Factors associated with adolescent pregnancy among Chepang women and their health-seeking behavior in Ichchhakamana rural municipality of Chitwan district.

Adolescent pregnancy is a critical public health issue, particularly in developing regions like Nepal, where it poses significant risks to maternal and child health and perpetuates the cycle of poverty. This study focused on the marginalized Chepang community, which is endangered and faces unique challenges. The study aimed to explore the factors associated with adolescent pregnancy among Chepang women in Ichchhakamana Rural Municipality, Chitwan, Nepal, and also assessed their reproductive health-seeking behavior. A cross-sectional analytical study was conducted with 217 Chepang women aged 15-20 years, and data was collected through face-to-face interviews using a semi-structured questionnaire. The collected data was entered and analyzed using IBM SPSS version 20. Descriptive statistical tools like frequency, and percentage were used to express the results. Pearson chi-square test, Fisher exact test were used for bivariate analysis to determine the presence of association between the dependent and independent variables. Binary logistic regression was used for further analysis. The prevalence of current adolescent pregnancy was 8.3%(18), while one-fourth had experienced prior pregnancies during their adolescence. Factors significantly associated with adolescent pregnancy included lack of education among the women and their mothers, as well as living in joint families. Additionally, number of antenatal visits and consumption of iron tablets seemed to be lower among Chepang women in comparison to the national data. Chepang women had high adolescent pregnancy rates, with low education level and joint family structure being important risk factors for it. They also had inadequate reproductive health seeking behavior. Addressing these problems requires strategies that prioritize education and raise awareness about reproductive health.

Effect of nutrition education intervention on nutrition knowledge, attitude, and diet quality among school-going adolescents: a quasi-experimental study.

BACKGROUND: Nutrition education is being used to encourage school adolescents to adopt healthy eating habits. To the best of our knowledge, very little study has been undertaken in Nepal to examine the effectiveness of nutrition education programs. This study aimed to assess the effect of nutrition education on nutritional knowledge, attitude, and diet quality among school-going adolescents in selected private schools in Nepal. METHODS: A quasi-experimental study was conducted among 226 students aged 12 - 19 years of two selected private schools in Banepa municipality of Nepal. Students (n = 113) from the first school were assigned to intervention and the same number of students from the second school were enrolled in the study as the control. Over 12 weeks, students in the intervention group received one hour of nutrition education in the form of mini-lectures and interactive discussions, whilst students in the control group received no education. The student's two-sample t-test was used to compare two groups and to assess the effectiveness of the nutrition education program. RESULTS: Between the intervention and control group, the magnitude of difference in knowledge score was 1.80 (95% CI: 1.11 - 2.49), emotional eating was 0.98 (95% CI: 0.42 - 1.54), uncontrolled eating was 3.60 (95% CI: 2.10 - 5.09), and cognitive restraint of eating was 2.26 (95% CI: 1.51 - 3.01). CONCLUSIONS: A tailored health education intervention was found to be effective in increase nutritional knowledge and attitude among school-going adolescents. Adopting nutrition education interventions as part of public health school intervention builds positive knowledge, attitudes, and healthy eating habits in school-going adolescents.

Prevalence of anemia and its associated factors among adolescent girls on Weekly Iron Folic Acid supplementation (WIFAS) implemented and non-implemented schools at Tokha municipality, Kathmandu.

Anemia, the prevailing nutritional disorder worldwide, exerts its greatest impact on individuals in developing nations, exhibiting a heightened prevalence among adolescents. There is a window of opportunity for children to improve their nutritional status during their adolescence period. Weekly iron-folic acid supplementation is the preventive measure to break the intergenerational cycle of anemia. The correlation between the consumption of iron folic acid supplements and the prevention of anemia has been firmly established by numerous studies, revealing a statistically significant association. Therefore, this study was undertaken with the aim to assess the difference in the prevalence of anemia and its associated factors among adolescent girls in Weekly Iron Folic Acid Supplementation (WIFAS) implemented and non-implemented schools at Tokha Municipality, Kathmandu. A cross-sectional study was carried out among 602 adolescent girls from grade six to ten equally divided into WIFAS implemented and WIFAS non-implemented schools. Hemoglobin estimation was done using the HemoCue Hb 301 method. The descriptive, univariate and multivariable logistic regression analysis was done using SPSS version 25 to identify a significant association between anemia and its associated variables at p-value<0.05. The overall prevalence of anemia among adolescent girls was found to be 17.4% out of which, 14% and 20.9% from WIFAS-implemented and non-implemented schools respectively. The factors like type of school, fathers' education and dietary diversity were found to be statistically significant with anemia during multivariable logistic regression analysis. Given the findings of this research, proper counseling and promotion of utilization of WIFAS in order to decrease the prevalence of anemia among adolescent girls are recommended.

Are circadian rhythms in disarray in patients with chronic critical illness?

Aim: The aim of our study is to assess circadian rhythms in patients with chronic critical illness due to severe brain injury in intensive care unit by establishing the relation between melatonin and cortisol secretion, considering astronomical time and the sleep-wake cycle in chronic critical illness. Materials and methods: The study included 54 adult patients with chronic critical illness who resided in the intensive care unit for at least 30 days. The level of consciousness was determined using the CRS-R scale. We did the continuous electroencephalographic (EEG) monitoring with polygraphic leads for 24 h. Also, we determined the serum levels of cortisol and melatonin using the tandem mass spectrometry method with ultra-performance liquid chromatography. Results: 90.74 % of patients had one acrophase in melatonin secretion curve, which suggests the preservation of the rhythmic secretion of melatonin. These acrophases of the melatonin rhythm occurred during the night time in 91.8 % of patients. Most of the patients (69.3 %) slept during the period from 2:00 to 4:00 a.m. The evening levels of cortisol and melatonin had an inverse relation (rs=0.61, p<0.05), i.e., a decrease in the level of cortisol secretion accompanies an increase in melatonin. Conclusions: We concluded from our study that the rhythmic secretion of melatonin and cortisol is preserved in patients with chronic critical illness that resulted from severe brain injury. No statistically significant discrepancy between melatonin and cortisol secretion, day-and-night time and the sleep-wake cycle are found. We may focus our future work on finding more reliable methods to stabilize the preservation of circadian rhythms to protect vital organ functions.

Occupational stress and environmental impact among traffic police officers in Kathmandu Valley, Nepal: A qualitative study.

Policing is considered an extremely stressful, physically demanding, and mentally challenging occupation. The growing population with an increasing number of vehicles and the harsh working environment has made the work of traffic police even more stressful. This qualitative study aims to examine work and environment-related stressful factors among traffic police officials of Kathmandu Valley, Nepal. This qualitative study used a thematic analysis approach. Face-to-face interviews were conducted with different cadres of 15 traffic police personnel working in Kathmandu Valley, Nepal for at least six months. The study adhered to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) guideline. The findings of this study are structured around five major themes- workload, work-life balance, basic amenities, work environment and occupational health problems, and possible solutions and suggestions. Most of the participants (10 out of 15) reported having work stress due to the heavy workload and hazardous working conditions that had a significant impact on their job performance and mental well-being. This study highlights the challenges faced by traffic police officers in Kathmandu Valley, Nepal. The findings suggest that efforts should be made to improve the working environment of traffic police officers to reduce the physical as well as mental burden among them. The occupational health and safety (OHS) and mental well-being of traffic enforcers' is a critical public health issue, therefore, it should be on the agenda of policymakers, organizational leaders, and stakeholders.

Effectiveness of a dietician-led intervention in reducing glycated haemoglobin among people with type 2 diabetes in Nepal: a single centre, open-label, randomised controlled trial.

Background: Nutrition education and counselling are considered a cornerstone for the management of type 2 diabetes (T2D). However, there is limited research related to the management of T2D through dietary approach, particularly in low-income and middle-income countries (LMICs) like Nepal. This study assessed the effectiveness of a dietician-led dietary intervention in reducing glycated haemoglobin (HbA1c) levels among people with T2D. Methods: An open-label, two-armed, hospital-based, randomised controlled trial was conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Participants were randomly assigned to either dietician-led dietary intervention group (n = 78) or usual care control group (n = 78). People with type 2 diabetes with HbA1c >6.5% and aged 24-64 years were included in the study. The primary outcome was a change in HbA1c level over six months, and secondary outcomes included changes in biochemical and clinical parameters, Problem Areas in Diabetes (PAID) score, diabetic knowledge, dietary adherence, and macronutrient intake level. Data were analysed using an intention-to-treat approach. This trial is registered with ClinicalTrials.gov, NCT04267367. Findings: Between August 15, 2021 and February 25, 2022, 156 people with type 2 diabetes were recruited for the study, of which 136 participants completed the trial. At six months of follow-up, compared to baseline values, the mean HbA1c (%) level decreased in the intervention group by 0.48 (95% CI: -0.80 to -0.16), while it increased in the control group by 0.22 (95% CI: -0.21 to 0.66). In an adjusted model, the reduction in HbA1c (%) levels for the intervention was 0.61 (95% CI: -1.04 to -0.17; p = 0.006). In addition, fasting blood glucose was decreased by 18.96 mg/dL (95% CI: -36.12 to -1.81; p = 0.031) after the intervention. The intervention resulted in the reduction of BMI, waist and hip circumference, PAID score, dietary adherence, and macronutrient intake in the intervention group compared to the control group. Interpretation: The dietician-led intervention improved glycaemic control, improved macronutrient intake, and clinical outcomes among people with type 2 diabetes. The dietician-led intervention may be considered for diabetes management in LMICs. Funding: The research was funded by the University Grants Commission (UGC), Nepal.

Extent of illicit cigarette sales in Nepal: findings from a retail survey.

INTRODUCTION: Increasing the tax on cigarettes is widely considered the most effective method to reduce its consumption. However, Nepal has a low cigarette tax as policymakers in Nepal are concerned about illicit trade of cigarettes if taxes are increased. METHODS: The study employed a retail survey approach used in India suitable for countries with prevalent loose cigarette sales, with improved methodology. In 2021, empty cigarette packs generated in a day's loose cigarette sales were collected directly from cigarette retailers from 23 primary sampling units covering rural/urban, geographic divisions, border/non-border to India and tobacco factory locations. The central points of each primary sampling unit were identified, and retailers were selected for the survey. A cigarette pack was classified as illicit if it had at least one of the following attributes: (a) no authentic excise duty sticker, (b) no graphic health warning, (c) no mention of 'maximum retail price/MRP' and (d) no production date, name, address and trademark. FINDINGS: We collected 4307 empty cigarette packs from 1204 retailers and 0.33% of them were classified as illicit. The estimates varied across location with the highest prevalence of illicit packs in Kathmandu (1.25%). All the illicit cigarettes were imported and were high-priced brands (>90%), mostly found in urban areas and not bordering India. CONCLUSION: Our estimate of the illicit cigarette market share of 0.33% suggests that the industry's statement of 25% is grossly overstated.

Workplace violence and its associated factors among health care workers of a tertiary hospital in Kathmandu, Nepal.

Workplace violence (WPV) is a globally prevailing public health concerns among healthcare workers. Workplace violence includes occupational abuse (physical, sexual, verbal and psychological), threats or harm among health workers, and workplace harassment. It is important to identify the prevalence of workplace violence at the workplace. Therefore, this study aimed to assess workplace violence and its associated factors among healthcare workers at a tertiary hospital in Kathmandu, Nepal. A descriptive cross-sectional study was carried out among 369 health care workers in a tertiary hospital in Kathmandu. A semi-structured questionnaire was used for data collection. Data was entered and analyzed using SPSS v20. Descriptive statistics were used to assess workplace violence and other independent variables. Bivariate and multivariate logistic regression model was used to examine the factors associated with workplace violence. The prevalence of verbal violence was highest among doctors (34.3%) and nurses (52.8%) followed by bullied/mobbed among doctors (11.9%) and nurses (17%) any time in the past. Experience of any type of workplace violence in the past among doctor was 45.5% and among nurses was 54% while 35.8% doctors and 46.8% nurses had experienced it in the past 12 months. Patients and relatives of patient were major perpetrator for physical and verbal violence while management and staff members were major perpetrators for bullying/mobbing. Participants marital status, work experience, posted department, nature of work shift, frequency of night shift and working hours per week showed statistically significant association with the experience of workplace violence within past 12 months (p<0.05) in binary logistic regression analysis. There is a crucial need to establish evidence-based actions to prevent violence in the workplace and promote a healthy workplace setting. Placing adequate staffs at emergency and medical departments and providing training to cope with the stressful emergency situations would help in minimizing workplace violence among health workers.

Rapid Effects of BCI-Based Attention Training on Functional Brain Connectivity in Poststroke Patients: A Pilot Resting-State fMRI Study.

The prevalence of stroke-induced cognitive impairment is high. Effective approaches to the treatment of these cognitive impairments after stroke remain a serious and perhaps underestimated challenge. A BCI-based task-focused training that results in repetitive recruitment of the normal motor or cognitive circuits may strengthen stroke-affected neuronal connectivity, leading to functional improvements. In the present controlled study, we attempted to evaluate the modulation of neuronal circuits under the influence of 10 days of training in a P3-based BCI speller in subacute ischemic stroke patients.

Effect of platelet-rich plasma versus steroid injection in plantar fasciitis: a randomized clinical trial.

BACKGROUND: Plantar fasciitis (PF) is a common orthopaedic problem, with heel pain worsening the quality of life. Although steroid injection is often used if the conservative treatment fails, Platelet-Rich Plasma (PRP) injection is gaining popularity due to its safety and long-lasting effect. However, the effect of PRP versus steroid injection in PF has not been studied yet in Nepal. Therefore, this study aimed to assess the effect of PRP compared with steroid injection in the treatment of PF. METHODS: This study was a single-center, hospital-based, open-label, parallel-group randomized clinical trial to compare the effect of PRP injection with steroid injection in plantar fasciitis between August 2020 and March 2022. A total of 90 randomly selected participants aged 18 to 60 years suffering from plantar fasciitis with failed conservative treatment were intervened. The American Orthopaedic Foot and Ankle Society (AOFAS) and the Visual Analog Scale (VAS) scoring system were used to evaluate functional mobility and pain before and after the intervention for three and six months, respectively. Statistical analyses were performed using a Student's two-sample t-test. P-value < 0.05 was considered statistically significant. RESULTS: The PRP injection showed a better outcome than the steroid injection in six months follow-up. The mean (± SD) VAS score was significantly decreased in the PRP group (1.97 + 1.13) than in the steroid group (2.71 ± 0.94) with the group difference of -0.73 (95% CI: -1.18 to -0.28) at six months. Similarly, there was a significant increase in the AOFAS scores in the PRP group (86.04 ± 7.45) compared to the steroid group (81.23 ± 9.60) at six months of follow-up with a group difference of 4.80 (95% CI: 1.15 to 8.45). There was also a significant reduction of plantar fascia thickness in the PRP group compared to that of the steroid group (3.53 ± 0.81 versus 4.58 ± 1.02) at six months of follow-up with the group difference of -1.04 (95% CI: -1.44 to -0.65). CONCLUSION: The PRP injection showed better outcomes than steroid injection in plantar fasciitis treatment over the course of six months. Further research with a larger population and longer follow-up than six months is needed to generalize the findings and their long-term efficacy. TRIAL REGISTRATION: NCT04985396. First registered on 02 August 2021. ( https://clinicaltrials.gov/ct2/show/NCT04985396 ).

Digital Eye Strain in Medical Undergraduate Students during COVID-19 Pandemic.

BACKGROUND: Digital devices have been an integral part of our daily lives. With the emergence of COVID-19 pandemic we have gone through strict lockdowns. Most educational institutions conducted classes virtually. This increased the symptoms of digital eye strain. This study aims to assess the prevalence, symptoms, and level of awareness regarding digital eye strain in medical undergraduate students following the COVID-19 pandemic. METHODS: Our study was a questionnaire-based cross-sectional study with a duration of 3 months. All the undergraduate medical students studying at Kathmandu Medical College Teaching Hospital were included in the study. A self-administered questionnaire was sent to each student electronically via google forms. Descriptive statistics, frequency tables, and percentages were calculated. RESULTS: A total of 208 students were included in the study. The mean age of participants was 22.7±1.6 years (Mean ± SD) with a mean duration of online classes being11.39 ± 5.2 months (Mean ± SD) . The average screen time of students before the start of online classes was 4.14 (SD=2.13) hours. The average screen time after the start of online classes was 7.93 (SD=2.44) hours, an increase of 91.54%. The overall prevalence of digital eye strain among the respondents was 90.8% (n=189). CONCLUSIONS: The prevalence of digital eye strain in our study was high. The average screen time increased significantly following COVID-19. Therefore, it is important to create awareness regarding digital eye strain and practices that decrease the symptoms of digital eye strain.

Factors associated with anemia among children in South and Southeast Asia: a multilevel analysis.

BACKGROUND: South and Southeast Asian countries (SSEA) account for the highest burden of anemia globally, nonetheless, progress towards the decline of anemia has almost been stalled. This study aimed to explore the individual and community- level factors associated with childhood anemia across the six selected SSEA countries. METHODS: Demographic and Health Surveys of SSEA countries (Bangladesh, Cambodia, India, Maldives, Myanmar, and Nepal) conducted between 2011 and 2016 were analyzed. A total of 167,017 children aged 6-59 months were included in the analysis. Multivariable multilevel logistic regression analysis was used to identify independent predictors of anemia. RESULTS: The combined prevalence of childhood anemia across six SSEA countries was 57.3% (95% CI: 56.9-57.7%). At the individual level, childhood anemia was significantly higher among (1) mothers with anemia compared to non-anemic mothers (Bangladesh: aOR = 1.66, Cambodia: aOR = 1.56, India: aOR = 1.62, Maldives: aOR = 1.44, Myanmar: aOR = 1.59, and Nepal: aOR = 1.71); (2) children with a history of fever in the last two weeks compared to those without a history of fever (Cambodia: aOR = 1.29, India: aOR = 1.03, Myanmar: aOR = 1.08), and; (3) stunted children compared to those who were not (Bangladesh: aOR = 1.33, Cambodia: aOR = 1.42, India: aOR = 1.29, and Nepal: aOR = 1.27). In terms of community-level factors, children with mothers in communities with a high percentage of community maternal anemia had higher odds of childhood anemia in all countries (Bangladesh: aOR = 1.21, Cambodia: aOR = 1.31, India: aOR = 1.72, Maldives: aOR = 1.35, Myanmar: aOR = 1.33, and Nepal: aOR = 1.72). CONCLUSION: Children with anemic mothers and stunted growth were found vulnerable to developing childhood anemia. Individual and community-level factors identified in this study can be considered to develop effective anemia control and prevention strategies.

Association of nutrition knowledge, practice, supplement use, and nutrient intake with strength performance among Taekwondo players in Nepal.

Background: Optimum dietary intake and adequate nutritional knowledge have been recognized as the key factors that play a critical role in improving the athlete's health and nutrition status. This study aimed to measure the association of nutritional knowledge, practice, supplement use, and nutrient intake with strength performance among Nepalese Taekwondo players. Methods: Between August 2019 and January 2020, a cross-sectional study was conducted among 293 Taekwondo players in Kathmandu Metropolitan City (mean age, 18 years; 63.1% male, 36.9% female). Face-to-face interviews were conducted using semi-structured questionnaires. Anthropometric measures, nutritional intake, nutrition knowledge, and practice were all recorded. The handgrip strength was measured using a handgrip dynamometer as a proxy for strength performance. Univariate and bivariate analyses were used to find out the association between predictor and outcome variables. Results: More than half of the participants had poor nutrition knowledge [54.3% (159/293)], and poor nutrition practice [55.3% (162/293)] scores. Daily mean energy, carbohydrate, protein and fat intake were 48.0 kcal.kg-1.d-1, 8.6, 1.6, and 1.5 g.kg-1.d-1, respectively among Taekwondo players. Daily total energy and carbohydrate intake were 48.2 kcal.kg-1.d-1 and 8.7 g.kg-1.d-1, respectively among male players which is higher than female players. However, daily protein and fat intake were higher in female players (1.7 and 1.6 g.kg-1.d-1, respectively). Both calcium (375.3 mg) and iron (9 mg) intake among Taekwondo players were significantly lower than current sports nutrition guidelines. Nutritional knowledge score (r = 0.117), height (r = 0.538), weight (r = 0.651), body mass index (r = 0.347), fat (r = 0.075), and energy (r = 0.127) intake showed significant positive correlation with strength performance of athletes. The strength performance was positively associated with training hours per day (ß = 0.41, 95% CI: 0.09-0.91), body mass index (ß = 0.35, 95% CI: 0.09-0.61), nutrition knowledge score (ß = 0.13, 95% CI: 0.01-0.25), and energy intake (ß = 0.13, 95% CI: 0.12-0.14). Conclusions: The nutritional knowledge and practice both were suboptimal among Taekwondo athletes. Height, weight, body mass index, nutritional knowledge, energy, and fat intake showed a positive correlation with strength performance. Future studies can build on the premise of this study to identify the robust relationship between nutritional knowledge, practice, different supplement use, and nutrient intake among other athletes too.

Two-year outcomes of patients with prolonged disorders of consciousness: a prospective cohort study in Russian Federation.

BACKGROUND: Epidemiological data on prolonged disorders of consciousness (pDOC) are not available due to lack of research in this field. The objective of this pioneering prospective cohort study in the Russian Federation was to collect the data on the survival and the level of consciousness of patients with pDOC, as well as to search for prognostic markers of survival and improvement of the level of consciousness on long-terms outcomes (up to 24 months). METHODS: All patients (n=184) had pDOC and were admitted to the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology. We assessed the neurological status and acquired follow-up diagnosis as well. Out of total patients: anoxic brain injury (ABI) (n=52), vascular lesions (VL) (n=50), traumatic brain injury (TBI) (n=74), and other causes (n=8). Changes in patients' vital and conscious status were recorded in four-time slices: 3, 6, 12, and 24 months after the event that led to pDOC. RESULTS: The survival rate is less than 30%, and the rate of recovery in terms of consiousness is 21%, which are both low, though do not differ significantly from existing data for this category of patients. Unprofessional home care may have a role to play in the declined long-term survival rate. We still do not have reliable prognostic markers among demographical and clinical indices; however, younger age can be considered the only significant predictor of survival and positive dynamics in the level of consciousness. CONCLUSIONS: We expect that our research will help to personalize and help the patient and families with the appropriate clinical as well as social measures.

Co-occurrence of non-communicable disease risk factors and its determinants among school-going adolescents of Kathmandu Metropolitan City.

BACKGROUND: Adolescence is a critical transition in human growth and adolescents tend to engage in various risky behaviors which are likely to continue into adulthood. Co-occurrence of non-communicable disease risk factors has the potential to increase risks of chronic disease comorbidity and increased mortality in later life. Behavioral risk factors are adopted due to changes in lifestyle and adolescents are more prone to acquire them. This study aimed to determine the prevalence and associated factors of co-occurrence of non-communicable disease risk factors among school-going adolescents of Kathmandu Metropolitan City. METHODS: We conducted a cross-sectional study among school-going adolescents of Kathmandu Metropolitan City in January/February 2020. We used stratified random sampling to select 1108 adolescents studying in 9, 10, 11, and 12 grades. We used Global Schools Health Survey tools to collect data. We entered data in EpiData 3.1 and exported it into Statistical Package for Social Science (SPSS) version 20 for statistical analysis. We estimated prevalence of NCDs risk factors and co-occurrence of risk factors. We applied multivariate multinomial logistic regression analysis adjusting for age, gender, ethnicity, religion, education, type of school, and parental education to determine factors associated with co-occurrence of NCDs risk factors. RESULTS: The prevalence of physical inactivity, unhealthy diet, harmful use of alcohol and tobacco among school-going adolescents were 72.3% (95%CI: 69.6-74.9), 41.1% (95%CI: 38.2-44.0), 14.8% (95%CI: 12.8-17.0) and 7.8% (95%CI:6.3-9.5) respectively. The adolescent with co-occurrence of two or more risk factors was 40.7% (95%CI: 37.8-43.7). The school-going adolescents who were in higher age group (AOR = 1.72, 95% CI- 1.06, 2.77), Hindus (AOR = 1.78, 95% CI-1.09, 2.89), other than Brahmin/Chhetri by ethnicity (AOR = 2.11, 95% CI-1.39, 2.22) and with lower education level of mothers (AOR = 2.40, 95% CI- 1.46,3.98) were more likely to have co-occurrence of NCDs risk factors after adjusting for all socio-demographic variables. CONCLUSION: The co-occurrence of non-communicable disease risk factors was high among school going adolescents and was associated with age, religion, ethnicity and mother's education. Integrated and comprehensive interventional programs should be developed by concerned authorities.

The effect of pre-operative carbohydrate loading in femur fracture: a randomized controlled trial.

BACKGROUND: Femur fracture is a major burden among elderly people, leading patients to be bedridden for a long time in the hospital. The body is more likely to be in a catabolic state as a result of the prolonged fasting period required for surgery, leading to an increase in insulin resistance. Pre-operative carbohydrate loading has been shown to improve postoperative outcomes in several countries. The study aimed to evaluate the effect of pre-operative carbohydrate loading in femur fracture surgery. METHODS: This study was single-center, hospital-based, open-label, parallel-group randomized controlled trial conducted between August 2020 and November 2021. A total of 66 participants, aged 50 years and above having femur fractures planned for surgery were included in this study and assigned to the control (n = 33) and study (n = 33) groups through computer-generated random numbers. The control group was kept fasting from midnight to the next morning as in existence while the study group was intervened with carbohydrate loading according to the Enhanced Recovery After Surgery (ERAS) protocol. The pre-operative nutritional status was identified and the postoperative outcomes were measured using the Visual Analogue Score (VAS), Cumulative Ambulatory Score (CAS), and Modified Barthel Index (MBI) scoring systems. Statistical analyses were performed using the Chi-square test and the Student's two-sample t-test to compare the outcomes between the two groups. RESULTS: All the participants completed the study. There was a significant reduction in the average postoperative pain in the carbohydrate loading group (VAS: 4.8 (SD ± 1.8), 95% CI: 4.7-5.4) as compared to the control group (VAS: 6.1 (SD ± 2.1), 95% CI: 5.3-6.8). The average CAS showed a significant improvement in regaining the mobility function of participants in the study group (CAS: 8.1 (SD ± 2.8), 95% CI: 7.1-9.1) than that of the control group (CAS: 6.8 (SD ± 2.8), 95% CI: 5.8-7.8). The mean MBI score of the participants at the time of discharge from the hospital was higher in the study group (MBI:13.1 (SD ± 2.3), 95% CI: 12.2-13.9) compared to the control group (MBI: 11.8 (SD ± 3.1), 95% CI:10.6-12.9). Similarly, the length of hospital stay after surgery had decreased in the study group than in the control group. CONCLUSIONS: The uptake of carbohydrate loading showed reduced post-operative pain, enhanced functional mobility, and decreased length of hospital stay. This study warrants larger trials to show the effect of pre-operative carbohydrate loading in a clinical setting. TRIAL REGISTRATION: NCT04838366, first registered on 09/042021 ( https://clinicaltrials.gov/ct2/show/NCT04838366 ).

Tobacco Use and Its Associated Factors among Undergraduate Public Health Students in Kathmandu Valley, Nepal.

Background: Despite the crucial role of public health students in tobacco control, there is a paucity of information regarding tobacco use among this population in Nepal. This study aims to assess the prevalence of tobacco use among undergraduate public health students in Kathmandu valley, Nepal. Methods: A web-based survey was conducted among 386 undergraduate public health students in Kathmandu valley, Nepal, using the Global Health Professions Student Survey (GHPSS) questionnaire. Associated factors were examined using multivariate logistic regression analyses at the level of significance of 0.05. Results: A total of 16.8% of students were current cigarette smokers, 39.9% had ever smoked cigarettes, and 62.2% had smoked their first cigarettes during adolescence. Among the participants, 11.7% currently used other tobacco products. Male students (aOR: 15.4; 95% CI: 4.9-47.8), students with higher age (aOR: 2.4; 95% CI: 1.0-5.4), students belonging to non-Brahmin/Chhetri ethnic group (aOR: 2.3; 95% CI: 1.2-4.4), and those staying without family (aOR: 2.0; 95% CI: 1.1-5.0) had higher odds of being current smoker. Similarly, students with a parental history of tobacco use (aOR: 2.4; 95% CI: 1.3-5.0) and friends with smoking habits (aOR: 7.9; 95% CI: 2.3-27.0) were more likely to be a current smoker. Conclusion: There is a notable prevalence of tobacco use among public health students in Kathmandu valley, Nepal. Concerned stakeholders should work jointly to implement a cessation program to discourage tobacco use among these populations who have a potential role in educating communities about the hazards of tobacco smoking, tobacco use prevention, and control.

Prevalence and factors associated with symptoms of depression, anxiety and stress among traffic police officers in Kathmandu, Nepal: a cross-sectional survey.

OBJECTIVE: This study aimed to assess the prevalence of depression, anxiety and stress, associated factors and stress-coping strategies among traffic police officers in Kathmandu, Nepal. DESIGN: Cross-sectional survey. SETTING: Kathmandu Valley, Nepal. PARTICIPANTS: A total of 300 traffic police officers working under the different traffic units of Kathmandu Valley for at least 6 months were recruited via a simple random sampling procedure. PRIMARY OUTCOME MEASURES: State of depression, anxiety and stress among traffic police officers based on the Depression, Anxiety and Stress Scale. SECONDARY OUTCOME MEASURES: Coping strategies under stressful conditions based on the Coping Orientation to Problems Experienced Inventory (Brief-COPE) tool. RESULTS: Altogether 124 (41.3%) traffic police officers had symptoms of depression, 141 (47%) had anxiety symptoms and 132 (44%) had symptoms of stress. Smoking was significantly associated with an increased likelihood of experiencing symptoms of depression (adjusted OR (AOR): 10.7, 95% CI: 4.8 to 23.6), anxiety (AOR: 7.1, 95% CI: 3.4 to 14.9) and stress (AOR: 6.8, 95% CI: 3.3 to 14.1). Similarly, longer working hours was significantly associated with higher odds of experiencing symptoms of depression (AOR: 3.4, 95% CI: 1.8 to 6.4), anxiety (AOR: 2.3, 95% CI: 1.3 to 3.9) and stress (AOR: 1.9, 95% CI: 1.1 to 3.4), and lack of physical exercise was associated with an increased likelihood of exhibiting depressive symptoms (AOR: 2.3, 95% CI: 1.1 to 4.7). Participants in this study used positive coping strategies more than negative coping strategies. CONCLUSION: Our study found a high prevalence of depression, anxiety and stress symptoms among traffic police officers in Kathmandu Valley, Nepal. Smoking and longer working hours were associated with an increased likelihood of experiencing symptoms of depression, anxiety and stress, and lack of physical exercise was associated with an increased likelihood of depressive symptoms.

Congenital Colour Vision Deficiency among Patients Attending Outpatient Department of Ophthalmology in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Congenital colour vision deficiency may affect a person's day-to-day activity and may also affect the choice of occupation a person chooses. This study aims to find the prevalence of congenital colour vision defects in patients presenting in outpatient department of Ophthalmology in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted in a tertiary care centre after receiving ethical clearance from the Institutional Review Board of Kathmandu Medical College and Teaching Hospital (Reference number: 1006202102). The study was conducted for a 3 months period from 2021 July to 2021 September. Research participants were selected by the convenience sampling technique. A detailed ophthalmological examination was performed and colour vision was tested using Ishihara pseudoisochromatic colour vision chart. Only congenital colour vision defects were included in the study. Statistical Package for the Social Sciences version 20.0 was used for data analysis. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. Results: The overall prevalence of congenital colour vision deficiency was 14 (5.24%) (2.54-7.86 at 95% Confidence Interval). The prevalence of congenital colour vision defects in females was 1 (0.74%) and in males was 13 (9.77%). The mean age of the participants with congenital colour vision deficits was 27.42±7.90 years. Conclusions: The prevalence of congenital colour vision deficiency was similar to the prevalence in other studies done in a similar setting. Awareness should be raised about this condition and people need to be screened at an early age to prevent disappointments in career choices later in life. Keywords: colour vision defect; Nepal; prevalence.

Anxiety and Depression among Hypertensive Adults in Tertiary Care Hospitals of Nepal.

Introduction: Cooccurrence of hypertension and depression/anxiety increases the chance of cardiovascular mortality and morbidity. Therefore, this study is aimed at assessing the prevalence of anxiety and depression and their association with hypertension among hypertensive adults in a tertiary care hospital in Kathmandu, Nepal. Methods: A descriptive cross-sectional study was conducted using a semistructured self-administered questionnaire based on Hamilton Anxiety and Hamilton Depression Rating Scale. The data was entered in EPI Data and analyzed using descriptive and inferential statistics in SPSS version 22. P value < 0.05 was considered statistically significant. Results: A total of 260 individuals participated in the study, with a mean age of 42.6 years. About 46% of patients did not have any symptoms of depressed mood, and 73 (28.1%) of the participants experienced feelings of depressed mood only on questioning. Similarly, (151) 58.1% did not have feelings of guilt, and 48 (18.5%) participants who had the feeling of guilt had let people down. Among 260 respondents, most participants ((102) 39.2%) had mild symptoms of anxious mood, followed by (86) 33.1% participants with moderate symptoms. Only (4) 1.5% of participants had severe symptoms. Similarly, the majority of participants ((114) 43.8%) had a mild form of mental and emotional strain, followed by (72) 27.7% with moderate mental and emotional strain while (43) 16.5% had no mental and emotional strain. The occupation and marital status of the hypertensive individual was associated with anxiety and depression (P = ≤0.01). Conclusion: In conclusion, anxiety and depression were common among patients with hypertension. Anxiety and depression were linked to some of the patients' sociodemographic and clinical features. This study demonstrates that treating hypertension alone is not enough to improve patients' quality of life; mental illness screening among chronically ill individuals is also required.