May Measurement Month 2017: An analysis of blood pressure screening results in Nepal - South Asia

Hypertension is the leading risk factor of mortality in Nepal accounting for ∼33 000 deaths in 2016. However, more than 50% of the hypertensive patients are unaware of their status. We participated in the May Measurement Month 2017 (MMM17) project initiated worldwide by the International Society of Hypertension to raise the awareness on the importance of blood pressure (BP) screening. In this paper, we discuss the screening results of MMM17 in Nepal. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May 2017 following the standard MMM protocol. Data were collected from 18 screening sites in 7 districts covering 5 provinces. Screenings were conducted either in health facilities, public places, or participants' homes. Trained volunteers with health science background and female community health volunteers were mobilized to take part in the screening. A total of 5972 individuals were screened and of 5968 participants, for whom a mean of the 2nd and 3rd readings was available, 1456 (24.4%) participants had hypertension; 908 (16.8%) of those not receiving treatment were hypertensive; and 248 (45.2%) of those being treated had uncontrolled BP. MMM17 is the first nationwide BP screening campaign undertaken in Nepal. Given the suboptimal treatment and control rates identified in the study, there is a strong imperative to scale up hypertension prevention, screening, and management programmes. These results suggest that opportunistic screening can identify significant numbers with hypertension. Mobilization of existing volunteer networks and support of community stakeholders, would be necessary to improve the overall impact and sustainability of future screening programmes

Visceral Leishmaniasis Relapse in Southern Sudan (1999–2007): A Retrospective Study of Risk Factors and Trends

Visceral leishmaniasis (kala-azar) caused by Leishmania donovani is spread from person to person by Phlebotomus sandflies. Major epidemics of visceral leishmaniasis have occurred in Southern Sudan during the 20th century. The worst of these killed 100,000 people in the western Upper Nile area of Southern Sudan from 1984–1994, a loss of one-third of the population. Médecins Sans Frontières has treated 40,000 kala-azar patients in Southern Sudan since the late 1980's. In this study we used routinely collected clinical data to investigate why some patients relapse after treatment. We found that patients with severely enlarged spleens (splenomegaly) are more likely to relapse. Patients treated for 17 days with a combination of two drugs (sodium stibogluconate and paromomycin) were more likely to relapse (but less likely to die) than patients treated for 30 days with a single drug (sodium stibogluconate). However, the transition from sodium stibogluconate to the sodium stibogluconate/paromomycin combination as standard treatment between 2001–2003 has not led to a significant increase in visceral leishmaniasis relapse

Determinants of Water Connection Type and Ownership of Water-Using Appliances in Ireland

Developing optimal policies on management of water resources, investment in relevant infrastructure and the protection of the environment requires data on the current and likely future demand for water services. In jurisdictions without water metering, information on the factors influencing demand tends to be limited. Microdata from household surveys can provide some relevant information. Domestic water demand is influenced both by the number of households and their characteristics, in particular the extent to which they employ water-using appliances. This paper focuses on domestic ownership of water-using appliances in the Republic of Ireland, a country where rapid economic and demographic change have put pressure on water and sewerage infrastructure but where there is little domestic metering. Using a large household micro-dataset, we use regression analysis to examine the determinants of the water and sewage mains connection status of Irish homes and to identify the characteristics of households that are associated with having larger or smaller numbers of appliances. Our empirical results suggest that Ireland will have a rising share of mains water and sewerage connections in the future. Household income, house price, dwelling types other than 'detached', younger dwellings, and urban location are all positively associated with having a mains connection. The number of types of water-using appliance in a household is positively associated with income, house price, number of residents, owner-occupation, having children (or, to a lesser extent, multiple people) in the household, having a detached house, being located in a rural area and living in a dwelling built after 1997

Primeiro episódio da esquizofrenia e assistência de enfermagem Primer episodio de la esquizofrenia y asistencia de enfermería First episode of schizophrenia and nursing care

A esquizofrenia é um dos principais problemas de saúde da atualidade, exigindo considerável investimento do sistema de saúde. A intervenção no primeiro episódio do transtorno oferece uma oportunidade única no tratamento da esquizofrenia, influenciando no curso da doença. O presente artigo consiste em uma revisão crítica de literatura cujos objetivos são examinar o conhecimento sobre o primeiro surto de esquizofrenia e discutir a contribuição da enfermagem na assistência. Foi utilizada pesquisa bibliográfica em índice informatizado de referências. Os dados obtidos permitiram organizar informações sobre o conceito geral de esquizofrenia, seu primeiro surto, tipos de intervenções e a atuação de enfermagem. Observamos que existe pouca literatura brasileira relacionada ao primeiro surto esquizofrênico, na área da enfermagem, poucos serviços especializados e disponíveis e poucos recursos sociais. Tal condição mostra a necessidade de estudos relacionados ao primeiro surto.<br>La esquizofrenia es uno de los principales problemas de salud de la actualidad, exigiendo considerable inversión del sistema de salud. La intervención en el primer episodio del trastorno ofrece oportunidad única en el tratamiento de la esquizofrenia, influyendo en el curso de la enfermedad. El presente artículo consiste en una revisión crítica de la literatura cuyos objetivos son examinar el conocimiento sobre el primer episodio de esquizofrenia y discutir acerca de la contribución de la enfermería en la asistencia. Fue utilizada la investigación bibliográfica en índice informatizado de referencias. Los datos obtenidos permitieron organizar informaciones sobre el concepto general de esquizofrenia, su primer episodio, tipos de intervenciones y la actuación de enfermería. Observamos que existe poca literatura brasileña relacionada a la primera aparición de signos de esquizofrenia, en el área de la enfermería, pocos servicios especializados disponibles y pocos recursos sociales. Tal condición muestra la necesidad de estudios relacionados al primer episodio.<br>Schizophrenia is one of the main health problems in current days, requiring considerable investment from the health system. Intervening in the first episode offers a unique opportunity in the treatment of schizophrenia and influences the course of the illness. This article consists of a critical literature review aimed at examining knowledge on first episode schizophrenia and discussing the contribution of nursing care. A research was carried out in bibliographical databases. The data collected made possible the organization of information on the general concept of schizophrenia, its first episode, types of intervention and nursing performance. We found out that in Brazil there are few studies related to first episode schizophrenia in Nursing, few available specialized services, and few social resources. This situation reveals the need for more studies on first episode schizophrenia

In the Shadows of the Himalayan Mountains : Persistent Gender and Social Exclusion in Development

Climate change in combination with socioeconomic processes and opportunities have an especially severe impact on people living in remote mountain areas of the Hindu Kush Himalaya. What is less well known is how changes in climate will affect in the quality of lives, livelihoods, and resources of diverse groups of people of the region. The chapter argues that it is not only important but also necessary to link climate science and climate interventions with relevant contextual experiences of the different groups of people due their differential experiences and vulnerabilities. The chapter provides illustrative cases studies to demonstrate the differential experiences and vulnerabilities of women and men as a result of the dynamics of gender relations in the context of climate change