by Herman Bailey | Apr 27, 2023 | Essays |
Corporate governance deliberates on the established principles, systems and procedures through which competent individuals govern an entity (Colley, 16).
The directors of the business entities formulate the principles by which the company can be controlled to meet the set objectives of the business.
In truth, the fulfillment of the goals will bring additional value to the company as well as the stakeholders in the long run.
In reality, corporate governances assume the role of our inner ear.
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This is because the inner ear is not visible when an individual walks, same to the organization’s system of governance procedure that can hardly be visible in the daily running of the organization.
However, when the ear is dysfunctional, the effects and systems are visible to everyone; the individual loses balance and direction. Similarly, the symptoms and effects of poor governance are observable (Kim and John, 76).
Furthermore, governance reflects on the exercise of authority, power and the rule of law in an institution’s economic, political, and administrative dimensions.
Both leadership and governance embraces accountability and transparency for they go hand in hand.
Governance is completely based on leadership of the institution.
The impulsive investment of the organization in the development of leadership is entirely steered by the notion that the leader can be made; and it is further predicted that more effective leadership will lead to improved outcomes of the organizations.
In the recent past, studies have been conducted by scholars on the dimension of managing their incomes as well as reports on financial frauds in the companies.
Monks et al (2007) stated that codes of conduct are just one of many components within an organization that may influence ethical behavior.
In addition, there are varied both informal and formal measures in the organizations that are considered to have an effect on ethical behavior.
A study conducted on governance and ethics in the United Kingdom revealed that there has been an increased trend to associate ethics and corporate governance (Monks et al, 2007).
The organizations in Australia have a defined code of ethics that assist in the reduction of the financial embezzlement in various institutions.
Indeed, the key issue to rise in governance and ethics should begin with the directors themselves in order to embrace ethical culture in the organization (Monks et al 2007).
In reality, effective ethics and behavior with control measures will ensure transparency and ethical financial reporting.
Corporate governance and the essence of ethical behavior have been viewed differently with different researchers.
An interesting contribution in the area of corporate governance and ethics identified major areas of weaknesses in exercising the indulgence of corporate ethics and corporate governance in Australia.
It is important to justify that corporate governance has a perennial influence on the ethics of the institution.
Therefore, it is mandatory for the organization to exercise ethical behaviors for the meaningful implementation of both formal and informal behaviors.
Furthermore, the management hierarchy should employ ethical behaviors considering the code of conduct prescribed.
The shareholders’ stand point in Australian entities on the rate of remuneration in the business entity cannot be overlooked.
Whether corporately owned or privately owned entity, they are the employers of the corporate society.
In work, the executive is directly accountable to the owners of the business.
The accountability is to run the business in accordance with the shareholder’s wishes. When this is overlooked, the consequences can be better than imagined.
Certainty, internal conflicts between the two parties will transpire.
Therefore, when the shareholders are dissatisfied by the company’s remuneration reports, they are the final decision makers in regard to this perception (Čadež et al, 485).
According to Dirke (229), the remuneration systems in an organization refer to the salaries and wages rewarded to the employee of the organization.
The salaries are directly proportional to the performance level of the managers’ and the general staff.
The rate of encouragement remunerated to the employee and the staff can either motivate them to increase their performance financially or de-motivate them to lower their financial performance.
In the long term, the cases of financial account forgery are greatly reduced.
The effects of short term remuneration to the employee have an adverse effect on the productivity on the firm.
Monks et al (29) indicated that with short term system of remuneration, more cases of financial fraud have been reported.
However, the findings shown that forging of accounts in the long term is not easily achievable as the managerial remuneration and financial output are confidently correlated.
Short term remuneration also indicates the incompetence level of the executive and as long as they remain in the management role, the more cases of financial loss to the company.
Secondly, short term bonuses to the employees cultivate the motivation of the employees via monetary compensation.
Instead, the motivation of the employees should be entirely based on either concrete or intangible incentives to the employee.
Short term earnings based on bonuses are assumed to be the primary procedure used to measure the performance of the employees.
Actually, in some cases it is used to figure out the level of employee worthiness.
A dissimilar opinion by (Wolk et al 2007) asserted that the performance of the employees cannot be tied to the rate of earning received.
Mallin (114) pointed out that according to compensation and agent theory; the managers of the business are likely to have their fair share in mind before the stockholders wealth.
This is because the managers believe that the entire responsibility is more of their risk than the shareholders.
However, the shareholders increase their wealth through increasing the stock (Wolk et al 2007).
As per se, the managers bear the largest risk of the business. He makes financial decisions, investment decisions and shareholders’ value in the entity. Indeed, if this is wrongly done then the business will be at risk of collapsing. They argue that the shareholders bare a smaller risk as they can control their risks by investing in more than one company.
Lastly, in favors of short term bonuses the managers of the company may feel external pressure and hence be rewarded handsomely (Čadež et al, 487). A competitive labor market will constantly look for new managers to recruit into their pool of professionals. Therefore, when the company does not reward their managers well, the best ones will be poached by the competing partners.
Colley (106) asserted that earnings based on short term bonuses can cause great conflict of interest in the company. This can majorly be motivated when the earnings are based on the corporate effort by the staff especially if the company finds collaboration more effective for their outcome. For example, an employee working alone may work harder than the rest to maximize the income while the rest may not have the same spirit. However, when the firm prefers group activity, it can lead to conflict of interest because the level of commitment to work will be different.
Conversely, there are employees who get motivated with the potential of bonuses. This may be due to the revenue they generate when they work on short term rather than long term. In this case the employee will prefer short term over the long term bonuses. In truth, short term bonuses may motivate the employee to finalize his or her financial deals more conveniently than long term pay. However, this may cost the company because the relationship between the employees will be indefinite and cultivated relationships have a positive impact on the productivity of the firm. Therefore, these effects will absolutely strain the financial muscles of the company if not well managed (Dirke, 44).
Meanwhile, a high compensation to the management results in the high financial output of the company. Furthermore, the companies are able to bring more competent and trustworthy managers on board. This is because the higher wages has the ability to attract more professional managers. Additionally, a company with prudent expertise in a managerial role wills generally improve the productivity of the company. Therefore, long term remuneration to the members of the organization is convenient for the positive productivity of the business (Kim et al, 229).
Globally, the companies have suffered sharp criticism from various stakeholders for their short term bonus programs. This has seen the chief executive officers the members of the business receive huge bonuses as their rewards. This controversial subject has made the stakeholders to criticize the executive of greed. Short term bonuses can at times be unfair especially during a financial crisis and unstable economy. A variation of research on using bonuses to reward employees has brought varied outcomes. In some research, they argue that it is the best procedure to get world class employees and a good motivator of the employees as effectively hence short term bonuses are the best for the company (Monks et al, 2007). Although, some research on this area asserts that employees are not necessarily motivated by thefinancialincentivesandthereforeunhealthyforboththecompanyandthemembers of the business.
Contrary to this argument, some researchers observe that very high levels of remuneration to the managers and the whole staff will make them too rich. In addition, they say that the rich employees will careless about the management of the business and this leads to failure (Mallin, et al, 2004). Report done by the researchers indicates that bossy people are more likely to become lazy in the workstation. This is because they feel satisfied with the fatness of their wallets and discontinue working hard in the organization. In general, a negative impact will be realized as the business productivity will aggressively collapse.
Long term pay incents the employees to work hard and reach the highest level of performance in the place of work. They hit the targeted sales outlined by the business thought they may not. The management usually grants rewards and bonuses to the high performing employees and managers. In this manner, the manager and the company will achieve their fair share and hence create healthy working relations (Kim et al, 2007).
On the contrary, long term incentives also have its drawbacks. Firstly, the level of motivation can drop drastically when the managers reach a specified performance level. Once they hit the target, some will leave their offices and turn to some other activities that are not beneficial to the company. For example, a manger can be spotted playing golf while he or she should be in the workstation.
Secondly, long term incentives may alter timings of the company in regard to the plans laid down. This can happen when the employees hit the target early in the financial year and wait until the next season to engage in work again (Cadez, et al, 2012).When this happens, the whole business will in a big mess since plans are like estimations. This means that plans can either be met early in the financial year; late in the financial year or may be the plans may never be met.
Some researchers’ also argue that long term pay punish the employees of the prospective firms. They assert that punishment and rewards that are related with long term pay are both sides of the same coin. This can happen when the employee expects a reward and by the end of the day he does not. The dissatisfaction that is brought by this is a total torture to the employee who by virtue expected the reward associated with the long term pay. According to Cadez (53), employees shy off from taking the risks because of the long term pay but they only do what is necessary to achieve the benefits associated with long term pay.
In conclusion, several advantages and disadvantages of both long term pay and short term incentives are outlined in this paper. Meanwhile, a comprehensive analysis should be done to determine the most convenient procedure for compensation. In a proposal by several stakeholders, a combination of basic salary, incentives, bonuses and rate of commissions should be determined depending on the level and competency of the employee. Therefore, the members of the business get remunerated in accordance with the qualifications.
Works Cited
Čadež, Simon, and Chris Guilding. “”Strategy, Strategic Management Accounting and Performance: A Configurational Analysis.” Industrial Management + Data Systems. 112 (2012): 484-501. Print.
Colley, John L. Corporate Governance. New York: McGraw-Hill, 2003. Print.
Dirke, George C.Employee Remuneration and Incentives. London: Distributors: Gee & Co, 1954. Print.
Kim, Kenneth A, and John R. Nofsinger. Corporate Governance. Upper Saddle River, N.J: Pearson/Prentice Hall, 2007. Print.
Mallin, Chris A. Corporate Governance. Oxford: Oxford University Press, 2004. Print.
Monks, Robert A. G, and Nell Minow. Corporate Governance. Malden, Mass: Blackwell Pub, 2004. Print.
Wolk, Sanna. “Remuneration of Employee Inventors – Is There a Common European Ground?: A Comparison of National Laws on Compensation of Inventors in Germany, France, Spain, Sweden and the United Kingdom.” Iic : International Review of Industrial Property and Competition Law. 42.3 (2011). Print.
With a student-centered approach, I create engaging and informative blog posts that tackle relevant topics for students. My content aims to equip students with the knowledge and tools they need to succeed academically and beyond.
by Herman Bailey | Apr 27, 2023 | Essays |
As an employee, it is significant to continually seek ways to improve yourself. The skills and talent that you have, in the changing market can become outdated and in turn translate to less productivity (Wilson 1960). For each company, the human resource is perhaps the best essential and important asset of the organization. However, in order for an asset to continue bringing greater advantage and leading to potential business growth, it must continually develop, becoming more skilled and flexible (Academy of Human Resource Development 1999).Unlike common belief, CPD is not a process that can be easily defined. In fact, the process is unique to each individual employee. Although employees maybe working together, in the Tesco branches, facing the same challenges and opportunities , the process of CPD according to Wexley & Hinrichs (1991) needs to be differentiated from other training and development needs. The company has developed a strategy where the individual employees, are able to evaluate their own work and skills so that they are able to become better and more productive.
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How can Tesco help employees improve CPD and reflective learning
Reflective practice is the most vital part of CPD and includes two fundamental forms of reflection that is the reflection in action and reflection on action. The main difference arises from the time frame, reflection on action, is a backward look at situations, reactions and behavior in the past (Bratton & Gold 2000). Employees draw from the behavior and opt to change or improve for better service delivery. On the other hand, reflection in action requires the Tesco employees interacting with consumers, to think as they act. This is for the employees in the customer care department ho may need to continually explore their own behavior, reacting and attending to the current situation immediately (Torrington 1998).
The process of reflective practice and CPD involves various steps which have been taken into consideration by Tesco, the biggest retail company.
Feedback
As a retail business, Tesco encourages its own employees to continually seek and receive feedback from the clientele. Such feedback began as a process of helping the company improve on the timeliness and nature of service delivery (Brine 2005). However, today as employees interact more and more with clients, these same clients can be a good source of feedback on behavior and skills that the employees poses. The company needs to provide an environment where the clients are free enough to provide honest feedback to the employees, and where employees take this feedback as positive instead of completely negative. Criticism is not just a reflection on negativity, but an opportunity to improve (Brockbank & McGill 2006p.105).
Harris and Desimone (1994) indicated that Feedback is not only sought from the clients but also from fellow employees. Recent changes in the training and development strategy of the company has led to the introduction of sessions where employees can make positive suggestions to each other on behavior improvement. It is important to ensure that these sessions, however, do not turn into negativity and opportunities to criticize each other unconstructively. For this explanation, it is prudent to hire a professional to direct the feedback; however, once the employees have mastered the basic skills of feedback, these are translated into an everyday activity (Thomson & Mabey 1994).
Objective viewing of experiences
According to Verdict Research (2006p.381), Tesco employees face a wide variety of experiences daily. A retail store deals with different clientele daily. The workers should be in a position to view their past experiences, objectively breaking them down in order to be able to learn from the same. For example, Swanson & Holton (2009) suggested that the employees can be trained to recall the experiences that they recently had with a customer on the retail zone or in the customer care department, even delivery of goods, then carefully observe and listen to exactly what they said thereby determining what they could have done better. This is a significant part of learning and improving behavior.
Mankin (2009) highlighted that this is one characteristic that also allows employees to develop empathy. They are able to experience emotionally and physically what their clients experienced and, therefore, plan on ways that they can be able to improve the experience of the clients, whether it is by making service delivery faster, easier, and more comfortable or by saying something differently. Companies whose employees have mastered this skill are often rated highly in terms of customer service.
Like developing a properly trained strategy, Stephpenson et al (2012) observed that there are times that the company may need to push and show employees how to reflective objectively. This may require some meetings, training session where the company employees are taken through some experience objectively. The human resource asset is completely based on the commitment of employees. The employees need the tools and resources to go through their past experiences objectively and learn from their mistakes as well as the opportunities that were presented to them (Dessler 2000).
Recording CPD lessons
According to Sergiovanni (1987), few companies understand the value of journal keeping among the employees. While it may seem like a trivial and small exercise, it is a vital stage in recording the lessons that have been learnt during the improvement exercise. Employees can easily learn something but after a while forget how and what they learnt exactly. With a journal, they are able to learn properly, remember bad recall experiences that have contributed to their own learning (Swanson and Holton 2009p.56).
Tesco has elaborate training departments where employees’ skills are improved and new behavior is installed. With a journal, employees can be able to record exactly what they have learnt and incidences where the lessons have been used at work. This increases the sense of ownership, on the decisions and new characters developed over time (SchöN 1983).
As professionals employees have the task of ensuring that the employees’ skills and knowledge are updated. CPD journals help to keep them accountable so that they are able to make a reflection on what they have learned and situations here they have failed to apply the lessons that they have learned. Johns (2004p.119) recommended that periodically employees come together and do some reflections on what they have ;earned, how applicable the lessons have been and what can be done to improve the lessons in the future for easier application.
Importance of personal strengths
Tesco employs a wide variety of characteristics, skills and talents which differ among the employees. Where one employee is strong, the others may be quite weak. It is significant for employees to appreciate the value that they bring to the business. This works hand in hand with proper management. The managers need to recognize the achievements of the employees. This helps employees to be able to identify their own personal strengths, own them and use them to grow the business. It is important that individuals feel they have contributed and are contributing something to the company (Golding & Currie 2000).
The important thing to do is reflect on the lessons that have been learnt. Even with an elaborate training and skill development strategy such as that developed by Tesco, employees need to continually evaluate what they have learnt, reflecting on the past lessons and gaining new ones through this reflection. Whereas traditionally and in most of the old time literature, focus more on learning from negative behavior. Thompson and Thompson (2007p.30) insisted on focusing more on incidences where employees were tested by clients, forgot their training, skills and talent and instead, gave in to their own emotions. However, recent breakthroughs in research have shown that the company also needs to focus employees on more positive events, where their skills and talents were put into good use. Even here employees achieved something they considered small, they should be able to reflect and focus on this times and draw lessons from the same. This way the employees are able to decrease and manage their weaknesses using the strength skills and talents that they already possess (Goldstein 1989p.51).
According to Swanson and Holton (2009), the Johns models Identify areas where the need for reflective practice becomes a vital part and leads to Continuing Professional Development. These areas are indicated below as:
- Finding the experiences that are significant and important to the employees.
- Identifying some of the personal markings that were developed from these experiences.
- Identifying the intentions and personal goals of the employees.
- Learning to empathize especially with clients and consumers
- Recognizing the strengths, skills and talents of each individual employee
- Linking the current situations to previous experiences that have reflected on the employee personality.
- Creating new ideas and alternatives which can be used to improve future behavior
- Looking at personal ways that the employee can help improve the experience of the clientele.
Added Value of the Organization
While there is a slight difference between CPD and reflective practice, being that reflective practice is the most essential part of CPD (Scaife 2010p.227). The significant thing to make note of is that the benefits for both are intertwined and related. CPD and reflective practice improves the organization in the following areas:
First employees need to reflect on their own skills and talents to ensure that they are able to meet the demands that the job sets upon them (Harris & Desimone 1994). Tesco employees are hired for their skills and training, however, it may be hard for them to translate these skills into success at the job. For this reason, it is vital and important for them to remember how such characteristics can be applied to ease the job and to meet specific goals of the organization.
Humby, Hunt & Phillips (2008) asserted that employees also need CPD to ensure that their skills and knowledge remain relevant in the employment market. Tesco is operating in a market that is continuously changing, and for the company to remain relevant, its employees need to ensure that the skills they poses remain completely relevant at all times. The global economic trend and large competitors have bitten the dust, closed shop and been made irrelevant simply because the company lacked an environment that supported the change of the market (Noe 2006p.303). When employees continue to develop competitive skills in the market, the company is able to adopt better and continue to survive in an ever changing company (Megginson and Whittaker 2007p.213).
Noe (1999) observed that the retail market is flooded with competitors who are continuously developing new strategies to throw out giants such as Tesco. With the much competition, price cutting and other marketing strategies, it is important to maintain and remain as interesting and outstanding as it was before. At the beginning of the past decade, Tesco lost many of its clients to newer, tech-savvy and advanced companies (Jasper 2003p.327). With CPD, employees have been able to make the company even more interesting, drawing even more interest than before.
Reflective practice and CPD greatly improves job satisfaction and reduces the flow of labor into and out of the company. Job satisfaction is hard for employees, but when the employees experience satisfaction with their work, and find it easy to complete the tasks assigned to them despite the challenges that they may be facing, they are able to become even more productive (Jefferson et al 2009p.112). The retail industry records one of the highest turnovers in the industry and it is important for Tesco to ensure that they remain below the required and profitable turnover level. This can only be achieved if employees show a high level of job satisfaction. A high index of job satisfaction, in fact, also attracts some of the best talents in the market. When a company is attracting the best talent in the market, then profits are assured as well as complete growth of the business (Nadler & Nadler 1989p.419).
The 360 degree appraisal by Tesco which is a vital part of feedback by stakeholders has not only ensured that the company employees are able to improve behavior but has indeed increased the publicity level of the company (Mondy et al 2005). Clients feel that they are appreciated and are part of the business growth. When clients are asked for feedback, they are more likely to return to the business continuously. They feel part of the business, and are glad to remain in a relationship with the business. Since the introduction of the 360 degree appraisal system, Tesco has seen so much growth and profits increase that it has become a benchmark not only for other retailing companies, but even other large international manufacturers (Johns 2004). The systems developed by the businesses works so well, that the customers who are loyal to Tesco are hard to move or even convince to pick up another retailer. The customers are proud to be related and associated with a company that continually seeks their opinion.
Stephpenson and Mills (2007p.229) observed that when employees are engaged in reflective practice they are able to put together a viable personal development plan, which the manager can in turn translate into a growth plan for the employee. The company is not able to support the employee well if they are unaware of where there is a need for improvement, which weaknesses need to be managed and which strengths need to reflect more on. Tesco’s options programme has seen even more growth of the employees than any other program in the business (Laird et al 2003). The options provided to the employees are in direct relation with the company goals. As the employees grow they are able to bring in better skills which ensure that the company remains not just active but highly competitive. Many researchers have shown that one of the reasons other companies are unable to reach the level of Tesco that the company employees are continuously growing and expanding their skills in the market, therefore brining the company to its own levels (Mankin 2009).
Conclusion
CDP and reflective thinking lead to personal development which in turn causes the individuals to be highly motivated. The retail business as Tesco has discovered can be highly monotonous with few challenges to incite excitement among the employees. With personal development employees are able to deal with more challenging situations and take up more responsibilities in the business (Megginson & Whitaker 2007). They are able to create their own environment, requiring less supervision and follow up. Motivated employees are able to work by themselves meeting their goals and developing various strategies through which they can enjoy their skills and talents.
Not many companies understand the importance of reflective practice and CPD in the training and development of special skills by the employees. The growth of Tesco is highly dependent on a skilled and elaborate work force (Mondy et al 2005). Employees need to understand themselves in much the same way they will understand and value the company. Reflective behavior allows improvement of skills and development of new behavior which will ensure that the employees remain productive even in a changing environment. With the strong Tesco training structure, employees can take advantage to learn new lessons and skills, develop their own talents and enjoy high job satisfaction. In return the company would enjoy high standards of delivery service, which will not only ensure that the company maintains its current clients but also attain new ones (Verdict Research 2006).
References
Academy Of Human Resource Development (U.S.). (1999). Advances In Developing Human Resources. San Francisco, Ca, Berrett-Koehler.
Academy Of Human Resource Development (U.S.). (2002). Human Resource Development Review Hrd Review. Thousand Oaks, Calif, Sage Publications.
Bratton, J., & Gold, J. (2000). Human Resource Management Theory and Practice. Mahwah, N.J., Lawrence Erlbaum
Brine, A. (2005). Continuing Professional Development: A Guide for Information Professionals. Oxford, Chandos.
Brockbank, A., & McGill, I. (2006). Facilitating Reflective Learning through Mentoring & Coaching. London, Kogan Page.
Chartered Institute Of Personnel and Development.
Dessler, G. (2000). Human Resource Management. Upper Saddle River, NJ, Prentice Hall.
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Golding, D., & Currie, D. (2000). Thinking about Management a Reflective Practice Approach. London, Routledge.
Goldstein, I. L. (1989). Training and Development in Organizations. San Francisco, Jossey-Bass Publishers.
Harris, D. M., & Desimone, R. L. (1994). Human Resource Development. Fort Worth, Dryden
Humby, C., Hunt, T., & Phillips, T. (2008). Scoring Points How Tesco Continues To Win Customer Loyalty. London, Kogan Page Ltd.
Jasper, M. (2003). Beginning Reflective Practice. Cheltenham, Nelson Thornes.
Jefferson, A. M., Pollock, R. V. H., & Wick, C. W. (2009). Getting Your Money’s Worth From Training And Development A Guide To Breakthrough Learning For Managers ; Getting Your Money’s Worth From Training And Development : A Guide To Breakthrough Learning For Participants. San Francisco, Ca, Jossey-Bass.
Johns, C. (2004). Becoming a Reflective Practitioner. Oxford, UK, Blackwell.
Laird, D., Naquin, S. S., & Holton, E. F. (2003). Approaches to Training and Development. Cambridge, Mass, Perseus Books Group.
Mankin, D. (2009). Human Resource Development. New York, Oxford University Press.
Megginson, D., & Whitaker, V. (2007). Continuing Professional Development. London,
Mondy, R. W., Noe, R. M., & Gowan, M. (2005). Human Resource Management. Upper Saddle River, N.J., Pearson Prentice Hall.
Mondy, R. W., Noe, R. M., & Gowan, M. (2005). Human Resource Management. Upper Saddle River, N.J., Pearson Prentice Hall.
N.S.W., Pearson Australia.
Nadler, L., & Nadler, Z. (1989). Developing Human Resources. San Francisco, Jossey-Bass Publishers.
Noe, R. A. (1999). Employee Training and Development. Boston, Irwin/McGraw-Hill.
Noe, R. A. (2006). Human Resource Management: Gaining a Competitive Advantage. Boston, Mass, McGraw-Hill.
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SchöN, D. A. (1983). The Reflective Practitioner: How Professionals Think In Action. New York, Basic Books.
Sergiovanni, T. J. (1987). The Principalship: A Reflective Practice Perspective. Boston, Allyn and Bacon.
Stephpenson, E., Gibbs, C., & Mills, G. (2012). The Reflective Practitioner. Frenchs Forest,
Swanson, R. A., & Holton, E. F. (2009). Foundations of Human Resource Development. San
Thomson, R., & Mabey, C. (1994). Developing Human Resources. Oxford, Butterworth Heinemann.
Torrington, D., Hall, L., & Torrington, D. (1998). Human Resource Management. London, Prentice Hall Europe.
Verdict Research. (2006). Tesco Company Profile 2006. [Great Britain], Verdict.
Wexley, K. N., & Hinrichs, J. R. (1991). Developing Human Resources. Washington, D.C., Bureau of National Affairs.
Wilson, H. (1960). Employee Training and Development. Deerfield, Ill, Administrative Research Associates.
With a student-centered approach, I create engaging and informative blog posts that tackle relevant topics for students. My content aims to equip students with the knowledge and tools they need to succeed academically and beyond.
by Herman Bailey | Apr 26, 2023 | Essays |
Abstract
The purpose of the study was to find the role of IMA in the diagnosis of myocardial ischemia in ischemic and nonischemic groups amongst different age groups and gender variance. Diagnosis of myocardial ischemia has been done using other biomarkers such as troponin. However, their lower diagnostic accuracy, in addition to lower symptoms specificity has made them unreliable. IMA is present in high levels in cardiac ischemic patients. Many studies have been done on the role of other biomarkers such as troponin to gender and different age groups of ischemic patients (Rodriguez-Ospina, 331; Wiviott et al, 1415). Therefore, further research needs to be done to find out whether there exist differences in the levels of IMA between different age groups, and also in gender in ischemic and nonischemic groups. The results of the study will be a helpful incorrect diagnosis of cardiac ischemia among patients, in addition to the stratification of the patients that suffer from acute chest pains. Correct diagnosis means immediate treatment and management of the cardiac ischemia before it destroys the myocytes.
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Introduction
Cardiac bio makers according to Rodriguez-Ospina et al (14) are substances released by the heart into the bloodstream when it is stressed or damaged. Measurement of the released bio makers in the bloodstream is helpful in diagnosis, monitoring, risk stratification, and management of people suspected to have cardiac ischemia and acute coronary syndrome (ACS). Cardiac ischemia results when the blood supply that goes to the tissues of the heart is not enough to meet the needs of the heart. ACS results from plaque rapture that causes creating awareness. The majority of the employees are not aware they are suffering from certain medical issues, such as high blood clot formation in the coronary arteries. This results in a sudden psychological effects. For example, blood decrease and oxygen that reaches the heart. Rodriguez-Ospina et al (15) highlighted some of the different types of cardiac biomarkers tests but the most used and effective one is the troponin test. However, cardiac troponin is only specific and sensitive for detection of damage in the myocardium but sometimes may not rise if there is reversible myocardial ischemia. In contrast, recent studies have indicated that Ischemia Modified Albumin (IMA) is a very sensitive and effective biochemical marker of ischemia (Wiviott et al, 1414; Sinha et al, 209|). Ischemia-modified albumin (IMA) from different studies have shown that it is an early marker in patients that are undergoing the process of coronary angioplasty for ischemia. Moreover, IMA is very sensitive compared to cardiac troponin (cTn) and 12-lead ECG levels when diagnosing acute coronary syndrome (ACS) in patients that experience chest pain, and within three hours are attending the emergency department at the onset of the pain. During the ischemic attack, IMA is produced and is present in blood in concentrations that is easily detectable. Recent studies have also indicated that there exist differences in the levels of biomarkers in gender but minimal differences in different age groups (Sinha et al, 72; Radha et al, 225). Wiviott et al (1413) indicated that diagnosis of diseases of the coronary artery in women is more difficult. This is because of the lower diagnostic accuracy of the noninvasive tests and lower symptoms specificity. In their study, they found out that in patients with Non-ST-Elevation Myocardial Infarction (NSTEMI) and Unstable Angina (UA), there existed different patterns of biomarkers presentation. For instance, men had had a higher likelihood of elevated troponins and creatine kinase-MB. Women, on the other hand, had a higher likelihood of having elevated brain natriuretic peptide and C-reactive protein. Similarly, age differences exist in the level of bio makers. The levels of Brain Natriuretic peptide (BNP) are higher in older populations and Women in America. (1990). Black women compared to men (Wiviott et al, 1413). Further research is needed to clarify whether pathophysiological differences that are gender-related exist in acute coronary syndromes presentation. Similarly, further study can be done on real-life populations of the patients to assess the role of IMA in myocardial ischemia as a marker. The study aimed to find out the levels of IMA in ischemic and nonischemic groups amongst different age groups and gender variance.
Methods
Ninety-six patients with acute chest pain between the age group 30-60years admitted in ICCU of hospital participated in the study. Among these subjects, 40 were male and 56 were female. Of the 96 patients, 16 had no evidence of myocardial ischemia. They were categorized as group II. The remaining 80 patients with human society develop. The evidence of myocardial ischemia was categorized into group I. About 41% of the patients of group I was between 50-60 years of age. The control group of healthy subjects was 28, of which 10 were males and 18 females.
Patients were evaluated as being nonischemic or potentially ischemic through standard coronary disease indicators [(CK), CK-MB, LDH, and electrocardiography findings] and were tested by a Co (II)-albumin binding assay for IMA.
Of the 80 ischemic patients (group I) 34 were males and 46 females. The mean±SD age for the males was 50± 6.8 years and the female was 58±10.1 years. The control group was made up of 10 males and 18 females, and the mean±SD age was 45±8.6 years and 56±10.6 years respectively.
The patients of the ischemic group (group 1) were further divided into three groups based on their age &sex as follows; 30-40 years (M&F), 40-50 years (M&F), and 50-60 years (M&F).
Methods
The study was conducted on two groups; ischemic and nonischemic groups. 96 patients with acute chest pain between age group 30-60 years admitted in ICCU of hospital participated in the study. Among these subjects, 40 were male and 56 were female. Of the 96 patients, 16 had no evidence of myocardial ischemia. They were categorized as group II. The remaining 80 patients with human society develop. The evidence of myocardial ischemia was categorized into group I. Of the 80 ischemic patients (group I) 34 were males and 46 females. About 41% of the patients of group I was between 50-60 years of age. The control group of healthy subjects was 28, of which 10 were males and 18 females.
Patients were evaluated as being nonischemic or potentially ischemic through standard coronary disease indicators [(CK), CK-MB, LDH, and electrocardiography findings] and were tested by a Co (II)-albumin binding assay for IMA.
The mean±SD age for the males was 50± 6.8 years and the female was 58±10.1 years. The control group was made up of 10 males and 18 females, and the mean±SD age was 45±8.6 years and 56±10.6 years respectively.
The patients of the ischemic group (group 1) were further divided into three groups based on their age &sex as follows; 30-40 years (M&F), 40-50 years (M&F), and 50-60 years (M&F).
Results
The mean±SD of CK-MB for the age group 30-40 years was normal in both males and females. But for the females of age group 40-50years, it was higher (24±1.6) compared to males. Likewise, in the age group of 50-60 years in females, the CKMB values (56±4.8) had high mean than males (52±6.0).In addition to CK-MB, the LDH values were also higher in females (225±6.4) than males (198±10.6). The LDH levels were normal in the other two groups.
The mean ±SD of IMA in the ischemic group (Group I, n=80) was 0.519±0.086 ABSU which was much higher when compared to control subjects with no evidence of ischemia (Group2, n=16) 0.316±0.092ABSU. This is statistically significant with a P-value of <0.001. The Group 1 patients had high levels than a decision threshold of 0.400 ABSU (ABSU>/=0.400).
Discussion
Many important findings regarding IMA in different age groups and gender variance in Ischemic patients presenting with Co (II)-albumin binding assay for IMA have emerged from the analysis. The ischemic group had higher levels of IMA compared to the nonischemic group. Similarly, skeletal muscles. In a study conducted by (), the findings indicated that HRT improves the functions of muscles in Women had a higher likelihood of having IMA biomarker compared to ischemic men, this is in correlation to a study done by Kazanis et al (). Further analysis indicated that as age increases (from 40 to 60 years) IMA levels get elevated among the ischemic patients. The study also shows a correlation to a study done by Bar-Or et al (12) where myocardial ischemic patients had elevated assay levels ((0.529±0.086)), and for the age group of 50 to 60 years which had higher levels of IMA. The clinical diagnosis was assigned and correlated with standard biomarker (CK, CK-MB, and LDH) test results which were high compared with group II (0.316±0.092) with no human society develops. The evidence of myocardial ischemia (Bar-Or et al, 12).
In a previous study done by Januzzi (116), IMA was positive in four of five patients with pipeline of school to prison. Ecenbarger (2012) believes that that evidence of ischemia in ECG being 16 of 20 patients who had negative ECG but with coronary ischemia (Rodriguez-Ospina et al, 228). The combination of IMA along with the other standard biomarkers among these patients increases the sensitivity for detecting ischemia to 97% (Tousoulis et al, 102). This supports this study in which there is an appropriate setting in which to consider the use of the multimarker combination of IMA plus markers of myonecrosis would be for the rapid assessment of low to intermediate patients with chest discomfort risk.
High levels of the IMA in Women in America. (1990). The Black women and the elderly are an indication that the accuracy of the diagnosis of coronary heart diseases such as cardiac ischemia has been increased (Sinha et al, 89). The application of IMA to detect ischemia before the destruction of the myocardium muscles will help treat the elderly who mostly suffer from cardiac diseases such as cardiac ischemia. Furthermore, it would be helpful in the stratification of the patients who have cardiac ischemic and normal chest pains (Radha et al, 225).
Conclusion
In summary, IMA is an effective marker for ACS diagnosis. High negative predictive IMA values make it an independent predictor of ACS development among patients. Furthermore, IMA is not just specific to cardiac ischemia only. This makes it potential as a biomarker for other acute ischemic events. Similarly, the increase in the level of IMA in women, and as age increases in ischemic patients is a breakthrough for the elderly, and the women who are ailing from cardiac ischemia or just experience chest pain. Correct diagnosis would enable them to get people treatment on time.
Work Cited
Bar-Or, D, E Lau, and JV Winkler. “A Novel Assay for Cobalt-Albumin Binding and Its Potential As a Marker for Myocardial Ischemia-a Preliminary Report.” The Journal of Emergency Medicine. 19.4 (2000): 311-5. Print.
[email protected], Govender, Radha, De Greef, Jacques, Delport, Rhena, Becker, Piet J., & Vermaak, William J.H.” Biological Variation of Ischaemia-Modified Albumin in Healthy Subjects. Clinics Cardiff, 2008.” Internet resource.
Rodriguez-Ospina, LF, CP Rosales-Alvarez, and A Lopez-Mas. “Cardiac Biomakers for the Evaluation of Acute Coronary Syndrome.” Boletín De La Asociación Médica De Puerto Rico. 101.4 (2009). Print.
Sinha, M, Roy, D, Gaze, D, Collinson, P, & Kaski, J. “Role of “ischemia Modified Albumin”, a New Biochemical Marker of Myocardial Ischaemia, in the Early Diagnosis of Acute Coronary Syndromes.” BMJ Group, 2004. Print
Wiviott, Stephen D, Christopher P. Cannon, David A. Morrow, Kausik K. Ray, Marc A. Pfeffer, and Eugene Braunwald. “Differential Expression of Cardiac Biomarkers by Gender in Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction.” Journal of the American College of Cardiology. 46.8 (2005): 1411-1416. Print.
Januzzi, James L. Cardiac Biomarkers in Clinical Practice. Sudbury, Mass: Jones and Bartlett Publishers, 2009. Print.
Tousoulis, Dimitris, and Christodoulos Stefanadis. Biomarkers in Cardiovascular Diseases. Boca Raton: CRC Press, 2013. Print.
Kazanis, K, M Dalamaga, C Nounopoulos, AS Manolis, N Sakellaris, G Jullien, and A Dionyssiou-Asteriou. “Ischemia Modified Albumin, High-Sensitivity C-Reactive Protein and Natriuretic Peptide in Patients with Coronary Atherosclerosis.” Clinica Chimica Acta; International Journal of Clinical Chemistry. 408 (2009): 1-2. Print.
Table No I: Cardiac biomarker in Ischemic and nonischemic groups:
Table No II: Age distribution in ischemic and control groups:
| Ischemic subjects
(n=80) |
Control group
(n=28) |
|
| Males(n=34)
Mean ± SD |
Females(n=46)
Mean ± SD |
Males(n=10)
Mean ± SD |
Females(n=16)
Mean ± SD |
|
| 50±6.8Yrs |
58±10.1Yrs |
45±8.6Yrs |
56±10.6Yrs |
|
Table no III: Age-wise distribution of cardiac markers in Ischemic group
Table no IV Mean ± SD of males & females in Ischemic & nonischemic group
With a student-centered approach, I create engaging and informative blog posts that tackle relevant topics for students. My content aims to equip students with the knowledge and tools they need to succeed academically and beyond.
by Herman Bailey | Apr 25, 2023 | Essays |
Please read carefully the attached case study on ‘Exporting Ford Automobiles to Japan’ and answer all five questions referring to this. The length of the whole document with your answers should range between 3,000 and 3,500 words. Each question should be answered separately.
Exporting Ford automobiles to Japan
The 29-year-old customer wheels his old Toyota onto the lot at the Ford dealership and parks near the showroom. A polite salesman greets him and accepts the Toyota’s keys. After some brief paperwork, the salesman and customer walk to another area outside the showroom. There, the salesman goes through the delivery checklist and then hands the customers the keys to a new dark-green Ford Mustang coupe that sports a 3.8-liter V6 engine.
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What’s so unusual about this story? Well, this scene occurred in Tokyo, Japan, and both the salesman and customers were Japanese. For much of the 1960s, ’70s, and ’80s, Japanese car companies like Toyota and Honda pretty much had their way in the U.S. car market. Meanwhile, American companies either had little interest in exporting to Japan or found the process very difficult.
Ford has decided to change all that. The new Mustang that Seiichi Tsuzuki bought represents Ford’s flagship model in a new line of cars it introduced in Japan in mid-1994. Although Japanese cars have their steering wheel on the right-hand side of the car, Ford’s Mustang is a left-hand-drive model that targets a high-profile niche market. Ford is positioning the Mustang squarely against Nissan’s Z cars and Toyota’s Supra cars that have dominated the ‘muscle car’ niche in Japan. Along with the Mustang, however, Ford is introducing three right-hand-drive models -Probe, Laser, and Mondeo – that will target the compact-sedan market long ruled by Honda’s Accord. This segment accounts for one-third of the Japanese market. Ford produces these new ‘world cars’ as part of a 6 billion dollar development effort. They represent the first time any American car company has offered right-hand-drive cars in Japan.
Mr. Tsuzuki, a manager at a life insurance company, believes that the Mustang is ‘sexy’, and he appreciates the ‘roughness’ of its mystique. The cars running-horse emblem, he notes, is a symbol of the United States,’ and he finds the car’s design very impressive. He also appreciates the fact that the Mustang offers safety features, like airbags and anti-lock brakes that cost much more on Japanese cars. Another recent customer, 72-year-old Tadashi Okabe, points out that ‘People say bad things about foreign cars – that the service is bad and that they don’t run efficiently. But the Mustang is not like that. It is big, cool, and durable, and it also has airbags.”
Although the Mustang offers images and accessories, its real advantage may be price. In recent years, the yen has gained strength relative to the U.S. dollar, falling from about 130 yen to the dollar to about 100. This means that Japanese consumers find American goods about 23 percent cheaper than they had been. For example, Mr. Tsuzuki’s Mustang cost about 2.3 million yen or about USD 22,000. That is at least USD 7,000 lower than a comparable Japanese sports car’s price. Ford is pricing its world cars at USD 2,000 to USD 3,000 below comparable versions of the Nissan Altima or the Honda Accord.
For years, American car companies have complained about their market shares in Japan and asked the Japanese government for concessions. Now, Ford may finally have found the right formula – offer an American icon at a discount price and back it up with other models adapted for the Japanese market.
Taking on the world
This is not Ford’s first attempt to crack the Japanese market. Until 1939, before World War II, the company sold about 10,000 Model A Fords annually in Japan. When Ford reentered the market after the war, in 1953, it imported only a limited number of cars each year. In 1979, Ford brought a 25-percent stake in Mazda Motor Corporation. This affiliation allowed Mazda to produce the Ford vehicles sold in Japan and gave Ford access to Mazda’s 286 dealerships. To disguise the relationship, Ford and Mazda called the dealerships “Autorama.” Despite the joint venture, however, Ford imported only 2,959 vehicles into Japan in 1991 and only 5,407 in 1993.
Ford’s interest in Japan and other international markets is just part of the American auto industry’s growing interest in exporting. The weaker dollar and improved products are helping the companies reverse U.S.-made vehicles’ historically weak export sales. In 1994, analysts estimated that American and Japanese companies would have exported 529,000 cars and trucks from the United States, a 48.5 percent jump from 1993. The “Big Three,” Ford, Chrysler, and General Motors, would account for 382,000 of those vehicles, up from 254,766 in 1993. Japanese companies operating in the United States would also increase their exports in 1994 by over 30 percent, but most of these exports would go to Taiwan.
The stronger yen is also forcing Japanese companies to continue their investments in U.S.-based manufacturing. Toyota recently doubled its Kentucky plant’s capacity to 400,000 vehicles per year. Like Ford, General Motor is also targeting Japan, although it has been less aggressive. In 1993, GM sold 17,400 vehicles in Japan, about one-half of them made in Germany by GM’s Opel unit. By the mid-1990s, GM plans to sell right-hand-drive Saturns and a right-hand-drive van that it manufactures in Georgia. Also, by 1996, it will offer Chevrolet Cavaliers with a Toyota nameplate. GM owns 37 percent of the Japanese auto company Isuzu.
Driving Ford
Just introducing reasonably priced new cars to the Japanese market is not enough by itself. Ford realizes it will need a full marketing mix. Ford is depending on Konen Suzuki, president of Japanese operations, to manage its marketing strategy in Japan. Suzuki stunned his superiors at Toyota when he jumped to Ford in 1991. Suzuki’s first goal was to make Ford more sensitive to the needs of Japanese motorists. He knew that Ford offered roomier cars which the Japanese preferred for family outings and recreation. Improved fuel economy made the cars more attractive in a country with very high gasoline prices. Suzuki also realized that Ford would have to back up its cars with better service than many local rivals provided. He issued Ford’s first recall in Japan to replace broken steering hoses and malfunctioning fuel pumps on Tauruses. Japan’s narrow, twisting roads and constant stopping and starting were too much for these parts, so Ford replaced them with more reliable substitutes. Keeping replacement parts in stock has been one of Ford’s challenges.
The typical Japanese consumer is also less interested in power car drives than in how it looks. Because Japan has such well-developed public transportation, much Japanese use that system for day-to-day travel. The Japanese treat their car as an ornament to be polished and cared for but used only occasionally. Suzuki is also focusing on distribution. He wants to sign up for an additional 1,000 dealers by the year 2000 to supplement the 286 Autorama dealers. He has even enticed one Nissan dealer to offer Fords at many of its dealerships. One problem, however, is that in Japan door-to-door salespeople sell about one-half of the cars sold each year. Because real estate is so expensive in Japan, most auto dealerships do not resemble American dealerships with their large buildings and massive car lots. They serve instead as the basis of operation for the sales force. Toyota alone has a 1,000-person sales force – equal to about one-half of the entire U.S. auto sales force – for a country the size of California. Toyota roving salespeople help it capture two of every five car customers in Japan. The salespeople establish personal relationships with each of the 3,000 or so households in a typical sales area and make their sales pitches in their customers’ living room. The salespeople primarily target homemakers who don’t work outside the home. Because of the door-to-door sales forces, most Japanese never go to an auto dealership, and most are strongly brand loyal. Many Ford dealers don’t like the time and expense involved in the traditional sales approach, but they have yet to develop any better ideas.
To entice customers to visit the dealerships, Suzuki ordered a multimillion-dollar ad campaign that positions Ford’s offerings as fun breast cancer. Ann has been a staunch Christian since childhood just like the rest of her family cars. Two trends may help Suzuki’s efforts. First, more Japanese women are working and are therefore not at home for traditional sales calls. Second, more consumers are willing to go to showrooms to see the latest new cars.
By 2000, Ford and Suzuki want to capture 5 percent of the Japanese market, roughly 200,000 cars. Ford would import about one-half of these if its Mazda affiliate making the balance. Suzuki knows, however, that Nissan, Toyota, Honda, and the other Japanese carmakers will not sit idly by. He also knows that Chrysler and GM will want their shares of the Japanese market.
Case study questions
Q.1 What economic, cultural, political-legal, or other environmental factors should Ford take into consideration in exporting its cars to Japan and why? What specific opportunities and threats can be extracted from the Japanese environment?
Q.2 What features of the Japanese consumer behavior have Ford to take into consideration in selling its goods to the Japanese market? What is the nature and characteristics of the competition faced by Ford in this market?
Q.3 What possible criteria did Ford use in selecting Japan as a market for its cars? What were the possible target segments for Ford in the Japanese market? How did Ford position its Mustang brand in this market?
Q.4 Which specific method did Ford use to enter the Japanese market? What are the possible advantages and disadvantages encountered by Ford using this method? What other entry method (s) to Japan would you suggest to Ford and why?
Q.5 What adjustments has Ford made on each of the elements of its marketing mix in exporting to the Japanese market and why? What marketing strategy recommendations would you make to Ford to help it to be successful in this market?
With a student-centered approach, I create engaging and informative blog posts that tackle relevant topics for students. My content aims to equip students with the knowledge and tools they need to succeed academically and beyond.
by Herman Bailey | Apr 25, 2023 | Essays |
1.0 Introduction
Harris & Emberley (2014) defined sex hormones as a class of steroid hormones regulating the function and growth of the reproductive organs or stimulate secondary sexual characteristics development. They include estrogen, testosterone, and Dihydrotestosterone (DHT). Sex hormones, estrogen, and testosterone play a fundamental role in the function and regulation of skeletal muscle (Griggs et al, 1989).
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There are two types of skeletal muscles, type I fibers and type II fibers. Type I fibers also referred to as slow oxidative fibers or slow-twitch fibers contain many mitochondria and large amounts of myoglobin and many capillaries of blood. These fibers have a slow velocity of contraction, split ATP at a slow rate, and are resistant to fatigue. On the other hand, Type II fibers also referred to as fast oxidative fibers or fast-twitch fibers have very many mitochondria, large amounts of myoglobin, and many capillaries of blood. Moreover, Type II fibers split ATP at a rapid rate, has a high capacity of ATP generation through oxidative metabolic processes, are resistant to fatigue, and have a faster velocity of contraction.
The female sex hormone estrogen is secreted by the ovaries. Testosterone, a male sex hormone, is secreted by the testis. Estrogen is the dominant hormone in females and testosterone is dominant in males (Griggs et al, 1989). Estrogen hormone has protective effects on different types of skeletal muscle injuries. Enns & Tiidus (2010) indicated that estrogen may influence the contractile properties of muscles and attenuate post-exercise muscle damage indices. Moreover, estrogen stimulates muscle repair and the regenerative process such as proliferation and activation of the satellite cells. Enns & Tiidus (2010) further asserted that estrogen may exert its protective effects on the skeletal muscle by playing the role of an antioxidant hence limiting the oxidative damage; binding to the receptors of estrogen hence governing the downstream genes regulation and molecular targets, and acting as a stabilizer of the membrane by intercalating within the membrane phospholipids. The estrogen concentration in women declines as women enter menopause, and this results in negative outcomes including delay in recovery from skeletal muscle injuries and greater injury of skeletal muscles. Muscle mass and strength decrease is believed to occur faster in women with menopause than in older men and this is due to differences in hormonal levels where estrogen levels in women tend to decrease with a mean age of 51yrs compared to men (Harris & Emberley, 2014). Women in the menopausal period stop producing eggs which mark the ends of their menstrual cycle and fertility. Menopausal periods are categorized into two phases; pre-menopausal and postmenopausal. During pre-menopausal periods, estrogen levels slowly drop even though women are still experiencing regular menstrual periods and are capable of giving birth (Hickey, Elliott & Davison, 2012). During the postmenopausal period, women experience a fast and constant drop in estrogen levels. In this period, women stop ovulating marking the end of their fertility and they also experience a lot of discomfort in their bodies (Hickey, Elliott & Davison, 2012). The decreasing estrogen levels in these two phases convey a direct effect on peripheral tissues like a skeletal muscle (Maltais, Desroches & Dionne, 2009). A current study conducted by Pöllȧnen et al (2011), suggested that women in pre-menopausal stages have better muscle strength, power, and larger muscles than women in post-menopausal periods. This suggested that estrogen might have a direct effect on skeletal muscle, but this research is still uncertain.
According to Herbst & Bhasin (2004), the testosterone hormone decreases fat mass and increases lean body mass in young men. Testosterone hormone in young men induces hypertrophy of the skeletal muscle leading to improved leg power and muscle strength. As the men age, they lose muscle mass because of the natural decline in testosterone levels. A significant reduction in testosterone hormone can also result in sarcopenia (Pöllȧnen et al., 2011). Sarcopenia is characterized by muscle weakness and is caused by decreasing circulating levels of sex hormones in skeletal muscles and bones. Sarcopenia in men (mass weakness) is associated with a decrease in testosterone (Pöllȧnen et al., 2011). Similarly, Dihydrotestosterone (DHT) is a male sex hormone that is converted to testosterone using 5-α reducates enzyme. It is 90% responsible for changes and the development of male sex characteristics (Phillips et al, 1993). In skeletal muscle, through the non-genomic pathway, physiological levels of DHT affects the fast twitch and slow twitch fibers of skeletal muscle by increasing tetanic contractions and twitching of the fast-twitch fibers but then it decreases them in slow-twitch fibers (Phillips et al, 1993). Skeletal muscles are also capable of converting estrogen to androgens through a pathway involving steroidogenic enzymes (Prentice et al, 2009).
As people, age, steroid sex hormones like estrogen, testosterone, and DHT are said to affect muscle strength and power. This proposal will address: first the influence of estrogen replacement therapies on skeletal muscle in both post-menopausal and pre-menopausal women. Second, the effects of testosterone replacement therapy on older men and athletes.
2.0 Body: comparison and analysis of relevant research articles
1. The use of HRT and why women use HRT
Hormonal replacement therapy (HRT) is a medication that contains hormones that the body of a woman stopped producing after menopause and is used to treat the symptoms of menopause. HRT is normally given to some of the women whose progesterone and estrogen levels significantly dropped because of menopause. Bagger (2004) stated that when the levels of estrogen and progesterone drop especially when the women approach menopause, some women may boost their levels of hormones artificially to reduce certain symptoms of menopause. Estrogen hormone helps maintain bone density, regulate vaginal moisture, and skin temperature. Therefore, a drop in the levels of estrogen can cause urinary problems, vaginal dryness, thinning hair, night sweats, sleep problems, moodiness, irregular periods, lower fertility, memory and concentration difficulties, hot flushes. Fat accumulation in the abdomen and breast getting smaller. Bakour & Williamson (2015) pointed out that some of these symptoms may occur in peri-menopause before the start of menopause. The main function of the Progesterone hormone is to prepare the womb of a woman for possible pregnancies in addition to protecting the endometrium. There is a higher risk of developing endometrial cancer when the progesterone levels go down (Enns & Tiidus, 2010).
Even though several studies Goldstein (2010) has linked HRT with life-threatening conditions such as ovarian cancer, breast cancer, and other illness conditions, doctors still prescribe it in some conditions. There are several benefits as to why women use HRT, key among them being the treatment or prevention of osteoporosis, and the relief of menopausal symptoms.
(a) Improvement in skeletal muscles function and reduction in osteoporosis risks
According to Hickey, Elliott & Davison (2012), HRT improves the functions of the skeletal muscles. In a study conducted by Hickey, Elliott & Davison (2012), the findings indicated that HRT improves the functions of muscles in women, up to the muscle fibers. Even though women showing the symptoms of menopause, Hickey, Elliott & Davison (2012) found out that even though the muscle fibers did not show any change in size, the HRT users’ muscles showed greater strength by generating maximum force than the non-HRT users. It is believed that at least in part, using HRT reduces modifications of the contractile proteins of the muscle linked to aging. In addition to skeletal muscles, HRT is effective in the preservation of the mineral density of the bone. Stevenson et al (2006) stated that taking HRT amongst women leads to osteoporosis reduction in the hip and spine and this could explain why women use HRT.in a study conducted by Marjoribanks et al (2012), taking HRT by women have decreased significantly the incidences of fractures with the long-term use of HRT. According to Hickey, Elliott & Davison (2012), HRT is the first line of treatment for the management and prevention of osteoporosis in women with the symptoms of menopause and who are aged below 50 years. Even though the density of the bone declines after HRT discontinuation. Bagger (2004) in their study demonstrated that women taking HRT for a few years around menopause have a long protective effect for several years after stopping using HRT. To determine whether HRT administration for 2- 3 years in the early years of postmenopausal provide long-term visits, such as prevention of bone fractures and prevention of bone Loss, Bagger (2004) studied a group of 347 healthy women in post menopause with normal bone mass who had completed earlier one of four HRT trials that are placebo-controlled and who were reexamined after stopping HRT for 5, 11 or 15 years. 263 of those women received either placebo or HRT for 2-3 years with no further treatment of bone sparing until follow-up. Moreover, the remaining 84 women in the study reported either current or prolonged HRT use at reexamination. The mineral density of the bone at the spine (L1 to L4) and mineral content of the bone in the forearm was then measured at baseline, the end of the trial, and follow-up. Bagger (2004) assessed, at the follow up the radiological presence of the vertebral fracture and collected new information on the non-vertebral fractures incidences. When a comparison was done with that of women treated with placebo, bone mineral content and bone mineral density in women treated with HRT continued to show higher values significantly (>5%) even several years after the HRT stoppage. After the treatment stoppage, the rate of loss of bone returned to normal rates of post-menopause. In summary, limited HRT administration in the early years of post-menopause offers long-lasting benefits for postmenopausal bone loss prevention and osteoporotic fractures (Bagger, 2004).
(b) Urogenital symptoms improvement
Women in premenopausal or menopause also use HRT to improve their urogenital menopause symptoms. Several studies have indicated that HRT improves vaginal dryness significantly and also sexual function. Moreover, HRT is very much effective in improving the related symptoms of vaginal atrophy (Sturdee et al, 2010). Panay et al (2013) indicated that women also use HRT in relieving the symptoms of urinary frequency since it has a proliferative effect on the urethral and bladder epithelium. Goldstein (2010) also observed that HRT improves vaginal symptoms, decrease the vaginal pH, and vaginal atrophy. Moreover, there is an improved maturation of the epithelia with HRT compared to non-hormonal gels and placebo and that could explain the reasons why women use HRT. In a study conducted by Goldstein (2010) on how to recognize and treat urogenital atrophy in postmenopausal women, Goldstein (2010) observed that it results from menopausal estrogen deficiency and has several clinical effects which include sexual dysfunction, vaginal dryness, recurrent urinary infections, and urinary incontinence. Goldstein (2010) further asserted that estrogen therapy either administered systematically or locally provides significant relief. Local vaginal estrogen therapy in low dose, in the form of rings, creams, and vaginal tablets has been shown to reduce vaginal dryness and dyspareunia, restore normal cytology of the vagina, and restorative the vaginal pH
(c) Reduction in cardiovascular diseases
HRT also reduces the risks of heart attack and heart failure. Bakour & Williamson (2015) asserted that women who receive the HRT immediately after the commencement of their menopause have a lower likelihood of developing heart failures and heart attacks. This could also explain the reasons why women use HRT. Even though the relationship between cardiovascular diseases and HRT is still controversial, Hickey, Elliott & Davison (2012) asserted that the duration and timing of HRT and the pre-existing cardiovascular disease have a likelihood of affecting the outcomes. A study conducted by Prentice et al (2009) quoted trial research done by Women health initiative (WHI) found out that there was a slight increase in coronary heart disease incidences in the first year after commute enforcement of HRT. The women in the trial were taking the conjugated equine estrogens without or with medroxyprogesterone acetate (Prentice et al, 2009). In another recent study by Schierbeck et al (2012), the results demonstrated that HRT reduces coronary heart disease incidences by around 50% if it commenced within years of the menopausal years. Similarly, Schierbeck et al (2012) showed that women who receive HRT early after menopause had a significant reduction in mortality risk without any apparent increase in the risk of stroke, venous thromboembolism, or cancer.
2. How HRT effects, skeletal muscle of post-menopausal women compared to pre-menopausal women
In the previous randomized controlled trials, post-menopausal HRT administration for 6 to 1 year has shown improvement in mobility and an increase in the strength of the muscles in young postmenopausal women (Sipilä et al, 2001; Skelton et al, 1999, Taaffe et al, 2005). However, 27 and 46 in their studies documented that amongst the older women there was no improvement in mobility and muscle strength with HRT treatment. Skeleton et al (1999) on their randomized controlled trials investigated the effects of HRT on muscle composition and muscle cross-sectional areas. The results indicated no change in the cross-sectional area of the muscle adductor policy after one year of cyclical norgestrel and estrogen treatment amongst women with a mean age of 61 years although there was a significant strength gain on the same muscle.
Similarly, Sipilä et al (2001) also did a double-blind randomized controlled test among early post-menopausal women and the results showed a significant mean increase of 6% in the cross-sectional area of the knee extensor muscle after continuous treatment with combined progestin and estradiol compared to the controlled subjects. In the same study, Sipilä et al (2001) examined the thigh muscle density by CT and recorded an increase after HRT. This suggested decreased intramuscular content. Additionally, the relative fat proportion within the knee compartment of the extensor muscle remained unchanged in the women under HRT, while it increased amongst the controlled group (Sipilä et al, 2001).
Pöllänen et al (2015) conducted a study to examine the relationship between characteristics of muscles in pre-menopausal (n=8) and intramuscular steroid hormones and in the postmenopausal pairs of monozygotic twin sisters (n=16, eight pairs of twin sisters), discordant for estrogen use based on the replacement of hormones. Pöllänen et al (2015) assessed the isometric strength of the skeletal muscles by measuring the strength of knee extension. Moreover, the explosive muscle power of the lower body was assessed as the height of the vertical jump. From the study. Intramuscular estrogen, testosterone, DHEA, and DHT proved to be independent, significant predictors of power, and strength explaining the variation of 59-64% in the strength of knee extension and 80-83% of the vertical jumping height variation in women. The study by Pöllänen et al (2015) suggests that intramuscular sex steroids are associated with power and strength regulation in muscles of women.
3. Changes in muscle mass after menopause
Menopause is linked with the natural estrogen decline which increases the fat mass of the visceral, decreases the mass density of the bones, muscle strength, and muscle mass. In their study review, Maltais, Desroches & Dionne (2009) examined the menopause transition role and associated decrease in the status of hormone regarding the changes. Furthermore, the study overviewed the efficiency of nutrition and physical exercise on sub-characteristics of muscle.
According to Harris & Emberley (2014), the role of estrogen in the maintenance of muscle mass remains unclear. For instance, in a study done by Trenkle (1976), estrogen was reported to stimulate the growth of muscles in developing cattle and sheep. However, in a study done by Ihemelandu (1980), estrogen was found to be hindering the growth of the skeletal muscles of the developing rodents. In women, Petrofsky et al (1976) and Seeley et al (1995) found that estrogen does not affect muscle mass. Similarly, in a study done by Philip et al (1993), the results indicated that women who are deficient in sex hormones which includes the post-menopause women had less specific strength in their adductor pollicis muscle (force/muscle cross-sectional area), compared to their aged-matched women who were under HRT.
Pamela (n.d) pointed out that an average woman during their menopausal transition can expect to gain 2-5 pounds of muscle, especially in the lower tummy. The major reason for weight gain among women is estrogen decline. Healthtalk.org. (2015) also elaborated that fat cells in the buttocks, thigh, and hip have estrogen receptors. In most women, estrogen drives most storage of fat to the lower body parts, and therefore as the levels of estrogen begin to decline, it loses its hold on the storage of fat below the waist. Instead, the fat begins to be deposited around the waistline
4. The use and why athletes use testosterone replacement therapy
According to Gregory et al (2003), there is an increasing number of males using testosterone therapy to help in the treatment of erectile dysfunction, fatigue, and loss of sex drive, and also to enhance their physical performance as these are the most common symptoms of low testosterone in the body. Testosterone therapy is normally used in treating male hypogonadism or simply low testosterone. This is a condition where the body fails to make hormones that are enough because of a problem with pituitary glands or the testicles (Griggs et al, 1989).
Athletes tend to use testosterone replacement therapy to enhance their physical performance during sports. This is because testosterone hormone allows the athletes to increase their muscle mass and also performance (Herbst and Bhasin, 2004). Herbst and Bhasin (2004) indicated that bodybuilders and athletes use supplements that boost testosterone to increase their strength as well as improve their recovery time. This practice is also referred to as doping (Herbst and Bhasin, 2004).
Leaner body mass helps control weight and increases energy which athletes require. Evidence shows that testosterone treatment can increase muscle strength and size and decrease fat. This effect is much greater where testosterone therapy is combined with strength training exercises. In a study done by Snyder et al (1999) on 108 men who are aged over 65 years and under the treatment of testosterone for 36 months, the results indicated that testosterone therapy decreased fat significantly. Especially in the legs and arms. Moreover, these same men under the study have an increase in their lean mass majorly around their trunk.
Another reason why athletes tend to use testosterone replacement therapy is for stronger bones which help in supporting their internal organs and muscles hence boosting their athletic performance. A drop in testosterone levels leads to a drop in bone density, and this raises the risk of osteoporosis or weaker bones among the athletes. The argument is echoed by another study by Snyder (1999) which indicated that testosterone replacement therapy can make older men with low testosterone levels increase their bone density.
5. The effects of testosterone replacement therapy in athletes’ skeletal muscles
Testosterone replacement therapy has the ability to increase muscle mass and muscle strength on the skeletal muscle of the athletes. It works by increasing the protein synthesis of the muscle. Griggs et al (1989) conducted a study on the effects of testosterone on muscle protein synthesis and muscle mass. The researchers the pharmacological dose effect of testosterone enanthate on total body potassium and muscle mass, and muscle protein synthesis, and whole body in normal male subjects. Among the 9 subjects, estimated muscle mass by creatine exertion increased. Estimation of the total body potassium by 40k counting increased among all participants. A primed infusion protocol that is continuous with L-[1-13C] leucine was applied in determining the whole body oxidation and leucine flux. Furthermore, the estimation of the protein synthesis of the whole body was done from nonoxidative flux. Lastly, the synthesis rate of the muscle protein was determined by measuring the incorporation of [13C] leucine into the obtained muscle sample by needle biopsy. The results from the study indicated that testosterone therapy increased protein synthesis of the muscle in all subjects, leucine oxidation slightly decreased, but a whole-body synthesis of protein did not significantly change. Additionally, muscle morphometry did not show significant increases in the diameter of the muscle fiber. This study suggested that testosterone increases muscle mass is by increasing the synthesis of the muscle protein (Griggs et al, 1989).
Gregory et al (2003) also conducted a study on the effects of testosterone replacement therapy on the skeletal muscle after injury of the spinal cord. Using a randomized controlled study design and settings in Georgia, USA, and Athens, Gregory et al (2003) took soleus, gastrocnemius, tibialis anterior, vastus lateralis, and triceps branch muscles from 12 young Charles River male rats after sham surgery or complete SCI after 11 weeks. The rats were given TRT after surgery and their muscle samples sectioned and fibers quantitatively analyzed for alpha-glycerol-phosphate dehydrogenase (GPDH), succinate dehydrogenase (SDH), and actomyosin ATPase (qATPase) and qualitatively analyzed for myosin ATPase activities. The results of the study showed a decrease in the average size of fibers in affected muscles. Additionally, there was an SDH decrease and an increase in qATPase and GPDH activities across the muscles of the four hind limbs of the SCI animals. Moreover, the size of fiber in the TRI was increased by SCI (31+/-2%). This shows that TNT has an effect on muscle mass, and it increases muscle mass (Gregory et al, 2003).
3.0 Conclusion
In summary, the literature review looked at the effects of sex hormones on skeletal muscles during aging. It discussed the role of each sex hormones in the skeletal muscles before discussing the muscle reduction in pre-menopause and post-menopause period and how estrogen hormone is associated during these periods. Similarly, the literature review briefly highlighted the reduction of muscle mass as men age and how testosterone is associated with muscle reduction. Additionally, the paper reviewed several articles by comparing and analyzing their data under five different groupings. That is the use of HRT and why women use HRT; How HRT affects the skeletal muscle of post-menopausal women compared to pre-menopausal women; Changes in muscle mass after menopause; the use and why athletes use testosterone replacement therapy; and the effects of testosterone replacement therapy in athletes’ skeletal muscles.
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