Urbanization

Over time, there have been many different modifications to facilitate transportation and the economy. The transcontinental railroad is one factor that introduced the American indusrty. This immense industry turned into an even greater business and touched from coast to coast. Because of the railroads, urbanization and industrialization grew although the corruptions with scandals came as well. The nation was in a time of spurring even higher from starting in 1865. Before the railroads, the population was more scattered around farming areas. As the railroads grew, urbanization also expanded and began gathering around the railroads.

Because the government gave a significant amount of land grants, the railroad companies, which were able to choose alternative mile-square sections, had much land that they did not use to build their railroads. President Grover Cleveland gave the unclaimed portions for land settlement in 1887. Although this was seen as the “giveaway” of land, the government ended up benefiting with long-term preferential rates for postal service and military traffic; the railroad corporations could also sell the land at an average of three dollars an acre.

With new railroads in placed, people moved beside them and brought in business for the railroads and towns which gave the railroads another source of profit. Immigration also started uprising, with the Chinese and Irish working on the railroads. As the railroads traveled across the country, it gave the nation a way to get products or people across the country. Food and materials traveled to all from farms to towns and cities. People found it easier to move across the country; urbanization grew throughout the whole country rather than being scattered among the farms.

The railroads were built because of industrialization and expanded it even further. As the railroad network snaked around the country, the economic growth did as well. The locomotives touched coast to coast offering what each side of the country had for the other. The west had many wealthy resources and the east had many workers. Raw materials traveled back and forth as so did the finished goods afterwards, such as steel for the generation of more railroads. The United States soon became the largest integrated national market in the world.

As the railroads grew there was more demand for raw supplies from different parts of the country. The steel and wood for the railroads impacted greatly the forestry and mining industry while the coal industry also grew to power the trains; new factories and industries were built and powered to load more onto the new railroads. Millionaires greatly benefited from this, such as Cornelius Vanderbilt who was one of the most profitable amongst the new aristocracy. As the railroads expanded, so did industrialization, which made the United States economy one of the best that it has had over history.

Although the effects of the railroads were mostly positive, there was the negative aspect of corruption and scandals came as well. Congress commissioned the Union Pacific Railroad, which the company received huge sums of money and land to build tracks. What the government did not know was that the corporation had frauds which were known as the Credit Mobilier; insiders from the construction company had reaped twenty-three million dollars in profits. Jay Gould was many of those who also executed many robberies. For nearly thirty years he gained money from the stocks of Erie, the Kansas Pacific, and the Texas and Pacific.

One of the many different ways these million-dollar-thieves manipulated was “stock watering”. Originally coming from the definition of bloating up a cow to sell for more, the stock promoters were doing this but with the economy and stocks. The railroad stock promoters inflated their claims about a given line’s assets and profitability and sold stocks and bonds much higher than the railroad’s actual value. Railroad managers where therefore forced to charge much higher and compete against each other in order to pay the exaggerated financial obligations. In the midst of all the scandal, the Vanderbilt’s were involved as well.

As many railroaders, they had to fight and bribe for rights. As long as there were railroads, and with their many positive effects, there was also corruption, competition, and scandal. The building of the transcontinental railroads changed the American economy immensely. It has changed the nation as a whole and spurred with a new way of supply and demand traveling all over the country. The new web of steel brought up urbanization, industrialization and corruption with scandals as well. The transcontinental railroads brought the country together with a new form of economy.

Rapid urbanisation, modernisation and population growing in developing states has led to an rush of non-communicable diseases which are associated with important morbidity and mortality. Metabolic Syndrome besides described as “ Deadly Quartet ” and X syndrome ( 2, 3 ) is one of these disease entities defined by bunch of cardiovascular hazard factors which to a greater extent is influenced by ethnicity/race. This encompasses atherogenic dyslipidemia, high blood pressure, dysglycemia and splanchnic fleshiness and pro coagulator province. Apart from increasing prevalence, the age of oncoming is besides worsening among South Asiatic ( SA ) population due to familial sensitivity, ingestion of easy available energy dense nutrients from an early age. This tendency has got major wellness deductions since South Asians constitute one fifth of population all over the universe ( 4 ) and the wellness attention system is non really fit to cover with this medical crisis. Evidence suggests that it non merely amplifies the hazard of coronary bosom disease ( 5 ) but besides gives rise to cerebrovascular diseases.

Five diagnostic standards have been put frontward since the origin of this syndrome which has created perplexity among practicians. In 1998, World Health Organization ( WHO ) ab initio proposed a definition for metabolic syndrome ( 6 ) with chief accent on gluco-centricity. In 1999, the European Group for the survey of Insulin Resistance ( EGIR ) recommended more or less similar standards with lower cut offs for high blood pressure ( 7 ) .

Thereafter in 2001, National Cholesterol Education Program Adult Treatment Panel III ( NCEP ATP III ) proposed another definition for the diagnosing of metabolic syndrome with less focal point on insulin opposition as compared to WHO standards but non turn toing separate cut off points of waist perimeter for Asiatic population ab initio ( 8 ) . In 2003, American Association of Clinical Endocrinologist ( AACE ) proposed another set of standards for the diagnosing of metabolic syndrome. The chief restriction of the above mentioned standards is that the diagnosing is based on clinical judgement alternatively of presence of specific figure of hazard factors ( 9 ) .

Sing that SA have a higher per centum of organic structure fat chiefly in the signifier of abdominal adiposeness at a lower BMI in comparing with other population, International Diabetes Federation ( IDF ) in 2005 suggested separate cutoff points of waist perimeter for Asiatic population and defined cardinal fleshiness as waist perimeter of more than 80 centimeter for adult females and 90 centimeter in work forces based on local statistics from the corresponding country ( 10 ) . The revised NCEP ATPIII modified for South Asiatic population incorporated the same cut off points for Asiatic population as given by IDF ( Table 1 ) . Apart from the cut off differences, NCEP ATP III gives equal weight to each constituent of metabolic syndrome as compared to IDF for which abdominal fleshiness remains a requirement for the diagnosing ( 10 ) . Furthermore, microalbuminuria which is a controversial variable of WHO criteria is non included in other definitions. Among these definitions, WHO, NCEP ATPIII & A ; IDF have been the chief 1s which are used most widely ( Table 1 ) .

Type 2 diabetes is besides emerging as a planetary epidemic with increasing prevalence in developing states. Pakistan is among top 10 states estimated to hold the highest figure of diabetics busying 6th place on the diabetes prevalence naming presently ( 11 ) and it is estimated that prevalence would be doubled by 2025. Metabolic syndrome in combination with diabetes increases the hazard of both macro vascular, micro vascular complications and coronary artery disease patterned advance due to associated high blood pressure, lipoprotein abnormalcies and splanchnic fleshiness ( 12 ) .

There are surveies that have looked into the differences in most widely used definitions of metabolic syndrome in general ( 13-17 ) , but merely few surveies have compared these definitions in the diabetic population ( 18-20 ) . Therefore we decided to find the frequence of metabolic syndrome in Type 2 diabetics harmonizing to NCEP ATPIII, IDF and WHO definitions and so to compare and contrast these traits within Pakistani population.

Methods:

This survey was conducted at the out-patient clinics of one of the big third attention infirmaries at Karachi, Pakistan. Data was collected retrospectively of type 2 diabetic patients sing clinics between June till November 2008 by utilizing a questionnaire which included demographic features and single constituents of metabolic syndrome i.e. weight, tallness, waist perimeter and BMI etc. Both hip and waist perimeter were recorded in centimetres and waist/hip perimeter was calculated ( WHR ) . BMI was calculated as a ratio of weight in kilogram to height in metres squared.

Lab checks:

All the research lab trials which are routinely done for patients with type 2 diabetes including triglycerides and high denseness lipoprotein ( HDL-C ) were recorded. Patients already on anti hypertensive and anti lipid medicines specifically in the signifier of fibric acid derived functions and nicotinic acids were taken as instances of high blood pressure and hypertriglyceridimia severally irrespective of their blood force per unit area and lipid degrees. Since all the patients in the survey were diabetics, insulin degrees were non taken into history.

Statistical Analysis:

The information was analyzed individually harmonizing to NCEP ATP III, IDF and WHO definitions and the consequences were so compared. The frequence of Metabolic syndrome was calculated with 95 % CI based on three different standards ‘s. The informations were presented as the mean A± SD or per centum ; uninterrupted variables were compared by agencies of independent sample t-test and categorical variables were compared by chi-square. All analyses were conducted by utilizing the statistical bundle for societal scientific disciplines SPSS 14. A kappa trial was done to find the concurrency between three definitions. In univariate analyses, comparing between metabolic syndrome and without metabolic syndrome was done for each variable of involvement. Multivariable logistic arrested development analysis was conducted to place the factors associated with metabolic syndrome. All P values were two tailed and considered statistically important ifA a‰¤ 0.05.

Out of entire 210 type 2 diabetic patients, 112 ( 53.3 % ) were males and 98 ( 46.7 % ) were females. Their average age ( standard divergence ) was 53.35 A± 11.46 old ages. The mean ( SD ) continuance of diabetes mellitus was 8.48 A± 7.18 old ages. One hundred and ninety three ( 91.9 % ) were found to hold metabolic syndrome harmonizing to NCEP ATP III in comparing to 182 ( 86.7 % ) based on IDF standards. Lower frequence was documented with WHO standards of 171 ( 81.4 % ) . The frequence increased to 179 ( 85.2 % ) by WHO by utilizing the new cut offs for specifying corpulence ( BMI of 23 vs. 30 ) .

The grade of understanding ( kappa statistic ) between WHO and ATP III and WHO and IDF definitions were 0.436 95 % CI 0.26-0.60 and 0.417 95 % CI 0.25-0.57respectively. In contrast kappa statistic between IDF and ATP III definitions was found to be 0.728 95 % CI 0.57-0.87.The overall understanding between three definitions was 0.37 ( 95 % CI 0.26-0.51 ) .The cardinal fleshiness was present in 162 patients ( 77 % ) by WHO followed by 197 ( 90.5 % ) based on IDF & A ; NCEP ATP III. Hypertension was found in 116 patients ( 55.2 % ) harmonizing to WHO in comparing to 147 ( 70 % ) by NCEP & A ; IDF cut off of blood force per unit area. Presence of low HDL cholesterin once more differed being present in 77 ( 36.7 % ) when WHO definition was applied and 144 ( 68.6 % ) by ATP III and IDF.

Furthermore, gender wise dislocation of frequence of metabolic syndrome by WHO showed that 84 ( 85.7 % ) of females suffered from metabolic syndrome as compared to 87 ( 77.7 % ) in males a difference non statistically

important ( p=0.13 ) . However, by all other standards metabolic syndrome was significantly more common among females as compared to males, 95.9 % vs. 88.4 % ( p=0.04 ) by ATP III & A ; 95.9 % vs. 78.6 % ( p & lt ; 0.001 ) by IDF.

For prevalence of hypertriglyceridemia, no statistically important difference between both genders was found. However, for low HDL cholesterin, prevalence was higher in males 44 ( 57.14 % ) than in females 33 ( 43 % ) by WHO standards ( P & lt ; 0.001 ) . In contrast on the footing of ATP III and IDF definitions, prevalence of low HDL cholesterin degrees was higher ( p=0.009 ) in females 77 ( 57.46 % ) than in males 57 ( 42.53 % ) . Likewise, cardinal fleshiness was found to be more common among female patients based on IDF & A ; NCEP ( ATPIII ) cutoffs 64.8 % females vs. 35.2 % ( & lt ; 0.001 ) but demoing rearward form with WHO criteria,57.14 % males vs. 43 % females ( p-value & lt ; 0.001 ) .

Discussion:

Our survey showed a high frequence of metabolic syndrome in type 2 diabetics based on NECP ( ATPIII ) and IDF standards. This frequence was rather high ( 91.9 % ) as compared to 46 % found in another infirmary based survey from Pakistan ( 21 ) . This difference could non be merely attributed to the different waist cutoffs used based on modified NCEP ( ATPIII ) in our survey because even comparing with WHO categorization revealed important difference between two surveies from the same part. This difference in frequence is really interesting maintaining in position that both of these surveies were done in the same part but different vicinities. The disparity could be due to low frequence of fleshiness found in the old survey ( 30 % ) in comparing to our survey ( 90.5 % ) . It is speculated that this intra regional difference could be due to the fact that certain communities have high inclination to develop fleshiness and metabolic syndrome despite of belonging to the same state due to differences in life manner, eating wonts and degree of physical activity. On the other manus, another infirmary based survey another metropolis revealed comparable frequence of metabolic syndrome harmonizing to NCEP standards ( 22 ) .

In infirmary based survey from Iran the prevalence in type 2 diabetics on footing of NCEP ( ATPIII ) standards utilizing BMI alternatively of waist perimeter was found to be 65 % ( 23 ) .This difference highlights the importance of abdominal adiposeness which is a better marker of metabolic syndrome as compared to BMI. A multicenter infirmary based survey in Brazil showed instead close frequence ( 85 % ) in type 2 diabetics ( 24 ) although the survey population was rather different being white people of European descent. Likewise, in Finnish survey prevalence was found to be 91.5 % in diabetic work forces and 82.7 % in adult females ( 25 ) . Our information was besides consistent with Indian survey demoing prevalence of 91.1 % ( 16 ) utilizing the same NCEP ( ATPIII ) definition. However, separate constituents of metabolic syndrome were found to be more common in our population as compared to South Indians ( 16 ) . The higher frequence of metabolic syndrome in diabetic population found in our survey is a beginning of major concern since diabetes itself is an of import hazard factor for atherosclerotic cardiovascular disease ( ASCVD ) and presence of metabolic syndrome in combination plants as a two border blade.

Evidence suggests that combination of the constituents of the metabolic syndrome is associated with both micro and macro vascular complications and distal neuropathy in patients with type 2 diabetes mellitus ( 24 ) . In position of the high frequence, type 2 diabetic patients should non merely be screened for this deathly syndrome but besides offered intensive direction in order to avoid complications.

Similarly highly high frequence of cardinal fleshiness ( 90.5 % ) in our diabetic population is besides unreassuring since there is ample grounds associating cardinal fleshiness with coronary bosom disease ( 26 ) and insulin opposition is besides significantly associated with waist girth ( 27 ) .

The higher frequence of metabolic syndrome in adult females harmonizing to all standards besides consistent with other surveies from South Asiatic states ( 28 ) could be attributed to less physical activity in adult females due to cultural and cultural limitations on out-of-door activities. This besides highlights the importance of instruction of our adult females in footings of bar of the development of metabolic syndrome with life manner intercession which would indirectly act upon life manner and eating wonts of whole household.

The presence of multiple definitions of metabolic syndrome has been really confusing and argument ever exist which standards should be used in footings of diagnosing of metabolic syndrome particularly in diabetic patients.

The somewhat higher prevalence of metabolic syndrome by ATP III definition in comparing to IDF ( 91.9 % vs. 86.7 % ) was likely due to the comparative flexibleness of the ATP III definition in footings of non taking abdominal fleshiness as a requirement for the diagnosing.

Except for this difference the ATP III and IDF definitions are basically indistinguishable reflected in the grade of understanding ( kappa statistic ) between the two definitions which was in a good scope at 0.728. Harmonizing to this, NCEP ( ATPIII ) and IDF are the most dependable standards ‘s for naming metabolic syndrome in type 2 diabetic patients, with NECP capturing more patients in comparing with IDF definition. In contrast WHO showed lower frequence of metabolic syndrome due to different cutoffs used for HDL degrees and fleshiness. This difference remained important even after seting it with BMI cutoffs for Asiatic population of 23 vs.30 endorsed by WHO expert audience every bit good ( 29, 30 ) pointing towards the fact that waist perimeter or cardinal fleshiness is more valuable tool for sensing of metabolic syndrome in Asiatic population.

Decision:

On the footing of these findings NCEP ( ATPIII ) modified standards should be sooner used in Pakistani population since doing waist perimeter as an obligatory standard would still lose out 5.2 % of the instances of metabolic syndrome harmonizing to our survey. But to farther validate these recommendations we need surveies to gauge the prognostic power for micro vascular and macro vascular complications to set up the most appropriate definition of metabolic syndrome to be used in South Asiatic population with a diagnosing of type 2 diabetes. The alarmingly high frequence of metabolic syndrome in type 2 diabetes found in our survey points towards the fact that our wellness attention system needs to take emergent stairss in bar of this syndrome through life manner intercession plans.

The population of the metropolis increases because people from rural areas and overseas migrate to the urban areas in large numbers, averaging 7. 6 per cent per year (United Nations Population Division, 2001). Increasing of population in many big cities may causes serious problems even in advanced countries. Seoul, the capital city of South Korea, which more than 11 millions of population, has grown rapidly into a metropolis since the end of Korean War (Kim, 2005). Over population in Seoul creates many problems such as traffic congestion and lack of housing.

This essay will discuss about two issues caused by increasing number of population in the city. The first is traffic congestion in Seoul and policies to decline this problem and the second is lack of housing and solution by the government. Traffic congestion is one of the most serious problems in Seoul because of a large number of vehicles in the city (Asianinfo. org, 2000). The increasing number of population in an urban area produces a plentiful number of passenger cars on the road. Approximately amount of cars is 2. 8 million (Mok, 2007).

In Seoul, the statistic shows that one out of three citizens has a car (Zhang, 2010). This situation brings a big pressure to the traffic in the city. The congestion issue causes a distress of travel to metropolitans. Due to this serious problem, the Seoul metropolitan government has created the key measures to solve the traffic congestion. The first measure is to reform the metropolitan transportation system. There are many kinds of transportation in Seoul such as bus, subway and taxi. Under the revolution and reform of transport system, the government has developed bus services according to route demands.

In addition, the extension of subways and establishment of exclusive median bus lane make easier and cheaper for passengers to transfer between buses and subways (Jin, 2005). The other measures are policies and encouraging drivers to reduce traffic volume. For example, the government’s measure which encouraging drivers to avoid using of private vehicles for one day of the five-day working week and Seoul Car Free Day campaign which the parking lots of public organization are compulsory closed and drive people to use public transport (Mok, 2007).

The government is also searching for a new measure to address the issue of traffic congestion and benefit the megacity’s residents (Cohen, 2009). Apart from traffic congestion, lack of housing is also an important issue caused by population growth in Seoul. Since the end of the Korean War, the nation has focused on increasing only the output within industry (Seoulsouthkorea. jimdo. com, n. d. ) This is the reason for encouraging many people to move into urban centers. A lack of housing for the majority of the new residents has been resulted by rapid urbanization.

This is one product of rapid urban development. The influx of population increases need for housing infrastructure. For example, during the last few years there have been approximately twice as many households as houses. Those who can find no houses must become squatters and construct shanties and this cause emergence of slum areas in Seoul. The government has an urban development activity with the purpose to clear and relocate squatters from parks and green zones to the outskirts of the city.

The measure of Seoul’s government is to allocate houses for the residents which named as Citizen Apartment Building Program (Lee, 2000). Under this program, the government constructs low-rise apartment buildings for squatters and low-income groups. The apartments are intended to be cheap to build and buy. In addition, the government produces low-interest loans that make buyers purchase more easily. In conclusion, urbanization in Seoul began at the end of war. With a rapid growth of the city, Seoul is one of the largest cities in the world with a large amount of population.

It can be seen from above examples that increasing number of population in Seoul causes serious problems such as traffic congestion and lack of housing. However, the government has attempted to address the problems with logical plans and policies.