Cultural Competency of Clinical Students in a Caribbean Medical School

We aimed to find out the clinical students’ scores on cultural competencies and its different components (awareness and sensitivity, behavior, patient-centered communication, practice orientation, and self-assessment); to check the correlation between different components of cultural competency; and to examine the influence of students’ demographic characteristics on their cultural competency. A 48-item Schwarz’s Healthcare Provider Cultural Competence Instrument (HPCCI) comprising five scales was used to measure the cultural competency of Trinity Medical Sciences University students in clinical years. The descriptive statistics, Pearson’s correlation, and multivariable regression analysis were done using SPSS. The students obtained 81.8% in overall cultural competency, 83.3% in awareness and sensitivity towards cultural competency, 75.8% in behavior, 82.6% in patient-centered communication, 83.3% in practice orientation, and 92% in self-assessment of cultural competency. A significant positive correlation was found among different scales of HPCCI with some exceptions. Age, gender, race, school semester of study, and birth country of students and their fathers were found as independent predictors for different components of cultural competency measured. The medical students’ awareness/sensitivity toward cultural competence, concerning behavior, their patient-centered communication, and practice orientation skills need attention and have to be a driving point in the planning, developing, and implementing focused effective cross-culture curricula to better prepare the medical students for the benefit of diverse patients and communities they will serve

Food insecurity during COVID-19 pandemic: A genuine concern for people from disadvantaged community and low-income families in Province 2 of Nepal.

Background: Food insecurity is a serious social and public health problem which is exacerbated by the COVID-19 pandemic especially in resource-poor countries such as Nepal. However, there is a paucity of evidence at local levels. This study aims to explore food insecurity among people from the disadvantaged community and low-income families during the COVID-19 pandemic in Province-2 of Nepal. Methods: The semi-structured qualitative interviews were conducted virtually among purposively selected participants (n = 41) from both urban and rural areas in eight districts of Province 2 in Nepal. All the interviews were conducted in the local language between July and August 2020. The data analysis was performed using thematic network analysis in Nvivo 12 Pro software.ResultsThe results of this study are grouped into four global themes: i) Impact of COVID-19 on food security; ii) Food insecurity and coping strategies during the COVID-19 pandemic, iii) Food relief and emergency support during the COVID-19 pandemic, and iv) Impact of COVID-19 and food insecurity on health and wellbeing. Most participants in the study expressed that families from low socioeconomic backgrounds and disadvantaged communities such as those working on daily wages and who rely on remittance had experienced increased food insecurity during the COVID-19 pandemic. Participants used different forms of coping strategies to meet their food requirements during the pandemic. Community members experienced favouritism, nepotism, and partiality from local politicians and authorities during the distribution of food relief. The food insecurity among low-income and disadvantaged families has affected their health and wellbeing making them increasingly vulnerable to the COVID-19 infection.ConclusionFood insecurity among low-income and disadvantaged families was found to be a serious problem during the COVID-19 pandemic. The study suggests that the relief support plan and policies should be focused on the implementation of immediate sustainable food security strategies to prevent hunger, malnutrition, and mental health problems among the most vulnerable groups in the community

Impact of COVID-19 on health services utilization in Province-2 of Nepal: a qualitative study among community members and stakeholders

Background The COVID-19 pandemic has posed unprecedented challenges and threats to the health care system, particularly affecting the effective delivery of essential health services in resource-poor countries such as Nepal. This study aimed to explore community perceptions of COVID-19 and their experiences towards health services utilization during the pandemic in Province-2 of Nepal. Methods The semi-structured qualitative interviews were conducted among purposively selected participants (n = 41) from a mix of rural and urban settings in all districts (n = 8) of the Province 2 of Nepal. Virtual interviews were conducted between July and August 2020 in local languages. The data were analyzed using thematic network analysis in NVivo 12 Pro. Results The findings of this research are categorized into four global themes: i) Community and stakeholders’ perceptions towards COVID-19; ii) Impact of COVID-19 and lockdown on health services delivery; iii) Community perceptions and experiences of health services during COVID-19; and iv) COVID-19: testing, isolation, and quarantine services. Most participants shared their experience of being worried and anxious about COVID-19 and reported a lack of awareness, misinformation, and stigma as major factors contributing to the spread of COVID-19. Maternity services, immunization, and supply of essential medicine were found to be the most affected areas of health care delivery during the lockdown. Participants reported that the interruptions in health services were mostly due to the closure of health services at local health care facilities, limited affordability, and involvement of private health sectors during the pandemic, fears of COVID-19 transmission among health care workers and within health centers, and disruption of transportation services. In addition, the participants expressed frustrations on poor testing, isolation, and quarantine services related to COVID-19, and poor accountability from the government at all levels towards health services continuation/management during the COVID-19 pandemic. Conclusions This study found that essential health services were severely affected during the COVID-19 pandemic in all districts of Province-2. It is critical to expand and continue the service coverage, and its quality (even more during pandemics), as well as increase public-private sector engagement to ensure the essential health services are available for the population

Analysis of cardiac autonomic modulation in normotensive obese and eutrophic adults of Nepal

Background: Obese people have a higher prevalence of cardiovascular disease, though unknown mechanism, supposed to be due to autonomic dysfunction which is still in controversy. This study aimed to assess and compare heart rate variability (HRV) between normotensive obese and adults.Methods: The study was conducted on 30 normotensive obese adults (mean age 32.07±7.25 years) with BMI>30 and 29 age- and sex-matched normal weight controls (mean age 30.48±8.01 years) with BMI: 18-24 Kg/m2. Short-term HRV variables were assessed using standard protocol. The data were compared between the groups using Mann Whitney ‘U’ test.Results: In obese group, there was significant increase in the mean heart rate [79.17±8.80 Vs 71.48±8.41 beats/min, p=0.001], systolic blood pressure [121.20±9.89 Vs 113.24±11.07, mmHg, p=0.004] and diastolic blood pressure [84.97±7.87 Vs 74.83±10.31 mmHg, p=0.000]. The HRV parasympathetic indicators were less [RMSSD {28.75(16.72-38.35) Vs 41.55(30.6-56.75) ms, p=0.018}, NN50 {15.5(2-39) Vs 83.5(32.75-116.25), p=0.010}], and sympathetic indicator LF/HF ratio [1.2(0.65-2.20) Vs 0.79(0.5-1.02), p=0.004] was more in obese group.Conclusions: Obese persons have increased sympathetic activity with a reduction in parasympathetic (vagal) tone indicating poor autonomic cardiac rhythm control. Moreover, the altered autonomic activity could be the reason for increased mean heart rate and blood pressures in normotensive obese persons

Association of RT-qPCR Ct Values and Disease Severity among COVID-19 Patients Visiting a Tertiary Care Hospital in Nepal

COVID-19 pandemic due to SARS-CoV-2 has been one of the major global health issues of this aeon. The aim of this study was to evaluate the association of SARS-CoV-2 cycle threshold (Ct) values with multiple factors among COVID-19 patients visiting a tertiary care hospital in Sudurpashchim province of Nepal. A retrospective analysis was performed on the data of randomly selected COVID-19 cases among the total RT-qPCR tested patients from March 2020 to April 2022. The Ct values at the time of patient admission and their clinical outcomes (discharge or death) were compared. Among the COVID-19 patients, survivor group had significantly higher initial Ct value compared to non-survivors [median Ct values 23.21 and 24.39 (P < 0.0001)]. Selected haematological parameters; white blood cells (P<001), neutrophils (P<001), and monocytes (P<0.0001), and all the biochemical parameters were significantly different between these two groups (p < 0.005). Furthermore, significantly increased CRP (61.54±63.00, P<0.0017), D-dimer levels (0.8979± 1.480, P<0.0001), creatinine (0.7931±0.2551, P<0.0001), monocytes (0.6782±0.7981, P<0.0001), and random blood sugar (152.4±34.32, P<0.0001) were observed among non-survivors indicating as cause of disease severity in COVID-19. The findings of this study imply that the Ct value, CRP and D-dimer levels could be a crucial marker for the early detection of severe COVID-19 patients or those at higher risk of developing severe disease. This will eventually help to identify cases requiring immediate and critical medical care and reduce mortality

Constraints on the χ_(c1) versus χ_(c2) polarizations in proton-proton collisions at √s = 8 TeV

The polarizations of promptly produced χ_(c1) and χ_(c2) mesons are studied using data collected by the CMS experiment at the LHC, in proton-proton collisions at √s=8  TeV. The χ_c states are reconstructed via their radiative decays χ_c → J/ψγ, with the photons being measured through conversions to e⁺e⁻, which allows the two states to be well resolved. The polarizations are measured in the helicity frame, through the analysis of the χ_(c2) to χ_(c1) yield ratio as a function of the polar or azimuthal angle of the positive muon emitted in the J/ψ → μ⁺μ⁻ decay, in three bins of J/ψ transverse momentum. While no differences are seen between the two states in terms of azimuthal decay angle distributions, they are observed to have significantly different polar anisotropies. The measurement favors a scenario where at least one of the two states is strongly polarized along the helicity quantization axis, in agreement with nonrelativistic quantum chromodynamics predictions. This is the first measurement of significantly polarized quarkonia produced at high transverse momentum