The role of family support in the self-rated health of older adults in eastern Nepal: findings from a cross-sectional study.

BACKGROUND: Nepal's low fertility rate and increasing life expectancy have resulted in a burgeoning older population. For millennia, filial piety shaped family cohesion and helped Nepali older adults achieve positive outcomes, but recently, it has been eroding. Furthermore, there are not enough institutional support options or alternatives to family-based care to deal with the biosocial needs of older adults. This study explored the association between family support and self-rated health among Nepali older adults. METHODS: A community-based cross-sectional survey in eastern Nepal's two districts, Sunsari and Morang, interviewed 847 older adults (≥ 60 years). The final analytical sample was 844. Participants were asked whether they received assistance with various aspects of daily life and activities of daily living from their families. Multivariable logistic regression examined the association between family support and self-rated health. RESULTS: Participants who received support with various aspects of daily life had 43% higher odds of good health, but after adjusting for control variables, the result only approached statistical significance (p = 0.087). Those who received family assistance with activities of daily living had nearly four times higher odds (OR: 3.93; 95% CI: 2.58 - 5.98) of reporting good health than participants who lacked this support. CONCLUSIONS: Given the important role of family support in Nepali older adults' health, government programs and policies should create a conducive environment to foster family-based care until more comprehensive policies for older adults' care can be put into effect. The results of this study can also help shape the global aging environment by highlighting the need for family support in older care, particularly in low-income nations with declining traditional care systems and weak social security policies.

Neighborhood environment and quality of life of older adults in eastern Nepal: findings from a cross-sectional study.

INTRODUCTION: Quality of life (QoL) is a subjective measure reflecting individuals' evaluations based on their personal goals and values. While global research shows the role of neighborhood factors like ethnic diversity and socio-cultural dynamics on QoL, these are unexplored in the Nepali context. Therefore, this study examined the relationship between neighborhood environment and QoL among Nepali older adults in eastern Nepal. METHODS: This cross-sectional study involved 847 non-institutionalized older adults (aged ≥ 60 years) from two districts in eastern Nepal. QoL was evaluated using the 13-item brief Older People's Quality of Life questionnaire, where a mean score of < 3 indicated low/poor QoL. The neighborhood environment, conceptualized across three domains (demographic, socio-cultural, and built environment), included ethnic diversity, connections with family, friends, and neighbors, cultural ties, residential stability, and rurality. Their association with QoL was examined using multivariable logistic regression. RESULTS: Around 20% of older adults reported poor QoL. Higher ethnic diversity (adjusted Odds Ratio [aOR] = 0.12, 95% confidence interval [CI]: 0.04-0.36), moderate contact with family and relatives (aOR = 0.26, CI: 0.11-0.61), and high contact with neighbors (aOR = 0.09, CI: 0.03-0.21) were associated with lower odds of poor QoL. Conversely, high contact with friends (aOR = 2.29, CI: 1.30-4.04) and unstable residence (OR = 6.25, CI: 2.03-19.23) increased the odds of poor QoL. Additionally, among the covariates, chronic disease, tobacco use, unemployment, and lack of education were also significantly associated with poor QoL. CONCLUSION: Overall, the demographic environment, socio-cultural factors, and the built environment of the neighborhood influence QoL. Therefore, diversifying the neighborhood's ethnic composition, promoting social connections such as frequent contact with family, relatives, and neighbors, and ensuring residential stability can enhance the QoL of older adults.

Estimation of greenhouse gases emission from domestic wastewater in Nepal: A scenario-based analysis applicable for developing countries.

Domestic wastewater and wastewater treatment plants (WWTPs) are key emitters of greenhouse gases (GHGs). Quantifying these emissions in the present and future is crucial to tackle global climate change issues. As a developing country with few rural and urban wastewater treatment facilities, Nepal may have a unique opportunity to reduce future GHGs emissions by a proper selection of wastewater treatment technology. In this paper, the authors used Python programming to estimate the GHGs emissions from the domestic wastewater sector in Nepal under various technological development scenarios for 2020 to 2040 using the refined 2019 estimation methodology developed by Inter-governmental Panel on Climate Change (IPCC). Results show total equivalent CO2 emission of 3829.43 and 4523.65 Gigagrams in 2020 and 2040, respectively. The 2020 value is seven times greater than Nepal's 2017 national estimates because this study considered rural population and updated methodology. Comparing the technology development scenarios with the Business as Usual scenario, the highest GHGs reduction could be achieved by hybrid constructed wetlands (69.20%) followed by a combined anaerobic and aerobic system with biogas recovery for energy generation (61.72%). Further accuracy may be attained only through the actual measurement of WWTPs emissions and country-specific emission factors. Thus, this paper proposes GHGs estimation of future scenarios portraying urban and rural populations may be invaluable to policymakers of GHGs mitigation for selection of feasible WWTPs, especially in developing countries with limited wastewater treatment facilities and wastewater activity data.

Older adults with pre-existing noncommunicable conditions and their healthcare access amid COVID-19 pandemic: a cross-sectional study in eastern Nepal.

BACKGROUND: COVID-19 has greatly impacted older adults with pre-existing noncommunicable conditions (hereafter called pre-existing conditions) in terms of their access to essential healthcare services. Based on the theory of vertical health equity, this study investigated access to healthcare by Nepali older adults with pre-existing conditions during the COVID-19 pandemic. METHODS: A cross-sectional study surveyed 847 randomly selected older adults (≥60 years) in three districts of eastern Nepal. Survey questionnaires, administered by trained community health workers, collected information on participants reported difficulty obtaining routine care and medications during the pandemic, in addition to questions on demographics, socioeconomic factors and pre-existing conditions. Cumulative scores for pre-existing conditions were recoded as no pre-existing condition, single condition and multimorbidity for the analyses. χ2 tests and binary logistic regressions determined inferences. RESULTS: Nearly two-thirds of the participants had a pre-existing condition (43.8% single condition and 22.8% multimorbid) and reported experiencing difficulty obtaining routine care (52.8%) and medications (13.5%). Participants with single (OR 3.06, 95% CI 2.17 to 4.32) and multimorbid (OR 5.62, 95% CI 3.63 to 8.71) conditions had threefold and fivefold increased odds of experiencing difficulty accessing routine care. Findings were similar for difficulty obtaining medication (OR single: 3.12, 95% CI 1.71 to 5.69; OR multimorbid: 3.98, 95% CI 2.01 to 7.87) where odds were greater than threefolds. CONCLUSIONS: Older adults with pre-existing conditions in Nepal, who require routine medical care and medication, faced significant difficulties obtaining them during the pandemic, which may lead to deterioration in their pre-existing conditions. Public health emergency preparedness should incorporate plans for both managing the emergency and providing continuing care.

Lightweight cylindrical composite shell structures to support optical instruments in extremely large telescopes: A case study.

Aiming at the issues of heavy weight and insufficient structural performance of optical instrument supporting structures in extremely large telescopes, the Wide-Field Optical Spectrograph (WFOS) of the Thirty Meter Telescope (TMT) was taken as a case to study. In order to develop lightweight structures which satisfies the design requirements for mass and stiffness, a design scheme of cylindrical composite shells supporting structure was proposed and their finite element models were developed. A size optimisation and a ply sequence optimisation of the composite structure were carried out. The structures before and after optimisation were evaluated from the aspects of mass, displacement, failure index and fundamental frequency. After the optimised design, the mass of the optimised WFOS cylindrical composite shell structure is reduced to approximately 50%, but its maximum displacement (0.513 mm) and fundamental frequency (8.275 Hz) are nearly unchanged. The study indicates that a cylindrical composite shell structure is an efficient structural form for large optical instruments.

Improvised cost-effective halo vest brace using a recycled Ilizarov ring and a threaded rod.

We designed less expensive halo vest brace using an Ilizarov ring and a threaded rod, which is as effective as the normal halo vest. It can be used in any orthopedic set-up.