Hypokalemia After Acute Acetaminophen Overdose Health And Social Care Essay

Aims: This survey intended to find the prevalence of hypokalemia and its clinical correlatives in acute psychiatric unwellness among hypokalemic and normokalemic patients after acetaminophen overdose. Methods: This is a retrospective cohort survey of infirmary admittances for ague Datril overdose conducted over a period of 5 old ages from January 1, 2004 to December 31, 2008. Demographic informations and different types of psychiatric unwellness were compared between hypokalemic and normokalemic patients. Hypokalemia was predefined by a serum concentration & A ; lt ; 3.5 mmol/ L. SPSS 15 was used for informations analysis. Consequences: Two hundred and eighty patients out of 305 admittances were studied. Hypokalemia was found in 63.6 % of patients with a higher prevalence in the presence of psychiatric unwellness ( 67.7 % ) . Hypokalemic patients were significantly associated with the presence of major depression ( P = 0.04 ) , adjustment upset ( P & A ; lt ; 0.001 ) , anxiousness ( P = 0.01 ) , and self-destructive efforts ( P = 0.04 ) . Decision: Hypokalemia was common among patients with psychiatric unwellness and ague Datril overdose. Cardinal Wordss: Acetaminophen ; Hypokalemia ; Overdose ; Potassium ; Psychiatric unwellness.IntroductionDeliberate self-poisoning ( DSP ) is recognized as a major cause of self-destruction around the world.1 Acetaminophen ( Paracetamol ) is the most common drug employed in DSP in many states, 2, 3 including Malaysia.4 Despite first-class safety in curative doses of Datril ; it is besides one of the prima causes of terrible hepatic necrosis.5 Acetaminophen overdose may be accompanied by electrolyte perturbations including hypokalemia, and these appear to be independent of the hepatotoxic effects.6 These electrolyte alterations appear to be due to the addition in fractional nephritic elimination of K, but the implicit in cellular mechanisms by which Datril might change electrolyte conveyance are still unknown.6-9 In some instances, hypokalemia may be terrible, making a degree of 2.3 mmol/ L after reported consumption of 48 g of acetaminophen.8 Hypokalemia, an easy identifiable and clinically of import status in clinical scenes, has received small attending from research workers worldwide. Not merely is hypokalemia associated with frequent cardiac and neuromuscular complications, but its consequence on mental map may besides worsen psychiatric disturbances.10, 11 Both anxiety12 and intense exercise13 addition go arounding adrenaline, which induces a ?2 – receptor-mediated inflow of K into skeletal muscle.14 As this status may be similar to the acute psychotic province, it was hypothesized that the diminution in serum K concentration could be associated with the presence of psychiatric unwellness during Datril overdose. To better our cognition of hypokalemia after acute Datril overdose, we carried out a five-year, hospital-based survey with the following aims: 1 ) to find the prevalence of hypokalemia in patients showing to infirmary after Datril overdose, and 2 ) to look into the clinical correlatives in acute psychiatric unwellness among hypokalemic and normokalemic patients after acetaminophen overdose.MethodsSettings and Study DesignThis is an experimental retrospective instance reappraisal of all patients with acute Datril overdose admitted to a 1200-bed infirmary located in the Northern part of Malaysia. The infirmary provides wellness attention and exigency intervention for all unwellnesss and accidents. All facets of the survey protocol, including entree to and usage of the patients ‘ clinical information, were authorized by the local wellness governments before induction of this survey.Participants and Data CollectionDatas were collected from January 1, 2004 to December 31, 2008. A co mputing machine generated list was obtained from the Hospital Record Office. We identified our instances harmonizing to the T-codes of the International Classification of Diseases-Tenth alteration ( ICD-10 ) . All patients with diagnostic codifications T 39.1 ( acetaminophen overdose ) were included in the survey. Specially designed data-collection signifiers were used to roll up informations refering age, gender, fortunes of overdose ( inadvertent or suicidal ) , stated day of the month and clip of poisoning to cipher the latency clip ( the clip of consumption to the clip the patient was presented at the infirmary ) , measure of Datril ingested, GI decontamination such as tummy wash, research lab trials including serum Datril concentration, and serum K concentrations during the first twenty-four hours of admittance and after a lower limit of 4 hours of consumption. Data on serum Datril concentration measurings were obtained from the infirmary ‘s curative drug supervising laboratory service. In add-on, informations related to the presence of psychiatric unwellness were obtained. psychiatric unwellness was defined as the presence of any perturbation of emotional equilibrium, as manifested in maladaptive behaviour and impaired operation, caused by familial, physical, chemical, biological, psychological, or societal and cultural factors such as depression, anxiousness, accommodation upsets, unprompted behaviours and emphasis reactions, either emotional or behavioural ; these causes were noted by the infirmary psychiatric specialist study..Hypokalemia was defined as a serum K degree of less than 3.5 mmol/ L.11 Patients with hypokalemia were classified into three groups based on K degrees: ( 1 ) mild/ grade 1 ( 3.0 – 3.4 mmol/ L ) , ( 2 ) moderate/grade 2 ( 2.5 – 2.9 mmol/ L ) and, ( 3 ) severe/grade 3 ( & A ; lt ; 2.5 mmol/ L ) .15 The charts of all patients identified through the hunt were reviewed and the information collected. Charts were excluded from analysis for the undermentioned grounds: ( 1 ) baseline K concentrations were non measured, ( 2 ) if patients had taken acetaminophen but the cause of consumption was unknown or undetermined, ( 3 ) the clip of consumption was non known or ( 4 ) the patients were on regular prescribed drugs that lead to hypokalemia, such as Lasix, and ( 5 ) the patients were kids under 13 old ages of age. Charts of patients who had research lab trials at or more than 4 hours post-ingestion were extracted for farther analysis.Statistical analysisDatas were entered and analyzed utilizing the Statistical Package for Social Sciences plan version 15 ( SPSS ) . Data were expressed as average  ± SD for uninterrupted variables and as frequence for categorical variables. The Chi square or Fischer ‘s exact trial, as appropriate, was used to prove the significance between categori cal variables. The independent samples t-test was used to compare agencies of uninterrupted variables. Variables were tested for normalcy utilizing the Kolmogorov-Smirnov trial. Variables that were non usually distributed were expressed as a median ( lower – upper quartiles ) . Statistical significance was considered at P & A ; lt ; 0.05.ConsequencesThree hundred and five instances of Datril overdose were identified. Of these, 25 patients ( 8.2 % ) were excluded. Baseline K concentrations were non measured in eight patients, one patient was given furosemide at admittance, five patients were less than 13 old ages old, the cause of consumption was unknown or undetermined in 11 patients, and hence, the survey population consisted of 280 patients ( 45 male and 235 female patients with a average age of 23.4  ± 7.1, giving a female: male ratio of 5.22: 1 ) . The bulk ( 72.1 % ) of instances of acetaminophen consumption were presented within eight hours. The average ( interquartile scope ) measure of Datril ingested was 10 g ( 6 – 15 g ) . Initial direction included tummy wash, which was performed in 181 ( 64.6 % ) instances. Activated wood coal was given while patients were in the Accident and Emergency section ; it was given as individual or multiple doses in 173 instances ( 61.8 % ) . Intravenous N-acetylcysteine ( NAC ) was given to 140 patients ( 50 % ) after Datril degrees were estimated. The average ( interquartile scope ) serum acetaminophen concentration was 55.6 mg/ L ( 14 – 120 mg/ L ) . During the survey period, 63.6 % ( 178 patients ; 33 males and 145 females ) had K degrees of less than 3.5 mmol/ L. For the hypokalemic patients, the average K degree was 3.1  ± 0.26 mmol/ L, while that for the normokalemic patients was 3.76  ± 0.35 mmol/ L. Most of the patients ( 129 ) were in mild phase hypokalemia and 45 patients were in moderate phase hypokalemia. Few patients ( 4 ) were in terrible phase hypokalemia. Psychiatrically sick topics were found to hold hypokalemia, and the prevalence was higher than that in non-psychiatrically sick topics ( 67.7 % versus 43.8 % ; severally, P = 0.002 ) ( Figure 1 ) . The most common clinical diagnosing among medically treated self-destruction triers was adjustment upset ( 45.7 % ) followed by unprompted behaviour ( 24.3 % ) , major depression ( 10.7 % ) , and anxiousness ( 2.1 % ) . Hypokalemia was significantly associated with the presence of major depression ( P = 0.04 ) , adjustment upset ( P & A ; lt ; 0.001 ) , anxiousness ( P = 0.01 ) , and self-destructive efforts ( P = 0.04 ) . However, normokalemia was significantly associated with unprompted behaviour ( P & A ; lt ; 0.001 ) , the absence of psychiatric unwellness ( P = 0.002 ) , and the presence of inadvertent overdose ( P = 0.04 ) ( Table 1 ) . One hundred and twelve patients with adjustment upset and six patients with anxiousness were found to hold hypokalemia, and the prevalence of hypokalemia among these patients was higher than that in the overall survey population and in patients with other psychiatric upsets ( 100 % and 87.5 % , severally ) . Similarly, their average K degree was lower than that of the overall survey population ( 3.16  ± 0.41 and 3.2  ± 0.21 mmol/ L, severally ) ( Table 2 ) . Eight hypokalemic patients ( 4.5 % ) were supplemented with unwritten K medicine, and 85 hypokalemic patients ( 47.8 % ) were treated with endovenous K chloride, and their K degrees were normalized in the following blood trial. Additionally, most of the treated patients ( 59 ) were in mild phase hypokalemia and 32 patients were in moderate phase hypokalemia. Few patients ( 2 ) were in terrible phase hypokalemia.DiscussionThis survey is the first of its sort in Malaysia and has been carried out to find the prevalence of hypokalemia in patients showing to infirmary after acute Datril overdose, and to look into the clinical correlatives in acute psychiatric unwellness among hypokalemic and normokalemic patients after acetaminophen overdose in 280 patients with acute Datril overdose collected retrospectively from a records register. In this survey hypokalemia was identified in 178 patients, and the prevalence of hypokalemia among hospitalized patients with acetaminophen overdose was 63.6 % . A old survey found that hypokalemia was common in medical inmate settings.16 About 20 % of shot, 10 % of myocardial infarction patients,17 21.2 % of psychiatric disorders,18 and about one tierce of ague Datril overdose patients suffered from hypokalemia.9 The high prevalence of hypokalemia after Datril overdose might be due to multiple hazard factors. The etiology of hypokalemia is complex. The degree of serum K depends on the balance between unwritten consumption, nephritic and GI losingss every bit good as the balance and motion between excess and intra-cellular compartments.11 A old survey found that 7.6 % of psychiatric patients had nutritionary jobs ; 19 unequal dietetic K consumption was comparatively rare unless day-to-day K consumption was less than 25 mmol.20 This survey found that it was the psychiatrically sick patients, instead than those patients with no psychiatric unwellness, who were more likely to develop hypokalemia. This determination is consistent with other published surveies that showed that hypokalemia was common among acute psychiatric inpatients.18, 21, 22 Adjustment upsets are frequently precipitated by emphasis reactions.23 For most people, emphasis is associated with higher hydrocortisone levels.24, 25 Previous surveies have suggested that high hydrocortisone degrees may be the chief cause of hypokalemia.26-28 In this survey, patients with anxiousness were enduring from a low mean K concentration and a high prevalence of hypokalemia. The exact mechanism was unsure. This determination is in understanding with another published survey that has shown little lessenings in serum K among 200 pre-operative patients who had an addition in anxiety.12 The account of this determination is that anxiousness increases the circulating adrenaline, 12 which induces a ?2 – receptor-mediated inflow of K into skeletal muscle.14 In the present survey, patients with major depression were enduring from a high prevalence of hypokalemia. This determination is similar to a old work that has shown patients with major depression had lower average serum K values and a higher incidence of hypokalemia than other upsets such as dysthymic upset and schizophrenic psychosis.18 This determination may be due to alterations in sympathomimetic thrust or in sensitiveness or denseness of the ?2-receptor. 18 Expected findings in our survey were the low incidence of hypokalemia in the patients with unprompted behaviour. These patients differed significantly from the other types of psychiatric unwellness and considered as a portion of the normal behavior.29 This is supported by findings that impulsivity is a type of human behaviour characterized by the disposition of an person to move on impulse instead than thought.30 It has been concluded in old survey that the reduced peripheral adrenaline degrees may be involved in pathophysiology of unprompted and overactive behaviors.31 This mechanism consequences in a reduced consumption of K by cells. In add-on, this survey found that it was the self-destructive patients, instead than those with inadvertent overdose, who were more likely to develop hypokalemia. Attempted self-destruction is assumed to be a hyper-adrenergic state.18 A retrospective survey carried out on patients with psychiatric upsets concluded that important differences existed among the attempted self-destruction group with respect to hypokalemia.18 ?-adrenergic receptor stimulation causes hypokalemia in experimental animate beings and humans.32 There is small uncertainty that one of the mechanisms of hypokalemia is a beta 2-receptor-mediated inflow of K into skeletal musculus, induced by go arounding epinephrine.18, 33, 34 It has been demonstrated that adrenaline causes inordinate activation of the sodium/potassium-ATPase pump as a consequence of ?2-adrenergic receptor stimulation.14, 33 This mechanism consequences in an increased consumption of K by cells, taking to a lessening in serum K degrees. As the influ ence of the sympathomimetic system on serum K is found in many psychiatric state of affairss, 18, 21, 22, 35 it may explicate why a high prevalence of the patients included in our survey were presented with hypokalemia. A high per centum of patients ( 47.7 % ) were still non being treated for low K degrees, seting their wellness in hazard. The common happening of hypokalemia in patients with acute Datrils overdose should alarm all clinicians to the importance of rectifying K loss, since most of the patients with an Datril overdose might hold received endovenous fluids or N-acetylcysteine in serum dextrose 5 % . However, this may hold altered serum K concentrations through endogenous insulin production induced by 5 % dextroglucose, ensuing in motion of K into the intracellular compartment. However, the extended usage of dextroglucose may expose the patients to higher hazards. This survey is the first one of its type in Malaysia to look into the clinical correlatives in acute psychiatric unwellness among hypokalemic and normokalemic patients after acetaminophen overdose. It is besides the first survey suggested that hypokalemia is related to psychiatric position after Datril overdose instead than the old studious that showed a dose-dependent relationship between autumn in serum K and serum Datril at presentation.6, 9 Our survey suffers from a few restrictions. First, farther hazard factors for hypokalemia were non taken into history in the analysis. A 2nd restriction is its retrospective nature and the deficiency of structured interview appraisal of the topics. Third, we can merely propose, instead than turn out, that the psychiatric province is responsible for the high happening of hypokalemia diagnosed in our population.Decisions and recommendationsIn decision, hypokalemia is extremely prevailing among psychiatrically sick patients and after acute Datril overdose. Therefore, monitoring of serum K concentration may be clinically of import on exigency admittance for all instances of ague Datril overdoses to forestall the effects of hypokalemia. Supplemental potassium disposal should be commenced every bit shortly as possible. Recognitions: The writers would wish to thank the Universiti Sains Malaysia ( USM ) for the fiscal support provided for their research. The aid of the medical and record office staff is appreciatively acknowledged. Conflict of involvements: We would wish to declare that there was no struggle of involvements in carry oning this research.

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Many Of The Characters In Of Mice And Men Have Dreams Essay John Steinbeck wrote the novel Of Mice and Men in 1937. The settings were personally related to the author himself. The Novel is set were he originally came from, around Salinas, California. It was written during the great depression which not only effected America, but Europe as well; however the novel only focuses on America. Steinbeck had his reasons for writing about it. He wanted to show the reality of the great depression as it struck everyone in different ways. He used realistic characters that represented the main groups of people living in America and what effects took place according to their status. One of the biggest problems was that twenty-five percent of the whole population was unemployed, leaving a mass of civilians to roam the streets, desperate to survive by any means. Others were forced to become itinerant workers. George and Lennie, the main characters, are two ranch workers. They are prime examples or itinerant workers due to the economic disaster they faced. They had slight difficulties maintaining a job as Lennie has a mental and almost physical disability. His child-like mind didnt allow him to correspond well with his beastly physicality. This means he is unaware of how brutal and uncivilized his actions may be. Its what always got him in trouble and George was the one always defending him. All they had was each other. As Itinerant workers they travelled far in search of work as did many others who were desperate to earn enough money to survive or perhaps support their family. They pretty much had no choice if they wanted to live. Work on a ranch didt always pay well ; however, the workers were provided with the necessities which had already cover a lot of costs such as a roof over their head, cooked meals, bathing facilities, so they were grateful. All those small things are the things that are taken for granted, but to those times they were valued and appreciated. Whatever salaries they received at the end of each month they would send home to their families or spend it all on a cat house (prostitute house) and start all over again. George and Lennie had other plans which differentiated them from the rest. George and Lennie both shared a dream. Besides the fact that their relationship status was quite rare, the dream made it that little bit more special. Most people travelled alone and just had their minds set on surviving. George and Lennie had their hearts set on bigger things. We could live off the fatta the lan, a quote used constantly by both George and Lennie. They are implying that they want to buy land in which they can live off everything they grow so they wont have to rely on any one to survive. Its a big change from working for someone to working for yourself; its more satisfying knowing they can do what they want for themselves. Well have a big vegetable patch and a rabbit-hutch and chickens. And when it rains in the winter, well just say the hell with going to work! Their dream gets deeper with endless wants; to them its almost like an obsessive fantasy. However, their dreams are still realistic compared to a modern day dream which tends to be more selfish and greedy. A sense of freedom is what they are after which is highly understandable and admirable. Lennie also has an obsession with tending rabbits. Again his child-likeliness is getting the better of him; then again all children look forward to particular things they enjoy. Their dream is like a private sanctuary in their minds, an escape from reality, the one thing that no one can take from them. Its their goal, the one thing that keeps them motivated to carry on. Come on, George. Tell Me. Please, George. Like you done before. George tells their dream like a story out of a fairytale to satisfy Lennies childish behavior. Lennie also repeats his sentences as a sign of enthusiasm. The dialect used gives quite a clear impression of what they sound like and helps to visualize their words and actions. What is said is written quite different from how we would write and speak today, so it emphasizes on how long ago this took place. The Ranch consists of more than just workers and one dream. George and Lennie werentt alone; there were others with different occupations and completely different dreams. George and Lennies dream later developed into a larger dream including one other member. Candy, a former worker, who had lost his hand on the ranch so he wasnt much use. He was aware that it wouldntt be long until he would have no were to go, he was only getting benefits for his loss on the ranch, and no one wants a useless worker hanging about. When Candy over hears George going into story mode, he was overwhelmed knowing that there was some hope. You know wheres a place like that? and How much they want for a place like that? showed Candy was deeply interested by asking questions. Candy was interested by all of this because his life was slowly passing by and he was still not doing anything about it. So this dream of having a ranch and not working for somebody was a big eye-one for candy and seemed very interested in the dream. He stated obviously that hes interested by saying, Spose I went in with you guys and shows us how desperate he is by offering three hundred an fifty bucks which was more than half of the overall payment required. Just to sweeten up the deal even more he adds, I could cook and tend the chickens and hoe the garden some. And Id make a will an leave my share to you guys in case I kick off, Candy chose his words carefully letting George know it will benefit everyone rather than it being a selfish gesture. Just to make sure they kept him in he used a very short but never the less a very effective emotional line, When they can me here I wisht somebodys shoot me. Automatically they feel sympathetic towards him because he lost his hand and his best friend, the dog. It was after that conversation that Candy gained hope after all. However, a serious incident occurred which lead George to kill Lennie for the good and safety of others. He gave up on the dream and decided to become a part of what everyone else already was. then its all off? Candy asked sulkily. Without George, Candy couldntt stand a chance making the dream come true alone and there was no persuading George to reconsider. Candy was vexed at Curleys wife as she laid dead, Everbody knowed youd mess things up. He knew that if she didnt disturb Lennie they would all be able to leave the ranch and have a good life together. Now that she had caused all these problems he had no respect for her at all and insulted her by using harsh names such as lousy tart and bitch. Women to those times werent seen as equals, they done what they were told and werent much use. Curleys wife is a good example of a typical woman to those times. She is referred to as Curleys wife and nothing else to show her lack of importance. She craves attention as no one pays her no mind, so she resorts to Lennie who listens too her dream. Her dream was to make something of her self by becoming an actress. Coulda been in the movies, an had nice clothes all of them nice clothes they wear. An I coulda sat in them big hotels, an had pitchers took of me. she reminisces on the past were she had a chance of fulfilling her dream and all the materialistic things she would have had. She sounded ungrateful when she said, I wouldnt be livin like this, you bet as if to say what Curley had to offer wasnt good enough when thats what nearly all women wish they could have. Her marriage to Curley was an escape from loneliness which seemed to have failed. As she was an attention seeker she used her sexuality to her advantage to lure in other men, even if they were at the bottom of the social hierarchy. Although the other men were aware of the sly schemes, Lennie was mesmerized by her beauty and was generally vulnerable. She even admitted that she was lonely to make Lennie feel sorry for her by saying, Why cant I talk to you? I never get to talk to nobody. I get awful lonely. She did this to make him feel sorry for her and give in to her cunning ways. She had finally found someone dumb enough to listen to her pitiful life story without passing a judgment on her and it all started from, Maybe I will yet. Then with such passion she let lose what she had bottled up inside for a while. She couldnt care about what Lennie had to say when he included his own dream in the conversation, she went on with her story quickly, before she could be interrupted. For someone desperate to talk to someone she seemed awfully ungrateful and selfish. She was fully aware of what he was capable of yet she still took the risk of getting to close. She took Lennies hand and put it on her head she told him to Feel right aroun this was the biggest mistake she could have ever possibly made. From the slightest jerk he began to panic. His child and animalistic side began to collide again. Like a child he held on and panicked, however, he didnt realize he was hurting her and she wasnt strong enough to struggle free. She died young and still could have made something of herself but she could never get another chance after that. This quote is taken after Curleys wife died, her dreams like the others but hers different of wanting to be famous were shattered. Crooks is just the isolated nigger at the bottom of the social hierarchy on the ranch who constantly got degraded by everyone. His status is even lower than any womans. Any black person to those times would have the most selfless dream, to be treated as an equal and to have freedom. George and Lennie were the only ones that communicated with Crooks so it probably made him feel somewhat wanted. Crooks also developed a desire to join the dream. Crooks constantly had to take everything thrown at him verbally by Curleys wife as he had no status as a busted-back nigger. She constantly abused him and when he finally decided to stand up for him self he got knocked back down again. Keep your place then, Nigger. I could get you strung up on a tree so easy it aint even funny. This shows that if Crooks did anything out of the ordinary it will be reported and he will be dealt with in harsh ways. It made him realise that he couldnt take part in the dream, all hope had been lost thanks too the threat Curleys wife made. Every character mentioned above presented their dreams in the form of a story to another character. Each of the dreams were different yet similar in many ways. All of the dreams resorted to freedom from somewhere or someone, and not to suffer from financial problems. They all wanted to be able to support themselves and survive from what they owned. The only difference being that some were unrealistic and they had different views of the dreams they wished too accomplish. In the past Curleys wife was close to being an actress twice. Only thing that stopped her was her mother, who didnt let this dream continue knowing what the consequences would be later on in life. George, Lennie and Candy were less than a month away from completing their task of obtaining the land. In the end Lennie accidentally ruined everything and didnt even know what he had caused. Crooks wasnt as close, he only had hopes of becoming apart of the dream, but nothing had been established officially. I think the situation on the whole affected George the most as it was originally his aim to work towards it and without it he felt like there was nothing left for him. He lost faith in his dream and his fellow companion. I believe Steinbeck looked at how the Great Depression affected the different people in America and sympathized on their behalf. All the characters represent all types of people in America; the elderly, disabled, women and the ethnic minorities. They all played important parts as they helped to show how major the issue was.

Has Television Taken Over Photography?

Has Television Taken Over Photography? In the age of television and internet streaming videos, photography is no longer as pervasive a tool of social control as it used to be. Its golden age is now over, since it flourished and died along with the great dictatorships of the 20th Century. In fact, the most eloquent examples of the use of photography as a means to seduce people and annihilate their ability of a critical analysis of reality (in order to submit their will to the goals of a governing elite) can be found in the period between the 1920’s and the 1950’s. It was in such period that the fascist, nazi, and communist propaganda saw in photographers the perfect craftsmen who could transform images, often fake or posed, into messages to convey a particular information about what was going on in their country. In Italy, it was through the pictures taken by anonymous photographers that Benito Mussolini managed to give the people the idea of being part of a great nation, where everybody (intellectuals, sport smen, the Church, the unions, the common men) were proud to demonstrate their faith in the fascist regime[1]. It was through them that he was able to depict the country as a plentiful land, led by a good-hearted man embodying the virtues of the great Roman emperors. Most of those photographers were working for the same institution, the Istituto Luce, a formally independent organism that was actually controlled by the fascist regime. Its purpose was to operate as a modern news agency, but any proof of the disastrous economic and social conditions of many areas of Italy (such as Sicily, Veneto or Sardinia) was withdrew from the press. So, there were no news, if they had to be bad news. Another example of Mussolini’s attempt at distorting reality was the photographic book Italia imperiale (Imperial Italy), published in 1937. The author, Manilo Morgagni, wrote a visual elegy of the virtues of the dictator. In the same period, Adolf Hitler was making a similar use of photography in Germany, especially thanks to the collaboration of Leni Riefenstahl, who later would become one of the most famous artists of the world. The book Schoenheit im Olympischen Kampf (Beauty in the Olympic games), published in 1938, was a collection of her shots of the German youth, taken during the Olympic Games held in Berlin in 1936; it was an instrument of Hitler’s propaganda aimed at celebrating the perfect bodily features that only the pure Aryan race could boast[2]. In this way, German population was given an amount of visual messages that confirmed the superiority of their race, so that there was no questioning about the crimes their leader was committing in foreign countries. On the other hand, Hitler wie ihn keiner kennt (The unknown Hitler) was an homage to the Furher from his personal photographer, Heinrich Hoffmann, and was completely dedicated to him and his private life. It showed a leader ca ressing children and enjoying mountain resorts, depicting him as father and protector on the nation. In the USSR, Iosif Stalin reduced the avant-garde photographer Aleksandr Rodchenko to a mere instrument to convey the perfection of a state working in the best imaginable way, where every movement was preordained and nothing could go wrong. In fact, the usual subjects of Rodchenko were military parades and public meetings, during which everybody had a specific role to play and a proper place to fit in[3]. Moreover, Stalin made a wide use of photomontage to insert his figure in all the topic moments of the October Revolution of 1917, so that the people were induced to think that it was him who actively participated and fought in the process that led to the creation of a land that was supposedly governed by them. Another famous example of the way photography and its manipulation were used to attain the consent of the people is the picture taken by Yevgeny Khaldei in Berlin on May 2nd, 1945. It is the image of a soldier of the Red Army raising the communist flag on the roof of the Reich stag[4]. Since Khaldei arrived too late, when the action had already been accomplished, he asked a soldier to repeat it in order to fix the moment on film, and give Russian population another proof of the power of their leader. Further east, Mao Tse-tung was acting in the same way, one of his preferred photographers being Li Zenghshen, who took also many shots of the atrocities committed by the regime but hid them until the late Nineties, when he thought it was safe to show them to the public without risking to be prosecuted by the communist regime. The above mentioned examples are taken from the major dictatorships of the past century; nonetheless in the 1930’s the greatest democracy of the world, the USA, had a similar approach to photography, although lacking the militaristic vision of the country that characterised the totalitarian regimes. The American government did not make a wide and evident use of photography to make its citizens agree on its political and financial behaviour, but in some occasions documentary images were used as proofs of the necessity of its decisions. The Farm Security Administration, for instance, was founded in 1935 by president Franklin Delano Roosevelt as part of his New Deal program aimed at rescuing the nation after the great depression of 1929. Its goal was to relieve the rural populations from their poverty and many famous photographers (Russell Lee, Jack Delano, Dorothea Lange, Walker Evans among the others) were hired to document their situation, in order to inform about it people li ving in the urban areas. But this project was also meant to provide a visual justification on how and why the government was spending public money, preventing any questioning by the richest part of the population[5]. The best output of this policy was a book compiled by Archibald McLeish, titled Land of the free and published in 1938. In the meanwhile, another way to use photography in order to exert social control was beginning to see the light in the USA. But this one was completely different from the propaganda experienced in Europe, since it was focused on not showing, rather than on showing. It is the case of the 216 nuclear tests held by the Army between 1945 and 1962 (in the desert in the state of Nevada or in the middle of the Pacific Ocean). They were documented by anonymous officials mainly through aerial photography, but the pictures were kept in secret archives till very recently, because the government thought that such experiments might arise doubts in public opinion about nuclear power and the cold war[6]. This attitude quickly developed and expanded to the majority of the nations, prompting governments to prevent their people from looking at what might endanger their consent. A form of undeclared censorship has been watching over photography all the time, and war reporters have been its principal t argets. One of the most recent and outstanding case is the story occurred to a now famous picture taken by Kenneth Jarecke during the first Gulf War (1991). He shot the body of an Iraqi soldier, burnt to a cinder by American bombing while he was retreating with his troop on the Basra road[7]. This picture was published abroad but not in the USA until the war was definitively over, since it might counter the Pentagon’s notion of a technological a war amended of all the atrocities of the previous ones. Nonetheless, nowadays television has taken over the role that was played by photography, and it has become the principal tool to exert social control. Probably, this function is still accomplished by photography only through commercials, but in this case the aim is altering people’s perception of reality in order to influence their needs. The most interesting aspect of this function is that who is sending the message to the public usually does not depict a fake situation as it were real, nor does hide a particular side of it. Most commercials evoke a hypertechnological world or a lost one, like in Marlboro Country’s advertisements, where values and lifestyle are as simple and good as in the good old days[8]. Two opposite worlds that have just one feature in common: they can be reached through the product advertised. This kind of social control is very different from that exercised through propaganda and censorship, but it must be noted that its target is not the citizen as a political individual, but the consumer as a participant in the local and global market. Moreover, there is not such a monopoly of the mass media as the one that is proper of a governing institution, but all the organs emitting messages to control the public are constantly competing against each other to be most visible. Consequently, this particular use of photography requires bigger and more accessible platforms wherefore communicate, such as glossy, fancy magazines and huge city billboards. Bibliography Michael Famighetti: Underexposed, Aperture 173, winter 2003, pages 14-16. Marshall McLuhan: Understanding media, Routledge, 2002, chapters 2 and 20. Martin Parr and Gerry Badger: The photobook: a history. Volume 1, Pahidon, 2004, chapter 6. Ian Jeffrey: Photography, Thames and Hudson, 1981, chapter 9. Li Zhensheng: Red-color news soldier, Phaidon, 2003. Michael Light: 100 Suns, Contrasto Due, 2004. 1 Footnotes [1] See picture 1 [2] See pictures 2 and 3 [3] See picture 4 [4] See picture 5 [5] See picture 6, by Dorothea Lange [6] See pictures 7, 8 and 9 [7] See picture 10 [8] See picture 11