities in keeping records. Most of the micro taxpayers fall under informal sector There are advantages in grouping taxpayers, which according to Kimungu and Kileva (2007) include: Simple to manage. Simple to recognize. Simple to educate or counsel on taxation issues. Risk minimization. Higher compliance. The tax system is unfavorable for SMEs development. According to SME Development Policy (2002), the business community has the following perception about Tanzanias taxes: The rates of taxes are higher in relation to neighboring countries in the region Taxes are many and collected by a variety of authorities including: the Tanzania Revenue Authority (TRA), some Central Government Ministries (e.g. Lands, Natural Resources Environment Tourism Energy and Minerals etc.) and Local government Authorities. These are some of the reasons why entrepreneurs are ignorant of tax matters and the cost of acting in agreement with tax regulations is regarded as high. While taxation of businesses is a requirement for national economic development, the current tax system inflicts a major weight on SMEs. The following are the strategies that are set up in order to promote compliances in paying tax by the SMEs: Simplify tax systems: for SMEs the tax system is considered to be complicated. Simplifying the tax system can promote voluntary compliance in paying tax. Mittah (2009) stated that Tanzania has opted for the introduction of presumptive tax system to reinstate income tax, VAT and stamp duties. Presumptive tax system was set up in July 2004 with the intention of minimizing the problems that are faced by SMEs taxpayers in abiding by with the laws of tax. Introduce tax incentives to foster SMEs: tax incentives like low tax rate to those who comply with the tax laws can encourage SMEs to comply and abide by with the tax laws. The Sustainable Industrial Development Policy SIDP (1996 2020): SME Development Policy (2002) reported that this scheme was set up in order to place specific stress on encouragement of small and medium industries through the following measures: Supporting current and new promotion institutions Simplification of taxation Licensing and registration of SMEs Progress access to financial services. Persuades informal sector businesses to grow and be formalized. TANZANIA REVENUE AUTHORITY (TRA): TANZANIA TRA is one of the government companies that are responsible for the application of the Value Added Tax (VAT) to SMEs in Tanzania. VAT was set up in Tanzania on 1st July 1998. Formerly, VAT was known as Sales Tax, but it was replaced because it was unable to create adequate revenue as it was narrow-based. According to TRA (2010) in Tanzania, there are two valid rates of VAT: Standard rate, which is 20% Zero rate, which is 0%. This is generally valid to exports. TRA (2010) gave the following main reasons for setting up VAT: Widen the tax base Achieve economic neutrality Encourage exports Achieve its administrative advantages According to TRA (2010), small businesses are those with yearly taxable turnover of not more than Tshs.40 million. By 31st December 2004, Tanzania had about 355,750 businesses that were registered as small size businesses. This group contributes about 0.44% to the TRA domestic revenue collections. Medium size businesses are those with the yearly taxable turnover exceeding Tshs.40 million, but whose yearly total domestic tax payments to TRA do not go beyond Tshs.400 million. By 31st December 2004, the businesses that were registered as medium size businesses for VAT were about 6,815. This group contributes about 13.2% to TRA total domestic revenue collection. Businesses whose yearly aggregate tax payments to TRA exceed Tshs.400 million are categorized as large taxpayers. TRA has registered about 200 businesses as large taxpayers, including non VAT registered traders such as banks and insurance companies, which entirely deliver free from VAT services. This group contributes about 18% o f TRA total domestic revenue collections. From July to December 2004, about Tshs.2,015.2 million of presumptive tax was accumulated from small businesses. TRAs target was to accumulated tax amounting to Tshs.2,887.3 million, leading to a performance rate of 70%. The key reason for not accomplishing their target was caused by the administrative complicatedness of monitoring the businesses under the informal sector, who do not keep records. About Tshs.60,084.8 million was accumulated from medium size businesses during the first half of Tanzanias financial year 2004/5. TRAs target was to accumulated tax amounting to Tshs.59,212 million, leading to a performance rate of 101%. TRA (2010) stated the following were the reasons for good performance from the medium size businesses: There was close follow-up of monthly tax collections in which the estimated collections are verified by 15th of every month. Recovery of outstanding amount of tax Effective audits Close monitoring of those businesses who do not keep records Tight controls over special free of VAT and VAT repayments Staff training Carrying out of the Departmental Actions Plans The challenges facing Tanzania with respect to taxation of SMEs are in particular to those in the formal sector. Kimungu and Kileva (2007) listed the challenges as: Identification Registration Non compliance Poor of non record keeping Kimungu and Kileva (2007) stated in order to tax SMEs, the TRA has engaged in various activities: Taxpayer education and sensitization Block management system door to door survey Presumptive approach to taxation Assessment procedures Collection formalities and procedures. Conclusion: An assessment of every feature involved in macro-economy i.e. inflation affects, implications of taxation, role of monetary policy and role of international trade suggest variable results. Research has revealed that the SME sector plays a significant role in the economy of Tanzania. The results showed that a third of the GDP originates from the SME sector and employs approximately 20% of the Tanzanian work force. Research has also shown that SME sector has many challenges, which need to be addressed effectively. Given the significance of the sector and the need to transform it to a vibrant and dynamic one, it is essential to put in place strategies that will ease the elimination of those challenges so that it can achieve the desired results. One of the problems that SMEs in Tanzania face, in relation to monetary policy is limited access to finance. This problem exists because the SME sector is viewed as a high risk and costly to finance sector. In order to try eliminating this challenge, the government in collaboration with other financial institutions developed schemes such as SME-CGS, J.K. Fund, etc. which were set up with a main objective of helping the SME sector to have access finance. SMEs also face challenges with international trade. The challenge is caused by SMEs lack of knowledge, information and skills needed to effectively compete in a global environment. Apart from setting up different schemes that tackle this challenge, the government in collaboration with private non-governmental organization (NGOs) also organizes workshops and seminars to sensitize and educate people on how to cope with the existing global challenges. Inflation is considered as one of the factors that get in the way of the growth of SMEs in Tanzania, in a way that it puts off investors. Investors prefer to invest in countries where currencies are stable and rates of inflation are low. The rate of inflation also affects SMEs access to finance. A high rate of inflation restricts SMEs from access to finance while a low rate of inflation widens the SMEs chances of accessing funds. In order to help the SMEs sector, the central bank of Tanzania has set up a chain of strict fiscal measures to control inflation. The tax system is considered as being unfavorable for SMEs development. Business community perceive the rates of Tanzania taxes as being high, complicated and that taxes are many and collected by a variety of authorities. In order to tackle this problem, the tax system need to be simplified so that the SME sector can understand how the whole system works and introduction of tax incentives to foster the SME sector to comply to tax laws.

Early Pregnancy

The Internet ! Teenagers nowadays have so many problems. One of the most common problems is big occupation with the Internet. Teenagers use it every day but not in a good way. The fact is that we can’t imagine one day without the Internet, but children today use it for things which don’t have a good influence on them. For example , kids spend few hours every day playing computer games. They don’t learn anything good from it. Years ago children used to spend all of their free time to hang out with each other, but nowadays they spend all of it to chat online with their friends.That’s the worst thing with Internet. They spend their childhood with the ‘ peace of technology ‘ , not with real people. It would be the best if parents took care of their children and thought more what they do in their free time. They should restrict their time and in that way they could have more time for something that are important in their life. On the other side we n eed Internet for everything today. The bright side of the Internet is that we can get intouch with our cousins and friends form other countries by skype.Unsociable children Big problem of children nowadays is that they have problems with finding friends. It’s really hard for them to find someone who will understand and support them in every way. The Internet , that I’ve just written about has a big influence on their sociable life,so they’re often lonely and feel depressive all the time. They watch lots of movies that are not suitable for their age and they think it’s okay to do those things.Because they don’t have friends and feel depressive , they become aggressive and often don’t find their soulmates. Children don’t understand each other al all. There is too much bullying and misunderstanding in their lives. When someone doesn’t want to do something bad, like smoking cigarettes , or drinking alcohol , what is ‘normalâ €™ nowadays in their age , that person for the rest of society is not normal or modern and than they reject him/her from their group. But , the only truth is that if you don’t do those bad things you stayed good unlike them. Early Pregnancy In considering an article on â€Å"Early Pregnancy: Normal and Abnormal† for a monograph on ultrasound in reproductive medicine and infertility, several issues arise. It is essential that the sonologist or sonographer understand what early pregnancy looks like on transvaginal ultrasound and why it looks like that, so that one can distinguish early pregnancies that are normal from those absolutely destined to fail.Regardless of the level, if any, of assisted reproduction, the use of ultrasound in early pregnancy begins with basic physiology and anatomy. Most often, the patient with an issue of questionable fertility is well-known to the medical establishment, highly motivated, compliant, and usually follows any instruction offered. More often than not, the biochemical evidence of a pregnancy event (i. e. , detection of human chorionic gonadotropin in blood or urine) precedes our ability to see the pregnancy sonographically.In fact, the gap between biochemical detection (as earl y as 30 to 50 mIU/mL) often from over-the-counter home pregnancy tests and our ability to detect a pregnancy even with the sonomicroscopy of the vaginal probe has widened in the recent past. Human chorionic gonadotropin (hCG) is produced by trophoblastic tissue. It is detectable 8 days after conception. [1] Conventional over-the-counter home pregnancy tests turn positive at around the time of the missed menses (30 to 50 mIU/mL). It is often erroneously referred to as the â€Å"beta subunit† or simply the â€Å"beta† although most current tests measure the intact hCG molecule.The ? subunit was originally described to distinguish it from the ? subunit, something that is shared with other molecules such as thyroid stimulating hormone (TSH). Normally, hCG doubles every 48 hours, although a minimum rate of rise is 53 to 66%[2,3] in 48 hours. It is essential to realize that apparently normal doubling times of hCG do not ensure an intrauterine location, as 15 to 20% of ectopi c pregnancies can follow normal doubling times of hCG, and these are ones that often end up with a beating heart and normal appearance, although extrauterine in location Early Pregnancy The Internet ! Teenagers nowadays have so many problems. One of the most common problems is big occupation with the Internet. Teenagers use it every day but not in a good way. The fact is that we can’t imagine one day without the Internet, but children today use it for things which don’t have a good influence on them. For example , kids spend few hours every day playing computer games. They don’t learn anything good from it. Years ago children used to spend all of their free time to hang out with each other, but nowadays they spend all of it to chat online with their friends.That’s the worst thing with Internet. They spend their childhood with the ‘ peace of technology ‘ , not with real people. It would be the best if parents took care of their children and thought more what they do in their free time. They should restrict their time and in that way they could have more time for something that are important in their life. On the other side we n eed Internet for everything today. The bright side of the Internet is that we can get intouch with our cousins and friends form other countries by skype.Unsociable children Big problem of children nowadays is that they have problems with finding friends. It’s really hard for them to find someone who will understand and support them in every way. The Internet , that I’ve just written about has a big influence on their sociable life,so they’re often lonely and feel depressive all the time. They watch lots of movies that are not suitable for their age and they think it’s okay to do those things.Because they don’t have friends and feel depressive , they become aggressive and often don’t find their soulmates. Children don’t understand each other al all. There is too much bullying and misunderstanding in their lives. When someone doesn’t want to do something bad, like smoking cigarettes , or drinking alcohol , what is ‘normalâ €™ nowadays in their age , that person for the rest of society is not normal or modern and than they reject him/her from their group. But , the only truth is that if you don’t do those bad things you stayed good unlike them.

Care Plan Chronic Heart Failure Health And Social Care Essay

Medical intercession contributes to a addition in life anticipation albeit to differing grades depending on mark populations2. Therefore, the quality of services provided is straight relative to the addition in life anticipation. The fleet growing in the Numberss of physicians in the United Kingdom in the last decennary was seen to be a step to suit the lifting figure of hospital admittances that rose as a consequence of the increased life expectancy3. The physician to population ratio grew from 2/1000 people in 2000 to 2.4/ 1000 people in merely a mere 5 years3. Despite the rapid growing, the ratio is still short as compared to other European states viz. France, Germany or Italy. This is worsened by the fact that the figure of patients treated in NHS infirmaries rose by 15 % at the same clip interval3. It is of import to use the expertness of other health care professionals, viz. community druggists, in support of the increasing figure of patients in the community in order to better patient attention. The World Health Organization defines chronic complaints to be ‘a wellness job necessitating on-going direction over a period of old ages or decennaries ‘ . NHS Scotland has identified that chronic unwellness is farther complicated by demographical alterations, increasing co-morbidities, widening spread of wellness inequalities and the increased outlooks placed on the health care system4. Actions have been taken to promote modernisation of NHS community pharmaceutics in Scotland. The debut of the New Pharmacy Contract was the action program from the Scottish Executive ‘s scheme papers ‘The Right Medicine ‘ in which nucleus pharmaceutical attention services such as Chronic Medication Service ( CMS ) , Minor Ailments Service ( MAS ) , Acute Medication Service ( AMS ) and Public Health Service were designed to optimise the use of community druggist ‘s accomplishments to widen the range and farther better the quality of attention proviso to patients5. The contract was driven by a quotation mark by the World Health Organization ( WHO ) in 2002, adverting that reacting to the demands to patients with chronic conditions post the biggest challenge to wellness systems around the globe4. The foundation of the CMS is built upon the cardinal countries: patient centered ; clinical administration ; collaborative working ; support for execution ; monitoring and reappraisal and service development6. The nucleus aims of CMS are summarized in Appendix 1. The altering function of the druggist is in response to the increasing demand for betterment in patient ‘s medicines direction. The debut of the CMS is to further develop the parts of the community druggist to guarantee the continuity of pharmaceutical attention in patients with long-run conditions every bit good as cementing the stature of community druggists in the NHS4. Pharmaceutical attention is an effectual tool in the direction of chronic complaints and is defined as the responsible proviso of drug therapy for the intent of accomplishing definite results that improve a patient ‘s quality of life harmonizing to Hepler and Strand7. Pharmaceutical attention is hence a collaborative attempt between healthcare professionals endeavoring to better drug therapy direction via uninterrupted monitoring of inauspicious effects, effectivity and patient instruction all meeting to better patient ‘s quality of life8. Healthcare professionals play a critical function in autho rising patients to take charge of their ain wellness, as this would ease them in accomplishing their coveted quality of life relevant to their wellness believes6. Community druggist can be the accelerator in smoothing the patient ‘s journey of attention by being the gateway of information via improved entree to healthcare services and to back up self-care6. It is simple to merely purchase a battalion of medicine over the counter to handle an false unwellness but the bulk is incognizant of the possible injury it presents. Some might non take earnestly an overdose of medicines that have a broad curative index but for drugs that have a narrow curative index, a simple overdose could be fatal. There is merely so much a prescriber could make but hanker term attending is indispensable to guarantee that patients get the best out of their medicine particularly in those who have multiple co-morbidities. The attack of CMS is through the constitution of curative partnerships between general medical practicians, druggists and patients to better patient attention by guaranting better local entree to wellness care6. Fostering such commitment will minimise duplicate of functions and, with good defined functions, can advance a holistic attack to the pharmaceutical and clinical attention of patients6. The end is to assist patients harvest the most out of their medical specialties but besides minimise any associated risks4. Community druggist is frequently the first and lone point of call. Community druggists can bridge the spread in a patient ‘s journey of attention and therefore better the whole curative class by expecting, placing, deciding and forestalling medicine-related issues4,9. These medicine-related issues include: Safety and efficaciousness Side effects Conformity and harmony Identify markers of hapless control Symptom specific markers to motivate referral Supplying and advancing wellness information and instruction CMS is a service that requires patients ‘ voluntary engagement and is by and large broken down into 3 phases. Phase 1 involves the enrollment of the patient for the service. Stage 2 involves the debut of a generic model for pharmaceutical attention planning. Phase 3 is the constitution of the shared attention component between the GP and the community pharmacist6. A pharmaceutical attention program paperss the patient ‘s pharmaceutical attention demands, attention issues, desired results and actions required as portion of the pharmaceutical attention planning of the patient. Figure 1 summarizes the pharmaceutical attention be aftering rhythm. Identify and prioritise patients with pharmaceutical attention demands Identify and reexamine pharmaceutical attention issuesImplement and proctor pharmaceutical attention programFormulate and document a pharmaceutical attention programFigure 1: Pharmaceutical Care Planning CycleTo get down of with attention planning, critical information that may act upon the attention program such as patient ‘s general wellness, allergic reactions or sensitivenesss, other medical conditions and hazard factors are noted. A hazard appraisal is so made to help the druggist in placing and prioritising any pharmaceutical attention needs that a patient might necessitate or is deprived from in footings of service, which as a consequence influences the therapy6. Next, an appraisal is made to place and reexamine the patients pharmaceutical attention demands and refering issues. This can enable the druggist to measure the medical specialties regimen that a patient is on in footings of efficaciousness or toxicity profile and besides allows the druggist to measure how deep the patients understand their medicines and intervention and the extend of their wellness believes. Subsequently, a pharmaceutical attention program is drafted based on the attention issues that have been identified with the understanding of the patient. This attention program serves as a protocol in which issues are placed on a hierarchy of precedence, outcome ends are defined, proposals to any class of action documented every bit good as clearly specifying the health care forces and their duties for assorted monitoring that ought to be conducted. Changeless reappraisals and monitoring is done to measure the results of the attention program upon execution and alterations are made along the manner, when required, to maximise the curative result. To accomplish the maximal curative benefit, the patient ‘s wellness belief and apprehension of the therapy is indispensable. Hence, reding and advice by the druggist before, during and after the procedure is good. Chronic Heart Failure ( CHF ) is one of the 13 long-run disease provinces covered in the CMS protocol stand foring the most frequent indicant for therapy4. The list of all 13 disease provinces are listed in Appendix 2. Heart Failure is one of the most crippling medical conditions which can badly impact a patient ‘s quality of life hence seting force per unit area on hospitalization and health care budgets10. The Scots Intercollegiate Guidelines Network ( SIGN ) defines CHF as a complex clinical syndrome ensuing from any structural/ functional upset that impairs the ability of the bosom to react to physiological demands for increased cardiac output11. Hence, bringing of blood is compromised12. Abnormality in cardiac construction, beat, map or conductivity can all take to unequal perfusion, venous congestion and disturbed H2O and electrolyte balance that underlie CHF13. In add-on, normal compensatory mechanisms become compromised taking to maladaptive secondary physiological effe cts that contribute to the progressive nature of the disease12. CHF can be a effect of assorted underlying complications such as myocardial infarction and/or high blood pressure and the most common being left ventricular systolic disfunction ( LVSD ) . Coronary arteria disease, aortal stricture, dilated myocardiopathy, alcoholic myocardiopathy, Chagas ‘ disease, endomyocardial fibrosis and other mechanical defects such as cardiac valvular disfunction, degenerative valve disease, arthritic valve disease, terrible anaemia and thyrotoxicosis are the more common causes of CHF around the Earth but other rarer causes do exist12,13. Management of these predisposing factors can be good in relieving the symptoms of bosom failure. Table 1 is the New York Heart Association ( NYHA ) categorization system used to sort patients with bosom failure based on their functional position. Table 2 is ACC /AHA phases of HF ; a addendum to the NYHA categorization. It is estimated that there is a prevalence of about 1-2 % for bosom failure in developed countries10,14. The life-time hazard of developing HF is approximately 20 % for patients above 40 old ages old and besides the taking cause of hospitalization for patients above 65 old ages old10,14. Harmonizing to the European Society of Cardiology, above 15 million patients are diagnosed with HF in 51 European states consisting a population of around 900 million15. The prevalence of HF is about 1-2 % in the western society and the incidences are between 5-10/ 1000 instances per annum16. A recent US population-based survey, the prevalence of bosom failure was 2.2 % ( 95 CI 1.6 % to 2.8 % ) , increasing from 0.7 % in individuals aged 45 through 54 old ages to 8.4 % for those aged 75 old ages or older17. Similar minor expense forms, 1 % for the 55-64 age group increasing to 13 % in the 75-84 age group was observed from the Rotterdam study18. In the contrary, for the below 50 age group, incidences of HF are rare16. Improved endurance from acute myocardial infarction ( MI ) coupled with the aging population contributes to the spike in incidence and prevalence of HF19. One critical function community pharmacist drama is to advice and offer guidance on a healthy life style. Lifestyle and dietetic alterations are schemes aimed at forestalling cardiovascular diseases ( CVD ) which are possible predisposing factors taking to CHF. The development of CVD is affected by multiple dietetic factors and an overall healthy diet will significantly cut down the hazard of CVD20. Consumption of fruits, veggies, grain merchandises, low-fat dairy merchandises and curtailing the sum of salt and unstable consumption are all portion of a well balanced diet11,21. Keeping a healthy organic structure weight is indispensable as fleshiness is an independent hazard factor for CVD. Morbid fleshiness has a strong association with mortality from CVD particularly in immature grownup males. Therefore, bar of fleshiness has to be taken early and in an aggressive manner22. Keeping optimum blood force per unit area, blood glucose every bit good as a desirable lipid profile is advise d to command or lower the hazard of CVD21. Maintaining physical and cardiovascular fittingness and a healthy weight can be achieved by changeless physical activities as it improves cardiovascular hazard factors every bit good as take downing the hazard of developing other chronic diseases21,23. Evidence has proven the strong association between smoking and cardiovascular jeopardies every bit good as the benefits of smoking cessation24. Therefore, look intoing the smoke position of patients and offering intercession where appropriate will be good to patients peculiarly in those who are at hazard of enduring from cardiovascular events24. Patients with CHF should be advised to discontinue smoking11. Moderate ingestion of intoxicant should besides be advised as extra alcohol ingestion can increase the hazard of CVD11,25. The above are merely the chief life style and dietetic parametric quantities that should be addressed with precedence to command or lower CVD hazards. Such steps should non be seen as stairss taken to forestall CVD but instead as stairss taken to promote everybody to populate a healthy life style to forestall any signifier of disease provinces. Psychosocial and psychological hurt have a important impact in morbidity and mortality after HF and hence societal and relationship factors may play an of import function in pull offing chronic conditions such as CHF26. The ends of intervention are to better quality of life11,13.Angiotensin Converting Enzyme Inhibitors ( ACEi )Evidence has shown that ACEi therapy is good in take downing mortality, MI and rehospitalization for patients enduring from HF with LVD or HF with or without a recent MI27. A meta-analysis has shown that patients with CHF prescribed with an ACEi have a 23 % decrease in mortality and a 35 % decrease in rehospitalization27. Further meta-analysis is patients with LVSD, HF or both after MI has a comparative decrease in mortality rate of 26 % 27. Therefore, ACEi therapy is recommended in patients with all NYHA functional categories of HF due to LVSD11. Adverse effects include cough, hypotension, nephritic damage, angio-oedema and hyperkaelaemia. Dose titration and nephritic and electrolyte monitoring should be included in the attention program particularly in susceptible patients utilizing other medicines so that intercession could be established in instances where inauspicious effects are marked.Beta BlockersTreatment with bisoprolol, carvedilol and Lopressor Forty shows a decrease in mortality in patients with advanced HF based on the CIBIS- II, COPERNICUS, and MERIT-HF tests severally. Beta-blockers benefits in HF by demoing a 29 % decrease in hazard of mortality in CVD, 36 % decrease due to pump failure and all cause mortality decrease of 23 % 28. All patients with HF due to LVSD of all NYHA functional category should be started on beta-blockers every bit shortly as their status is stable and should be the first line picks for patients with CHF due to LVSD11. The effects of beta-blockers might non be seen instantly. Furthermore , deterioration of HF and hypotension might be present at the get downing hence dose should be titrated up suitably upon supervising. Beta-blockers are contraindicated in those with asthma, bronchospasm, 2nd or 3rd degree auriculoventricular bosom block or diagnostic hypotension11.Angiotensin II Receptor Blocker ( ARB )ARBs antagonizes the binding of angiotonin II to its type 1 receptor hence exercising its action similar to ACEi ‘s with the benefit of non bring forthing dry cough as a side effect13. In CHARM Alternative, ARB intervention led to a comparative decrease of 23 % in primary result of CV deceases or rehospitalsation for patients with CHF having candesartan who are intolerant to ACEi29. The add-on of ARB to ACEi or beta-blocker intervention non merely had no consequence on mortality but markedly reduced HF rehospitalisation and mortality combined30. Patients with CHF due to LVSD, HF or LVSD or both station MI who are intolerant to ACEi should be considered for ARBs whilst patients with HF due to LVSD who are still diagnostic despite already on ACEi and beta-blockers, add-on of candesartan might be beneficial11.Aldosterone AdversariesAldosterone adversary has been studied in patients with terrible diagnostic HF, led to a pronounced decrease in mortality and morbidity and improved symptoms13,31. It is recommended for patients with HF in NYHA category III and IV despite being on ACEi and beta-blocker while there is no grounds that Aldactone has any benefits in mild HF11,13. The RALES test has shown that the add-on of Aldactone to an ACEi yielded an all cause mortality of 30 % and cardiac mortality by 31 % 31. However, aldosterone adversaries produce many inauspicious effects on vascular map and myocardial fibrosis11. Spironolactone produces gynaecomastia, hyperkaelaemia, and nephritic disfunction hence blood carbamide, creatinine and electrolyte monitoring is essential11. Patients with terrible HF due to LVSD should be on Aldactone unless contrai ndicated11. Eplerenone can be used if patients are intolerant to spironolactone as grounds from EPHESUS survey has demonstrated a 13 % decrease from CVD or hospitalization for CVD and 21 % comparative rate of sudden decease in patients on eplerenone32.Diuretic drugsFluid keeping doing ankle hydrops, pneumonic hydrops or both consequences in symptoms of dyspnea in most patients enduring from HF11. A meta-analysis supports that diuretic therapy is good for patients with dyspnea or hydrops with a 75 % decrease in mortality and 63 % betterment in exercising capacity33. The hazard of loop water pills doing hypokalaemia is offset by ACEi, ARBs and Aldactone. Therefore, monitoring of serum K is of import. Doses of water pills should be individualized to minimise unstable keeping taking into history the possibility of desiccation and nephritic impairments11.DigoxinIn a Cochrane reappraisal, patients on Lanoxin showed a 64 % betterment in symptoms and a 23 % decrease in hospitalization but u nluckily no betterment seen on survival34. Digoxin should be considered as an accessory therapy for instances in which patients with HF in fistula beat are non relieved on optimal therapy11. There are many issues associated with the usage of Lanoxin because of its narrow curative index, some of which are fatal such as its ability to increase the possibility of sudden decease and the hazard of toxicity in instance of hypokalaemia11. Therefore, the hazard over benefit of Lanoxin therapy should be carefully considered in the best involvement of the patient.

Benefits of Using the Phonics Method to Teach Children to...

â€Å"The more that you read, the more things you will know. The more that you learn the more places youll go.† This quote by Dr. Seuss explains the importance of reading. Knowing how to read is very important to be successful in life. In 2009,a nationwide study by the National Center for Educational Statistics recorded that sixty-seven percent of 4th grade students, seventy-five percent of 8th grade students, and seventy-four percent of 12th grade students were not reading at a proficient level. This will cause many problems as the child progresses through life and later on to adulthood. According to the National assessment of Adult Literacy (NAAL), forty-three percent read at the lowest 2 literacy level (Who Needs Phonics). They will†¦show more content†¦A few of the educational resources that heavily use phonics is Huntington and Sylvan learning center. The most well-known resource is, Hooked on Phonics. Hooked on Phonics is recommended by over ninety percent of th eir costumer (Http://learntoread.hookedonphonics.com/why_it_works/homeschooling). Majority of the customers who endorse this program had significant results. Thus phonics is a proven and dependable mechanism for young readers. The phonics method is also great for the economy. Nebraska Sen. requested the U.S department to examine the reading programs in schools and the outcome was astounding. Out of fifteen phonics centered reading programs examined, the average cost per student is $30.34 opposed to the whole language approach which cost $214.53 per student (Whole Language vs. Phonics). Also the at home programs like Hooked on Phonics, are inexpensive too. As stated before, whole-language advocates believe words should be read as a whole instead of breaking the word down, then reading it as a whole word because that is how proficient readers recognize words (Rayner et al.). Although that isn’t how the brain distinguishes words. There are three parts of the brain that help rea d words. The temporal lobe, frontal lobe, and the angular supramarginal gyrus all act together simultaneously in the reading process. The temporal lobe is in control ofShow MoreRelatedTeaching Phonics And Teach Phonics1474 Words   |  6 Pagesthe tasks required by teachers’ is to teach children to read and write, with this comes different approaches that teachers’ need to be aware of. Phonics is one of the approaches adopted by teachers when teaching children to read and write. Adopting different methods of teaching phonics its what makes teachers effective, and adaptive. This essay aims to look closer at phonics and some of the different approaches used to teach phonics in the classroom. Phonics approaches that will be discussed in thisRead MoreTeaching Phonics And Teach Phonics1414 Words   |  6 Pagesthe tasks required by teachers is to teach children to read and write, with this comes different approaches that teachers need to be aware of. Phonics is one of the approaches adopted by teachers when teaching children to read and write. Teachers adopt different methods to teaching phonics its what makes them effective teachers and adaptive. This essay aims to look closer at phonics and some of the different approaches used to teach phonics in the classroom. Phonic approaches that will be discussedRead MoreThe Effect Of Low Phonics On The Existing English Curriculum At The Early Grades Essay1554 Words   |  7 Pagesimportance and effects of adding Phonics to the existing English curriculum at the early grades of elementary 4th to 6th grades in Saudi Arabia. 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The benefits of allowing children to choose their own reading literature and the findings of the research completed in thisRead MoreLiterature Review On The Phonics2472 Words   |  10 PagesThere are a million adults who cannot read, one in six Londoners is functionally illiterate and people who cannot read or write ar e excluded from opportunities and may eventually become alienated and turn to crime (Johnson 2010, cited by Gross 2010). Gross (2010) expresses her concern and believes it is not where the children live, it is how they were taught to read and how they were properly motivated to learn to read. She endorses the synthetic systematic phonics approach as opposed to that of theRead MoreThe Importance Of Systematic Synthetic Phonics For School Reading Schemes And Then From The School s Library Of Classic Books2530 Words   |  11 Pages â€Æ' I learnt to read at an early age. 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