Caring Theory

Swanson’s Middle Range Nursing Theory of Caring By: Shari Semelroth RN, BSN Mennonite College of Nursing Abstract Do we honestly make an effort to improve the environment, care, medical treatment, and interactions with those patients who are suffering a loss? Do we adequately provide the care that they need? These questions are answered in Swanson’s Middle Range Theory of Caring. We examine the five caring processes and their applications to one’s daily nursing routines. Many healthcare organizations have adopted the caring theory as their model of care for their philosophy and principles for nursing.Caring theory has also been the focus of many research articles that have concluded that caring is a natural part of nursing and it is based on evidence. All healthcare professionals should be able to achieve the concepts into their daily nursing profession. We care for patients, and what we are currently doing we can always switch to improve for more positive intera ctions. What is caring and why is it essential to nursing? What are the perceptions of caregivers, care receivers, and care observers regarding caring? A nurturing way of relating to a valued other person toward whom one has a personal sense of commitment and responsibility.Nursing has traditionally been concerned not only with the caring needs of individuals, but also with caring as a value or principle for nursing action. (Swanson, 1991) The underlying structure of the nursing philosophical system or grand theory of nursing as caring is created by the assumptions of the theory and their interrelationships. (Boykin & Schoenhofer, 2001) These assumptions develop the most fundamental belief that all persons are caring by virtue of their humanness, that to be human is to be caring.A deep understanding of the practical meaning of that foundational assumptions also organize the theory that personhood is living grounded in caring; that caring is lived moment to moment in relationships wi th caring others, and that nursing as a discipline and profession of caring is orientated not towards diagnosing needs nor compensating for deficiencies, but as its focus, nurturing persons living caring and growing in caring. (Boykin, 2003) Swanson suggests that a universal definition or conceptualization of caring does not exist within and outside of nursing as to the role of caring in personal and professional relationships. Swanson, 1991) Kristen Swanson is a native of Rhode Island, graduated with a bachelor’s degree in nursing from the University of Rhode Island in 1975. She went on to earn her master’s degree from the University of Pennsylvania in 1978 and PhD in nursing from the University of Colorado. Swanson worked as a Registered Nurse at the University of Massachusetts, as she was drawn to that institution because the founding nursing administration clearly articulated a vision for professional nursing practice and actively worked with nurses to apply these ideas while working with clients. Swanson, 1993) As a novice nurse she wanted to become a knowledgeable and technically skillful practitioner with an ultimate goal of teaching these skills to others. She pursued graduate studies. While studying she worked as a clinical instructor on a med surgical unit. Swanson studied psychosocial nursing with an emphasis on exploring the concepts of loss, stress, coping, interpersonal relationships, persons, environment and caring. As a doctoral student, she was able to experience hands on health promotion activity.She was involved in a cesarean birth support group. One historical meeting for her was on miscarriage. Swanson noticed that the discussion was based by the physician more on the pathophysiology and health problems of miscarriage. The women of the group were interested in discussing their personal experiences with pregnancy loss. (Alligood & Tomey, 2010) From that day forth she decided to learn more about the human experience. Caring and miscarriage became the focus of her doctoral dissertation and her program of research.She has since then received numerous awards, has taught fellow nursing students, became the Dean at the University of North Carolina at Chapel Hill and Associate Chief Nursing Officer for Academic Affairs at UNC Hospitals. In addition to teaching and administrative responsibilities, she conducts research funded by National Institutes of Nursing Research, publishes, mentors faculty and students and serves as a consultant at national and international levels. Swanson was inducted as a fellow in the American Academy of Nursing and received Distinguished Alumni Award from the University of Rhode Island.Swanson used various theoretical sources while developing her theory. During her doctoral studies, she was influenced by other nurses and their theories related to caring. She took Dr. Jacqueline Fawcett’s course on the conceptual basis of nursing practice as a master’s prepared nurse, not only made her better at understanding the differences between the goals of nursing and other health disciplines, but also made her realize that caring for others as they go through life transitions of health, illness, healing, and dying was congruent with her personal values. (Swanson 1991)Dr.Fawcett developed the Language of Nursing and Metatheory; she displayed a distinctive role in caring for others and the importance of altruistic caring for the person’s well-being. (Fawcett, 1989) Dr. Jean Watson was also a mentor during her doctoral studies. Dr. Watson is known for her Theory of Human Caring. Even with the close relationship, they had, neither has ever seen Swanson’s program of research as an application of Watson’s theory of human caring. They do agree that compatibility of finding on caring in their individual programs add creditability to their individual programs of research.Swanson acknowledges Dr. Kathryn E. Barnard for encouraging her to make the t ransaction from interpretive to contemporary empiricist paradigm to convey what she learned and postulated about caring through several phenomenological investigations to direct intervention research and hopefully clinical practice with women who had miscarriages. (Alligood &Tomey, 2010) Dr. Barnard is recognized for her Parent Child Interaction Model. She encouraged Swanson to test her theory through randomized controlled trials.Swanson’s theory of caring is a nursing set of processes that are formed from the nurse’s own principles and his or her interaction with the patient, with five fundamental processes of knowing, being with, doing for, enabling, and maintain belief. Her theory was formed from three descriptive phenomenological studies from perinatal nursing. The five processes that help explain the concept of this theory has subcategories. The theory has four phenomena of concern: nursing, person, health and environment. Theory concepts of nursing are informed c aring for the well-being of others. Beatty, 1984) Person in theory concept is unique beings who are becoming and whose wholeness is manifested in thoughts, feelings, and behaviors. Health in theory is related to having meaning filled experience with wholeness. Environment is any situation that is influenced by the client or influences the client. Knowing is the first process of caring. Knowing is striving to understand the meaning of the event in the life of the other, avoiding assumptions, focusing on the person cared for, seeking clues, assessing thoroughly, and engaging both the one caring and the one cared for in the process of knowing. Swanson 1991) The second caring concept, being with emotionally present to the other. It involves simply â€Å"being there†, conveying ongoing availability and sharing feelings whether joyful or painful. Monitor so that the one caring does not ultimately burden the one cared for. The third concept is doing for others what would do for the self at all possible, including anticipating needs comforting, performing skillfully and unconditionally, and protecting the one cared for while preserving his or her dignity (Swanson, 1993) Enabling is the fourth concept.It is facilitating the others passage through life transitions and unfamiliar events by focusing on the event, informing, exploring, supporting, validating feelings, generating alternatives, thinking through, and giving feedback (Swanson, 1991) The final concept is maintaining belief. Sustaining faith in the others capacity to get through an event or transition and face a future with meaning, believing in others capacity and holding him or her in high esteem, maintaining a hope filled attitude, offering realistic optimism, helping to find meaning and standing by the one cared for no matter what the situation is. Swanson, 1993) Her later work introduced â€Å"Informed Caring†, aimed to provide structure for relating the five caring processes and describes ass umptions about the four main phenomena of concern to nursing. (Swanson, 1998) An assumption of nursing is informed caring for the well-being of others. Providers must be informed and regarding common responses to health concerns. The nurse will increase care given based on her experiences. Included is evidenced based practices, compassion, understanding of other structure of caring, and understanding of the nursing profession.Along with this assumption, the nurse may be affected by Benner’s Novice to Expert Theory. Persons are defined as unique beings who are in the midst of becoming and whose wholeness is made manifest in thoughts, feelings and behaviors. (Benner, 1984) Each individual experiences are molded by environment. Spiritual endowment connects each being to an external and universal source of goodness, mystery, life creativity, serenity and free will to choose a range of possibilities. Each person does have equal choices.Nurses are mandated to take on leadership rol es in fighting for human rights, equal access to health care and other humanitarian causes. (Hanson, 2004) Health and well-being is a complex process of curing and healing that includes â€Å"releasing inner pain, establishing new meaning, restoring integration, and emerging into a sense of renewed wholeness†. (Swanson, 1993) Bonds are created, free expression of spirituality, thoughts, feelings, intelligence and creativity. The well-being of health is negatively affected by actions of individuals upon the other that inhibit expression of wholeness.Environment is situational. Any context that influences or is influenced by the designated client informed. (Swanson, 1993) Any forces that exert influence upon or are influenced by the patient. (Hanson, 2004) Forces could come from cultural, economic, political, spiritual, social, physiological realms. Any disturbance or change in the environment or realms will affect the wholeness of the other. According to Swanson (1993), the te rms environment and person in nursing may be viewed interchangeable, therefore, what is considered an environment in one situation may be considered a client in another situation.Internal evaluation of the theory consists of clarity, adequacy, consistency logical development, and level of theory development. Clarity of the caring theory is straight forward and easy to interpret. Swanson’s definition of the environments clearly describes her thought process of how the environment and patient are interchangeable. Adequacy adequately addresses each process with thorough descriptions that bring the theory together as a whole. It recognizes nursing values and missions and uses prior theories and research as the basis for its formation.It is clear descriptions of its process allow it to be easily applied to practice. Consistency within the theory focus, definition and interpretation of relationships remain consistent throughout the description of the theory. Logical development is described as the formation of caring as an interaction process. It acknowledges the processes that affect each level of the interpersonal relationship between client and environment. Swanson included previous research and knowledge of caring, but later individualized her theory with empirical evidence that her processes can be used to form a healing environment.Level of theory development is displayed of components of a middle range theory including empirical testing applicable to direct practice, based on a specific phenomenon and narrower in scope because it focusses on the five processes of caring and their interaction, rather that focus on both the medical and psychosocial aspects of nursing. (Peterson & Bredow, 2009) External evaluation of the Theory of Caring include, complexity, discrimination, reality convergence, pragmatic, scope, significance, and utility. Complexity is easily understood with the simple definitions of the four concepts and five processes.Discrimination is not unique to the nursing field. There are many other theories based on caring. The theory does not have a precise boundary as it can be applied to many situations of nursing as well as outside the nursing practice itself. Reality convergences represent the real worlds of nursing and are true. The concepts and processes are described thoroughly enough to be understood by any professional. This allows the theory to be applied to a broad spectrum of human interaction meant to be caring. Pragmatic can be operationalized in real life setting which is seen in Swanson’s empirical testing.Scope is met by Swanson of a middle range theory by having the processes narrowly described for individual situations however it is broad enough to be applied to caring interactions that range from nursing to other professions. The components can be testes but remain concrete to be repeatedly applied to different practice setting. Significance of the caring theory is truly substantial to the nursin g profession. It has recognized and organized key values of caring that will help to provide improved client to nurse interactions.The theory clearly describes the importance of recognizing the situational environment, and the influence of a nurse’s interactions on the health and potential outcome of a patient. Utility is a clear with definition and descriptions and has allowed Swanson to continue to have her theory tested for further research. Each process stands on its own, but some also help to build and define the others. Knowing, being with, doing for, and enabling work together to have the path filled with meaning will be chosen and thereby meet the goal of maintaining belief. Limitation in theory was to show relationship between five processes.She recognized the limitations and worked to link all five processes in to Nursing in Informed Caring for well-being of others. Swanson’s theory is congruent with Benner’s theory of Helping Role of Nursing and Watso n’s Carative Factors. There is cross validation and rationale for perception. The University of North Carolina hospital has operationalized Swanson’s Caring theory. Swanson’s Theory has led to research based practicing. The initial investigation that launched this program of clinical research was a phenomenological pilot study of five women who had miscarried within fourteen weeks of participating in the study.The research questions were: â€Å"What is the meaning of miscarriage to the woman who has recently experienced it? † Another study was a phenomenological study of twenty women who had miscarried two specific aims were (a) to describe the human experience of miscarriage and (b) to describe the meaning of caring as perceived by women who had miscarried. This research study shifted the program of research from a qualitative, interpretative approach to a descriptive quantitative design. Kyle, 1995) Swanson was able to develop instruments to assist in t he measuring of her results. The Impact Miscarriage Scale was delivered from her research. (Swanson, 1999) The scale was developed in three phases, it was repeated, measures, and randomized. This scale measures significant aspects of suffering from a miscarriage. She developed an Emotional Strength Scale that measures the extent of how individuals view themselves emotionally and the Caring Other Scale which measures the received after miscarriage from one’s significant other and â€Å"others†.The Caring theory postulates that nurses demonstrating they care about it is as crucial to patient well-being for them through clinical activities such as preventing infection and administration medications. ( Bulfin, 2005) ) Implemented the Carolina Care Model is one approach to actualizing caring theory across a healthcare organization by systematically incorporating interventions that link nursing actions, caring processes, and expectations. The professional practice model for the University of North Carolina hospital completed in 2008 grounded in caring theory.A model was developed into specific caring behaviors and incorporated them in practice. Four key behavioral characteristics of Carolina Care were developed 🙠 1) multilevel rounding, (2) words and ways that work, (3) relationship service components, (4) partnerships with support services. Hourly rounds combine elements of the caring process of being with and doing for. Scripts may have an adverse reaction, so words and ways that work. Suggests key points to include in interaction that frequently occur that are individualized conversations.These words are linked to enabling. These may be linked to the other caring process, such as being with. A moment of caring is asked to be done with each patient for 3-5 minutes to talk about how they are coping with their illness while touching the patient's hand or arm. Moments like this exemplify being with, and information the patient shares may contrib ute to knowing. These links between caring processes and caring behavior suggested are grounded in a culture of maintaining belief. There are many healthcare organizations that use Swanson’s theory as their care model.Norton Healthcare, University of North Carolina, Children’s Hospital of Michigan, Virginia Mason Medical Center, Hudson Valley Sinai Hospital in Michigan and Meritus Healthcare in Maryland are a few that has adopted this theory into practice. A theory is an explanation and it is said that nothing is as practical as a good theory. Yet there is a persistent gap between nursing theory and practice. Theory guided practice remains and ideal versus a realized goal in most organizations. Swanson’s caring theory may be a notable exception in accelerating progress toward this goal.Caring theory postulates that nurses demonstrating they care about patients is as important to patient’s well-being as caring for them through clinical activities such as p reventing infection and administrating medication. By incorporating interventions that link nursing actions, caring process and expectations is an approach to actualizing caring theory. All areas of nursing should be able to incorporate the theory of caring into their daily routine with no barriers of resistance. My practice is initiated usually as an inpatient status.Our providers are called to consult any neurological concern that the admitting physician would like evaluated. We see pediatric patients and their families in the emergency room, NICU, PICU, and general pediatric floor. Some of the patients are new to their current health crisis and some are established patients of our service already. Knowing as defined in Swanson’s theory of caring could be implemented during our first initial visit that we center on the patient. We offer a realistic optimism that we will devote our services to properly diagnosing the patient.Taking a detailed history and searching for clues to why this admission came about and to determine the next step in helping the patient. Staying with the patient during this complicated and stressful initial consult can be related to Swanson’s being with. Nurses can take the time with our patients and explain in depth the diagnosis and testing that may need to be ordered. Many times we will spend hours with our teenage patients explaining the electroencephalogram. This age of patients can be scared of any testing and need to be told the truth on what is going to take place.Working in a children’s hospital it is a blessing that we have access to child life. These professionals are specifically trained in child development and can help with the education process with our children. We ask for their assistance to educate our patients. Many of times they have pictures or videos to show that can explain in a way a child or teenager may understand, visual and audio sometimes works in our modern technology generation. We enc ourage questions and let the patient and their families understand there is no burden on asking questions.Asking questions is the way our patients learn, and we want them to be educated so they are not scared. With our population, the more the patient knows, the easier the testing usually goes. Doing is applied to all our patients. When we have a seizure patient we have an abundance of education. Seizure patients need to be explained the many safety precautions. When they are being discharged from the hospital we are enabling setting up and scheduling follow up appointments at our clinic. Maintaining belief occurs as we are reassuring that if they are in need of anything before they come in to our clinic to please call and we can try to help.Many schools require a seizure action plan before students can come back in to class. This is why we try to stay in communication with the patients and their families before their follow up as many times they are scheduled out four months from d ischarge. Our patients are transferred to adult when they reach 18 years of age, and we hear too often that the adult world is not as caring as we were in pediatrics. I do believe that our services are being seen as a caring process. How can we enhance the theory of caring? Can the theory help us with research in the future?I believe that the theory of caring can be beneficial in care models, research and evidenced based practice. According to Johnson and Webber (2005), a model should capture central themes and theoretical relations in such a way to help guide nurses in their practice. Boykin, Smith, and Aleman (2003) believed that a model would help create a work environment for nurses that support their commitment to nurture and caring. This model would display the important values that nurses have stated to be critical in the practice of nursing. Caring is the foundation of nursing and defines the nurse’s professional identity. Boykin ; Schoenhofer, 2001) A caring-based nu rsing model, identified that care is an essential value for nurses and that being able to incorporate this value into their practice increases satisfaction of the nurse and the patient. A study by Bulfin (2005), using the care concepts developed by Boykin and Schoenhofer generated a model of care to patients in a large community hospital. In the Bulfin (2005) study, the researcher asked if a visual model would enhance and support caring in nursing practices and, thus, improve the job satisfaction of the nurse and impact the level of patient satisfaction.Following the implementation of the caring model, patient satisfaction increased and more positive comments were received from the patients and families (Bulfin, 2005). The National Organization of Nurse Practitioner Faculties (NONPF) issued domains and competencies for every NP graduate that included emphasis on the nurse-patient relationship, use of healing modalities, respect of the worth and dignity of the patient, and incorporat ion of spiritual beliefs into the plan. These competencies describe the core abilities of NP graduates.NONPF states that these competencies are a â€Å"gold standard† to maintain and shape quality graduate NP programs. NONPF's emphasis on caring qualities in the NP-patient relationship is further evidence that NPs do not practice from a medical perspective but, rather, as facilitators of holism and health with their patients. Theory of caring can be used to better understand how to relate to our patients. Each process slows for a nurse to formulate an intervention to better care for a patient. This is a theory for the future.Caring defines nursing and is moving to be an evidence-based profession. Swanson’s five caring process are first grounded in the maintenance of a belief in human kind, anchored by knowing another’s reality, conveyed by being with and enacted through doing for and enabling. When time is taken to observe and interpret nurses' actions, it becom es clear that nursing practice is the result of blended understandings of the empirical, aesthetic, ethical and intuitive aspects of a given clinical situation and a nexus of maintaining belief in, knowing, being with, doing for and enabling the other. Nursing caring†¦consists of subtle, yet powerful, practices which are often virtually undisclosed to the casual observer, but are essential to the well-being of its recipient†. (Swanson, 1993, p. 357) Swanson gives nurses a platform to base our caring foundation on. As nurse’s gain experiences we build small levels on the foundation. Like building a house, we all start with the basics of the foundation that we learn in nursing school. It is up to us what we do with that foundation.Every nurse in any clinical setting can use the theory of caring daily. They may not know the five caring process by name, but they are used in every situation, with every patient, by every nurse. References Alligood. M. R. , ; Tomey, A. M. (2010). Nursing theorists and their work. (7th Ed. ). St. Louis: Mosby. Beatty KD. Reflection on caring for a home care client using Kristen M. Swanson’s theory of caring. Int J Hum Caring 2004; 8: 61–64 Benner, P. (1984). From novice to expert. Menlo Park: Addison-Wesley.Boykin, A. , ; Schoenhofer, S. (2001). Nursing as caring. Sudbury, MA: Jones ; Bartlett. Boykin, A. , Smith, N. , St. Jean, J. , ; Aleman, D. (2003). Transforming practice using a caring-based nursing model. Nursing Administration Quarterly, 27, 223-231. Bulfin, S. (2005). Nursing as caring theory: Living caring in practice. Nursing Science Quarterly, 18, 313-319. Fawcett, J. (1989). Analysis and Evaluation of Conceptual Models of Nursing, 2nd Edn. F. A. Davis, Philadelphia, PA. Hanson MD.Using data from critical care nurses to validate Swanson’s phenomenological derived middle range caring theory. J Theory Construction Testing 2004; 8: 21–25 Kyle, T. (1995). The concept of caring: A re view of the literature. Journal of Advanced Nursing, 21, 506-514. Kavanaugh K, Moro TT, Savage T, Mehendale R. Enacting a theory of caring to recruit and retain vulnerable participants for sensitive research. Res Nurs Health 2006; 29: 244–52. Nightingale, F. (1859). Notes on nursing: What it is and what it is not.London: Harrison and Sons. Peterson, S. J. , ; Bredow, T. S. (2009). Middle Range of Theories: Application to Nursing Research (3rd ed. ). Philadelphia, PA: Wolters Kluwer, Lippincott Williams ; Wilkins. Schoenhofer, S. , ; Boykin, A. (1998a). The value of caring experienced in nursing. International Journal for Human Caring, 2(4), 9-15. Swanson, K. (1998). Caring made visible. Creative Nursing, 4(4), 8-12. Swanson K. What’s known about caring in nursing: a literary meta-analysis. In: Hinshaw AS, Feetham S, Shavers J, eds. f Clinical Nursing Research; Thousand Oaks, CA: Sage; 1999:31-58. Swanson, K. M. (1991). Empirical development of a middle range theory of caring. Nurse Researcher, 40(3), 161-16 Swanson, K. M. (1993). Nursing as informed caring for the wellbeing of others. Image: Journal of Nursing Scholarship, 25, 352-357 Watson J. Caring theory as ethical guide to administrative and clinical practices. Nurse Adm Q. 2005; 30(1):48-55. Watson, J. (1988). New dimensions of human caring theory. Nursing Science Quarterly, 1(4), 175-181.

Greek or Shakespearean Essay

The essential component to any tragedy, Greek or Shakespearean, is a protagonist with a fatal flaw. In Greek tragedy this is called hamartia. This Latin term translates directly into the word â€Å"flaw† but is usually used to describe an excess of a personality trait – virtue or vice. The protagonist’s fatal flaw pushes the the plot and action of the tragedy forward. It is this tragic flaw, which leads to the eventual downfall of the character, his circumstances, and the denouement of the drama. In examining the bulk of the literature’s protagonists, no other character embodies the essential role of the flawed protagonist like Hamlet. Hamlet’s fatal flaw is his idealism. Only once Hamlet overcomes his idealism is he able to seek his revenge. The climax of the play occurs with Hamlet’s realization that the world is not as it seems and that he must shrug off his idealistic values and avenge his father’s murder Act 3, scene 4. In Shakespeare’s Hamlet, act 3 scene 4, is a pivotal scene within the play. The scene begins in the Queen’s chamber, as Hamlet slams the door open, with sword in hand. They engage in a dialogue of riddles combined with Hamlet’s mishandling of the weapon makes the Queen uneasy. Hamlet is upset at the Queen for marrying his father’s brother. The Queen screams â€Å"Thou wilt not murder me? Help, ho! † and as Polonius responds, Hamlet promptly shoves his sword into the curtain where Polonius hides and swiftly kills him. Hamlet wonders if it was the King, half hoping that it was Claudius, who Hamlet has been trying to kill the whole play. He fantasies about killing him, in the previous scene, he states â€Å"In th’ incestuous pleasure of his bed. † Hamlet is consumed by the idea of Claudius and Gertrude making love. Once he knows that he only killed Polonius he continues to scold him mother. She responds â€Å"†In th’ incestuous pleasure of his bed† and Hamlet replies † A bloody deed. Almost as bad, good mother, As kill a king and marry with his brother. † Again Hamlet contrasts the two brothers that Gertrude has become involved with. Hamlet must avenge his father’s death. In doing so he must not only kill Claudius but also resurrect his father. He does this by outlining how his father’s good qualities compare to his uncle’s bad qualities. Hamlet laments: Look here upon this picture, and on this, The counterfeit presentment of two brothers. See what a grace was seated on this brow, Hyperion’s curls, the front of Jove himself,. . . This was your husband. Look you now what follows. Here is your husband, like a mildew’d ear Blasting his wholesome brother. Hamlet contrasts the two brothers which he claims are completely the opposite. Hamlet believes that Gertrude might has mistaken one for the other. Hamlet continues to verbally assault his mother. Much of what he says is a rephrasing of Hamlet’s first solioquy, â€Å"frailty thy name is woman† as well as Hamlet aggressive behavior toward Ophelia in the nun scene. Act 3, scene 4 is the part of the play when the climax happens. Hamlet must first confront the cause of this murder, Queen Gertrude. It is within in this scene that Hamlet gets his first taste of vengenance and murder when he easily kills Polonius. After this murder, Hamlet decides he can and must kill his father’s murderer, Claudius. However, Hamlet’s leaves his mother alone because his father’s ghost appears and advises Hamlet to â€Å"Leave her to heaven†. Hamlet respects and loves his father in life and also in death and adheres to the ghost’s advice. Hamlet’s goal is to bring back his father’s reign not just by pointing out Claudius’ faults but also by humiliating his mother and her new world to trash. Hamlet continues: Have you eyes? Could you on this fair mountain leave to feed And batten on this moor? Ha, have you eyes? Hamlet is trying to convince his mother give up her new life with Claudius, to find her loyalty to her dead husband, and back to the way things used to be. Hamlet takes the role of â€Å"scourge and minister,† and tells her she can redeem herself from being a whore to being the good wife she used to be. Hamlet advises her to leave Claudius, â€Å"the moor† and climbs up on her dead husband’s â€Å"mountain†. Hamlet explains â€Å" throw away the worser part† of your cleft heart, Hamlet instructs her, â€Å"And live the purer with the other half. † However, Hamlet, as much as he wants to love his mother, can not get past his belief that she is responsible for his father’s death. It is important to note that this scene takes place in the Queen’s bedroom. The conversation symbolized Hamlet and Gertrude essentially â€Å"in bed† together and hints to a sexual relationship. Hamlet speaks like a jealous lover chastising his girlfriend for sleeping with a different man and making their bed â€Å"enseamed†. The Queen is extremely upset and actually asks Hamlet to help her figure out what to do. At this point when Hamlet should have told her to confess, he urges her to stop her relationship with Claudius, â€Å"Not this, by no means, that I bid you do: Let the bloat king tempt you again to bed† (Act III, sc iv). It is in the moment that Hamlet allows his emotion to dominate over his intellect that Claudius was killed. He is consumed by the thoughts of his father’s demise and is haunted by the knowledge that his father’s soul will not be able to rest until his death is avenged. Hamlet willfully concludes, â€Å"My thoughts be bloody or be nothing worth† (Act IV sc iv). It is then that Hamlet finally had the ability to suppress his idealistic nature, and do what is right. The murder is not a well planned scheme and occurs in the heat of the moment. Hamlet, after the murder of Claudius never once wavers in his decision. He has done what is right and believes that â€Å"There is a special providence in the fall of a sparrow† (Act V sc ii). Hamlet is able to do anything but take vengeance upon the man who did away with his father and has taken his father’s place with his mother. The pain which should have caused him to take immediate revenge was replaced by pity for himself. It is Hamlet’s idealistic nature that creates the ultimate theme and driving force behind all the rising action, falling action, and resolution of this tragedy as well as the death of his mother. The way in which Hamlet views his mother, father, and Claudius is finally revealed in Act 3, scene 4. Once Hamlet is able to be honest about his feelings, he is able to finally seek revenge for his father’s murder. This scene is pivotal to denouement of the play and essential to Hamlet’s transformation from a boy to man who embodies the important qualities which were cherished and expect by an Elizabethan audiences.

Eatright

CHAPTER ONE (1) 1. 0 GENERAL INTRODUCTION 1. 1INTRODUCTION The game of football of which Americans call soccer, has engulfed the world serving as a means of entertainment for its audiences, profession for those who play the game, business for those who invest in it and finally as a unifying tool for peacemakers. All these have been as a result of the growth of football in these past years. The game of football has grown faster than any other sport in history, doubling in its number of viewers every two to three years (FIFA/F-MARC, 2006).The growing importance and popularity given to football as a sport has resulted in enormous researches to determine dietary intakes relevant for individuals undertaking such sport and nutritional influences on soccer performance (Kirkendall et al, 1993). Notwithstanding , the level of seriousness given to the dietary intakes of players and nutritional influences of foods taken, is lower in developing countries than in the developed ones although some aspects of football development has been launched in some of these developing countries.Besides this, a developing country may be rated amongst the third world countries of the world, the Republic of Ghana has found itself swooped along with this pandemic that is virtually ruling the world today. In this case we can cite the case of Egypt, that in the last years have shown a very high growth in football achievements, and the case of Ghana, that has already reached a good level of development of the game with respect to achieving laurels.In the last two decades, this sport has gained tremendous attention by sports scientists (Chryssanthopoulos et al, 2009). The net performance of a football player is as a result of the combination of talent, appropriate training and good nutrition. The latter of which has an effect on the preceding two (talent and appropriate training) has being the aspect neglected by clubs and even players in particular.The dietary pattern and food habits of footba ll players determines their nutritional status, as in eating more, less or just as recommended, eating appropriate or junk foods and as to whether nutrients consumed from food fill gaps created by mechanisms resulting in energy expenditure. The game is characterized by periods of low to moderate aerobic exercise interrupted by frequent activities of short duration and high intensity, such as sprinting, jumping, and tackling.It is obvious that such an energy-demanding sport requires proper dietary programmes that will restore or even super-compensate body energy stores and enhance the activity pattern of players during training and competition (Martin et al, 2006). The energy needs for an individual varies according to their age, sex and the physical activities they perform during the day. Healthy male individuals present an average energy demand of 2900 kcal ·day-1 (National Research Council, 1996); however, a professional soccer player's energy demand oscillates from 3500 to 4300 kcal/day (Clark, 1994; Bangsbo et al. 2006; Ebine et al. , 2002; Rico-Sanz, 1998). It should be acknowledged that these values for soccer players vary, and energy needs are met if the dietary pattern and food habits of a player provides the recommended requirements coupled with the appropriate physical activity as energy expenditure depends on the frequency and intensity of training sessions, exercises and matches which can affect the nutritional status of an individual (Clark et al, 2003). 1. 2PROBLEM STATEMENTMany researchers have studied the dietary habits of soccer players in an attempt to examine whether the reported diets fulfill dietary recommendations. The vast majority of these studies have examined players at especially Europe and a few times at the southern Americas. A large number of players, however, compete at the African region which is usually a pool from which foreign professional clubs in places like France, England, Italy and Germany choose their members to form their squads.Requirement specifications in these studies are difficult to apply to participants in this part of the world as they differ in terms of the geographical area, climatic and weather condition, morphological and physiological features, social setting, available foods altering patterns and habits-to mention a few (Lemon,1994). Few studies have examined the dietary habits of lower level soccer players. Furthermore, another aspect of particular importance that has not received much attention is the diet of soccer players during the game day and especially the pre-competition meal and the food they consume during after-game recovery.A proper pre-game meal will facilitate body energy stores before competition by helping to top up muscle and liver glycogen stores, something that may enable players to cover greater distances in the field and at higher speeds than they would with suboptimal glycogen levels (Chryssanthopoulos et al, 2009). Also, optimal dietary intake in the hours after the game will ensure rapid recovery (Burke et al, 2003). All participating teams at the 2006 world cup had a nutritionist/dietician in their technical setup (FIFA/F-MARC, 2006).Also 19 out of 20 premier league teams in England have a nutritionist/dietician in their setup (Article-peak performance, 2005). On the contrary, the growing importance given to nutrition in football has not really gained grounds in Africa as out of the 8 teams that participated in the just ended CAF champions’ league, only 2 teams had a nutritionist (CCL report, 2009). In Ghana, research has shown that only two teams out of 16 in the elite division have a nutritionist (Ghanafa. com, 15/01/10).In this case, players are left unguided to develop dietary patterns and food habits that might not be beneficial with respect to their chosen profession. 1. 3PURPOSE OF STUDY The purpose of this study is to assess the dietary patterns, food habits and energy expenditure of professional footballers in Real T amale United Football Club in Tamale Metropolis. 1. 4JUSTIFICATION With the growing interest in football in Sub Saharan Africa, specifically Ghana, there is the need for researches into the nutritional needs of it participants.Most information on dietary patterns, food habits, energy demands, training and conditioning strategies are extrapolated from researches on individuals out of this part of the world especially Europe and the Americas. This research will review the nutrition needs, energy expenditure, dietary patterns and habits of Ghanaian professional footballers and to identify what is not known to serve as a baseline data to encourage research in these populations. It will also establish the demands of a professional footballer in conditions here in Africa, specifically Ghana and also what influences these demands. . 5RESEARCH OBJECTIVES 1. 5. 1GENERAL OBJECTIVES The research aims at assessing the dietary patterns, food habits and energy expenditure of professional football ers in the Real Tamale United Football Club which is in the Tamale metropolis. 1. 5. 2SPECIFIC OBJECTIVES ?To assess the factors that influence dietary pattern and food habit of footballers. ?To assess the type of foods (macronutrients) commonly consumed by professional footballers. ?To assess the nutritional status of footballers in the club. ?To determine the physical activity level of footballers. To determine average energy expenditure of the footballers. ?To determine whether professional footballers meet their energy requirement. CHAPTER TWO (2) 2. 0LITERATURE REVIEW The purpose of this literature review is to summarize available research that is related to the concept of the dietary patterns, food habits and energy expenditure of professional footballers and the evaluation of its relevance and effects on nutritional status. The review includes sections devoted to various existing researches on dietary patterns, food habits and energy expenditure of professional footballers.A second section will take snap shots into sports nutrition, particularly in football (soccer), and a brief description of requirement specifications of dietary intakes for professional footballers. 2. 1 SOME EXISTING RESEARCHES ON DIETARY INTAKES AND ENERGY EXPENDITURE OF PROFESSIONAL FOOTBALLERS There are quite a number of researches on the dietary patterns, food habits and energy expenditure of professional footballers in the sciences area. Some are still being developed, and yet some are under considerations which are likely to possess some amount of knowledge as the game gains popularity and participation.Whatever be the case, one particular type of research might not contain just too much information or knowledge a professional footballer needs. The opposite is true, as knowledge in the sport does not necessarily trigger appropriate dietary patterns and food habits. As such, it is necessary to know the requirement specifications of participants and compare them to available acce pted research publication requirement specifications for a professional footballer in order to make the best choice.The requirement specifications might take into consideration, the geographical location, climatic and weather conditions, morphological and physiological features, social setting, available foods-just to mention a few. There is no doubt that the type, amount, composition, and timing of food intake can dramatically affect exercise performance, recovery from exercise, body weight and composition, and health (Burke et al, 2003). Good nutritional practice is essential to athletic success by improving the quality of training, maximizing performance and speeding recovery time.Soccer is described as a high intensity intermittent sport involving continual changes in activity (Hargreaves, 1994). When exercise or physical work increase to more than 1 hour per day, the importance of adequate energy and nutrient intakes becomes more critical (Manore, 2004). The dietary patterns an d food habits developed by individuals involved in such energy demanding sport determines their nutrient intake, coupled with demands of physical activity, have a collective influence on performance and nutritional status (Clark et al, 2003). 2. 2DIETARY PATTERNS AND FOOD HABITS OF FOOTBALLERSAll humans eat to survive. They also eat to express appreciation, for a sense of belonging, as part of family customs, for self-realization and due to their occupation and profession. For example, someone who is not hungry may eat a piece of cake that has been baked in his or her honour. People eat according to  learned behaviors  regarding etiquette, meal and snack patterns, acceptable foods, food combinations, and portion sizes. Individuals develop some kind of behaviors as a result of what goes on around them and they maintain these new behaviors as the best suitable for them (Bandura, 1997).The social cognitive theory explains how people acquire and maintain certain behavioural patterns , while also providing the basis for intervention strategies (Bandura, 1997). The more a person is exposed to a food and encouraged to eat it, the greater the chances that the food will be accepted (C. Nti, 2009). As the exposure to a food increases, the person becomes more familiar and less fearful of the food, and acceptance may develop (C. Nti, 2009). Some persons only eat specific foods and flavour combinations, while others like trying different foods and flavors (Rodriguez, 2009). . 2. 1 FACTORS THAT INFLUENCE PATTERNS OF FOOD HABITS To live one must eat. But, we not  only eat to live, what we eat also affects our ability to keep healthy, do work, to be happy and to live well. Knowledge of what to eat and in what quantities is a prerequisite to the healthy and happy life (Rodriguez, 2009). The average nutritional requirements of groups of people are fixed and depend on such measurable characteristics such as age, sex, height, weight, and degree of activity and rate of growth (Martin et al, 2006).Good nutrition requires a satisfactory diet, which is capable of supporting the individual consuming it, in a state of good health by providing the desired nutrients in required amounts. It must provide the right amount of fuel to execute normal physical activity. If the total amount of nutrients provided in the diet is insufficient, a state of under nutrition will develop. What and how people eat is determined by a variety of factors, including economic circumstances, cultural norms, and religious restrictions  (Judith C. Rodriguez, 2009).Some factors influencing food choices include preferences, ethnicity, values, habits, availability, health and nutrition. Dietary patterns, which are affected by a number of reasons, some of which are enumerated above, determine the nutritional and health status of people (Krause and Mahan, 1984). Regardless of the factors influencing dietary patterns, adequate food intake is essential as nutritional well-being plays an imp ortant role in health promotion and maintenance. Diet may influence the risk of developing certain chronic diseases and plays a role in preventing morbidity and mortality.Eating habits are thus the result of both external factors, such as politics, and internal factors, such as values. These habits are formed, and may change, over a person's lifetime. There is little research on the dietary patterns and food habits of soccer players, this notwithstanding, studying intakes gives some amount of information on their diet patterns. Professional footballers develop a habit of reducing the intake of carbohydrates and fats and increasing intake of proteins and vitamins with the knowledge of preventing increases in weight (Manore, 2000). This is not the case as R. J.Maughan (2000) recommended increased intake of carbohydrate in particular looking at the nature of the sports which is energy demanding. He did this after studying the macronutrient intakes of two elite teams in Scotland. Indivi duals have some sort of perceptions that go with the kind of profession they choose and football players are not left out. The fact that one is a professional footballer could alter the dietary pattern and food habit of that person. Also, availability of food (the individual’s environment) influences the range of food choices he or she can make. 2. 3ENERGY AND NUTRIENT REQUIREMENTS OF ACTIVE INDIVIDUALSMeeting energy needs is the first nutritional priority for athletes and one of the most frequently asked questions is â€Å"How much should I eat to stay fit and healthy? † A healthy diet contains the right proportions of carbohydrate, fat, protein, vitamins and minerals (Maughan, 2000). Carbohydrates and fats are the major sources of energy although energy can be obtained from protein. Active individuals need more energy (calories) each day than their sedentary counterparts-assuming individuals are of the same age, body size and participate in similar non-physically act ive daily activities (Manore, 2000).Exercise requires energy to fuel and repair the muscles, thus, meeting one’s energy needs to maintain body weight should be a priority for any athlete or active individual (Clark et al, 2003). Energy balance is achieved when the energy consumed (sum of energy from food, supplements and fluids) equals energy expenditure (sum of all the energy expended by the body in movement or to maintain body functions) (Swinburn and Ravussin, 1993). Knowing whether one is in energy balance is simple: weight is maintained.If energy intake does not cover the costs of energy expenditure, then weight and muscle mass are lost, and the ability to perform strenuous exercise typically declines (Black et al, 2000). When energy intake is restricted, fat and muscle mass will be utilized for energy to fuel the body, and the loss of muscle mass will result in the loss of strength and endurance. Additionally, chronically low energy intake usually results in poor nutrie nt intakes, including carbohydrate, protein, vitamins and minerals.Exactly how much energy an active individual needs each day will depend on a number of factors, including age, gender, body size, level and intensity of physical activity and activities of daily living. The Food and Nutrition Board (FNB) of the Institute of Medicine (IOM) in 2002 reviewed the energy needs of active and very active individuals and provided some general recommendations based on age and body size. In general, the first goal of an active individual is to maintain adequate energy intake to ensure that a healthy body weight is maintained.Although this seems like a simple task, there are many active individuals who find this difficult to do. For these individuals, a dietary plan that assures meals and snacks are not skipped will improve energy intake and help maintain weight (Manore, 2000). Finally, energy needs typically decrease with age, so even if activity levels do not change, the amount of energy requ ired to maintain body weight will decrease. For this reason, body weight typically increases with age, even if activity levels remain constant (Black et al, 2000). 2. 4MACRONUTRIENT CONSUMPTIONCarbohydrate, protein and fat are important nutrients for active individuals, but the amounts of these macronutrients needed will depend on an individual’s physical activity, its intensity, duration and frequency, the type of exercise engaged in, and their health, body size, age and gender (Maughan, 2000). Macronutrient recommendations for those engaged in daily physical activity are given below and in Table 2. 1. Table 2. 1 Dietary Reference Intakes (DRIs) for macronutrients and recommendations for active individuals Dietary Reference Intakes (DRIs) for macronutrients and recommendations for active individualsNutrientNew Guidelines-2002Old Guidelines-1989Guidelines for Active Individuals Carbohydrate45-65% of total energy? 50% of total energyThe amount of carbohydrate required for mode rate intensity exercise is 5-7 g/kg body weight; 7-12 g/kg body weight for high intensity endurance activities Protein10-35% of total energy, 0. 8 g/kg of bodyweight10-15% of total energy, 0. 8 g/kg of body weightProtein requirements are typically higher in active individuals. Recommendations range from 1. 2-1. 7 g of protein/kg body weight. This level of protein typically represents 15% of total energy.Fat20-35% of total energy? 30% of total energyFat intakes between 20-35%. Carbohydrate and protein needs should be met first. IOM, 2002. FNB, 1989. Burke et al, 2004; Tipton and Wolfe, 2004. 2. 4. 1Carbohydrate needs The mix of fuel (protein, fat, carbohydrate) burned during physical activity depends primarily on the intensity and duration of the activity performed, one’s level of fitness, and prior nutritional status. All other conditions being equal, as exercise intensity increases the use of carbohydrate for energy will also increase (Brooks & Mercier, 1994; Brooks & Trimme r, 1995).The duration of exercise also changes substrates use. As duration of exercise increases (e. g. , from 60 to 120 min), muscle glycogen becomes depleted, causing the body to draw on circulating blood glucose as a source of carbohydrate (Clark et al, 2003). If blood glucose cannot be maintained within physiological range during exercise, the ability to perform intensity exercise will decrease (Coyle et al. , 1986). Fat can be used as a source of energy over a wide range of exercise intensities; however, the proportion of energy contributed by fat decreases as exercise intensity increases.In these circumstances, carbohydrate becomes the dominant fuel source while the contribution from fat decreases (Bergman et al. , 1999). Protein can also be used for energy at rest and during exercise; however, in well-fed individuals it probably provides 4. 0 and TEE of 33 MJ/d in a bicycle race and a polar exploration. The maximum for a sustainable way of life may be that represented by sold iers on active service, with a mean PAL of 2. 4 and TEE of 18 MJ/d (Black et al, 2002). Among athletes in training, mean PALs is 2-3. 5, with TEE ranging from 11 to 18 MJ/d in women, and from 15 to 30 MJ/d in men (UNU, 2004).PALs greater than 2. 4 were obtained in periods of ‘rigorous training', which is unlikely to be a sustained lifestyle. The lower values for PAL, 2. 0-2. 3, were obtained in periods of apparently routine training and may well be sustained for extended periods of time (UNU, 2004). Table 2. 4 Characteristics and energy expenditure (obtained by DLW) in different age and sex groups by UNU, 2004. Age group (y)nAge (y)Height (m)Weight (kg)BMI (kg/m2)   means. d. means. d. means. d. means. d. Females 18-298924. 4(3. 7)1. 66(0. 06)69. 2(22. 3)25. 3(8. 1) 30-397633. 8(3. 0)1. 64(0. 07)67. (13. 9)25. 2(4. 9) 40-644751. 6(8. 3)1. 65(0. 07)70. 0(13. 3)25. 9(4. 6) Males 18-295622. 5(3. 5)1. 77(0. 07)75. 6(18. 4)24. 0(5. 3) 30-393634. 3(3. 3)1. 79(0. 06)86. 1(31. 4)26. 8(8. 8) 40-641550. 6(8. 8)1. 76(0. 06)77. 0(10. 0)24. 9(3. 0) TEE (MJ/d)BMR (MJ/d)AEE (MJ/d)PAL Age group (y)nmeans. d. means. d. means. d. means. d. Females 18-298910. 4(2. 2)6. 2(1. 1)4. 2(1. 7)1. 70(0. 28) 30-397610. 0(1. 7)6. 0(0. 6)4. 1(1. 5)1. 68(0. 25) 40-64479. 8(1. 7)5. 8(0. 7)4. 0(1. 4)1. 69(0. 23) Males 18-295613. 8(3. 0)7. 5(1. 2)6. 3(2. 5)1. 85(0. 33) 30-393614. 3(3. 1)8. 2(1. 8)6. 1(2. 5)1. 77(0. 1) 40-641511. 5(1. 7)7. 0(0. 8)4. 5(1. 3)1. 64(0. 17) The FAO/WHO/UNU Expert Consultation (2004) suggested the average daily energy requirement of adults whose occupational work is classified as light, moderate, or heavy, expressed as a multiple of BMR, to be as follows: LightModerateHeavy Men1. 551. 782. 10 Women1. 561. 641. 82 2. 7. 2Methods of determining caloric needs There are many different methods and formulas used to determine caloric maintenance level or energy expenditure by taking into account the factors of age, sex, height, weight, lean body mass, and activity le vel.Any method and formula that takes into account lean body mass (LBM) gives the most accurate determination of energy expenditure, but even without LBM a reasonably close estimate can be attained. 2. 7. 3Equations based on BMR. A much more accurate method for calculating total daily energy expenditure (TDEE) is to determine basal metabolic rate (BMR) using multiple factors, including height, weight, age and sex, then multiply the BMR by an activity factor to determine TDEE (FAO/WHO/UNU, 2004). BMR is the total number of calories your body requires for normal bodily functions (excluding activity factors).This includes keeping your heart beating, inhaling and exhaling air, digesting food, making new blood cells, maintaining your body temperature and every other metabolic process in your body. In other words, your BMR is all the energy used for the basic processes of life itself. BMR usually accounts for about two-thirds of total daily energy expenditure. BMR may vary dramatically fr om person to person depending on genetic factors. BMR is at its lowest when you are sleeping undisturbed and you are not digesting anything.It is very important to note that the higher your lean body mass is, the higher your BMR will be (Burke et al, 2004). This is very significant if loss of body fat is needed because it means that the more muscle you have, the more calories you will burn. Muscle is metabolically active tissue, and it requires a great deal of energy just to sustain it. It is obvious then that one way to increase BMR is to engage in weight training in order to increase and/or maintain lean body mass. In this manner it could be said that weight training helps you lose body fat, albeit indirectly (Clark et al, 2003). . 7. 4The Harris-Benedict formula (BMR based on total body weight) The Harris Benedict equation is a calorie formula using the factors of height, weight, age, and sex to determine basal metabolic rate (BMR). This makes it more accurate than determining ca lorie needs based on total bodyweight alone. The only variable it does not take into consideration is lean body mass. Therefore, this equation will be very accurate in all but the extremely muscular (will underestimate caloric needs) and the extremely overfat (will overestimate caloric needs). Mathematically; Men: BMR = 66 + (13. X wt in kg) + (5 X ht in cm) – (6. 8 X age in years) Women: BMR = 655 + (9. 6 X wt in kg) + (1. 8 X ht in cm) – (4. 7 X age in years) Total daily energy expenditure is calculated by multiplying BMR by a multiplier (PAL). 2. 7. 5Katch-McArdle formula (BMR based on lean body weight) This formula from Katch & McArdle takes into account lean body mass (weight) and therefore is more accurate than a formula based on total body weight. The Harris Benedict equation has separate formulas for men and women because men generally have a higher LBM and this is factored into the men's formula.Since the Katch-McArdle formula accounts for LBM, this single for mula applies equally to both men and women. Mathematically; BMR (men and women) = 370 + (21. 6 X lean mass in kg) To determine TDEE from BMR, you simply multiply BMR by the activity multiplier: the physical activity level. 2. 8SNAPSHOTS INTO GENERAL SPORTS NUTRITION AND NUTRITION IN FOOTBALL (SOCCER) In every day to day activity in life on earth, maintaining a good health within and without has being the main aim of humans in general. This is not different from that of football players, as keeping fit and playing regularly void of injuries has being the motive.Training and Diet plays a major role in this behaviour and keeping track of the latter (diet patterns and habits) becomes cumbersome with a lot of lapses coming up every now and then. Football was, for a long time, classed as an endurance sport due largely to the fact that a football match lasted at least 90 minutes. As a result, the nutritional requirements of football players were extrapolated from early scientific research carried out in relation to other ‘endurance sports’ such as running and cycling.It is true that the duration of a football match is normally 90 minutes; however, the training loads associated with these sports are vastly different (Maughan, 2000). On closer inspection it becomes clear that daily energy expenditure of professional football players may not be particularly high. Football players are generally inactive when not training and training load will vary, depending on factors such as the stage of the season, or whether tactical or fitness drills predominate in training.If football players were to consume 7-10g of carbohydrate per kg body weight each day (a recommendation found in many textbook) then a quick calculation that included reasonable amounts of protein and fat would generate a daily energy intake closer to 4,200kcal (Maughan, 2000). In Scandinavia this may be closer to the truth. Once the playing season gets underway the Scandinavian subjects typically t rain seven times per week (Manore, 2000). So it is not surprising that energy intakes will exceed 4,000kcal in a country like Sweden (Clark et al, 2003).An athlete’s diet must be high in carbohydrate, moderate in protein, low in fat, include sufficient vitamins and minerals, and plenty of fluid. ’ This was the original model with which many football nutritionists and players used to work (Article-peak performance, 2009). Although very simple, much of it still holds today. However, understanding the game has improved; nutritionists have been able to tease out strategies from each of the model’s sub-sections that more closely match the requirements of our sport. What is different is that science no longer holds ll the cards. Football has caught up with science and is now dictating where research efforts are directed. For, example, the glycemic index of foods, a ranking of foods based on their immediate effect on blood glucose, has become a particularly useful tool in football. Five years ago the approach in football was to advocate a high carbohydrate, low fat diet at all times. Any food that at all met these requirements would be recommended to players in a bid to maximise muscle glycogen storage for training and competition.Now a more measured approach is employed with the glycemic index and, to a lesser extent, the insulin index utilised in a bid to control body composition as well as carbohydrate provision (Article-peak performance, 2009). Emphasis is now placed more on achieving optimum carbohydrate intake prior to matches, and during the recovery period after matches, particularly when some clubs find themselves involved in up to three games per week in the busiest part of the season. Good attitudes to reducing fat intake are now a commonplace in the modern player.Emphasis is placed on increasing intake of certain fatty acids that are found to be lacking in players’ diets. When performing dietary analyses of players, low intakes of essential fatty acids (eicosapentaenoic acid, EPA; docosahexenoic acid, DHA) are consistently reported. Despite the appearance of oily fish in the canteens of football clubs, there may be a case for blanket supplementation in this particular group of sportsmen (Maughan, 2000). There is growing evidence that protein supplementation after training can promote protein synthesis and adaptation of muscle.The type, timing and amount of protein can be manipulated to enhance the adaptive response (Coyle et al, 1999). The work of researchers such as Bob Wolfe and Kevin Tipton in Texas, and Mike Rennie in Dundee (whose primary interest has been likened to ‘preventing older people falling down’) has enabled the design of strategies of protein-intake that may promote better adaptation to training. Despite the progress that has been made in our understanding of the demands of football, there is a need for continued improvement. No other sub-discipline of sports medicine comes wi th so many contrasting views of what is right and wrong.The ‘Zone’ diet, the ‘Atkins’ diet, mass supplementation, the concept of the ‘nutritional guru’ – all are still prevalent in the modern game. Players are becoming more demanding due to conversations with other players from other teams, and also other athletes from other sports. Players from overseas bring with them their own ideas (nearly always related to vitamin intake), but very often lacking in scientific support (Article-peak performance, 2009). In addition, at present there is a fundamental mismatch in what players and practitioners view as important.Players believe in supplements, extra vitamins and minerals: anything that involves increasing muscle mass, and reducing energy intake to achieve ‘lean’ body composition. Scientific research, on the other hand, demonstrates that players should concentrate more on appropriate energy intake, and high carbohydrate and fl uid intake. Sports nutrition is important in football because food provides us with energy for our muscles, brain and other organs. Football requires plenty of exercise, and therefore it is important to have energy available during the game. The energy available at any particular time depends on blood sugar levels.If we over-eat, we become over-weight. The heavier we are, the more work our muscles have to do to take us the same distance. This reduces stamina, and the ability to accelerate quickly. If we under-eat, we can become weak and our overall health can decline, because we are not getting enough nutrients. A healthy diet improves general level of health, and can help recovery more quickly from injuries (Clark et al, 2003). Along with a program of fitness training, diet can help develop stamina and improve athletic performance (Maughan, 2000). Diet is essential for our growth, and development.The timing of the meals consumed is important. Healthy male individuals present an ave rage energy demand of 2900kcal ·day-1 (National Research Council, 1996); however, a professional soccer player's energy demand oscillates from 3500 to 4300 kcal/day (Clark, 1994; Bangsbo et al. , 2006; Ebine et al. , 2002; Rico-Sanz, 1998a). It should be acknowledged that these values for soccer players vary from week to week, and energy expenditure depends on the frequency and intensity of training sessions, exercises and matches. In soccer, players require a diet with a high percentage of carbohydrates (Rico-Sanz et al. 1998).On the day of a match the intake of fat and protein should be restricted, as these nutrients require a relatively long time to be digested. Pre-competition meal must be 3-4 hours before the match (Bangsbo et al. , 2006). The pre-competition meal should be: high in carbohydrate (this is the fuel that your body needs to perform at the highest level), low in fat, low in protein, low in fiber, not too bulky, and easy to digest. A snack high in carbohydrate may be eaten about 2 hours before the match; however the time reference is only a guideline as there are great individual differences in the ability to digest food.Once the game is over, fluids should be replaced and carbohydrate should be consumed as soon as possible to promote recovery of glycogen stores. As soon as possible aim to consume a meal which is high in carbohydrates. Foods such as pasta, spaghetti, rice, noodles, low fat pasta sauce, bread, potatoes, and baked beans should be consumed during this period (Manore, 2000). Carbohydrate rich foods must be the main source of your diet. Consume the main bulk of the diet from complex carbohydrates. Simple carbohydrates should not be consumed in large quantities and are more useful as snacks between workouts, or to top up your energy intake.The carbohydrate consumed should be balanced with a healthy intake of protein, low fat and plenty of fruit and vegetables. The water lost from the body during sweating needs to be replaced to sto p the process of getting tired quickly, and also speed up the recovery process – that means feeling fitter and sharper afterwards a lot sooner. For footballers, the best fluid to drink is a diluted carbohydrate/electrolyte solution; ideally, it’s best to drink before, during and after a training session, as well as drinking frequently during a match (peak performance, 2009).After all matches, players should attempt to ingest enough carbohydrate-containing sports drink to replace all the fluid they've lost during competition. After strenuous workouts, water should also be replaced, and football athletes need to eat at least 500 calories of carbohydrate during the two hours following practice in order to maximize their rates of glycogen storage. CHAPTER THREE (3) 3. 0METHODOLOGY The research aims at assessing the dietary patterns, food habits and energy expenditure of professional footballers, in Real Tamale United Football Club in the Tamale metropolis, and its effect o n nutritional status.The research will answer specific questions about the factors that influence dietary pattern and food habits of footballers, foods/macronutrients commonly consumed by professional footballers; the nutritional status of footballers in the club, the physical activity level of footballers, the average energy expenditure of the footballers and then whether professional footballers meet their energy requirement. 3. 1BACKGROUND TO THE STUDY AREA 3. 1. 1Location and Size Tamale metropolis is one of the eighteen districts of the northern region of Ghana. Tamale, the administrative capital of the region is located at the center of the region.The metropolis shares common boundaries with Savelugu/Nanton district on the north, and Tolon/Kumbungu district on the northwest. Also, it is bordered west and central Gonja districts on the south; and east Gonja and Yendi districts on the east. The metropolis occupies a landmass with approximately 922 square kilometers, which is abo ut 13 percent of the total land area of the region (Regional Coordinating Council, RCC, 2010). 3. 1. 2Vegetation and Climate The vegetation of the metropolis is that of a typical guinea savanna zone with tall trees such as neem, shea and kapok, interspersed with grasses.During the rainy season, the vegetation becomes luxuriant, providing green scenery. The dry season is however, characterized by dry grasses with the trees shedding off their leaves as well as an exposed environment to bushfires. As a result of its location in the savanna belt, the metropolis experiences only one rainy season which begins in April/May, attains its peak in July/August and ends in September/October, and a long dry season from November to March. The mean annual rainfall and dry sunshine stands at 1100mm and 7. 5hours respectively.On the average, the metropolis experiences only 95days of intense rainfall. Also, the average maximum and minimum ranges are relatively 33 °C -39 °C and 20 °C -22 °C (Gh ana Meteorological Services, 2010). 3. 1. 3Demographic Characteristics Tamale metropolis has a population of about 350,000 inhabitants which constitutes about 20% of the total population of the region (Ghana Statistical Services, 2008). The metropolis is heterogeneous and encompasses diverse ethnic groups that are the Dagombas, Gonjas, Mamprusi and Akans among others with the dagombas constituting about 80% of the population.Moslems are the predominant religious group followed by Christians. The most important festivals of the people of the metropolis are damba and yam festivals. However, other festivals including Eid-ul-Fitr and Eid-ul Adha, which are Islamic festivals, are celebrated in the area. 3. 1. 4Socio-Economic Characteristics Farming is the major occupation of the people of Tamale. They cultivate rice, maize, guinea corn, cowpea, groundnuts, soybeans, yam and cassava. They also rear animals including sheep, goats, guinea fowls and cattle.However, the crops and animals are mostly produced by peri-urban and rural dwellers. Other economic ventures include groundnut oil extraction and trading by women mostly on small scale. Men are often seen to engage in smock weaving, tailoring, automobile repairs, carpentry and butchery. The increasing levels of educational attainments have contributed to the number of civil servants including teachers, nurses and security personnel among others in the area. 3. 1. 5Foods Consumed A variety of foods are consumed by the people of Tamale and its environs.At home, tuo-zaafi (TZ), a staple food of the Dagombas, which is prepared from maize, is consumed by most people. In general, TZ is consumed with a vegetable-based soup especially dry Okro. In the urban and peri-urban communities, TZ is usually the meal taken at supper, whilst a maize-based porridge or tea is taken as breakfast. In the metropolis, lunch is hardly prepared at home, hence the people choose from a variety of street foods available. Thus, the people in the u rban Tamale consume a lot of street foods including fried yam, rice and beans among others. . 2THE STUDY AREA 3. 2. 1HISTORY OF RTU Real Tamale United, often called as R. T. U. , is a Ghanaian football club based in Tamale in the Northern Region of Ghana. They are a member of the Ghanaian Globacom premier league. Their home stadium is the Tamale Sports Stadium. The club was founded in 1976 by the first chairman Alhaji Adam. The club has 36 players currently, of which 25 were used in this study. With the operational definition of a professional football team and player, RTU was the only team that met the criteria for selection in the Tamale metropolis.The club has only won the Ghana Telecom Gala once in 1997/98 season with three appearances in CAF competitions in 1992, 1996 and 1998 of which they were eliminated in the first round. Recently, the club battled for survival in the Ghanaian Globacom Premiership for two years running. 3. 3THE STUDY POPULATION AND SAMPLE SELECTION The popu lation for this study will be male professional footballers in the club. The operational definition of a professional footballer in the context of this study will be an individual who plays elite or first division club football.Football players in the Real Tamale United Football Club, in the Tamale metropolis of the Northern Region, were sampled purposively and used as the representative sample for this study on the basis that the club is based in Ghana, a country well known for its interest in football development; the club participates in the country’s first division known as the premiership which means all players in the club play at the top level of football in the country and finally located in the Northern Region of the country: an area where poverty and illiteracy rates are high which has influences in areas of sports nutrition and performance. . 3. 1SELECTION CRITERIA Thirty five members of the Real Tamale United football squad aged 17-30years were recruited for the s tudy. Only 25 subjects met the requirements of being void of illness and injury carried out during a two day fitness test in the presence of the team physiotherapist. All measurements and data were done at a time when the premier league was ongoing with players playing week in week out matches. 3. 4BODY MASS INDEX: its Calculation Body mass index is based on a weight-to-height ratio that indicates the energy reserves of an individual.BMI is a ratio of weight in kilograms to the square of the height in meters. Heights and weights are therefore the indicators for calculating the BMI of an individual. BMI is the current method for calculating a healthy body weight and is based on the study of a wide variety of people from many countries. The FAO/WHO/UNU (2004) established reference values for comparing the BMI of active individuals. Mathematically; BMI = WEIGHT (Kg) / height (M? ). The unit of BMI is thus, kgm. 3. 5BASAL METABOLIC RATES: its CalculationIt is the minimum amount of energ y needed to keep the body alive and is the largest component of an average person's daily energy expenditure. The BMR is usually expressed simply as kilocalories per day or in units of energy per unit surface area (or per kilogram body mass) per unit time. It is very difficult to determine the absolute minimum metabolic rate, but estimates are usually standardized by being made when a person is resting quietly after at least 8 hours sleep and 12 hours since the last meal.In this study, BMR of subjects was estimated using the Harris-Benedict equation which takes into consideration parameters such as age, height and weight of the individual. Mathematically; BMR (MEN) = 66 + (13. 7 X wt in kg) + (5 X ht in cm) – (6. 8 X age in years). The unit of BMR is therefore kcal/day. 3. 6DETERMINATION OF PHYSICAL ACTIVITY LEVELS AND ENERGY EXPENDITURE Physical activity levels of individuals are estimated from daily activities undertaken, taking into consideration its intensity and duration .According to Ainsworth et al (2004), these daily activities are represented as values known as physical activity ratios (PAR values). Considering the intensity and duration of the activity taken with respect to the PAR values, an estimate of the physical activity level (PAL) is determined (FAO/WHO/UNU, 2004). The PAL values are categorized as light, moderate and heavy activity (FAO/WHO/UNU, 2004) and when multiplied by the BMR of the individual, an estimation of energy expenditure is determined. Mathematically; PAL = ? (PAR ? DURATION OF ACTIVITY) ? (TIME SPENT IN EACH ACTIVITY) ENERGY EXPENDITURE = PAL ?BMR The unit of energy expenditure is thus, kcal/day or KJ. 3. 7DATA COLLECTION AND INSTRUMENTATION 3. 7. 1Questionnaire The major instrument for collecting the data was semi-structured questionnaire administered to soccer players through self-reporting. The questionnaire was designed to collect quantitative data, but some qualitative data was also gathered as well. The questionnai re was in three forms, namely, the general nutrition knowledge questionnaire which also had sections for anthropometric records, the food dairy and the physical activity dairy (Appendix I, II and III). 3. 7. 2AnthropometryAnthropometry was one of the techniques employed in the data collection and was based on the measurement of only the height and weight of the respondents. The anthropometry was made an integral part of the questionnaire and efforts were made to ensure that these parameters were measured to make the questionnaire completely filled. The procedures employed in carrying out the measurements are elaborated in the sections below. These procedures are based on the FAO/WHO/UNU technical report standards for the measurement of weight and height of physically active individuals. Weight measurementThe subjects were weighed using an electronic bathroom scale with an accuracy of 0. 1kg, before morning training. The subjects wore light clothes as much as possible and on bare foo t before weighing took place. Each subject to be weighed was made to stand upright and in a relaxed manner on the scale with the eyes looking horizontally to the feet and the hand by the sides. The weight was then read and immediately recorded. Height Measurement Heights of the respondents were measured using a wall-mounted stadiometer. Prior to the measurement, it was ensured that the subjects wore neither ootwear, boots nor socks. Each subject to be measured was made to stand upright and erect against the wall, with the heels, buttocks and the upper back touching the wall, the feet close together and the eyes looking straight. A ruler was then placed on the crown of the head towards the stadio measurements and the reading immediately recorded to the nearest 1. 0cm. 3. 7. 3Food intake Subjects were educated and given verbal and written instructions (Appendix IV) on the procedures involved in recording food intake in a food intake dairy on a free non-training day.A food intake dairy (Appendix II) was given to each of the participants to be filled according to their daily dietary intake taking into consideration meals, portion sizes, food type and quantity for seven consecutive days ((Bingham, 2000; Tilgner and Schiller, 1991). Dairies were checked in every two days to ensure correct recording and correction in any case of wrong recording or difficulty in recording. All dairies were collected after seven days. Samples of estimated portion sizes of foods were acquired and weighed using a kitchen weighing scale and recorded to the nearest 0. g. The nutrient composition of the meals was calculated using the FAO food composition table for Africa and reported as a mean of 4 days’ food intake. This data was used to assess nutrient consumption. To assess adequacy in nutrient intake, the results obtained were compared with the FAO/WHO/UNU RDA for physically active adults (FAO/WHO/UNU, 2004). 3. 7. 4Physical Activity Pattern Subjects were educated and given verba l and written instructions (Appendix IV) on the procedures involved in recording, as detailed as possible, information on their daily activity patterns.A physical activity or training dairy (Appendix III) was given to each subject to be filled under sections of activity type and its duration in minutes for seven consecutive days. Dairies were checked in every two days to ensure correct recording and correction in any case of wrong recording or difficulty in recording. Training sessions were constantly monitored and subjects where individually questioned in cases were irregularities in recording were encountered. Their activities were classified broadly into three categories: light, moderate and heavy. A 7-days’ activity record was compiled for each subject on imilar days when food intake was measured. The activity data were reported as a mean of 4 days’ activity records. This data was used to compute energy expenditure and nutrient requirement for each subject. 3. 7. 5 Observation Several observations were made at the training fields, at camp bases and in homes of the subjects. These dwelled in the kinds of foods consumed and activities undertaken, the places of meal consumption and purchasing. Also, the components of training regimes were observed and recorded. 3. 7. 6Focus-Group Discussion Focus-group discussions were held with subjects on free and camping days.Each discussion group was made up of between eight and twelve individuals with a facilitator and a recorder. The FDGs were meant to reveal certain issues that were not captured by the questionnaire and to confirm the answers provided in the semi-structured questionnaire including the factors that influence certain behaviours of subjects with respect to dietary habits and physical activity. 3. 8THEORETICAL FRAMEWORK AND CONCEPTS The study seeks to assess the dietary patterns, food habits and energy expenditure of professional footballers of Real Tamale United FC in the Tamale metropolis.Th is is achieved through the assessment of usual food intake and physical activity and the computation of BMI and BMR and the determination of daily energy expenditure. These have being reported as relevant measurement of an athlete’s nutritional status. The first and second objectives of which respectively seek to assess the dietary patterns and food habits and macronutrient consumption are achieved through reported nutrition questionnaires and recorded food consumption for seven consecutive days using the food dairy.The third objective, which seeks to assess the nutritional status of professional soccer players using BMI, was achieved through the measurement of height and weight of the footballers. The fourth and fifth objective, which seeks to determine the physical activity level and average energy expenditure of footballers was achieved through self-reported physical activity dairy for seven consecutive days computed using physical activity ratio with time duration (to att ain physical activity levels) and physical activity levels in multiples of their BMRs (to attain energy expenditure).The sixth and final objective, which seeks to determine whether professional footballers meet their energy requirements was achieved through a self-reported food record dairy for seven consecutive days with nutrient contents of foods consumed computed using the FAO food composition table for Africa. 3. 9STATISTICAL ANALYSIS Data were analyzed using the EpiInfo version 3. 2. 1 and Microsoft Excel computer programme. Results are presented as mean  ±SD, range, graphs, figures and tables. Anthropometric data from players was transformed into BMI to assess their nutritional status and BMR to assess physical activity levels.Dietary and physical activity data from players was transformed into nutrient requirements, physical activity levels and energy expenditure respectively to assess the level of malnutrition. 3. 10ASSUMPTIONS The most obvious assumption is that the sampl e represents the population. Also, it is believed that all instruments have validity and measure the required value. We assume that participants will not modify their habitual diet patterns and food habits during the course of the study week. Finally, we assume that respondents will answer sincerely all questionnaires and report truthfully in both the food and activity dairies. CHAPTER FOUR (4) . 0RESULTS The physical characteristics of the twenty five (25) subjects are shown in Table 4. 1. Out of the 25 subjects studied, only one weighed less than 60kg while the range indicated (57 and 87kg) were the two extreme body weights recorded in this study. Their body mass index (kg/m? ) ranged from 19. 38 to 30. 3 kg/m? ; out of the 25 subjects studied, only two were over the 190cm (1. 9m) while the range indicated (1. 52 and 1. 95m) were the extreme heights recorded in the study. Table 4. 1 Physical characteristics of subjects ParametersMeans (25)SDRange Age (yrs. )23. 684. 2417-30 Weight (kg)70. 647. 657-87 Height (m)1. 69. 41. 52-1. 95 BMI (kg/m? )23. 082. 719. 38-30. 3 4. 1Dietary Patterns and Habits 4. 1. 1Favourite Food Choices of Subjects The general meal patterns were obtained through self-reported food dairies. Porridges and beverages took the highest frequency of consumption in terms of its 7day presence in diets and its frequency among subjects. Records for breakfast shows that baby porridge made from corn, millet or rice, beans and groundnuts (tom brown) is mostly consumed by all subjects (100%). Fufu was the least consumed diet within the 7day period (2days) with Tuo Zaafi recording the least number of subject patronages (7subjects).The results of the common foods taken, their frequencies in the diet and meal times are shown in table 4. 2. TABLE 4. 2 Common foods eaten by players SOURCES OF MACRONUTRIENTS (FOODS)FREQUENCY IN DIET (7DAYS) FREQUENCY OF SUBJECTSEATING MOMENTS Plain rice/jollof rice5days20Lunch and dinner Kenkey (Ga and Fante)3days15Lunch Tu o Zaafi4days7Dinner Banku5days18Lunch and dinner Fried rice and chicken 4days22Lunch and dinner Soups (groundnut, palm nut, light, Okro)3days20Lunch and dinner Porridges (baby, hausa, tom brown)7days25Breakfast Meat and Beef7days21Lunch and dinner Fufu2days11Lunch and dinnerYam (boiled and fried)4days14Lunch and dinner Rice and beans (waakye)5days16Lunch Egg (fried and boiled)3days20Breakfast and lunch beverages (tea, oats, fruit drinks)7days22Breakfast and as a snack fish (fried)3days17Lunch and dinner 4. 1. 2Eating moments An assessment of the usual food pattern revealed that 90. 7% of the players took at least three meals a day. Most meal times skipped were breakfast and lunch, that is, 57. 14% and 28. 57% respectively. Table 4. 3 The eating moments of players in terms of meals skipped Meal TimeFrequencyPercentage BREAKFAST457. 14 LUNCH228. 57 SUPPER114 TOTAL7100 4. 1. Reasons for players food choices The reasons for the choice of foods by the subjects among others included conve nience, lack of money, inability to cook, general sports reasons and food availability. The results indicated (as shown in figure 1) that, 10 of the players made food choices based on sports reasons. Figure 1The reasons for food choices of players 4. 1. 4General Food Habits of Players (Sports Nutrition) From the results obtained from the questionnaire on general sports nutrition, 60% of the players consume fried rice and chicken before a competitive match with 40% consuming plain rice and stew.Players gave various reasons such as its easy and fast digestion, it not been too heavy, it been recommended by coaches and it been the only available food given at the camp base. 68% of players consumed these foods 3-4hrs before a match with 24% and 8% consuming theirs at 4 or more hours and 2-3hrs respectively. Most of the players gave similar reasons for eating at these times as giving the food ample time to digest. 92% of the players take fluids such as bottled water, glucose solution and energy drinks during a match. 88% of the players take 1-3 of 300ml fluid whiles 12% take 4-7 of 300ml of fluid.Snacks consumed before and during a match included energy drinks, glucose mixtures, soft drinks, savouries among others. Most snacks were taken 2hours before a match. 56% of the players take nutrition supplements such as multivitamin capsules, iron and zinc capsules and blood tonics. Reasons such as increasing energy levels, boosting appetite and to aid in the body’s fast recovery were given. 64. 29% of the players take these supplements all the time and they get these supplements from the pharmacy shops. 96% of the players buy wayside foods such as fried rice, tuo zaafi and fufu and soup. 2% of the players eat once a while at the restaurant with 44% and 4% eating at times and all the time at the restaurant respectively. 80% of players eat home prepared meals. 4. 2NUTRITIONAL STATUS OF PLAYERS BMI CATEGORIES (kg/m? )FREQUENCYPERCENTAGES (%)INTERPRETATION 0. 05), sugg esting average energy balance was achieved. The mean intakes of the energy producing macronutrients were 37. 18%, 43. 23% and 19. 6% for carbohydrate, fat and protein respectively. When reported as a percentage of total calories, carbohydrate and protein intakes were significantly lower and higher (p > 0. 05) respectively of the recommended levels.Fat intake was significantly higher (p > 0. 05) than the higher value in the recommended range (35%). When macronutrient intake is expressed in g/kg/day (Table 4. 6), carbohydrate and protein intakes fell below and above their recommended ranges. The table below shows the mean energy and macronutrient intake of players. MealsMean of IntakesPercentagesSDRange Total energy intakes (KJ/day) Breakfast763. 2927. 42178. 09256-1019. 4 Lunch1015. 2136. 47227. 22680. 9-1723. 3 Dinner1004. 9836. 12286. 07528-1637 Total2783. 48100451. 551985. 6-4105. 5 Total energy intake in proteins (KJ/day) Breakfast349. 7564. 1294. 97106. 3-437. 2Lunch89. 8816. 48 37. 9930. 8-183. 0 Dinner105. 8519. 461. 5134. 9-253. 4 Total (%TEI)545. 49100 (19. 6)130. 81297-783. 9 Total energy intake in carbohydrates (KJ/day) Breakfast282. 427. 2974. 46116. 7-438. 7 Lunch360. 3234. 8283. 9265. 5-642. 3 Dinner392. 0937. 89129. 15172. 1-790 Total (%TEI)1034. 79100(37. 18)168. 79768. 1-1507. 3 Total energy intake in fats (KJ/day) Breakfast111. 189. 2459. 9433. 2-280. 5 Lunch595. 7349. 5309. 55296-1793. 7 Dinner496. 2941. 25150. 02206. 1-838. 4 Total (%TEI)1203. 20100 (43. 23)373. 25756. 8-2587. 5 TABLE 4. 6The mean daily energy and macronutrient intake of players in terms of meal times.Energy intake from the table above indicates slightly higher levels of consumption at lunch times over dinner times at 1015. 21kcal/day (36. 47%) and 1004. 98kcal/day (36. 12%) respectively. Energy intakes range from 1985. 6-4105. 5kcal/day. Macronutrient intakes were slightly distributed across all meal times. Table 4. 7The mean daily energy and macronutrient intake of players in comparison with FAO/WHO/UNU 2004 reference values. IntakesMeans (kcal/dayPercentageskcal/kg/dayg/kg/dayReference: g/kg/day (%range) Energy (TDEI)2783. 43-39. 4-3500-4300 kcal/day Carbohydrate1034. 7937. 1814. 653. 7-12 (45-65) Protein545. 4919. 67. 721. 91. 2-1. 7 (10-35) Fat1203. 243. 2317. 031. 9- (20-35) TDEE3932. 55-55. 67– TDEI2783. 45-39. 4– TDEE-TDEI1149. 1-16. 27– 4. 4. 2Difference in energy intake and expenditure According to data gotten from both the food and physical activity dairy, the mean energy deficit is 1134kcal/day (16. 1kcal/kg/day). Energy intake was slightly higher than expenditure at point 7, 11 and 20 representing 141. 76kcal/day, 1045. 7kcal/day and 447kcal/day in extra energy respectively. Figure 3 shows the graphical illustration of energy intake as against expenditure.Figure 3Energy intake and expenditure of players CHAPTER FIVE (5) 5. 0DISCUSSION 5. 1DIETARY PATTERNS AND FOOD HABITS The dietary changes observed among these players are consistent with the findings of Rodriguez (2009) on changes in dietary habits as to a high protein intake of players in particular. R. Maughan (2000) suggested that football players tend to consume high intakes of protein with the belief of increasing muscle mass. This was not different with the current study as players consumed high levels of protein based foods due to its easy access and availability within the study area.The players also had habits of consuming foods high in fat leading to its contribution of 43. 23% to total energy intake, as these levels of fat proportion may be detrimental to health (Martin et al, 2006). Cost, availability and convenience were challenges and these made them adapt to the habit of patronizing wayside foods (96%). It is, therefore, not surprising that majority ate fried rice and chicken, tuo zaafi and fufu and soup. Although breakfast is an important meal of the day, quite a significant number of players in this study skipped it.Skipping brea kfast may also lead to over eating during the rest of the day. Most of the foods consumed were from staples but these resulted in very low carbohydrate intakes (1034. 79  ± 168. 8 kcal/day). These may be as a result of the poor nutrient content of the foods as a result of poor cooking habits as foods eaten are prepared by food vendors (C. Nti, 2009). Meals consumed before a match was plain rice and tomato stew which may have negative effect on performance, with respect to the tomato stew which is high in fat, and this may hinder the fast release of energy to the body for endurance activities.The over reliance on wayside food and players left to fend for themselves with no amount of supervision may be detrimental to health and nutritional status. Most of these way side foods have very high levels of fat and this may account for the high amount of fat in diets. The eating behaviour of the players might have been influenced by other factors including food availability, convenience an d personal income level, as these obviously determine an individual’s food choice and habit. Thus one cannot eat foods if they are not available, cannot be prepared or cannot be afforded. . 2MACRONUTRIENTS Carbohydrate is the primary fuel substrate during soccer, and consequently high dietary intakes of 45-65% of total calorific intake have been recommended for athletes (Clark, 1994; Bangsbo et al, 2006; Ebine et al. , 2002) and footballers (Burke et al, 2004; IOM, 2002). In this study, carbohydrate intake was significantly lower than these recommendations (37. 18  ± 6. 1%, p < 0. 05). When expressed relative to body mass (weight), the daily carbohydrate intake of 3. g/kg/day was way below the recommended 7-12g/kg/day for very active individuals (FAO/WHO/UNU, 2004). The current data provide further evidence to the commonly observed low carbohydrate intakes that are insufficient for adequate glycogen replacement in male athletes (R. Maughan, 2000). Dietary recommendations fo r promoting maximal glycogen replacement and for the maintenance of muscle glycogen levels are to consume a high carbohydrate diet, 45-60% (IOM, 2002) and a daily intake of 7-12g/kg/day (Bangsbo et al, 2006).Based upon these recommendations, players in the current study reported carbohydrate intakes that are likely to be inadequate to replace muscle and liver glycogen stores which rapidly deplete during repeated bouts of high intensity exercise performed during training and competition (Bangsbo et al, 2006). Ultimately, both the quality of training and match perform

Social Performance of Organizations Essay Example | Topics and Well Written Essays - 1500 words - 1

Social Performance of Organizations - Essay Example However, some of the producers refused making the De Beer to flood the market with products that were similar to those who refused to join it and it afterwards purchased all the products that were produced by the rivals thus controlling the market prices (Edward, 1982). The company is involved in mining activities in various countries. For example, in Botswana De Beers mine through the company referred to as Debswana. In South Africa, De Beers Consolidated Mines is responsible for the mining activities. As far as business structure is concerned, De Beer has two major shareholdings which include Botswana government owning 15% and Anglo America Company that owns 85%. Other related companies that are involved in the De Beers diamond value chain include Diamdel, Namdeb, De Beers Canada, Diamond Trading Company South Africa and Namibia Diamond Trading Company. As an international company, De Beers can be affected by two main external environment factors. First, the custom duties and quota s imposed by countries may make the company demand for its products to decrease. This is based on the government’s policy to lower the importation of foreign products in order to enhance domestic consumption. Secondly, the stiff competition from other companies in the mining industry may result to decrease in the prices of the company products. This may be due to the other companies’ intention to face off the companies in the international market. One of the major stakeholders of De Beers Diamond Company is Diamond Trading Company (DTC). DTC main duties include selling and distribution of the company products. By selling approximately 75% of rough diamond in the international market, DTC is able to generate high revenue for De Beers an aspect that has made the company to effectively expand in the international market (Martin, 2007). The second important part of the stakeholders is the employees. With more than 20,000 employees, the company objectives