Anxiety and depression in Nepal: prevalence, comorbidity and associations

BACKGROUND: Anxiety and depression are two important contributors to the global burden of disease. In many developing countries, including Nepal, their prevalences are yet to be assessed. METHODS: A nationwide cross-sectional study was conducted among a representative sample of Nepalese adults aged 18–65 years (N = 2100), selected by multistage random cluster sampling and interviewed at home during unannounced visits. The validated questionnaires included the Hospital Anxiety and Depression Scale (HADS), to detect cases of anxiety (HADS-A), depression (HADS-D) and comorbid anxiety and depression (HADS-cAD), the Eysenck Personality Questionnaire Revised Short Form-Neuroticism (EPQRS-N), and the World Health Organization Quality of Life 8-question scale (WHOQOL-8). Logistic regression analyses were used to explore associations of caseness with four groups of variables: demographic, domicile, substance use, and behavioural and health. RESULTS: Age- and gender-adjusted point prevalences of HADS-A, HADS-D and HADS-cAD were 16.1, 4.2 and 5.9 % respectively. In a multivariate model, HADS-A was positively associated with urban residence (AOR = 1.82; p < 0.001) and neuroticism (AOR = 1.32; p < 0.001), and negatively with alcohol consumption (AOR = 0.71; p = 0.041). HADS-D was positively associated with marijuana use (AOR = 3.61; p = 0.017) and negatively with quality of life (QoL) (AOR = 0.86; p < 0.001). HADS-cAD was positively associated with widowhood (AOR = 2.71; p = 0.002), urban residence (AOR = 2.37; p = 0.001), living at altitude ≥2000 m (AOR = 2.32; p = 0.002) and neuroticism (AOR = 1.26; p < 0.001), and negatively with alcohol use (AOR = 0.56; p = 0.026) and QoL (AOR = 0.79; p < 0.001). CONCLUSION: Depression and anxiety are important mental health conditions in Nepal, and major contributors to public ill health, being very highly prevalent, comorbid and associated with psychosocial burden. They are also linked to the unique topography, habitation and social structure of the country. High prevalence coupled with the disabling nature of these disorders establishes their health-care priority and their importance in national health policy

Comorbidities of psychiatric and headache disorders in Nepal: implications from a nationwide population-based study

Background Headache disorders, anxiety and depression – the major disorders of the brain – are highly comorbid in the western world. Whether this is so in South Asia has not been investigated, but the question is of public-health importance to countries in the region. We aimed to investigate associations, and their direction(s), between headache disorders (migraine, tension-type headache [TTH] and headache on ≥15 days/month) and psychiatric manifestations (anxiety, depression and neuroticism), and how these might affect quality of life (QoL). Methods In a nationwide, cross-sectional survey of the adult Nepalese population (N = 2100), trained interviewers applied: 1) a culturally-adapted version of the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire to diagnose headache disorders; 2) a validated Nepali version of the Hospital Anxiety and Depression Scale (HADS) to detect anxiety (HADS-A), depression (HADS-D) and comorbid anxiety and depression (HADS-cAD); 3) a validated Nepali version of the Eysenck Personality Questionnaire Revised Short Form-Neuroticism (EPQRS-N); and 4) the World Health Organization Quality of Life 8-question scale (WHOQOL-8). Associations with headache types were analysed using logistic regression for psychiatric caseness and linear regression for neuroticism. Adjustments were made for age, gender, household consumption, habitat, altitude and use of alcohol and marijuana. Results HADS-A was associated with any headache (p = 0.024), most strongly headache on ≥15 days/month (AOR = 3.2) followed by migraine (AOR = 1.7). HADS-cAD was also associated with any headache (p = 0.050, more strongly among females than males [p = 0.047]) and again most strongly with headache on ≥15 days/month (AOR = 2.7), then migraine (AOR = 2.3). Likewise, neuroticism was associated with any headache (p < 0.001), most strongly with headache on ≥15 days/month (B = 1.6), followed by migraine (B = 1.3). No associations were found between HADS-D and any headache type, or between TTH and any psychiatric manifestation. Psychiatric caseness of any sort, when comorbid with migraine or TTH, aggravated the negative impact on QoL (p < 0.001). Conclusion Headache disorders are highly comorbid with anxiety and show associations with neuroticism in Nepal, with negative consequences for QoL. These findings call for reciprocal awareness, and a holistic coordinated approach to management and in the health service. Care for common headache and common psychiatric disorders should be integrated in primary care.publishedVersion© 2016 Risal et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/

Odour reduction of manure through addition of boracic charcoal

ArticleOdours released during the land application of manure results from different gases released from the liquid phase. These gases do create objectionable odours in the vicinity of the land - applied manure. In order to reduce the intensity of odour durin g manure application, we investigated the effectiveness of combining Borkohle with manure during land application. Boracic acid is widely used as a flame retardant in cellulose insulation. During demolition of existing buildings, this insulation is sorted into its own residual waste fraction. The cellulose fibres are extracted and pelletized on site. Subsequently, the pellets are charred in a pyrolysis furnace. The resulting Borkohle – charcoal containing boron in various compounds - can be used as a soil e nhancer and provides the trace element Boron to the fields. Furthermore, Borkohle provides long - term storage of carbon in the soil. Initial trials of combining boracic charcoal with manure additionally showed that odour emissions seemed to be significantly lower when manure was combined with Borkohle. This work presents methods to quantify the odour reductions resulting from the addition of Borkohle to manure as well as first results. Parameters like the influence of the amount of charcoal added and exposur e time have been investigated. Charcoal was added at concentrations between 5 and 250 g L - 1 . While applying typical amounts of charcoal, a reduction of odour concentration of up to 85% was observed . A positive correlation between odour reduction and the amount of charcoal added was observed. Charcoal has a negligible effect when exposure times are less than 30 minutes

Genralized Robustness of Entanglement

The robustness of entanglement results of Vidal and Tarrach considered the problem whereby an entangled state is mixed with a separable state so that the overall state becomes non-entangled. In general it is known that there are also cases when entangled states are mixed with other entangled states and where the sum is separable. In this paper, we treat the more general case where entangled states can be mixed with any states so that the resulting mixture is unentangled. It is found that entangled pure states for this generalized case have the same robustness as the restricted case of Vidal and Tarrach.Comment: Final version. Editorial changes and references added to independent wor

Curvature representation of the gonihedric action

We analyse the curvature representation of the gonihedric action $A(M)$ for the cases when the dependence on the dihedral angle is arbitrary.Comment: 10 pages, LaTeX, 3 embedded figures with psfig, submitted to Phys.Lett.

Nonequilibrium electron spin polarization in a double quantum dot. Lande mechanism

In moderately strong magnetic fields, the difference in Lande g-factors in each of the dots of a coupled double quantum dot device may induce oscillations between singlet and triplet states of the entangled electron pair and lead to a nonequilibrium electron spin polarization. We will show that this polarization may partially survive the rapid inhomogeneous decoherence due to random nuclear magnetic fields.Comment: New version contains figures. New title better reflects the content of the pape

Cerebral oxygen vasoreactivity and cerebral tissue oxygen reactivity†

There has long been an appreciation that cerebral blood flow is modulated to ensure adequate cerebral oxygen delivery in the face of systemic hypoxaemia. There is increasing appreciation of the modulatory role of hyperoxia in the cerebral circulation and a consideration of the effects of such modulation on the maintenance of cerebral tissue oxygen concentration. These newer findings are particularly important in view of the fact that cerebrovascular and tissue oxygen responses to hyperoxia may change in disease. Such alterations provide important insights into pathophysiological mechanisms and may provide novel targets for therapy. However, before the modulatory effects of hyperoxia can be used for diagnosis, to predict prognosis or to direct therapy, a more detailed analysis and understanding of the physiological concepts behind this modulation are required, as are the limitations of the measurement tools used to define the modulation. This overview summarizes the available information in this area and suggests some avenues for further research. Br J Anaesth 2003; 90: 774-8