Prevalence of multimorbidity and its correlates among older adults in Eastern Nepal.

BACKGROUND: The number of people with multimorbidity is surging around the world. Although multimorbidity has been introduced in policy and practice in developed countries, developing countries like Nepal have not considered it as a matter of public health urgency due to the lack of enough epidemiological data. Multimorbidity profoundly affects older adults' wellbeing; therefore, it is crucial to estimate its prevalence and determinants. This study aimed to estimate the prevalence of multimorbidity among older adults in Eastern Nepal and identify its correlates. METHODOLOGY: A community-based cross-sectional survey was conducted in three districts of Eastern Nepal. Data were collected between July and September 2020, among 847 Nepali older adults, aged 60 and older, where study participants were recruited through a multi-stage cluster sampling technique. Semi-structured interviews were conducted at the community settings to collect data. Logistic regression assessed correlates of multimorbidity. SAS 9.4 was used to run all statistical tests and analyses. RESULTS: More than half (66.5%) of the participants had at least one of the five non-communicable chronic conditions; hypertension (31.6%), osteoarthritis (28.6%), chronic respiratory disease (18.0%), diabetes (13.5%), and heart disease (5.3%). The prevalence of multimorbidity was 22.8%. In the adjusted model, increased age (for 70-79 years, OR: 3.11, 95% CI: 1.87-5.18; for 80 + years, OR: 4.19, 95% CI: 2.32-7.57), those without a partner (OR: 1.52, 95% CI: 1.00-2.30), residing in urban areas (OR: 1.71, 95% CI: 1.16-2.51), and distant from health center (OR: 1.66, 95% CI: 1.04-2.64) were significantly associated with multimorbidity. CONCLUSIONS: This study found one in five study participants had multimorbidity. The findings will assist policymakers and stakeholders in understanding the burden of multimorbidity among the older population and identifying the groups in most need of health promotion intervention. Future interventions may include developing horizontal multimorbid approaches and multisectoral strategies specifically tailored to meet the needs of those populations.

Perceived risks of produced water management and naturally occurring radioactive material content in North Dakota.

Unconventional oil and gas development using hydraulic fracturing has caused conflict and controversy across the globe including the U.S. where some States banned the practice. Nevertheless, North Dakota (ND) has supported the practice because the State perceives the risks to be acceptable and because it has brought growth and opportunities to small communities. However, social acceptance of new technology is based on a number of factors and not contingent on economic benefits. To date, no research has been conducted to understand public risk perception of hazards associated with produced water from hydraulic fracturing in ND. This study focuses on understanding the risk perception of select ND stakeholder groups regarding produced water management and naturally occurring radioactive material. The software Qualtrics was used to create an online survey, collect data, and perform statistical analysis. The most important variables that seem to influence risk perception are the images and thoughts associated with produced water, level of knowledge about produced water handling and content, and knowing how to proceed in case of a spill of produced water. Overall, social risk perception could be in alignment with actual technical risk if availability of objective information is improved.

Occupational noise exposure at sea: A socio-legal study on fish harvesters' perceptions in Newfoundland and Labrador, Canada.

Introduction: Noise is a significant health hazard for fish harvesters. Chronic exposure to hazardous noise levels of 85 dB (A) for an 8-h work shift can have adverse health impacts, including both auditory and non-auditory health problems such as noise-induced hearing loss, stress, hypertension, sleeping disorders, and impaired cognitive performance. Methods: A review of legislation and policies governing workplace noise exposure, as well as qualitative, semi-structured interviews, were conducted to assess how fish harvesters in Newfoundland and Labrador (NL) manage onboard occupational noise exposure and perceive noise-induced health problems, as well as the barriers and challenges associated with preventing and controlling noise exposure. Results: The legal review shows no compulsory noise preventive measure at the fishing vessel design stage in Canada. Limited implementation of Occupational Health and Safety (OHS) regulations to control and prevent onboard noise by employers in Newfoundland and Labrador. Fishers reported that their workplace is noisy. Over time, fish harvesters adapted to the environment and learned to tolerate loud noise, displaying fatalistic behavior. Fish harvesters reported avoiding using hearing protection onboard due to navigation safety concerns. Fishers reported hearing loss as well as other non-auditory health problems. Inadequate noise control measures adopted by employers, a limited supply of hearing protection onboard, and a lack of regular hearing testing, training, and education were identified as the main barriers to preventing and controlling noise exposure. Conclusion: Proper implementation of NL OHS regulations and the development of hearing conservation initiatives by employers are necessary. All stakeholders, including the federal and provincial governments, WorkplaceNL, and not-for-profit fishing organizations in the province, are strongly recommended to initiate training and education campaigns to help fish harvesters understand noise exposure and adopt preventive measures.

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.

Occupational noise exposure and health impacts among fish harvesters: a systematic review.

BACKGROUND: Occupational noise exposure has been identified as a significant risk factor for fish harvesters. Chronic noise exposure causes hearing and other health problems and undermines the quality of life and well-being. This review paper aims to highlight noise-related auditory and non-auditory health effects among fish harvesters. MATERIALS AND METHODS: A systematic literature search approach was adopted using the following databases: PubMed, Embase, SCOPUS, Web of Science, Google Scholar, and by exploring grey literature. The literature search was conducted in 2020 (between October 15 and November 30). Relevant articles were explored by reviewing title, keywords, and abstract based on the inclusion and exclusion criteria. The full-text critical review of selected papers was made and finalized the most relevant studies. RESULTS: Initial 1,281 records were identified, exploring various databases and additional sources using relevant keywords. Duplicate articles were removed and retrieved 746 articles. After that, a screening of 746 research papers was done based on the selection criteria and finalised 28 articles for full-text review. Finally, articles were filtered based on the study's aim and extracted 17 papers for the final review. CONCLUSIONS: Noise-induced hearing loss was considered a significant health risk to fish harvesters across the studies, affecting physical and emotional well-being. The prevalence of hearing loss was observed from 6% to 80%. Other health problems, such as headache, dizziness, annoyance, stress, fatigue, elevated blood pressure, sleep disturbances, and impaired cognitive performance, were also reported. Further research is needed to validate the non-auditory health effects among fish harvesters.

Potential human health risks due to environmental exposure to nano- and microplastics and knowledge gaps: A scoping review.

Microplastics are an emerging global environmental contaminant that are affecting multiple spheres. Despite their ubiquity in all spheres of life and ecology, little is known about the health effects of microplastics exposure to humans. This scoping review explores the existing evidence on the potential human health effects of microplastics and subsequent knowledge gaps. An electronic search of published articles in PubMed, Scopus, EMBASE, Cochrane databases, and Google Scholar was conducted using a combination of subject headings and keywords relating to microplastics and human health effects. The initial search resulted in 17,043 published articles and grey literature documents. After a full review of published articles and their references, 129 publications were identified for further detailed review. These articles indicate that human exposure to microplastics can occur through ingestion, inhalation, and dermal contact due to their presence in food, water, air, and consumer products. Microplastics exposure can cause toxicity through oxidative stress, inflammatory lesions, and increased uptake or translocation. Several studies have demonstrated the potentiality of metabolic disturbances, neurotoxicity, and increased cancer risk in humans. Moreover, microplastics have been found to release their constituent compounds as well as those that are adsorbed onto their surface. Further research is needed to quantify the effects of microplastics on human health and their pathogenesis.

Perceived fear of COVID-19 and its associated factors among Nepalese older adults in eastern Nepal: A cross-sectional study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has affected all age groups worldwide, but older adults have been affected greatly with an increased risk of severe illness and mortality. Nepal is struggling with the COVID-19 pandemic. The normal life of older adults, one of the vulnerable populations to COVID-19 infection, has been primarily impacted. The current evidence shows that the COVID-19 virus strains are deadly, and non-compliance to standard protocols can have serious consequences, increasing fear among older adults. This study assessed the perceived fear of COVID-19 and associated factors among older adults in eastern Nepal. METHODS: A cross-sectional study was conducted between July and September 2020 among 847 older adults (≥60 years) residing in three districts of eastern Nepal. Perceived fear of COVID-19 was measured using the seven-item Fear of COVID-19 Scale (FCV-19S). Multivariate logistic regression identified the factors associated with COVID-19 fear. RESULTS: The mean score of the FCV-19S was 18.1 (SD = 5.2), and a sizeable proportion of older adults, ranging between 12%-34%, agreed with the seven items of the fear scale. Increasing age, Dalit ethnicity, remoteness to the health facility, and being concerned or overwhelmed with the COVID-19 were associated with greater fear of COVID-19. In contrast, preexisting health conditions were inversely associated with fear. CONCLUSION: Greater fear of the COVID-19 among the older adults in eastern Nepal suggests that during unprecedented times such as the current pandemic, the psychological needs of older adults should be prioritized. Establishing and integrating community-level mental health support as a part of the COVID-19 preparedness and response plan might help to combat COVID-19 fear among them.

Oral Health Knowledge, Attitude, and Practice among Nursing Students in the North-Eastern Part of Rajasthan, India.

BACKGROUND: Professional and paramedical students have a key role in oral health promotion. The aim of this study was to assess oral health-related Knowledge, Attitude, and Practice (KAP) among the nursing students in Rajasthan. MATERIALS AND METHODS: A cross-sectional, questionnaire-based study was carried out among 409 nursing students from five different institutes who were selected by simple random sampling. A 27-item questionnaire was used to assess KAP. The resulting data were analyzed using frequency distribution. RESULTS: Over 50% of the students used toothbrush and toothpaste twice a day to maintain their oral hygiene. Besides, 41% recognized the importance of dental visit in case of gingival bleeding and knew that poor oral hygiene is responsible for bad breath. CONCLUSIONS: Oral health-related behavior among the nursing students needs improvement. More educational and preventive programs should be organized to achieve better results.

Risk assessment of human exposure to Ra-226 in oil produced water from the Bakken Shale.

Unconventional oil production in North Dakota (ND) and other states in the United States uses large amounts of water for hydraulic fracturing to stimulate oil flow. Most of the water used returns to the surface as produced water (PW) containing different constituents. Some of these contents are total dissolved solids and radionuclides. The most predominant radionuclide in PW is radium-226 (Ra-226) of which level depends on several factors including the content of certain cations. A multivariate regression model was developed to predict Ra-226 in PW from the Bakken Shale based on the levels of barium, strontium, and calcium. The simulated Ra-226 activity concentration in PW was 535 pCi/L supporting extremely limited actual data based on three PW samples from the Bakken (527, 816, and 1210 pCi/L). The simulated activity concentration was further analyzed by studying its impact in the event of a PW spill reaching a surface water body that provides drinking water, irrigation water for crops, and recreational fishing. Using food transfer factors found in the literature, the final annual effective dose rate for an adult in ND was estimated. The global average annual effective dose rate via food and drinking water is 0.30 mSv, while the predicted dose rate in this study was 0.49 mSv indicating that there is potential risk to human health in ND due to Ra-226 in PW spills. This predicted dose rate is considered the best case scenario as it is based on the simulated Ra-226 activity concentration in PW of 535 pCi/L which is close to the low end actual activity concentration of 527 pCi/L.

Holistic risk assessment of surface water contamination due to Pb-210 in oil produced water from the Bakken Shale.

A holistic risk assessment of surface water (SW) contamination due to lead-210 (Pb-210) in oil produced water (PW) from the Bakken Shale in North Dakota (ND) was conducted. Pb-210 is a relatively long-lived radionuclide and very mobile in water. Because of limited data on Pb-210, a simulation model was developed to determine its concentration based on its parent radium-226 and historical total dissolved solids levels in PW. Scenarios where PW spills could reach SW were analyzed by applying the four steps of the risk assessment process. These scenarios are: (1) storage tank overflow, (2) leakage in equipment, and (3) spills related to trucks used to transport PW. Furthermore, a survey was conducted in ND to quantify the risk perception of PW from different stakeholders. Findings from the study include a low probability of a PW spill reaching SW and simulated concentration of Pb-210 in drinking water higher than the recommended value established by the World Health Organization. Also, after including the results from the risk perception survey, the assessment indicates that the risk of contamination of the three scenarios evaluated is between medium-high to high.

A review on risk assessment techniques for hydraulic fracturing water and produced water management implemented in onshore unconventional oil and gas production.

The objective of this paper is to review different risk assessment techniques applicable to onshore unconventional oil and gas production to determine the risks to water quantity and quality associated with hydraulic fracturing and produced water management. Water resources could be at risk without proper management of water, chemicals, and produced water. Previous risk assessments in the oil and gas industry were performed from an engineering perspective leaving aside important social factors. Different risk assessment methods and techniques are reviewed and summarized to select the most appropriate one to perform a holistic and integrated analysis of risks at every stage of the water life cycle. Constraints to performing risk assessment are identified including gaps in databases, which require more advanced techniques such as modeling. Discussions on each risk associated with water and produced water management, mitigation strategies, and future research direction are presented. Further research on risks in onshore unconventional oil and gas will benefit not only the U.S. but also other countries with shale oil and gas resources.

Epidemiology of periodontal diseases in Indian population since last decade.

OBJECTIVE: India suffers lot of disparities in terms of oral health care and 95% of the Indian population suffers from periodontal disease. The aim of this review is to estimate the risk factors responsible for periodontal diseases as well as prevalence for the same in the last decade to make an attempt to develop a strategy to improve formulation of an effective oral health care policy in India. MATERIALS AND METHODS: Keywords such as "prevalence of periodontal diseases," "epidemiology," "periodontitis in India," and "oral hygiene status in India" were searched for appropriate studies to obtain a bibliographic database. The references of selected articles and relevant reviews were searched for any missed publications that included studies conducted in India estimating periodontal diseases with adequate sample size. Clinical parameters, sample size, and findings for each study were tabulated from 2006 to 2015 (till September 15, 2015) in chronological order to observe the prevalence as well as epidemiology of periodontal disease in India. RESULTS: The projection of periodontal disease is disturbing. In addition, the majority of studies done have used the Community Periodontal Index of Treatment Needs (CPITN) as its epidemiological tool that can grossly underestimate the presence of deep pockets. CONCLUSION: Current knowledge has shown that periodontitis does not present a linear progression and is not age-dependent. Moreover, its distribution and severity are strongly influenced by host susceptibility and risk factors. A structured all-inclusive survey of all districts of the states is a prerequisite for the constitution of an apt and cogent health care policy in our country.

Photocatalytic degradation of methylene blue dye by zinc oxide nanoparticles obtained from precipitation and sol-gel methods.

Zinc oxide (ZnO) nanoparticles were synthesized by precipitation and sol-gel methods. The aim of this study was to understand how different synthetic methods can affect the photocatalytic activity of ZnO nanoparticles. As-synthesized ZnO nanoparticles were characterized by X-ray diffraction (XRD) and UV-Visible spectroscopic techniques. XRD patterns of ZnO powders synthesized by precipitation and sol-gel methods revealed their hexagonal wurtzite structure with crystallite sizes of 30 and 28 nm, respectively. Their photocatalytic activities were evaluated by photocatalytic degradation of methylene blue, a common water pollutant, under UV radiation. The effects of operational parameters such as photocatalyst load and initial concentration of the dye on photocatalytic degradation of methylene blue were investigated. While the degradation of dye decreased over the studied dye concentration range of 20 to 100 mg/L, an optimum photocatalyst load of 250 mg/L was needed to achieve dye degradation as high as 81 and 92.5 % for ZnO prepared by precipitation and sol-gel methods, respectively. Assuming pseudo first-order reaction kinetics, this corresponded to rate constants of 8.4 × 10-3 and 12.4 × 10-3 min-1, respectively. Hence, sol-gel method is preferred over precipitation method in order to achieve higher photocatalytic activity of ZnO nanostructures. Photocatalytic activity is further augmented by better choice of capping ligand for colloidal stabilization, starch being more effective than polyethylene glycol (PEG).