Baptiste-Roberts, K., Oranuba, E., Werts, N., & Edwards, LV (2017). Kuthana ndi Kusiyana kwa Zaumoyo Pakati pa Ochepa Ogonana. Obstet Gynecol Clin North Am, 44(1), 71-80. doi.org/10.1016/j.ogc.2016.11.003
Burgwal, A., Gvianishvili, N., Hard, V., Kata, J., Garcia Nieto, I., Orre, C., Smiley, A., Vidic, J., & Motmans, J. (2019). Kusiyana kwaumoyo pakati pa anthu a binary ndi omwe si a binary trans: kafukufuku woyendetsedwa ndi anthu. Int J Transgend, 20(2-3), 218-229. doi.org/10.1080/15532739.2019.1629370
Gahagan, J., & Subirana-Malaret, M. (2018). Kupititsa patsogolo njira zopita ku chithandizo chamankhwala choyambirira pakati pa anthu a LGBTQ ndi othandizira azaumoyo: zomwe zapezedwa kuchokera ku Nova Scotia, Canada. Int J Equity Health, 17(1), 76. doi.org/10.1186/s12939-018-0786-0
Rattay, KT (2019). Kupititsa patsogolo Kusonkhanitsa Kwa Data kwa Anthu Athu a LGBTQ Ndikofunikira Kuti Titukule Chisamaliro Chaumoyo ndi Kuchepetsa Kusiyanasiyana kwa Zaumoyo. Dela J Public Health, 5(3), 24-26. doi.org/10.32481/djph.2019.06.007
Tellier, P.-P. (2019). Kupititsa patsogolo mwayi waumoyo kwa ana osiyanasiyana, achinyamata, ndi akuluakulu omwe akungokulira kumene? Clinical Child Psychology ndi Psychiatry, 24(2), 193-198. doi.org/10.1177/1359104518808624
Cisgender alibe chochita ndi zomwe munthu amakonda kugonana. Ndiye kodi kugonana ndi jenda zimasiyana bwanji ndipo cisgender imagwera pati pazidziwitso za jenda?
chinsinsi
Cisgender ndi gawo lalikulu la zizindikiritso za jenda. Amatchedwanso "cis," amatanthauza munthu yemwe amadziwika kuti ndi amuna ndi akazi amafanana ndi kugonana komwe adapatsidwa panthawi yobadwa. Chifukwa chake ngati munthu yemwe wapatsidwa kugonana pakubadwa ndi wamkazi ndipo amadziwonetsa ngati mtsikana kapena mkazi ndi mkazi wa cisgender.
Zingaphatikizeponso cisnormativity - lingaliro lomwe aliyense amazindikira kuti ndi jenda lomwe adapatsidwa pakubadwa. Izi zitha kudziwitsa momwe mkazi wa cis amayembekezeredwa kuvala ndikuchita. Lingaliro lowonjezereka kwambiri ndilo kufunikira kwa jenda - ichi ndi chikhulupiriro chakuti kusiyana pakati pa amuna ndi akazi kumayambira mu biology ndipo sikungasinthidwe. Komabe, ngakhale mikhalidwe yokongola ya cisnormativity imatha kukhudza malingaliro a azimayi omwe amatha kulimbikitsa malingaliro a jenda. (Monteiro D, Poulakis M. 2019)
Mwayi wa Cisgender
Mwayi wa Cisgender ndi lingaliro loti anthu omwe ali ndi cisgender amalandira mapindu owonjezera poyerekeza ndi omwe satsatira chikhalidwe cha binary. Izi zikuphatikizapo akazi a cisgender ndi amuna. Mwayi umachitika pamene munthu wa cisgender akuganiza kuti ndizozoloŵera ndipo mosadziwa kapena mosazindikira amachitapo kanthu motsutsana ndi iwo omwe ali kunja kwa tanthauzo lachimuna ndi chachikazi. Zitsanzo za mwayi wa cisgender ndi izi:
Kusakanidwa ntchito ndi mwayi wocheza nawo chifukwa chosalowa mgulu la anyamata kapena atsikana.
Osakhala ndi mafunso okhudza kugonana.
Osakanizidwa chithandizo chamankhwala chifukwa cha kusapeza bwino kwa wothandizira.
Kukhala cisgender kulibe mgwirizano ndi zomwe munthu amakonda kugonana.
Chisamaliro cha Chiropractic Pambuyo pa Ngozi ndi Kuvulala
Zothandizira
Clayton, JA, & Tannenbaum, C. (2016). Kupereka Lipoti la Kugonana, Jenda, Kapena Onse Pakufufuza Zachipatala? JAMA, 316 (18), 1863-1864. doi.org/10.1001/jama.2016.16405
Monteiro, Delmira ndi Poulakis, Mixalis (2019) "Zotsatira za Miyezo ya Cisnormative Kukongola pa Malingaliro a Akazi a Transgender ndi Mawonekedwe a Kukongola," Midwest Social Sciences Journal: Vol. 22: Yes. 1, Ndime 10. DOI: doi.org/10.22543/2766-0796.1009 Ipezeka pa: Scholar.valpo.edu/mssj/vol22/iss1/10
Moleiro, C., & Pinto, N. (2015). Kugonana ndi kudziwika kwa amuna ndi akazi: kuwunikanso malingaliro, mikangano ndi ubale wawo ndi machitidwe amagulu a psychopathology. Frontiers in Psychology, 6, 1511. doi.org/10.3389/fpsyg.2015.01511
Kusintha kwa jenda ndi njira yotsimikizira ndi kufotokoza momwe munthu amaganizira za jenda m'malo mwa zomwe adapatsidwa atabadwa. Kuphunzira za kusintha kwa jenda ndi jenda kungathandize bwanji LGBTQ + gulu?
Kusintha kwa Jenda
Kusintha kwa jenda kapena kutsimikizira kuti jenda ndi njira yomwe anthu osintha jenda ndi omwe sakugwirizana ndi jenda amagwirizanitsa umunthu wawo wamkati ndi mawonekedwe awo akunja. Itha kufotokozedwa ngati yachiphamaso - yachimuna kapena yaikazi - komanso ikhoza kukhala yopanda binary, kutanthauza kuti munthu si mwamuna kapena mkazi yekha.
The ndondomeko ingaphatikizepo maonekedwe okongola, kusintha kwa maudindo a anthu, zovomerezeka mwalamulo, ndi / kapena maonekedwe a thupi..
Chitsimikizo cha anthu - kuvala mosiyana kapena kutuluka kwa abwenzi ndi abale.
Chitsimikizo chalamulo - kusintha dzina ndi jenda pamakalata ovomerezeka.
Chitsimikizo chachipatala - kugwiritsa ntchito mahomoni ndi/kapena opaleshoni kusintha mbali zina za thupi lawo.
Anthu a Transgender amatha kutsata zina kapena zonsezi.
Zopinga
Kusintha kwa jenda kumatha kusokonezedwa ndi zopinga zosiyanasiyana zomwe zingaphatikizepo:
Anthu ambiri omwe ali ndi ma transgender ndi omwe sakugwirizana ndi jenda amakonda kutsimikizira jenda kusiyana ndi kusintha kwa jenda chifukwa kusintha nthawi zambiri kumatanthawuza njira yosinthira thupi mwachipatala.
Munthu sayenera kulandira chithandizo chamankhwala kuti atsimikizire kuti ndi ndani, ndipo anthu ena osintha mtundu amapewa mahomoni kapena opaleshoni yotsimikizira kuti ndi amuna kapena akazi.
Kusintha ndi njira yokhazikika yomwe imakhudza mbali zonse za momwe munthu alili mkati ndi kunja.
Zina za kusintha zingakhale zofunika kwambiri kuposa zina, monga kusintha dzina ndi jenda pa satifiketi yobadwa.
Kuunikanso ndi kuunikanso za kudziwika kwa amuna ndi akazi kungakhale kosalekeza m'malo mongotsata njira imodzi yokha.
Panthawi ya kutha msinkhu, kusintha kwa thupi kungayambitse maganizo oti sakuyenerera ndipo angasinthe n’kukhala maganizo oti sakuyenerana ndi matupi awo.
Kusintha kwa jenda/kutsimikiza kumakhala gawo lotsatira. Kusintha sikungokhudza kusintha kapena kudzipanganso koma kufotokoza zomwe ali zenizeni ndikudziwonetsera kuti iwo ndi ndani mwamakhalidwe, mwalamulo, ndi/kapena mankhwala.
Social
Kusintha kwa chikhalidwe kumakhudza momwe munthu amasonyezera poyera kuti ndi mwamuna kapena mkazi. Kusinthaku kungaphatikizepo:
Kusintha matauni.
Kugwiritsa ntchito dzina losankhidwa.
Kutuluka kwa abwenzi, abale, ogwira nawo ntchito, etc.
Kuvala zovala zatsopano.
Kumeta kapena kukonza tsitsi mosiyana.
Kusintha kwamakhalidwe monga kusuntha, kukhala, etc.
Kusintha mawu.
Kumanga - kumanga pachifuwa kuti abise mabere.
Kuvala mabere ndi ma prosthetics a m'chiuno kuti alimbikitse kupindika kwa akazi.
Kulongedza - kuvala chiboliboli cha mbolo kuti apange chotupa cha mbolo.
Kusintha kwachipatala kumaphatikizapo chithandizo cha mahomoni kuti apange zina mwazochita za amuna kapena akazi. Zingaphatikizenso opaleshoni kuti asinthe mbali zina za thupi pamodzi ndi mankhwala a mahomoni.
Testosterone imatengedwa kuti ithandize kuzama mawu, kuwonjezera minofu, kulimbikitsa tsitsi la thupi ndi nkhope, ndikukulitsa clitoris. (MS Irwig, K Childs, AB Hancock. 2017)
Transgender Women
Estrogen amatengedwa komanso testosterone blockers kuti agawirenso mafuta a thupi, kuonjezera kukula kwa bere, kuchepetsa dazi lachimuna, ndi kuchepetsa kukula kwa machende. (Vin Tangpricha 1, Martin den Heijer. 2017)
Opaleshoni
Opaleshoni yotsimikizira kuti ndi mwamuna kapena mkazi imagwirizana ndi maonekedwe a munthu kuti akhale amuna kapena akazi. Zipatala zambiri zimapereka maopaleshoni otsimikizira jenda kudzera mu dipatimenti ya transgender. Njira zamankhwala zikuphatikizapo:
Opaleshoni ya nkhope - Opaleshoni ya nkhope ya akazi.
Kuchulukitsa mawere - Kumakulitsa kukula kwa bere ndi ma implants.
Chifuwa masculinization - Amachotsa mizere ya minyewa ya m'mawere.
Kumeta tracheal - Kumachepetsa apulo wa Adamu.
Phalloplasty - Kupanga mbolo.
Orchiectomy - Kuchotsa machende.
Scrotoplasty - Kupanga scrotum.
Vaginoplasty - Kupanga ngalande ya ukazi.
Vulvoplasty - Kupanga maliseche akunja aakazi.
Zotchinga pamsewu
Anthu a Transgender amatetezedwa ku tsankho la inshuwaransi yapagulu ndi yachinsinsi pansi pa malamulo aboma ndi boma, kuphatikiza Medicare ndi Medicaid. (National Center for Transgender Equality. 2021)
Mapulogalamu a Medicaid m'maboma asanu ndi anayi samakhudza chithandizo chamankhwala chotsimikizira kuti amuna kapena akazi ndi amuna, ndipo ku Illinois ndi Maine okha ndi omwe amapereka chisamaliro chokwanira chomwe World Professional Association for Transgender Health/WPATH. (Kaiser Family Foundation. 2022)
Ena amafotokoza kuti achibale kapena abwenzi sakuvomereza chifukwa chachikulu chomwe amasiyira kutsimikizira kuti ndi amuna kapena akazi. (Jack L. Turban, et al., 2021)
Ngati mukudziwa wina yemwe ali wosinthika kapena akuganiza zosintha, kuphunzira za kusintha kwa jenda ndi jenda komanso momwe mungathandizire ndi njira yabwino yokhalira wothandizira.
Kukulitsa Moyo Wanu
Zothandizira
Gülgöz, S., Glazier, JJ, Enright, EA, Alonso, DJ, Durwood, LJ, Fast, AA, Lowe, R., Ji, C., Heer, J., Martin, CL, & Olson, KR (2019) ). Kufanana pakukula kwa jenda kwa ana a transgender ndi cisgender. Zokambirana za National Academy of Sciences ku United States of America, 116 (49), 24480-24485. doi.org/10.1073/pnas.1909367116
Irwig, MS, Childs, K., & Hancock, AB (2017). Zotsatira za testosterone pa mawu achimuna a transgender. Andrology, 5(1), 107-112. doi.org/10.1111/andr.12278
Tangpricha, V., & den Heijer, M. (2017). Estrogen ndi anti-androgen mankhwala kwa amayi a transgender. The Lancet. Matenda a shuga & endocrinology, 5 (4), 291-300. doi.org/10.1016/S2213-8587(16)30319-9
National Center for Transgender Equality. Dziwani Ufulu Wanu pa Zaumoyo.
Kaiser Family Foundation. Kusintha kwa Medicaid pazachipatala zotsimikizira jenda.
Center of Medicare ndi Medicaid Services. Gender dysphoria ndi opareshoni yosinthira jenda.
Transgender Legal Defense and Education Fund. Ndondomeko zachipatala za inshuwaransi yazaumoyo.
National Center for Transgender Equality and National Gay and Lesbian Task Force. Kusalungama Nthawi Zonse: Lipoti la National Transgender Discrimination Survey.
Turban, JL, Loo, SS, Almazan, AN, & Keuroghlian, AS (2021). Zomwe Zimayambitsa "Kusiya" Pakati pa Anthu Osiyana Gender ndi Gender ku United States: Kusanthula Njira Zosakanikirana. LGBT thanzi, 8(4), 273-280. doi.org/10.1089/lgbt.2020.0437
Chidziwitso cha jenda ndi chosiyana. Kodi kuphunzira chilankhulo chomwe chimagwiritsidwa ntchito pofotokoza zamitundu yosiyanasiyana ya jenda ndi matauni osakhala a binary kungathandize kufotokoza kusiyana pakati pa jenda ndi kuthandizira pakuphatikiza?
Osakhala a binary
Non-binary ndi mawu omwe amagwiritsidwa ntchito kutanthauza anthu omwe samadziwika kuti ndi amuna kapena akazi. Mawuwa amafotokoza za mitundu yosiyanasiyana ya jenda ndi mawu omwe ali kunja kwa machitidwe achikhalidwe, omwe amayika anthu m'magulu ngati amuna kapena akazi.
Tanthauzo
Anthu osakhala a binary ndi anthu omwe kudziwika kwawo kuti ndi amuna kapena akazi komanso/kapena kusagwirizana ndi chikhalidwe cha amuna kapena akazi. (Kampeni ya Ufulu Wachibadwidwe. (ndi))
Anthu ena omwe si a binary amadziwika kuti ndi ophatikiza amuna ndi akazi; ena amazindikira kuti ndi amuna kapena akazi osiyana; ena sadziwika ndi jenda.
Mawu akuti "osakhala binary" angakhalenso "enby”/katchulidwe ka fonetiki ka zilembo NB kwa osakhala a binary, ngakhale si aliyense amene sagwiritsa ntchito binary amagwiritsa ntchito mawuwa.
Munthu amene amadziŵika kuti ndi mwamuna kapena mkazi kunja kwa chikhalidwe cha amuna ndi akazi.
Izi zingaphatikizepo anthu omwe amadzizindikiritsa kuti ndi amuna kapena akazi, jenda, kapena genderfluid ndi ena.
Kugwiritsa Ntchito Matchulidwe
Kugwiritsa ntchito matanthauzo osakhala a binary ndi njira yosonyezera ulemu ndi kutsimikizira kuti munthuyo ndi ndani. Nazi malingaliro amomwe mungagwiritsire ntchito matchulidwe: (National Center for Transgender Equality. 2023)
Funsani maina a munthu payekha
Ndikoyenera kupeŵa kufotokoza mawu a munthu potengera maonekedwe kapena stereotype.
Ngati simukudziwa mawu a munthu wina, funsani mwaulemu.
Kitzie, V., Smithwick, J., Blanco, C., Green, MG, & Covington-Kolb, S. (2023). Kupanga limodzi maphunziro a ogwira ntchito zachipatala kuti apititse patsogolo luso lothandizira anthu a LGBTQIA+. Front Public Health, 11, 1046563. doi.org/10.3389/fpubh.2023.1046563
McCave, EL, Aptaker, D., Hartmann, KD, & Zucconi, R. (2019). Kulimbikitsa Kuchita Zolimbitsa Thupi Zaumoyo za Transgender M'zipatala: IPE Standardized Patient Simulation kwa Ophunzira Omaliza Maphunziro a Zaumoyo. MedEdPORTAL, 15, 10861. doi.org/10.15766/mep_2374-8265.10861
Morris, M., Cooper, RL, Ramesh, A., Tabatabai, M., Arcury, TA, Shinn, M., Im, W., Juarez, P., & Matthews-Juarez, P. (2019). Maphunziro ochepetsa kukondera kokhudzana ndi LGBTQ pakati pa ophunzira azachipatala, unamwino, ndi mano ndi othandizira: kuwunika mwadongosolo. BMC Med Educ, 19(1), 325. doi.org/10.1186/s12909-019-1727-3
Sherman, ADF, Cimino, AN, Clark, KD, Smith, K., Klepper, M., & Bower, KM (2021). LGBTQ+ maphunziro azaumoyo kwa anamwino: Njira yatsopano yopititsira patsogolo maphunziro a unamwino. Nurse Educ Lero, 97, 104698. doi.org/10.1016/j.nedt.2020.104698
Jenda ndi lingaliro lomwe lili ndi mbali zambiri. Aliyense ali ndi mawonekedwe a jenda. Kodi kuphunzira zokhuza jenda kungathandize akatswiri azachipatala kupereka njira zabwinoko komanso zogwira mtima za gulu la LGBTQ+?
Kuwonetsera kwa Gender
Kufotokozera za jenda kumatanthauza njira zomwe anthu amawonetsera kuti ndi ndani komanso iwo eni. Izi zikhoza kukhala zovala, kumeta tsitsi, makhalidwe, ndi zina zotero. Kwa ambiri, pakhoza kukhala chisokonezo pakati pa zomwe anthu amayembekezera kuchokera kwa jenda ndi momwe anthuwa amasankhira kudziwonetsera okha. Kufotokozera za jenda kumapangidwa kuchokera ku chikhalidwe chozungulira, kutanthauza kuti pangakhale chiyembekezo chogawana pakati pa amuna ndi akazi. Zingatanthauzenso kuti tsitsi lachikazi lachikazi kapena kavalidwe kofananako kangaoneke ngati chachimuna m’malo ena.
Sosaite imayesa kuwongolera kufotokoza mwa kuwapangitsa akazi kuvala mitundu ina ya zovala, ndi amuna mitundu ina, kuti athe kutenga nawo mbali pasukulu, ntchito, ndi pamene ali pagulu.
Zikhalidwe zikamakhazikitsa zikhalidwe za jenda zimatchedwa apolisi pakati pa amuna ndi akazi, zomwe zingachokere ku malamulo a kavalidwe mpaka ku chilango chakuthupi ndi chamaganizo.
Kupanga malo otetezeka kwa amuna ndi akazi kumafuna kuzindikira za zikhulupiriro zodziwikiratu kapena zodziwikiratu kuti ntchito zapolisi zipewedwe. (José A Bauermeister, et al., 2017)
Kafukufuku wasonyeza kuti pali kuchuluka kwa tsankho kwa anthu omwe ali ndi amuna kapena akazi okhaokha poyerekeza ndi kukondera kwa omwe ali LGBTQ. (Elizabeth Kiebel, et al., 2020)
Care Health
Kufotokozera za jenda kumatha kukhudzanso mwayi wopeza chithandizo chamankhwala.
Anthu omwe ali ndi malingaliro osiyana ndi amuna ndi akazi omwe amayembekeza kugonana kwawo atabadwa akhoza kukhala ndi tsankho komanso kuzunzidwa ndi opereka chithandizo. (Human Rights Watch. 2018)
Munthu aliyense amasankha momwe angadziwonetsere ku dziko, ndipo timalemekeza onse. Ife ku Injury Medical Chiropractic ndi Functional Medicine Clinic tidzayesetsa kuthana ndi zovuta zapang'onopang'ono pakusiyana kwaumoyo ndikudziwitsa anthu za njira zopititsira patsogolo zokumana nazo zabwino. LGTBQ+ anthu omwe akufuna chithandizo chamankhwala chophatikiza kwa kuvulala kwa neuromusculoskeletal, mikhalidwe, kulimba, thanzi, komanso thanzi labwino.
Revolutionizing Healthcare
Zothandizira
Bauermeister, JA, Connochie, D., Jadwin-Cakmak, L., & Meanley, S. (2017). Apolisi Amuna Kapena Akazi Pa Ubwana Ndi Umoyo Wamaganizo a Amuna Achichepere Ochepa Ogonana Nawo ku United States. American Journal of Men's Health, 11 (3), 693-701. doi.org/10.1177/1557988316680938
Kiebel, E., Bosson, JK, & Caswell, TA (2020). Zikhulupiriro Zofunikira ndi Tsankho la Kugonana kwa Amuna Ogonana Akazi. Journal ya kugonana kwa amuna kapena akazi okhaokha, 67 (8), 1097-1117. doi.org/10.1080/00918369.2019.1603492
Human Rights Watch. “Simukufuna Bwino Kwambiri”—Kusankhana kwa LGBT ku US Health Care.
Ayhan, CHB, Bilgin, H., Uluman, OT, Sukut, O., Yilmaz, S., & Buzlu, S. (2020). Kuwunikiridwa Mwadongosolo kwa Tsankho Lolimbana ndi Kugonana ndi Amuna Ochepa Amuna Kapena Akazi mu Zokonda Zaumoyo. Nyuzipepala yapadziko lonse ya mautumiki azaumoyo: kukonzekera, kuyang'anira, kuwunika, 50 (1), 44-61. doi.org/10.1177/0020731419885093
Meyer IH (1995). Kupsinjika pang'ono komanso thanzi lamalingaliro mwa amuna ogonana amuna kapena akazi okhaokha. Journal ya thanzi ndi chikhalidwe cha anthu, 36 (1), 38-56.
Puckett, JA, Maroney, MR, Levitt, HM, & Horne, SG (2016). Ubale pakati pa kuwonetsa jenda, kupsinjika kwapang'ono, ndi thanzi lamalingaliro mu cisgender ochepa omwe amagonana amuna ndi akazi. Psychology of Sexual Orientation and Gender Diversity, 3(4), 489-498. doi.org/10.1037/sgd0000201
Carroll, R., & Bisshop, F. (2022). Zomwe muyenera kudziwa zokhudza chisamaliro chaumoyo chotsimikizira kuti amuna kapena akazi okhaokha. Emerg Med Australas, 34(3), 438-441. doi.org/10.1111/1742-6723.13990
Cooper, RL, Ramesh, A., Radix, AE, Reuben, JS, Juarez, PD, Holder, CL, Belton, AS, Brown, KY, Mena, LA, & Matthews-Juarez, P. (2023). Kutsimikizira ndi Kuphatikizira Kusamalira Maphunziro kwa Ophunzira Zachipatala ndi Okhalamo Kuti Achepetse Kusiyana kwa Zaumoyo Zomwe Zimachitika ndi Zochepa Zogonana ndi Amuna Kapena Akazi: Kubwereza Mwadongosolo. Transgend Health, 8(4), 307-327. doi.org/10.1089/trgh.2021.0148
Diana, P., & Esposito, S. (2022). LGBTQ + Youth Health: Chosowa Chosakwanira mu Pediatrics. Ana (Basel), 9(7). doi.org/10.3390/children9071027
Johnson, CD, & Green, BN (2012). Kusiyanasiyana kwa ntchito ya chiropractic: kukonzekera 2050. J Chiropr Educ, 26(1), 1-13. doi.org/10.7899/1042-5055-26.1.1
Maiers, MJ, Foshee, WK, & Henson Dunlap, H. (2017). Cultural Sensitive Chiropractic Care of the Transgender Community: Ndemanga Yofotokozera ya Zolemba. J Chiropr Humanit, 24(1), 24-30. doi.org/10.1016/j.echu.2017.05.001
McCave, EL, Aptaker, D., Hartmann, KD, & Zucconi, R. (2019). Kulimbikitsa Kuchita Zolimbitsa Thupi Zaumoyo za Transgender M'zipatala: IPE Standardized Patient Simulation kwa Ophunzira Omaliza Maphunziro a Zaumoyo. MedEdPORTAL, 15, 10861. doi.org/10.15766/mep_2374-8265.10861
Moran, CI (2021). LGBTQ yolimbikitsa mfundo zaumoyo wa anthu. Educ Health (Abingdon), 34(1), 19-21. doi.org/10.4103/efh.EfH_243_18