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1. Translation, Cultural Adaptation and Validation of the Medication Adherence Report Scale (MARS-5) in Nepalese Cancer Patients Experiencing Pain

Author

Shrestha S, Sapkota S, Paudyal V, Moon Z, Horne R, and Gan SH

Subjects
cancer pain, cultural adaptation, mars-5, medication adherence, nepalese patients, validation, Medicine (General), R5-920
Abstract

Sunil Shrestha,1 Simit Sapkota,2,3 Vibhu Paudyal,4,5 Zoe Moon,6 Rob Horne,6 Siew Hua Gan1 1School of Pharmacy, Monash University Malaysia, Bandar Sunway, Subang Jaya, Selangor, Malaysia; 2Department of Clinical Oncology, Kathmandu Cancer Center, Tathali, Bhaktapur, Bagmati Province, Nepal; 3Department of Clinical Oncology, Civil Service Hospital, Minbhawan, Kathmandu, Bagmati Province, Nepal; 4Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College, London, UK; 5School of Pharmacy, College of Medical and Dental Sciences, Sir Robert Aitken Institute for Medical Research, University of Birmingham Edgbaston, Birmingham, UK; 6Centre for Behavioural Medicine, Research Department of Practice and Policy, UCL School of Pharmacy, University College London, London, UKCorrespondence: Sunil Shrestha, Email sunilcresta@gmail.comBackground: Adherence to pain medication is crucial for cancer patients, since non-adherence can lead to increased suffering, reduced quality of life and increased healthcare costs. Although the five‐item Medication Adherence Report Scale (MARS-5) is a validated tool for assessing medication adherence, but it has not been translated and validated into the Nepalese language. This study aimed to translate, culturally adapt and validate the MARS-5 in Nepalese language for Nepalese cancer patients who were experiencing pain.Materials and Methods: The cross-sectional validation study utilized a convenience sampling method. Initially, a pre-test was conducted with 25 patients. The MARS-5 was then forward and backward translated following the EORTC QLG translation procedure. The final translated version was reviewed by experts and subjected to a second pre-test. Construct validity was assessed through principal component analysis, and internal consistency was measured using Cronbach’s alpha coefficient. Inter-rater reliability was evaluated using the Intra-Class Correlation coefficient (ICC).Results: The study included 204 cancer patients (ages 18– 86, 55% female). The Nepalese version of the MARS-5 was translated without significant issues and underwent pre-testing with participants. Participants discussed the scale during these pre-tests, providing feedback on its clarity and comprehensibility. While formal assessment tools were not employed, the iterative nature of the pre-testing process allowed for the refinement of the translation based on participant feedback, indicating a robust understanding of the scale among participants. The ICC of test-retest reliability was found to be 0.860. The Kaiser Meyer Olkin’s value was 0.690, and Cronbach’s alpha was 0.72, indicating good construct validity and high internal consistency. The medication non-adherence rate was 11.3%.Conclusion: The MARS-5 was successfully translated, culturally adapted, and validated in Nepalese for use among Nepalese cancer patients experiencing pain. The Nepalese version of MARS-5 is a reliable tool for evaluating medication adherence in this population.Keywords: cancer pain, cultural adaptation, MARS-5, medication adherence, Nepalese patients, validation

Published
2024

2. What is “Opioid Stewardship”? An Overview of Current Definitions and Proposal for a Universally Acceptable Definition

Author

Shrestha S, Khatiwada AP, Sapkota B, Sapkota S, Poudel P, KC B, Teoh SL, Blebil AQ, and Paudyal V

Subjects
opioid, opioid stewardship, opioid stewardship definition, stewardship, Medicine (General), R5-920
Abstract

Sunil Shrestha,1 Asmita Priyadarshini Khatiwada,2 Binaya Sapkota,3 Simit Sapkota,4,5 Prabhat Poudel,6 Bhuvan KC,7,8 Siew Li Teoh,1 Ali Qais Blebil,1 Vibhu Paudyal9 1School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor, 47500, Malaysia; 2Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA; 3Department of Pharmaceutical Sciences, Nobel College, Kathmandu, Nepal; 4Department of Clinical Oncology, Civil Service Hospital, Minbhawan, Kathmandu, Bagmati Province, Nepal; 5Department of Clinical Oncology, Kathmandu Cancer Center, Tathali, Bagmati Province, Nepal; 6Nepal Medical College Hospital, Kathmandu, Province Bagmati, Nepal; 7College of Public Health, Medical & Veterinary Sciences, James Cook University, Townsville, QLD, Australia; 8Faculty of Pharmacy and Pharmaceutical Sciences Monash University Parkville Campus Parkville, Melbourne, VIC 3052, Australia; 9School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UKCorrespondence: Sunil Shrestha; Vibhu Paudyal, Tel +60 102874113, Email Sunil.shrestha@monash.edu; sunilcresta@gmail.com; v.paudyal@bham.ac.ukIntroduction: Opioid stewardship has been widely used to promote rational use, monitoring and discontinuation of opioid therapy; however, its definition and scope of practice remain unclear.Objective: To synthesize definitions of opioid stewardship proposed by clinical practice guidelines and professional societies, and to offer a proposal for a universally acceptable definition.Methods: Systematic literature searches were performed (earliest records to May 2022) in six databases (MEDLINE, EMBASE, APA PsycINFO, Scopus, and CENTRAL) and grey sources guidelines development bodies and professional societies through Google. The conventional but widely applied content analysis and word frequencies were used to analyze the definitions and scope of practice.Results: After removing duplicates, 449 articles were retrieved (439 databases and registers and 11 from other sources), 19 of which included a definition of “opioids stewardship”. A total of 12 themes was identified in the definitions, including 1) improvement or appropriateness of prescribing opioids use, 2) mitigation of risk from opioids, 3) monitoring opioid use, 4) evaluation of opioid use, 5) judicious opioid use, 6) appropriateness of opioid disposal, 7) identification and treatment of opioid use disorder, 8) reduction in mortality associated with opioid overdoses, 9) appropriate procurement practices, 10) appropriate storage, 11) promoting better communications between patients and prescribers including education provision and 12) patient-centered decision-making.Conclusion: Opioid stewardship is inconsistently defined across professional and research literature. While there is a greater focus on appropriateness and need for improvement of prescribing and monitoring of opioid use, the importance of communications between patients and prescribers, and patient involvement in both prescribing and deprescribing decision-making remains sparse. A comprehensive definition has been proposed as part of the work. There is a need to develop and validate the proposed definition and scope of practice to promote rationale for opioid prescribing, use and attainment of favourable outcomes through international consensus involving practitioners, researchers, and patients.Keywords: opioid, opioid stewardship, opioid stewardship definition, stewardship

Published
2023

3. Nepalese patients’ perceptions of treatment modalities for type 2 diabetes

Author

Sapkota S, Brien JE, and Aslani P

Subjects
Perceptions, Treatment, Medications, Type 2 diabetes, Australia, Nepal., Medicine (General), R5-920
Abstract

Sujata Sapkota, Jo-anne E Brien, Parisa Aslani Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia Background: Perceptions and beliefs about treatment can influence patients’ adherence to treatment regimens. Perceptions, in turn, are often shaped by patients’ sociocultural context. Nepal and the Nepalese have unique sociocultural traditions and beliefs, and their perceptions of diabetes treatment remain largely unexplored. This study explored Nepalese participants’ perceptions of diabetes treatment, and whether perceptions differed between the Nepalese living in Australia and Nepal. Methods: Face-to-face qualitative interviews (n=48) were conducted with Nepalese participants with type 2 diabetes in Sydney and Kathmandu. All interviews were audio-recorded, transcribed verbatim, and thematically analyzed. Results: Perceptions of diabetes treatment were similar among Nepalese participants in Australia and Nepal. There was a general reluctance to start oral antidiabetic medications and an even greater reluctance to commence parenteral (insulin) therapy. Participants preferred to try lifestyle modifications and alternative treatments such as herbs and “traditional” medicines, particularly as a first step. Unwillingness to take medications was primarily associated with the belief that, once started, these medications needed to be taken for life, and perceptions of long-term harms caused by such medications. Even when commenced on medication, participants were averse to any type of therapy escalation, for example, moving to insulin therapy. Insulin was perceived as the “last option” available for diabetes treatment. Most participants, however, did not find medication taking challenging once they had commenced treatment. Conclusion: Antidiabetic medications were perceived to be harmful and unstoppable once initiated. These perceptions significantly impacted participants’ willingness to commence antidiabetic medications and therefore have the potential to adversely affect their medication-taking behavior. This study therefore highlights the need to explore the impact of these perceptions on participants’ medication-taking behavior, and the need to address patients’ views of “modern” (commonly prescribed) and “traditional” (natural) medications through information and education, to ensure increased understanding of how medications are used for diabetes management. Keywords: adherence, antidiabetic medications, qualitative study, Nepal, Australia

Published
2016

10. Body appreciation around the world: Measurement invariance of the Body Appreciation Scale-2 (BAS-2) across 65 nations, 40 languages, gender identities, and age

Author

Swami, V., Tran, U. S., Stieger, S., Aavik, T., Ranjbar, H. A., Adebayo, S. O., Afhami, R., Ahmed, O., Aimé, A., Akel, M., Halbusi, H. A., Alexias, G., Ali, K. F., Alp-Dal, N., Alsalhani, A. B., Álvares-Solas, S., Amaral, A. C. S., Andrianto, S., Aspden, T., Argyrides, M., Aruta, J. J. B. R., Atkin, S., Ayandele, O., Baceviciene, M., Bahbouh, R., Ballesio, A., Barron, D., Bellard, A., Bender, S. S., Beydağ, K. D., Birovljević, G., Blackburn, M. È, Borja-Alvarez, T., Borowiec, J., Bozogáňová, M., Bratland-Sanda, S., Browning, M. H. E. M., Brytek-Matera, A., Burakova, M., Çakır-Koçak, Y., Camacho, P., Camilleri, V. E., Cazzato, V., Cerea, S., Chaiwutikornwanich, A., Chaleeraktrakoon, T., Chambers, T., Chen, Q. W., Chen, X., Chien, C. L., Chobthamkit, P., Choompunuch, B., Compte, E. J., Corrigan, J., Cosmas, G., Cowden, R. G., Czepczor-Bernat, K., Czub, M., da Silva, W. R., Dadfar, M., Dalley, S. E., Dany, L., Datu, J. A. D., Berbert de Carvalho, P. H., Coelho, G. L. D. H., De Jesus, A. O. S., Debbabi, S. H., Dhakal, S., Di Bernardo, F., Dimitrova, D. D., Dion, J., Dixson, B., Donofrio, S. M., Drysch, M., Du, H., Dzhambov, A. M., El-Jor, C., Enea, V., Eskin, M., Farbod, F., Farrugia, L., Fian, L., Fisher, M. L., Folwarczny, M., Frederick, D. A., Fuller-Tyszkiewicz, M., Furnham, A., García, A. A., Geller, S., Ghisi, M., Ghorbani, A., Martinez, M. A. G., Gradidge, S., Graf, S., Grano, C., Gyene, G., Hallit, S., Hamdan, M., Handelzalts, J. E., Hanel, P. H. P., Hawks, S. R., Hekmati, I., Helmy, M., Hill, T., Hina, F., Holenweger, G., Hřebíčková, M., Ijabadeniyi, O. A., Imam, A., İnce, B., Irrazabal, N., Jankauskiene, R., Jiang, D. Y., Jiménez-Borja, M., Jiménez-Borja, V., Johnson, E. M., Jovanović, V., Jović, M., Junqueira, A. C. P., Kahle, L. M., Kantanista, A., Karakiraz, A., Karkin, A. N., Kasten, E., Khatib, S., Khieowan, N., Kimong, P. J., Kiropoulos, L., Knittel, J., Kohli, N., Koprivnik, M., Kospakov, A., Król-Zielińska, M., Krug, I., Kuan, G., Kueh, Y. C., Kujan, O., Kukić, M., Kumar, S., Kumar, V., Lamba, N., Lauri, M. A., Laus, M. F., LeBlanc, L. A., Lee, H. J., Lipowska, M., Lipowski, M., Lombardo, C., Lukács, A., Maïano, C., Malik, S., Manjary, M., Baldó, L. M., Martinez-Banfi, M., Massar, K., Matera, C., McAnirlin, O., Mebarak, M. R., Mechri, A., Meireles, J. F. F., Mesko, N., Mills, J., Miyairi, M., Modi, R., Modrzejewska, A., Modrzejewska, J., Mulgrew, K. E., Myers, T. A., Namatame, H., Nassani, M. Z., Nerini, A., Neto, F., Neto, J., Neves, A. N., Ng, S. K., Nithiya, D., O, J., Obeid, S., Oda-Montecinos, C., Olapegba, P. O., Olonisakin, T. T., Omar, S. S., Örlygsdóttir, B., Özsoy, E., Otterbring, T., Pahl, S., Panasiti, M. S., Park, Y., Patwary, M. M., Pethö, T., Petrova, N., Pietschnig, J., Pourmahmoud, S., Prabhu, V. G., Poštuvan, V., Prokop, P., Ramseyer Winter, V. L., Razmus, M., Ru, T., Rupar, M., Sahlan, R. N., Hassan, M. S., Šalov, A., Sapkota, S., Sarfo, J. O., Sawamiya, Y., Schaefer, K., Schulte-Mecklenbeck, M., Seekis, V., Selvi, K., Sharifi, M., Shrivastava, A., Siddique, R. F., Sigurdsson, V., Silkane, V., Šimunić, A., Singh, G., Slezáčková, A., Sundgot-Borgen, C., Ten Hoor, G., Tevichapong, P., Tipandjan, A., Todd, J., Togas, C., Tonini, F., Tovar-Castro, J. C., Trangsrud, L. K. J., Tripathi, P., Tudorel, O., Tylka, T. L., Uyzbayeva, A., Vally, Z., Vanags, E., Vega, L. D., Vicente-Arruebarrena, A., Vidal-Mollón, J., Vilar, R., Villegas, H., Vintilă, M., Wallner, C., White, M. P., Whitebridge, S., Windhager, S., Wong, K. Y., Yau, E. K., Yamamiya, Y., Yeung, V. W. L., Zanetti, M. C., Zawisza, M., Zeeni, N., Zvaríková, M., Voracek, M., Swami, V., Tran, U. S., Stieger, S., Aavik, T., Ranjbar, H. A., Adebayo, S. O., Afhami, R., Ahmed, O., Aimé, A., Akel, M., Halbusi, H. A., Alexias, G., Ali, K. F., Alp-Dal, N., Alsalhani, A. B., Álvares-Solas, S., Amaral, A. C. S., Andrianto, S., Aspden, T., Argyrides, M., Aruta, J. J. B. R., Atkin, S., Ayandele, O., Baceviciene, M., Bahbouh, R., Ballesio, A., Barron, D., Bellard, A., Bender, S. S., Beydağ, K. D., Birovljević, G., Blackburn, M. È, Borja-Alvarez, T., Borowiec, J., Bozogáňová, M., Bratland-Sanda, S., Browning, M. H. E. M., Brytek-Matera, A., Burakova, M., Çakır-Koçak, Y., Camacho, P., Camilleri, V. E., Cazzato, V., Cerea, S., Chaiwutikornwanich, A., Chaleeraktrakoon, T., Chambers, T., Chen, Q. W., Chen, X., Chien, C. L., Chobthamkit, P., Choompunuch, B., Compte, E. J., Corrigan, J., Cosmas, G., Cowden, R. G., Czepczor-Bernat, K., Czub, M., da Silva, W. R., Dadfar, M., Dalley, S. E., Dany, L., Datu, J. A. D., Berbert de Carvalho, P. H., Coelho, G. L. D. H., De Jesus, A. O. S., Debbabi, S. H., Dhakal, S., Di Bernardo, F., Dimitrova, D. D., Dion, J., Dixson, B., Donofrio, S. M., Drysch, M., Du, H., Dzhambov, A. M., El-Jor, C., Enea, V., Eskin, M., Farbod, F., Farrugia, L., Fian, L., Fisher, M. L., Folwarczny, M., Frederick, D. A., Fuller-Tyszkiewicz, M., Furnham, A., García, A. A., Geller, S., Ghisi, M., Ghorbani, A., Martinez, M. A. G., Gradidge, S., Graf, S., Grano, C., Gyene, G., Hallit, S., Hamdan, M., Handelzalts, J. E., Hanel, P. H. P., Hawks, S. R., Hekmati, I., Helmy, M., Hill, T., Hina, F., Holenweger, G., Hřebíčková, M., Ijabadeniyi, O. A., Imam, A., İnce, B., Irrazabal, N., Jankauskiene, R., Jiang, D. Y., Jiménez-Borja, M., Jiménez-Borja, V., Johnson, E. M., Jovanović, V., Jović, M., Junqueira, A. C. P., Kahle, L. M., Kantanista, A., Karakiraz, A., Karkin, A. N., Kasten, E., Khatib, S., Khieowan, N., Kimong, P. J., Kiropoulos, L., Knittel, J., Kohli, N., Koprivnik, M., Kospakov, A., Król-Zielińska, M., Krug, I., Kuan, G., Kueh, Y. C., Kujan, O., Kukić, M., Kumar, S., Kumar, V., Lamba, N., Lauri, M. A., Laus, M. F., LeBlanc, L. A., Lee, H. J., Lipowska, M., Lipowski, M., Lombardo, C., Lukács, A., Maïano, C., Malik, S., Manjary, M., Baldó, L. M., Martinez-Banfi, M., Massar, K., Matera, C., McAnirlin, O., Mebarak, M. R., Mechri, A., Meireles, J. F. F., Mesko, N., Mills, J., Miyairi, M., Modi, R., Modrzejewska, A., Modrzejewska, J., Mulgrew, K. E., Myers, T. A., Namatame, H., Nassani, M. Z., Nerini, A., Neto, F., Neto, J., Neves, A. N., Ng, S. K., Nithiya, D., O, J., Obeid, S., Oda-Montecinos, C., Olapegba, P. O., Olonisakin, T. T., Omar, S. S., Örlygsdóttir, B., Özsoy, E., Otterbring, T., Pahl, S., Panasiti, M. S., Park, Y., Patwary, M. M., Pethö, T., Petrova, N., Pietschnig, J., Pourmahmoud, S., Prabhu, V. G., Poštuvan, V., Prokop, P., Ramseyer Winter, V. L., Razmus, M., Ru, T., Rupar, M., Sahlan, R. N., Hassan, M. S., Šalov, A., Sapkota, S., Sarfo, J. O., Sawamiya, Y., Schaefer, K., Schulte-Mecklenbeck, M., Seekis, V., Selvi, K., Sharifi, M., Shrivastava, A., Siddique, R. F., Sigurdsson, V., Silkane, V., Šimunić, A., Singh, G., Slezáčková, A., Sundgot-Borgen, C., Ten Hoor, G., Tevichapong, P., Tipandjan, A., Todd, J., Togas, C., Tonini, F., Tovar-Castro, J. C., Trangsrud, L. K. J., Tripathi, P., Tudorel, O., Tylka, T. L., Uyzbayeva, A., Vally, Z., Vanags, E., Vega, L. D., Vicente-Arruebarrena, A., Vidal-Mollón, J., Vilar, R., Villegas, H., Vintilă, M., Wallner, C., White, M. P., Whitebridge, S., Windhager, S., Wong, K. Y., Yau, E. K., Yamamiya, Y., Yeung, V. W. L., Zanetti, M. C., Zawisza, M., Zeeni, N., Zvaríková, M., and Voracek, M.

Abstract

The Body Appreciation Scale-2 (BAS-2) is a widely used measure of a core facet of the positive body image construct. However, extant research concerning measurement invariance of the BAS-2 across a large number of nations remains limited. Here, we utilised the Body Image in Nature (BINS) dataset – with data collected between 2020 and 2022 – to assess measurement invariance of the BAS-2 across 65 nations, 40 languages, gender identities, and age groups. Multi-group confirmatory factor analysis indicated that full scalar invariance was upheld across all nations, languages, gender identities, and age groups, suggesting that the unidimensional BAS-2 model has widespread applicability. There were large differences across nations and languages in latent body appreciation, while differences across gender identities and age groups were negligible-to-small. Additionally, greater body appreciation was significantly associated with higher life satisfaction, being single (versus being married or in a committed relationship), and greater rurality (versus urbanicity). Across a subset of nations where nation-level data were available, greater body appreciation was also significantly associated with greater cultural distance from the United States and greater relative income inequality. These findings suggest that the BAS-2 likely captures a near-universal conceptualisation of the body appreciation construct, which should facilitate further cross-cultural research.

Published
2023

13. Slip pulse and resonance of the Kathmandu basin during the 2015 Gorkha earthquake, Nepal

Author

Galetzka, J., Melgar, D., Genrich, J. F., Geng, J., Owen, S., Lindsey, E. O., Xu, X., Bock, Y., Avouac, J.-P., Adhikari, L. B., Upreti, B. N., Pratt-Sitaula, B., Bhattarai, T. N., Sitaula, B. P., Moore, A., Hudnut, K. W., Szeliga, W., Normandeau, J., Fend, M., Flouzat, M., Bollinger, L., Shrestha, P., Koirala, B., Gautam, U., Bhatterai, M., Gupta, R., Kandel, T., Timsina, C., Sapkota, S. N., Rajaure, S., and Maharjan, N.

Published
2015

18. Light Reflection Analysis of PV Modules: Comparison to Building Facdes and Assessing the Possibility of Glare

Author

Moereke, J., Borowski, P., Grünsteidl, S., Palm, J., Sapkota, S., and Dalibor, T.

Subjects
PV and Buildings, PV Systems Engineering, Integrated/Applied PV
Abstract

8th World Conference on Photovoltaic Energy Conversion; 1050-1056, Light reflection measurements have been performed on several PV modules as well as a range of passive façade materials. The measurements have been performed in specular direction according to DIN EN ISO 2813 and resulted in the confirmation of very matt appearance for special façade PV modules compared to commonly used building façades. BRDF analysis of these façade PV modules further showed the absence of a specular reflection peak compared to glossy samples and established maximum reflection to occur at reflection angles above 80° to the normal of the module and in-plane with light incidence. Luminance estimations suggest that levels of absolute glare are only reached with both maximum Sun irradiation as experienced on Earth and geometries of maximum reflection. Since these geometries and irradiances occur for an observer of a south-facing façade BIPV installation only in the morning and evening hours, the risk of glare from the analysed façade PV modules is considered negligible.

Published
2022
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22. NATURAL HAZARDS: Slip pulse and resonance of the Kathmandu basin during the 2015 Gorkha earthquake, Nepal

Author

Galetzka, J., Melgar, D., Genrich, J. F., Geng, J., Owen, S., Lindsey, E. O., Xu, X., Bock, Y., Avouac, J.-P., Adhikari, L. B., Upreti, B. N., Pratt-Sitaula, B., Bhattarai, T. N., Sitaula, B. P., Moore, A., Hudnut, K. W., Szeliga, W., Normandeau, J., Fend, M., Flouzat, M., Bollinger, L., Shrestha, P., Koirala, B., Gautam, U., Bhatterai, M., Gupta, R., Kandel, T., Timsina, C., Sapkota, S. N., Rajaure, S., and Maharjan, N.

Published
2015
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24. Indigenous knowledge, optimum recipe and storage stability of khurma, a cereal based traditional Nepalese product

Author

Sapkota S, Subedi A, Katuwal N, and Kc Y

Subjects
Computer science, Recipe, Stability (learning theory), Product (category theory), Traditional knowledge, Manufacturing engineering
Abstract

Khurma is a cereal based food indigenous to hilly regions of Nepal. It is a deep fried flour confection prepared by mixing wheat flour, rice flour, semolina, ghee, sugar, spices mixture, milk and water. Despite its popularity, the scientific documentation and researches in khurma is scarce. Moreover, quality of khurma is often subject to variation due to differences in recipe and the data on storage stability is unavailable. Therefore, in this study recipe of the product was optimized using sensory analysis and the optimized product was analysed for physicochemical parameters and storage stability. Proximate analysis showed that optimized khurma had 2.48 ± 0.12%, 36.87 ± 0.34%, 9.51 ± 0.47%, 0.48 ± 0.03%, 0.06 ± 0.01% and 50.60 ± 0.82% of moisture, fat, protein, total ash, crude fiber and carbohydrates respectively. Moreover, product was more stable in laminated packaging material compared to polyethene (PE) package. The results showed that khurma can be served and promoted as an energy dense snack.

Published
2021

28. COVID-19 pandemic in Nepal: Emerging evidence on the effectiveness of action by, and cooperation between, different levels of government in a federal system

Author

Adhikary, P., Balen, J., Gautam, S., Ghimire, S., Karki, J.K., Lee, A., Marahatta, S.B., Panday, S., Pohl, G., Rushton, S., Sapkota, S., Simkhada, P., Subedi, M., and van Teijlingen, E.

Abstract

A new coronavirus disease (COVID-19) caused by a novel pathogen (SARS-CoV-2) spread rapidly around the world in the early months of 2020, and was declared a pandemic by the World Health Organization (WHO) on 11 March. COVID-19 has, and continues to have, large implications for individuals, societies, and for national health systems across the globe. Due to its novelty and impact, it has challenged all health care systems where the virus has taken hold.\ud \ud \ud The ways in which governments and health systems have responded have varied widely across the world. In the case of Nepal, the pandemic represented a major test for the newly decentralised health system, created as a result of the implementation of the 2015 federal constitution. This paper, which forms a part of our large on-going study of the decentralisation of the health system in the country, presents some of the early evidence on the effectiveness of the actions taken by Federal, Provincial and Local Governments and the levels of cooperation and coordination between them.

Published
2021

29. Health System Capacity and Access Barriers to Diagnosis and Treatment of CVD and Diabetes in Nepal

Author

Sharma, A, Kaplan, WA, Satheesh, G, Poudyal, IP, Gyawali, P, Neupane, D, Bhandari, PM, Malla, M, Sapkota, S, Mishra, SR, Sharma, A, Kaplan, WA, Satheesh, G, Poudyal, IP, Gyawali, P, Neupane, D, Bhandari, PM, Malla, M, Sapkota, S, and Mishra, SR

Abstract

BACKGROUND: Universal access to essential medicines and routine diagnostics is required to combat the growing burden of cardiovascular disease (CVD) and diabetes. Evaluating health systems and various access dimensions availability, affordability, accessibility, acceptability, and quality is crucial yet rarely performed, especially in low- and middle-income countries. OBJECTIVE: To evaluate health system capacity and barriers in accessing diagnostics and essential medicines for CVD and diabetes in Nepal. METHODS: We conducted a WHO/HAI nationally-representative survey in 45 health-facilities (public-sector: 11; private-sector: 34) in Nepal to collect availability and price data for 21 essential medicines for treating CVD and diabetes, during MayJuly 2017. Data for 13 routine diagnostics was obtained in 12 health facilities. Medicines were considered unaffordable if the lowest paid worker spends >1 days wage to purchase a monthly supply. To evaluate accessibility, we conducted facility exit interviews among 636 CVD patients. Accessibility (e.g., private-public health facility mix, travel to hospital/pharmacy) and acceptability (i.e. Nepals adoption of WHO Essential Medicine List, and patient medication adherence) were summarized using descriptive statistics, and we conducted a systematic review of relevant literature. We did not evaluate medicine quality. RESULTS: We found that mean availability of generic medicines is low (<50%) in both public and private sectors, and less than one-third medicines met WHOs availability target (80%). Mean (SD) availability of diagnostics was 73.1% (26.8%). Essential medicines appear locally unaffordable. On average, the lowest-paid worker would spend 1.03 (public-sector) and 1.26 (private-sector) days wages to purchase a monthly supply. For a person undergoing CVD secondary preventive-interventions in the private sector, the associated expenditure would be 7.511.2% of monthly household income. Exit-interviews suggest that a long/expe

Published
2021

31. The COVID-19 pandemic in Nepal: Emerging evidence on the effectiveness of action by, and cooperation between, different levels of government in a federal system

Author

Adhikary, P., Balen, J., Gautam, S., Ghimire, S., Karki, J., Lee, A., Marahatta, S. B., Panday, S., Pohl, G., Rushton, S., Sapkota, S., Simkhada, P., Subedi, M., van Teijlingen, Edwin, and Nepal Federal Health System Team

Abstract

A new coronavirus disease (COVID-19) caused by a novel pathogen (SARS-CoV-2) spread rapidly around the world in the early months of 2020, and was declared a pandemic by the World Health Organization (WHO) on 11 March. COVID-19 has, and continues to have, large implications for individuals, societies, and for national health systems across the globe. Due to its novelty and impact, it has challenged all health care systems where the virus has taken hold. The ways in which governments and health systems have responded have varied widely across the world. In the case of Nepal, the pandemic represented a major test for the newly decentralised health system, created as a result of the implementation of the 2015 federal constitution. This paper, which forms a part of our large on-going study of the decentralisation of the health system in the country, presents some of the early evidence on the effectiveness of the actions taken by Federal, Provincial and Local Governments and the levels of cooperation and coordination between them.

Published
2020

32. Peripheral Oxidative Stress Markers Are Related To Vascular Risk Factors And Subcortical Small Vessel Disease

Author

Warrick, N., Seitz, D., Prorok, J., Shawcross, D., Mahootchi, T., Esensoy, A., Yu, D., Danieli, E., Pushpakumar, D., Tony, J., Jacob, K., Dong, J., Javed, F., D’Souza, A., Mollayeva, T., Colantonio, A., Schulz, M., Burhan, A., Naidu, A. Srinivasan, Sarquis-Adamson, Y., Montero-Odasso, M., Cooper, N., Sekhon, H., Launay, C., Allali, G., Chabot, J., Beauchet, O., Watson, B., Lin, T., Korczak, A., Bartha, C., Best, S., Truemner, J., Borrie, M., Cammer, A., Whiting, S., Morgan, D., Newman, K., Duong, J. A., Mok, A., Wang, A. H., Lavoie, M., Bier, N., Macoir, J., Adlimoghaddam, A., Turner, R. S., Cadonic, C., Albensi, B. C., Davis, J., Lewis, V.-L., Pacione, J., Skanes, C., Feltz, N., Loncar, A., Naglie, G., Sanford, S., Stasiulis, E., Rapoport, M., Vrkljan, B., Tuokko, H., Porter, M., Polgar, J., Moorhouse, P., Mazer, B., Marshall, S., Gelinas, I, Crizzle, A, Belchior, P., Bedard, M, Kokorelias, K., Cameron, J., Gignac, M., Bechard, L., Beaton, D., McGilton, K.A., Tartaglia, M. C., Black, S., Mirza, S., Mutsaerts, H.-J., Cash, D., Bocchetta, M., Thomas, D., Dick, K., van Swieten, J., Borroni, B., Galimberti, D., Rowe, J., Bethell, J., Pringle, D., Commisso, E., Chambers, L., Cohen, C., Cowan, K., Fehr, P., Szeto, P., McGilton, K., Shaw, C., Okamura, H., Otani, M., Shimoyama, N., Fujii, T., Lusk, J., Punzalan, M., Dove, E., Cotnam, K., Astell, A., Chow, A. Froehlich, Bayly, M., Kosteniuk, J., Elliot, V., O’Connell, M. E., Kirk, A., Stewart, N., Holroyd-Leduc, J., Daku, J., Kennett-Russill, D., Hack, T., Dilara, A., Astell, A. J., Hernandez, A., Divine, A., Hunter, S., Jacova, C., Alexander, C., Joseph, J. T., Alvarez, A., Smith, E., Woo, S. M. S., Chan, P., Wilkins-Ho, M., Blackburn, P., Fernando, N., Mehra, A., Vasser, E., Musacchio, M., Waxman, R., Fischler, I., Ghaffar, O., DeBay, D. R., Macdonald, I. R., Reid, G. A., Pottie, I. R., Maxwell, S. P., Cash, M. K., Martin, E., Bowen, C. V., Darvesh, S., MacPhee, J., Jorgensen, M., Fogarty, J., Phillips, N., Diprospero, C., Parent, A., Whitehead, V., Campbell, T., Mohades, Z., Chertkow, H., Wong, S., Wilchesky, M., McCusker, J., Champoux, N., Vu, T.T. M., Ciampi, A., Monette, J., Lungu, O., Ballard, S. A., Belzile, E., Carmichael, P.-H., Voyer, P., Cetin-Sahin, D., Gore, B., Peretti, M., Gore, G., Landry, V., Yetman, L., MacDonald, E., McGibbon, C., MacNeil, D., Jarrett, P., Iaboni, A., Andrews, J., Hafezi, S., Marshall, C., Tsokas, M., Martin, L. Schindel, Van Ooteghem, K., Mansfield, A., Marcil, M., Gold, D., Musselman, K., Flint, A., Finger, E., Feldman, H., Cummings, J., Coleman, K., Boxer, A., Berry, S., Hsiung, R., Curtis, A., Zhang, K., Davidson, H. R., Boccone, G., Camicioli, R., Masellis, M., Tierney, M., Dolatabadi, E., Taati, B., Jonas-Simpson, C., Donovan, L., Cross, N., Keren, R., Shan, R., Holley, J., Waisman, Z., Katchaluba, J., Wimhurst, C., Steele, M., Loganathan, P., Gural, P., Shearer, T., Reardon, J., Pilgrim, J., Pitawanakwat, K., Jones, L., Piriano, E., Blind, M., Otowadjiwan, J., Makela, R., Spicer, B., Bretzlaff, M., Jacklin, K., McKay, Kristy, Graham, N., Tang-Wai, D., Leonard, C., Mitchell, S., Laird, L., Rochon, E., Maclagan, L., Maxwell, C., Guan, J., Campitelli, M., Herrmann, N., Lapane, K., Hogan, D., Amuah, J., Gill, S., Bronskill, S., Ebert, P., Kwok, J., Watt, A., Garrett, S., Hoefling, L., Ellery, C., Leggieri, M., Fornazzari, L., Thaut, M., Munoz, D., Barfett, J., Fischer, C., Schweizer, T., Yogaparan, T., Dallaire-Théroux, C., Potvin, O., Dieumegarde, L., Duchesne, Simon, Amini, A.E. Ebrahim, Amini, A.Z. Ebrahim, Dao, E., Barha, C. K., Best, J. R., Hsiung, G.-Y. R., Tam, R., Liu-Ambrose, T., Sztramko, R., Wurster, A., Papaiouannou, A., Cowan, D., St. Onge, J., Allaby, C., Harrison, L., Cimino, C., Marr, S., Patterson, C., Woo, T., Levinson, A., Fisher, S., Mojaverian, N., Hsu, A., Taljaard, M., Manuel, D., Tanuseputro, P., Park, E., Liu, L., VanderPloeg, K., Black, A., Bartha, R., Rabin, J., Yang, H.-S., Schultz, A., Hanseeuw, B., Marshall, G., Hedden, T., Rentz, D., Johnson, K., Sperling, R., Chhatwal, J., Desmarais, P., Miville, C., Keith, J., Lanctôt, K., Thomas, N., Mattek, N., Riley, T., Witter, P., Reynolds, C., Austin, J., Sharma, N., Kaye, J., Bechard, L. E., Mitchell, C. M., Regan, K., Bergelt, M. D., Middleton, L.E., Hewston, P., Kennedy, C., Merom, D., Trainor, L., Grenier, A., Ioannidis, G., Lee, J., Papaioannou, A., Qian, W., Churchill, N., Kumar, S., Rajji, T., Ojeda-López, C., Milán-Tomás, Á., Lam, B., Gao, F. Q., Cumberbatch, S., Gies, S., Tomas, A. Milan, Ojeda-Lopez, C., Lim, A. S., Black, S. E., Sharma, M. J., Ramirez, J., Holmes, M. F., Gao, F., Varatharajah, B., Yhap, V., Appel, L., Bogler, O., Appel, E., Wiseman, M., Cohen, L., Hill, D., Abrams, H., Campos, J., Sapkota, S., Adamo, S., Stuss, D. T., Martinez, M., Multani, N., Anor, C. J., Fox, S., Lang, A. E., Marras, C., Compagnone, J., Li, J., Freedman, M., Kleiner-Fisman, G., Kennedy, J., Chen, R., Lang, A., Sévigny-Dupont, P., Bocti, C., Joannette, M., Lavallée, M. M., Joubert, S., Knoefel, F., Goubran, R., Baker, A., Fraser, S., Allard, B., Wallace, B., Stroulia, E., Guana, V., Masson, P., Alli, S., Kolla, N., De Luca, V., Bouvier, L., Monetta, L., Vitali, P., Laforce, R., Martel-Sauvageau, V., Talebzadeh, A., Ashourinia, K., Moy, S., Lake, A., Cockburn, A., Krisman, D., Sadasivan, B., Sit, W., Stoops, S., McCurbin, S., Cullen, S., Carroll, S., Tasmim, S., Kapoor, E., Callahan, B., Sharma, M., Bierstone, D., Stuss, D., Kapadia, M., Mian, F., Ma, D., Rosa, E., Michalski, B., Zovkic, I., Forsythe, P., Sakic, B., Fahnestock, M., Baxter, J., Peloso, S., Tung, J., Cox, L., Benjamin, S., An, H., Ho, J., Turcotte, V., Parent, C., Gauthier-Beaupré, A., Biss, R., Sultana, A., Chu, C. H., Sun, W., Bartfay, E., Smye, V., Newton, D., Pepin, M., Biswas, S., Madahey, H., Crawford, S. J., Gutmanis, I., Blake, C., Duchesne, S., Hudon, C., Mah, L., Ali, A., Shorey, C., Szabuniewicz, C. M., Anderson, N. D., Verhoeff, N. P. L. G., Cheers, S., Penko, M., Gevaert, V., Yang, Y., Law, J., Modarresi, S., Grahn, J., Overend, T., Amini, D., Thiruparanathan, T., Cheung, T., Iskandar, S., Arone, Y., Young, C., Berezuk, C., and Zakzanis, K.

Subjects
Abstracts
Published
2018

37. Thermal structure and exhumation history of the Lesser Himalaya in central Nepal

Author

Bollinger, L., Avouac, J.P., Beyssac, O., Catlos, E.J., Harrison, T.M., Grove, M., Goffe, B., and Sapkota, S.

Subjects
Geology, Structural, Tectonics (Geology), Earth sciences
Abstract

[1] The Lesser Himalaya (LH) consists of metasedimentary rocks that have been scrapped off from the underthrusting Indian crust and accreted to the mountain range over the last ~20 Myr. It now forms a significant fraction of the Himalayan collisional orogen. We document the kinematics and thermal metamorphism associated with the deformation and exhumation of the LH, combining thermometric and thermochronological methods with structural geology. Peak metamorphic temperatures estimated from Raman spectroscopy of carbonaceous material decrease gradually from 520[degrees]-550[degrees]C below the Main Central Thrust zone down to less than 330[degrees]C. These temperatures describe structurally a 20[degrees]50[degrees]C/km inverted apparent gradient. The Ar muscovite ages from LH samples and from the overlying crystalline thrust sheets all indicate the same regular trend; i.e., an increase from about 34 Manear the front of the high range to about 20 Ma near the leading edge of the thrust sheets, about 80 km to the south. This suggests that the LH has been exhumed jointly with the overlying nappes as a result of overthrusting by about 5 mm/yr. For a convergence rate of about 20 mm/yr, this implies underthrusting of the Indian basement below the Himalaya by about 15 mm/yr. The structure, metamorphic grade and exhumation history of the LH supports the view that, since the mid-Miocene, the Himalayan orogen has essentially grown by underplating, rather than by frontal accretion. This process has resulted from duplexing at a depth close to the brittle-ductile transition zone, by southward migration of a midcrustal ramp along the Main Himalayan Thrust fault, and is estimated to have resulted in a net flux of up to 150 [m.sup.2]/yr of LH rocks into the Himalayan orogenic wedge. The steep inverse thermal gradient across the LH is interpreted to have resulted from a combination of underplating and post metamorphic shearing of the underplated units. INDEX TERMS: 8102 Tectonophysics: Continental contractional orogenic belts; 8122 Tectonophysics: Dynamics, gravity and tectonics; 9320 Information Related to Geographic Region: Asia; KEYWORDS: Himalaya, thermal structure, underplating, duplex, metamorphism, thermochronology. Citation: Bollinger, L., J. P. Avouac, O. Beyssac, E. J. Catlos, T. M. Harrison, M. Grove, B. Goffe, and S. Sapkota (2004), Thermal structure and exhumation history of the Lesser Himalaya in central Nepal.

Published
2004

46. Atrazine and Mesotrione-Induced Oxidative Stress and Impact on Antioxidant Enzymes and Chlorophyll Contents in Bermudagrass

Author

WANG, Y., YU, J., ZHOU, B., SAPKOTA, S., WEI, F., and WANG, Z.

Subjects
reactive oxygen species, antioxidant, carotenoides, espécies reativas de oxigênio, herbicide, antioxidante, carotenoids, herbicida
Abstract

The effect of atrazine, mesotrione, and joint activity of atrazine plus mesotrione on pigment, lipid peroxidation, and antioxidant enzyme activity was studied. Atrazine and mesotrione treatments significantly reduced chlorophyll a (Chl a), chlorophyll b (Chl b), carotenoid concentrations, and protein content in bermudagrass (Cynodon dactylon L.) plants, whereas they significantly enhanced lipid peroxidation. The treatment of atrazine plus mesotrione caused greater phototoxic effect on bermudagrass than either herbicide alone, which was evident from the significantly decreased membrane stability noted as a function of the enhanced singlet oxygen and malondialdehyde (MDA) contents, as well as from the greater reduction in Chl a, Chl b, and carotenoid contents. Although bermudagrass activated the antioxidant enzymes catalase (CAT), peroxidase (POD), and glutathione S-transferase (GST), it was significantly injured after the herbicide treatments. Thus, results suggested that the enzymatic and non-enzymatic antioxidants of bermudagrass was overloaded after the treatment of atrazine plus mesotrione, and the reactive oxygen species (ROS) subsequently caused lipid peroxidation, pigment and protein degradation, as well as other cellular constituent damage. RESUMO: O efeito de atrazina e mesotrione e da atividade conjunta de atrazina mais mesotrione no pigmento, n a peroxidação lipídica e na atividade da enzima antioxidante foi estudado. Os tratamentos com atrazina e mesotrione reduziram significativamente as concentrações de clorofila a (Clf a), de clorofila b (Clf b), de carotenoides e o teor de proteína em plantas de grama-seda (Cynodon dactylon L.), mas aumentaram significativamente a peroxidação lipídica. O tratamento com atrazina mais mesotrione causou maior efeito fitotóxico na grama-seda do que o herbicida isolado, o que foi evidenciado pela diminuição significativa da estabilidade da membrana em função dos teores de oxigênio singlete e malondialdeído (MDA), bem como pela maior redução dos teores de Clf a, Clf b e carotenoides. Embora a grama-seda ativasse as enzimas antioxidantes catalase (CAT), peroxidase (POD) e glutationa S-transferase (GST), ela foi significativamente danificada após os tratamentos com herbicidas. Assim, os resultados sugerem que os antioxidantes enzimáticos e não enzimáticos da grama-seda foram sobrecarregados após o tratamento com atrazina mais mesotrione, e as espécies reativas de oxigênio (ERO) causaram peroxidação lipídica, degradação de pigmentos e proteínas, além de outros danos a constituintes celulares.

Published
2018

48. May Measurement Month 2017: an analysis of blood pressure screening results in Nepal-South Asia

Author

Mishra, SR, Shrestha, N, Poudyal, IP, Malla, M, Gyawali, B, Shrestha, AD, Pokharel, S, Gyawali, M, Sapkota, S, Bhattarai, H, Dhakal, L, Soti, PB, Ghimire, S, Paudel, R, Xia, X, Beaney, T, Koirala, S, Olsen, MH, Poulter, NR, Kallestrup, P, Neupane, D, Mishra, SR, Shrestha, N, Poudyal, IP, Malla, M, Gyawali, B, Shrestha, AD, Pokharel, S, Gyawali, M, Sapkota, S, Bhattarai, H, Dhakal, L, Soti, PB, Ghimire, S, Paudel, R, Xia, X, Beaney, T, Koirala, S, Olsen, MH, Poulter, NR, Kallestrup, P, and Neupane, D

Abstract

Hypertension is the leading risk factor of mortality in Nepal accounting for ∼33 000 deaths in 2016. However, more than 50% of the hypertensive patients are unaware of their status. We participated in the May Measurement Month 2017 (MMM17) project initiated worldwide by the International Society of Hypertension to raise the awareness on the importance of blood pressure (BP) screening. In this paper, we discuss the screening results of MMM17 in Nepal. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May 2017 following the standard MMM protocol. Data were collected from 18 screening sites in 7 districts covering 5 provinces. Screenings were conducted either in health facilities, public places, or participants' homes. Trained volunteers with health science background and female community health volunteers were mobilized to take part in the screening. A total of 5972 individuals were screened and of 5968 participants, for whom a mean of the 2nd and 3rd readings was available, 1456 (24.4%) participants had hypertension; 908 (16.8%) of those not receiving treatment were hypertensive; and 248 (45.2%) of those being treated had uncontrolled BP. MMM17 is the first nationwide BP screening campaign undertaken in Nepal. Given the suboptimal treatment and control rates identified in the study, there is a strong imperative to scale up hypertension prevention, screening, and management programmes. These results suggest that opportunistic screening can identify significant numbers with hypertension. Mobilization of existing volunteer networks and support of community stakeholders, would be necessary to improve the overall impact and sustainability of future screening programmes.

Published
2019

49. Medical abortion in Nepal: a qualitative study on women's experiences at safe abortion services and pharmacies.

Author

Rogers, C, Sapkota, S, Paudel, R, Dantas, JAR, Rogers, C, Sapkota, S, Paudel, R, and Dantas, JAR

Abstract

BACKGROUND: Although Nepal legalised abortion in 2002, a significant number of women continue to access unsafe abortions. An estimated 60% of all abortions performed in 2014 were unsafe, with unsafe abortion continuing to be a leading contributor to maternal mortality. Despite medical abortion access being solely permitted through government accredited safe abortion services, medical abortion pills are readily available for illegal purchase at pharmacies throughout the country. METHODS: Utilising an Assets Focused Rapid Participatory Appraisal (AFRPA) research methodology, underpinned by a health information pyramid conceptual framework, this qualitative exploratory study collected data from in-depth, open-ended interviews. The study explored the medical abortion and sexual and reproductive health experiences of ten women who accessed medical abortion through an accredited safe abortion service, and ten women who accessed unsafe medical abortion through pharmacies. RESULTS: Thematic content analysis revealed emerging themes relating to decision-making processes in accessing safe or unsafe medical abortion; knowledge of safe abortion services; and SRH information access and post-abortion contraceptive counselling. Findings emphasised the interconnectivity of sexual and reproductive health and rights; reproductive coercion; education; poverty; spousal separation; and women's personal, social and economic empowerment. CONCLUSIONS: While barriers to safe abortion services persist, so will the continued demand for medical abortion provision through pharmacies. Innovated and effective harm reduction implementations combined with access and information expansion strategies offer the potential to increase access to safe medical abortion while decreasing adverse health outcomes for women.

Published
2019

50. Abortion in Nepal: perspectives of a cross-section of sexual and reproductive health and rights professionals.

Author

Rogers, C, Sapkota, S, Tako, A, Dantas, JAR, Rogers, C, Sapkota, S, Tako, A, and Dantas, JAR

Abstract

BACKGROUND: Globally, women face many barriers in the attainment of sexual and reproductive health and rights (SRHR). Since 2002, the legalisation of abortion in Nepal has seen significant progress in the expansion of safe abortion and family planning services. METHODS: This qualitative, exploratory study was conducted in 2014 and uses nine in-depth, open-ended interviews with a cross-section of SRHR professionals, to explore their perspectives on abortion in Nepal. The study was underpinned by the Assets Focused Rapid Participatory Appraisal (AFRPA) research methodology and used the health information pyramid conceptual framework. RESULTS: Thematic content analysis revealed emerging themes relating to barriers to access and uptake of skilled safe abortion services and post-abortion family planning. Findings also emphasised current practical and legal components relating to the provision of medical abortion through pharmacies and highlighted issues of sex-selective abortion within the predominantly patriarchal society. CONCLUSION: Effective and ongoing sector-wide monitoring and evaluation of safe abortion services and their staff is essential for women in Nepal to have adequate access to effective and efficient safe abortion services, access to contraception and sexual and reproductive health (SRH) information post-abortion and to ensure adherence to current Safe Abortion Policy. It is critical that the unsafe (less and least safe) provision of medical abortion through pharmacies and sex-selective abortion continues to be investigated and that innovative strategies are formulated to ensure the cultural, reproductive and sexual health and rights of Nepali women are realised.

Published
2019

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