Biochemical and Hormonal Changes in Childhood Obesity

Biochemical and Hormonal Changes in Childhood Obesity The prevalence of chronic or non communicable disease is escalating much more rapidly in developing countries than in industrialized countries. According to World Health Organization (WHO) estimates, by the 2020, non communicable diseases will account for approximately three quarter of all deaths in the developing countries (WHO. Global Strategy for non communicable disease prevention, 1997). In this regard, a potential emerging public health issue for the developing countries may be increasing incidence of childhood obesity with associated complications, which in turn is likely to create public health burden for poorer nations in the near future (Freedman et al, 2001). Lower to middle income nations face the double burden of having both malnourished and over nourished population, with most overweight and obese children being concentrated in urban areas. Rapid urbanization is associated with unhealthy lifestyle or New World Syndrome. In addition, in such communities, childhood obesit y is still considered a sign of healthiness and high social class. There is no universal consensus on a cut off points for defining overweight and obesity in children and adolescents, usually, for clinical practice and epidemiological studies, child overweight and obesity are assessed by means of indicators based on weight and height measurements, such as weight for height measures or body mass index (weight (kg)/height (m2))(WHO. Report series no.847, 1995).The US Centers for Disease Control and Prevention (CDC) defines obese as being at or above 95th percentile of body mass index for age (Kuczmarsk RJ et al, 2000). History of obesity is both interesting and gives details of its progression. Obesity is an age-old health condition. Through out the history of obesity, its reputation varies from appreciation and opposite among cultures and in time. Ancient Egyptians are said to consider obesity as disease. Perhaps the most famous and earliest evidence of obesity is the Venus figurines, Statuettes of an obese female torso that probably had a major role in rituals. Ancient China has also been aware of obesity and dangers that come with it. They always were a believer of prevention as a key to longevity. The Aztecs believed that obesity was supernatural, an affliction of the gods. Hippocrates, the father of medicines was aware of sudden deaths being more common among obese men than lean ones as stated in his writings. In certain cultures and areas where food is scarce and poverty is prevalent, is viewed as symbol of wealth and social status. To date, an African tribe purposely plumps up a bride to pre pare her for child bearing. Before a wedding can be set, a slim bride is pampered to gain weight until she reaches the suitable weight. Through out the history of obesity, the publics view and status of obesity changed considerably in the 1900s. It was regarded as unfashionable by the French designer, Paul Poi ret who designed skin-revealing clothes for women. About the same time, the incidence of obesity began to increase and become wide spread. Later in 1940s, Metropolitan life insurance published a chart of ideal weight for various heights. They also advocated that weight gain parallel to age is unhealthy. The government and medical society become more hands-on with obesity by imitating campaign against it. This was preceded by a study of risk factors for cardiovascular disease revealing obesity in the high ranks. Since then various diets and exercise programs have emerged. In 1996, the Body Mass Index (BMI) was published. This statistical calculation and index determined that a person is obese or not. At this time ,obesity incidence have soared, led by children and adolescent obesity, tripling in just a few short years, greater than any number in the history of obesity. This increase in the incidence of childhood obesity with associated cardiovascular risks, type 2 diabetes mellitus and stroke is supported by a considerable body of evidence. The prevalence of overweight and obesity in childhood and adolescents has been increasing throughout much of the developed and developing world for the past few decades. It has become increasingly clear that excess adiposity in childhood predisposes individual not only to increased risk of adiposity and its sequaele as adults (Freedman et al, 2001), but also to increased risk of multiple chronic diseases in childhood and adolescence (Rosen bloom et al, 1999). Though mechanism not clearly delineated, excess body weight and adiposity is associated with type 2 diabetes mellitus and its complications, cardiovascular disease risk factors, non alcoholic fatty liver disease and asthma in youth. Childhood Obesity 1930 1972 Risk factors for coronary heart disease (CHD) such as hypertension, dyslipidemia, impaired glucose tolerance and vascular abnormalities were present in overweight children. CHD is likely to be increased in overweight children when they become adults as a result of established risk factors. This study investigated whether excess weight in childhood was associated with CHD in adulthood among a very large cohort of persons born in Denmark in 1930 through 1972. They underwent mandatory annual health examination at public or private schools in Copenhagen. Each child was examined by school doctors or nurses and was assigned a health card bearing childs name, date of birth, birth weight reported by parents. 10,235 men and 4,318 women, for whom childhood BMI data were available, received a diagnosis of CHD or died of CHD as adults. The risk of CHD event, a non fatal event, and a fatal event among adults was positively associated with BMI at 7-13 years of age for boys and 10 to 13 years of ag e as girls. The associations were linear for each age and risk increased across the entire BMI distribution. Childhood Obesity 1930 1972 Risk factors for coronary heart disease (CHD) such as hypertension, dyslipidemia, impaired glucose tolerance and vascular abnormalities were present in overweight children. CHD is likely to be increased in overweight children when they become adults as a result of established risk factors. This study investigated whether excess weight in childhood was associated with CHD in adulthood among a very large cohort of persons born in Denmark in 1930 through 1972. They underwent mandatory annual health examination at public or private schools in Copenhagen. Each child was examined by school doctors or nurses and was assigned a health card bearing childs name, date of birth, birth weight reported by parents. 10,235 men and 4,318 women, for whom childhood BMI data were available, received a diagnosis of CHD or died of CHD as adults. The risk of CHD event, a non fatal event, and a fatal event among adults was positively associated with BMI at 7-13 years of age for boys and 10 to 13 years of ag e as girls. The associations were linear for each age and risk increased across the entire BMI distribution. Childhood Obesity and Economic Growth 1930-1983 Childhood obesity was related to the economic growth during the 50 years of economic growth in the industrialized world especially in Denmark. Annual measurements of height and weight were available for all children born between 1930 and 1983 attending primary schools in Copenhagen Municipality. 165,389 boys and 163,609 girls from the age of 7 through 13 years were included in this study. After computerization SBMI (kg/m2) were calculated and the prevalence of overweight and obesity according to international age and gender–specific criteria. Economics growth was indicated by the Gross National Product and the overall consumption per capita, adjusted for inflation. Prevalence of overweight and obesity among Danish children rose in phases, which were not paralleled by trends in economic growth. The microeconomics growth indicators seem inappropriate as proxies for the environmental exposures that have elicited the obesity epidemic. Childhood obesity and television viewing Children spend a substantial portion of their lives watching television (TV). Investigators have hypothesized that TV viewing causes obesity by one or more than three mechanisms: Displacement of physical activity. Increased calorie consumption while watching or caused by the effects of advertising. Reduced resting metabolism. The relationship between TV viewing and obesity has been examined in a relatively large number of cross sectional epidemiological but few longitudinal studies. Many of them have found relatively weak, positive association or mixed results. Many experimental studies have found that reducing TV viewing may help to reduce the risk of obesity. One school based experimental study was designed specifically to test directly the casual relationship between TV viewing behaviors and body fatness. The results of this randomized controlled trial provide evidence that TV viewing is a cause of increased body fatness and that reducing the TV viewing is a promising strategy for preventing childhood obesity (Robinson; 2001). The objective of another study (Utter J et al, 2006), was to explore how time spent watching television (TV) is associated with the dietary behavior of New Zealand children and young adolescents. Total number of participants was 3275 children aged 5-17 years. The findings suggest that longer duration of TV watching (thus more frequent exposure to advertising) influences the frequency of consumption of soft drinks, some sweets and snacks and some fast foods among children and young adolescents. Efforts to control the time spent watching TV may result in better dietary habits and weight control for children and adolescents. Childhood Obesity US- A decade of progress, 1990-1999 Current data suggest that 20% of US children are overweight .An analysis of the secular trends suggest that 20% of US children are overweight, and a clear up ward trend in body weight in children of 0.2 Kg between 1973 and 1994. In addition, childhood obesity is more prevalent among minority sub groups such as African Americans. Obesity that begins early in life persists into adulthood and increases the risk of obesity related conditions later in life. There has been tremendous increase in the number of studies examining the etiology and health effects of obesity in children (Goran MI, 1990-1999).1980 (boys 0.2% girls 0.5%) and 1997 (boys 1.2%, girls 2.0%). Ten years trends of childhood obesity in Israel 1990-2000 Cross sectional data was collected from 13284 second and fifth class school; children between 1990-2000. Prevalence of obesity was determined using Israeli and US reference values. BMI values at 95th percentile increased overtime in all ages and sex categories. Between 1990 and 2000, 95th centile values were increased by 12.7%and 11.8% among second grade boys and girls respectively. Among fifth graders in 2000, 10.7% of boys and 11.1% of girls exceeded the 1990 BMI reference values. The proportion of obese children increased over time using both Israeli and US reference values (Huerta Michael et al, 2008). Netherlands. Overweight, Obesity in 2003: V.1980-97. Data on 90,071 children, aged 4-16 years were routinely collected by 11 Community Heath Services during 2002-2004. International cut -off points for BMI to determine overweight and obesity. On average, 14.5% of boys and 17.5% of the girls were overweight (including obesity), which is a substantial increase since 1980 (boys 3.9% and girls 6.9%) and 1997 (boys 9.7% and girls 13%). Similarly 2.6% of the boys and 3.3% 0f the girls aged 4-16 years were obese, which is much higher than in 1980 (boys 0.2% and girls 0.5%) and 1997 (boys 1.2% and girls 2.0%), (KatjaVan Den Husk, 2007). Obesity trends in US. 2003-2006 Height and weight measurements were obtained from 8164 children and adolescents as apart of the 2003-2004 and 2005-2006 National Health and Nutrition Examination Survey (NHANES). Because no statistically significant differences in the prevalence of high BMI for age were found between the estimates for 2003-2004 and 2005-2006, data for four years were combined to provide more stable estimates for the most recent time period. Over all, in 2003-2006, 11.3% of children and adolescents aged 2 through years were at or above 97th percentile of the 2000 BMI- for- age growth charts, 16.3% were at or above 95th percentile. Prevalence estimates vary by age and by racial/ethnic group. Analysis of the trends in high BMI for age showed no statistically significant trend over the four time periods (1999-2000, 2001-2002, 2003-2004, and 2005-2006) for either boys or girls (Cynthia l.Ogden et al, 2008). 11-March 2005. Public Release Date: Consensus on Childhood Obesity, Recommends classification as disease A common statement on childhood obesity was published to day in the journal of Chemical Endocrinology and Metabolism (one of the journals of Endocrine Society). The consensus statement reflects the conclusions from an international summit held in Israel last year (2004) and includes a controversial recommendation to classify obesity as a disease. This decision was based upon the available research on the diagnosis, prevalence, causes (including endocrine disorders), risks, prevention and treatment of childhood obesity. Pediatric obesity is now recognized as a major health problem all over the world. Researcher have found that children who are obese have a higher risks adult obesity, which is strongly associated with many serious medical complications that impair quality of life and lead to additional increased risks. The statement also noted the prevalence of overweight/obesity among children 6-11 years (in the US) doubled between the years 1980-2000. By classifying obesity as legiti mate disease, public funding and in user sreimbursement for obesity treatment becomes legalized (consensus on childhood obesity, 2005). Serious health risks will likely to begin to appear in obese children and adolescents as they grow older. These may include diabetes mellitus, metabolic syndrome, hyperandrogenism, heart disease, hypertension, respiratory factors, and sleep disorders. Obese children are also at greater risk of anxiety and depression. It also recommended a number of measures that can be implemented by parents; schools, health providers and government and regulatory agencies to help to prevent the onset of childhood obesity Endocrine Regulation of Energy Metabolism Adipocytokines and Obesity The mechanism underlying obesity was further explained by the discovery of adipocytokines, the role of peripheral thyroid hormones (T4, T3), thyroid stimulating hormone and insulin the regulation of energy metabolism. The levels of some of the adipocytokines were shown to be related to visceral obesity, type 2 diabetes mellitus and coronary artery disease. Plasma levels of all the adipocytokines increase with the obesity except adiponectin (Yuji Matsuzawa et al, 2003). Recent studies point out to the adipose tissue as a highly active organ secreting a range of hormones, Leptin, Adiponectin, and Resistin. They are considered to take part in the regulation of energy metabolism. Leptin, Adiponectin and Resistin are produced by the adipose tissue. Leptin and Adiponectin are insulin sensitizing while Resistin increase the insulin resistance. Leptin The notion that genetic abnormalities contribute to obesity gained important support with the identification of the Ob gene and its protein product in 1994 (Zhangy et al, 1996). The Ob gene termed Leptin from the Greek Leptos, meaning thin, is produced in adipose tissue and is thought to act as an afferent satiety signal in a feed back loop that affects the appetite and satiety centre in the hypothalamus of brain. The ultimate effect of this loop is to regulate body-fat mass. In human, as noted by Considine et al, 1996; caloric restriction reduces leptin concentrations and Ob mRNA levels in adipose tissue, and refeeding increases these levels. One fundamental mechanism of obesity is insensitivity to the action of Leptin, presumably in the hypothalamus. The Leptins primary physiological function is to provide a signal to suppress body fat by decreasing food intake or increasing energy expenditure. Serum leptin concentrations change more during weight loss than during weight gain (Rose nbaum M et al, 1997). Adiponectin Adiponectin or Adipo Q, an adipocyte specific secreted protein with roles in glucose and lipid homeostasis (Insulin stimulates the secretion of adiponectin). Circulating adiponectin concentrations are high 500-30,000 Â µg/l (5-30mg/ml) accounting for 0.01% of total plasma proteins (Berget et al, 2002). Adiponectin was discovered in the mid 1990s by four different groups of researchers (Hu E et al, 1996). Adiponectin has various biological functions including insulin sensitizing (Hotta K et al, 2000), antiatherogenic (Yamauchi T et al, 2003), anti-inflammatory (Ouchi N et al, 2003), antiangiogenic and anti tumor functions (Brakenhielm E et al, 2004). Adiponectin acts through Adiponectin receptors, Adipo R1 and Adipo R2. Adipo R1 is mostly expressed in skeletal muscles and Adipo R2 is abundant in liver. These receptors are also expressed by the pancreatic ß cells (Kharroubi et al, 2003), macrophages and atherosclerotic lesions (Chinetti et al, 2004) as well as in brain (Yamauchi et al, 2003). Circulating Adiponectin levels display diurnal variation with a nocturnal decline and maximum levels in the late morning (Gavrila et al, 2003). Adiponectin is also found in breast milk, which in turn is implicated in childhood obesity prevention (Savino et al, 2008). Among the various adipocytokines, adiponectin, which is an abundant circulating protein (247 amino acids) synthesized purely in adipose tissue, appears to play a very important role in carbohydrates, lipid metabolism and vascular biology. Adiponectin appears to be a major modulator of insulin action and its levels are reduced in type 2 diabetes mellitus, which could contribute to peripheral insulin resistance in this condition. It has significant insulin sensitizing as well as anti inflammatory properties that include suppression of macrophage phagocytosis and TNF-a secretion and blockage of monocytes adhesion to endothelial cells in vitro. Although further investigations are required, Adiponectin administration, as well as regulation of the pathway controlling its production, represents a promising target for managing obesity, hyperlipidemia, insulin resistance, type 2 diabetes mellitus, and vascular inflammation (Manju Chandran et al, 2003). Resistin Human resistin is 108 amino acids prepeptide and is cleaved before its secretion from the Adipose tissue. Resistin circulates in the blood as dimeric protein consisting of 92 amino acids polypeptides that are linked by a disulfide bridge. Holcomb et al, 2000 first described the gene family and its tissue specific distribution. Originally described as lung specific, is also produced by the adipose tissue and peripheral blood monocytes. It is also present in dividing epithelia of the intestine. Resistin increase blood glucose and insulin concentration in the mice and impairs hypoglycemic response to insulin infusion. In addition, anti resistin antibodies decrease blood glucose and insulin sensitivity in obese mice (Ukkalo O, 2002). The physiological role of resistin in human remains controversial. There more resistin protein in obese than lean individuals, with a significant positive correlation between resistin and BMI. BMI is a significant predictor of insulin resistance, but resisti n adjusted for BMI is not. These data demonstrate that resistin protein is present in human adipose tissue and blood and that there is significantly more resistin in serum of obese individuals. Serum resistin is not a significant predictor of insulin resistance in human (Youn et al, 2003, Rear R and Donnelly R, 2004). Tumor Necrosis Factor-a It will be unreasonable not to mention the Tumor Necrosis Factor a and its role in vascular inflammation related to atherosclerosis especially in obesity. It is a cytokine involved in systemic inflammation and is a member of a group of cytokines that stimulate the acute phase reaction. The primary role of TNF is in the regulation of immune cells. TNF is able to induce apoptotic cell death, to induce inflammation and to inhibit tumourgenesis and viral replication. Dysregulation and, in particular, over production of TNF have been implicated in a variety of human diseases, as well as cancer (Locksley et al, 2001). The theory of antitumoural response of the immune system in vivo was recognized by the physician William B in 1968. Dr A Granger reported a cytotoxic factor produced by lymphocytes and named it Lymphotoxin (Kalli WB and Granger GA, 1968). Dr L Loyal old, in 1975 reported another cytotoxic factor produced by macrophages and named it Tumor Necrosis Factor (TNF) (Cars well et al, 1975). Interleukin – 6 (IL-6) Chronic inflammation is linked to endothelial dysfunction, atherosclerosis, and insulin resistance (Fernandez-Real JM and Ricart W, 2003 and Fernandez-Real JM, Ricart W, 2005). Plasma concentrations of proinflammatory cytokines, such as interleukin (IL) 18, IL-6, and tumor necrosis factor (TNF)-a, and of several other inflammatory markers are increased in patients with ischemic heart disease (Fernandez-Real JM and Ricart W, 2003, Ridker PM et al, 2002, Engstrom G et al, 2004, Ridker PM et al, 1997, Pradham AD et al, 2002). Circulating cytokines also are elevated in type 2 diabetes, obesity, and insulin resistance syndrome and play a central role in the pathogenesis of these disorders (Fernandez-Real JM and Ricart W, 2003). IL-6 is a mediator of the inflammatory response, and it is linked to dyslipidemia, type 2 diabetes, and risk of myocardial infarction (Fernandez-Real JM and Ricart W, 2003, Ridker PM et al, 2000, Esteve E et al, 2005, Yudkin JS et al, 2000). IL-6 is secreted by a variety of different cell types, including lymphoid and endothelial cells, fibroblasts, skeletal muscle, and adipose tissue. Circulating IL-6 levels correlate with obesity and insulin resistance and may predict the development of type 2 diabetes mellitus (Yudkin JS et al, 2000, Pradhan AD et al, 2001, Akira S et al, 1993, Mohamed-Ali V et al, 1997). Endothelial dysfunction is regarded as a causal factor in the development of atherosclerosis (Hansson GK, 2005). It is one of the earliest abnormalities that can be detected in people at risk for cardiovascular events, and it is linked to insulin resistance and type 2 diabetes (Steinberg HO and Baron AD, 2002, Natali A et al, 2006). Cytokines have an important role in the endothelial injury induced by inflammation. The vascular endothelium is involved in the inflammatory response to atherosclerosis (Hansson GK, 2005, Steinberg HO and Baron AD, 2002, Natali A et al, 2006, Widlansky ME et al, 2003), and changes in endothelium function could underlie the association between cardiovascular disease and inflammation. Obesity Related Insulin Resistance: Definition and Pathogenesis Insulin resistance is a state in which a given amount of insulin produces a subnormal biological response (Kahn CR, 1978). In particular, it is characterized by a decrease in the ability of insulin to stimulate the use of glucose by muscles and adipose tissue and to suppress hepatic glucose production and output (Matthaei et al, 2000). Furthermore, it accounts a resistance to insulin action on protein and lipid metabolism and on vascular endothelial function and genes expression (Bajaj M and Defronzo RA, 2003). Several defects in the insulin signaling cascade have been implicated in the pathogenesis of insulin resistance, Insulin resistance is believed to have both genetic and environmental factors implicated in its etiology (Matthaei et al, 2000 and Liu et al, 2004). The genetic component seems to be polygenic in nature, and several genes have been suggested as potential candidates (Matthaei et al, 2000). However, several other factors can influence insulin sensitivity, such as obesity, ethnicity, gender, perinatal factors, puberty, sedentary lifestyle and diet (Liu et al, 2004). The Role of Fatty Acids and Adipocytokines Obesity represents the major risk factor for the development of insulin resistance in children and adolescents (Caprio S, 2002), and insulin resistance/hyperinsulinemia is believed to be an important link between obesity and the associated metabolic abnormalities and cardiovascular risk (Weiss R and Kaufman FR, 2008). Approximately, 55% of the variance in insulin sensitivity in children can be explained by total adiposity, after adjusting for other confounders, such as age, gender, ethnicity and pubertal stage (Caprio S, 2002). Obese children have hyperinsulinemia and peripheral insulin resistance with an ~40% lower insulin-stimulated glucose metabolism than non-obese children (Caprio S et al, 19996). Adipose tissue seems to play a key role in the pathogenesis of insulin resistance through several released metabolites, hormones and adipocytokines that can affect different steps in insulin action (Matsuzawa Y, 2005) (Fig. 1). Adipocytes produce non-esterified fatty acids, which inhibit carbohydrate metabolism via substrate competition and impaired intracellular insulin signaling (Matsuzawa Y, 2005, Griffin ME et al 1999 and Randle PJ, 1998). In children, as in adults, several adipocytokines have been related to adiposity indexes as well as to insulin resistance. Adiponectin is one of the most common cytokines produced by adipose tissue, with an important insulin sensitizing effect associated with anti-atherogenetic properties (Despres JP, 2006 and Gil-Campos M et al, 2004). Whereas obesity is generally associated with an increased release of metabolites by adipose tissue, levels of Adiponectin are inversely related to adiposity (Matsuzawa Y, 2005). Therefore, reduced levels of this adipocytokine have been implicated in the pathogenesis of insulin resistance and metabolic syndrome (Matsuzawa Y, 2005). Decreased levels of Adiponectin have been detected across tertiles of insulin resistance in children and adolescents (Weiss R et al, 2004), where it is a good predictor of insulin sensitivity, independently of adiposity (Lee S et al, 2006). Adipose tissue also produces tumour necrosis factor-a, an inflammatory factor, which can alter insulin action at different levels in the intracellular pathway (Matsuzawa Y, 2005). Interleukin-6 (IL-6) is ano ther inflammatory cytokine released by adipose tissue and its levels are increased in obesity (Matsuzawa Y, 2005). IL-6 stimulates the hepatic production of C-reactive protein and this can explain the state of inflammation associated with obesity, and could mediate, at least partially, obesity-related insulin resistance (Matsuzawa Y, 2005). Data based mainly on animal studies also suggest that increased levels of resistin, another molecule produced by adipose tissue, could impair insulin sensitivity (Matsuzawa Y, 2005). The close relationship between Leptin levels and insulin resistance in children has also been suggested by the data (Chu NF et al, 2000). Serum levels of retinol-binding protein 4 (RBP4) correlate with insulin resistance in subjects with obesity as well as in those with impaired glucose tolerance (IGT) or type 2 diabetes mellitus, therefore suggesting that it could be useful in assessing insulin resistance and the associated risk for complications (Graham TE et al, 2006). Serum RBP4 is independently related to obesity as well as to components of the metabolic syndrome in normal weight and overweight children (Aeberli I et al, 2007). Diet composition in obese children might be an additional factor promoting and/or worsening insulin resistance. Animal and human studies suggest that a high energy intake as well as a diet rich in fat and carbohydrates and low in fiber could increase the risk of developing insulin resistance (Canete R et al, 2007). The Role of Fat Distribution An altered partitioning of fat between subcutaneous and visceral or ectopic sites has been associated with insulin resistance (Weiss R and Kaufman FR, 2008). Visceral fat has a better correlation with insulin sensitivity than subcutaneous or total body fat (Caprio S et al, 1995), in both obese adults and children. Visceral fat has higher lipolytic activity compared with subcutaneous fat, therefore a greater amount of free fatty acids and glycerol gain entry or carried out to the liver (Matthaei et al, 2000). Visceral fat in girls is directly correlated to the glucose-stimulated insulin levels and inversely correlated with insulin sensitivity and the rate of glucose uptake. No correlation was found between abdominal subcutaneous fat (Caprio S et al, 1995). Ectopic deposition of fat in the liver or muscle can also be responsible for insulin resistance in obese subjects, as the accumulation of fat in these sites impairs insulin signaling, with a reduced glucose uptake in the muscle and a decreased insulin-mediated suppression of hepatic glucose production (Weiss R and Kaufman FR, 2008). Intramyocellular lipid (IMCL) accumulation has been shown as a factor related to decreased insulin sensitivity (Jacob S et al, 1999 and Thamer C et al, 2003). Obese insulin sensitive children and adolescents present lower levels of visceral fat and IMCL when compared with obese insulin resistant children (Weiss R et al, 2005). Accumulation of fat in the liver has also been associated with insulin resistance, independently of adiposity (Kelley DE et al, 2003). It has also been suggested that deposits of fat around blood vessels can produce several cytokines and therefore contribute to the development of insulin resistance, through a so-called vasocrine effect (Yudkin JS et al, 2005). Insulin Resistance and Associated Complications Insulin resistance in obesity is strictly related to the development of hypertension (Marcovecchio ML et al, 2006 and Cruz ML et al, 2002), dyslipidemia (Howard BV and Howard WJ, 1994), impaired glucose tolerance (IGT) (Sinha R et al, 2002), hepatic steatosis (DAdamo E et al, 2008), as well as to the combination of these factors, also known as metabolic syndrome (Eckel RH et al, 2005). Furthermore, insulin resistance is associated with systemic inflammation, endothelial dysfunction, early atherosclerosis and disordered fibrinolysis (Dan Dona P et al, 2002). It is alarming that these metabolic and cardiovascular complications are already found in obese children and adolescents (Dietz WH, 2004). The presence of these alterations in prepubertal children is then particularly worrying, as insulin resistance and related complications might be further exacerbated by the influence of puberty, due to the physiological decrease in insulin sensitivity associated with normal pubertal development (Caprio S et al, 1989). Insulin resistance in childhood can track in adult life (Sinaiko AR et al, 2006). Insulin resistance at the age of 13 years predicts insulin resistance at age 19 years, independently of BMI, and is also associated with cardiovascular risk in adulthood (Sinaiko AR et al, 2006). The fundamental role of insulin resistance in human disease was already recognized in 1988 by Reaven (Reaven GM, 1988) who emphasized its role in the development of a grouping of metabolic abnormalities, which he defined as syndrome X. Later studies strengthened the concept of insulin resistance as a key component of the metabolic syndrome, a cluster of impaired glucose tolerance (IGT), dyslipidemia, hypertension, hyperinsulinemia, associated with an increased risk of type 2 diabetes mellitus and cardiovascular disease (Eckel RH et al, 2005). Insulin resistance represents a serious and common complication of obesity during childhood and adolescence. A timely diagnosis and an appropriated prevention and treatment of obesity and insulin resistance are required in order to reduce the Biochemical and Hormonal Changes in Childhood Obesity Biochemical and Hormonal Changes in Childhood Obesity The prevalence of chronic or non communicable disease is escalating much more rapidly in developing countries than in industrialized countries. According to World Health Organization (WHO) estimates, by the 2020, non communicable diseases will account for approximately three quarter of all deaths in the developing countries (WHO. Global Strategy for non communicable disease prevention, 1997). In this regard, a potential emerging public health issue for the developing countries may be increasing incidence of childhood obesity with associated complications, which in turn is likely to create public health burden for poorer nations in the near future (Freedman et al, 2001). Lower to middle income nations face the double burden of having both malnourished and over nourished population, with most overweight and obese children being concentrated in urban areas. Rapid urbanization is associated with unhealthy lifestyle or New World Syndrome. In addition, in such communities, childhood obesit y is still considered a sign of healthiness and high social class. There is no universal consensus on a cut off points for defining overweight and obesity in children and adolescents, usually, for clinical practice and epidemiological studies, child overweight and obesity are assessed by means of indicators based on weight and height measurements, such as weight for height measures or body mass index (weight (kg)/height (m2))(WHO. Report series no.847, 1995).The US Centers for Disease Control and Prevention (CDC) defines obese as being at or above 95th percentile of body mass index for age (Kuczmarsk RJ et al, 2000). History of obesity is both interesting and gives details of its progression. Obesity is an age-old health condition. Through out the history of obesity, its reputation varies from appreciation and opposite among cultures and in time. Ancient Egyptians are said to consider obesity as disease. Perhaps the most famous and earliest evidence of obesity is the Venus figurines, Statuettes of an obese female torso that probably had a major role in rituals. Ancient China has also been aware of obesity and dangers that come with it. They always were a believer of prevention as a key to longevity. The Aztecs believed that obesity was supernatural, an affliction of the gods. Hippocrates, the father of medicines was aware of sudden deaths being more common among obese men than lean ones as stated in his writings. In certain cultures and areas where food is scarce and poverty is prevalent, is viewed as symbol of wealth and social status. To date, an African tribe purposely plumps up a bride to pre pare her for child bearing. Before a wedding can be set, a slim bride is pampered to gain weight until she reaches the suitable weight. Through out the history of obesity, the publics view and status of obesity changed considerably in the 1900s. It was regarded as unfashionable by the French designer, Paul Poi ret who designed skin-revealing clothes for women. About the same time, the incidence of obesity began to increase and become wide spread. Later in 1940s, Metropolitan life insurance published a chart of ideal weight for various heights. They also advocated that weight gain parallel to age is unhealthy. The government and medical society become more hands-on with obesity by imitating campaign against it. This was preceded by a study of risk factors for cardiovascular disease revealing obesity in the high ranks. Since then various diets and exercise programs have emerged. In 1996, the Body Mass Index (BMI) was published. This statistical calculation and index determined that a person is obese or not. At this time ,obesity incidence have soared, led by children and adolescent obesity, tripling in just a few short years, greater than any number in the history of obesity. This increase in the incidence of childhood obesity with associated cardiovascular risks, type 2 diabetes mellitus and stroke is supported by a considerable body of evidence. The prevalence of overweight and obesity in childhood and adolescents has been increasing throughout much of the developed and developing world for the past few decades. It has become increasingly clear that excess adiposity in childhood predisposes individual not only to increased risk of adiposity and its sequaele as adults (Freedman et al, 2001), but also to increased risk of multiple chronic diseases in childhood and adolescence (Rosen bloom et al, 1999). Though mechanism not clearly delineated, excess body weight and adiposity is associated with type 2 diabetes mellitus and its complications, cardiovascular disease risk factors, non alcoholic fatty liver disease and asthma in youth. Childhood Obesity 1930 1972 Risk factors for coronary heart disease (CHD) such as hypertension, dyslipidemia, impaired glucose tolerance and vascular abnormalities were present in overweight children. CHD is likely to be increased in overweight children when they become adults as a result of established risk factors. This study investigated whether excess weight in childhood was associated with CHD in adulthood among a very large cohort of persons born in Denmark in 1930 through 1972. They underwent mandatory annual health examination at public or private schools in Copenhagen. Each child was examined by school doctors or nurses and was assigned a health card bearing childs name, date of birth, birth weight reported by parents. 10,235 men and 4,318 women, for whom childhood BMI data were available, received a diagnosis of CHD or died of CHD as adults. The risk of CHD event, a non fatal event, and a fatal event among adults was positively associated with BMI at 7-13 years of age for boys and 10 to 13 years of ag e as girls. The associations were linear for each age and risk increased across the entire BMI distribution. Childhood Obesity 1930 1972 Risk factors for coronary heart disease (CHD) such as hypertension, dyslipidemia, impaired glucose tolerance and vascular abnormalities were present in overweight children. CHD is likely to be increased in overweight children when they become adults as a result of established risk factors. This study investigated whether excess weight in childhood was associated with CHD in adulthood among a very large cohort of persons born in Denmark in 1930 through 1972. They underwent mandatory annual health examination at public or private schools in Copenhagen. Each child was examined by school doctors or nurses and was assigned a health card bearing childs name, date of birth, birth weight reported by parents. 10,235 men and 4,318 women, for whom childhood BMI data were available, received a diagnosis of CHD or died of CHD as adults. The risk of CHD event, a non fatal event, and a fatal event among adults was positively associated with BMI at 7-13 years of age for boys and 10 to 13 years of ag e as girls. The associations were linear for each age and risk increased across the entire BMI distribution. Childhood Obesity and Economic Growth 1930-1983 Childhood obesity was related to the economic growth during the 50 years of economic growth in the industrialized world especially in Denmark. Annual measurements of height and weight were available for all children born between 1930 and 1983 attending primary schools in Copenhagen Municipality. 165,389 boys and 163,609 girls from the age of 7 through 13 years were included in this study. After computerization SBMI (kg/m2) were calculated and the prevalence of overweight and obesity according to international age and gender–specific criteria. Economics growth was indicated by the Gross National Product and the overall consumption per capita, adjusted for inflation. Prevalence of overweight and obesity among Danish children rose in phases, which were not paralleled by trends in economic growth. The microeconomics growth indicators seem inappropriate as proxies for the environmental exposures that have elicited the obesity epidemic. Childhood obesity and television viewing Children spend a substantial portion of their lives watching television (TV). Investigators have hypothesized that TV viewing causes obesity by one or more than three mechanisms: Displacement of physical activity. Increased calorie consumption while watching or caused by the effects of advertising. Reduced resting metabolism. The relationship between TV viewing and obesity has been examined in a relatively large number of cross sectional epidemiological but few longitudinal studies. Many of them have found relatively weak, positive association or mixed results. Many experimental studies have found that reducing TV viewing may help to reduce the risk of obesity. One school based experimental study was designed specifically to test directly the casual relationship between TV viewing behaviors and body fatness. The results of this randomized controlled trial provide evidence that TV viewing is a cause of increased body fatness and that reducing the TV viewing is a promising strategy for preventing childhood obesity (Robinson; 2001). The objective of another study (Utter J et al, 2006), was to explore how time spent watching television (TV) is associated with the dietary behavior of New Zealand children and young adolescents. Total number of participants was 3275 children aged 5-17 years. The findings suggest that longer duration of TV watching (thus more frequent exposure to advertising) influences the frequency of consumption of soft drinks, some sweets and snacks and some fast foods among children and young adolescents. Efforts to control the time spent watching TV may result in better dietary habits and weight control for children and adolescents. Childhood Obesity US- A decade of progress, 1990-1999 Current data suggest that 20% of US children are overweight .An analysis of the secular trends suggest that 20% of US children are overweight, and a clear up ward trend in body weight in children of 0.2 Kg between 1973 and 1994. In addition, childhood obesity is more prevalent among minority sub groups such as African Americans. Obesity that begins early in life persists into adulthood and increases the risk of obesity related conditions later in life. There has been tremendous increase in the number of studies examining the etiology and health effects of obesity in children (Goran MI, 1990-1999).1980 (boys 0.2% girls 0.5%) and 1997 (boys 1.2%, girls 2.0%). Ten years trends of childhood obesity in Israel 1990-2000 Cross sectional data was collected from 13284 second and fifth class school; children between 1990-2000. Prevalence of obesity was determined using Israeli and US reference values. BMI values at 95th percentile increased overtime in all ages and sex categories. Between 1990 and 2000, 95th centile values were increased by 12.7%and 11.8% among second grade boys and girls respectively. Among fifth graders in 2000, 10.7% of boys and 11.1% of girls exceeded the 1990 BMI reference values. The proportion of obese children increased over time using both Israeli and US reference values (Huerta Michael et al, 2008). Netherlands. Overweight, Obesity in 2003: V.1980-97. Data on 90,071 children, aged 4-16 years were routinely collected by 11 Community Heath Services during 2002-2004. International cut -off points for BMI to determine overweight and obesity. On average, 14.5% of boys and 17.5% of the girls were overweight (including obesity), which is a substantial increase since 1980 (boys 3.9% and girls 6.9%) and 1997 (boys 9.7% and girls 13%). Similarly 2.6% of the boys and 3.3% 0f the girls aged 4-16 years were obese, which is much higher than in 1980 (boys 0.2% and girls 0.5%) and 1997 (boys 1.2% and girls 2.0%), (KatjaVan Den Husk, 2007). Obesity trends in US. 2003-2006 Height and weight measurements were obtained from 8164 children and adolescents as apart of the 2003-2004 and 2005-2006 National Health and Nutrition Examination Survey (NHANES). Because no statistically significant differences in the prevalence of high BMI for age were found between the estimates for 2003-2004 and 2005-2006, data for four years were combined to provide more stable estimates for the most recent time period. Over all, in 2003-2006, 11.3% of children and adolescents aged 2 through years were at or above 97th percentile of the 2000 BMI- for- age growth charts, 16.3% were at or above 95th percentile. Prevalence estimates vary by age and by racial/ethnic group. Analysis of the trends in high BMI for age showed no statistically significant trend over the four time periods (1999-2000, 2001-2002, 2003-2004, and 2005-2006) for either boys or girls (Cynthia l.Ogden et al, 2008). 11-March 2005. Public Release Date: Consensus on Childhood Obesity, Recommends classification as disease A common statement on childhood obesity was published to day in the journal of Chemical Endocrinology and Metabolism (one of the journals of Endocrine Society). The consensus statement reflects the conclusions from an international summit held in Israel last year (2004) and includes a controversial recommendation to classify obesity as a disease. This decision was based upon the available research on the diagnosis, prevalence, causes (including endocrine disorders), risks, prevention and treatment of childhood obesity. Pediatric obesity is now recognized as a major health problem all over the world. Researcher have found that children who are obese have a higher risks adult obesity, which is strongly associated with many serious medical complications that impair quality of life and lead to additional increased risks. The statement also noted the prevalence of overweight/obesity among children 6-11 years (in the US) doubled between the years 1980-2000. By classifying obesity as legiti mate disease, public funding and in user sreimbursement for obesity treatment becomes legalized (consensus on childhood obesity, 2005). Serious health risks will likely to begin to appear in obese children and adolescents as they grow older. These may include diabetes mellitus, metabolic syndrome, hyperandrogenism, heart disease, hypertension, respiratory factors, and sleep disorders. Obese children are also at greater risk of anxiety and depression. It also recommended a number of measures that can be implemented by parents; schools, health providers and government and regulatory agencies to help to prevent the onset of childhood obesity Endocrine Regulation of Energy Metabolism Adipocytokines and Obesity The mechanism underlying obesity was further explained by the discovery of adipocytokines, the role of peripheral thyroid hormones (T4, T3), thyroid stimulating hormone and insulin the regulation of energy metabolism. The levels of some of the adipocytokines were shown to be related to visceral obesity, type 2 diabetes mellitus and coronary artery disease. Plasma levels of all the adipocytokines increase with the obesity except adiponectin (Yuji Matsuzawa et al, 2003). Recent studies point out to the adipose tissue as a highly active organ secreting a range of hormones, Leptin, Adiponectin, and Resistin. They are considered to take part in the regulation of energy metabolism. Leptin, Adiponectin and Resistin are produced by the adipose tissue. Leptin and Adiponectin are insulin sensitizing while Resistin increase the insulin resistance. Leptin The notion that genetic abnormalities contribute to obesity gained important support with the identification of the Ob gene and its protein product in 1994 (Zhangy et al, 1996). The Ob gene termed Leptin from the Greek Leptos, meaning thin, is produced in adipose tissue and is thought to act as an afferent satiety signal in a feed back loop that affects the appetite and satiety centre in the hypothalamus of brain. The ultimate effect of this loop is to regulate body-fat mass. In human, as noted by Considine et al, 1996; caloric restriction reduces leptin concentrations and Ob mRNA levels in adipose tissue, and refeeding increases these levels. One fundamental mechanism of obesity is insensitivity to the action of Leptin, presumably in the hypothalamus. The Leptins primary physiological function is to provide a signal to suppress body fat by decreasing food intake or increasing energy expenditure. Serum leptin concentrations change more during weight loss than during weight gain (Rose nbaum M et al, 1997). Adiponectin Adiponectin or Adipo Q, an adipocyte specific secreted protein with roles in glucose and lipid homeostasis (Insulin stimulates the secretion of adiponectin). Circulating adiponectin concentrations are high 500-30,000 Â µg/l (5-30mg/ml) accounting for 0.01% of total plasma proteins (Berget et al, 2002). Adiponectin was discovered in the mid 1990s by four different groups of researchers (Hu E et al, 1996). Adiponectin has various biological functions including insulin sensitizing (Hotta K et al, 2000), antiatherogenic (Yamauchi T et al, 2003), anti-inflammatory (Ouchi N et al, 2003), antiangiogenic and anti tumor functions (Brakenhielm E et al, 2004). Adiponectin acts through Adiponectin receptors, Adipo R1 and Adipo R2. Adipo R1 is mostly expressed in skeletal muscles and Adipo R2 is abundant in liver. These receptors are also expressed by the pancreatic ß cells (Kharroubi et al, 2003), macrophages and atherosclerotic lesions (Chinetti et al, 2004) as well as in brain (Yamauchi et al, 2003). Circulating Adiponectin levels display diurnal variation with a nocturnal decline and maximum levels in the late morning (Gavrila et al, 2003). Adiponectin is also found in breast milk, which in turn is implicated in childhood obesity prevention (Savino et al, 2008). Among the various adipocytokines, adiponectin, which is an abundant circulating protein (247 amino acids) synthesized purely in adipose tissue, appears to play a very important role in carbohydrates, lipid metabolism and vascular biology. Adiponectin appears to be a major modulator of insulin action and its levels are reduced in type 2 diabetes mellitus, which could contribute to peripheral insulin resistance in this condition. It has significant insulin sensitizing as well as anti inflammatory properties that include suppression of macrophage phagocytosis and TNF-a secretion and blockage of monocytes adhesion to endothelial cells in vitro. Although further investigations are required, Adiponectin administration, as well as regulation of the pathway controlling its production, represents a promising target for managing obesity, hyperlipidemia, insulin resistance, type 2 diabetes mellitus, and vascular inflammation (Manju Chandran et al, 2003). Resistin Human resistin is 108 amino acids prepeptide and is cleaved before its secretion from the Adipose tissue. Resistin circulates in the blood as dimeric protein consisting of 92 amino acids polypeptides that are linked by a disulfide bridge. Holcomb et al, 2000 first described the gene family and its tissue specific distribution. Originally described as lung specific, is also produced by the adipose tissue and peripheral blood monocytes. It is also present in dividing epithelia of the intestine. Resistin increase blood glucose and insulin concentration in the mice and impairs hypoglycemic response to insulin infusion. In addition, anti resistin antibodies decrease blood glucose and insulin sensitivity in obese mice (Ukkalo O, 2002). The physiological role of resistin in human remains controversial. There more resistin protein in obese than lean individuals, with a significant positive correlation between resistin and BMI. BMI is a significant predictor of insulin resistance, but resisti n adjusted for BMI is not. These data demonstrate that resistin protein is present in human adipose tissue and blood and that there is significantly more resistin in serum of obese individuals. Serum resistin is not a significant predictor of insulin resistance in human (Youn et al, 2003, Rear R and Donnelly R, 2004). Tumor Necrosis Factor-a It will be unreasonable not to mention the Tumor Necrosis Factor a and its role in vascular inflammation related to atherosclerosis especially in obesity. It is a cytokine involved in systemic inflammation and is a member of a group of cytokines that stimulate the acute phase reaction. The primary role of TNF is in the regulation of immune cells. TNF is able to induce apoptotic cell death, to induce inflammation and to inhibit tumourgenesis and viral replication. Dysregulation and, in particular, over production of TNF have been implicated in a variety of human diseases, as well as cancer (Locksley et al, 2001). The theory of antitumoural response of the immune system in vivo was recognized by the physician William B in 1968. Dr A Granger reported a cytotoxic factor produced by lymphocytes and named it Lymphotoxin (Kalli WB and Granger GA, 1968). Dr L Loyal old, in 1975 reported another cytotoxic factor produced by macrophages and named it Tumor Necrosis Factor (TNF) (Cars well et al, 1975). Interleukin – 6 (IL-6) Chronic inflammation is linked to endothelial dysfunction, atherosclerosis, and insulin resistance (Fernandez-Real JM and Ricart W, 2003 and Fernandez-Real JM, Ricart W, 2005). Plasma concentrations of proinflammatory cytokines, such as interleukin (IL) 18, IL-6, and tumor necrosis factor (TNF)-a, and of several other inflammatory markers are increased in patients with ischemic heart disease (Fernandez-Real JM and Ricart W, 2003, Ridker PM et al, 2002, Engstrom G et al, 2004, Ridker PM et al, 1997, Pradham AD et al, 2002). Circulating cytokines also are elevated in type 2 diabetes, obesity, and insulin resistance syndrome and play a central role in the pathogenesis of these disorders (Fernandez-Real JM and Ricart W, 2003). IL-6 is a mediator of the inflammatory response, and it is linked to dyslipidemia, type 2 diabetes, and risk of myocardial infarction (Fernandez-Real JM and Ricart W, 2003, Ridker PM et al, 2000, Esteve E et al, 2005, Yudkin JS et al, 2000). IL-6 is secreted by a variety of different cell types, including lymphoid and endothelial cells, fibroblasts, skeletal muscle, and adipose tissue. Circulating IL-6 levels correlate with obesity and insulin resistance and may predict the development of type 2 diabetes mellitus (Yudkin JS et al, 2000, Pradhan AD et al, 2001, Akira S et al, 1993, Mohamed-Ali V et al, 1997). Endothelial dysfunction is regarded as a causal factor in the development of atherosclerosis (Hansson GK, 2005). It is one of the earliest abnormalities that can be detected in people at risk for cardiovascular events, and it is linked to insulin resistance and type 2 diabetes (Steinberg HO and Baron AD, 2002, Natali A et al, 2006). Cytokines have an important role in the endothelial injury induced by inflammation. The vascular endothelium is involved in the inflammatory response to atherosclerosis (Hansson GK, 2005, Steinberg HO and Baron AD, 2002, Natali A et al, 2006, Widlansky ME et al, 2003), and changes in endothelium function could underlie the association between cardiovascular disease and inflammation. Obesity Related Insulin Resistance: Definition and Pathogenesis Insulin resistance is a state in which a given amount of insulin produces a subnormal biological response (Kahn CR, 1978). In particular, it is characterized by a decrease in the ability of insulin to stimulate the use of glucose by muscles and adipose tissue and to suppress hepatic glucose production and output (Matthaei et al, 2000). Furthermore, it accounts a resistance to insulin action on protein and lipid metabolism and on vascular endothelial function and genes expression (Bajaj M and Defronzo RA, 2003). Several defects in the insulin signaling cascade have been implicated in the pathogenesis of insulin resistance, Insulin resistance is believed to have both genetic and environmental factors implicated in its etiology (Matthaei et al, 2000 and Liu et al, 2004). The genetic component seems to be polygenic in nature, and several genes have been suggested as potential candidates (Matthaei et al, 2000). However, several other factors can influence insulin sensitivity, such as obesity, ethnicity, gender, perinatal factors, puberty, sedentary lifestyle and diet (Liu et al, 2004). The Role of Fatty Acids and Adipocytokines Obesity represents the major risk factor for the development of insulin resistance in children and adolescents (Caprio S, 2002), and insulin resistance/hyperinsulinemia is believed to be an important link between obesity and the associated metabolic abnormalities and cardiovascular risk (Weiss R and Kaufman FR, 2008). Approximately, 55% of the variance in insulin sensitivity in children can be explained by total adiposity, after adjusting for other confounders, such as age, gender, ethnicity and pubertal stage (Caprio S, 2002). Obese children have hyperinsulinemia and peripheral insulin resistance with an ~40% lower insulin-stimulated glucose metabolism than non-obese children (Caprio S et al, 19996). Adipose tissue seems to play a key role in the pathogenesis of insulin resistance through several released metabolites, hormones and adipocytokines that can affect different steps in insulin action (Matsuzawa Y, 2005) (Fig. 1). Adipocytes produce non-esterified fatty acids, which inhibit carbohydrate metabolism via substrate competition and impaired intracellular insulin signaling (Matsuzawa Y, 2005, Griffin ME et al 1999 and Randle PJ, 1998). In children, as in adults, several adipocytokines have been related to adiposity indexes as well as to insulin resistance. Adiponectin is one of the most common cytokines produced by adipose tissue, with an important insulin sensitizing effect associated with anti-atherogenetic properties (Despres JP, 2006 and Gil-Campos M et al, 2004). Whereas obesity is generally associated with an increased release of metabolites by adipose tissue, levels of Adiponectin are inversely related to adiposity (Matsuzawa Y, 2005). Therefore, reduced levels of this adipocytokine have been implicated in the pathogenesis of insulin resistance and metabolic syndrome (Matsuzawa Y, 2005). Decreased levels of Adiponectin have been detected across tertiles of insulin resistance in children and adolescents (Weiss R et al, 2004), where it is a good predictor of insulin sensitivity, independently of adiposity (Lee S et al, 2006). Adipose tissue also produces tumour necrosis factor-a, an inflammatory factor, which can alter insulin action at different levels in the intracellular pathway (Matsuzawa Y, 2005). Interleukin-6 (IL-6) is ano ther inflammatory cytokine released by adipose tissue and its levels are increased in obesity (Matsuzawa Y, 2005). IL-6 stimulates the hepatic production of C-reactive protein and this can explain the state of inflammation associated with obesity, and could mediate, at least partially, obesity-related insulin resistance (Matsuzawa Y, 2005). Data based mainly on animal studies also suggest that increased levels of resistin, another molecule produced by adipose tissue, could impair insulin sensitivity (Matsuzawa Y, 2005). The close relationship between Leptin levels and insulin resistance in children has also been suggested by the data (Chu NF et al, 2000). Serum levels of retinol-binding protein 4 (RBP4) correlate with insulin resistance in subjects with obesity as well as in those with impaired glucose tolerance (IGT) or type 2 diabetes mellitus, therefore suggesting that it could be useful in assessing insulin resistance and the associated risk for complications (Graham TE et al, 2006). Serum RBP4 is independently related to obesity as well as to components of the metabolic syndrome in normal weight and overweight children (Aeberli I et al, 2007). Diet composition in obese children might be an additional factor promoting and/or worsening insulin resistance. Animal and human studies suggest that a high energy intake as well as a diet rich in fat and carbohydrates and low in fiber could increase the risk of developing insulin resistance (Canete R et al, 2007). The Role of Fat Distribution An altered partitioning of fat between subcutaneous and visceral or ectopic sites has been associated with insulin resistance (Weiss R and Kaufman FR, 2008). Visceral fat has a better correlation with insulin sensitivity than subcutaneous or total body fat (Caprio S et al, 1995), in both obese adults and children. Visceral fat has higher lipolytic activity compared with subcutaneous fat, therefore a greater amount of free fatty acids and glycerol gain entry or carried out to the liver (Matthaei et al, 2000). Visceral fat in girls is directly correlated to the glucose-stimulated insulin levels and inversely correlated with insulin sensitivity and the rate of glucose uptake. No correlation was found between abdominal subcutaneous fat (Caprio S et al, 1995). Ectopic deposition of fat in the liver or muscle can also be responsible for insulin resistance in obese subjects, as the accumulation of fat in these sites impairs insulin signaling, with a reduced glucose uptake in the muscle and a decreased insulin-mediated suppression of hepatic glucose production (Weiss R and Kaufman FR, 2008). Intramyocellular lipid (IMCL) accumulation has been shown as a factor related to decreased insulin sensitivity (Jacob S et al, 1999 and Thamer C et al, 2003). Obese insulin sensitive children and adolescents present lower levels of visceral fat and IMCL when compared with obese insulin resistant children (Weiss R et al, 2005). Accumulation of fat in the liver has also been associated with insulin resistance, independently of adiposity (Kelley DE et al, 2003). It has also been suggested that deposits of fat around blood vessels can produce several cytokines and therefore contribute to the development of insulin resistance, through a so-called vasocrine effect (Yudkin JS et al, 2005). Insulin Resistance and Associated Complications Insulin resistance in obesity is strictly related to the development of hypertension (Marcovecchio ML et al, 2006 and Cruz ML et al, 2002), dyslipidemia (Howard BV and Howard WJ, 1994), impaired glucose tolerance (IGT) (Sinha R et al, 2002), hepatic steatosis (DAdamo E et al, 2008), as well as to the combination of these factors, also known as metabolic syndrome (Eckel RH et al, 2005). Furthermore, insulin resistance is associated with systemic inflammation, endothelial dysfunction, early atherosclerosis and disordered fibrinolysis (Dan Dona P et al, 2002). It is alarming that these metabolic and cardiovascular complications are already found in obese children and adolescents (Dietz WH, 2004). The presence of these alterations in prepubertal children is then particularly worrying, as insulin resistance and related complications might be further exacerbated by the influence of puberty, due to the physiological decrease in insulin sensitivity associated with normal pubertal development (Caprio S et al, 1989). Insulin resistance in childhood can track in adult life (Sinaiko AR et al, 2006). Insulin resistance at the age of 13 years predicts insulin resistance at age 19 years, independently of BMI, and is also associated with cardiovascular risk in adulthood (Sinaiko AR et al, 2006). The fundamental role of insulin resistance in human disease was already recognized in 1988 by Reaven (Reaven GM, 1988) who emphasized its role in the development of a grouping of metabolic abnormalities, which he defined as syndrome X. Later studies strengthened the concept of insulin resistance as a key component of the metabolic syndrome, a cluster of impaired glucose tolerance (IGT), dyslipidemia, hypertension, hyperinsulinemia, associated with an increased risk of type 2 diabetes mellitus and cardiovascular disease (Eckel RH et al, 2005). Insulin resistance represents a serious and common complication of obesity during childhood and adolescence. A timely diagnosis and an appropriated prevention and treatment of obesity and insulin resistance are required in order to reduce the

Hierarchical Databases Essay

There are four structural types of database management systems: hierarchical, network, relational, and object-oriented. Hierarchical Databases (DBMS), commonly used on mainframe computers, have been around for a long time. It is one of the oldest methods of organizing and storing data, and it is still used by some organizations for making travel reservations. Related fields or records are grouped together so that there are higher-level records and lower-level records, just like the parents in a family tree sit above the subordinated children. Based on this analogy, the parent record at the top of the pyramid is called the root record. A child record always has only one parent record to which it is linked, just like in a normal family tree. In contrast, a parent record may have more than one child record linked to it. Hierarchical databases work by moving from the top down. A record search is conducted by starting at the top of the pyramid and working down through the tree from parent to child until the appropriate child record is found. Furthermore, each child can also be a parent with children underneath it. The advantage of hierarchical databases is that they can be accessed and updated rapidly because the tree-like structure and the relationships between records are defined in advance. Hierarchical databases are so rigid in their design that adding a new field or record requires that the entire database be redefined. Types of DBMS: Network Databases Network databases are similar to hierarchical databases by also having a hierarchical structure. There are a few key differences, however. Instead of looking like an upside-down tree, a network database looks more like a cobweb or interconnected network of records. In network databases, children are called membersand parents are called owners. The most important difference is that each child or member can have more than one parent (or owner). two limitations must be considered when using this kind of database. Similar to hierarchical databases, network databases must be defined in advance. There is also a limit to the number of connections that can be made between records. Types of DBMS: Relational Databases In relational databases, the relationship between data files is relational, not hierarchical Relational databases connect data in different files by using common data elements or a key field. Data in relational databases is stored in different tables, each having a key field that uniquely identifies each row. Relational databases are more flexible than either the hierarchical or network database structures. Types of DBMS: Object-oriented Databases (OODBMS) Able to handle many new data types, including graphics, photographs, audio, and video, object-oriented databases represent a significant advance over their other database cousins. an object-oriented database can be used to store data from a variety of media sources, such as photographs and text, and produce work, as output, in a multimedia format. Object-oriented databases have two disadvantages. First, they are more costly to develop. Second, most organizations are reluctant to abandon or convert from those databases that they have already invested money in developing and implementing. COMPUTING TYPES: CLUSTER COMPUTING: clustering means linking together two or more systems to handle variable workloads or to provide continued operation in the event one fails. Each computer may be a multiprocessor system itself. For example, a cluster of four computers, each with two CPUs, would provide a total of eight CPUs processing simultaneously. When clustered, these computers behave like a single computer and are used for load balancing, fault tolerance, and parallel processing. Two or more servers that have been configured in a cluster use a heartbeat mechanism to continuously monitor each other’s health. Each server sends the other an I am OK message at regular intervals. If several messages or heartbeats are missed, it is assumed that a server has failed and the surviving server begins the failover operation. That is, the surviving server assumes the identity of the failed server in addition to its identity and recovers and restores the network interfaces, storage connections, and applications. Clients are then reconnected to their applications on the surviving server. The minimum requirements for a server cluster are (a) two servers connected by a network, (b) a method for each server to access the other’s disk data, and (c) special cluster software like Microsoft Cluster Service (MSCS). The special software provides services such as failure detection, recovery, and the ability to manage the service as a single system. Benefits of Clustering Technology Availability, scalability and to a lesser extent, investment protection and simplified administration are all touted as benefits from clustering technology. Availability translates into decreased downtime, scalability translates into flexible growth, and investment protection and simplified administration translate into lowered cost of ownership. Clustered systems bring fault-tolerance and support for rolling upgrades. The most common uses of clustering technique are mission-critical database management, file/intranet data sharing, messaging, and general business applications. PARALLEL COMPUTING: The Message Passing Interface (MPI) standard provides a common Application Programming Interface (API) for the development of parallel applications regardless of the type of multiprocessor system used. In the recent past, the Java programming language has made significant inroads as the programming language of choice for the development of a variety of applications in diverse domains. IPV4/IPV6: What is Internet Protocol? Internet Protocol is a set of technical rules that defines how computers communicate over a network. There are currently two versions: IP version 4 (IPv4) and IP version 6 (IPv6). What is IPv4? IPv4 was the first version of Internet Protocol to be widely used, and accounts for most of today’s Internet traffic. There are just over 4 billion IPv4 addresses. While that is a lot of IP addresses, it is not enough to last forever. What is IPv6? IPv6 is a newer numbering system that provides a much larger address pool than IPv4. It was deployed in 1999 and should meet the world’s IP addressing needs well into the future. PROTOCOLS: File Transfer Protocol (FTP) is a standard network protocol used to transfer files from one host or to another host over a TCP-based network, such as the Internet. The Hypertext Transfer Protocol (HTTP) is an application protocol for distributed, collaborative, hypermedia information systems.[1] HTTP is the foundation of data communication for the World Wide Web. Hypertext is a multi-linear set of objects, building a network by using logical links (the so-called hyperlinks) between the nodes (e.g. text or words). HTTP is the protocol to exchange or transfer hypertext. Secure Sockets Layer (SSL), are cryptographic protocols that provide communication security over the Internet. SSL encrypt the segments of network connections at the Application Layer for theTransport Layer, using asymmetric cryptography for key exchange, symmetric encryption for confidentiality, and message authentication codes for message integrity. In computing, the Post Office Protocol (POP) is an application-layer Internet standard protocol used by local e-mail clients to retrieve e-mail from a remote server over a TCP/IPconnection.[1] POP and IMAP (Internet Message Access Protocol) are the two most prevalent Internet standard protocols for e-mail retrieval.[2] Virtually all modern e-mail clients and servers support both. The POP protocol has been developed through several versions, with version 3 (POP3) being the current standard. Most webmail service providers such as Hotmail, Gmail and Yahoo! Mail also provide IMAP and POP3 service. Simple Mail Transfer Protocol (SMTP) is an Internet standard for electronic mail (e-mail) transmission across Internet Protocol (IP) networks. While electronic mail servers and other mail transfer agents use SMTP to send and receive mail messages, user-level client mail applications typically only use SMTP for sending messages to a mail server for relaying. The User Datagram Protocol (UDP) is one of the core members of the Internet protocol suite, the set of network protocols used for the Internet. With UDP, computer applications can send messages, in this case referred to as datagrams, to other hosts on an Internet Protocol (IP) network without prior communications to set up special transmission channels or data paths. UDP is suitable for purposes where error checking and correction is either not necessary or performed in the application, avoiding the overhead of such processing at the network interface level.

Effective Teaching and Learning Essay

Teaching is not just one way, giving information to students and expecting them to draw from the information! A teacher (to be professional and effective) also needs to know all the different theories, models and learning styles. Embedding models to enable best practice in each session and allow students to absorb valuable information. The tutor is to reflect on each session, for example look at what went well and what didn’t go so well. Differentiating between different students abilities and learning styles. Teachers are constantly reflecting, not only if the students are learning from the tutor but the tutor should be constantly learning best practice and not become stagnant! Petty, G states â€Å"It is not an admission of weakness to seek advice and support; it is a measure of your active professionalism† The author explores the different theories associated with teaching of learning and assessment, demonstrating how she uses them in her confidence and self esteem course. The main ones that will be looked at in detail are behaviourist, cognitivists and humanist, Transactional analysis and types of assessment. Androgogy and Pedagogy, Maslow’s hierarchy of needs, the three main ego states and Temporal and Boydell’s (1977) Barriers to learning. There are three main theorists; behaviourist, cognitivists and humanist. Behaviourist theory was based on stimulus response from a dog. To see and measure how it learns. Pavlov (1927) states that what can be measured is classed as learning. Pavlov did an experiment with a dog. This to me is more like conditioning rather than learning. Pavlov was primarily a physiologist and very interested in how the mind works. If a person was hungry they could be conditioned to salivate by the ring of a bell if they were conditioned to have food straight after. Starving a person and getting it to do something (ring a bell) to enable it to eat is a strange way to analyse a human is learning! To treat humans in this way and relate it to humans is barbaric, just look at the year it was printed. This was also the time when electric shock treatment and locking people in straight jackets was acceptable! Skinner (1938) also did some work with animals and called it operant conditioning. His findings were the reward that the animals were working towards not the stimulus e. g. not the bell but the food! Reward is good and has been proven by theorists that this keeps the students interested (although these findings were tested on animals and humans). The reward could be learning new skills to change and overcome a barrier, gain the qualification in confidence building. Getting a pat on the back for good work handed in! The students will repeat behaviour if they are gaining a reward. The reward can also be the achievement of learning new skills for life, as in the confidence course. Skinner also believed that negative feedback was demoralising and stopped learners learning which the author fully backs up. One has to be very sensitive with feedback, especially when dealing with students with low self esteem. Most of the learning is self reflective and many self awareness exercises are done, rather than criticising or not passing a certain grade. Most learning is done through discussion and self reflection Piaget (1926) had a different view from Pavlov, he believed that the persons thought process was more important and learning was developmental. Meaning they learn and add to what they already know or have learnt. It is about linking information Knowledge is constructed though interaction with the environment. A cognitive process which requires new information, allowing the learner to evolve and transform their existing knowledge and apply this to new situations. (Armatage, 1999 Pg62) On the confidence course a cognitive approach could be to ask the learners to describe how you have used the goal setting to achieve a happier life? I am asking the students to work on a deeper level, not just retaining the information but also demonstrating how to develop it into their own life and past experiences. The cognitivists and the behaviourist are more to do with controls and being tutor led, the Humanist theory looks more into the nature of the learner and the learners’ actions that create the learning situation. The direction is for autonomy, development and growth, the search for meaning and setting goals for themselves. This is very relevant in the goal setting stage of the confidence building course. When the students goal set for a happier, healthier and more positive future. This is looking at and building on the skills that learners already have through life experiences. The role of the tutor is to encourage the students to reflect and to increase the range of experiences for the students to move on with their individual goals that are not dictated by the tutor (myself) The two major writers in this field are Rogers (1974) and Maslow (1968) Rogers viewed this as a series of drives towards adulthood, autonomy, responsibility and self direction. This is all about empowering oneself rather than being told what to do. Maslow looks at a whole hierarchy of needs (please see graph below) Maslow believes that one has to move up the pyramid of needs before they can self actualise. For example one wants their basic needs to be met Biological and Physiological needs – air, food, drink, shelter, warmth, sleep. This then moves on to look at safety and security. Safety needs – protection from elements, security, order, law, limits, and stability. Belongingness and Love needs – work group, family, affection, relationships. The learners on the confidence course are encouraged to continue as a group to support each other with future goals once the ten weeks are up. This continues to have a positive effect on the learners’ future goals and encourages positive relationships. Esteem needs – self-esteem, achievement, mastery, independence, status, dominance, prestige, managerial responsibility. This comes from the achievement of attending and finishing the course. Cognitive needs – knowledge, meaning, making sense of things. Understanding why they come to have low self esteem and understanding there are many ways to change this. Self-Actualization needs – realising personal potential, self-fulfillment, seeking personal growth and peak experiences. This definitely comes on the last session when the learners feel so empowered to move on with goals that have been set. Making a vision board that is related to a persons self actualisation. Up until 1970 teaching strategies were known as pedagogy which is Greek and means â€Å"to lead a child† Knowles who is a huge figure in the humanist school challenged this as he didn’t think it appropriate for adults. Knowles (1970 Pg 57) believes â€Å"Once an adult makes the discovery that he can take responsibility for his own learning, as he does for other facets of his life, he experiences a sense of release and exhilaration. He then enters into learning with a deep ego involvement, with results that are frequently startling to both himself and the tutor† Hanson (1996 pg 99) argued against a clear dichotomy between adult and compulsory education. He believed that adults are not necessarily more experienced because they have lived longer! This can be true as some of the students I come across have no literacy skills which will be classed as a major intellectual barrier (see the five barriers below) and come on the course with a support worker. This does not mean they don’t have articulate skills in other areas, such as time management and people skills. There is no point taking only an androgogical approach until students acquire the ability to learn the basic study skills. This leads onto the barriers that adult learners may face. Temporal and Boydell (1977) highlighted five barriers to learning which were: perceptual, cultural, emotional, intellectual and expressive. Perception could be a huge barrier that students face. Most that come on the course have had a bad school experience and this maybe the last time they studied. Students are worried if they will feel comfortable in the class, worried if they don’t understand what the tutor is talking about, concerned if they know someone in the class from their local area, or have concerns about feeling stupid. Perception is a huge barrier to overcome and nothing the tutor can do if the learner does not start the course. Cultural pressure could be family and friends not wanting the learner to do courses to progress, especially when they see time is being taken from the family. Temporell and Bordell (1977) have identified low self esteem as a barrier to learning. This is very difficult as there are many potential learners that phone up to do the course but then don’t have the self esteem to walk through the door. When the learner finds it difficult to express themselves, they can still learn from the course by listening to group activity. It has been noted on many courses when introducing another person to the group the learner finds it easier to talk, rather than introducing themselves they can talk for a longer period of time about their colleague. This is useful on this type of course (self esteem building) if this is not the first course the student does as a mature learner I am not sure how they will cope if they are moving onto more academic courses. Overcoming personalities and ego states can also be classed as a huge barrier, getting the student to the adult- adult ego state. They may only have had the experience of critical child ego state. One of the students commented on their childhood school memories, of standing in the corner and made to feel stupid because dyslexia wasn’t recognised then! The critical teacher (ego state critical parent). Transactional analysis (D Childs, 2004) describes three ego states Parent, Adult and child. The parent ego state falls into two categories, critical parent and nurturing parent. The nurturing parents function is to nurture themselves and others. Critical parent function is to control the behaviour of themselves and others. This can show as a critical teacher putting their students down and being condescending. The first class is entered by most students in the adapted child ego state, helpless and hurtful. Facial expressions looking scared and tearful. All students are treated as adults with a lot of nurturing parent in the first session. This is to put the students at ease and in a relaxed state with myself the tutor and their peers. The scene is set together writing boundaries as a group for the group to bond, be comfortable, respected and respectful. Once this is done the students are aware that they are being respected. This is overcoming the first barrier to allow learning to take place. The author strongly believes that if a student is not at ease they will not absorb valuable information. Also putting the students in the adult ego state. This agreement is done in unison, with the students taking ownership of their actions and behaviour with others. This can be done through setting their own boundaries. The last group agreed to switch off mobiles, only allow good gossip, no dumping (talking about personal problems), have fun, respect on another, what’s said in the room stays in the room, listen if someone is talking, not hog the conversation (give everyone time to talk), not to give opinions unless they are asked for, support one another, no swearing. This could be a Eureka moment as some students may have never been aware of how they come across nd wonder if they have been respectful to people in the past. Learnt behaviour is very hard to change in just one session. This is a huge self awareness exercise. A student may write â€Å"no swearing† (as a boundary) as it is offensive; another student may challenge this as this is challenging how that student has been reared. Where swearing is part of everyday language. They are bewildered to find that this would offend another person. Due to another student being brought up in a house full of arguments and fighting he feels threatened whenever he hears swearing. This could be the first course students have done out of their comfort zones. Other students can be from other classes, cultures and backgrounds. Being made aware what is acceptable and what is not acceptable can sometimes come as a shock. Some students complain to me of other students not washing and smelling unclean. This is a very sensitive issue and has to be dealt with very carefully, especially when working with people with mental health or very low self esteem. Some students wonder why they should bother washing as they have come from a family with no hygiene. How would a person know this if it wasn’t taught at home? We don’t learn from people sniggering behind our backs! When looking at why the students have chosen the victim path, their eyes widen as discussion unfolds. Especially when looking at critical parent. Most of the students have got or had a parent, partner, friend (so called), sibling or even a child that tries to control their behaviour. For the student looking at this in black and white is a real Eureka moment. What they find hardest is when they change ego state to adult. They find that the person that plays critical parent in their life becomes angry and resentful. Critical parent usually trying to make the student feel guilty for their â€Å"adult† state. The student then becoming the victor not the victim. When reflected upon the student can see how this relationship no longer serves a purpose. Unless the critical parent changes their behaviour the student sees the relationship as negative and will no longer want to pursue it. Learners generally come onto the course with some negative attitudes about the world or people around them. Empowering learning and research and overcoming barriers they may have encourages the students to challenge their own behaviour. When the tutor contradicts learner’s attitudes and values, class discussion can become heated. Students can become angry. This is very much a part of the learning journey in confidence building. Self assessment and self awareness exercises come in very useful, enabling the student much self reflection allowing students to overcome their own barriers through their own assessment. Initial assessment is used to see what level the student is at if the learner can cope with the work load. Do they need an individual learning plan or see if extra support is needed with numeracy, literacy or ICT. Petty, G does agree â€Å"If the needs of the learners are met, the chances of success are greatly increased† backing up how important an initial assessment can be (2009, pg 530) Curzon, L argues that examinations on many courses can be different, so can sometimes not have legitimate weighting (2006 Pg385) meaning they can have repressive or restrictive influences on teachers and students. It is thought that an initial assessment (numeracy or literacy) could startle a student at the beginning and make them feel inadequate. This could be because they were academically inadequate at school, the same fear could return, with no return of the student on the next session. Petty, G also states that just because a student has their math’s GCSE doesn’t mean they can do algebra or percentages. This won’t help in the science lab. (2009, Pg 542) One argument would be that this has separated the wheat from the chaff. Teachers now have to teach to individual learning styles, instead of blaming the learners for not learning or gaining the qualification, the tutors are looked upon! Petty believes all students can learn, given the help and support that is needed, the author being agreeable. Assessment is very important to know where the learners are at the beginning, middle and the end of the course. This is to reflect and measure where they are at the beginning of the course in terms of self esteem. This is done by a scaling questionnaire, which also measures where the learner is in terms of happiness, self esteem, confidence, relationships, communications skills, health, social skills and social activities. The author would prefer to empower her students, instead of giving the students fish, she would prefer to give them a fishing rod to eat for life. It is about empowering students to move on with their life positively. The students don’t need to be spoon fed or hand held. They just need to learn the tools and skills for a happier and productive healthier lifestyle. This is why the tutor is in favour of the Humanist theory. Skinner believes that positive feedback gets students motivated whilst negative feedback stops students in their tracks, demotivating. The behaviourist teacher is in charge and is a good role model to her students giving the students rewards which are positively reinforced with praise, smiles and positive comments on work done. This is very useful as it also activates growth in self esteem. This theory is very successful with students who lack self esteem, therfor very apt in the confidence course. The learners work more effectively as they are encouraged to reflect and self evaluate where they are in terms of self esteem and confidence. Students work well interacting and challenging negative self fulfilling ideas as a group and overcoming barriers together. The students finish the course still on a learning journey of positive self discovery through meetings and recommended reading. The role of the tutor is to encourage the students to reflect and to increase the range of experiences for the students to move on with their individual goals that are not dictated by the tutor (myself) The two major writers in this field are Rogers (1974) and Maslow (1968) Rogers viewed this as a series of drives towards adulthood, autonomy, responsibility and self direction. In conclusion the author believes teaching is not directive and one way, It has to be two way for it to be effective. Tutors need to be reflective and differentiate between all students learning styles and abilities. The author strongly feels that Pavlov’s theory is inhumane and out with the ark. Taking responses from animals is very old hat and I’m sure if you starved any animal or human they would ring a bell to get food, as this is our primary need to live. Humans are much more intelligent than rats and dogs. Pavlov was firstly a psychologist and would be looking at animal responses rather than learning. The author backs up Skinners theory and has seen it work in the confidence course. Once the student is told they are actually good at something (not just a mother, father or sibling) it encourages them to want to do better and have a happier, healthier life style for all their family. This has a huge knock on effect on their friends and people around them. They usually signpost their friends and partners on to the course. Negative feedback is demoralising, what the tutor finds useful is asking the student how they would do it next time if they wanted a positive outcome. This allows the student to self reflect and learn by experience, which is a far great learning curve. This theory links in with what Paignent, 1926 believes, that a persons thought process was more important and learning is developmental, linking information and learning what they already know. The cognitivists and behaviourist are more to do with being tutor led. The author prefers the humanist theory which looks more into the nature of the learner and their actions that create the learning situation. Maslow looks at the whole hierarchy of needs and backs up the belief of the author. Maslow believes that one must move up the pyramid before they can self actualise. Maslow’s theory is used and demonstrated on the confidence course. The tutor wants the students to see what is needed to move up the pyramid. One student came in the following week and told me she had moved house because her safety needs were not being met due to having ASBO neighbours. The student had been complaining to the council for many years. After seeing Maslow’s hierarchy the student decided to take herself out of the situation! Using the Maslow model in class, students can see in black and white why they have no self esteem and cannot self actualise and why their social or safety needs are not being met. For example fuel your body with healthy food like a car would use the best oil. Safety needs, live with people that you feel happy and safe with. Look at the positive people and negative people in ones life. Associate with positive people more rather than the negative ones. Belonging and love. Students start measuring who is respectful and positive in their life. Teporal and Bordell (1977) have identified low self esteem as a barrier to learning. One believes that overcoming barriers and having self esteem is much wider spread than one thought. It would be beneficial for students to have a self esteem test as part of their initial assessment. This would be invaluable efore the students go on to do literacy and numeracy. Looking into how ego states come into learning is very interesting; the humanist would welcome the adult to adult state. Whereas the cognitivists would play a more critical parent role when teaching. Whilst doing this essay the author has really looked into all the theories and models and it is apparent that these ideas were put forward many year s ago. We have moved on so much in seventy years, it would be interesting to see new theories or updated old theories that are based on more realistic activities and research.

Police corruption - 770 Words

The definition of Police corruption is a specific form of police misconduct designed to obtain financial gain, other personal gain, or career advancement for a police officer or officers in exchange for not pursuing, or selectively pursuing, an investigation or arrest. One common form of police corruption is taking bribes in exchange for not reporting organized drug or prostitution rings or other illegal activities. Another example is police officers misusing the police code of conduct in order to secure convictions of suspects — for example, through the use of falsified evidence. Often police officers may deliberately and systematically be involved in organized crime themselves. In most large cities such as†¦show more content†¦Frank Serpico retired from the NYPD in 1972 after receiving the Medal of Honor for his actions. In 1973 a movie was made about the story of Frank Serpico portrayed by Al Pacino and the events that led up to one of the largest findings of polic e corruption in U.S. history. The movie truly opens eyes in regards of â€Å"dirty cops†. As a Ivy tech criminal justice student I thought it was an excellent movie because it really shows how a police officer can still maintain his or hers honesty and integrity even in the face of adversity and turmoil. Serpico probably knew his life was in danger but he still held his head up and kept his composure and did the right thing. Even after he was almost murdered he still went on with the investigation and still spoke out against police corruption. During the movie during the part where he received 300 dollars and refused to just keep it as his own instead he went to his superior about it and it was just blown under the rug come to find out it was money that cops were routinely extorting from local criminals. 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