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Effect of face veil on ventilator function among Saudi adult females

Authors:

Abstract

Objective: The use of face veil called "niqab" by women to cover their faces at public places is a common practice in some Muslim communities. The long-term effect of niqab use on ventilatory function (VF) has not previously been reported. The aim of this cross-sectional study was to compare VF between niqab wearing and non-niqab wearing healthy Saudi females. Methodology: Thirty eight healthy adult Saudi females participated in this study. Nineteen subjects were regular niqab users and the other nineteen were either not using niqab at all or used it for less than one hour per day. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC (%), and maximal voluntary ventilation (MVV) were recorded using a digital spirometer. Results: Mean values of FVC, FEV1, FEV1/FVC (%) and MVV for niqab wearers were significantly lower than the corresponding values for non-niqab wearers. Significant negative correlation was found between the FVC and FEV1 values and the number of hours of the use of face veil per day. Conclusions: Long-term use of traditional niqab use can affect VF.
Pak J Med Sci 2012 Vol. 28 No. 1 www.pjms.com.pk 71
IntroductIon
Free and unobstructed airow in the upper and
lower respiratory tract during inspiration and ex-
piration is a prerequisite for normal respiratory
function. Any pathological or non-pathological
condition that can compromise free airow during
respiratory cycle can result in hypoventilation with
increased respiratory effort that can lead to physi-
ological burden involving cardiovascular
1-3
and
temperature regulatory system,
1
and can also cause
psychological stresses.
4
A large body of knowledge exists about possible
mechanisms and short- and long-term physiological
responses for different pathological airow limiting
conditions, involving the respiratory system endog-
enously, such as obstructive sleep apnea,
5
chronic
obstructive pulmonary disease and asthma.
6
How-
ever, studies on physiological responses to external
airow limiting factors such as surgical and pro-
tective masks, are relatively few. Use of facemasks
of different air permeability can cause changes in
temperature and humidity in the microclimates of
the facemasks, causing different effects on heart
rate, thermal stress and perception of discomfort.
7
It is also shown that 1-4 hours use of surgical masks
during surgeries can result in decreased arterial
oxygen saturation levels and increased pulse rate in
surgeons.
8
1. Dr. Ahmad Alghadir, PT, PhD,
2. Dr. Farag Aly, PT, PhD,
Faculty of PT, Cairo University, Egypt.
3. Dr. Hamayun Zafar, PT, PhD,
Odontology Department, Clinical Oral Physiology,
Umea University, Sweden.
1-3: Rehabilitation Research Chair, King Saud University,
Riyadh, Saudi Arabia.
1, 3: Rehabilitation Sciences Department, CAMS,
King Saud University, Riyadh, Saudi Arabia.
Correspondence:
Dr. Ahmad Alghadir,
Department Rehabilitation Sciences, CAMS,
King Saud University,
PO BOX 10219, Riyadh 11433, Saudi Arabia.
E-mail: alghadir@ksu.edu.sa
* Received for Publication: July 7, 2011
* Revision Received: January 2, 2012
* Revision Accepted: January 5, 2012
Original Article
Effect of face veil on ventilatory function
among Saudi adult females
Ahmad Alghadir
1
, Farag Aly
2
, Hamayun Zafar
3
Abstract
Objective: The use of face veil called “niqab” by women to cover their faces at public places
is a common practice in some Muslim communities. The long-term effect of niqab use on
ventilatory function (VF) has not previously been reported. The aim of this cross-sectional
study was to compare VF between niqab wearing and non-niqab wearing healthy Saudi females.
Methodology: Thirty eight healthy adult Saudi females participated in this study. Nineteen
subjects were regular niqab users and the other nineteen were either not using niqab at all or
used it for less than one hour per day. Forced vital capacity (FVC), forced expiratory volume
in one second (FEV1), FEV1/FVC (%), and maximal voluntary ventilation (MVV) were recorded
using a digital spirometer.
Results: Mean values of FVC, FEV1, FEV1/FVC (%) and MVV for niqab wearers were signicantly
lower than the corresponding values for non-niqab wearers. Signicant negative correlation
was found between the FVC and FEV1 values and the number of hours of the use of face veil
per day.
Conclusions: Long-term use of traditional niqab use can affect VF.
KEY WORDS: Face veil, Ventilatory function test, Saudi, Healthy, Adult, Females.
Pak J Med Sci January - March 2012 Vol. 28 No. 1 71-74
How to cite this article:
Alghadir A, Aly F, Zafar H. Effect of face veil on ventilatory function among Saudi adult females.
Pak J Med Sci 2012;28(1):71-74
Ahmad Alghadir et al.
72 Pak J Med Sci 2012 Vol. 28 No. 1 www.pjms.com.pk
In some Muslim communities, women use face
veil called “niqab” to cover their faces at public
places. The use of niqab is more common in Arab
gulf countries, and in Saudi Arabia it is a cultural
norm and a social obligation for Saudi women to
wear niqab at public places. Due to the similarity
in which the use of facial mask and niqab can in-
terfere with the normal airow during respiration,
it can be reasonable to draw an analogy between
the use of facial masks and niqab with regard to the
physiological responses. However, to the best of
our knowledge, no previous data on physiological
impact for short- or long-term use of niqab on the VF
is available.
The spirometry data can help to study respira-
tory function and dysfunction in different condi-
tions and diseases affecting the airow in lungs
during respiration,
9
and can also provide informa-
tion about breathing reserve and exercise tolerance
to determine tness levels of healthy subjects.
10
For
spirometry, the most commonly used parameters
are vital capacity (VC), forced vital capacity (FVC),
forced expiratory volume in one second (FEV1),
and maximal voluntary ventilation (MVV). The VC
is the maximum volume of air that can be expelled
from the lungs after a maximum inspiration, FVC
is the volume of air that can forcibly be blown out
after full inspiration, FEV1 is the maximum volume
of air that can be forcibly blown out in the rst sec-
ond during the FVC manoeuvre, and MVV is the
maximum volume of air that can be inhaled and ex-
haled in one minute.
11
These VF values are gender
dependent with lower values in females.
12
We have previously shown that the parameters of
VF tests in Saudi subjects are lower than the Cauca-
sian reference values, and these gender related dif-
ferences for Saudi adults is larger than correspond-
ing differences in Caucasian population.
13
Based on
the analogy between the use of facial masks and
niqab with regard to the physiological responses, it
can be assumed that the long-term use of niqab can
have an impact on the VF of its user. It is hypoth-
esized that the VF values would be lower for face
veil users than non-face veil users.
The aim of this study was to compare VF values
off face veil users and non-face veil users among
healthy Saudi adult females.
MethodoLoGY
Subjects: Thirty eight healthy Saudi females (aged
18-31 years; mean age 24) participated in this study.
Nineteen subjects were regular niqab users (mini-
mum of 3 years for 4 hours per day) (veil group),
and nineteen subjects were either not using niqab
at all or for less than one hour per day (non-veil
group). Users of any tobacco products and obese
subjects with body mass index (BMI) >25kg/m
2
were excluded. General characteristics of subjects
are shown in Table-I.
Measurements and Procedures: This study was
performed at the Cardiopulmonary Laboratory,
CAMS, King Saud University. The standing
height without shoes (cm), and weight (kg) for
calculation of BMI, and age and number of hours
of niqab use per day was noted for each subject. The
investigation was approved by the Ethics committee
of Rehabilitation Research Chair, King Saud
University. All subjects gave their informed consent
to be part of the study. The VF tests were conducted
in accordance with ‘Guidelines for Standardization
of Spirometry’
14
using a portable spirometer Pony
Fx (COSMED, Rome, Italy). Subjects were given
detailed information about all test procedures and
were asked to practice the test manoeuvre before the
actual test. The spirometer was calibrated daily and
tests were conducted between 9 am to 12 noon to
minimize diurnal variation,
15
at room temperature
between 20-25
o
C. The FVC, FEV1, and MVV were
recorded while subjects were seated comfortably in
a chair. The FEV1/FVC% was later calculated. Each
manoeuvre was performed for three to ve times
by every subject, and the largest value for each
parameter was selected.
14
Statistical Analysis: Mean and SD were used
for descriptive statistics. The FVC, FEV1, FEV1/
FVC (%) and MVV mean values for the face veil
group and non-face veil group were compared by
one-tail unpaired t-test with a signicance level of
Table-I: Mean, standard deviation (SD) and range of age, weight, height and BMI for healthy
face veil and non-face veil using Saudi women (n = 19, each group).
Subjects Age range Age Weight Weight(kg) Height range Height(cm) BMI range BMI
(years) (mean± SD) Range(kg) (mean± SD) (cm) (mean± SD) (kg/m2) (mean± SD)
Non-face veil 19-31 24.4 ± 2.9 51-74 58.5 ± 6.7 152-168 158.3 ± 4.8 19.4-28.5 23.3 ± 1.9
group (n= 19)
Face veil 18-31 23.7 ± 3.2 50-79 59.8 ± 7.0 149- 180 159.1 ± 6.9 19.3-27.4 24.0 ± 2.4
group (n=19)
p -value 0.74 0.26 0.94 0.93
Pak J Med Sci 2012 Vol. 28 No. 1 www.pjms.com.pk 73
<0.05. The Pearson product moment correlation
coefcient test was used to test the presence of any
linear relationship between the number of hours of
veil use per day and the values of VF parameters.
The software SPSS version 10, was used for all
statistical analyses.
resuLts
Table-II shows the mean and SD values of FVC,
FEV1, FEV1/FVC (%) and MVV for face veil and
non-face veil groups. The values for all parameters
were signicantly lower in veil group than the non-
veil group.
Correlation statistics revealed signicant negative
relationship between number of hours of wearing
face veil per day and FVC (r=0.9, p-value = 0.0001)
and the FEV1(r=0.8, p-value = 0.0001), respectively.
However, correlation between number of hours
of wearing face veil per day and FEV1/FVC (%)
(r=0.215, p-value = 0.19) and MVV (r=0.188, p-value
=0.22) was not signicant.
dIscussIon
To the best of our knowledge, this is the rst study
on the effect of niqab use on the ventilatory func-
tion. The present results show that VF values (FVC,
FEV1, FEV1/FVC (%) and MVV) for niqab wearing
females were signicantly lower than the corre-
sponding values for non-niqab wearing females. In
fact, the FVC, FEV1 and MVV values were approxi-
mately 30% lower, and the FEV1/FVC (%) was 9%
lower for niqab wearing females. The data also show
a signicant negative correlation between the dura-
tion of niqab use and the FVC and FEV1 values.
It is reasonable to believe that any condition,
pathological or otherwise, which can interfere
with the free airow in the respiratory system
or adequate expansion of lungs and chest wall,
can result in insufcient ventilation or excessive
work of respiratory muscles to maintain required
ventilation. Previous studies show that different
conditions limiting chest expansion during
respiration, such as obesity, scoliosis or use of bullet
proof vests, body armour and heavy backpacks can
reduce FVC and FEV1, without affecting the FVC/
FEV1 ratio.
16-18
These results indicate a proportionate
reduction in FEV1 and FVC values. However, our
present results show that FEV1/FVC% value for
niqab wearing females was signicantly lower than
the non-niqab wearing females. This indicates that
with long-term use of niqab, the FEV1 was relatively
reduced more than the FVC.
Although data on the changes in VF related to dif-
ferent pathological airow limiting conditions such
as obstructive sleep apnea,
5
chronic obstructive
pulmonary disease and asthma
6
are available, but
data on changes in VF related to non-pathological
airow limiting conditions with use of protective
masks are not available. A few previous studies on
the use of facial masks
7,8
only reported short-term
physiological responses (heart rate, thermal stress
and oxygen saturation). Thus, our present data add
new knowledge on the effect of long-term use of
niqab on VF.
It has been reported that with increased physical
activity the temperature in the facemask microcli-
mate increases,
7,19
causing increase in thermal sen-
sations of the whole body
20
, which decreases work
endurance.
21
The temperature of air entering the
facemask during inspiration corresponds to ther-
mal stimulus to the skin under mask and affects
heat exchange from the respiratory tract, reducing
breathing comfort sensation.
22
Decrease in blood
oxygenation level among surgeons has also been
reported following the use of surgical masks during
surgery lasting 1 to 4 hours,
8
and long duration use
of facemasks by medical emergency staff has been
related to extreme stress.
23
Taken together, it is reasonable to believe that
the short-term physiological responses to the use of
niqab maybe similar to those previously described
for different kinds of facial masks. It can be argued
that unlike the facial masks, the niqab is usually
not very tightly applied to the face, and thus the
thermal and circulatory changes that occur when
wearing a surgical mask may not be applicable.
However, in comparison to the facial masks that
cover mainly the nose and mouth, the niqab used by
Effect of face veil on ventilatory functions
Table-II: Mean, SD and statistical comparison between mean values of different VF parameters
for healthy face veil and non-face veil using Saudi women (n = 19, each group).
Parameters Non-face veil Face veil Mean difference % of difference p-value
group (mean± SD) group (mean± SD)
FVC (litres) 3.4 ± 0.3 2.6 ± 0.4 0.8 30 % <0.001
FEV1 (litters/sec) 2.6 ± 0.5 1.9 ± 0.3 0.7 28% <0.001
FEV1/FVC (%) 80.6 ± 3.6 72.6 ± 3.1 8.0 9% <0.001
MVV (litres/min) 62.9 ± 9.0 45.6 ± 7.6 17.3 28% <0.001
FVC= Forced vital capacity, FEV1= forced expiratory volume in one second, MVV= maximal voluntary ventilation.
74 Pak J Med Sci 2012 Vol. 28 No. 1 www.pjms.com.pk
Saudi women covers the whole face except the eyes
and is thus maybe capable of causing facial mask
like short-term physiological responses. In fact, in-
creased breathing discomfort during summer is a
common complaint among our niqab wearing sub-
jects corroborating previous studies.
19,22
No data
is available on the air and moisture permeability
of the layers of fabric used in making the niqab. It
has been reported that use of two different kinds of
facemasks with 95% and 96% ltration efciency,
can result in different mean heart rate, microclimate
temperature, humidity and skin temperature under
facemask, together with perceived discomfort, fa-
tigue and breathing resistance.
7
In light of these pre-
vious ndings, it is reasonable to speculate that the
present result of lower VF values in veil group than
non-veil group, is not only due to direct airway re-
sistance caused by niqab, but increase in microcli-
mate temperature, humidity and skin temperature
inside the niqab can be contributing factors. In addi-
tion, it is a possibility that part of the exhaled carbon
dioxide may also be trapped inside the niqab, lead-
ing to some shortage of oxygen causing an increase
in heart rate via sympathetic nervous system.
24
Furthermore, the use of niqab in presence of
known sedentary life style of Saudi females proba-
bly does not require extra respiratory effort to over-
come physiological responses to the use of niqab, as
these ladies may adapt to shallow breathing pat-
terns with higher heart rate. Prolonged reduction of
pulmonary ventilation during the use of niqab for
several hours may result in lowering the tidal vol-
ume, which may induce insufcient oxygenation
and inadequate carbon dioxide elimination. This
affects gas exchange
15
and thus can cause some de-
gree of hypoxia, which may lead to different mus-
culoskeletal pain disorders and reduction in endur-
ance levels. We can also speculate that the regular
use of niqab by Saudi women can probably be one
of the reasons of higher prevalence of bromyalgia
and cervicobrachialgia among Saudi females.
25
The
present results of lower VF values in veil group
than non-veil group, merit further investigations
where different physiological responses, blood oxy-
gen saturation levels and subjective perception of
discomfort should be investigated during different
levels of physical activity with niqab made of differ-
ent air and moisture permeability.
In conclusion, our data show that there are
differences in VF tests among niqab and non-niqab
wearing Saudi adult females, where values for
niqab users are lower than the values for those who
do not use niqab. Further studies are required to
investigate the effect of different fabric materials
with different air and moisture permeability that
can safely be used for niqab with minimal effect on
ventilatory function.
AcknowLedGeMents
This study was supported by the grant from the
Rehabilitation Research Chair, King Saud Univer-
sity, Riyadh, Saudi Arabia. The authors have no
conict of interest to declare.
reFerences
1. Laird IS, Goldsmith R, Pack RJ, Vitalis A. The effect on heart rate and facial
skin temperature of wearing respiratory protection at work. Ann Occup Hyg
2002;46(2):143-8.
2. Seliga R, Bhattacharya A, Succop P, Wickstrom R, Smith D, Willeke K. Effect of
work load and respirator wear on postural stability, heart rate, and perceived
exertion. Am Ind Hyg Assoc J 1991;52(10):417-22.
3. Lange JH. Health effects of respirator use at low airborne concentrations. Med
Hypotheses 2000;54(6):1005-7.
4. Morgan WP. Psychological problems associated with the wearing of industrial
respirators: a review. Am Ind Hyg Assoc J 1983;44(9):671–6.
5. Szymanowska K, Piatkowska A, Nowicka A, Cofta S, Wierzchowiecki M. Heart
rate turbulence in patients with obstructive sleep apnea syndrome. Cardiol J
2008;15(5):441-5.
6. Boulet LP, Turcotte H, Hudon C, Carrier G, Maltais F. Clinical, physiological
and radiological features of asthma with incomplete reversibility of airow
obstruction compared with those of COPD. Can Respir J 1998;5(4):270-7.
7. Li Y, Tokura H, Guo YP, Wong AS, Wong T, Chung J, et al. Effects of wearing
N95 and surgical facemasks on heart rate, thermal stress and subjective
sensations. Int Arch Occup Environ Health 2005;78(6):501-9.
8. Beder A, Buyukkocak U, Sabuncuoglu H, Keskil ZA, Keskil S. Preliminary
report on surgical mask induced deoxygenation during major surgery.
Neurocirugia 2008;19(2):121-6.
9. Hayes D Jr, Kraman SS. The physiologic basis of spirometry. Respir Care
2009;54(12):1717-26.
10. Guenette JA, Witt JD, McKenzie DC, Road JD, Sheel AW. Respiratory
mechanics during exercise in endurance-trained men and women. J Physiol
2007;581(Pt3):1309-22.
11. Pierce R. Spirometry: an essential clinical measurement. Aust Fam Physician
2005;34(7):535-9.
12. Ostrowski S, Barud W. Factors inuencing lung function: are the predicted
values for spirometry reliable enough? J Physiol Pharmacol 2006;57(Suppl
4):263-71.
13. Alghadir A, Aly F. Ventilatory function among healthy young Saudi adults: a
comparison with Caucasian reference values. Asian Biomed 2011;5(1):157-161
14. Standardization of Spirometry, 1994 Update. American Thoracic Society. Am J
Respir Crit Care Med 1995;152(3):1107-36.
15. Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al.
Interpretative strategies for lung function tests. Eur Respir J 2005;26(5):948-68.
16. Coast JR, Baronas JL, Morris C, Willeford KS. The effect of football shoulder
pads on pulmonary function. J Sports Sci Med 2005;4:367-71
17. Legg SJ. Inuence of body armour on pulmonary function. Ergonomics
1988;31(3):349-53.
18. Muza S, Latzka W, Epstein Y, Pandolf K. Load carriage induced alterations of
pulmonary function. Int J Ind Ergonomics 1989;3(3):221-27.
19. Hayashi C, Tokura H. The effects of two kinds of mask (with or without exhaust
valve) on clothing microclimates inside the mask in participants wearing
protective clothing for spraying pesticides. Int Arch Occup Environ Health
2004;77(1):73-8.
20. Nielsen R, Berglund LG, Gwosdow AR, DuBois AB. Thermal sensation of the
body as inuenced by the thermal microclimate in a face mask. Ergonomics
1987;30(12):1689-703.
21. White MK, Hodous TK, Vercruyssen M. Effects of thermal environment and
chemical protective clothing on work tolerance, physiological responses, and
subjective ratings. Ergonomics 1991;349(4):445-57.
22. Meyer JP, Héry M, Herrault J, Hubert G, François D, Hecht G, et al. Field study
of subjective assessment of negative pressure half-masks. Inuence of the work
conditions on comfort and efciency. Appl Ergon 1997;28(5-6):331-8.
23. Farquharson C, Baguley K. Responding to the severe acute respiratory
syndrome (SARS) outbreak: lessons learned in a Toronto emergency
department. J Emerg Nurs 2003;29(3):222-8.
24. Ganong WF. Review of Medical Physiology. Appleton and Lange. Stamford.
1997: 565–566.
25. Kaki AM. Pain clinic experience in a teaching hospital in Western, Saudi
Arabia. Relationship of patient’s age and gender to various types of pain. Saudi
Med J 2006;27(12):1882-6.
Ahmad Alghadir et al.
... Niqab (face veil) wearing is most common in gulf countries, particularly in Saudi Arabia [1]. Saudi women wear the niqab in public places. ...
... Saudi women wear the niqab in public places. A previous study showed mean values of ventilatory function parameters including; forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and its ratio with the FVC (FEV1/FVC %) and the maximum voluntary ventilation (MVV) for niqab wearing women were significantly lower than the values for women who did not wear the niqab [1]. ...
... The important role of the pulmonary system in determining a person's functional exercise capacity [2,3] and the significant reduction of ventilatory function with niqab wearing [1] raised the question: does niqab wearing affect the functional exercise capacity of Saudi women and how might physical activity alter any affect? ...
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Background: Wearing a face veil (niqab) was found to have a negative effect on the ventilatory function of Saudi adult women, which may challenge their functional exercise capacity. Objectives: To investigate the effect of physical activity on a 6-minute walked distance (6-MWD) among young adult niqab-wearing healthy Saudi women. Materials and Methods: Forty healthy young Saudi women were recruited for this study. The study participants (aged 22.8 ± 2.5 years) were selected from students and administrative staff at King Saud University. They were normotensive, nonsmokers, and of normal or mildly overweight. They were divided into 2 groups on basis of niqab wearing. A 6- minute walk test was implemented as measure of the participant’s functional exercise capacity. Their physical activity level was expressed as low, moderate, or high levels using the International Physical Activity Questionnaire-Short Form. Comparisons between the basal physiological characters of the 2 groups, 6-MWD, and physical activity level were conducted. A two-way independent ANOVA was used to study the interaction of niqab wearing and the physical activity level on the 6-MWD for niqab wearing women. Results: Women in the niqab wearing group had a significantly higher physical activity level and longer 6-MWD than those in the niqab nonwearing group (370.7 ± 62.95 and 510.0 ± 81.75 m (mean ± SD) respectively). Conclusion: A physically active lifestyle improves and preserves the functional exercise capacity reflected by longer 6-MWD among the physically active niqab-wearing Saudi adult healthy women compared with less active women who did not wear the niqab.
... The variation in the physical activity level between the two study groups was explained by the longer duration of walking practiced by the niqabwearing group than by the niqab-nonwearing one [22]. The "positive" effect of niqab-wearing on 6MWD should be considered with a lot of doubt, since a previous study showed mean values of spirometry data including FVC, FEV1, FEV1/FVC ratio and the maximum-voluntaryventilation for niqab-wearing women significantly lower than the values for niqab-nonwearing ones [86]. As the respiratory system has a vital role in determining a person's functional exercise capacity [87,88] and as there is a significant reduction of ventilatory function with niqabwearing [86], the functional exercise capacity of Saudi women wearing niqab should be altered. ...
... The "positive" effect of niqab-wearing on 6MWD should be considered with a lot of doubt, since a previous study showed mean values of spirometry data including FVC, FEV1, FEV1/FVC ratio and the maximum-voluntaryventilation for niqab-wearing women significantly lower than the values for niqab-nonwearing ones [86]. As the respiratory system has a vital role in determining a person's functional exercise capacity [87,88] and as there is a significant reduction of ventilatory function with niqabwearing [86], the functional exercise capacity of Saudi women wearing niqab should be altered. ...
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... Worldwide, many women wear various types of facial coverings that cover the nose and mouth (e.g., veils, balaclavas, bandanas, niqabs, burqas, respirators and medical/surgical masks, cloth masks, etc.) for any of a number of purposes (e.g., heat/moisture exchangers in cold environments, protection from airborne contaminants and infectious agents, religious/social norms, etc.) [1][2][3][4][5][6][7]. These facial coverings impose variable external resistive loads (~19. ...
... These facial coverings impose variable external resistive loads (~19. 6 -196.1 Pa [2 -20 mm H 2 O] pressure) to the wearer, depending on fabric properties (e.g., fiber diameter, packing density, pore size, electrostatic charge, etc.) [4,5,8] and how tightly the covering is applied to the face, that have been shown to negatively impact pulmonary function and cardiovascular responses [1,6]. Given that an estimated 208 million pregnancies occur worldwide annually [9], a significant proportion of women wearing facial coverings will be pregnant, yet little scientific data is available on the effects of these low external airflow resistive loads (EARL) on pregnancyassociated cardiovascular and pulmonary responses [10,11]. ...
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Facial coverings (e.g., balaclavas, niqabs, medical/surgical masks, respirators, etc.), that impose low levels of airflow resistive loads, are worn by millions of pregnant women worldwide, but little data exist addressing their impact on pregnancy-associated cardiovascular and pulmonary responses. 16 pregnant and 16 non-pregnant women were monitored physiologically (heart rate, blood pressure, mean arterial pressure, total peripheral resistance, stroke volume, cardiac output, oxygen saturation, transcutaneous carbon dioxide, fetal heart rate) and subjectively (exertion) for 1 h of mixed sedentary postural activity (sitting, standing) and moderate exercise (bicycle ergometer) with and without wearing N95 filtering facepiece respirators with filter resistive loads of 94.1 Pa (9.6 mm H2O) - 119.6 Pa (12.2 mm H2O) pressure. The external airflow resistive loads were associated with increases in diastolic pressure (p = 0.004), mean arterial pressure (p = 0.01), and subjective exertion score (p < 0.001) of all study subjects. No significant differences were noted with the external resistive loads between the pregnant and non-pregnant groups for any cardiovascular, pulmonary and subjective variable over 1 h. Low external airflow resistive loads, during combined sedentary postural activity and moderate exercise over 1 h, were associated with increases in the diastolic and mean arterial pressures of all study subjects, but pregnancy itself was not associated with any significant differences in physiologic or subjective responses to the external airway resistive loads utilized in the study.
... The niqab has attracted some attention from medical researchers interested in its impact on health. Evaluations of Vitamin D levels in niqab wearers seem to be of particular interest (El-Kaissi and Sherbeeni 2010; Fuleihan 2010; Al-Mogbel 2012), along with effects of the face veil on pulmonary function (Alghadir, Aly, and Zafar 2012). These studies generally find that the niqab has a negative impact on both Vitamin D absorption and pulmonary function (functioning of the lungs and breathing). ...
Book
Bringing niqab wearers' voices to the fore, discussing their narratives on religious agency, identity, social interaction, community, and urban spaces, Anna Piela situates women's accounts firmly within UK and US socio-political contexts as well as within media discourses on Islam. The niqab has recently emerged as one of the most ubiquitous symbols of everything that is perceived to be wrong with Islam: barbarity, backwardness, exploitation of women, and political radicalization. Yet all these notions are assigned to women who wear the niqab without their consultation; “niqab debates” are held without their voices being heard, and, when they do speak, their views are dismissed. However, the picture painted by the stories told here demonstrates that, for these women, religious symbols such as the niqab are deeply personal, freely chosen, multilayered, and socially situated. Wearing the Niqab gives voice to these women and their stories, and sets the record straight, enhancing understanding of the complex picture around niqab and religious identity and agency.
... Among the Saudis, there are many restrictions related to women's public self-expression (Le Renard, 2008). Indeed, Saudi women are encouraged to use a face covering or niqab in public (Alghadir et al., 2012). The niqab is a cultural norm and a social obligation in Saudi Arabia. ...
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With the rise of digital technologies, selfies are a contemporary and popular form of digitally produced self-expression for Saudi women. Informed by Goffman’s (1959) self-presentation theory and Hall’s (1966) proxemics theory, this study explores the process of producing and posting selfies on Instagram and Snapchat platforms, and examines how these practices are shaped by cultural norms and platform affordances. Methodologically, an ethnographic approach was employed to observe selfie practices involving: focus groups, face-to-face interviews, online observation, and photo-elicitation interviews. The sample consisted of 35 Saudi women between 18-57 years old. The results were used to develop a framework for understanding selfie production consisting of six processes: the motivation process, pre-photo process, platform affordances process, audience customization process, assessment of cultural norms process, and the process of reposting selfie. Also, the study identified a number of strategies practiced by Saudi women to present a more desirable self, including: digitally editing the selfie using beautifying filters, arranging the background, retaking the selfie, and adding digital makeup. Cultural norms were found to heavily influence selfie practices, as selfie takers carefully select particular audiences with whom to share the selfie, while blocking others from viewing the selfie using “virtual walls” depending on veiling practices, habitual proximity, and the appropriateness of the content. The model and the identified strategies make an important empirical contribution that provides a new way of thinking about selfie practices outside Euromerica.
... The niqab has attracted some attention from medical researchers interested in its impact on health. Evaluations of Vitamin D levels in niqab wearers seem to be of particular interest (El-Kaissi and Sherbeeni 2010; Fuleihan 2010; Al-Mogbel 2012), along with effects of the face veil on pulmonary function (Alghadir, Aly, and Zafar 2012). These studies generally find that the niqab has a negative impact on both Vitamin D absorption and pulmonary function (functioning of the lungs and breathing). ...
... Masks reduce the surface area exposed to sunlight. The long-term use of traditional niqab can adversely affect the functional vital capacity and the fractional expiratory volume at one second (FEV1) among Saudi adult females (Alghadir, Aly, & Zafar, 2012). Respiratory infections and asthma were significantly more common among veils users (p < 0.00001 and p < 0.0003, respectively, probably secondary to infection (Ahmad et al., 2001). ...
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Objectives We aimed to analyze factors impacting the Covid-19 epidemic on a macro level, comparing multiple countries across the world, and verifying the occurrence at a micro level through cluster analysis. Design Statistical analysis of large datasets. Methods We used publicly available large world datasets (1-11). Data was transformed to fit parametric distributions prior to statistical analyses, which were performed with Student’s t-test, linear regression and post-hoc tests. Especially for ordinary least squares regression, natural logarithmic transformations were done to remediate normality violations in the standardized residuals. Results The severity of the epidemic was most strongly related to exposure to ultraviolet light and extrapolated levels of vitamin D and to the health of the population, especially with regards to obesity. We found no county with an obesity level < 8% with a severe epidemic. We also found that countries where the population benefited from sun exposure or vitamin D supplementation and spent time outside fared well. Factors related to increased propagation of the virus included the use of heating ventilation and air conditioning (HVAC), population density, poorly aerated gatherings, relative humidity, timely policies of closing clustering places until aeration was improved, and daily amount of ridership on public transportation, especially subways. Population lockdowns, masks, and blood type did not provide much explanatory power. The excess mortality observed is within the ranges of severe past influenza epidemics of 2016/2017 or 1999/2000. Conclusions Our study suggested that prevention measures should be directed to improving aeration systems, enhancing diets and exercise, and ensuring adequate levels of vitamin D. Further research on masking is indicated as our study could not separate policies from how well they were actually followed. Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors’ Strengths and Limitations of the Study The Study examines large datasets across countries to look for macrotrends in management of the Covid-19 outbreak. The Study cannot necessarily establish causation but rather correlation. The Study raises some novel possibilities for further studies in relation to country-wide and individual-level susceptibility to Covid-19 and to other epidemics in general. The Study raises questions about some political policies based upon country-level comparisons and suggests some areas for exploration of prevention policies.
... In Saudi, there are many restrictions related to women's public self-expression (Le Renard, 2008). Indeed, Saudi women are encouraged to use a face cover or niqab in public (Alghadir, Farag, & Hamayun, 2012). The niqab is a cultural norm and a social obligation in Saudi. ...
Thesis
With the rise of digital technologies, selfies are a contemporary and popular form of digitally produced self-expression for women in Saudi Arabia. Drawing from a phenomenological approach, informed by Goffman’s (1959) self-presentation theory and Hall’s (1966) proxemics theory, this study explores how Saudi women express their identity through selfie images on Instagram and Snapchat platforms, examining how these practices are shaped by cultural norms and platform affordances. Methodologically, the study consisted of four staged phases with 25 Saudi women involving focus groups, in-depth interviews, online observation, and photo-elicitation interviews. Through the research I developed a framework for understanding selfie production, consisting of seven stages, and I identified six key motives for taking and posting selfies on these platforms. This study draws on critical technological perspectives and theories of spaces to show how Saudi cultural norms, in combination with platform architecture and affordances, shape and inform selfie production in a number of ways. For example, Saudi women are discerning about which platforms they use, depending on which audiences they want to reach, and they build what I conceptualise as “virtual walls” to keep audiences separate. The study makes several important empirical, theoretical, and methodological contributions by shedding light on the selfie production and sharing process, highlighting how users and culture are shaping online practices, providing a new way of thinking about selfies in terms of dramaturgical analysis, and pioneering a mixed method design providing multidimensional understanding of selfie presentation in online spaces.
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Background: The 6-minute walk test (6-MWT) is commonly used to measure functional capacity in clinical and research settings. The reference equations for predicting the 6-minute walk distance (6-MWD) in different populations have been established; however, there is a lack of information regarding healthy Saudi individuals over 50 years old. Objectives: This study aimed to establish the reference values of 6-MWD in a sample of healthy Saudi adults aged 50-80 years, develop regression equations for the established 6-MWD, and compare the measured 6-MWD in the present study with the predicted 6-MWD derived from the previously published regression equations. Methods: In total, 210 healthy Saudi volunteers aged 50-80 years participated in this cross-sectional study. The 6-MWT was performed according to the American Thoracic Society (ATS) guidelines. Lung function, physical activity, blood pressure, heart rate, oxygen saturation, exertion level of leg fatigue, and sensation of dyspnea were measured. Results: The mean 6-MWD was 396.2 ± 69.4 m. It was significantly correlated with age, sex, height, body mass index (BMI), and physical activity. The predictors of 6-MWD were age and BMI for men, while they were age, BMI, and height for women. They accounted for 25% and 35% of the total variance of 6-MWD for men and women, respectively. The measured 6-MWD was significantly shorter than the predicted 6-MWD. Conclusion: Saudi populations have significantly shorter 6-MWDs than those reported in other ethnic groups. The sex-specific equations developed in this study are expected to provide a useful measure of 6-MWT for Saudi adults. However, further investigation is required to validate the application of these equations to individuals living in different regions of Saudi Arabia.
Book
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This book composes a couple of exploratory studies that were conducted in the city of Dammam in Saudi Arabia with the aim of informing lifestyle-related health conditions, specifically Type 2 Diabetes Mellitus (T2DM), in Saudi women. In the first study, a cross-section of women (n=407) participated in survey-questionnaire interviews about lifestyle-related health beliefs and behaviours, and lifestyle-related religious teachings. In the second study, women at risk of or diagnosed with T2DM (n=35 including drop-outs) were assigned to two groups; an Intervention Group participated in a T2DM education program, based on international standards and adapted to participants cultural and religious contexts, and a Usual Care Group received the usual care for diabetes. Outcomes included blood glucose, body composition measures, six-minute walk distance, life satisfaction, quality of life, and diabetes knowledge. Participants in the Intervention Group participated in a focus group discussion of their program experience. Data from both studies were analyzed based on mixed methods; descriptive statistics SPSSv.20 was used to analyze the quantitative data and Atlas.ti® software to code themes in Hana Al-Bannay was born in Qatif, Saudi Arabia. She obtained M.A. of Professional International and Intercultural Communication from Royal Roads University and Ph.D. of Rehabilitation Sciences from the University of British Columbia in Canada. Her research interests include cross-cultural health communication, and the health of Muslim women.
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Background: Ethnic differences in lung function are recognized. However, most of the modern lung function equipments are pre-programmed with Caucasian reference values. Objective: Measure spirometric values among healthy Saudi male and female adults and compare with the Caucasian reference values in a standard spirometer. Methods: Thirty healthy Saudi young adults (15 males and 15 females; mean age 25 years) participated in this study. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC (%), and maximal voluntary ventilation (MVV) were recorded using a portable digital spirometer. Results: Mean values of FVC, FEV1, FEV1/FVC (%) and MVV for the Saudi subjects were significantly lower than the Caucasians predicted values. Conclusion: Interpretation of lung function tests of Saudi subjects based on the Caucasian prediction equations is generally not valid, as the parameters of lung function tests in Saudi subjects are lower than the Caucasian reference values. The present results underline an urgent need for larger studies to develop prediction equations based on normative spirometric values for Saudi population involving subjects of all ages and both genders living in different climates of the country.
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Spirometry is the most useful and commonly available tests of pulmonary function. It is a physiological test that measures individual inhalation and exhalation volumes of air as a function of time. Pulmonologists and general-practice physicians commonly use spirometry in their offices in the assessment and management of lung disease. Spirometric indices are well validated and easily interpreted by comparison with established normal values. The remarkable reproducibility of spirometry results from the presence of compliant intrathoracic airways that act as air flow regulators during forced expiration. Because of this anatomic arrangement, expiratory flow becomes dependent solely on the elasticity of the lungs and airway resistance once a certain degree of expiratory force is exerted. Insight into this aspect of respiratory physiology can help in the interpretation of spirometry.
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Objetivos. Este estudio se realizó para determinar si la saturación de oxígeno del cirujano se afectaba por el uso de la mascarilla, durante intervenciones de larga duración. Métodos. Se hizo un estudio longitudinal y prospectivo en 53 cirujanos con medidas de la hemoglogina realizadas con un oxímetro para medir la saturación del pulso arterial. Se hicieron estudios antes y después de la operación. Resultados. Nuestro estudio puso de manifiesto una disminución de la saturación de oxígeno de las pulsaciones arteriales (SpO2) y un ligero aumento de las pulsaciones en comparación con el estado preoperatorio en todos los grupos de cirujanos. La disminución era mayor en el grupo de edad superior a los 35 años. Conclusiones. Según nuestros hallazgos, el ritmo del pulso aumenta y la concentración de SpO2 disminuye después de la primera hora de la operación. Este cambio temprano de SpO2 puede deberse a la mascarilla o al estrés de la intervención. Puesto que un ligero descenso en la saturación a este nivel refleja una mayor disminución de la PaO2, nuestros datos pueden tener un valor clínico para la salud del personal sanitario y para los cirujanos.
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Conference Paper
Bitter Taste Receptor Agonists Relax Airways By Inhibiting Agonist-Induced Calcium Signalling And Calcium Sensitivity Of Airway Smooth Muscle Cells In Lung Slices, [Publication Page: A5270] X. Tan, PhD, M.J. Sanderson, PhD Worcester, MA/US Rationale: TAS2Rs are G-protein coupled receptors (GPRC) that sense bitter compounds. Recently, stimulation of TAS2Rs in human and rodent airway smooth muscle cells (ASMC) was paradoxically reported to induce airway relaxation while increasing intracellular Ca2+ ([Ca2+]i). Previously, we have shown that agonist-induced airway relaxation is mediated by a reduction of the rate of [Ca2+]i oscillations (mediated by inositol 1,4,5-trisphosphate, IP3) as well as by decreasing the Ca2+ sensitivity of ASMC. Consequently, we used mouse lung slices to investigate how the TAS2R agonists chloroquine and quinine altered ASMC contractility, [Ca2+]i signalling and Ca2+ sensitivity. Methods: Lungs from BALB/C mice (7-10 weeks) were inflated with warm agarose (1.8%) and cut into 200 μm thick slices that were maintained in DMEM for up to 48 hr at 37°C. Experiments were performed at 37°C. Agonists were dissolved in Hanks’ buffered saline solution. Airway responses to chloroquine and quinine were assessed in the presence of methacholine (MCh) (400 nM) or serotonin (5HT) (1 μM) using phase-contrast microscopy. ASMC [Ca2+]i responses were assessed by monitoring fluorescence intensity with 2-photon microscopy of lung slices loaded with the Ca2+-sensitive fluorescent dye Oregon Green BAPTA-1-AM (20 μM) (with or without caged-IP3 (2 µM)). To evaluate Ca2+ sensitivity, [Ca2+]i was kept constant by permeabilizing ASMC to Ca2+ (Bai & Sanderson Am J Physiol Lung Cell Mol Physiol, 2006). Results: Chloroquine fully relaxed MCh and 5HT-contracted airways at 50 µM and 500 μM respectively. Quinine fully relaxed MCh/5HT-contracted airways at 200 μM. MCh and 5HT elicited Ca2+ oscillations with frequencies of 72±5 min-1 (n=17) and 62±5 min-1 (n=10) respectively. Submaximal concentrations of chloroquine (20 µM) and quinine (50 µM) decreased the Ca2+ oscillation frequency (57±11% and 61±4% respectively, n=10). High concentrations of chloroquine (100 µM) and quinine (500 µM) abolished the Ca2+ oscillations (n=10) and inhibited [Ca2+]i signalling generated by IP3 (n=15). TAS2R agonists alone did not evoke any [Ca2+]i signals (n=8), nor did they attenuate the release of Ca2+ from internal stores stimulated by caffeine (20 mM) (n=6). In Ca2+-permeable lung slices, MCh and 5HT increased Ca2+ sensitivity to mediate airway contraction despite no change in [Ca2+]i. Under these conditions, chloroquine and quinine relaxed the MCh or 5HT-contracted airways (n=6). Conclusion: TAS2R agonists relax airways 1) by inhibiting agonist-induced Ca2+ oscillations mediated via IP3 receptors, and 2) by reducing Ca2+ sensitivity of ASMC. These responses are highly consistent with predicted ASMC physiology determined with other contractile and relaxing agonists. Am J Respir Crit Care Med 187;2013:A5270
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Load carriage systems supported by the trunk have been shown to decrease certain indices of pulmonary function. We investigated the hypothesis that these pulmonary function reductions are directly related to the backpack load carrier due to the mechanical constraint to imposes on the thoracic cage. To investigate this hypothesis, 5 young males with no pulmonary disorders were tested while standing upright carrying well-fitted 0, 10 or 30 kg loaded U.S. Army ALICE backpacks. Forced vital capacity (FVC), forced expiratory volume (FEV1) and 15 s maximal voluntary ventilation (MVV15) were measured. With increasing load, FVC and FEV1 progressively decreased reaching 6 and 6.7% decrements (p < 0.05), respectively, with the 30 kg load. The MVV15 was decreased (p <0.05) by about 8.4% with the 10 kg load, but did not demonstrate any further decrement with the 30 kg load. Analysis of flow-volume loops obtained with the 0 and 30 kg loads showed that the reduction of FVC was not associated with any decrement of peak inspiratory or expiratory flows. These results indicate a limitation on the ventilatory pump caused by load carriage which is directly related to the load carried and characteristic of restrictive disease of the respiratory system (reduced FVC and FEV1 with no decrement in FEV1/FVC).
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Heart rate turbulence (HRT) assessment is used as noninvasive method based on physiological sinus node response to the premature ventricular beat. Blunted HRT may indicate the autonomic nervous system impairment and can be helpful in identifying high-risk patients. Obstructive sleep apnea syndrome (OSAS) leads to cardiovascular complications. Autonomic nervous system and baroreflex dysfunctions may play the main role in the development of cardiovascular diseases. In the present study we aimed to assess HRT parameters in OSAS patients with and without coronary artery disease (CAD) in comparison to control group. HRT analysis (TO--turbulence onset and TS--turbulence slope) was performed in 22 OSAS patients (confirmed by polisomnography, apnea-hypopnea index >or= 15) and 21 healthy persons, obtained from 24-hour ECG recordings. CAD was confirmed in 10 OSAS patients, by positive exercise test ECG and coronary angiography. Results: TS was significantly lower in OSAS patients in comparison to control group (1.14 +/- +/- 2.83 vs. 21.28 +/- 16.2, p < 0.001). TO didn't differ in both group. Significant negative correlation between TS and apnea-hypopnea index was observed (r = 0.49, p < 0.01). There were no significant HRT changes in OSAS and CAD patients vs. OSAS without CAD patients, although tendency to more impaired HRT in OSAS and CAD patients was observed. In OSAS patients, blunted HRT (especially TS) was observed. This may indicate baro-reflex dysfunction correlated with the severity of sleep disorders. The additional diagnosis of CAD did not significantly influence HRT parameters.
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This study examined the physiological and subjective responses of nine healthy men who performed work while wearing two types of protective ensembles in each of three thermal environments. The subjects, all experienced with the use of protective ensembles, each performed low intensity treadmill exercise (23% of VO2 max while not wearing a Self-Contained Breathing Apparatus [SCBA] or protective clothing) under six experimental conditions: two ensembles (SCBA--light work clothing and SCBA; and CHEM--a two-piece chemical protective ensemble with SCBA) during exposure to 'cool' (10.6 degrees C/water vapour pressure [Pw] 0.76 kPa), 'neutral' (22.6 degrees C/Pw 1.52 kPa), and 'hot' (34 degrees C/Pw 2.90 kPa) environments. Each test was intended to continue for 120 min; however the duration and number of work/rest periods within the testing session varied according to the specific responses of each individual. At the completion of each test seven subjective responses were recorded. Physiological data, collected every minute during each test, included heart rate, and skin and rectal temperature. The total worktime was significantly shorter in the hot environment while wearing the CHEM ensemble (53.4 min) compared to all the other conditions (103-105 min). The mean maximum physiological values also indicated significant differences due to thermal environment and/or ensemble. Work performance did not appear to be limited in a cold environment with either ensemble tested. The physiological responses to working in the CHEM/neutral condition were very similar to those occurring in a hot environment wearing the SCBA ensemble. The subjective responses also indicated significant differences due to thermal environment and ensemble, with subjects perceiving the CHEM ensemble as less favourable than the SCBA ensemble. The results suggested that, even at a low work intensity, individuals wearing chemical protective clothing in the heat will require progressively shorter work periods, and more frequent and longer rest periods.