Occupational Safety and Health Vulnerability among Brick Factory Workers in Dhading District, Nepal

Background: Occupational safety and health vulnerability considers multiple dimensions, such as hazard, policy/procedure to protect workers, workers’ awareness and their empowerment to participate in injury prevention. This study attempts to bridge the inadequate knowledge regarding the factors associated with occupational safety and health vulnerability in brick factories. Objectives: To identify the status and factors associated with occupational safety and health vulnerability among brick factory workers in Dhading district. Methods: A cross-sectional descriptive study was carried out in five brick kilns of Dhading district. A two-stage cluster sampling method was used; at the first stage, probability proportionate to sample size was used to select the brick factories and simple random sampling was used to select participants from each selected brick factory. A total of 201 workers with at least a year of experience and who had worked over the last year in brick factories were included in the study. The data was collected through face-to-face interviews using a structured questionnaire. Vulnerability was defined as exposed to hazards and having inadequate policies, procedures, awareness and empowerment. Pearson Chi-square test was used to examine the relationship between vulnerability and demographic, occupational and workplace characteristics. Results: Four-fifths of the participants experienced occupational safety and health vulnerability. All participants experienced policy/procedure vulnerability; four-fifths experienced hazard vulnerability and about two-thirds experienced awareness and empowerment vulnerability. Younger, nonnative immigrants, workers carrying bricks out of a chimney and workers from small-sized workplaces experienced higher odds of vulnerability across all domains and overall vulnerability. Conclusion: Occupational safety and health vulnerability was very high among the brick factory workers. Young workers, non-native immigrant workers, workers carrying cooked bricks out of a chimney and workers from small-sized workplace were found to be more vulnerable

Nutrition Management in Neurogenic Dysphagia

Neurogenic dysphagia is an increasingly common problem. This chapter describes current approaches to enteral nutrition in patients with neurogenic dysphagia. We have shown the possibilities and our experience of using diet with a measured degree of density, specialized thickeners for drinks and food, ready-made enteral mixtures. We also identified patients who need a nasogastric tube or gastrostomy

Three-year survival rate and changes in the level of consciousness in outpatients after severe brain injuries

Introduction. There is a worldwide lack of statistical data about the patients with chronic disorders of consciousness (DOC). In Russia, there are no such data at all. Objective: to perform the first study in Russia to assess the survival rate and changes in the level of consciousness in outpatients with the chronic DOC after their hospital discharge as well as to identify the predictors of survival and improvement in the level of consciousness. Materials and methods. All the participants (n = 142) underwent their treatment and rehabilitation in Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology from January 2016 to January 2020. We recorded the changes in patient's vital status and their level of consciousness at the endpoints of 3, 6, 12, 24, and 36 months from the brain injury (both for hospital and outpatient stages). We used the KaplanMeier method to assess the survival rate. We also used the logistic regression model to determine the correlation between the predictors of the survival and the improvement in the level of consciousness at baseline and 36 months after the injury. Results. The mortality rate in the study group 3 years after the brain injury was 86.6%. Regardless of the survival rate, the level of consciousness had significantly improved (i.e., they regained communication) in 22.5% of patients within 3 years after the index event. The statistically significant final model of the regression analysis (for 142 patients) showed that younger age and higher overall CRS-R score improved the survival rate. The logistic regression model used to determine the predictors of the improvement in the level of consciousness among the survivors gave no significant results. Conclusions. High mortality rate among the outpatients, whose level of consciousness had improved at discharge, proves the ineffectiveness of the outpatient rehabilitation. Thus, we need to find a way to improve it. The authors hope that the data obtained in this study will form the basis of their research

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Cross-Sectional Survey on Quitting Attempts among Adolescent Smokers in Dharan, Eastern Nepal

Background. Adolescents frequently attempt smoking cessation but are unable to maintain long term abstinence because they are dependent on nicotine and experience withdrawal symptoms. Objectives. This study aimed to explore the quitting attempts among adolescent smokers in Dharan Municipality of Eastern Nepal. Methods. A cross-sectional study was conducted using pretested self-administered questionnaire adapted from Global Youth Tobacco Survey to assess current smokers and quitting attempts among 1312 adolescent students in middle (14-15 years) and late adolescence (16–19 years). Chi square test was used for association of various factors with quitting attempts. Results. The prevalence of current smoking was 13.7%. Among the current smokers, 66.5% had attempted to quit in the past because they believed smoking was harmful to health (35.5%). The median duration of quitting was 150 days. Nearly 8% of the current smokers were unwilling to quit in the future because they thought it is already a habit (60%). Smokers who are willing to quit smoking in the future were more likely to have made quitting attempts (OR = 1.36, 95% CI = 0.40–4.45). Conclusion. Relapse often occurs even after multiple quitting attempts. Tobacco focused interventions to support abstinence are important during adolescence to prevent habituation

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\u3c0.05) 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