Showing posts with label Journal of Community Medicine. Show all posts
Showing posts with label Journal of Community Medicine. Show all posts

Friday, 22 September 2023

Lupine Publishers | Ultrafiltration and Reinfusion of Ascites to Treat Pregnancy Complicated with Severe Ovarian Hyper-Stimulation

 Lupine Publishers | Journal of Clinical & Community Medicine


Abstract

Background: Ovarian hyper-stimulation syndrome (OHSS) is one of the most serious iatrogenic complications during in vitro fertilization-embryo transfer (IVF-ET). How to treat OHSS has attracted the attention of many scholars. Here we reported a case treated with reinfusion of ascites after concentration and ultrafiltration in hope of providing a new option in clinics.

Case presentation: The patient experienced severe OHSS demonstrated by severe electrolyte disorder, blood concentration, hypercoagulability and loss of protein. The symptom aggravated even with symptomatic treatment. After treat with reinfusion of ascites after concentration and ultrafiltration, the above-mentioned symptoms were significantly relieved. The patient was discharged with two alive embryos and low hospital expense.

Conclusion: We inferred reinfusion of ascites after ultrafiltration and concentration could achieved a good curative effect and can be further used in clinical practice.

Keywords: Ascites; Ultrafiltration; IVF-ET; OHSS; Reinfusion

Introduction

In recent years, the incidence of infertility due to anovulatory is getting higher and higher, which results to the boom of assisted reproductive technology (ART). OHSS mainly occurs in the patients with infertility, who experiences the treatment of ovulation induction. The incidence of OHSS ranges from 1% to 10% in IVF-ET cycle[1,2]. The main clinical manifestations of OHSS are enlargement of ovarian volume, increased permeability of capillary leading to the formation of local or systemic tissue edema [3-5]. Liver and kidney failure may be induced by hypovolemic shock, oliguria or even anuria due to decreased blood flow [6]. Here we report a case of pregnancy with severe OHSS treated by reinfusion of ascites after ultrafiltration and concentration, in hope of providing a new insight for the treatment of OHSS. This study was undertaken with ethical approval of the Human Ethics Committee of JiNan University, which was in accord with the Declaration of Helsinki. The enrolled patients have signed the informed consents.

Case Presentation

A 40-year-old woman was admitted to our hospital for “vomiting and abdominal distention for 8 days after embryo transplantation”. Ultrasonography showed a large amount of ascites and increased bilateral ovary. The patient was supposed to experience OHSS. Laboratory tests demonstrated Total Protein 51.0g/L, Albumin 27.8g/L, HGB 184.40g/L, Hct 56.79%, PLT 499.0*109/L, WBC 32.85*109/L, Potassium 4.26mmol /L, Sodium 127.3mmol/L, Chlorine 95mmol/L, Plasma D-dimer quantification 2780ng/ml. All those index showed disordered electrolyte, blood concentration, hypercoagulability and loss of protein. To correct the disordered state, we adopted low molecular weight heparin to prevent thromboembolism, administration of human albumin, crystal and colloid supplementation to maintain osmotic pressure, diuresis and other symptomatic treatment. Unfortunately, the ascites continued to increase, Albumin and total protein continued to decrease. Two weeks later, ultrasonography demonstrated even larger ovary and increased ascites in the liver and kidney crypt and the intestinal lacunae. To relieve the symptom, we performed reinfusion of ascites after ultrafiltration and concentration. WLFHY-500 computer ascites ultrafiltration and concentration system were adopted. The patients experienced the treatment twice every week, during which 2000-3000ml of ascites was filtered every time. After two times of treatment, the symptoms of abdominal distension were significantly relieved. The volume of urine was increased without further use of diuretic. Laboratory test indicators, such as blood routine and electrolyte examination fluctuated in the normal range. Also, the hypercoagulable state was corrected. Ultrasonography showed transplanted embryos were alive and the ascites was significantly decreased. The patient was discharged with good prognosis after 10 times of treatment.

Discussion

The pathogenesis of OHSS is complex and diverse, which is mainly related to the increased permeability of ovarian blood vessels and peritoneal epithelial cells [7]. Up to now, about 25 factors have been proved to be involved in the regulation of vascular permeability, such as renin-angiotensin-aldosterone system (RAS) [8], human chorionic gonadotropin beta subunit [9], estradiol [10], luteinizing hormone [9],vascular endothelial growth factor. Among all of these factors, the role of vascular endothelial growth factor is particularly critical [11]. With the widespread development of assisted reproductive technology, the incidence of OHSS has gradually increased. About 2% to 6% of women who experiences ART experienced severe OHSS [12]. About 16% of OHSS patients were accompanied with a large amount of ascites, leading to abdominal distension, dyspnea and even acute abdominal symptoms [13]. Therefore, it is very important to treat ascites actively. At present, the clinical treatment of traditional abdominal puncture and drainage is generally adopted, but it is easy to cause the loss of a large number of protein [13]. Comparing with traditional abdominal puncture and drainage, reinfusion of ascites after ultrafiltration and concentration has the following advantages [14], such as effective relieve of abdominal compression, reuse of autologous albumin, and rapid increment of plasma albumin concentration. Also, reinfusion of ascites after ultrafiltration and concentration can alleviate the economic burden of patients and avoid the risk of infection some contagious disease when using blood-derived products. In our case, the disordered conditions of the patients were significantly ameliorated after two times of treatment and the patient was discharged with low expense. In a word, reinfusion of ascites after concentration and ultrafiltration is an effective treatment for a large number of ascites, dyspnea and oliguria induced by severe OHSS in pregnancy. It can rapidly improve the symptoms and shorten the period of the disease. It is worth further promotion and application in clinical practice.

Conflict Of Interest

The authors declare that they have no conflict of interests.

Acknowledgement

Not applicable.

Funding

The National College Students Innovation and Entrepreneurship Training Program (CX18024).

Read More About Lupine Publishers Journal of Clinical & Community Medicine Please Click on Below Link:
https://journalofclinicalcommunitymedicine.blogspot.com/

Thursday, 3 August 2023

Lupine Publishers | Knowledge, Awareness, Attitudes and Practices Regarding Cystic Echinococcosis in Khartoum State, Sudan

 Lupine Publishers | Journal of Clinical & Community Medicine


Background

Cystic echinococcosis (CE) is a neglected disease of public health significance worldwide, especially in low- and middle-income countries caused by the larval form (hydatid cyst) of Echinococcus species tapeworm. Control of CE is difficult and requires a community-based integrated approach. The objectives of this study were to describe, using a questionnaire survey, the characteristics, attitudes, knowledge, awareness and practices of population regarding CE and tounder stand some of the risky practices that could contribute to spread of such disease.

Introduction

Cystic echinococcosis (CE) is a zoonotic parasitic disease caused by larval stage of small taeniid type tapeworm known as dog tapeworm (Echinococcus granulosus) that may cause infection in herbivorous animals and humans. Echinococcosis is one of the 17 neglected tropical diseases (NTDs) stated by the World Health Organization. E. granulosus is responsible for causing CE, which affects more than 1 million people around the world and responsible for over $3 billion in expenses every year [1]. It is characterized by the development of cysts either unilocular or may be multilocular of different extents ranging from the medium sized football to the size of a pea [2]. Genus Echinococcus comprises four species, i.e., Echinococcus multilocularis, Echinococcus granulosus, Echinococcus vogeli, and Echinococcus oligarthrus. There are two more Echinococcus species E. ortleppi and E. equinus on the basis of host-parasite interaction and their probable geographical distribution [3]. Analysis of mitochondrial and nuclear genes of different Echinococcus species has led to taxonomic revisions and the genotypes G1-G3 are now grouped as E. granulosussensustricto, G4 as Echinococcus equinus, G5 as Echinococcus ortleppi, G6-G10 as Echinococcus canadensis, and the “lion strain” as Echinococcus felidis [4]. E. granulosus life cycle is maintained by its definitive cannid host, i.e., dogs that nourish the adult worm in their smaller part of their intestine while wide range of domestic livestock and human acts as an intermediate host. CE is responsible for extensive livestock and human mortality and morbidity [5]. In details life cycle of E. granulosus, adult tapeworms that are usually 3-6 mm long reside in the small intestine of definitive hosts, then hydatid cyst stages occur in herbivorous intermediate hosts, such as sheep, cattle, goats, camels, horses, pigs and humans as well. In a typical dog-sheep cycle, tapeworm eggs are passed in the feces of an infected dog and may subsequently be ingested by grazing sheep; they hatch into embryos in intestine, penetrate intestinal lining, and are then picked up and carried by blood throughout the body to major filtering organs (mainly liver and/or lungs). After localization of developing embryos in a specific organ or site, they transform and develop into larval echinococcal cysts in which numerous tiny tapeworm heads called protoscolices are produced via asexual reproduction. A single cyst can have thousands of protoscolices, and each protoscolex is capable of developing into an adult worm if ingested by the definitive host [6]. There are many social reasons favouring the life cycle of E. granulosus and prevalence of CE in various parts of the world. Many families in rural have small plots of land and live-in close proximity with their flocks and dogs.

The gathering and grazing together of groups of animals belonging to different owners lead to circulation of infections, including CE. Home slaughter and feeding of dogs with raw offals favour the parasite’s life cycle [7]. Various small and poor equipped slaughterhouses built in the area of human settlements, lack of public health education are other factors that favour the life cycle of E. granulosus. Stray dogs and other canids, especially wolves may feed on dead animals and garbage, and hunt intermediate hosts. Dogs and livestock living in close proximity with man leads to circulation of zoonotic infection. Humans are incidental intermediate hosts; they do not play a role in the transmission cycle [8]. Dogs are particularly important in zoonotic transmission due to their close relationships with humans. E. granulosus is distributed worldwide, and it occurs on all continents, including Sudan. Cystic echinococcosis is one of the most important parasitic zoonoses in all regions of Sudan, resulting in high economic losses both in the public health sector and in the livestock industry. The epidemiology of hydatidosis varies from one area to another so control measures appropriate in one area are not necessarily of value in another [9,10]. It is essential to have adequate knowledge of the disease before contemplating control programs. For achieving an operative CE control program, it is vital to assess the level of understanding about the knowledge and awareness of disease and its preventive measure and hazardous acts that spread the infection more rapidly within the community. For these reasons, an investigation is conducted to explore the CE-related knowledge and awareness among human in different localities of Khartoum state, Central Sudan.

Methods

cross-sectional survey was conducted in Khartoum state – Sudan to find out recent knowledge, attitudes and practices on the occurrence of cystic echinococcosis. The quantitative data was collected in the form of questionnaire to investigate the knowledge and awareness of CE among community members and their routine practices that were behind the factors involved in hydatid cyst infection. The descriptive survey was performed between December 2017 and April 2018 by face-to-face communication.

Materials and Methods

Study design

This is a descriptive cross-sectional study was conducted over a period from December 2017 and April 2018todetermine up on the knowledge, awareness, attitudes, and practice regarding cystic echinococcosis among human in Khartoum state, Sudan.

Study area

This study conducted in three townships in Khartoum state (Khartoum, Omdurman and Bahry), a part of central Sudan (Figure 1).

Figure 1: A map of the localities included in the study area of Khartoum State, Sudan [10].

lupinepublishers-clinical-community-medicine

Khartoum State lies at the junction of the two rivers, the White and the Blue Niles in the Northeastern part of central Sudan. It lies between latitude 15-16 N and longitude 21-24 East with a length of 250 k and a total area of 20,736 km2 the surface elevation ranges between 380 to 400 m a.s.l. Most of Khartoum State falls within the semi-arid climatic zone while the Northern part of it falls within the arid climatic zone. The state is prevailed with a hot to very hot climate with rainy season during the summer and warm to cold dry winter. Rain falls ranges between 100-200 mm at the Northeastern parts to 200-300 mm at the Southern parts with 10-100 mm at the Northwestern parts. Temperature in summer ranges between 25- 40 CO during the months of April to June and between 20-35 CO during July-October Period. Temperature degrees continue to fall during the winter period between November-March to the level of 15-25 CO. Khartoum State is divided into three clusters (cities), built at the convergence of the Blue and White Niles: Omdurman to the northwest across the White Nile, North Khartoum, and Khartoum itself on the southern bank of the Blue Nile.

Data collection

Clinical data were collected by the facility medical staff via study structured questionnaire.

Questionnaires

Individuals ≥ 18 years of age were included in the study. After receiving individual verbal permission, a questionnaire was administered to obtain basic epidemiological and individual information regarding known CE risk factors. Age, sex, educational level, residence location, occupation, personal hygiene, dog ownership, dog contact, and treatment of domestic dogs were recorded. The questionnaire was administered in face-to-face interviews. Only one investigator administered the surveys, in order to prevent inter-observer differences.

Study variables

The following are the variables utilized by this study:

a) Demographic data

b) Dog ownership

c) Dog contacts

d) Treatment of owned dog

e) Home slaughtering and raw offal disposal

f) Education level

g) Knowledge of disease

Study population

five hundred and twelve individuals were enrolled in this study, 198 males and 314 females, their place of resident is in Khartoum state and their age range from ≥18 years.

Statistical analysis

Descriptive statistics was applied in order to analyze the data using Statistical Package for Social Science (SPSS) version 21.0 software. Data was analyzed descriptively using the frequency table and cross tabulation.

Ethical approval

This study was approved by the Institutional Review Board Committee of Alneelain University, Khartoum, Sudan. Then study participants were first asked whether they accept to take part in the survey.

Results

Socio-demographic characteristics of the study population

We interviewed 512 individuals, 314 (61%) female and 198 (39%) male, all of them were originated from Khartoum state. Their ages range from 18 -90 years with age mean (41.3 ± 18.08 SD) (Table 1). Regarding the populations’ level of education, 24% of the population had completed primary school, 25% for secondary school, 35% at university level, and 16% of them were unable to read and write (Table 1). Sheep and goat was the main livestock species owned by the population interviewed in this study (Table 1).

Table 1: Socio-demographic characteristics of people (N = 512) participated in cystic echinococcosis (CE) knowledge, awareness and practices survey in Khartoum, Sudan.

lupinepublishers-clinical-community-medicine

Practices towards CE prevention

Of all the participants interviewed, 9% (44/512) indicated owning dogs on their houses (Table 2). Our result highlights some negligent dog management practices. For instance, among participants owning dogs, 13% (6/44) dewormed their dogs. Added to that, approximately all 91% (468/512) of the participants reported slaughtering livestock at home for their families’ consumption, of whom, 23.5% (110/512) they provide raw infected organ and uneatable offal like lung, intestine, etc. for their dog and cats. The interviews also revealed that the vast majority of the participants 94% (479/512) they never boiled water prior to drinking it. On the other hand,10% (53/512) of study participants come in close contact to their dogs (Table 2).

Table 2: Descriptive results of study population practices relevant to CE prevention and control.

lupinepublishers-clinical-community-medicine

Knowledge and awareness about CE infection

The interviews revealed that 83% (427/512) of the study subjects did not know about the possibility of transmission of certain diseases (zoonoses) between livestock and humans. Small proportions 17% (85/512) of study participants had heard of hydatid disease prior, but 4.7%from them had wrong knowledge about this disease as some of them think that the hydatid cyst is a sebaceous cyst (Table 3).

Table 3: Descriptive results of study populations’ knowledge about and awareness of sources of infection with CE.

lupinepublishers-clinical-community-medicine

Discussion

The purpose of this descriptive study was to determine sociodemographic characteristics, awareness, household practices, and attitudes of population in Khartoum state, Sudan regarding the preventive measures against such important neglected zoonosis (cystic echinococcosis), and risky practices that could contribute to spread and persistence the disease. Parasites leading to chronic diseases can be fatal to humans and animals in warm and temperate climate countries [11]. Sudan is a country where parasitic diseases are widespread because of its geographical characteristics, wide variety of animal populations, and various other environmental and socio-cultural factors. Several potential risky practices have been underlined among the community interviewed in this study, notably practices related to dog management and treatment. Fortyfour (9%) of the surveyed person owned one or more dogs. Of these, six reported to deworm their dogs. This finding reflects a poor awareness among the population regarding the role of dogs in CE transmission. The majority of the interviewees did not de-worm their dogs, and more than half of them indicated feeding uncooked viscera to their dogs when slaughtering at home for household consumption. Such risky practices have been among the most important factors that increase contamination of the environment with faeces containing Echinococcus eggs [12]. Similar findings have been documented in other CE endemic settings. A study in Sardinia (Italy) reported that the majority of the interviewed people used raw offal, after home slaughtering, for feeding their dogs [13]. In addition, a study in Tibet demonstrated that feeding dogs with uncooked viscera is a risk factor for increasing the likelihood of human infection with E. granulosus [14].

In highly endemic areas it is quite possible for individuals to contract CE through indirect transmission through contaminated food or water [15]. Our results show that almost 94% of the respondent’s drink water directly without boiling. Water supply has been also found to be associated with infection with CE, and this may be due to water contamination with dog faeces [15,16]. Studies in Jordan [17] and Kenya [18] established that contaminated drinking water was a risk factor for human CE and detected Echinococcus eggs in water used by both people and livestock. Consequently, treatment of water prior to drinking is an important process to minimize the risk of disease transmission. Adequate hygienic handling practices and heat treatment (cooking food or boiling water) should contribute to minimizing the risk of foodborne echinococcosis. In Sudan, the incidence of Echinococcosis has probably increased in recent years as a result of increased ownership of dogs, and presence of stray dogs in close contact with people in markets and around the slaughterhouses. Also, the slaughter practices in Sudan play a vital role in maintenance of the parasite cycle because of low quality and number of slaughterhouses. In addition, slaughter at house level without any practices of safe slaughter increases chances of maintenance of the parasite. The level of knowledge of Sudan’s citizens must be increased to enable the successful control of parasites. Several studies determining high risk groups for CE and discussing the theory of “lack of knowledge can increase the disease” have been published [19-21]. We conclude that, the participants of this survey were found to be with insufficient knowledge regarding CE. Therefore, it is concluded as the disease is less aware in the community, and it is very important to impart public health education to build up public awareness about the sources of infection and its control and collaboration between veterinary and medical personnel in sharing knowledge on zoonoses and working together to identify and control zoonose.

Results

We interviewed 512 people, 314(61%) female and 198(39%) male, all of them were originated from Khartoum state (three localities: Khartoum, Omdurman and Bahry). Their ages range from 18 -90 years with age mean (41.3 ± 18.08 SD). 9% of people dog ownership in the area. Of whom only (13.6%) dewormed their owned dogs. Moreover, participants’ response also showed that 10% had contact with dogs. Approximately all (91%) of the participants reported slaughtering livestock at home for their families’ consumption, of whom, (23.5%) they provide raw infected organ and uneatable offal like lung, intestine, etc… for their dog and cats.94% reported that they never boiled water prior to drinking it. On the other hand, small proportions (17%) of study participants had heard of hydatid disease prior, but (4.7%) from them had wrong knowledge about this disease as some of them think that the hydatid cyst is a sebaceous cyst, more than half of participants knew about the hydatid disease were at university educational level. The majority of the interviewed persons were not aware about how humans get infected with CE disease.

Conclusion

The participants of this survey were found to be with insufficient knowledge regarding CE. Therefore, it is concluded as the disease is less aware in the community, and it is very important to impart public health education to build up public awareness about the sources of infection and its control and collaboration between veterinary and medical personnel in sharing knowledge on zoonoses and working together to identify and control zoonose. This study highlighted a gap in health education efforts regarding CE in Khartoum state, we advocate the implementation of training programs to improve public awareness on this important disease.

Authors’ contributions

SSA, MEA designed and coordinated the work. SSA produced the questionnaire, which was reviewed by MEA and MPG. MKM , SSA,MEA collected the data. SSA analyzed the data and wrote the manuscript. MEA revised and edited the manuscript. All authors read, commented and approved the final manuscript.

Read More About Lupine Publishers Journal of Clinical & Community Medicine Please Click on Below Link:
https://journalofclinicalcommunitymedicine.blogspot.com/


Saturday, 17 June 2023

Lupine Publishers | Basic Sciences and Clinical Implications of Alzheimer’s Disease

 Lupine Publishers | Journal of Clinical & Community Medicine


Abstract

Alzheimer’s disease (AD) is an irreversible and chronic progressive neurodegenerative disorder characterized by progressive cognitive dysfunction, memory loss, and decline. This disorder is the most common dementia type in elderly, accounts for 60%-80% of all cases [1-4]. Current estimates described that about 50 million people are living with dementia worldwide and treatment options are limited, placing significant suffering and financial burden on families and society. This number of people with dementia is predicted to increase to 131.5 million by 2050, as the population ages [4,5]. Although the AD etiology is still unknown, certain risk factors may influence on the clinical course of this illness, such as: age, gender, ethnicity, expression of the epsilon4 allele of apolipoprotein E (ApoE4), advanced parental age, cerebrovascular disease, severe or repeated head trauma, hypertension, myocardial infarction, diabetes mellitus, hyperlipidemia, and immunological defects; genetic factors as chromosomal defects (e.g., Down syndrome); and environmental factors as infective agents, toxins, smoking, elitism, limited education resulting in low neurofunctional stimulation, and sedentary lifestyle. Despite some controversies, authors report that limited education can be related to the high incidence of AD, once low neurofunctional stimulation could result in less cerebral metabolism and, as a consequence, favor the β-amyloid peptide (Aβ) deposits in the brain [1,6-8]. About 1% of cases of AD is autosomal dominant inheritances which is caused by high penetrance mutations in three genes, including APP (amyloid precursor protein, chromosome 21), PSEN1 (Presenilin 1; chromosome 14) and PSEN2 (Presenilin 2; chromosome 1) genes. The presence of the ApoE gene, located on the long arm of chromosome 19 (locus 19q13.2), increases the risk of developing AD. Among the three common ApoE allelic forms (epsilon2, epsilon3, and epsilon4), the ApoE4 is the most significant genetic risk factor for formation and deposition of β-amyloid peptide (Aβ) plaques in the brain tissue. These plates are neurotoxic agents which impair the synapses and ultimately cause neurodegeneration for early-onset and late-onset AD [2,3,6,8,9].

Introduction

This neurological condition is characterized by the following cardinal signs and symptoms: presence of extracellular senile plaques (extraneuronal deposition of beta-amyloid fibrils) and intracellular neurofibrillary tangles (intraneuronal aggregates of tau protein), gradual and progressive loss of episodic memory or other cognitive domains, inability to recognize common objects, family or friends (visual agnosia), to comprehend or formulate language (aphasia), and to carry out their basic activities in daily living (apraxia), and motor dysfunction. This last feature leads to immobility, inanition due to severe weakness and wasting from lack of food, and death. Personality changes, delirium, depression, and various behavioral abnormalities are also identified [3,10]. AD may affect a person in different ways and the disease progression depends upon the impact of the disease itself, the person’s personality, and health conditions. Considering these contexts, this illness has been divided into three stages: mild, moderate, and severe. The literature has still described that chronic cardiovascular and respiratory diseases and their comorbidities, e.g. obstructive sleep apnea, may increase the risk for development of AD and/or accelerate its progression. So, the treatment of these illnesses may contribute to AD prevention and/or control its progression [11]. Thus, it is important to comprehend the impact of pathogenesis on daily living and to know the clinical implications and approaches of this disease to provide good health for patients with AD, especially for institutionalized elders. Furthermore, the continuous application of the best transdisciplinary practices in health may result in good general health status and better preservation of stomatognathic system in this population.

Probably, these practices together may contribute to construction of knowledge, creation of new work philosophies and, consequently, improvement of lifestyle quality and longevity of people with dementia.

With respect to AD progression, elders become more dependent, resulting in major limitations in their self-care for general and oral health‐promoting practices. Then, it is extremely important that family members and/or caregivers are continually guided by physicians and dental physicians to control the evolution of preexisting illness and to avoid the appearance of new comorbidities. As a support therapy, transdisciplinary approaches must be applied to activate his/her memory and cognitive skills, including games, music therapy, physical exercises, and others. This may allow a good adaptation to several limitations which are caused by chronic and progressive exacerbation of AD.

An overview of the oral healthcare scenario, many dental physicians have great difficulty in assisting this public-target due to the physical, behavioral, and mental impairments. Oral dysfunctions sucking habits and involuntary oral and perioral movements are very frequent, compromising an appropriate oral rehabilitation. So, the choices of therapeutic approaches depend upto the evolution stages of AD. In initial stage, the dental physicians must remove all the infection foci (e.g., caries, periodontal diseases, and periapical abscess and cysts) and to restore the functions of the oral and maxillofacial complex. In severe stage, oral healthcare must be performed through safe and effective clinical procedures using intravenous sedation or general anesthesia in a hospital environment.

Conclusion

Considering that the World Health Organization has recognized AD as a global public health priority due to the increase of the elderly population and disparity in health inequality in all around the world, continuous collaborative efforts of specialized health multiprofessionals must be done to provide a well-being and satisfactory health conditions for these individuals. Furthermore, the best transdisciplinary and clinical practices in continuing healthcare must be recommended in private and public health units, as an irrefutable fact, mainly in healthcare services of long-term private or public nursing homes. In this manner, great benefits may be attained with success, leading to the management and control of AD progression, reduction in appearance of new comorbidities, decline of morbidity and mortality, and finally preservation of good quality of life of this target public.

Read More About Lupine Publishers Journal of Clinical & Community Medicine Please go through the Below Link:
https://journalofclinicalcommunitymedicine.blogspot.com/

Friday, 21 April 2023

Lupine Publishers | Gender and Two Major Traumas of 20th and 21st Century: War and Breast Cancer

 Lupine Publishers | Journal of Clinical & Community Medicine


Review Article

’’Children here find refuge in their hopes to die. The fact that death is equated to life is horrifying me. How are we going to deal with this generation in the future, how could we talk about life?’’ (Message from Nadera Shalhoub-Kevorkian, working in the Palestinian Balata camp during the Israeli raids of March 2002).

’’ I carressed my left breast, I rolled the lump under my fingers and I told myself it was at the exact same place where my mother, thirty-seven years earlier, had sewed up the yellow star. Finally, it had hit us. The much hoped for punishment was here. Would the dead be resurrected?’’ (Ania Francos, p. 47).

The first quote is from an email message I received from Nadera, an extraordinary woman I met in Istanbul in September 2001, who works with and for women in Israel and Palestine. It very much sums up the place we have reached in our present world: children in the Middle East and in many parts of the world, hope to die, the world offers them only despair, injustices are the order of the day… How can it go on like this? How can we go on living in such a world?

The second one is by Ania Francos, a Jewish woman suffering from breast cancer who ultimately died from it. Throughout her book, Sauve-toi Lola, she compares her trial with breast cancer to the ordeal her family went through with the Holocaust.

In both quotes, we find History repeating itself, as if human beings had so little imaginations and resourceful creativity, that the only response they have to violence is more violence and war which in turn brings more violence and bloodshed.

In this article I would like to make the connection between two major traumas of 20th and 21st century: war and breast cancer. Throughout my book, Cancer Journeys, I draw consistently on the same parallel, equating cancer and war. Having suffered in my body through the war in Lebanon and through breast cancer, having witnessed the agony and death of loved ones during the bombing of the city, and at the bedside of friends succumbing to cancer, I began to get the feeling that the two were connected.

Close analysis has indeed produced a number of similarities.

I was in terrific pain when I woke up after my mastectomy, and was given what are commonly known as “pain killers.” There is an uncannily frequent use in medicine of words that connote violence.

In the treatment of cancer, military metaphors and violent images abound. The body is ‘attacked’ by poisons in chemotherapy, or “nuked” as some say; patients undergo “radiation”; surgical intervention is called an “operation.”

But there’s more: chemotherapy as we know it was discovered during World War II, “thanks” if I dare say, to the observed effects of nerve gas. After an explosion of mustard gas bomb containing nitrogen in a submarine, it was observed that those on board who had been exposed were all deficient in white blood cells. Since leukaemia features a surplus of white blood cells, it was thought that nitrogen could halt the proliferation of the undesired cells. And thus chemotherapy was born.

The presence of war symbolism in cancer made me hate the disease all the more. My entire being, mind, body and spirit, are in revolt against this violence-laden aspect of cancer, and all other aspects as well, but this one in particular. I detest violence, and I sincerely yearn for the day when there will be gentler, more peaceful treatments for this disease.

War and the aggressive fight against cancer serve only to transfer the problem, placing emphasis on the symptoms without getting to the origin of the evil. War and “battling” cancer are not intrinsically necessary, but rather represent a failure to deal with problems in alternative ways, to resolve disorder in a situation that is out of control. Wars of mass destruction and the aggressive fight against cancer are the touchstones of the 20th century, of a world that contradiction and conflict have reduced to tatters.

Lebanon has had its share of war and destruction in the last decades, between 1975 and 1992, it was torn apart by a civil war fed by many countries worldwide that cashed in with sales of weapons to various militias, sometimes to both sides, regardless of alliance. Some militias in exchange for money and weapons buried nuclear waste products in various parts of Lebanon. The Lebanese population is now paying the price with a rise in cancers of all kinds. Cancers of the mind and heavy depressions plague the youth that have had to deal with the war. The wounds and scars are visible. It will take a long time for the country and its people to heal. And then again two summers ago, Israel hit again in response to Hezbollah capturing of two of their soldiers and managed to destroy the whole infrastructure of the country, polluting the air, sea and land, leaving behind million of fragmentation bombs. It will take years again for Lebanon to come out of this new disaster!

The hairdresser who came to do Mother’s hair, when I was visiting her in Beirut in 1995 while recovering from breast cancer, told me he was used to seeing hair that turned out like mine due to cancer treatments. It was radiation, particularly, that made it curly in that strange, electric way. In Arabic he said to me that kahraba (electricity) caused kahraba. I didn’t believe it when people had told me hair reacted differently to these treatments, hair that used to be curly became straight and straight hair turned curly. I thought they were old wives tales. And I could tell people thought I was making it up when I told them my hair was not curly like that before.

The Beirut hairdresser told me there were two kinds of cancer: the feminine and the masculine, the feminine was much more virulent than the masculine. It was very aggressive, a real killer. I pondered over his remark: gender differences applied to illness. I had always been interested in gender differences. It was the subject of one of my books. In it I analyzed how gender differences were closely linked to war. Sexuality and war were interconnected. This popular image of cancer reinforced my analysis in showing that the fear men have of women was manifested even in their portrayal of disease. The female brand of a disease (is there any such thing scientifically?) was much more dangerous than the male one? It killed faster. Where did the idea come from?

Cancer victims enter, or are pushed into, a space which I have called “a zone of illness,” where they lose control over their lives and their freedom of choice; and this state, too, resembles that of concentration camp victims. Patients enter an organization conceived as a rational machine, an industrial machine made to treat the disease, one whose discourse is not to give a conscious choice to the patient but to orient her/him in a programmed direction. The patient is not warned about many of the consequences of the treatment she/he will be subjected to, but discovers them on the way: castrations, mutilations, loss of certain limbs’ use, certain pains, threat of other treatment-induced cancers, weakness, debilitation, fragility, death, danger. They are accompanied by other consequences often warned about but minimized as “secondary effects” while actually so central: baldness, nausea, pain, muscle weakening, heart muscle damage, loss of appetite, burns, tiredness.

The importance of incorporating a discourse on sexuality when formulating a revolutionary feminist theory became very evident as I started analyzing and writing about the Lebanese war. The war itself seemed closely connected with the way people perceived and acted out their sense of love and power, as well as their sense of relationship to their partners, to the family and to the general society. Usually the argument has been made that women’s issues detract from the war effort, that wars create such conditions of despair that, within this context, women’s issues are unimportant, and if the “right” side in a war were to win, women’s problems would automatically be solved. I argued the reverse. I suggested that sexuality was centrally involved in motivations to war, and if women’s issues were dealt with from the beginning, wars might be avoided, and revolutionary struggles and movements for liberation would take on a very different path. Justice cannot be won in the midst of injustice. All these levels are interwoven.

In my book on Sexuality and War, I analyzed how the whole range of oppression women suffered from in the Middle East: forced marriage, virginity, and the codes of honour, forced confinement, the veil, polygamy, repudiation, beating, lack of freedom and the denial of the possibility to achieve their aims and desires in life--practices, some of which motivated me to run away from Lebanon at the age of twenty-two--were closely connected to the internal war in Lebanon (I was not referring to the Israeli and Syrian occupations, nor to the foreign interferences). There are at least seventeen political parties--with many subdivisions—that were fighting each other in Lebanon. During the war, each of these parties had different interests; each tried to dominate a small piece of territory and impose its vision of Lebanon onto that territory. Each group tried to dominate the others largely through the control of women in a way I tried to formulate. One of the codes of Arab tribes is sharaf (honour) which also means the preservation of girls’ virginity, to ensure that the women are kept exclusively for the men of their tribe.

The means of conquest were given a value in proportion to their success. The gun, the machine-gun, the cannon--all masculine sexual symbols which are extensions of the phallus--were put forward and used to conquer and destroy. For Adam Farrar, there is a kind of jouissance --pleasure in a sexual sense, no equivalent word in English--in war:

One of the main features of the phenomenology of war is the unique intensity of experience. War experience is exactly the converse of alienation. In war, the elimination of all the norms of intersubjectivity produces, not alienation, but the most intense jouissance. The machining of events on the plane of intensity (to use the Deleuzian image), the form of desire, is utterly transformed. Power no longer consists in the capacity to redeem the warrants of communicative intersubjectivity. It consists in the ability of the spear, the sword, the gun, napalm, the bomb etc. to manifest ‘in a blast of sound and energy and light’ (or in another time, in the blood of a severed limb or a disembowelled body), the merest ‘wish flashing across your mind like a shadow’1.

FOOT NOTE

1 Adam Farrar, “War, Machining Male Desire,” War/Masculinity (ed. Paul Patton, Ross Poole, Sydney: Intervention) p. 66.

Farrar continues, quoting an article by William Broyles in Esquire entitled “Why Men Love War,” that it is at some terrible level, for men, the closest thing to what childbirth is for women: the initiation into the power of life and death2.

In Arab society, most sexual relations are not built on pleasure, tenderness or love, but on reproduction, the preservation of girl’s virginity (so-called ‘honour’ of the family), the confinement and control of women for the increase in male prestige, and the overestimation of the penis. Many important studies by women and men in the last few years see a link between sexuality and national/international conflicts. In an article published in an important French review entitled Alternatives Non-Violentes, Jean-William Lapierre, well-known specialist on the subject, sees a real “deep connection between masculine predominance and the importance of war3.” According to him, most civilizations are based on conquest and war. “The importance of hunting, then of war in social existence, in economic resources, in cultural models (which valorise the warrior exploits), are at the roots of masculine domination and of women’s oppression4.” He explains how in socalled “modern” societies, politics, industry, business, are always a kind of war where one (mostly men, and sometimes women imitating men’s behaviour) must be energetic, aggressive, etc., to be powerful. It is not only capitalist societies which “carry war like clouds carry the storm, but productivism in all its forms, including the so-called ‘socialistic’ one. In all societies in which economy and politics require a spirit of competition (while its ethic exalts it) women are oppressed5.” And Bob Connell sees a relationship between masculinity, violence and war. He says that it is not by chance if the great majority of soldiers are men--of the 22 million people under arms in the world in 1976, 20 million of them were men. “Most of the police, most of the prison warders, and almost all the generals, admirals, bureaucrats and politicians who control the apparatus of coercion and collective violence. Most murderers are men. Almost all bandits, armed robbers, and muggers are men; all rapists, most domestic bashers; and most people involved in street brawls, riots and the like6.” But such connection should not be attributed to biology that would absolve masculine responsibility- -men’s violence associated to some human “destiny”--but rather to social and cultural factors.

The discussion of sexuality and its relationship to political and social conflicts is also silenced through women’s unquestioning adherence to dogmatic political systems of thinking. Many nationalist and leftist women felt that women should rally behind the already existing movements and ideologies. Yet in these movements, traditional morality often filters through dogmas, setting new barriers between women’s sense of obligation and their search for truth and freedom. Yolla Polity-Charara provides an incisive analysis of this problem as exemplified in Lebanese politics. According to her, many Lebanese women joined political parties thinking that the condition of women would change. But “how could it be possible with so many ideological differences and antagonisms, representing the whole range of political forces in Lebanon, not to be divergent on the details of women’s demands7.” According to Charara, the party and ideological loyalties made women loath to complain about their fate to other unknown women, and even more so to rivals. The militants among them, when conscious of the discrimination women faced, when they were not themselves token-women in the party, preferred to wash their dirty laundry within the family; they refused to question publicly the men of their party, to admit that their men were not the most advanced, the most egalitarian and the most revolutionary. Thus, in such a context, loyalty and siding with a group became more important than the issues themselves.

Betty Reardon explains how the patriarchal system is not only happy with dividing women along loyalty lines, but uses violence to train people into gender roles which reinforce the war system:

The fundamental willingness to use violence against others on which warfare depends is conditioned by early training and continuous socialization in patriarchal society. All are taught to respect authority, that is, fear violence... Boys and men are encouraged to become more fierce, more aggressive when they feel fear. Fear in men is channelled into aggression, in women into submission, for such behaviours are necessary to maintain patriarchal authoritarianism. Aggression and submission are also the core of the basic relations between men and women, accounting, many believe, for women’s toleration of male chauvinism. Some assert that these behaviours are the primary cause of all forceful exploitation, and account for perhaps the most significant common characteristic of sexism and the war system: rape8.

Issa Makhlouf in his book, Beirut or The Fascination with Death, talks and analyzes rape in the war of Lebanon, a subject no one before him had been willing to expose. He says that it is another facet of the Barbary, frequently practiced by militias during massacres and occurring almost everywhere on Lebanese soil.

The fixation of militias on sexual organs did not only hit women. Several male cadavers were discovered with their sex cut off and sometimes pushed into their mouths; the simulation of fellatio, generally repressed by morality, is very revealing as a rejection of moral codes. On the other hand, numerous mutilations were practiced on victims, dead or alive. In rape, all forms of violence are combined. All possibilities of death and pleasure are present. All dreams of domination are fulfilled. The victim of rape is the toy of all phantasms and ambitions. Rape is the place of all experimentations9.

FOOT NOTE

2 2Ibid., p. 61.

3Lapierre, «Femmes: Une oppression millénaire.» Alternatives non-violentes: Femmes et violences 40 (Spring 1981) p. 21.

4Ibid.

5Ibid., p. 22.

6Bob Connell, “Masculinity, Violence and War,” War/Masculinity, op. cit., p. 4.

7Yolla Polity Charara, “Women and Politics in Lebanon,” Third World, Second Sex (op. cit.) pp. 19-29.

8Reardon, op. cit., pp. 38-39.

Susan Brownmiller in Against Our Will has shown how rape is a conscious tactic of warfare10. Michel Foucault has written a great deal on the connection between death, sex, violence and male sexuality11. Wilhelm Reich has analyzed how repressed sexuality based on authoritarian family patterns is at the root of sadistic murders, perversions, psychological problems, social and political conflicts12. And Farrar notices that: “War is a paradigm of masculinist practices because its pre-eminent valuation of violence and destruction resonates throughout other male relationships: relationships to other cultures, to the environment and, particularly, to women. If the ‘masculinism’ of war is the explanation for its intractability, then we must follow this path to its conclusion, wherever that may be13.”

The whole system must be changed and rethought. To use Betty Reardon’s words:

What I am advocating here is a new world order value, reconciliation, and perhaps even forgiveness, not only of those who trespass against us, but primarily of ourselves. By understanding that no human being is totally incapable of the most reprehensible of human acts, or of the most selfless and noble, we open up the possibilities for change of cosmic dimensions. Essentially this realization is what lies at the base of the philosophy of nonviolence. It we are to move through a disarmed world to a truly non-violent one, to authentic peace and justice, we must come to terms with and accept the other in ourselves, be it our masculine or our feminine attributes or any of those traits and characteristics we have projected on enemies and criminals, or heroes and saints14.

And as Andrea Dworkin put it: “To transform the world we must transform the very substance of our erotic sensibilities and we must do so as consciously and as conscientiously as we do any act which involves our whole lives15.”

By sexual revolution, I mean one which starts at the personal level, with a transformation of attitudes towards one’s mate, family, sexuality, and society; specifically, a transformation of the traditional relations of domination and subordination which permeate interpersonal relationships, particularly those of sexual and familial intimacy. We need to develop an exchange of love, tenderness, equal sharing and recognition among people. This would create a more secure and solid basis for change in other spheres of life--political, economic, social, religious, and national, as they are often characterized by similar rapports of domination. As Elisabeth Badinter insightfully expressed:

Equality, which is taking place, gives birth to likeness which stops war. Each protagonist wanting to be the ‘whole’ of humanity, can better understand the Other who has become his/her double. The feelings which unite this couple of mutants can only change in nature. Strangeness disappears, replaced by ‘familiarity’. We may lose some passion and desire, but gain tenderness and complicity, the feelings which unite members of the same family: a mother to her child, a brother to his sister... At last, all those who have dropped their weapons16.

The similarities and differences between the ways women and men express and deal with violence and sexuality can lead us to a greater comprehension of the complexities in the relationship between the two and bring us to a solution: i.e. a new rapport between men/women, women/women, and men/men, relationships based on trust, recognition of the other, tenderness, equal sharing and love void of jealousy and possession. My contention--going along with the cherished vision of Feminists--that the personal is the political, changes in relationships traditionally based on domination, oppression and power games will inevitably bounce back on other spheres of life.

FOOT NOTE

9 Issa Makhlouf, Beyrouth ou la fascination de la mort (Paris: La Passion, 1988) pp. 88-90.

10Susan Brownmiller, Against our Will: Men, Women and Rape (New York: Bantam, 1976).

11See in particular Michel Foucault, “Tales of Murder,” I, Pierre Rivière (Penguin, 1978).

12Wilheim Reich, L’irruption de la morale sexuelle (Paris: Payot, 1972, first published in German in 1932).

13Farrar, op. cit., p. 59.

14Betty Reardon, Sexism and the War System (New York/London: Teacher’s College/Columbia University, 1985) p. 94.

15Andrea Dworkin, Marx and Gandhi were Liberals: Feminism and the ‘Radical’ Left (CA: Frog in the Well, 1980) p. 6.

16Elisabeth Badinter, L’un est l’autre: Des relations entre hommes et femmes (Paris: Editions Odile Jacob, 1986) p. 245.

Examples from the Lebanese War Novels

I will quote two passages from two Lebanese war novels, and you can guess which one was written by the woman and which by the man:

And this city, what is it? A whore. Who could imagine a whore sleeping with a thousand men and continuing to live? The city receives a thousand bombs and continues its existence nonetheless. The city can be summarized by these bombs... When we had destroyed Beirut, we thought we had destroyed it... We had destroyed this city at last. But when the war was declared finished and the pictures of the incredible desolation of Beirut were broadcasted, we discovered we had not destroyed it. We had only opened a few breaches in its walls, without destroying it. For that, other wars would be necessary.

This city is like a great suffering being, too mad, too overcharged, broken now, gutted, and raped like those girls raped by thirty or forty militia men, and are now mad and in asylums because their families, Mediterranean to the end, would rather hide than cure...but how does one cure the memory? The city, like those girls, was raped...In the City, this center of all prostitutions, there is a lot of money and a lot of construction that will never be finished. Cement has mixed with the earth, and little by little has smothered most of the trees. If not all.

In these two images of Beirut, two opposing feelings are being expressed, two contrasting visions emerge. The first wants to get rid of the sinner, the whore, source of all evils, decadence, and the problems of modern existence. The total and violent destruction of the woman is seen as the only way out of an inextricable situation. The second feels sorry for the woman, the city, victim of rape, victim of man’s violence. Mediterranean customs are accused. Hypocrisy and the oppression of women are presented as the origin of madness and the destruction of the city.

The first quote is by a man, Elias Khoury, author of The Small Mountain (Minnesota: University of Minnesota Press, 1990)17, the second by a woman, Etel Adnan, author of Sitt Marie Rose (Sausalito, Calif.: Post-Apollo Press, 1982)18. This difference between a man and a woman’s visions of Beirut and their ways of expressing them was even more clearly defined one year during the war, as I watched women friends, determined to cross Beirut two or three times a week, pass through the demarcation line--the most desolate, depressing and often dangerous spot in the city. They went most of the time on foot, as only a few cars with special permission were allowed through. They were convinced that by this gesture, real as well as symbolic, Lebanon’s reunification would take place. They did this against all logic, under the ironic and sometimes admiring look of male companions19. Defying weapons, militias, political games, women friends told me how that site had become a meeting place where each morning they looked forward to seeing this friend or that one, walking steadfastly in the apocalyptic space of the museum passage (another name for the no man’s land dividing the city, because the museum is located there). They smiled at each other as they walked assuredly, conscious that their march was not an ordinary one, that their crossing was a daring act, important and vital to Lebanon’s survival.

I have chosen six novels about the war to illustrate the connections between sexuality, war, nationalism, feminism, violence, love and power as they relate to the body, the partner, the family, Marxism, religion, and pacifism. These novels do not necessarily represent the entire range of creative works about the war20. They were chosen for their significance in terms of the issues under discussion and for their availability in languages understandable to the Western reader. The works, originally written in Arabic or French, are by Lebanese women and men authors who have lived or are still living in Lebanon. All of the novels chosen are set in Beirut, in the context of the war. Days of Dust (Washington: Three Continents Press, 1983)21 by Halim Barakat and Death in Beirut (London: Heineman, 1976)22 by Tawfiq Awwad--works written before the war started in 1975--foreshadow the events. Even though the subject is treated differently, all of the writers show how war and violence have roots in sexuality and in the treatment of women in that part of the world. Most of the characters meet a tragic fate due to the war, but women are the principal victims of both political and social violence. For example, the heroine of Death in Beirut is seduced, raped, beaten, her face slashed, her ambitions smashed, as she tries to gain autonomy and education in the midst of her country’s social and political unrest. Zahra, in The Story of Zahra (London: Readers International, Quartet Books Limited, 1986)23 by Hanan El-Cheikh, who tries to find a way out of herself and of the civil war that has just erupted by having a sexual relationship with a sniper, becomes the target not only of his sexual weapon, but of his Kalashnikov as well. In the end, he kills her. In Etel Adnan’s novel Sitt Marie Rose, Marie Rose is struggling for social justice, Arab women’s liberation, and directs a school for the handicapped. She is put to death by Phalangist executioners who first torture her to get rid of their bad conscience. In House without Roots (Paris: Flammarion, 1985)24 by Andrée Chedid, Sybil dies from a sniper’s bullet at the point of possible reconciliation, the place where Kalya advanced trying to save Ammal and Myriam, one of them having been hit by the sniper’s death machine as they were starting a peace march. In Days of Dust, Pamela, trying to find herself by helping the refugees and protesting against American imperialism, loses herself in a no-exit relationship with the male protagonist. And in Elias Khoury’s novel The Small Mountain, the female characters are destroyed, disappear, or are trapped in disgustingly hateful marriage routines.

In addition to the relationship between war and sexuality, I examined the positive and negative actions and resolutions male and female characters took, the differences and similarities between male and female protagonists, between male and female authors, and between those writing in Arabic and in French. I also tried to assess the necessary changes Lebanon had to undergo to solve its tragedy and play, once again, the democratic role--melting pot of tolerance and freedom--it had in the region, and which is so much needed in that part of the world.

In this study, my hypothesis was verified and showed that although both female and male novels make the connection between sexuality and war, their ways of expressing it, and most of all the solutions implied, are quite different. Women writers paint the war and the relationships between women, men and their families in the darkest terms: sexuality is tied to women’s oppression and the restrictions put on their lives, the war brings destruction, despair and death. The female protagonists look for alternatives in non-violent active struggles such as peace marches, engagement in causes to help the oppressed and the dispossessed. At the same time, they seek for changes in their life styles and in their relationships with the men and families around them. Men writers also paint the war and men/women relationships in the bleakest terms, emphasizing the connection between the two. But their depression does not lead them to search for alternatives different from the historically accepted ones: heroism, revenge and violence as catharsis to men/women deplorable communication.

FOOT NOTE

17 First written in Arabic (Al-Jabal al-Saghir, Beirut: Mu’assassat al-Abhath, 1977) also available in French (La petite montagne, Paris: Arléa, 1987).

18 First written in French (Sitt Marie-Rose, Paris: Des Femmes, 1977).

19 There are also men who, believing in the reunification of Lebanon, make the gesture, crossing the demarcation line, but it seemed to me they were fewer than women--perhaps because men risk more, are more often victims of kidnappings, assaults, murders. Men do it more in a spirit of duty or for professional interests.

20Cooke, op. cit.

21First written in Arabic (‘Awdat alta’ir ilal bahr, Beirut: Al’Mu’assassat Al-’Arabiya, 1969), also available in French (Le vaisseau reprend le large, Sherbrooke: Naaman, 1977).

22First written in Arabic (Tawaheen Beirut, Beirut: Dar al-Adab, 1972).

23First written in Arabic (Hikayat Zahra, Beirut: Al-Nahar, 1980), also available in French (Histoire de Zahra, Paris: Lattès, 1980).

24First written in French (La maison sans racines, Paris: Flammarion, 1985) also available in English (Return to Beirut, London: Serpent’s Tail, 1989).’

In both women’s and men’s writing, the war is used to break down the patriarchal system and the traditional order. The female protagonists do it through masochism while the male ones use cruelty and sadism. But such action/reaction leads nowhere because the use of war to free oneself from domination and oppression only reinforces the authoritarian order by reproducing the power structure with different colours.

Both women and men writers question God and the use of religion in war. Institutionalized religion is blamed explicitly, while faith and personal belief are praised implicitly and constitute-- more specifically in the women writers--strength and a way of overcoming war. So while male protagonists justify their fighting through religion or to show how it was used for imperialist purposes, the female ones draw their strength in helping the oppressed, sacrificing themselves for others welfare and in active non-violent struggles.

Both women and men writers seem to concur in showing female protagonists whose political outlook and actions are accompanied by similar ways in their personal lives, while male protagonists live double standards and hypocritical attitudes. In male authors, the female protagonists who are concerned and active politically also reject the traditional passive roles and refuse the taboos surrounding virginity and sexuality. They find themselves in situations where they are unable to live this conscious desire to be free because the men around them cannot cope with it. The irony is that these men voice beautiful statements concerning the need to achieve revolution in both domains: the private and the political, but when it comes to actualizing these theories in interpersonal relationships, it is as if they were paralyzed. It leads one to really doubt the effectiveness of what they advocate. Both male and female authors agree in portraying this difference between their male and female protagonists. To this characterization, women authors add an element not found in the men: their female protagonists often affirm themselves and live different life styles even if it means being marginalized, having to live in exile or being put to death.

Another major preoccupation of female and male writers is their outlook on multiculturalism and the question of roots, exile and pluralism mixed with violence and war, and how it is reflected in interpersonal relationships. Female authors tend to see mixity as something positive. Exile often means freedom. The search for roots can be an expression of nostalgia for one’s childhood or a need for security and love. Male authors tend to depict mixity as confrontation. Their search is for purity, mixity meaning dishonour. Multiculturalism increases their schizophrenia and makes them uneasy and depressed. Roots are a search for identity and exile is a terrible fate.

For example, Kalya in House Without Roots, raises questions about the significance of roots, and expresses the importance of grafting within her all the various roots and sensitivities of the cultures she is made of. She insists on the positive aspects of such hybridization and cosmopolitanism, and the enrichment, tolerance and openness it brings. These values are what Lebanon used to represent and what Kalya had come to seek. While Ramzy in Days of Dust, despairs at multiplicity which he associates with loss of identity, and sees it as one of the causes for the war. Ramzy is constantly split between East and West. It leads to schizophrenia and the inability to harmoniously integrate the various sides of his personality.

Intercultural and interconfessional marriages reflect the same outlook. Women authors depict female protagonists who live them harmoniously and with a great sense of achievement, commitment and possible solution to the war (even when they get killed because of it as with Marie Rose). Men authors show male protagonists split between a desire to achieve mixity on the political level and an impossibility to live it in their personal lives, even when they have voiced the importance of breaking down tradition on that level. Men authors also depict female protagonists better able to harmonize the personal with the political. Their failure to achieve true liberation stems not from their lack of action, but from the males’ inability to realize it with them.

Another notion implied by both female and male novels is androgyny. In this domain, there is less contrast between the two genders. Both women and men authors depict the negative and positive aspects of androgyny. Adnan refers to an androgynous mythical past to confront the male protagonists with their corrupted values. Chedid shows women characters who assume traits traditionally viewed as masculine. And Awwad also portrays women who, in order to free themselves, take on a masculine discourse and decide to engage in guerilla warfare. In these two authors however, the outcome is not positive. It does not engender life, nor is it a solution to war. And Barakat’s male protagonist who assumes both the female and male sides of his personality is not portrayed as having harmoniously integrated the two. He is constantly ill at ease and torn between aggressiveness and masochism, the male side being associated with victory and the female with defeat. The most positive portrayal of an androgynous character is in Khoury. One of the main protagonists is described as androgynous-looking and appears free from society’s restrictions. She is obviously a projection of who the central male character would like to be, how he imagines freedom and a way to reject war. This androgynouslooking character laughs, argues, moves freely, captivates the hero, runs towards the sea, and is unattainable because the man is too busy fighting “the revolution.” Why did the author choose to construct an androgynous-looking woman to represent freedom? Is he saying that woman and man are doomed to destroy each other and that only the androgynous can escape such fate? The novel as a whole does not seem to imply such a solution. Freedom is never chosen as the answer to men and women’s miseries. Instead, destruction appears as the ultimate response to human condition.

The question of poverty and class-consciousness related to war and women’s condition emphasizes women writers’ awareness, leading them to search for positive alternatives, while men writers use it to justify violence. Both male and female authors show the link between the fate of the dispossessed, their struggle to overcome it, women’s oppression and the war. Awwad paints a direct connection between the classes his female protagonists belong to and the degrees of abuse and violence they are subjected to. Chedid shows women characters whose private and political consciousness and commitment gives them real awareness and sensitivity to the condition of the poor and vice versa: watching the poor’s lives leads them to become socially committed and active for change in their personal as well as political lives. Similarly, Adnan portrays a female protagonist who is socially, politically and personally committed to women’s issues and to the fate of the poor, the dispossessed and the oppressed in general. As for Khoury, he often talks about “the war of the poor” to describe the link between oppression and war, and to justify a revenge of the dispossessed. The crowd, which invades the plush hotel district of Beirut, is coming from camps, ghettos and the poor areas of Lebanon. Khoury ironically recalls the name they walk on “France” (there is such a street in Beirut), to show it is also a revenge of the colonized against the colonizers.

Both male and female authors paint the disastrous consequences of virginity rites connected with the notions of honour, ownership of women and sexual relationships. It is these customs, which lead Al-Shaykh’s female protagonist to despair, madness and final death. She rejects them from the beginning and is revolted against male’s views of her body and sexuality. She would like to be freed from them and in control of her body and of her life. She uses the war to break down the taboos and to assert herself sexually. She finds out that the war is much stronger and more destructive than anything she has known before, and that the customs she hoped to get rid of through it are only temporarily shifted. They come back with greater strength and more destructive violence. And Adnan uses the narrator’s voice to comment on the frighteningly dangerous outcome of the codes of honour related to virginity, and how they reinforce tribal confessional sectarianship. As for Awwad, he shows the direct link between the customs of virginity, the exclusive propriety of women leading to violence and crimes at the foundation of a society built on divisions and an exclusive sense of propriety. In such a system, women are dominated, raped, led to suicide or killed by men themselves manipulated by political power. It is a vicious circle of power struggles in which women are the ultimate victims. And Barakat, through the interwoven stories of the Hyena and the Flying Dutchman, demonstrates the importance of the concept of virginity and the codes of honour related to women’s roles in society, with the strong implications of woman as earth, and Palestine as the ultimate woman.

In most of the novels under study, the codes of honour--related to virginity and to crimes meant to wash the family’s or tribe’s honour/pride in blood--are connected to rape, itself associated with death. Rape is linked to the notion of death. It is the absolute forbidden (specially on women of one’s tribe) therefore the absolute temptation of death (when inflicted on women of the other tribe). Men prove their masculinity through sexual acts of violence against women of the other clans. It, therefore, reinforces the system of the clan by making women vulnerable and in need of the men’s protection. In Al-Shaykh, the major female protagonist is subjected to rapes throughout her sexual life, which ends with death as the ultimate rape. In Awwad, the sexual act, in most of the men’s imagination and in their practice, is associated with rape. They seem unable to conceive of it differently; it is part of the system of power where they prove their masculinity and domination. Their way of conceiving sexuality often results in the death, suicide or annihilation of the female protagonist. And in Khoury, the wish of the central male protagonist is for the city/woman to be raped because she is like a prostitute and incarnates all the decadent moral values of industrial and modern life. But rape is not enough, it has to reach its limits into total destruction, and the devastation has to spread to other cities/women in the world, leading to annihilation and oblivion. While in Adnan, who also compares the city to a woman, she sees her rape/destruction as men’s ultimate cruelty, sadism and violence. She feels sorry for this woman/city and seeks for solutions in peaceful non-violent alternatives, even in the notion of self-sacrifice if that could help alleviate the hate and destruction. As for Barakat, the images used for the Arabs’ being defeated by Israel are of invasion, destruction and rape, taking place on the male protagonist’s body that is utterly frustrated and depressed because rendered powerless.

Sexual relations conceived in a system of power struggles and a structure of submission/domination will obviously result in rapes and in the abuse of women. Rapes are associated with unwanted pregnancies and abortions. In none of the war novels do we find conception, pregnancy and giving birth as something positive and happy. Both female and male authors seem to view life conception and creation as impossible and repulsive in the context of the war. The female protagonists are the ones who pay the price, because the male protagonists view women as having to assume the whole responsibility of contraception and pregnancy. The sexual act being, in most instances, one of rape and domination, women appear as mere objects of possession, vessels into which the men pour their anger and frustration, prolongation of the feelings and acts of war. Abortion is the direct result of rape, like destruction is the direct result of war. Life cannot be engendered in such a context.

The novels by both male and female authors end with the brutal death of some of the female protagonists. Their death is the direct result of the male protagonist’s violence, worse perpetrators of the war. Zahra and the child in her womb die from the sniper’s--and father of the child--bullet. A gang of young Christian militiamen executes Marie Rose. Young Sybil also dies from a sniper’s bullet. Zennoub is cruelly gang raped and, as a result, she commits suicide. While Miss Mary, who shows real solidarity for her female friends, and who tries to protect Tamima dies, shielding her from her brother’s cruel hand. In only one of the male author’s novel, one of the male protagonists dies. It is from fighting and one does not feel as sorry for him as with the female protagonists’ deaths. His death is the result of his own violence and not a cruelty inflicted from the outside as with the women. Even if violence coming from the oppressed holds a certain justification, the death of its victims does not stir our sympathy, as does the death of innocent victims.

In all of the studied novels, female and male authors concur in portraying their female protagonists as the ultimate victims. Where they disagree is in showing their responsibility and/or innocence. Khoury is the one who holds women responsible for their own victimization. His rage against the victims is so great that he calls for their total destruction. It is as if he were blaming the oppressed for being oppressed and calling for more oppression to get rid of oppression. Fanon’s view of violence as catharsis can be compared to Khoury’s call for total annihilation. They both call on negative, destructive means for the transformation of society. There is a similar element in Al-Shaykh’s novel where Zahra who goes to the sniper seeks a homeopathic cure against the war. The difference between Khoury and Al-Shaykh is that Zahra does it through masochism, thereby emphasizing her own victimization, while Khoury inflicts it through sadism, thereby increasing the cruelty and expressing a total lack of compassion for the victims. Finally, an obvious conclusion to this study is that the fear men have of women leads them to domination and war, while the fear women have of men’s violence leads them to masochistic submission or/and rejection of the men, and commitment to political, human and feminist causes. Both the female and male authors agree on this. For example, the sniper’s first reaction to Zahra is rape, as a way of proving his masculinity through control and domination. Fear is one of his primary motivations: fear of life, fear of women’s capacity to reproduce, to give birth, fascination with death and destruction. He does not want to assume the responsibility of the life he has engendered in Zahra’s womb, when he daily kills innocent victims and destroys life. In order to reestablish the chaos, daily drug and only meaning of his existence, he must kill her. And for Talal in The Small Mountain, fighting is like making love to a woman: it is frightening and never fulfilling. The author describes a group of fighters who have lost the meaning of life, a fraternity of men always afraid, attracted and repulsed by women and by war, who know only destruction in which they loose themselves. The hate and fear they feel for women becomes their ultimate motivation for war. Such fear is epitomized by the relationship the central character has with his wife. The author describes boredom and weariness in their relationship, thereby trying to justify the need for war to bring about necessary changes. The main character has an obvious fascination with death and destruction, which is closely related to his sense of pleasure. He is chained to his wife through habits he can only destroy through war. And he runs away from the other two women in his life, because they represent life and freedom, which he is unable to accept, busy as he is with destruction. It leads to an obsession with destruction, as if destroying the city and the woman it symbolizes brings in ultimate jouissance. And Zahra, afraid of the violence ripping her country apart, submits herself masochistically to one of its worse perpetrators, thereby hoping to overcome her fears. While the central women characters, in House Without Roots, live their lives independent from men and with a commitment to bring about the transformation of society through peaceful means. And Marie-Rose stands in front of the fascist young men of her country, confronting them with their perverted values, in an act that defies their violence and rejects them all together. This chabab gang is afraid of Marie- Rose who epitomizes feminine/feminist values and who dares confront them with words, showing them their corruption while asserting her w-humanism and her commitment to the oppressed and the downtrodden. They will have to get rid of her, just like the sniper had to get rid of Zahra.

Thus, while women writers are finding a way out, a circle of hell is being perpetuated, each sex fearing the other, the male one starting the chain through violence and domination. Only a different vision, new actions, and altered relationships based on trust, recognition, and acceptance of the other can help heal the wounds and bring about the cure necessary to project a new future for the world. Such a change has already started taking place with personal and political actions aimed at solving the problems rooted in oppression, domination, and the victimization of women. Writing this article has been one of these actions.

The connection between sexuality and war is so present in the novels that it is probably one of the most evident unifying themes. It demonstrates how strongly at work it is in the collective imaginary or culture of the people and how central it is to an understanding of the situation and the causes of the war. The similarities and differences between the ways women and men express and deal with violence and sexuality can lead us to a greater comprehension of the complexities in the relationship between the two and bring us closer to a solution: i.e., what I have described throughout this study as the need for a new rapport between men/women, women/ women, and men/men, relationships based on trust, recognition of the other, tenderness, equal sharing and love void of jealousy and possession. My contention being that the personal is political--a vision also dear to Feminist movements--changes in relationships traditionally based on domination, oppression and power games will inevitably bounce back on other spheres of life.

What Miriam Cooke writes about the Lebanese women writers’ vision of Lebanon as a sick child in need of care, became for me a reality. It was the Lebanese war, which made me want to go back and try to help. I would not have felt the same concern for Lebanon had it not been for the war and for what I perceived as real suffering in my friends and many of the people I came in contact with. I shared their pain and desire to remedy. It led me to apply for grants to go and teach there. My experiences in living the war, talking with students, teaching, conducting research, travelling in Lebanon, crossing the demarcation line dividing the city, participating in nonviolent peace initiatives, spending time in the shelter when shelling became too violent, sharing the anguish and suffering of friends and relatives, gave me insights I might not have had otherwise. It led to a conviction that only peaceful means could bring about a solution to Lebanon and reunite the country. It also showed me the importance of activism for the transformation of society: peace marches, hunger strikes, consciousness raising groups, solidarity among women, singing, writing, crossing the divided city, and most of all, changing the system of rapport between men and women, the values connected with these relations and the confessional structures tied to the concepts of honour, virginity, exclusive property and oppression.

It also became very clear to me that women’s solidarity and an international feminism, uniting women all over the world, are vital in bringing about such changes. I would like to stress the importance of achieving unity in the midst of cultural differences, if we want to provide some hope in ending the war culture which exists all over the world. I became very aware, when in Lebanon, of the strength the peace initiative started by two women from enemy communities had, first on women, and then on the population as a whole, in uniting people towards peace. It is one of the rare times in my life I witnessed the tremendous impact, which values of love and tolerance can have on people.

The activities I have described above--such as going to Lebanon, teaching, researching, living the war, crossing the demarcation line, participating in non-violent peace initiatives, discussing with students and with people directly affected by the war, writing a novel about it, composing songs on the war and performing them in public--undertaken as a result of my concern and suffering over the destruction of my country, are directly involved with the transformation of society. Changing the system and the values behind it requires more time and a long process of in-depth political, economical, psychological, religious, sexual, familial and social transformations established on an understanding of the different factors, causes and links between these various fields. My concern over long range plans to bring about social transformations necessary to end the war system and bring about hopeful and lasting changes to a world falling apart made me undertake this study and analyze the relationship between sexuality, war and literature.

When the English version of my novel The Excised was going into its second edition in 1994, I found myself being faced with mastectomy or lumpectomy, having being diagnosed with breast cancer. These two ectomies are lived by an increasing number of women all over the world, and particularly in the United States. It is the price we pay for modern civilization. The pollution, pesticides, depletion of the ozone layer, nuclear disasters, oestrogen induced carcinogens, mistreatment of nature are finally catching up with us. As Chikwenye Okonjo Ogunyemi well expresses in an article untitled, “Ectomies: A treasury of Juju Fiction by Africa’s Daughters,”: “Cultural determinism becomes the focal point of the politics of ectomy: to cut or not to cut? The mind boggles at Western culture’s playing on women’s bodies: hysterectomies, oopherectomies or ovariectomies, salpingestomies, episiotomies, mastectomies... I envision ectomy as a trope to express the excision, the cutting off, the exclusion attached to woman’s destiny25.” I was too overwhelmed by emotions, fears, anguish, rage, but also a renewed sense of the urgency, beauty and cruelty of life to be able to express what I was going through at the time, except in my journal. My journal became a publication: The Wounded Breast: Intimate Journeys through Cancer. Melbourne: Spinifex Press, July 2001, 543 pages (available as e-book on www.spinifex.com). Voyages en Cancer (Préface Yves Velan). Paris: L’Harmattan, Tunis: Aloès, Beirut: An-Nahar, 2000, 448 pages. Phénix Prize 2001. The link that ties me to all the women around the world was being reinforced in this tribulation and sorrow.

In conclusion I would like to point out that those who suffer the most in wars and violent conflicts are women. They not only bleed from the devastations caused by wars and armed conflicts, often through rapes, torture and death, but they are also often crushed and rendered silent through practices such as crimes of honour, beatings, veils and confinement. It has become urgent to link all these various traumas of our time in order to gain better insights in how to solve them.

FOOT NOTE

25 Chikwenye Okonjo Ogunyemi, “Ectomies: A treasury of Juju Fiction by Africa’s Daughters,”pp.4-5 (Forthcoming article).

Read More About Lupine Publishers Journal of Clinical & Community Medicine Please Click on Below Link:
https://journalofclinicalcommunitymedicine.blogspot.com/

Thursday, 9 March 2023

Lupine Publishers | Occupational Health and Nutritional Status of Traffic Policemen

 Lupine Publishers | Journal of Clinical & Community Medicine


Abstract

Health is the level of functional and metabolic efficiency of a living being. in humans, it is the general condition of person in mind, body and spirit, usually meaning to being free illness, injury or pain. With the increase in urbanization, many cities around the world are experiencing a very rapid growth in the number of vehicles which lead to serious traffic congestion problems. This is the reasons to accept that occupational environment also plays a major role on the health of the exposed. The health hazard get more sever when the duration of exposure increases. This fact is more important in situations as the personnel engaged in traffic duty. The traffic is exposed to vehicular pollution in varied degrees. Among all of them traffic police are unduly and chronically expose to vehicular exhaust pollutants as they remain on duties for longer periods.

Traffic policemen had to undergo physical strain in on environmental polluted by fumes, exhausted of vehicles, use of blowing horns, blow of dust in the air by a speeding vehicle.

The present study shows that traffic policemen and office worker have not better nutritional status there are deficient nutrient intake and many health problems. The possible reasons are poor physical activity, work pressure, pollution, long hours in standing position and lack of knowledge OF nutrients. There are lack of deficiency in calcium, β-carotene, and protein. The fat intake was high.

Introduction

Health is the level of functional and metabolic efficiency of a living being. in humans, it is the general condition of person in mind, body and spirit, usually meaning to being free illness, injury or pain (as in “good health”). The world health organization defined health in its broader sense in 1946 as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. The maintenance and promotion of health is achieved through different combination of physical, mental and social wellbeing, together sometimes referred to as the “health triangle”.

With the increase in urbanization, many cities around the world are experiencing a very rapid growth in the number of vehicles which lead to serious traffic congestion problems. To ensure a steady move on the traffic congestion, the traffic police have work in midst of hundreds of noisy and polluting vehicles throughout their working hours.

This is the reasons to accept that occupational environment also plays a major role on the health of the exposed. The health hazard get more sever when the duration of exposure increases. This fact is more important in situations as the personnel engaged in traffic duty.

The traffic is exposed to vehicular pollution in varied degrees. Among all of them traffic police are unduly and chronically expose to vehicular exhaust pollutants as they remain on duties for longer periods [1].

Nowadays, noise pollution is considered as one of the main problems of urban communities which has many hazardous effects on the urban environment and may results in a great deals of cost on the society [2] traffic can be considered as the main source of noise pollution in large cities. According to the researches, noise pollution caused by traffic is one of the major problems in the southern large cities of Sweden. In another research conducted in 2004 in the same country, in addition to the big cities of Sweden, the researchers have demonstrated that noise effects will limit the episodic memory [3] . The traffic policemen in metropolises are the most affected groups exposed to this dangerous factor during their working hours and in their leisure time. Ingle et al. [4] have been policemen measured the noise dose received by this group as 88 dB and, in some cases, it has been increased up to even 100 dB [4]. Statistic results published by organization for economic Co-operation and Development( OECD) in 1994 specified that more than 17 million people in France are exposed to sounds louder than 55Db during 8-20 hours of their lives, whereas the minimum standard noise for the problems of noise pollution in the environment is 55dB [5]. Canadian hearing society (CHS) researchers had considered urban environment as crowded, busy and noisy. Jack hammers pounding, sirens whining, alarms ringing, subway trains screeching, aircraft zooming overhead, car horns honking are a few of the annoying and potentially hazardous sounds face to dwellers. Moreover, it was concluded that the noise in some parts of these cities is so much that can lead to long- lasting and effects on the citizens and in places like masonry workshops and the shopping centres as 81 dB. Regarding to the sound standards 9 less than 55 dB) determined by world health organization (WHO), studying of the urban environmental noise become significant [5]. In a similar research conducted in Spain, it was demonstrated that the noise resulted from traffic can lead to physical and mental effects on the individuals stated that the speed of the vehicles, the traffic load, the number of trucks and the road surface were also the main factors of traffic noise in Beijing.

Materials and Methods

A. General information: information regarding general profile of respondent was collected by interviewing using standard questionnaire of information, age sex, occupation, type of work, hours of work per day, place and shift etc.

B. Study population: Traffic policemen working in Kanpur city.

C. Sample selection: sample was selected by purposive random sample techniques total 150 respondents was selected, 90 traffic policemen and 60 traffic policemen from office.

D. Nature of Job:

Traffic policemen- traffic policemen worked for 8 hours continuously working days 6 days (one week) for working this is nature of work continuously standing on land of city day come in to contact of outdoor exposed to vehicular exhaust pollution, and physical or chemical agent at their work place.

Office worker: office workers doing 8 hours a day for 6 days( one week) working in room or chamber so they do not exposed to vehicular exhaust pollution, noise pollution or any other physical, chemical agents at work place.

E. Clinical Examination

It is important practical method for assessing the nutritional status of community and the method is based on examination for changes believed to be related to inadequate nutrition. Clinical examination consists of physical examination. In order to find nutritional adequacy clinical examination was done. Hair was examined for lock of lustre, thinness, easy pluck ability etc. Face was examined for diffuse dispigmentation, dry face. Eyes were examined for conjuctival xerosis, bitot spot. Lips are examined for angular stometitis, glositis. Skin was examined for roughness, dryness, and dispigmentation. Tongue was examined for magenta tongue, pigmented and row tongue. Gums were examined for purplish swelling, bleeding gums. Nails were examined for shine less and normal.

F. Nutritional information: The present study nutritional information and diet survey was conducted by using repeated twenty four recall method and food frequency method.

G. Food frequency methods: the respondent was also asked frequency of intake of various food groups during interview of session. Frequency of consumption of non vegetarian food was also noted.

H. Statistical analysis: Data was analysed using

a. Percentage-

b. Chi-square test

c. Correlation coefficient

Deficient Percent = RDA-nutrient(average)/RDA ˟ 100

Result and Discussion

Clinical assessment

Distribution of respondent on the basis of symptoms

The table 1 reveals distribution of respondents on the basis of eye symptoms. In traffic policemen group 24.4 percent respondents were having water discharge, 22.2 percent respondents were having bitot spot, 26.7 percent respondents were having eye sight weak, 16.7 percent respondents were having normal eye. In office worker 20 percent respondents were having water discharge, 15 percent respondents were having bitot spot, 40 percent respondents were having eye sight weak and 25 percent respondents were having normal eyes [6, 7].

It found in the table distribution of respondents on the basis of assessment of lips. In traffic policemen group maximum 60 percent respondents were having normal lips, 13.3 percent respondents were having cheilosis and 15.6 percent respondents were having cracked 11.1percent respondent were having normal lips.

In office worker group maximum 46.7 percent respondents were having normal lips 28.3 percent respondents were having cheiloses lips 16.7 percent respondents were having cracked lips. 8.3 percent respondents were having normal lips.

The assessment of hair of the respondent table reveals that in traffic policemen group, maximum 40 percent respondent were having normal hair, 20 percent respondents were having rough hair,10 percent were having loss of lustre their 7.8 percent respondents were having thick hair 22.2 percent respondents were having other hair problem. Office worker group maximum 47 percent respondents were having normal hair, 22 percent respondents were having rough hair, 13 percent respondents were having loss of lustre hair 10 percent respondents were having thick hair, 8 percent respondent were having no other problems of hair.

Table 1:

lupinepublishers-clinical-community-medicine

Table 1 shown in traffic policemen group maximum 33.3 percent respondents were have normal teeth,22.2 percent were have carries in their teeth, 27.8 percent respondents were have dirty teeth, 16.7 percent respondents were have other related to teeth problem.

In office worker maximum 30 percent were having normal teeth, 15 percent respondents were have carries in hair teeth, 40 percent respondents were have dirty teeth, 15 percent respondents were have other problem related to teeth.

Table 1 shown in the distribution of respondents on the basis of gums. In traffic policemen group maximum 36.7 percent respondents were having normal gums, 16.7 percent respondents were having bleeding gums, 14.4 percent respondents were having swelling gums, and 11.1 percent respondents were having pyorrhoea problem in gums. 21.1 percent respondents were having bad smell problems in gums. In office worker group maximum 35 percent respondents were having normal gums, 10 percent respondents were having swelling in the gums, 20 percent respondents were having bad smell in gums.

Assessment of tongue of the respondent table reveals that in traffic policemen group, 7.8 percent respondents were having scarlet and raw tongue, 16.8 percent respondents were have pigmented tongue, 11.1 percent respondents were having magenta tongue, maximum 64.4 percent respondents were having normal.

Office worker group 10 percent respondents were having scarlet and raw tongue, 20 percent respondents were having pigmented tongue, 26 percent respondents having magenta tongue, maximum 35 percent respondents having normal tongue.

The table 1 reveals distribution of respondents on the basis of appearance of face, in traffic policemen group of maximum 40 percent respondents were having normal face, 13.3 percent respondents were having dull face, 30 percent respondents were having dry face, 17.7 percent respondents were indicated other symptoms of face.

In office worker group maximum 56.7 percent respondents were having normal face, 15 percent respondents were having dull face, 18.3 percent respondents were having dry face, 10 percent respondents were indicated other symptoms of face.

In the assessment of respondents on the basis of nails the table indicate in traffic policemen group 37.8 percent respondents were having brittle and ridged nail, 26.7 percent respondents were having having shineless nails, 22.2 percent respondents were having normal nails, 13.3 percent having other nails problem. In office worker group 11.7 percent respondents were having brittle and ridged and 30 percent respondents were having shineless nails, 33.3 percent respondents were having normal nails and 25 percent respondents having other nails problems.

In the assessment of respondents on the basis of skin the table indicate in traffic policemen group 36 percent respondents were having dispigmented skin, 18 percent respondents were having wrinkled skin, 10 percent respondents having dry skin, 7.8 percent respondents having normal skin and 22.2 percent were having other skin problem. Office worker group 47 percent respondents were having dispigmented skin, 22 percent respondents having dry skin, 10 percent respondents having normal skin and 8 percent having other skin problem.

Intake of Nutrient Compared with Recommended Dietary Allowance

Table 2:

lupinepublishers-clinical-community-medicine

(Table 2)

The information collected by survey which represented the difference of intake of nutrients in traffic police male and female .the survey value compared with RDA value and found deficient percent and non- deficient percent

Energy value compared to RDA value found that 6.08 percent increment in traffic police male and 10.6 percent deficient in traffic police female. Whereas, the protein intake value compared with RDA value found deficient 13.3 percent in traffic police female. After the value fat intake compared with RDA and found 21 percent in traffic police male and 11.15 percent increment in traffic police female. In calcium comparison found 22.2 percent deficient in traffic police male and 27.5 percent deficient in traffic police female. The iron value comparison with RDA value found 14 percent increment in traffic police male and 29.2 percent deficient police female. Β-carotene value compared with RDA value 18.75 percent deficient in traffic police male and 28.12 percent deficient in traffic police female. Vitamin-C value compared with RDA value 23.5 percent deficient in traffic police male and 27.5 percent deficient in traffic police female.

In the difference of nutrient intake in office worker, male and female. The survey value compared with RDA value and found deficient percent and increment energy value to RDA value found that 9.91 percent increment in office worker male and 8.5 percent increment in office worker female whereas, the protein intake value compared with RDA 12.6 increment found in office worker male and 14.7 increments found in office worker female.

In calcium comparison found 20.75 percent deficient in office worker male and 15.2 percent deficient in office worker female. The iron value comparison with RDA found 43.3 percent office worker female beta- carotene compared with RDA value 41.5 percent deficient in office worker male and 38.7 percent deficient in B- carotene. Vitamin-c value compared with RDA value 8.37 percent increment in office worker male and 74.5 percent increment in office worker female.

Conclusions

Health is very important for everybody. The work environment consistories on important part of mans total environment, this fact is more important in situation as the personal engaged in traffic duty.

Traffic policemen had to undergo physical strain in on environmental polluted by fumes, exhausted of vehicles, use of blowing horns, blow of dust in the air by a speeding vehicle.

The present study shows that traffic policemen and office worker have not better nutritional status there are deficient nutrient intake and many health problems. The possible reasons are poor physical activity, work pressure, pollution, long hours in standing position and lack of knowledge OF nutrients. There are lack of deficiency in calcium, β-carotene, and pro tein. The fat intake was high.

Read More about Lupine Publishers Journal of Clinical & Community Medicine Please Click on Below Link:
https://journalofclinicalcommunitymedicine.blogspot.com/