Placental thickness and its correlation to gestational age in Nepalese woman: a hospital based study

Introductions: Gestational age is estimated on the basis of last normal menstrual period and the measurement of foetal growth parameters by ultrasonography. The lack of accurate recollection of the last menstrual period and dependence of growth parameters on intra-uterine environment, physical and mental well-being of the mother, maternal nutrition and genetic factors leads to the over or under estimation of gestational age. The aim of this study was to investigate the correlation between placental thicknesses (PT) in normal singleton Nepalese foetuses. Methods: This was a cross sectional study of ultrasound measurement of placental thickness during 2nd and 3rd trimester pregnancy from April 2015 to October 2015 at Department of Radiology, Suraksha Hospital, Biratnagar, Nepal. All viable singleton uncomplicated pregnancies, history of regular menstruation with known LNMP were included. Microsoft Excel and SPSS 17 were used for data analysis. Pearson’s correlation analysis was used for correlation between placental thickness and gestational age. Statistical tests were two-tailed with p<0.01 as statistical significance. Results: There were 592 pregnant women who met the criteria. Placental thickness increased by 0.86 mm in every week of increase in gestational age. The maximum mean PT of 40.42±1.05 mm was observed at 39th week. There was a significant positive correlation between placental thickness and gestational age, correlation coefficient r=0.986 (P<0.001). Conclusions: PT was found to be a reliable alternative predictor in calculating gestational age. Measurement of PT should be done routinely during obstetrics ultrasonography. Keywords: antenatal ultrasound,gestational age, placental thickness, singleton pregnancy,Â

Hand hygiene compliance among rural healthcare workers of Nepal

Introductions: Transmission of healthcare associated infections through contaminated hands of healthcare workers are common. This study was designed to explore the existing compliance of hand hygiene among the healthcare workers workings in different level of health care centers of Makwanpur district of Nepal. Methods: This was a cross sectional observational study conducted in Makwanpur district, Nepal, during 2015. Healthcare workers from nine healthcare centers were selected randomly for the study. Standard observation checklists and World Health Organization guidelines on hand hygiene were used to assess the compliance of hand hygiene during patient care. Results: There were 74 participants. Overall compliance for hand washing was 24.25% (range 19.63 to 45.56). Complete steps of hand washing were performed by 38.3% of health care workers. The factors associated for noncompliance were lack of time (29.3%), example set by seniors (20%), absence or inadequate institution protocol (20%) and unfavourable health care setting (> 20%).Conclusions: Overall hand washing compliance rate amongst the healthcare workers in rural health facilities of Nepal were low (24.25%).  Keywords: hand hygiene, healthcare worker, rural health facilitie

Health sector readiness for the prevention and control of non-communicable diseases: A multi-method qualitative assessment in Nepal

In Nepal, deaths attributable to NCDs have increased in recent years. Although NCDs constitute a major public health problem, how best to address this has not received much attention. The objective of this study was to assess the readiness of the Nepalese health sector for the prevention and control of NCDs and their risk factors. The study followed a multi-method qualitative approach, using a review of policy documents, focus group discussions (FGDs), and in-depth interviews (IDIs) conducted between August and December 2020. The policy review was performed across four policy categories. FGDs were undertaken with different cadres of health workers and IDIs with policy makers, program managers and service providers. We performed content analysis using the WHO health system building blocks framework as the main categories. Policy documents were concerned with the growing NCD burden, but neglect the control of risk factors. FGDs and IDIs reveal significant perceived weaknesses in each of the six building blocks. According to study participants, existing services were focused on curative rather than preventive interventions. Poor retention of all health workers in rural locations, and of skilled health workers in urban locations led to the health workers across all levels being overburdened. Inadequate quantity and quality of health commodities for NCDs emerged as an important logistics issue. Monitoring and reporting for NCDs and their risk factors was found to be largely absent. Program decisions regarding NCDs did not use the available evidence. The limited budget dedicated to NCDs is being allocated to curative services. The engagement of non-health sectors with the prevention and control of NCDs remained largely neglected. There is a need to redirect health sector priorities towards NCD risk factors, notably to promote healthy diets and physical activity and to limit tobacco and alcohol consumption, at policy as well as community levels

Influenza B virus: Need for heightened surveillance and epidemiologic case studies

Recent report of increased influenza B virus infection, particularly theclinical profiles and treatment challenges imposed like that of influenza A,underscores the importance of continuing influenza B virus surveillance.This is, especially in resource limited country, early detection of influenzavirus, its clinical presentation and complications would be vital in minimizingthe public heath burden imposed by this virus.Keywords: chronic obstructive pulmonary disease, influenza B, severe acutepulmonary infection

Global burden of influenza-associated lower respiratory tract infections and hospitalizations among adults : a systematic review and meta-analysis

BACKGROUND : Influenza illness burden is substantial, particularly among young children, older adults, and those with underlying conditions. Initiatives are underway to develop better global estimates for influenza-associated hospitalizations and deaths. Knowledge gaps remain regarding the role of influenza viruses in severe respiratory disease and hospitalizations among adults, particularly in lower-income settings. METHODS AND FINDINGS : We aggregated published data from a systematic review and unpublished data from surveillance platforms to generate global meta-analytic estimates for the proportion of acute respiratory hospitalizations associated with influenza viruses among adults. We searched 9 online databases (Medline, Embase, CINAHL, Cochrane Library, Scopus, Global Health, LILACS, WHOLIS, and CNKI; 1 January 1996-31 December 2016) to identify observational studies of influenza-associated hospitalizations in adults, and assessed eligible papers for bias using a simplified Newcastle-Ottawa scale for observational data. We applied meta-analytic proportions to global estimates of lower respiratory infections (LRIs) and hospitalizations from the Global Burden of Disease study in adults ≥20 years and by age groups (20-64 years and ≥65 years) to obtain the number of influenza-associated LRI episodes and hospitalizations for 2016. Data from 63 sources showed that influenza was associated with 14.1% (95% CI 12.1%-16.5%) of acute respiratory hospitalizations among all adults, with no significant differences by age group. The 63 data sources represent published observational studies (n = 28) and unpublished surveillance data (n = 35), from all World Health Organization regions (Africa, n = 8; Americas, n = 11; Eastern Mediterranean, n = 7; Europe, n = 8; Southeast Asia, n = 11; Western Pacific, n = 18). Data quality for published data sources was predominantly moderate or high (75%, n = 56/75). We estimate 32,126,000 (95% CI 20,484,000-46,129,000) influenza-associated LRI episodes and 5,678,000 (95% CI 3,205,000-9,432,000) LRI hospitalizations occur each year among adults. While adults <65 years contribute most influenza-associated LRI hospitalizations and episodes (3,464,000 [95% CI 1,885,000-5,978,000] LRI hospitalizations and 31,087,000 [95% CI 19,987,000-44,444,000] LRI episodes), hospitalization rates were highest in those ≥65 years (437/100,000 person-years [95% CI 265-612/100,000 person-years]). For this analysis, published articles were limited in their inclusion of stratified testing data by year and age group. Lack of information regarding influenza vaccination of the study population was also a limitation across both types of data sources. CONCLUSIONS : In this meta-analysis, we estimated that influenza viruses are associated with over 5 million hospitalizations worldwide per year. Inclusion of both published and unpublished findings allowed for increased power to generate stratified estimates, and improved representation from lower-income countries. Together, the available data demonstrate the importance of influenza viruses as a cause of severe disease and hospitalizations in younger and older adults worldwide.S1 Data. CSV-formatted analysis dataset.S1 Fig. Forest plot of individual study estimates included in meta-analysis (all adults).S1 PRISMA Checklist. PRISMA checklist.S1 Table. Literature search methodology and results, by database.S2 Table. Summary of published articles included in the analyses, with reference list.S3 Table. Median number of specimens tested and percent positive for influenza, by age group, study design, and population, among all data sources.S4 Table. Regional estimates of influenza-associated lower respiratory infection (LRI) episodes and hospitalizations, by age group.S5 Table. Sensitivity analyses.Grants from the Foundation for Influenza Epidemiology, grants from Innovative Medicines Initiative, grants from the WHO, personal fees from Bill and Melinda Gates Foundation, grants and personal fees from Sanofi, grants from National Institute of Health Research, personal fees from Janssen and personal fees from AbbVie.https://journals.plos.org/plosmedicine/am2023Medical Virolog

Global burden of influenza-associated lower respiratory tract infections and hospitalizations among adults: A systematic review and meta-analysis

Background: Influenza illness burden is substantial, particularly among young children, older adults, and those with underlying conditions. Initiatives are underway to develop better global estimates for influenza-associated hospitalizations and deaths. Knowledge gaps remain regarding the role of influenza viruses in severe respiratory disease and hospitalizations among adults, particularly in lower-income settings. Methods and findings: We aggregated published data from a systematic review and unpublished data from surveillance platforms to generate global meta-analytic estimates for the proportion of acute respiratory hospitalizations associated with influenza viruses among adults. We searched 9 online databases (Medline, Embase, CINAHL, Cochrane Library, Scopus, Global Health, LILACS, WHOLIS, and CNKI; 1 January 1996–31 December 2016) to identify observational studies of influenza-associated hospitalizations in adults, and assessed eligible papers for bias using a simplified Newcastle–Ottawa scale for observational data. We applied meta-analytic proportions to global estimates of lower respiratory infections (LRIs) and hospitalizations from the Global Burden of Disease study in adults ≥20 years and by age groups (20–64 years and ≥65 years) to obtain the number of influenza-associated LRI episodes and hospitalizations for 2016. Data from 63 sources showed that influenza was associated with 14.1% (95% CI 12.1%–16.5%) of acute respiratory hospitalizations among all adults, with no significant differences by age group. The 63 data sources represent published observational studies (n = 28) and unpublished surveillance data (n = 35), from all World Health Organization regions (Africa, n = 8; Americas, n = 11; Eastern Mediterranean, n = 7; Europe, n = 8; Southeast Asia, n = 11; Western Pacific, n = 18). Data quality for published data sources was predominantly moderate or high (75%, n = 56/75). We estimate 32,126,000 (95% CI 20,484,000–46,129,000) influenza-associated LRI episodes and 5,678,000 (95% CI 3,205,000–9,432,000) LRI hospitalizations occur each year among adults. While adults &lt;65 years contribute most influenza-associated LRI hospitalizations and episodes (3,464,000 [95% CI 1,885,000–5,978,000] LRI hospitalizations and 31,087,000 [95% CI 19,987,000–44,444,000] LRI episodes), hospitalization rates were highest in those ≥65 years (437/100,000 person-years [95% CI 265–612/100,000 person-years]). For this analysis, published articles were limited in their inclusion of stratified testing data by year and age group. Lack of information regarding influenza vaccination of the study population was also a limitation across both types of data sources. Conclusions: In this meta-analysis, we estimated that influenza viruses are associated with over 5 million hospitalizations worldwide per year. Inclusion of both published and unpublished findings allowed for increased power to generate stratified estimates, and improved representation from lower-income countries. Together, the available data demonstrate the importance of influenza viruses as a cause of severe disease and hospitalizations in younger and older adults worldwide

Validation of mental agility test and personal qualities assessment tools for selecting medical students in Nepal: Mental agility and personal qualities tests

Introduction: Patan Academy of Health Sciences (PAHS) decided to test mental agility and personal qualities to select undergraduate medical students, different than the conventional approaches used to test for physics, chemistry, and biology contents in other universities in Nepal. Method: Personal Qualities Assessment (PQA) test batteries used to select medical students in twelve different countries were pilot tested with 10+2 non-sciences, 10+2 science, and 10+3 health science students. The PQA tools were forward translated into Nepali and back-translated in English by bilingual experts independently. The face and content validity of these tools in the Nepali language was established through discussions and consensus with the PAHS admission team and PQA team in Australia. Result: The PQA tools assessing non-cognitive qualities in the Nepali language were found to be internally consistent in the first pre-test with science and non-science students. PQA tool assessing mental agility in the English language showed acceptable internal consistency in the second pre-test with science and health science students. Conclusion: Mental agility test in the English language was found to be a suitable cognitive test for selecting medical students. Non-cognitive tests in the Nepali language were found to be reliable and valid to identify applicants with unusual personal traits, leading to deselection. These tests can be considered for selecting undergraduate medical students.   Keywords: Cognitive, mental agility test- MAT, Nepal, Non-cognitive, Patan Academy of Health Sciences- PAHS, personal qualities assessment- PQA

Self-management and patient activation in COPD patients: An evidence summary of randomized controlled trials

Background: Chronic Obstructive Pulmonary Disease (COPD) is associated with multiple health problems including physical and psychological impairment as well as socioeconomic deprivation. COPD can be managed if self-management efficiency and disease management knowledge of patients is improved. Patient activation is believed to improve patients\u27 quality of life (QOL) and health outcomes through enhancing self-management skills. This review is an attempt to identify the benefits and knowledge gaps in self-management and patient-activation position in COPD self-management interventions Methods: Four electronic databases (Medline, Pubmed, Google Scholar and Cochrane Airways Group Specialized Register of Trials) were systematically searched from 1 January 2011 to 30 November 2016. The search strategy included the combined use of Medical Subject: Headings (MeSH) term, which are as follows; Self-management , Self-care , Self-treat , Pulmonary disease , Chronic Obstructive Pulmonary Disease , Patient activation , Patient Activation Measure , Personalized support , Chronic Obstructive Pulmonary Disease , COPD . The screening of the abstracts and full texts of the papers, data extraction and quality assessment were independently done by three reviewers. Results: The results of this review showed that health outcomes (QOL, perceived quality of care, knowledge and severity on disease, lower rate of exacerbation, patient activation level) can be improved by self-management interventions with well cleared content on self-care guidelines and targeted behavior change models that possibly can increase self-efficacy of the patients. However, most of the studies have not applied patient activation which is shown to play a central role in COPD self-management behaviors. Conclusions: This review has identified that there is paucity of literature on patient activation in tailored COPD self-management intervention. As a way forward, there is need to test a well-designed randomized controlled trial considering key points like patients characteristics, compliance, intervention delivery period, multi-morbidity conditions and measurement of the outcomes with standardized tools, might help to arrive at enable scientific conclusions