Immediate and Mid-Term Effect of a Natural Topical Product in Patients with Musculoskeletal Pain: Randomized, Double-Blinded, and Placebo-Controlled Clinical Trial - Juniper Publishers

 Orthopedics and Rheumatology - Juniper Publishers

Abstract

Introduction: Musculoskeletal pain is a common affection due to ageing, sedentarism and injuries. The objective of this trial is to prove efficacy of a natural topical composition containing Arnica montana, Hypericum perforatum, Calendula officinalis, Melaleuca sp. and menthol in pain management in adults with acute or chronic pain.

Methods: This randomized, double-blinded and placebo-controlled trial included 200 patients with musculoskeletal pain, 100 in the intervention group receiving the topical formula and 100 in the placebo group, receiving a similar formula without active ingredients. The products were applied topically twice daily for 14 days in affected areas. Immediate pain alleviation and stiffness perception were monitored for two hours at days 0, 7 at 14. Pain reduction and recovery perception upon sustained application were assessed after 7 and 14 days.

Results: Intervention immediately reduced pain and stiffness at rest and in motion 30 minutes after application and kept being superior to placebo in all short-term timepoints (p < 0.05). Immediate pain reduction was maintained even at late stages of recovery. A two-week sustained intervention resulted in significant pain reduction and improvement in recovery perception. Even if both groups reached statistical significance with respect to baseline due to spontaneous lesion recovery, a significantly improved recovery was reported in the intervention group with respect to placebo.

Conclusion: Intervention was found to reduce pain and stiffness upon minutes of its application and to improve pain and mobility over the 14 days of treatment, showing benefits both for immediate alleviation and for longer term recovery.

Keywords: Musculoskeletal pain; Chronic pain; Joint mobility; Massage; Rehabilitation

Level of Evidence: Therapeutic Level I

Abbreviations: NSAIDS: Non-steroidal anti-inflammatory drugs, SEM: Standard Error of the Mean; VAS: Visual Analog Scale

Introduction

Well-being is understood as the absence of limitations or debilitating conditions that make impossible to enjoy a full and satisfactory life. Among these limitations, a reduced or impaired motility because of painful and inflammatory processes (acute and chronic), can greatly disturb a vital and optimistic attitude. Chronic pain affects between one-third and one-half of the population only in the UK [1], and around 20.4% in the US [2]. It is likely to increase with population ageing and tends to be more common in women [3]. Ageing is translated in an increase in the incidence and span of chronic illnesses, including osteoarthritis, [4] fibromyalgia, [5] lower back pain, [6] non-arthritis joint pain or carpal tunnel syndrome [7], among others. In addition, muscular and joints pain unrelated to any specific disease also tends to appear with age [8]. Beyond that, current lifestyle frequently involves stressful jobs, eventful agendas and non-stop activity either in professional or leisure time. These facts extend the prevalence of chronic pain to younger segments of the population and to people not affected by previous disease.

Sedentary lifestyle and computer-based jobs represent a common cause of muscular contractures and pain, especially in the back and neck areas [9,10]. Another important contributor to chronic pain is perceived stress and anxiety response systems [11–13]. As an emergent antagonist phenomenon, increasing awareness of a healthy lifestyle has entailed a rise in the popularity of physical exercise in the last decades. As an example, the number of running events finishers in the U.S. stabilized in 2014 at almost 20 million people, with figures having been on the rise for the previous 25 years [14]. The popularization of exercise programs such as CrossFit [15] illustrate that the trend is directed not only towards a rise in practice, but also in intensity. Thus, the increase in the practice of high-intensity physical activity and the alternation between sedentary and exercise periods involve an increase in inflammatory and acute painful episodes, being tendinitis and joint lesions the major problem, followed by sprains or bruises [16].

The pharmacological management of these conditions involves nonsteroidal anti-inflammatory drugs (NSAIDs), local corticosteroids, acetaminophen, chondroitin sulfate or even opioids [7,17,18]. These are effective drugs but with serious side effects in some cases, especially in the long-term utilization [19]. Severe drawbacks related to the prolonged utilization of these drugs include drug ineffectiveness, toxicity of certain agents, hypersensitivity, gastrointestinal hemorrhage, nauseas and even fatal outcomes including death and suicide. Importantly, increased abuse of painkillers has been reported in several countries, exceeding tobacco consumption and being considered a public health problem [20–22]. Furthermore, the use of painkillers should be avoided in sensitive population groups including children and pregnant women, who are equally exposed to sustained or acute pain episodes.

Alternative solutions of greater safety but equivalent rapid relief and recovery effectiveness are a necessity. In this sense, the most useful approach are natural products, without tolerability concerns, compatible with other interventions and providing a rapid effect. These generalize access to effective treatment to both patients and physiotherapy professionals. Considering the wellestablished beneficial effects of physiotherapy in handling chronic pain [23], professionals need effective and safe solutions that they can use without concerns of side effects or pharmacological interactions, since they may not have access to the full medical record of the patients. In turn, the ability of handling selftreatment without concern increases the quality of life in patients suffering from pain-involving conditions.

This study evaluates the use of a topical cream composed by natural extracts with complementary and synergistic effects for pain management. Menthol reduces pain and increases blood flow, warming up the muscle and enhancing absorption of the rest of the extracts [24–28]. Arnica montana reduces pain, has anti-inflammatory effects and potentiates tissue repair [29,30]. Hypericum perforatum provides anti-inflammatory effect and drives tissue regeneration and scarring [31–34]. Calendula officinalis reduces swelling and distension, boosts healing of mild injuries and prevents infection [35–38]. Finally, Melaleuca alternifolia complements the anti-inflammatory effect and acts as a natural preservative due to its potent antimicrobial effect [39–42]. The synergistic combination of these natural ingredients may provide a convenient solution for the management acute or chronic pain. The aim of this study is to assess the benefits of the topical formulation in reducing musculoskeletal pain, both as an immediate relief of pain and as a solution for injury recovery.

Methods

Study design

This prospective double-blinded, randomized, placebocontrolled, multi-centric clinical trial was conducted in the Rehabilitation Center of the Quironsalud Hospital of Barcelona and other centers of the Quironsalud network in Spain. The main objective of the study was to demonstrate efficacy of the topical cream Fisiocrem^® to reduce perceived pain in patients suffering from moderate or severe musculoskeletal pain in the short and medium term. Secondary outcomes assessed efficacy in reducing immediate pain, improving joint mobility and flexibility and evaluated recovery perception.

Subjects

Target sample size was n = 200 patients, 100 in the intervention group and 100 in the control group, allocated on a 1 to 1 ratio. Inclusion criteria were as follows: men or women above 18 years old, with acute or chronic musculoskeletal pain scoring above 4 in the Visual Analogue Scale (VAS) and with a diagnostic of either tendinopathy, vertebral algias, sprains or symptomatic osteoarthritis. Exclusion criteria were a diagnostic in either neuropathic chronic pain, fibromyalgia or neoplasia, or an allergy to any ingredient in the formula. Sample size was calculated by accepting an alpha risk of 0.05 and a beta risk of 0.2. In a two-sided test and based on previously reported results with NSAIDs, 200 subjects are necessary to find a statistically significant difference in the proportion of pain reduction between groups. No drop-out rate has been considered.

Materials

The study product was Fisiocrem^®, a topical cream composed of natural ingredients for the management of pain and inflammation by massaging the affected area (i.e. muscles, joints and tendons). Patients were randomly assigned, using the Excel (Microsoft) RAND function, into 2 groups: treatment group (Fisiocrem^®) and placebo group, a topical cream with similar characteristics and aspect, without active ingredients.

Allocation was concealed from the recruiter and participants.

Procedure

The study product was given in visit 1 (day 0), and during the next 14 days it was applied twice per day to the muscular or joint areas with moderate or severe pain, while exerting a light massage. Its effects were monitored up to two hours after application in three programmed visits (days 0, 7 and 14).

Study outcomes

The primary endpoint was defined as pain reduction after intervention, considering both pain at rest and in motion. This was monitored at two timescales, defined as immediate pain alleviation and sustained pain reduction. The former was monitored using a Faces Pain Scale obtained at 0.5, 1 and 2 hours after product application in each visit. The latter was assessed by subjects completing a VAS two hours after the intervention at each visit day. Both the Faces Pain Scale and the VAS evaluate pain with scores ranging from 0 to 10, with higher values indicating more pain.

Secondary endpoints were also assessed at the immediate and sustained timescales. In each visit day, the immediate intervention effects on stiffness (both at rest and in motion) were assessed at 0.5, 1 and 2 hours using a stiffness scale, being (0) no stiffness, (1) slight stiffness, (2) moderate stiffness and (3) severe stiffness.

Sustained intervention effects were monitored two hours after product application at each visit day. Joint mobility was assessed by evaluating passive joint balance in a scale ranging from 1 to 4, with the lowest score (1) corresponding to free mobility, (2) partial limitation, (3) moderate limitation and (4) severe limitation. Global perception of recovery after 7 and 14 days was measured using a Likert scale, in which (1) meant fully recovered, (2) much better, (3) better, (4) same as before and (5) worse than before.

Instructions of recording adverse effects (if any) were given to the investigators.

Statistical analysis

stiffness) were analyzed using a cumulative linear mixed model. The significance of the effect of immediate product application as well as of one and two weeks of sustained intervention on the response endpoints was evaluated through Wald tests. A significance value of 0,05 (95% confidence) was established for all measurements. The analysis of clinical efficacy has been carried out with the analysis of efficacy in ITT population, including 200 patients (n = 100 per group).

Ethical considerations

The study was conducted in accordance with the Declaration of Helsinki, ethical standards, current legislation and GCPs. The study was approved by the Ethics Committee of the Quironsalud Group, and informed consent was obtained from all patients prior to their enrolment. Patients were informed that they could quit the study at any time and for any reason.

Trial registration

This trial was approved by a local Ethical Committee with an Ethical approval sanctioned number 58/2019. This trial is registered in ClinicalTRials.gov PRS with registration number NCT04683263, as of 24th December 2020 (retrospectively registered) with URL https://www.clinicaltrials.gov/ct2/show/ NCT04683263.

Results

Participants

200 patients were assessed for eligibility and randomized into the intervention (n = 100) and placebo (n = 100) groups. 12 volunteers did not attend visit 1, which resulted in 98 patients in the study group and 90 patients in the placebo group. Statistical analysis was performed on an ITT protocol, including 100 patients per group.

Baseline data

No differences between groups with regards to demographic data, and baseline data of pain and stiffness before the intervention were found (Table 1).

Alleviation of symptoms in the short-term

Immediate alleviation of pain at rest

Significant differences between the intervention and placebo groups were found after 30 min (25% variation), 1 hours (27%) and 2 hours (27%) on the first day of application (Figure 1A). After one-week, significant differences were already present before applying the formulas (12%) due to a sustained pain reduction effect (see below). The differences between the two groups increased after 30 min (30%), 1 hour (33%) and 2 hours (34%). After two weeks, the group difference was even more obvious before product application (26%), after 30 min (43%), 1 hour (48%) and 2 hours (48%). Within each group, differences among the 0, 0.5, 1 and 2 hours timepoints were always significant in the intervention group, while no statistical significance was observed for the placebo group at days 7 and 14. This indicates sustained effectivity of the formula even at advanced stages of lesion recovery.

NS = not significant (p > 0.05) as evaluated using a two-tailed t-test (demographic data) or a Wald test (endpoint scores). (a) Pain parameters are reported in the Faces Pain Scale: (0) means no pain, (2) a bit of pain, (4) quite some pain, (6) quite much pain, (8) so much pain and (10) worst pain imaginable. (b) Subjective perception of stiffness scale: (0) no stiffness, (1) slight stiffness, (2) moderate stiffness and (3) severe stiffness. Some volunteers did not provide full demographic data.

Immediate alleviation of pain in motion:

Variations between the intervention and placebo groups were already significant after 30 min (17%), 1 hours (20%) and 2 hours (22%) on the first day of intervention (Figure 1B). After one and two weeks, a sustained pain reduction effect (see below) implied that significant differences were already present before applying the formula (11% and 22% for days 7 and 14, respectively). Such differences were increased after 30 min (23% and 35%) 1 hour (26% and 41%) and 2 hours (19% and 40%). Within each group, while differences among the monitored timepoints were significant at all visits for the intervention group, at day 14 they were not for the placebo group. Again, this supports the sustained effectivity of the formula for pain alleviation.

Immediate effects on stiffness at rest

On the first visit, significant differences between the intervention and the placebo groups were already found 30 min after product application (19% of variation) and increased after 1 hour (22%) and 2 hours (25%) (Figure 1C). At days 7 and 14, significant differences were present before application (20% and 33%), thus indicating sustained stiffness reduction effectivity of the formula. Differences increased after 30 min (31% and 42% for days 7 and 14, respectively) 1 hour (36% and 44%) and 2 hours (38% and 40%). Of note, differences among timepoints were not significant for the placebo group at any study stage. Conversely, a significant stiffness reduction with time was observed in the intervention group at days 0 and 7. At day 14, significant differences were found only after 1 hour of product application,probably due to the reduced improvement margin left for lesions in an advanced recovery stage.

Immediate effects on stiffness in motion

On day 0, significant differences between groups were observed already after 30 min (20%), which increased after 1 hour (21%) and 2 hours (24%). After one and two weeks of treatment, significant differences were already observed at time 0 (20% and 28% for days 7 and 14, respectively) due to the sustained effectivity of the formula at reducing the perception of stiffness in motion. Differences between groups increased after 30 min (31% and 38%), 1 hour (34% and 37%) and 2 hours (36% and 34%). Within groups, timepoint differences were never significant for the placebo group, while in the intervention group they were consistently significant throughout day 0 and after 1 hour of product application on day 7. Again, this indicates that the formula is effective at reducing stiffness on early lesion recovery stages (Figure 1D).

Effects of sustained intervention

The effects of the sustained intervention (twice a day for 14 days) are summarized in Table 2. Pain (both at rest and in motion) was evaluated using a VAS scale two hours after intervention at each visit day. For both pain variables, differences between the intervention and the placebo groups were already present two hours after the first application (day 0) and kept being consistently significant throughout the time period of the study, thus evidencing the superior effect of the formula. Within each group,significant differences between the day 0, 7 and 14 timepoints reflect the progression of lesion recovery. Joint mobility was also evaluated after two hours of intervention at each visit day, using a passive joint balance scale. Timepoint differences within groups reflected lesion recovery progression, even if differences between groups were not significant. Finally, a Likert scale was used to measure the recovery perception. Differences between groups were consistently significant throughout the study, indicating formula superiority.

Statistical differences between intervention and placebo: *p < 0.05, **p < 0.01 Statistical differences between Day 7 or Day 14 and Day 0: #p < 0.05, ##p < 0.01.

Safety and Tolerability

No adverse effects were observed throughout the study. Volunteers reported an overall good perception of the treatment, and no compliance or tolerability issues were detected.

Discussion

The design and characteristics of the study respond to the interest of demonstrating the analgesic and reparative functionalities of Fisiocrem^®, formulated with natural plant extracts. According to the intrinsic product characteristics, its application route and the final objective - accelerate muscle and articular lesions recovery, which takes place naturally over time - it is essential to use a placebo group with which to neutralize possible biases attributable to psychological and physiological factors.

In accordance with the contrasted properties of its active ingredients, Fisiocrem^® is formulated to favour lesion recovery. It provides a pleasant sensation of relief and well-being immediately after its application, thus meeting an heterogenous need in a wide range of patients. For this reason, inclusion criteria were designed to enrol patients suffering ailments in multiple anatomical locations, chronically or in acute timeframe. The primary objective of the study was to assess the ability of Fisiocrem^® to reduce pain during lesion recovery or improve debilitating chronic disfunctions. The product has been formulated to reduce inflammation and improve tissue repair through the synergic action of its natural components (Menthol, Amica Montana, Hypericum perforatum, Calendula officinali and Melaleuca alternifoliaii). This study has been designed to monitor the evolution of lesions and injuries at two timescales while avoiding or minimizing masking effects. On the short timescale, our results show the immediate efficacy of Fisiocrem^® in alleviating both pain at rest and in movement (Figures 1A & B). On the long term, a sustained application of Fisiocrem^® for two weeks results in a superior alleviation of pain when compared to placebo (Table 2).

Together with significant improvements in stiffness alleviation in the short term (Figures 1C & D) and recovery perception in the long term (Table 2), these data provide a clear vision of the statistical but also physiotherapeutic relevance of the results in all the parameters tested. Even when the placebo group is experiencing a good percentage of improvement due to spontaneous recovery, in all cases Fisiocrem^® exceeds the placebo results becoming a superior solution.

To fully understand the range of applications of Fisiocrem^®, the fast pain relief becomes essential. This property presents a double value. On the one hand, to encourage patient adherence to treatment and thus facilitate its reparative action and recovery from injury. On the other hand, this provides patients and physiotherapy professionals with a solution to improve highly disabling pain situations, constituting an alternative to pharmacological principles but with a much safer profile. Thus, the safety profile of Fisiocrem^®, with no limit in the number of daily applications, offers a quantum satis solution for pain relief. On this regard, as summarized in Figure 1, the simple application of the placebo product by means of a massage improves the subjective perception of the patients in each one of the analysed parameters from 30 to 120 minutes, which can be explained considering natural lesion recovery. However, the efficacy for rapid relief of the extracts formulated in Fisiocrem^® (menthol and Arnica montana) presents better results than the placebo in all days and times tested. This observation reinforces the product proposal as an alternative to systemic, safety-limited, pharmacologic treatments such as NSAIDs. Concomitantly, the immediate reduction of pain or stiffness perception after product application is significant regardless of spontaneous lesion recovery over time only in the intervention group, since improvement reported by the patients receiving the treatment keeps its clinical relevance along the trial. This highlights the efficacy of Fisiocrem^® at reducing pain even at advanced stages of lesion recovery.

Along with immediate symptom relief, our results show that Fisiocrem^® efficiently reduces pain and improves recovery perception when applied in a sustained manner for two weeks. Thus, this provides patients with a solution to self-treat injuries on a daily basis, while it serves physiotherapy professionals as a reliable tool to be applied alongside professional massage in discrete visits during treatment. While the present study provides evidence of the benefits of Fisiocrem^® for pain management, some aspects of the study design may limit its interpretation. Regarding the studied cohorts, despite being integrated by patients with heterogeneous characteristics the study groups are comparable according to baseline data. However, a classification of subjects into groups of acute or chronic pain would allow an independent analysis of the recovery and short-term perception in each group of patients, which could help identify benefits and particularities of the product in chronic or acute pain or lesions, respectively.

Future trials enrolling patients affected by chronic musculoskeletal pain or debilitating conditions requiring larger periods of recuperation should include longer periods of monitoring, allowing to determine and identify the limit of recovery attributable to the product of application and not to the spontaneous resolution of the injury. Some limitations also arise with regards to the interpretation of the fast recovery after product application. In line with the previous observation, a longer follow-up than 2 hours after the application of Fisiocrem^® would help determine the duration of its relief effect and would make possible to even consider a head-to-head comparison with pharmacologic treatments. Fisiocrem^® has been shown to be safe and efficacious for pain management and recovery of lesions of different origin. Its effects over time make it an ideal natural approach for the improvement of pain and disability that can be safely applied home by the patient daily.

Conclusion

The immediate alleviation of pain and stiffness conferred by Fisiocrem^® implicates that the product is an optimal solution both for reducing the pain caused by the lesion itself but also for alleviating the discomfort that the therapy may cause. In addition, and due to its dual action, alleviation and recovery, Fisiocrem^® meets the requirements for home, professional and combined use.

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Comprehensive Review on Turmeric (Curcuma Longa l.) as Medicinal Plant and its Nutraceutical Quality to Human - Juniper Publishers

 Cancer Therapy & Oncology - Juniper Publishers

Abstract

The objective of this comprehensive review assesses research analysing the nutraceutical qualities and bioactive compounds within turmeric that contribute to human nutrition, health promotion and chronic disease prevention. Curcuma longa L. (root and rhizome), commonly known as turmeric, is a plant of high medicinal and economic value globally, where it is mainly used as a spice and food supplement. The major active ingredients of turmeric include three curcuminoids; curcumin (diferuloylmethane, the primary constituent responsible for yellow color of turmeric), demethoxycurcumin, and bisdemethoxycurcumin. In addition, volatile oils (tumerone, atlantone, and zingiberene) also have pharmacological activity. In addition, carbohydrates, proteins, and resins are also present in turmeric. Turmeric has excellent anti-inflammatory properties and is a superior antioxidant. The anticancer property of turmeric may be closely related to its anti-inflammatory property.

Keywords: Curcumin; Turmeric; Spice; Anti-oxidant

Introduction

Turmeric is a spice that is spread throughout the world’s tropical and subtropical regions. In Asian countries, it is widely cultivated, primarily in China and India. With a short stem, the plant measures up to 1 m long. Turmeric is an important spice throughout the world, particularly among the Eastern people, with a distinct human use [1]. In many Asian dishes, turmeric is one of the main ingredients, imparting a mustard-like, earthy aroma and pungent, slightly bitter taste to foods. Most of it is used in savory dishes, but some sweet dishes, such as the cake sfouf, are also used. In India, turmeric leaf is used by layering rice flour and coconut-jaggery mixture on the leaf to prepare special sweet dishes, patoleo, and then closing and steaming it in a special utensil [2]. Most of the turmeric is used to impart a golden yellow color in the form of rhizome powder. It is used in a wide variety of products, including canned drinks, baked goods, dairy products, ice cream, milk, yellow cakes, orange juice, cookies, popcorn, sauces, cereals, and gelatin. It is a primary ingredient in curry powders, while turmeric is often used fresh, such as ginger, usually used in its dried, powdered form [3].

Curcuma longa Linn. (Turmeric) is a member of the Zingiberaceae family. In terms of medicinal properties, the plant has a lot of promise. Its anti-inflammatory, cholagogue, hepatoprotective, blood-purifying, antioxidant, liver tissue detoxifier and regenerator, antiasthmatic, anti-tumor, antiprotozoal, stomachic, carminative properties are revealed in literature. It decreases elevated plasma cholesterol levels. Its antiplatelet activity provides the heart and arteries with protection. In lymphocytes, it also prevents DNA damage. Curcumin (a flavonoid) [4] is found in many constituents present in this plant. The turmeric powder is about 60-70% carbohydrates, 6-13% water, 6-8% protein, 5-10% fat, 3-7% dietary minerals, 3-7% essential oils, 2-7% dietary fiber, and 1-6% curcuminoids [5]. The Diarylheptanoids, a class of various curcuminoids, such as curcumin, demethoxycurcumin, and bisdemethoxycurcumin, contain phytochemical components of turmeric [5].

Curcumin accounts for up to 3.14% of assayed commercial turmeric powder samples (the average was 1.51%); curry powder contains much less turmeric powder (an average of 0.29 percent) [6]. There are some 34 essential oils in turmeric, the main constituents of which are turmerone, germacrone, atlantone, and zingiberene [7-9]. Furthermore, nutrients present in turmeric do more than just resist diseases of deficiency. It has an elevated dietary status that can be abused. Curcumin contains vitamins or vitamin precursors which, together with fatty acids and essential oils, produce vitamin C, beta-carotene and polyphenol. Compared with other spices, turmeric is a good source of spice. It was regarded as an under-exploited spice, although it was consumed in Africa and some sub-Saharan countries. It was probably one of the tropical crops that was most underutilized. Leaves are a great source of minerals and vitamins [10].

Antioxidant activity of Turmeric

It has been shown that curcumin is an effective scavenger of oxygen free radicals. Its antioxidant function is like that of vitamins C and E. It can protect against oxidation by lipids or hemoglobin. The generation of reactive oxygen species (ROS) such as H2O2, superoxide anions and nitrite radical generation by activated macrophages can be significantly inhibited. There are also antioxidant activities of the curcumin derivatives, bisdemethoxycurcumin and demethoxycurcumin [11]. Curcumin pre-treatment has been shown to minimize the oxidative stress and changes in the heart caused by ischemia [12].

Anti-cancer effect of Turmeric

The activity of many common mutagens and carcinogens can be suppressed by turmeric and curcumin. Direct antioxidant and free-radical scavenging effects and their ability to indirectly increase glutathione levels have been correlated with the anticarcinogenic effects of turmeric and curcumin, thereby aiding in hepatic detoxification of mutagens and carcinogens and inhibiting nitrosamine production. It has also been shown that curcumin inhibits UV rays’ mutagenic induction effect [13-16].

Inflammatory and Edematic Conditions

Curcumin is a potent anti-inflammatory with specific inhibitory properties of lipoxygenase- and COX-2-. Invitro and in vivo trials have shown their effect on the reduction of both acute and chronic inflammation [13].

Photo-protection activity of Turmeric

This behavior is due to its role as an antioxidant. The lipids on the surface of the skin are mostly unsaturated. Therefore, free radicals strike them quickly. The sun’s ultraviolet rays penetrate the skin and increase the harm these radicals do. Prolonged exposure to such radiation will weaken lipids, resulting in a degradation of the skin’s texture. In laboratory studies, turmeric extract has been shown to be effective in suppressing inflammation and protecting epidermal cells from ultraviolet B-radiation damage [17]. Moreover. Curcumin has been shown to protect against chromosomal damage caused by gamma-radiation in small doses of turmeric.

Conclusion

Curcumin, which has a yellow color and is the basic component of this plant, is considered the coloring concept of turmeric. The yellow pigment associated with curry powder, turmeric, and, to a lesser degree, ginger, is curcumin. Turmeric’s anti-cancer, antiinflammatory and photo-protection role may be closely linked to its antioxidant properties [17].

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The Impact of Body Diversity of Female Media Characters on Preadolescent Self-Esteem: An Assessment of Children’s Television Content - Juniper Publishers

 Gynecology and Womens Health - Juniper Publishers

Abstract

There are more forms of media bombarding children than ever before in history, yet not enough of the media has focused on a preadolescent audience. Furthermore, of the content targeting preadolescents, we do not know if it is well-informed through research on preadolescent television-viewing habits. This manuscript reviews recent research on the female characters portrayed in current children’s television programs and examines the glorification of female thinness that is most frequently perpetuated in non-Hispanic white media. Results from four studies showed greater body dissatisfaction and lower self-esteem among preadolescents who engaged in peer discussions on body image that glorified the thin ideal. Based on these studies, there is evidence that body diversity by showcasing multiculturalism onscreen can combat the Western thin ideal and increase self-esteem, not only by encouraging and celebrating differences in body types and appearance, but also by shifting the focus of peer conversations away from topics on thinness.

Keywords: Pre-adolescence; Children’s media; Diversity; Body image; Learning; Peer influence

Body Diversity in Preadolescent Media

An area of media research that has not yet received adequate attention is pre-adolescent television content. According to Dr. Laurence Steinberg [1], professor of psychology at Temple University, psychological journals tend to focus solely on analyzing adolescents in the context of family and peers, and the hormonal changes they undergo as they emerge adulthood, rather than as independents (p. 84). This inattention for this age group is also portrayed by how television channels dedicated to children are geared more specifically towards younger audiences around the age of preschool and early elementary [2]. Given that there is not yet a consensus on the relationship between youth and the media in psychological research, it is safe to assume that pre-adolescents are within the youth category and are therefore also not given enough recognition. In the Landscape of Children’s Television in the US & Canada, a journal report prepared for The Center for Scholars & Storytellers, media researchers Dr. Dafna Lemish and Dr. Colleen Russo Johnson (2019) confirm that preadolescents are neglected in media research and describe how “tweens often get left out when it comes to programs specifically created for them” (p. 7). The absence of sufficient formative research and programs for preadolescents and children emerging this age range creates a risk of premature exposure to content inappropriate for their comprehension level as children may turn to watching teenage or adult programming inappropriate for their age [2].

Premature exposure to inappropriate television content could ultimately pose as an obstacle to learning [3]. The following studies analyze the effects of current television programs on young audiences, specifically among young girls ranging from 10 to 12 years old. This age range is also defined by Jean Piaget, one of the first child development psychologists, as the developmental stage in which a child would undergo a cognitive transition from the concrete operational stage of mental operation development to the formal operational stage of abstract thought. According to Piaget, until the age of eleven, a child will not yet be able to comprehend abstract and deductive reasoning and will still be establishing mental operations such as reversibility, conservation, and [4]. This theory of cognitive development therefore indicates that children ages 10 to 12 undergo a developmentally crucial transition yet rely on a scarcity of appropriate media programming that may or may not match their cognitive development due to lack of research. Thus, more formative research is necessary in the field of psychology to accommodate this youth population. The following journal articles question the portrayals of body image and diversity in children’s television programs and the effects of television-viewing among preadolescent youth.

Television as a Teaching Tool

The Canadian Paediatric Society (2003), a national association of over 3,000 pediatricians focused on care for children, published a position statement in 2003: “Impact of media use on children and youth”, with the goal of evaluating the role that technological devices play in the educational environment of young audiences. The association found that “a substantial number of children begin watching television at an earlier age and in greater amounts than what experts recommend” (p. 301). While the CPS does not explicitly argue whether early exposure generates positive or negative effects on learning, Samantha Goodrich [5] posits in a content analysis on formal features in digital media, that early exposure produces negative effects; referring to the American Academy of Pediatrics’ research that concludes that early exposure to screens and adult programs can disrupt brain development, parent-child interaction, and playtime (p. 9). On the contrary, Heather Kirkorian [6], an associate professor in early childhood development, argues in her research article, “Media and Young Children’s Learning”, that early exposure to televised ageappropriate, educational programs are associated with cognitive and academic enhancement (p. 39).

Between these two viewpoints, the CPS appears to be in accordance with Kirkorian’s [6] views that television can be a powerful and beneficial teaching tool when combined with healthy television habits and appropriate content. The CPS (2003) deems that moderation of television exposure is essential, noting that “evidence suggests that television’s influence on children and adolescents is related to how much time they spend watching television… [because] watching television takes time away from reading and schoolwork” (p. 301-302). Therefore, the most viable recommendation put forth by the CPS is to implement more “parental involvement in determining desirable programming… to monitor and control their children’s viewing habits” (303). Kirkorian [6] supports this recommendation as well, encouraging parents to accommodate a more interactive relationship between children and the media by co-viewing programs to extend children’s learning beyond the screen and into “real” life (p. 45). In addition, both the CPS and Kirkorian acknowledge the negative impact of inappropriate, violent television content, addressing how the rise of broadcasted violence in recent years and “early exposure to violent and non-educational entertainment programming was positively associated with later symptoms of attention deficit but exposure to educational television was not related to attentional problems”, respectively [6,7].

Thus, the report published by CPS portrays how television has a great influence over preadolescent learning experiences and may generate positive effects depending on the time and amount of exposure and whether that exposure includes educational content. One fact is for certain - more children are watching television programs at an earlier age than ever before. Therefore, providing more age-appropriate and educational material in television programming is essential in response to the increase in young television-viewers; this reinforced the importance of a television series media product geared towards this specific audience and the need to understand the benefits of televised educational content and consider the value in adding more coviewing aspects to make television more conducive to learning.

Effects of Televised Content on Body Image

Few journal articles in recent years have highlighted the importance of the portrayal of women’s bodies in the media: “Sociocultural Influences and Body Image in 9- to 12-Year Old Girls: The Roles of Appearance Schemas” conducted by Levina Clark & Marika Tiggemann [8], and “Concurrent and Prospective Analyses of Peer, Television and Social Media Influences on Body Dissatisfaction, Eating Disorder Symptoms and Life Satisfaction in Adolescent Girls” conducted by Christopher Ferguson, Monica Munoz, Adolfo Garza & Mariza Galindo [9]. These studies suggest that while television can be a major teaching tool with enormous influence, peer conversations had a greater impact on self-esteem than did media exposure.

Clark & Tiggemann [8] focused on answering the question of whether media exposure has a negative influence on body image among pre-adolescents through questionnaires completed by girls ranging from Grades 4 to 7 (p. 76). Given that the median age of the 265 participants was 10.71 years, the sample size of Clark & Tiggemann’s [8] research study informs the need for a preadolescent-oriented television series because their research studies the social effects on an overlooked audience age group (young girls from 10 to 12 years old; i.e. the transition from concrete operational to formal operational stages) to explain how this age range is susceptible to images shown on television (p. 76). This article relates to the necessity for diversity, representation, and inclusion in children’s media that a television series conscious of the preadolescent age group aims to resolve - in particular, the necessity for more realistic body portrayals to combat what Clark & Tiggeman [8] refer to as “the thin ideal” (p. 77). Clark and Tiggemann (2007) note that culture and society play a major role in the construction of body idealization and that young girls are more likely than boys to receive messages from society about their weight and appearance: “the number of preadolescent girls who desire a thinner body size… range between 28% to 55%... girls between the ages 8 and 11 compared themselves to fashion models and other media images and felt bad about the comparison” (p. 76-77). Likewise, Ferguson et al. [9] study also argues that “media influences on body dissatisfaction may extend to eating disorder symptoms, possibly explaining increases in eating disorders such as bulimia nervosa across the twentieth century in Western nations” (p. 1). This argument on the link between the media and eating problems is supported by Lemish & Johnson [2], who state that “Children are highly influenced by what they see on-screen… the cultural glorification of female thinness and sexualization is correlated with the prevalence of eating disorders and low selfesteem. Showing realistic body types can help boost self confidence in viewers” (p. 17). This article thereby informs the need for more research on preadolescent media consumption and an increase in age-conscious television series as it suggests that young girls are the most vulnerable demographic to body appearance, which affects their self-confidence and increases the risk of developing eating disorders.

The most interesting aspect of Clark & Tiggeman’s [8] study was that “in 9- to 12-year-old girls, exposure to appearance media did not predict body dissatisfaction directly but was predictive of conversations about appearance, which in turn predicted body dissatisfaction” (p. 77). Ferguson et al. (2013) also support this notion in their article, referring to the Catalyst Model which suggests that “peer influences are likely to have a greater influence on body dissatisfaction than media images” (p. 2). In addition, Ferguson et al. [9] results also similarly suggest that “only peer competition, not television or social media use, predicted negative outcomes” (p. 5). Hence, although excessive exposure to media ideals of thinness and attractiveness will increase the likelihood of body dissatisfaction (from failure to meet unattainable ideals), ultimately both Clark & Tiggeman [8] and Ferguson et al. [9] conclude that peer conversations were more impactful on selfesteem. These results stemming from the lack of diversity in body portrayals in the media should inform content developers of new considerations to implement in television programs.

The background research from Ferguson et al. [9] study sheds light on how body diversity can affect well-being regarding self-esteem of appearance among children. Ferguson et al. [9] describe the major influence of culture on eating behaviors: “eating related pathology is often conceptualized as culturally bound… body dissatisfaction was lower in Hispanic females compared to non-Hispanic whites and suggested that culture, particularly minimization of thin ideals, can be protective for body dissatisfaction issues” (p. 2). Therefore, Ferguson et al. [9] study exemplifies how Western nations such as the United States have embedded into their media, a pervasive glorification of female thinness, which is not necessarily shared in other cultures. Psychologist Lev Vygotsky would agree that cultural appreciation will engender higher cognitive development among children based on his cultural historical theory, which postulates that the unity of mind and culture strengthens children’s learning within a social environment as learned cultural beliefs and attitudes affect children’s learning [10]. The significance of cultural upbringing is also supported in Steinberg’s [1] literature that says, “Research suggests that maintaining ties to both cultures, or biculturalism, is associated with better psychological adjustment” (p. 92). Thus, Steinberg and Vygotsky’s research suggests that well-being can be enhanced in the media by acknowledging biculturalism and maintaining positive in-group identities. With the literature from Vygotsky and Steinberg reinforcing Ferguson’s emphasis on the importance of culture in children’s media, this article, therefore, informs the dire need for appreciation for body differences through diverse and realistically depicted television characters and program curricula centered on topics that generate intellectual peer discussions on topics unrelated to appearance.

Absence of Diversity in Children’s Television

Children already have an affinity for their group identity, exemplified by their preference for socially meaningful characters [3]. However, Toni Schmader and Katharina Block [11] highlight the detrimental stereotypes of ethnic minorities depicted on television to the youth in their research paper: “Social Identity Threat in Response to Stereotypic Film Portrayals: Effects on Self- Conscious Emotion and Implicit Ingroup Attitudes”. According to Schmader and Block (2015), “Disadvantaged ethnic groups are often portrayed stereotypically in film… Such one-dimensional depictions of groups play a role in the transmission of cultural stereotypes by inaccurately representing behaviors, preferences, and traits within a group” (p. 54-55). This argument that ethnic groups are stereotyped on-screen is supported by Carlos E Cortes [12] in the Children Are Watching: How the Media Teach About Diversity, where he describes how media makers tend to base their products by creating assumptions about the audience; media makers stick to and repeat themes that sell well, thereby overusing specific character traits and creating stereotypes (p. 39). Cortes (2000) notes that “Most of the big media subscribe to certain prejudices” (p. 43). The lack of diversity in children’s television, specifically, is noted in Lemish and Johnson’s (2019) data on character diversity: “The majority of human characters on children’s TV are Caucasian” (p. 14). Lemish & Johnson [2] state that this poses a risk to children’s TV because “without room to explore various facets of both females and people of color, writers are more likely to turn to inaccurate stereotypes” (p. 14). Therefore, Schmader & Block’s [11] argument that minorities are presented largely in stereotypical fashion is in the limelight in studying children’s media and proves how there must be more diversity to reduce the perpetuation of these stereotypes.

Schmader & Block’s [11] article also demonstrates how stereotyping is detrimental to children’s self-esteem by causing a social identity threat, giving an example of a study on Native American children that concluded: “even brief exposure to stereotypic Native American sports mascots can temporarily lower self-esteem among Native American students” and “the absence of Native Americans in the media can limit the aspirations of Native American children” (p. 55). This shows how stereotypes are not only vastly misrepresenting minority groups in the American media, but also how it particularly affects the self-esteem of young children and hinders them from achieving healthy self-esteem and positive aspirations. This idea is supported in Jennifer Kotler, Tanya Haider, and Michael H Levine’s [13] study, “Identity Matters: Parents’ and Educators’ Perceptions of Children’s Social Identity and Development”. In this study, the evidence that Kotler et al. [13] collected reveals that “children learn best from positive role models. Many scholars have indicated that a paucity of role models exist in mainstream media for certain marginalized groups” (p. 35). This proves Schmader and Block’s argument on the negative effects of television stereotypes on young audiences who identify as minority groups, as Kotler et al. [13] agree that children need a strong appreciation of group identity to develop healthy social relationships [13].

Although Schmader & Block’s [11] study focuses on Mexican Americans specifically, the concept of social identity threat emerging from stereotypes of minorities shown on television can be attributed to other minority groups. Thus, from this literature stems new considerations in developing a television series, particularly to create the ethnically diverse characters in TV series in a way that makes them more aspirational. Schmader & Block [11] note that “people are motivated to have a positive attitude toward their social groups… [and] socially disadvantaged groups members sometimes show more positive implicit attitudes toward higher status groups” (p. 56). Given that people are naturally motivated to view their social identity groups positively yet feel discouraged in their aspirations (as did the Native American students), this implies that American television so far has done a poor job in attributing minority groups to high-status groups and thereby lowers children’s self-esteem. Therefore, to combat this trend of television content, media makers need to focus on giving each of the main characters and their families admirable traits and careers so that children will not be hindered from positively associating with their social identity, to foster healthy selfesteem and aspirational goals. Another factor that this literature emphasizes is the importance of focusing on the realism and comedic aspect of the characters. Schmader and Block’s [11] study concluded that feelings of shame and self-consciousness were exacerbated among Mexican Americans after watching unrealistic and negatively comedic portrayals of their ethnicity with European Americans (p. 68). This shows how watching highly negative comedic and unrealistic portrayals elicit a higher negative implicit association, which reinforces the benefits of eliminating reliance on comedy to entertain audiences in children’s television [14].

Conclusion

Overall, these four articles helped inform the nature of children’s television today and explain how, if used appropriately, television can be used as a teaching tool, shedding light on the negative effects of ideal body portrayals seen on television on conversations among its preadolescent audience, and addressing the absence of diverse TV characters in children’s media. These articles connect to important topics of learning from the media and the significance of diversity, representation, and inclusion as shown by the portrayal of body ideals and ethnicities in television content, which media makers can consider in new developments. Ultimately, more research is needed on the preadolescent population as current research reinforces the value of body diversity on well-being. We know through past literature that cultural integration brings about more positive attitudes towards body images through minimization of thin ideals tied heavily to media content created by and for non-Hispanic whites and thereby ensure a healthy psychological development for preadolescent audiences.

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Knowledge, Attitude and Practices on Prevention of Noise Induced Hearing Loss Among Factory Workers in Tanzania - Juniper Publishers

 Global Journal of Otolaryngology - Juniper Publishers

Abstract

Background: Noise-induced hearing loss (NIHL) is sensory deafness caused by long-term exposure of the auditory system to a noisy environment. The pathogenesis of noise-induced hearing loss is complex. Various theories try to explain this, such as the oxidative stress theory, but none perfectly explains the occurrence of noise-induced hearing loss. There is no treatment which can completely reverse the damage. More research is required to explore the pathogenesis and to better guide clinical practice. Preventative strategies, such as educating the public about hearing health, should be adopted to reduce the harm of noise-induced hearing loss [1-3].

Objective: The main objectives were to explore the knowledge, attitudes and practices among factory workers in Ilala regarding noise induced hearing loss and the use of hearing protective devices in NIHL prevention. Noise induced hearing loss is a well-known entity in daily practice of Otorhinolaryngology (ORL).

Methodology: A descriptive cross-sectional design was used to assess knowledge, attitude, practices among factory workers. A study was conducted in Cement Factory and minor factories in, Dar Es Salaam, Tanzania. Non-probability convenience sampling technique was used to obtain all 185 participants. The data was collected using Kiswahili questionnaire with close ended questions. All participants were consented before participating in study, and all the responses were coded and entered in a computer software programme statistical package of social sciences (SPSS) for data analysis.

Results: Large proportion of participants were males (79.5%), aged 26-35years old (34.6%) and with primary education (48.6%). 70.3% were aware of NIHL their main source of information being their teammates. Level of knowledge were 49.2% 40.8% and 10.0% for high, moderate and low levels respectively. Knowledge was influenced by gender and working experience. 84.6% had good attitude on prevention of NIHL which was largely influenced by education level. Only 19.2% had good practice on prevention of NIHL.

Conclusion: There is still a problem among factory workers to practice prevention of noise induced hearing loss despite of knowledge they have

Keywords: Knowledge; Attitude; Practice; Noise induced hearing loss; Factory workers

Abbreviations: ACC: Accident Compensation Cooperation; CDC: Centres for Diseases Control and Prevention; dB: Decibels; HL: Hearing loss; KAP: Knowledge, Attitude and Practice; NHIL: Noise Induced Hearing Loss; ORL: Otorhinolaryngology; OSHA: Occupational Safety and Health Administration; PPE: Personal Protective Equipment’s; PTA: Pure Tone Audiometry; SPSS: Statistical Package for Social Services; SRT: Speech Reception Threshold; WHO: World Health Organization

Introduction

Noise induced hearing loss is the gradual bilateral sensorineural hearing loss that occurs due to the effect of workplace noise. In all workplaces there is always risk of exposure to occupational noise, but some workers are more susceptible to a higher exposure of workplace noise in comparison to others. Noise-induced hearing loss is one of the most common forms of major health problem, is largely preventable and is probably more widespread than revealed by conventional pure tone threshold testing [2,3]. Noise-induced damage to the cochlea is traditionally considered to be associated with symmetrical mild to moderate hearing loss with associated tinnitus; however, there is a significant number of patients with asymmetrical thresholds and, depending on the exposure, severe to profound hearing loss as well.

A wide variety of NIHLs are work related. Occupational noise is the most common cause of NIHL in adults which is up to now considered incurable and the best approach to it is to utilize maximum protection. An effective noise exposure prevention programme consists of identification of sources of noise and implementation of controlling measures and regulations at working environments as well as performing periodic audiologic evaluation of those who are working at noisy environment [4]. Worldwide, more than one billion people are affected by hearing loss. Noise-induced hearing loss (NIHL) is reported among the most prevalent occupational diseases. However, little is known about the current level of knowledge and attitude towards NIHL among general population [5].

Hearing impairment is still a major challenge for public health organizations. According to the World Health Organization (WHO), there are approximately 466 million people living with disabling hearing loss, including approximately 34 million children. Furthermore, of these, nearly 90% live in middle and low-income countries. Previous reports have also highlighted the significance of noise-induced hearing loss (NIHL), both work- and recreational activity-related NIHL. In the United States, the estimated percentage of individuals with hearing impairment is around 14.4% of adults aged18 years and above, and approximately 10 million of them suffer from hearing loss due to noise exposure. In the UK, approximately 11 million people have a hearing impairment [6].

Besides loud noise, there are many other risk factors (modifiable and non-modifiable) which can induce progression of noise-induced hearing loss. Modifiable risk factors include smoking, diabetes and lack of exercise, and non-modifiable risk factors include aging, race and genetics. These factors can overlap with noise and accelerate the occurrence of noise-induced hearing loss. Different genders respond almost equally to noise, but gender influences acoustic risk-taking behaviors, boys engage in significantly more high-risk noise activities than girls. Older people and those who have ever suffered from sensorineural hearing loss are more susceptible to noise. Approximately 23% of those between the ages of 65 and 75 years suffer from mild or severe hearing loss. Over the age of 75 years, about 40% have hearing impairment [7,8].

Noise induced hearing loss as the great burden was reported by ACC that it increases the cost each year in rehabilitation centres in New Zealand. The total cost was almost $43 million in 2004/05, over double those just five years earlier. Across the variety of industry, academic, narrative, and government sanctioned sources on noise-induced hearing loss, one clear thread is evident: that noise-induced hearing loss is a significant and widespread public health issue, it leads to substantial negative impacts upon the lives of those that are afflicted, and while there is no cure for those that are already affected, the condition itself is regarded as essentially preventable [9].

Problem statement

Noise-induced hearing loss is identified as a significant public health issue worldwide. There is some evidence that the number of new cases is declining in some European countries but increasing in others. Interestingly consistently in the surveys there is apparent increase in the number of people who believe that they are exposed to dangerous noise levels in the workplace [10]. It has been reported that more than one billion people worldwide are affected from noise induced hearing loss [2,3,5]. Also, there is a study conducted in South Africa that showed greater prevalence of NIHL among mine workers [11]. While it is difficult to precisely define and catalogue the disorder, somewhere in the region of 180 million people worldwide may currently be affected with a further 600 million at a high risk of developing it due to excessive noise exposure levels.

Construction, agriculture, manufacturing and metalworking industries show a higher prevalence of noise-induced hearing loss and the greatest losses are consistently among men above the age of 45 years [12]. Occupational Safety and Health Administration (OSHA), has reported that 22 million Americans are exposed to “potentially damaging” noise in the workplace every year. About one-third of Americans in these kinds of workplaces do, in fact, experience noise-induced hearing loss, the CDC has reported [13]. Prevention for NIHL is most used since the problem is still not curable. Action to prevent noise-induced hearing loss is necessary, especially because many causes of permanent hearing loss are preventable.Due to greater development of industries and urbanization in both developed and developing countries NIHL has emerged to be the problem of public health importance [6, 12].

Societal changes are increasing exposure to noise. Although the sensitivity of each individual is different, sound intensity over 85dB can cause noise-induced hearing loss. High levels of noise exposure usually come from occupational noise (such as factories) or recreational noise (such as personal music players). There are also few studies done on prevention on noise induced hearing loss [14]. In Tanzania there was a study conducted that showed many people to have poor knowledge, attitude and practice on prevention of NIHL [15].

Rationale

The purpose of this study was to assess the level of knowledge, attitude and practices among factory workers on prevention of NIHL. Determining the predictors of knowledge, attitude and practice of noise induced hearing loss (NIHL) among factory workers was important because it may help prevent a serious irreversible noise induced hearing loss [16]. Also, the results of this study will help health practitioners to emphasize more on the prevention of NIHL among the factory workers and the society at large. The results also provide evidence for forming policies which are more effective and influence better response basing on the ground realities. The study also serves as an opportunity for other colleagues to get knowledge and being aware about noise induced hearing loss on how to prevent it emphazing more to reduce exposure to noise and to use PPE’s [17]. The data obtained from this research serves as a platform of data for further research and for comparison of statistics all over Tanzania.

Broad objectives

To assess knowledge, attitude and practices on prevention of noise induced hearing loss among factory workers in Tanzania.

Specific objectives

a) To assess knowledge on prevention of noise induced hearing loss among factory workers

b) To assess attitude on prevention of noise induced hearing loss among factory workers.

c) To assess practices on prevention of noise induced hearing loss among factory workers.

Materials and Methods

Study design

Descriptive cross-sectional study was used to assess knowledge, attitude and practice on prevention of NIHL among factory workers. This was the study of choice because it was meant to collect information once and there was no follow up of participants, it was also cheap, relatively easy to perform and not time consuming. The study was conducted in April to July 2021. A quantitative method was employed. Such a design was chosen to meet the objectives of the study

Study Area

Cement Factory and minor publishing industries in Tanzania.

Study population

All factory workers with noise exposure.

Inclusion criteria

The inclusion criteria were all factory workers that are on exposure to noise in their working environment and who consented to participate.

Exclusion criteria

Workers in other sections that are not on occupational noise exposure and those who were unable to read Kiswahili.

Data collection methods

Data was collected using Kiswahili questionnaires that were having closed ended questions. This was involving pre-test and actual data collection.

Investigation tools and validity and reliability issues

To test for validity in this study the employed research tool (questionnaires) was pretested and revised to ensure that it gives intended information. The pretest involved a small number of participants that conducted a day before actual data collection day. The essence of pretest study was to ensure that the questionnaire measures and give the required information.

Ethical considerations

The ethical clearance was obtained from the Institute of reviewer board of Muhimbili University of Health and Allied Science. Informed consent was obtained from the study participants before enrolment.

Result

(Tables 1-9)

Discussion

This study revealed that there were more males 147(79.5%) participants compared to females 38(20.5%). Other studies also found the same results i.e., were more males than females [5,16]. Most of study participants aged between 26-35 years. This was contrary to the study done among Malaysian workers where most participants aged 40-49 years, main reason was due to different settings. However, more than half of participants aged above 50 years [16]. This study found out that most participants were aware of the NIHL and reported that working mates were the main source of information on prevention of NIHL. Majority of the participants had high level of knowledge on prevention of NIHL. However, the study done among iron and steel workers in Tanzania, found that high proportion of participants suffers NIHL because of the low-level knowledge [15].

It was found that gender and working experience had positive impact on level of knowledge on prevention of NIHL. Zulkefl et al. [16] found out that gender had no role to the level of knowledge, however they found that working experience and age of workers to have a statistical association with knowledge level [16]. Similar study on level of knowledge done by Jacob et al. [17] found out that many participants had high level of knowledge [17]. Overall, most participants in this study had good attitude in prevention of NIHL. This was shown to be influenced by level of education of participants. Contrary to these results, it was shown that most workers have poor attitude to NIHL. Factors associated with poor attitude were reported to be perception that noise at work is inevitable and therefore taking precautions for both workers and management is important [18]. Level of education was found to have positive impact on attitude of workers in this study.

Study done by Zulkefl et al. [16] found out that attitude was influenced by level of education and working experiences, despite that the level of attitude was low [16]. Despite that high proportions of participants reported to have high knowledge and good attitude, few of them practice preventive measures to noise induced hearing loss. Poor practices on prevention of noise induced hearing loss found to be highly influenced by level of education of participants whereby majority of the participants had primary level of education. The same results were found in other studies done in different settings [8,15,19]. Reasons for poor practices reported were poor management [20], and commitment among workers [21-27].

Conclusion and Recommendation

This study revealed that there is high level of knowledge and good attitude to prevention of noise induced hearing loss to factory workers. Surprisingly, there is poor practice to prevention of NIHL. There is still a problem among workers to practice the measures to prevent noise induced hearing loss despite of knowledge they have. Further studies have to be done on how to bridge the gap between knowledge and practices on prevention of NIHL. Management has to make sure that everyone in working area is abiding to preventive measures as per protocol. Regular health check-up and continuous education to workers for more practice in prevention of NIHL.

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Geoecological Danger of Anthropogenic Eutrophy - Juniper Publishers

 Environmental Sciences & Natural Resources - Juniper Publishers

Abstract

The most priority problems of modern geoecology still include the issues of anthropogenic eutrophication of water bodies. A special place in the above problems is occupied by the issues of anthropogenic eutrophy of water bodies in the arid steppe zone, since one of the very significant factors of eutrophy, as is known, is the increased temperature of the air and, as a result, of the water surface during the warm season. Anthropogenic eutrophy, of course, having some dependence on the temperature of the environment, is determined primarily by the amount and intensity of nutrient intake, among which phosphorus compounds present in detergents used by the population are of decisive importance. Hence, the most difficult situations associated with anthropogenic eutrophy of waters are observed near large settlements and urban areas. The territory washed by the Sea of Azov is characterized by a significant number of settlements that intensively discharge municipal wastewater rich in nutrients, including phosphorus compounds. The Taganrog Bay, as an object of research, is interesting in that it combines natural conditions that are very favorable for the development of water eutrophy (shallow water, warming during the warm season, lack of water stratification, low salinity) with an intensive supply of anthropogenically determined nutrients, which, as is known, are conditions for the development of anthropogenic eutrophy.

Keywords: Eutrophy; Nutrients; Water bodies; Pollution of water bodies; Natural factors; Anthropogenic eutrophy

Introduction

Eutrophy is a naturally determined process of increasing the biomass of the living matter of aquatic ecosystems. In this sense, natural eutrophy is a completely logical climax stage of the highest development and biomass growth of the studied ecosystems. It is important to understand that this highest stage of their development - eutrophic, which is very often climax - is very dynamic and, perhaps, in the near future it will again move to the mesotrophic stage, without leading to a general degradation of the entire aquatic ecosystem. Also, natural eutrophy can proceed for decades, developing very slowly, without generally reducing the diversity and productivity of aquatic ecosystems. In this sense, there is no geoecological danger from natural eutrophy. However, its study is necessary as a kind of basis for the development of anthropogenic eutrophy. The main factors of euthhrosis due to natural causes are: the shallowness of the object, the absence of a well-defined stratification of the reservoir, a certain configuration of bottom currents, insufficient mixing of water, and also its good heating. Anthropogenically induced eutrophy, in contrast to natural eutrophy, develops at a very rapid pace, affecting a variety of water bodies, mainly depending only on the amount of incoming nutrients. In this sense, the study summarizes the main ideas about anthropogenic eutrophy, which depends on the natural component and provides a geoecological hazard not only for aquatic ecosystems of water bodies, but also for society [1-3].

Conclusion

The scale and rate of pollution of the hydrosphere appears to be much higher than that of other natural environments. Increasing volumes of domestic wastewater discharge into water bodies and irrational use of water causes, as practice shows, significant socio-economic damage to society. The growing degradation of natural waters requires decisive action and special targeted programs to save them. Given that the Taganrog Bay is part of a closed marine water body, a reservoir that is close to a lake type and for which, for example:
a) the Woodiwiss method is not applicable, since the Taganrog Bay does not belong to river watercourses;
b) macrophytes are not suitable for assessing trophicity (bay, hydrodynamic factor, waves, higher aquatic vegetation will be absent);
c) the assessment by the shares of algocommunities within the phytocenosis is quite applicable;
d) the method of surveying the reservoir for changes in the value of phytoplankton biomass will be the most acceptable.

In connection with the possible complete loss of the biological resources of the Taganrog Bay, as well as their significant deterioration against the background of an increase in the environmental hazard of the water body, it seems to the author of the work that it is necessary to immediately develop and implement possible systems to prevent the entry of nutrients into the bay. It is important to emphasize that the use of various methods for cleaning wastewater that enters an already eutrophicated reservoir is ineffective, since this will only slightly slow down the death of the reservoir. Therefore, it is necessary to carry out the procedure for restoring the reservoir and minimizing the ingress of new nutrients into it.

It should be noted that when choosing measures to solve the problem of intensifying eutrophication of the waters of the Taganrog Bay, it is important to take into account the factors of safety and environmental friendliness of the chosen measures. In the absence of due attention to the problems of anthropogenically caused eutrophy, the risk of toxic effects of low-quality eutrophicated water from a water body affected by eutrophy for the population will increase. Due to the fact that there is a risk of danger to health, and even human life, when staying near a eutrophicated reservoir, it is necessary to take immediate measures to reduce the rate of development of anthropogenic eutrophication, which will ultimately lead to a decrease in the likelihood of hazardous factors. Having approved the priority principles of environmental safety, with a careful approach to the deeutrophication of a reservoir, one can achieve a very successful and positive result.

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