Dementia care landscape in Nepal: Understanding the context, barriers, and opportunities for the development of a national dementia care plan.

OBJECTIVE: This study was conducted to comprehensively understand the context, barriers, and opportunities for improving dementia care, treatment, and support. The objective is to guide the development of a national dementia care plan. METHODOLOGY: This document review was conducted by analyzing literature available in the public domain, including scientific publications, project documents/reports, media reports, and hospital records. Additionally, annual reports published by the Department of Health Services, national census and demographic and health survey reports, Old Age Homes, and other relevant government reports were examined. Firsthand information was gathered from relevant stakeholders based on the World Health Organization's situational analysis framework for dementia plans. This framework encompasses four domains: Policy context (national ministries, legislation, policies, strategies, plans related to dementia, mental health, aging, and disability), service delivery assessment (health and social care workforces, services, support and treatment programmes, and promotion of awareness and understanding), and epidemiological indicators (prevalence and incidence rates of dementia, risk factors). Ethical clearance was obtained from the Institutional Review Committee (IRC) of B.P. Koirala Institute of Health Sciences (IRC no.2658/023). RESULTS: Existing policies in Nepal inadequately address the needs of people with dementia and their caregivers. Concerning health services, the Government of Nepal provides financial subsidies to individuals diagnosed with dementia; however, numerous hurdles impede access to care. These obstacles include geographical and structural barriers, an inefficient public healthcare system, weak governance, financial constraints, low awareness levels, stigma, and inadequate workforce. Furthermore, the absence of robust nationally representative epidemiological studies on dementia in Nepal hampers the development of evidence-based plans and policies. Similarly, there are no interventions targeted at caregivers of people with dementia, and no initiatives for dementia prevention are in place. CONCLUSIONS: This review underscores the urgent need to formulate a comprehensive national dementia care plan to address the growing challenges. Key priority action areas include the integration of dementia care into primary healthcare services, training workforce to provide the care, increasing awareness, mitigating stigma, developing caregiver support programs, and initiating high-quality research to inform evidence-based policymaking.

Developing a scalable training model in global mental health: pilot study of a video-assisted training Program for Generalist Clinicians in Rural Nepal.

BACKGROUND: In low- and middle-income countries, mental health training often includes sending few generalist clinicians to specialist-led programs for several weeks. Our objective is to develop and test a video-assisted training model addressing the shortcomings of traditional programs that affect scalability: failing to train all clinicians, disrupting clinical services, and depending on specialists. METHODS: We implemented the program -video lectures and on-site skills training- for all clinicians at a rural Nepali hospital. We used Wilcoxon signed-rank tests to evaluate pre- and post-test change in knowledge (diagnostic criteria, differential diagnosis, and appropriate treatment). We used a series of 'Yes' or 'No' questions to assess attitudes about mental illness, and utilized exact McNemar's test to analyze the proportions of participants who held a specific belief before and after the training. We assessed acceptability and feasibility through key informant interviews and structured feedback. RESULTS: For each topic except depression, there was a statistically significant increase (Δ) in median scores on knowledge questionnaires: Acute Stress Reaction (Δ = 20, p = 0.03), Depression (Δ = 11, p = 0.12), Grief (Δ = 40, p < 0.01), Psychosis (Δ = 22, p = 0.01), and post-traumatic stress disorder (Δ = 20, p = 0.01). The training received high ratings; key informants shared examples and views about the training's positive impact and complementary nature of the program's components. CONCLUSION: Video lectures and on-site skills training can address the limitations of a conventional training model while being acceptable, feasible, and impactful toward improving knowledge and attitudes of the participants.

Determining minimum sticking efficiencies of six environmental Escherichia coli isolates.

In health impact assessments, the sticking efficiency of a bacteria or virus population largely determines the transported distance of that biocolloid population, and hence, the potential health impact. However, at the same time, one of the most difficult parameters to estimate is the lower value of the sticking efficiency that should be used in calculating the health impact. In this paper, we introduce the concept of the minimum sticking efficiency (alpha(i)) value of a bacteria population, including a method to determine the minimum sticking efficiency. Thereto, sticking efficiency distributions of 6 environmentally isolated Escherichia coli strains were determined by carrying out laboratory column experiments over a transport distance of about 5m. Experiments were conducted in de-mineralized (DI) water and in artificial groundwater (AGW). Sticking efficiencies were calculated for column segments (at varying distances from top of column) and fractions of total bacteria mass input in each segment were estimated by mass balance. The sticking efficiencies were highest close to the top of the column, near the point of bacteria mass input (0.103-0.352 in DI, and 1.034-9.470 for AGW) and reduced with distance with the lowest alpha(i) values (10(-5)-0.06 in DI and 0.006-0.283 in AGW) determined at the two most distant column segments (between 2.33 and 4.83 m from the top of the column). Power-law distributions best described the relationship between fraction of cells retained, F(i), and alpha(i). The minimum sticking efficiency was defined as the sticking efficiency belonging to a retained bacteria fraction of 0.001% of the original bacteria mass (total number of cells) flowing into the column (F=10(-5)), and coinciding with a 99.999% reduction of the original bacteria mass, and minimum sticking efficiencies were extrapolated from the fitted power-law distributions. In the DI experiments, minimum sticking efficiency values ranged from as low as 10(-9) (for E. coli strain UCFL-94) to 10(-2) (for E. coli strain UCFL-348); in the AGW experiments, minimum sticking efficiency values ranged from 10(-6) (for strain UCFL-94) to > or =1(for strain UCFL-348). We concluded that in quantifying health impacts of biocolloids traveling in aquifers, the concept of the minimum sticking efficiencies, and the percentage of individual biocolloids of a total population having such low sticking efficiency, together with an inactivation rate coefficient, can serve as a useful tool to determine the maximum transported distance as a worst case scenario, and, hence, the potential health impact.

Evaluation of Ochrobactrum anthropi TRS-2 and its talc based formulation for enhancement of growth of tea plants and management of brown root rot disease.

AIM: To evaluate Ochrobactrum anthropi TRS-2 isolated from tea rhizosphere and its talc based formulation for growth promotion and management of brown root rot disease of tea. METHODS AND RESULTS: Ochrobactrum anthropi TRS-2, isolated from tea rhizosphere could solubilize phosphate, produce siderophore and IAA in vitro and also exhibited antifungal activity against six test pathogens. Application of an aqueous suspension of O. anthropi to the rhizosphere of nursery grown tea seedlings of five varieties of tea (TV-18, T-17, HV-39, S-449, UP-3 and) led to enhanced growth of the treated plants, as evidenced by increase in height, in the number of shoots and number of leaves per shoot. Treatment with O. anthropi also decreased brown root rot of tea, caused by Phellinus noxius. Multifold increase in activities of chitinase, beta-1,3-glucanase, peroxidase and phenylalanine ammonia lyase in tea plants was observed on application of O. anthropi to soil followed by inoculation with P. noxius. A concomitant increase in accumulation of phenolics was also obtained. Further, talc based formulation of O. anthropi was prepared and its survival determined every month up to a period of 12 months. Ochrobactrum anthropi could survive in the formulation up to a period of 9 months with a concentration of 7.0 log(10) CFU g(-1), after which there was a decline. Talc formulation was as effective as aqueous suspensions in both plant growth promotion and disease suppression. CONCLUSION: Ochrobactrum anthropi, either in aqueous suspension or as talc formulation induced growth of tea plants and suppressed brown root rot disease. It induced defense responses in tea plants. SIGNIFICANCE AND IMPACT OF THE STUDY: Ochrobactrum anthropi and its talc based formulation can be considered as an addition to available plant growth promoting rhizobacteria (PGPR) currently being used for field application. The present study offers a scope of utilizing this bacterium for growth promotion and disease management which would help in reduction of the use of chemicals in tea plantations.

The effect of surface characteristics on the transport of multiple Escherichia coli isolates in large scale columns of quartz sand.

Bacteria properties play an important role in the transport of bacteria in groundwater, but their role, especially for longer transport distances (>0.5 m) has not been studied. Thereto, we studied the effects of cell surface hydrophobicity, outer surface potential (OSP), cell sphericity, motility, and Ag43 protein expression on the outer cell surface for a number of E. coli strains, obtained from the environment on their transport behavior in columns of saturated quartz sand of 5 m height in two solutions: demineralized (DI) water and artificial groundwater (AGW). In DI water, sticking efficiencies ranged between 0.1 and 0.4 at the column inlet, and then decreased with transport distance to 0.02-0.2. In AGW, sticking efficiencies were on average 1log-unit higher than those in DI (water). Bacteria motility and Ag43 expression affected attachment with a (high) statistical significance. In contrast, hydrophobicity, OSP and cell sphericity did not significantly correlate with sticking efficiency. However, for transport distances more than 0.33 m, the correlation between sticking efficiency, Ag43 expression, and motility became insignificant. We concluded that Ag43 and motility played an important role in E. coli attachment to quartz grain surfaces, and that the transport distance dependent sticking efficiency reductions were caused by motility and Ag43 expression variations within a population. The implication of our findings is that less motile bacteria with little or no Ag43 expression may travel longer distances once they enter groundwater environments. In future studies, the possible effect of bacteria surface structures, like fimbriae, pili and surface proteins on bacteria attachment need to be considered more systematically in order to arrive at more meaningful inter-population comparisons of the transport behavior of E. coli strains in aquifers.