Engaging rural communities to incorporate social determinants in developing strategies to improve access to health care in the Missouri Bootheel counties.

INTRODUCTION: The purpose of the study was to engage community members and practice partners across multiple sectors in a participatory strategy development process to identify social and organizational determinants of accessing health care, collectively prioritize identified issues, and develop strategies for change. METHODS: Using concept mapping, a mixed-methods approach, a collaborative team of academics, practice partners, and community health workers collected data from community members and agency representatives (n=366) across four counties through facilitated community forums and an online survey in four counties in the Bootheel region of Missouri, USA. These responses were consolidated into a set of statements that were used with a smaller group of participants (n=60, 15 per county) for sorting and rating purposes. The resulting concept maps were presented to community participants, who were guided through a structured process for prioritization of issues and strategy development. RESULTS: Participants identified several individual-, social-, community-, and organization-level barriers to accessing health care, including cost, lack of transportation, lack of information about services, lack of coordinated care, lack of trust, and racism and classism in local healthcare systems. CONCLUSION: While the key social and organizational determinants of access to health care were similar across counties, the prioritization of these determinants and the strategies developed to address key issues differed across the counties.

Assessment of nicotine dependence among tobacco users visiting outreach programs in Dharan, Nepal: a cross-sectional study.

BACKGROUND: Nicotine is a highly addictive substance present in tobacco. This study was conducted to assess the level of nicotine dependence among smokers and smokeless tobacco users visiting dental outreach programs of B.P. Koirala Institute of Health Sciences -Dharan, Nepal. METHODS: A cross sectional study was conducted from June 2018 to April 2019. A total of 726 people were selected from participants of dental outreach programs of 6 districts using convenience sampling technique. The data collection was done using semi-structured questionnaire through face-to-face interview by a single researcher. History of tobacco use and level of nicotine dependency was measured using Nepali translated and validated form of Fagerström Test for Nicotine Dependence for smoking and smokeless tobacco. The mean age of the tobacco users was 39.55 ± 15.57. Descriptive statistics including the mean, median, percentage, standard deviations and interquartile range were computed. Chi-square test, Fisher's exact test, univariate and bivariate logistic regression were used where needed. RESULTS: Nicotine dependence (moderate and severe) was found in 80% of smokeless tobacco users and 48% of smokers. Among the smokeless tobacco users, nicotine dependency was found to be more with increase in duration of tobacco use (AOR = 50.25, 95%CI = 3.51-718.62, p = 0.004), low socioeconomic status (AOR = 6.27, 95%CI = 1.30-30.31, p = 0.02), less number of tobacco packets used per day and tried to quit tobacco use in last 1 year. Among smokers nicotine dependency was found to be significantly higher with smoking more than 10 cigarettes per day (AOR = 7.14, 95% CI = 2.00-25.40, p = 0.002). CONCLUSIONS: The study concluded that level of nicotine dependence for both smoking and smokeless tobacco was high among the people visiting dental outreach programs. It is high time to develop a policy to control tobacco use along with creating tobacco cessation centers. Currently, tobacco control program is mostly focusing on smoking. However, it is also important to incorporate smokeless tobacco control at policy level.

Methodology development for calibration assessment using quasi-deep convective clouds with application to Aqua MODIS TEB.

Deep convective clouds (DCC) are identified by using a combination of brightness temperature (BT) and visible reflectance thresholds. Moreover, it is common practice to use daytime DCC measurements for the calibration assessment of reflective solar and longwave infrared (LWIR) bands. The DCC cold core is suitable for the MODIS Thermal Emissive Bands (TEB) calibration assessment; more specifically, for the offset effect in the quadratic calibration function. However, the reflected solar radiance in the daytime DCC measurements affects the midwave infrared (MWIR) bands. Thus, an assessment over low BT measurements is not applicable to these bands. Because of this, a quasi-DCC (qDCC) technique is developed for the MWIR bands calibration assessment. The feasibility of using nighttime DCC measurements is demonstrated by comparing the DCC and daytime qDCC techniques. A DCC normalization method is also developed to remove the DCC fluctuation impact and enhance the assessment accuracy. The DCC measurements' distribution is asymmetrical for all TEB, and their BT ranges fluctuate around 20 K. An empirical model is developed and applied to normalize the measurements over DCC to a reference temperature. After the normalization, the DCC and qDCC measurements' distributions are close to symmetrical and Gaussian in shape. These improvements are applied to the Aqua MODIS instrument. The calibration stability, noise performance, and consistency are evaluated for all Aqua MODIS TEB. Lastly, the Aqua MODIS formatter reset effect on the calibration offset bias between two mirror sides is analyzed, and a calibration coefficient correction is proposed for future calibration improvements.

Prevalence of Dental Fear among 6-15 Years Old School Children.

INTRODUCTION: Odontophobia or dental fear is a "unique phobia with special psychosomatic components that impact on the dental health of the odontophobia persons". It is well documented that dental fear has a significant impact on dental care utilization behaviors. The objective of this study was to find out the level of dental fear among school children studying in government schools of Dharan, Nepal. METHODS: A descriptive cross-sectional study was conducted from March to August 2017 among 215 school going children of Dharan of age group 6 to 15 years. Ethical approval was obtained. Children studying in six different government schools of Dharan were selected using two stage cluster sampling method. The Children's Fear Survey Schedule-Dental Subscale was used to measure dental fear among the study group. Data were entered in Microsoft Excel Sheet 2007 and analyzed in Statistical Package of Social Sciences 11.5. RESULTS: This study showed that among the total study population, 96 (44.7%) had high fear, 62 (28.8%) had moderate fear and 57 (26.5%) had low dental fear. Among males, 29 (34.5%) had high fear whereas more than half of the female respondents had high fear. CONCLUSIONS: The present study showed that most of the school going children had high fear of dental treatment. So, school health programs should be planned to make the children familiar to dentistry and proper treatment modalities should be provided to make the child comfortable to seek dental care.

Barriers in the access, diagnosis and treatment completion for tuberculosis patients in central and western Nepal: A qualitative study among patients, community members and health care workers.

BACKGROUND: Nepal has achieved a significant reduction of TB incidence over the past decades. Nevertheless, TB patients continue to experience barriers in access, diagnosis and completion of the treatment. The main objective of this study was to explore the factors affecting the access to the health services, diagnosis and the treatment completion for TB patients in central and western Nepal. METHODS: Data were collected using in-depth interviews (IDI) with the TB patients (n = 4); Focus Group Discussions (FGDs) with TB suspected patients (n = 16); Semi Strucutred Interviews (SSIs) with health workers (n = 24) and traditional healers (n = 2); and FGDs with community members (n = 8). All data were audio recorded, transcribed and translated to English. All transcriptions underwent thematic analysis using qualitative data analysis software: Atlas.ti. RESULTS: Barriers to access to the health centre were the long distance, poor road conditions, and costs associated with travelling. In addition, lack of awareness of TB and its consequences, and the belief, prompted many respondents to visit traditional healers. Early diagnosis of TB was hindered by lack of trained health personnel to use the equipment, lack of equipment and irregular presence of health workers. Additional barriers that impeded the adherence and treatment completion were the need to visit health centre daily for DOTS treatment and associated constraints, complex treatment regimen, and the stigma. CONCLUSIONS: Barriers embedded in health services and care seekers' characteristics can be dealt by strengthening the peripheral health services. A continuous availability of (trained) human resources and equipment for diagnosis is critical. As well as increasing the awareness and collaborating with the traditional healers, health services utilization can be enhanced by compensating the costs associated with it, including the modification in current DOTS strategy by providing medicine for a longer term under the supervision of a family member, peer or a community volunteer.

Risk Assessment of Smokeless Tobacco among Oral Precancer and Cancer Patients in Eastern Developmental Region of Nepal

Background: Oral potentially malignant disorders (OPMDs) and oral cancer (OC) are preventable oral mucosal diseases prevalent in Asian region. This epidemiological study aims to identify oral potentially malignant disorders (OPMDs) and oral cancer (OC), confirm histopathologically, and treat or refer these cases among the population of Eastern Development Region (EDR) of Nepal. It also attempts to assess the risk factors associated in order to compare dose­response measurements of oral habits in these patients. Methods: Cross-sectional epidemiological study was conducted over a period of 2 years in 16 districts of EDR. A total of 3,200 people were screened. A brief history was taken and visual screening examination was conducted in two phases as described by British Columbia Oral Cancer Prevention Program. Suspicious oral lesions were biopsied either by punch or scalpel after toluidine blue staining. Tissue specimen was transported to the institutional lab for histopathological processing. The reports were sent to the patients through the local leaders or organizations. Results: More than 40% of the study population either chewed areca nut and/or tobacco. Eighteen percent were smokers. OPMDs were prevalent among 468 study population with male-female ratio of 3:1. Tobacco pouch keratosis (50.4%) was the most prevalent OPMD, followed by OSF (29.1%). Fifty-two had squamous cell carcinoma and 8 had verrucous carcinoma. Conclusion: Chewing areca nut, tobacco, commercial areca nut/tobacco preparation and smoking being the major risk factors, there is high prevalence of oral cancer and OPMDs in the EDR of Nepal.

Translation and validation of the Nepalese version of the Geriatric Oral Health Assessment Index.

OBJECTIVE: To translate and validate the Geriatric Oral Health Assessment Index (GOHAI) (Nepali version) from original English version. BACKGROUND: Growing numbers of elderly people have problems in different aspects of oral health increasing the demand for dental care services among them GOHAI may be one of the effective means of gathering information on oral health problems of the elderly people. MATERIALS AND METHODS: A total of 168 individuals ≥60 years from seven old-age homes located in Eastern Nepal were included in the study. The Nepali version of GOHAI was translated and validated. RESULTS: A total of 168 elderly people (79 male and 89 female participants) completed GOHAI questionnaire. The mean age (±SD) of the participants was 72.49 (±10.00) years. The mean GOHAI score (±SD) was 42.29 (±6.93) and ranged from 17 to 59. Cronbach's alpha coefficient for the Nepali version of GOHAI (GOHAI-N) was 0.74, which is categorised as very good agreement. Analysis of discriminant validity showed that lower mean GOHAI score was seen in study participants with more number of missing and decayed teeth. However, those who had more than one filled surface had higher mean GOHAI score. CONCLUSION: The Nepali version of the GOHAI exhibited acceptable reliability and validity when used for older people residing in old age homes. The GOHAI-N showed good consistency and homogeneity among the items.

Effectiveness of a Mass Media Campaign on Oral Carcinogens and Their Effects on the Oral Cavity

Objective: To develop a mass media campaign on oral carcinogens and their effects on the oral cavity in order to increase awareness among the general population. Methods: Documentary and public service announcements highlighting the effects of tobacco and its products were designed and developed based on principles of behavior change. A questionnaire, designed to determine the knowledge, attitude and practice of people regarding oral carcinogens, was used to conduct a baseline survey at various sites in eastern Nepal. Local television channels and radio stations broadcasted the documentary and public service announcements. An evaluation survey was then performed to assess the effectiveness of the campaign. Results: Baseline and evaluation surveys covered 1,972 and 2,140 individuals, respectively. A third of the baseline population consumed quid, 22% chewing tobacco, 16% gutka (commercial preparation of arecanut, tobacco, lime and chemicals) and 25% cigarettes. Tobacco consumption differed significantly between 3 ecologic regions with greater use in the Terai region. The knowledge prevalence regarding the oral carcinogens quid (70%), chewing tobacco (82%), gutka (58%) and cigarettes (93%) significantly increased in the evaluation population. Females were more aware about the various tobacco products and their effects on health. More people knew about the harmful effects of tobacco on their health and oral cavity, and had their mouth examined and the frequency of consumption of these products reduced significantly after the campaign. Attitudes towards production, sale and advertisements of tobacco also improved significantly. Conclusions: The mass media campaign was an effective tool for increasing awareness among the population.