Depression in adolescence.

Study objective: This study investigated the relation between heat and mortality in London to determine the temperature threshold at which death rates increase and to quantify the effect of extreme temperatures on mortality. Design: Daily data on all cause mortality and temperature were obtained for a 21 year period and the relation between them investigated both graphically and by using non-parametric time series methods of analysis. Setting: Greater London. Participants: Daily mortality counts in Greater London between January 1976 and December 1996. Main results: A plot of the basic mortality-temperature relation suggested that a rise in heat related deaths began at about 19°C. Average temperatures above the 97th centile value of 21.5°C (excluding those days from a 15 day “heatwave” period in 1976) resulted in an increase in deaths of 3.34% (95% CI 2.47% to 4.23%) for every one degree increase in average temperature above this value. It was found that the 1976 heatwave resulted in a particularly large number of deaths in comparison with other hot periods. Conclusions: These results suggest that heat related deaths in London may begin at relatively low temperatures. Hot days occurring in the early part of any year may have a larger effect than those occurring later on; and analysis of separate heatwave periods suggest that episodes of long duration and of highest temperature have the largest mortality effect.

The impact of hot temperatures on death in London - A time series approach

In rats with streptozotocln-induced diabetes an increase in arterial blood pressure was observed as early as the first week after the drug was injected. Blood pressure reached maximal values around the fourth week and remained stable for a long period of follow-up. The responsiveness of these rats to the three major vasopressor hormones, angiotensin II, norepinephrine, and vasopressin, was decreased in the early phase of diabetes and returned to normal in the late phase. Acute treatment at the third, sixth, and twelfth weeks with blockers of these vasopressor hormones resulted in a significant fall in blood pressure at the third week with captopril and at the twelfth week with propranolol plus phentolamine. No significant fall was observed when a specific vasopressin inhibitor was administered. Good control of the blood pressure was obtained when these rats were treated chronically with captopril or prazosin, and partial control was achieved when they were fed a low salt diet. An attenuation in arterial blood pressure levels was observed hi rats with two-kidney, one clip hypertension when diabetes was induced by streptozotocin. Plasma creatinlne levels hi diabetic rats were significantly higher than those in control rats only in the sixth and twelfth weeks. Electron microscopy revealed some minor glomerular lesions only at the twelfth week. (Hypertension 11 [Suppl I]: I-14-I-18, 1988)

Diabetes mellitus and hypertension

Impact of heat on mortality and morbidity in low and middle income countries: A review of the epidemiological evidence and considerations for future research

Depression in childhood and adolescence

An ecological time-series study is conducted to quantify health-effect coefficients associated with climate-sensitive variables namely temperature, rainfall, relative humidity, and wind speed and estimate environmental burden of diseases attributed to temperature as the main climatic variable together with climate change in Nepal. The study is based upon daily data of climate-sensitive variables and hospitalizations collected for 5 years between 2009 and 2014. Generalized linear model is used to estimate health-effect coefficients accounting distributed lag effects. Results show 3.08%, 10.14%, and 3.27% rise in water-borne, vector-borne, and renal disease hospitalizations, respectively, and 3.67% rise in water- and vector-borne disease deaths per 1 °C rise in average temperature. Similarly, 2.45% and 1.44% rise in heart disease hospitalization and all-cause mortality, respectively per 1 °C rise in absolute difference of average temperature with its overall average (20 °C). The computed attributable fractions are 0.3759, 0.6696, 0.2909, and 0.1024 for water-borne, vector-borne, renal, and heart disease hospitalizations, respectively, and 0.0607 and 0.4335 for all-cause mortality and disease-specific mortality of water- and vector-borne diseases, respectively. The percent change in attributable burdens due to climate change are found to be 4.32%, 4.64%, 7.20%, and −2.29% for water-borne, vector-borne, renal, and heart disease hospitalizations, respectively, and −1.39% and 6.55% for all-cause deaths and water-borne and vector-borne disease deaths, respectively. In conclusion, climate-sensitive variables have significant effects on many major health burdens in Nepal. In the context of changing climatic scenarios around the world including that of Nepal, such changes are bound to affect the health burden of Nepalese people.

Statistical Modeling of Health Effects on Climate-Sensitive Variables and Assessment of Environmental Burden of Diseases Attributable to Climate Change in Nepal

Method: The study is based upon daily meteorological data including temperature, rainfall, relative humidity and wind speed collected from the Department of Hydrology and Meteorology, Kathmandu and hospitalizations including water-borne (enteric fever, diahrreoal diseases and hepatitis), vector-borne (malaria, dengue, encephalitis, leishmaniasis and filarisis), urinary system (chronic kidney diseases, urinary tract infections and renal failure) and heart diseases (ischemic heart disease including angina pectoris, cardiovascular arrest, cardiac failures and other cardiovascular diseases) and mortality (all cause and diseases specific) are collected from the leading hospitals of the study area for 5 years in between 14 April 2009 and 13 April 2014.

/pdf/region-wise-effects-of-climate-sensitive-variables-on-some-2bj0sd4fy3.pdf

Region-wise Effects of Climate Sensitive Variables on Some Specific Disease Burdens in Nepal

Women’s autonomy on sexual and reproductive health issues is critical to women’s health and well-being. Women have the right to decide on their fertility and sexuality, be free from coercion and violence, and achieve well-being. This study has identified women’s autonomy regarding decision and exercise of their sexual reproductive health and rights and its association with determining factors in Nepal. Descriptive and analytical statistics such as bivariate and multivariate regression analysis were performed using data from Nepal Demographic and Health Survey 2016. The survey collected data from 12,862 women of reproductive age groups i.e. 15–49 years. However, for this study, we analyzed the data of only ever-married women and they were 9,875 in total. The analysis showed that women’s autonomy in exercising their sexual reproductive health rights is highly associated with media exposure after controlling demographic variables. The frequency of exposure to media (i. less than a week: adjusted odds ratio (AOR):1.383; confidence interval (CI):1.145–1.670, p<0.001, ii. at least once a week: AOR:1.657; CI:1.359–2.021, p<0.001) is positively associated with women’s autonomy. Furthermore, factors like women from Janajati (AOR:1.298; CI:1.071–1.576, p<0.01) and other Terai ethnic groups (AOR:1.471; CI:1.160–1.866, p<0.01), higher education attainment (AOR:1.482; CI:1.164–1.888, p<0.01), richest wealth quintile (AOR:1.527; CI:1.151–2.026, p<0.01), paid work (AOR:1.277; CI:1.045–1.561, p<0.05) and living in Lumbini Province (AOR:0.622; CI:0.486–0.797, p<0.001) and Sudur Paschim Province (AOR:0.723; CI:0.554–0.944, p<0.05) were found to be significantly associated with women’s autonomy in sexual and reproductive health decision making. Similarly, women’s autonomy is also increased with their increased age. In conclusion, women’s exposure to media, improved socio-economic status and increased age influence their autonomy to make decisions about sexual and reproductive health rights in Nepal. Therefore, this study underscores the need to address socio-economic barriers and improve women’s exposure to the media to enhance their autonomy further.

/pdf/factors-that-determine-womens-autonomy-to-make-decisions-1sje7s0b.pdf

Factors that determine women’s autonomy to make decisions about sexual and reproductive health and rights in Nepal: A cross-sectional study

Depression which is characterized by hopelessness and loss of interest in social activities is commonduring adolescence However it is often unrecognized and the burden is even more in low incomecountries It also increases the risk of suicide in future Hence in a developing country like Nepalit is important that such cases are detected at the early stage preventing further worsening of thecondition A simple set of questionnaires like Patient Health Questionnaire (PHQ) 9 can be used toscreen for depression Using this questionnaire screening for depression was carried out in adolescentsof Gokarneshwor municipality, ward 4 Four hundred and twenty participants were selected by theprocess of systematic random sampling Based on answers to nine questions score was given andadolescents categorized as having no, mild, moderate or severe depression The PHQ 9 score suggestedthat 131% were suffering from depression, out of which 236% from moderate to severe depressionwhich required psychiatric consultation Out of those shown to have some form of depression 400%said they had thought of self harm in last 2 weeks Late adolescence was significantly associated withdepression Thoughts related to self harm were also six times more in late adolescent age group thanthe early adolescent age group
Keywords : Adolescence, Depression,Gokarneshwor-4

/pdf/screening-for-depression-in-adolescents-in-gokarneshwor-3zopeevwoq.pdf

Screening for Depression in Adolescents in Gokarneshwor Municipality-4, Kathmandu

Diabetes mellitus is a chronic disease that through its complications can seriously impact the quality of life of an individual. The incidence of diabetes mellitus is starting to rise at a younger age. This study is carried out to determine the prevalence of diagnosed diabetes mellitus in productive aged persons and to study the association of socio-demographic characteristics, body mass index (BMI) and blood pressure among persons with and without diabetes mellitus. A community-based cross-sectional, observational study was conducted in Makalbari area. Systematic random sampling technique was used to select the households. The family members from those households who met the inclusion criteria were interviewed with self-constructed semi-structured questionnaire which included socio-demographic information of respondents. Height, weight and blood pressure were recorded. BMI was interpreted as per WHO guidelines and hypertension was defined as per Joint National Committee (JNC) VII guidelines. Among total 662 participants, 342 (51.7%) were female and 320 (48.3%) were male. About 196 (29.6%) of subjects were between 25 to 34 age group followed by 145(21.9%) of them in 35 to 44 age group. Prevalence of diagnosed diabetes mellitus in productive aged persons in urban area was 3.8%. The prevalence of BMI of ≥25 was 42.4%. Out of total subjects, maximum number of respondents were prehypertensive 406 (61.3%). Mean age of total participants was 37.9±13.59 and BMI was 24.15±3.89.The age of respondents was highly statistically significant among the persons with diabetes (p = 0.000). The number of diabetes mellitus increased with increase in age and BMI of the participants. Prevalence of diabetes mellitus was almost same in both male 13 (52.0%) and female 12 (48.0%). Diabetes mellitus was seen more in subjects who had completed secondary level education 11 (44.0%) and in homemakers and government job holders, 3 (33.3%) each. In conclusion, most of the people in productive age groups were preobese and were in prehypertensive stage which may increase the risk of acquiring diabetes mellitus in future. This necessitates the screening of more persons in productive age group for diabetes mellitus. Department of Community Medicine, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneshwor-8, Kathmandu, Nepal Corresponding author Dr Bharati Shakya, Lecturer Department of Community Medicine, Nepal Medical College Teaching Hospital, Attarkhel, Gokarneswor-8, Kathmandu, Nepal, Email: shakyabharati@hotmail.com Orcid ID: http://orcid.org/0000-0001-7834-168X DOI: https://doi.org/10.3126/nmcj.v22i3.32653

Niraj Shrestha

Papers

Statistical Modeling of Health Effects on Climate-Sensitive Variables and Assessment of Environmental Burden of Diseases Attributable to Climate Change in Nepal

Region-wise Effects of Climate Sensitive Variables on Some Specific Disease Burdens in Nepal

Factors that determine women’s autonomy to make decisions about sexual and reproductive health and rights in Nepal: A cross-sectional study

Screening for Depression in Adolescents in Gokarneshwor Municipality-4, Kathmandu

An Epidemiological Study of Diabetes Mellitus in Productive Aged Urban Nepalese of Makalbari Area of Gokarneshwor Municipality