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Background: Injury-related mortality and morbidity, a leading cause of death and disability worldwide, is common among adolescents. However, there is insufficient information on the status and factors responsible for injury among adolescents in Nepal. Hence, the paper estimates the injury prevalence and identify the factors associated with it among adolescent Nepalese students. Methods: This study used national representative cross-sectional data of the Global School-based Student Health Survey 2015. Complex sample analysis was performed after adjusting the selection probability of each sample participants to identify the correlates of injury among 6529 students of 68 schools in Nepal. Results: Out of 6529 study participants, 62.79% reported severe injury. The most common injury type was cut or stab wound (67.61%) followed by broken bone/dislocated joints (11.03%) and the most common cause of injury was fall (56.40%). Serious injury was significantly associated with a physical attack (AOR=1.54, CI=1.17-2.04), being involved in a physical fight (AOR=1.62, CI=1.2-2.2), being bullied (AOR=2.73, CI=2.25-3.31), feeling unsafe at school (AOR=1.53, CI=1.23-1.91), helmet use(never/rarely/sometimes) while driving a motorbike (AOR=1.69, CI=1.21-2.38) and drink and drive(AOR=2.28, CI=1.05-4.96). Conclusions: This study reported the injury as a significant public health concern in Nepal associated with several factors like physical attack, being involved in a physical fight, being bullied, feeling unsafe at school, helmet use while driving motorbike and drink and drive. The high prevalence of injury in Nepal suggests the application of appropriate prevention strategies. Keywords: Adolescents; injury; Nepal

Background Patients treated with dialysis or living with a kidney transplant (kidney replacement therapy, KRT) have an increased risk of bone fracture. Patients with diabetes also have an increased risk of fracture. The aim of this study was to investigate whether the presence of diabetes in patients on KRT aggravates the risk of fracture. Methods Nationwide Danish registries were used in this retrospective cohort study. All prevalent adult patients on hemodialysis (HD) or peritoneal dialysis (PD) on 1st of January 2000 and all incident patients starting KRT (HD, PD, kidney transplanted (KTX)) until 31st of December 2011 were included in the KRT group. Adult persons not on KRT and without diabetes on 1st of January 2000 were used as a reference group. Patients were separated in groups with and without (+/−) diabetes. They were followed until first fracture, emigration, death, or end-of-study on 31st of December 2016. Results A total of 4,074,085 not on KRT +/− diabetes and 9053 patients on KRT +/− diabetes were included. Comparing the different groups with diabetes to the corresponding group without diabetes, the unadjusted HR (95% CI) for any first fracture were 1.2 (1.0–1.3) in the HD population, 1.4 (1.1–1.7) in the PD population, and 1.7 (1.4–2.2) in the KTX population. Further adjustments for age, sex, prior fractures, comorbidity and medication did not change these results significantly. Conclusions Diabetes increases the risk of fracture in patients on KRT.

Purpose of Review: Both diabetes and kidney disease associate with the development of bone disease and an increased risk of fragility fractures. The etiologies of bone disease in patients with diabetic kidney disease (DKD) are multiple and complex. This review explores the association between DKD and bone disease and discusses how the presence of both diabetes and kidney disease may impair bone quality and increase fracture risk. Diagnostic tools as well as future research areas are also discussed. Recent Findings: Patients with DKD have an increased risk of fragility fracture, most pronounced in patients with type 1 diabetes, and in DKD a high prevalence of adynamic bone disease is found. Recent studies have demonstrated disturbances in the interplay between bone regulating factors in DKD, such as relative hypoparathyroidism and alterations of bone-derived hormones including fibroblast growth factor-23 (FGF-23), sclerostin and klotho, which lead to bone disease. Summary: This review examines the current knowledge on bone disease in patients with DKD, clinical considerations for patient care, as well as subjects for future research.

Background: Unintended pregnancy, unplanned birth and unsafe abortion have been a major challenge to the reproductive health of women worldwide. Despite the availability of highly effective methods of contraception, still many pregnancies are unwanted predisposing them to higher risk of mortality, often due to unsafe abortion. These unwanted pregnancies can be prevented using emergency contraceptive pills. This study aimed to investigate the knowledge, attitude and practice of emergency contraceptive pills and factors hindering its use among females of reproductive age group.Methods: Institution based cross-sectional study was conducted among 416 females of reproductive age group visiting urban heath centre of Rajbiraj, selected by purposive sampling technique. Data was collected using pretested semi-structured questionnaire after written informed consent. Descriptive & inferential statistics were used to analyze the data generated.Results: Out of 416 respondents, 34.6% were aware of emergency contraceptive pills and majority (56.9%) of them got to know it from Media. Among respondents who were aware of ECPs, 64% had good knowledge of it, 90% had positive attitude towards ECPs and 63% have used it earlier. A significant association was found between age, residence, educational level and occupational status with awareness of ECPs. Lack of awareness regarding ECPs has been hindering the usage of ECPs in emergencies to prevent unwanted pregnancies.Conclusions: Awareness and utilization of ECPs is low among females of terai region. Therefore awareness should be raised through formal education and communication by health personnel and through mass media which could provide reliable and accurate knowledge on ECPs.

BackgroundGlobally violence is a matter of public health concern with severe physical and mental health implications and social consequences. Evidence suggest that adolescents have an elevated risk of exposure to physical and sexual violence. However, there is a lack of nationally representative research on violence and its associated factors in Nepal to inform interventions. This paper attempts to find the factors associated with various forms of physical and sexual violence among school-going adolescents in Nepal.MethodsWe analysed the cross-sectional data from the Global School-based Student Health Survey (GSHS) 2015. The GSHS survey applied a two-stage cluster sampling process to select a representative sample of 7 to 11 grade students from 74 schools across the country. We applied logistic regression analysis to identify the factors associated with physical and sexual violence.ResultsOut of the total 6,529 participants, 45.24% of them faced a physical attack, 39.25% were involved in a physical fight, and 11.65% were victims of sexual violence in the survey administered between 7 August 2015 to 14 March 2016. In a multiple regression analysis, the age of participants, parental supervision, feeling unsafe at school, and the number of close friends were found to be associated with a physical attack. Participants who were bullied, had multiple sex partners, and had received corporal punishment in school had a higher engagement in a physical fight. Likewise, school grade, having parents who understand the problems, having multiple sex partners, and corporal punishment at school were associated with instances of sexual violence.ConclusionThe study identified multiple factors associated with experiences of physical attacks, involvement in a physical fight, and sexual violence among school-going adolescents. This study results can have important implications for school administration, parents, and policymakers alike to plan appropriate anti-violence strategies and interventions. Since various forms of violence share some common risk factors, a comprehensive strategy could be worth considering to prevent such acts of violence.

The clinical importance of immunoglobulin A (IgA) deficiency in otherwise healthy individuals is not well described. We aimed to investigate the self-reported mental and physical health and the risk of infection in IgA-deficient blood donors compared to healthy control blood donors. Infectious events, recorded in public health registries either as prescriptions filled of any antimicrobial medicine or as hospital infections, were compared between 177 IgA-deficient blood donors and 1770 control blood donors. A subset of the IgA-deficient donors were further characterized by self-reported health (Short Form-12, n = 28) and circulating C-reactive protein (CRP) (n = 10). IgA-deficient individuals had lower self-reported mental health (p = 0.01) and higher CRP (p < 0.05). A strong trend was found regarding prescription of antimicrobial medicine (hazard ratio = 1.19, p = 0.05). No association was found with hospital infections (hazard ratio = 1.02, p = 0.95) or self-reported physical health (p = 0.86). IgA-deficient blood donors have impaired self-reported mental health, enhanced inflammation and possibly an increased risk of infection. Despite these findings, this study does not provide sufficient evidence to warrant specific health precautions for donors with IgA deficiency.