Improving the provision of nutritional care for people living with dementia in care homes.

Issues with eating and drinking are common in all stages of dementia but are most prevalent in the middle and late stages of the condition. This can lead to unintentional weight loss and malnutrition. Previous work by the authors has attempted to understand how to improve the nutritional care of people living with dementia, and has resulted in the development of a guide for care staff to improve their knowledge and skills regarding nutrition in people with dementia. The aim of this service evaluation was to investigate how use of the nutritional guide for care staff could improve the provision of nutritional care for people living with dementia in care homes. An online survey questionnaire was emailed to care homes who had received copies of the guide between November 2018 and August 2019. Completion of the survey was sought eight weeks after use of the guide. Forty-seven questionnaires were returned from staff working in care homes. Respondents reported that the guide had supported them to increase the appetite and fluid intake of people living with dementia. The guide prompted staff members to monitor for malnutrition using validated screening tools and provided strategies to encourage people living with dementia to eat more at mealtimes. These findings indicated that the guide has contributed to changes in the practice of care home staff when providing nutritional care for people with dementia

Cardiovascular risk in high altitude people of Nepal

Background Permanently living at high altitude (HA) directly affects the cardiovascular system because of lower arterial blood oxygen content compared to sea-level and other associated physiological changes. It is uncertain if there are clear-cut benefits or risks to cardiovascular health from living at HA and whether these benefits or risks, if they exist, vary in different populations. In Nepal, a comprehensive cardiovascular risk assessment of a sample of individuals representing a HA population has not previously been performed. The main aims of this project were to estimate, in residents at HA, the prevalence of coronary heart disease (CHD) and cerebrovascular disease; to estimate the distribution of key cardiovascular risk factors; and to estimate any possible relationships between CHD or blood pressure with altitude. Methods The study design was a cross-sectional survey. The sampling technique was cluster sampling of study areas on the basis of altitude level, population density and logistical support to undertake the study, but the participants within the study areas were randomly selected. The sample consisted of 521 residents aged 30 years or over from the Nepal districts of Mustang and Humla, permanently living at altitudes of 2800 metre (m), 2890 m, 3270 m, or 3620 m. Data was collected by administering the WHO STEPS interview questionnaire for non-communicable disease risk factors, a questionnaire for verifying stroke-free status (QVSFS), bio-physical measurements (blood pressure, height, weight, waist, hip), biochemical measurements (lipid profile and glycated haemoglobin), and a resting 12 lead electrocardiogram (ECG). The prevalence of CHD was defined as the presence of pathological Q waves in the ECG or self-report of personal history of CHD (previous event of myocardial infarction (MI) or chest pain from heart disease (angina)). ECG recordings were categorized as definitely abnormal (e.g. showing evidence of previous MI, borderline (e.g. non-specific T-wave inversion) or normal after review by a cardiologist using standard widely accepted criteria. Blood pressure (systolic/diastolic) was classified as normal (<120/80 mmHg), pre-hypertension (HT) (120–39/80–89 mmHg), HT (≥140/90 mmHg), Stage I HT (140–159/90–99 mmHg), and Stage II HT (≥160/100 mmHg). Analysis of variance (ANOVA) and analysis of covariance (ANCOVA) models were used for the relationship between systolic blood pressure (SBP), diastolic blood pressure (DBP) and altitude. Logistic regression was used to estimate the association between an abnormal (or borderline abnormal) ECG and altitude in univariate and multivariate models. Results None of the participants showed definite electrocardiographic evidence of CHD. Overall, 5.6% of the participants gave a self-reported history of CHD. Altogether 19.6% of the participants had an abnormal (or borderline abnormal) ECG. The main categories of abnormality were right axis deviation (5.4%) and left ventricular hypertrophy by voltage criteria (3.5%). Observed ECG abnormalities differed between ethnic populations: suggestive of left sided cardiac abnormalities in the Mustang district with a majority population of Tibetans; and right sided abnormalities in the Humla district with a majority population of Khas-Arya. There was a moderate association between the probability of abnormal (or borderline abnormal) ECG and altitude, adjusted for potential confounding variables, with an odds ratio for a greater probability of an abnormal ECG (95% CI) of 2.83 (1.07 to 7.45), P=0.03 per 1000 m elevation of altitude. A history of stroke or of symptoms of stroke (by positive self-report of at least one criterion of the QVSFS) was identified in 6.7% of the participants. A multivariate model adjusting for potential confounding variables showed that there was moderate evidence of an association between SBP and altitude; mean SBP (95% CI) increase by 11.3 mmHg (-0.1 to 22.7), P=0.05 for every 1000 m elevation. The distribution and prevalence of key cardiovascular disease-related risk factors did not differ by altitude level. Rather, they differed by ethnicity, residential settings (urban or rural) and cultural practices. The prevalence of HT or being on treatment for HT was higher in the Mustang district with dominant Tibetan-related populations (between 41% and 54.5%) than in the Humla district, with dominant Khas-Arya (29.1%). Only 3.3% to 10.3% participants in Mustang self-reported being current smokers, whereas this rate was 38.6% in Humla. The prevalence of current drinker was high at all altitude levels ranging from 45.4% (3620 m) to 63.9% (3270 m). The prevalence of abnormal lipid components, diabetes or being on treatment for diabetes, and overweight or obesity, were all higher in urban (2800 m and 3620 m) compared to rural (3270 m and 2890 m) residential settings. Conclusion The HA populations sampled in this study had a lower prevalence of CHD and a higher prevalence of stroke than that of relevant comparator low altitude populations. None of the participants had ECG evidence of past CHD. Cardiovascular risk profiles of HA populations may depend on altitude, ethnicity, cultural lifestyle practices, and residential setting (urban or rural). Altitude per se could be an important additional risk factor because of its association with SBP and abnormal (or borderline abnormal) ECG. Different ancestry-related physiological responses to the low oxygen environment at HA may affect cardiovascular health consistent with the evidence of different patterns of ECG abnormality. The findings of the present study suggest that ethnicity and associated lifestyle or cultural practices (such as salt and alcohol intake, smoking habit) and residential settings (mainly differences in physical activity and fruit and vegetable consumption in urban and rural participants), are also likely to be important determinants of cardiovascular health for HA residents

Cardiovascular Risk Factors Among People being Treated for HIV in Nepal: a Cross-Sectional Study.

Background: Human Immunodeficiency Virus (HIV) and antiretroviral therapy (ART) are found to be strongly associated with cardiovascular diseases. Data are sparse on the prevalence and distribution of cardiovascular risk factors among people being treated for HIV in South Asia region. Methods: A cross-sectional study of 103 HIV patients (51 women and 52 men) attending routine follow-up consultations at the largest ART centre in Nepal was conducted. Data on several cardiovascular risk factors were collected through interview questionnaires, biophysical measurements and consulting medical records. Results: The most common cardiovascular risk factors observed were central obesity [34.6%, 95% Confidence Interval (CI): 25.3% to 43.9%], chronic kidney disease [20.7% (95% CI: 11.6% to 29.7%)] and tachycardia [20.6% (95% CI: 12.7% to 28.5%)]. Females were significantly more likely to have central obesity (male 9.8% vs. female 60%, p=0.016) and chronic kidney disease (male 15.4% vs. female 26.3%, p=0.003) as compared to the males. Participants were fairly active but a large proportion, especially men, had smoked [65% (95% CI: 57%-72.3%)], used tobacco products [66% (95% CI: 56.4%-74.4%)] or drugs (53.8% of the men) and consumed alcohol [60.2% (95% CI: 50.5%-69.1%)]. Conclusion: A high prevalence of several cardiovascular risk factors was observed among patients being treated for HIV in Nepal. Further larger studies are warranted to better understand the relevance and public health impact of cardiovascular risk factors in this region

Electrocardiography in people living at high altitude of Nepal.

OBJECTIVE: The main objective of this study was to estimate the prevalence of coronary heart disease (CHD) of high-altitude populations in Nepal determined by an ECG recordings and a medical history. METHODS: We carried out a cross-sectional survey of cardiovascular disease and risk factors among people living at four different altitude levels, all above 2800 m, in the Mustang and Humla districts of Nepal. 12-lead ECGs were recorded on 485 participants. ECG recordings were categorised as definitely abnormal, borderline or normal. RESULTS: No participant had Q waves to suggest past Q-wave infarction. Overall, 5.6% (95% CI 3.7 to 8.0) of participants gave a self-report of CHD. The prevalence of abnormal (or borderline abnormal) ECG was 19.6% (95% CI 16.1 to 23.4). The main abnormalities were: right axis deviation in 5.4% (95% CI 3.5 to 7.7) and left ventricular hypertrophy by voltage criteria in 3.5% (95% CI 2.0 to 5.5). ECG abnormalities were mainly on the left side of the heart for Mustang participants (Tibetan origin) and on the right side for Humla participants (Indo-Aryans). There was a moderate association between the probability of abnormal (or borderline abnormal) ECG and altitude when adjusted for potential confounding variables in a multivariate logistic model; with an OR for association per 1000 m elevation of altitude of 2.83 (95% CI 1.07 to 7.45), p=0.03. CONCLUSIONS: Electrocardiographic evidence suggests that although high-altitude populations do not have a high prevalence of CHD, abnormal ECG findings increase by altitude and risk pattern varies by ethnicity

Effects of COVID-19 during lockdown in Nepal.

Nepal started its full lockdown on March 24, 2020 and has been extended until 14 June 2020 as a precaution for prevention of COVID-19 infection. However, the strict lockdown has been criticised by many as not all the deaths are caused by COVID-19. The long and strict lockdown have had some negative effects in many aspects of health of an individual in the community. Many women are facing barriers to access maternity health care during the lockdown period and there has been rise in the suicidal behaviour such as sucidal attempt and actual suicide itself among the general population. As the lockdown began in Nepal, all the school and colleges were suspended, and children were forced to spend their time indoors and exams has been postponed leaving the students stressed about the uncertainty of their future. Social distancing, isolation and quarantine at home can result in isolated in an abusive home where there could be even more increase in abuse during such crisis. Millions of babies are missing the routine vaccinations which is a threat to global achievement in immunization. Apart from the rise in negative impact on health of Nepali people, there are other impacts related to health such as serious impacts on logistics and supply management including shortage of medicine and food supply; and impacts on farming including both production and sale. Nepal took several precautionary measures as a response towards COVID-19 such as First, limiting international air travel, sealing the land border-crossings with India and introduction of social distancing measures. However, with rise in deaths due to non COVID related causes and negative impacts on economic and financial condition of the country, there is a need for the country to ease its lockdown. Contact tracing, making face mask mandatory along with social distancing measure can be an alternative to lockdown for Nepal while the country is preparing to ease its lockdown. Social distancing, hygiene, lifestyle factors and PPE measures need to continue for long term, whilst we need to keep working on the big public health issues such as poverty reduction, improving access to health service to achieve universal health coverage

Lipid Profiles, Glycated Hemoglobin, and Diabetes in People Living at High Altitude in Nepal.

This study aimed to describe lipid profiles and the distribution of glycated hemoglobin (HbA1c) in a sample of a high altitude population of Nepal and to explore associations between these metabolic risk variables and altitude. A cross-sectional survey of cardiovascular disease and associated risk factors was conducted among 521 people living at four different altitude levels, all above 2800 m, in the Mustang and Humla districts of Nepal. Urban participants (residents at 2800 m and 3620 m) had higher total cholesterol (TC) and triglyceride (TG) than rural participants. A high ratio of TC to high-density lipoprotein-cholesterol (HDL) (TC/HDL ≥ 5.0) was found in 23.7% (95% CI 19.6, 28.2) and high TG (≥1.7 mmol/L) in 43.3% (95% CI 38.4, 48.3) of participants overall. Mean HbA1c levels were similar at all altitude levels although urban participants had a higher prevalence of diabetes. Overall, 6.9% (95% CI 4.7, 9.8) of participants had diabetes or were on hypoglycaemic treatment. There was no clear association between lipid profiles or HbA1c and altitude in a multivariate analysis adjusted for possible confounding variables. Residential settings and associated lifestyle practices are more strongly associated with lipid profiles and HbA1c than altitude amongst high altitude residents in Nepal

Diabetes prevention and management in South Asia

Background: Globally, the number of people living with Diabetes Mellitus (DM) has increased four-fold since 1980. South Asia houses one-fifth of the world’s population living with diabetes, and it was the 8th leading cause of deaths in 2013 for South Asians.Aim: To review and discuss the context of diabetes in South Asia, with a particular focus on, a) contributing factors and impact; b) national health policies around non-communicable diseases in the region, and c) to o er recommendations for prevention and management of diabetes.Method: We assessed relevant publications using PubMed, Scopus and OvidSP. Similarly, the World health Organization (WHO) and relevant ministries of each South Asian country were searched for reports and policy documents.Results: Emerging evidence supports that the prevalence of diabetes (ranging from 3.3% in Nepal up to 8.7% in India) in South Asia follows the global trend over the past decades. Urban populations in the region demonstrate a higher prevalence of diabetes, although is also a public health concern for rural areas. Changes in the pattern and types of diet, together with increasingly sedentary, lifestyles are major causes of diabetes. The overall agenda of health promotion to prevent diabetes has not yet been established in the region, and the majority of the countries in the region are inadequately prepared for the therapeutic services for diabetes.Conclusions: The early onset of the diabetes, longevity of morbidity and early mortality may have a significant impact on people’s health expenditure and health systems, as well as on the region’s demographic composition. There is an urgent need to reduce the prevalence of diabetes in the region through evidence-based interventions ranging from prevention and early detection to appropriate treatment and care. We suggest that a multi-sectorial collaboration across all stakeholders is necessary to raise awareness about diabetes, its prevention, treatment and care in the region

Publishing, identifiers & metrics: Playing the numbers game

The number of scientific articles published each year is rapidly growing and so is the number of academic journals. This makes it impossible for an individual practitioner or researcher to keep track of all research published in their own field or sub-discipline. With the growing amount of publications, it is also becoming more difficult to distinguish between similar papers published on the same topic, in the same journal, or by the same researchers (or research team). This perspective paper could support students and novice researchers, outlines the difference between the unique identifier for: (1) you as the researcher, (2) a specific paper; and (3) a specific journal. This paper further outlines the various numerical identifiers associated with academic publishing to help demystify academic publishing

Assessing the knowledge of, attitudes towards, and practices in, food safety among migrant workers in Klang Valley, Malaysia

Background Annually, 600 million individuals are affected by food-borne diseases (FBD), alongside 425,000 fatalities. Improving the general public knowledge of, attitudes towards, and practices in, (KAP) food safety is necessary for minimizing FBD transmission. In Malaysia, migrant workers account for 11.1% of the workforce, with a high proportion involved in food and beverage services. Therefore, this study aimed (i) to evaluate the current food safety KAP, and (ii) to identify the strategies to promote food safety awareness, among migrant workers across occupational sectors in Klang Valley. Method A survey was conducted with 403 migrant workers through phone interviews and online self-administered questionnaires. Piecewise structural equation modelling and multinomial regression were applied to identify predictor variables for food safety KAP and to explore differences across nationalities. Results The respondents were Nepalese, Filipino and Indonesian. The majority were male, working in the services industry, had completed high school, aged between 30 and 39 years and had worked in Malaysia for less than ten years. Knowledge was significantly correlated with attitudes and practices. Female respondents had lower knowledge and attitude scores while younger respondents had lower knowledge scores. Indonesian and Filipino respondents had lower knowledge and attitudes scores than Nepalese respondents. Understanding food safety information from social media was positively correlated with the respondents’ food safety knowledge and practices. Conclusion These findings highlighted: (i) the need to target female, younger, Indonesian and Filipino migrant workers, and (ii) the potential of social media to improve public awareness of food safety and hygienic practices