Study of personality factors in attempted suicide.

BACKGROUND: Suicidal attempt is becoming a major problem in the world, as it affects the person's career, life style, and family dynamics. Comorbid personality disorders are a risk factors for suicidal behavior. The aim of this study was to determine the various personality factors involved in attempted suicide. METHODS: This is a descriptive study. This study was carried out in the patients, who attempted suicide, who were admitted in the wards of Kathmandu Medical College Teaching Hospital during 1st January 2010 to 30th July 2010. The 16-PF scale was used in all the subjects. RESULTS: Total 46 cases were studied. Six (13%) subjects were seen as having "schizothymic" traits. Sixteen(34.8%) of the subjects were seen as having low intelligent traits. Total 14 (30.4%) were seen as having affected by feelings. Seven (15.2%)were seen as having humble traits. Fifteen (32.6%) were seen as having sober traits and there are no cases of happy-go-lucky. Three (6.5%) were seen as having expedient. Eight (17.4%) were seen as having shy traits and there are no cases seen of venturesome traits. Total 14 (30.4%) were seen as having tough-minded traits. Eight (17.4%) were seen as having suspicious personality traits while nine(19.6%) were seen as having practical personality traits. Ten (21.7%) were seen as having shrewd personality traits. Total 17 (37.0%) were seen as having apprehensive personality traits. Twelve (26.1%) were seen as having experimenting personality traits and 6 (13.0%) were seen having group dependent personality traits. Among the patients, 10 (21.7%) were seen having undisciplined personality traits. Seven (15.2%) were seen having relaxed personality traits. Total 12 (23.1%)were seen having extroversion traits. Six (13.0%) were seen having low anxiety traits. Ten (21.7%) were seen having tender-minded emotionality personality traits. Seven (15.2%) were seen having subduedness personality traits. CONCLUSIONS: Our study highlights the importance of personality factors in attempted suicide and these factors are at risk in attempting suicide, therefore, which can be implemented in prevention of suicide.

Achieving Millennium Development Goals 4 and 5 in Nepal.

The under 5 child mortality rate in Nepal is on track to achieve the target of 54 per 1000 live births by 2015 compared with 158 per 1000 live births in 1991. The maternal mortality rate also looks set to drop to its target of 134 per 100,000 live births by 2015 from 539 per 100,000 live births in 1991. A 3-year interim plan (2008-11) was established to provide free basic health care for all citizens and the safe delivery incentive programme has proved to help progression towards achieving Millennium Development Goals 4 and 5. The development of a policy targeting women, children and vulnerable populations in hard to reach places is a key feature. The principle of a primary healthcare approach is applied in the development and implementation of strategy plans and programmes. The focus is on ensuring that there are functioning facilities for essential obstetric care at health facilities and provision of trained personnel at delivery.

Low birth weight at term: relationship with maternal anthropometry.

The objective of this study was to determine the relationship of maternal anthropometry with low birth weight at term. This study was conducted at the Maternity Hospital, Thapathali, from 6th December 2004 to 30th January 2005. It was a prospective, hospital based, comparative study, carried out in 308 women who had delivered singleton live babies at term. The study population was divided into two groups based on baby's weight. During the study period, 154 women, who had delivered term low birth weight (LBW) babies (<2500gm), were taken as cases. For each case, a comparative case (matching in age and parity) who had delivered normal birth weight (NBW) baby (2500gm) was selected and served as control. Maternal anthropometric measurements were compared between the two groups. The variables studied were post-delivery maternal weight, height, body mass index (BMI) and mid upper arm circumference (MUAC). The incidence of low birth weight during the study period was 12.76% (329 of 2577 total births). The incidence of term low birth weight was 8.15% among the 2283 term births. In mothers with low weight (<45.0kg), low birth weight babies were three times more common than in mothers with normal weight (OR 3.5 95% CI 1.82-6.77) and with low MUAC (<22.0cm), it was twice as common (OR 2.04 95% CI 1.14-3.63). In mothers with low height (<145.0cm), LBW babies were higher but could not reach significant level (OR 1.87 95% CI 0.98-3.75). Similarly, in mothers with low BMI (<18.5kg/m2), the difference was not significant (OR 1.9 95%CI 0.61-5.65). On multiple logistic regression analysis, only low maternal weight was powerful enough to remain significant (OR 2.84 95% CI 1.34-5.99). From these results, it can be concluded that low maternal anthropometric measurements have a definite role in causing LBW babies at term. Among the studied variables, maternal weight showed the strongest influence on low birth weight.

Process indicators for safe motherhood programmes: their application and implications as derived from hospital data in Nepal.

Measuring maternal mortality ratios is fraught with problems and underestimates. Therefore process indicators have been proposed for monitoring the availability and use of obstetrics services. We report the results of process indicators for measuring the availability, use and quality of obstetric care in five districts in Nepal between 1997 and 1998. The number of comprehensive essential obstetric care (EOC) facilities was adequate for four of the five districts, but none had a minimum acceptable level of basic EOC facilities as set by UNICEF et al. The proportion of expected births in hospital was 21.5% in Rupandehi and < 5% in Baglung, Kailali, Okhaldunga and Surkhet. The minimum acceptable level is 15%. The 'met need' for obstetric care which pertains to the proportion of all women with direct obstetric complications that are treated in hospital was 14.9% in Rupandehi and < 5% in the other four districts, against the required minimum of 15%. The caesarean section rate calculated of all expected births in the population varied between 0.2% and 1.4%. The case fatality rate was 4.0% in Rupandehi Zonal Hospital. Analysis of these indicators clearly identified tremendous underuse of maternity services which has stimulated national policy discussions in Nepal with ensuing safe motherhood interventions and monitoring strategies.

Association of hepatitis E virus with an outbreak of hepatitis at a military training camp in Nepal.

From 29 January 1995 to 15 March 1995, an outbreak of hepatitis occurred among 692 soldiers at an isolated training camp 25 km east of Kathmandu. Thirty-two cases occurred approximately 8 weeks after arrival of soldiers at the camp. To determine the etiology of the outbreak, patient sera were examined for evidence of infection with hepatitis A, B, C, and E viruses using commercially available enzyme-linked immunosorbent assay (ELISA) kits. The polymerase chain reaction (PCR) was used to detect hepatitis E virus (HEV) RNA. Evidence of recent infection (IgM to HEV and/or HEV RNA) was found in all but two patients, whereas none had evidence of recent infection with hepatitis A, B, or C viruses. Therefore, the outbreak was attributed to HEV. Fecally contaminated drinking water was suspected as the source of the outbreak. To determine the extent of HEV infections among those without clinical hepatitis, sera from the remaining soldiers were examined for markers of HEV infection. Evidence of past infection (IgG to HEV in the absence of IgM or HEV RNA) was found among 204 soldiers (prevalence = 30%), leaving 488 individuals susceptible to infection at the onset of the outbreak. Evidence of recent infection was found among another 83 individuals. We conclude that most exposed, susceptible soldiers sustained HEV infection without experiencing overt hepatitis. If the levels of virus inoculum and prior immunity in this population were typical, inapparent infection may be the usual adult response to virus exposure in an endemic area.

Thermal control of the newborn: knowledge and practice of health professional in seven countries.

Hypothermia is a common problem in neonates, particularly in developing countries where it is an important contributory factor to neonatal mortality and morbidity. An evaluation of the knowledge and practices of health professionals on the thermal control of newborns was carried out in seven countries: Brazil, India, Indonesia, Kazakhstan, Mozambique, Nepal and Zimbabwe. The evaluation, conceived as a preliminary phase for a one-day training course on thermal control, involved 28 health facilities and 260 health professionals (61 doctors and 199 nurses and midwives). It included an assessment of thermal control practices carried out in each health facility by external investigators and a questionnaire on knowledge about thermoregulation administered to health professionals involved in newborn care. The findings of the evaluation were consistent across countries and showed that thermal control practices were frequently inadequate in the following areas: ensuring a warm environment at the time of delivery; initiation of breastfeeding and contact with mother, bathing; checking the baby's temperature; thermal protection of low birth weight babies, and care during transport. Knowledge on thermal control was also insufficient, especially concerning the physiology of thermoregulation and criteria for defining hypothermia. During the one-day course that followed the evaluation, participants were able to recognize the existing gaps and to identify appropriate interventions. Knowledge and practice on the thermal control of the newborn are currently insufficient. However, awareness of the importance of thermal control and basic knowledge on thermal regulation and thermal protection can be easily acquired and on this basis motivation for improving thermal control practices can be developed.

A survey of technology and temperature control on a neonatal unit in Kathmandu, Nepal.

An assessment of the incubators in use at the Kathmandu Maternity Hospital neonatal unit was undertaken; this was followed by a prospective survey of neonatal temperatures on the unit. In the incubator assessment 11 studies were carried out in five incubators. Three of the thermostats in the five incubators did not work at all and those in the other two incubators were more than 3 degrees C inaccurate. All the incubator thermometers gave recordings less than the actual temperature (with a range of error: 1.3-4.4 degrees C). Six out of the 11 babies studied were hypothermic (defined as rectal temperature < 36 degrees C). In the prospective survey of temperatures a high incidence of hypothermia was found on the neonatal unit at the time of first temperature measurement (64 per cent had a rectal temperature of < 36 degrees C). A significant association between admission hypothermia and mortality was noted. Sixteen per cent (10/64) of babies admitted with temperatures < 36 degrees C died within the first week, compared to 0 (0/36) of those admitted with temperatures > or = 36 degrees C.

Effect of post-delivery care on neonatal body temperature.

A prospective observational study of post-delivery care and neonatal body temperature, carried out at Kathmandu Maternity Hospital, was followed by a randomized controlled intervention study using three simple methods for maintaining body temperature. There were 500 infants in the initial observation study and 300 in the intervention study. In the observation study, 85% (420/495) of infants had temperatures < 36 degrees C at 2 h and nearly 50% (198/405) had temperatures < 36 degrees C at 24 h (14% were < 35 degrees C). Most of the infants who were cold at 24 h had initially become cold at the time of delivery (only seven infants had been both well dried and wrapped). In the intervention study, all infants were dried and wrapped before random assignment to one of the three methods: the "kangaroo" method, the traditional "oil massage" or a "plastic swaddler". All three were found to be equally effective. Overall, 38% (114/298) of the infants had temperatures < 36 degrees C at 2 h and 18% (41/231) at 24 h (when none was < 35 degrees C).

Clinical experience with trophoblastic diseases in Nepal.

The epidemiology of trophoblastic disease in Nepal remains unknown. In this study, the first data regarding patients with trophoblastic disease were collected from two hospitals in Kathmandu, Nepal. We found 68 molar pregnancies during 1986 to 1987 at the Maternity Hospital, there. The incidence of molar pregnancies during two years ranged 2.84 per 1000 pregnancies and 3.24 per 1000 deliveries, while the total number of trophoblastic diseases from 1985 to 1988 at Teaching Hospital, Tribhuvan University, Kathmandu, numbered 26. The incidence of trophoblastic disease ranged from 7.07 per 1000 pregnancies to 8.04 per 1000 deliveries. As a result, the rate of trophoblastic disease in Nepal seems to be higher than expected, and it indicates a incidence similar to that other Asian countries at sea level.

Open drop ether anaesthesia for caesarean section: a review of 420 cases in Nepal.

Anaesthesia for Caesarean sections performed during 1982-83 at the Women's Hospital in Kathmandu, Nepal is reviewed. In a twelve-month period 535 Caesarean sections were performed, representing 7.36 per cent of 7,263 deliveries. Many pregnant women in Nepal do not have antenatal care and the mean haemoglobin of these mothers was 86 g X L-1. In the absence of an on-call anaesthetist for obstetrics, more than 90 per cent of the anaesthetics were given by junior obstetric residents, using open drop diethyl ether without endotracheal intubation. Eleven patients developed postoperative chest infection; in none of these was there any suggestion of inhalation of gastric contents and all recovered uneventfully. Of the 18 maternal deaths in the 7,263 deliveries during this period, one occurred during Caesarean section. This was due to uncontrollable haemorrhage and was not attributable to the anaesthetic. For poor risk patients, and in unskilled hands, diethyl ether remains a remarkably safe anaesthetic.