Attitude towards Spirituality and Spiritual Care among Nurses of Bharatpur Hospital.

BACKGROUND: Understanding spirituality and spiritual care is a prerequisite for holistic care in nursing. Spirituality is an important dimension of human existence with a crucial role in health promotion. The objective of this study was to assess the level of attitude towards spirituality and spiritual care among nurses. METHODS: A cross-sectional analytical study design was used among 208 nurses to assess attitude toward spirituality and spiritual care among nurses of Bharatpur Hospital. A pretested semi-structured, self-administered questionnaire was used to collect data from the respondents. The instrument spirituality and spiritual care rating scales were used. Collected data were coded and entered in Microsoft office excel and SPSS version 22 was used for analysis. RESULTS: The finding of the study revealed that, out of 208 respondents, the majority (74.0%) of respondents were of age 20-29 years with a mean and SD of 28.2±5.510. Among all, 125(60.1%) respondents had a moderate attitude score of 32-62, 83(39.9%) had a high level of attitude score of 63-92, whereas 0.5% had a low level of attitude towards spirituality and spiritual care score (0-31).There is no statistically significant relationship between the level of attitude and socio-demographic variables. CONCLUSIONS: It is concluded that most of the respondents had a moderate level of attitude. In-service education and awareness on providing spiritual care among nurses needs to be focused.

Experience of Mindfulness Meditations Based on Stress Reduction among Undergraduate Nursing Students, Chitwan, Nepal.

BACKGROUND: Undergraduate nursing students are frequently vulnerable to stress during their education with a high rate of attrition. Mindfulness Mediations based on Stress Reductions have been found to promote psychological well-being and mental health among nursing students. Therefore, the objective of the study was to explore the experiences of Mindfulness among undergraduate nursing students. METHODS: Qualitative Hermeneutic Phenomenology research design was adopted. Data were collected from under graduate nursing students from Chitwan Medical College, Institute of Medicine who had been practicing Mindfulness Meditation for 6 weeks. The duration of data collection was January to June 2022. Data were collected after obtaining ethical approval from Nepal Health Research Council. Focused Group Discussions were conducted to collect data by the researcher using the Focused Group Discussion guide in Nepali language. A total of three Focused Group Discussions was carried out among 12 participants in each Focused Group Discussion with a total of 36 participants. Data were analyzed by thematic analysis technique based on Giorgi's qualitative data analysis technique. RESULTS: Five developed themes were stress managed well in daily life and during examination time, present moment awareness and positivity, self-realization of inner peace and more self-acceptance, and feeling of developed future role for advocating mindfulness meditations. CONCLUSIONS: Mindfulness-based mediations have been found effective strategies among undergraduate nursing for the management of stress during daily living and during examinations, development of self-realization, increase inner peace, self-acceptance and developed skills for future role for advocating mindfulness meditations.

Nepal needs Continuing Professional Development for Re-registration in Nursing and Midwifery.

The nursing and midwifery profession needs to stay up to date with the latest developments.  In this Viewpoint, we shall be referring to 'nurses' and 'nursing' to mean 'nurses and midwives' and 'nursing and midwifery' respectively. Nurses must continue to update their skills and competences to meet changing future population health needs effectively and safely. However, the reality is that many staff are reporting difficulty accessing and completing Continuing Professional Development (CPD) in all settings. Keywords: CPD; midwifery; nursing; post-registration education; training.

Chemical Profiling and Biological Activities on Nepalese Medicinal Plant Extracts and Isolation of Active Fraction of Nyctanthes arbor-tristis.

The importance of medicinal plants for the treatment of different diseases is high from the aspects of the pharmaceutical industry and traditional healers. The present study involves nine different medicinal plants, namely, Neolamarckia cadamba, Nyctanthes arbor-tristis, Pogostemon benghalensis, Equisetum debile, Litsea monopetala, Spilanthes uliginosa, Desmostachya bipinnata, Mallotus philippensis, and Phoenix humilis, collected from Chitwan district of Nepal for biochemical analysis followed by the isolation of active plant fractions from the bioactive plant extract. The methanolic extracts of roots, barks, seeds, seed cover, and the other aerial parts of plants were used for the phytochemical analysis and biological activities. The DPPH (2,2-diphenyl-1-picrylhydrazyl) free radical scavenging assay was adopted to evaluate the antioxidant activity. Antibacterial activity was evaluated using the agar well diffusion method. The antidiabetic activity was studied by the α-amylase enzyme inhibition assay. The highest antioxidant activity was observed in extracts of Nyctanthes arbor-tristis followed by Mallotus philippensis (seed cover), Pogostemon benghalensis, Litsea monopetala, Phoenix humilis, and Neolamarckia cadamba with IC50 values of 27.38 ± 1.35, 32.08 ± 2.81, 32.75 ± 2.13, 33.82 ± 1.07, 40.14 ± 0.93, and 50.44 ± 3.75 µg/mL, respectively. The highest antidiabetic activity was observed in extracts of Phoenix humilis followed by Desmostachya bipinnata and Pogostemon benghalensis with IC50 values of 95.69 ± 6.97, 99.24 ± 12.6, and 106.3 ± 12.89 µg/mL, respectively. The mild α-amylase enzyme inhibition was found in extracts of Nyctanthes arbor-tristis, Spilanthes uliginosa Swartz, Litsea monopetala, and Equisetum debile showing IC50 values of 110.4 ± 7.78, 115.98 ± 10.24, 149.83 ± 8.3, and 196.45 ± 6.04 µg/mL, whereas Mallotus Philippensis (seed cover), Mallotus philippensis (seed), and Desmostachya bipinnata showed weak α-amylase inhibition with IC50 values of 208.87 ± 1.76, 215.41 ± 2.09, and 238.89 ± 9.27 µg/mL, respectively. The extract of Nyctanthes arbor-tristis showed high zones of inhibition against S. aureus (ATCC 25923) and E. coli (ATCC 25922) of ZOI 26 and 22 mm, respectively. The chemical constituents isolated from the active plant Nyctanthes arbor-tristis were subjected to GCMS analysis where the major chemical compounds were 11,14,17-eicosatrienoic acid and methyl ester. These results support the partial scientific validation for the traditional uses of these medicinal plants in the treatment of diabetes and infectious diseases by the people living in different communities of Chitwan, Nepal.

Integrated Management of Childhood Illness implementation in Nepal: understanding strategies, context, and outcomes.

BACKGROUND: Health system-delivered evidence-based interventions (EBIs) are important to reducing amenable under-5 mortality (U5M). Implementation research (IR) can reduce knowledge gaps and decrease lags between new knowledge and its implementation in real world settings. IR can also help understand contextual factors and strategies useful to adapting EBIs and their implementation to local settings. Nepal has been a leader in dropping U5M including through adopting EBIs such as integrated management of childhood illness (IMCI). We use IR to identify strategies used in Nepal's adaptation and implementation of IMCI. METHODS: We conducted a mixed methods case study using an implementation research framework developed to understand how Nepal outperformed its peers between 2000-2015 in implementing health system-delivered EBIs known to reduce amenable U5M. We combined review of existing literature and data supplemented by 21 key informant interviews with policymakers and implementers, to understand implementation strategies and contextual factors that affected implementation outcomes. We extracted relevant results from the case study and used explanatory mixed methods to understand how and why Nepal had successes and challenges in adapting and implementing one EBI, IMCI. RESULTS: Strategies chosen and adapted to meet Nepal's specific context included leveraging local research to inform national decision-makers, pilot testing, partner engagement, and building on and integrating with the existing community health system. These cross-cutting strategies benefited from facilitating factors included community health system and structure, culture of data use, and local research capacity. Geography was a critical barrier and while substantial drops in U5M were seen in both the highest and lowest wealth quintiles, with the wealth equity gap decreasing from 73 to 39 per 1,000 live births from 2001 to 2016, substantial geographic inequities remained. CONCLUSIONS: Nepal's story shows that implementation strategies that are available across contexts were key to adopting and adapting IMCI and achieving outcomes including acceptability, effectiveness, and reach. The value of choosing strategies that leverage facilitating factors such as investments in community-based and facility-based approaches as well as addressing barriers such as geography are useful lessons for countries working to accelerate adaptation and implementation of strategies to implement EBIs to continue achieving child health targets.

Advances in sample preparation methods for pesticide residue analysis in medicinal plants: A focus on Nepal.

Medicinal plant safety is a rising challenge worldwide due to the continued overuse of pesticides to their maximum residue limits. Due to the high demand for medicinal plants, their production is being increased and sometimes protected by pesticide use. The analysis of these residues requires robust analytical methods to ensure the safety and quality of medicinal plants. Developing effective sample preparation for detecting pesticides is challenging, due to their diverse natures, classes, and physico-chemical characteristics. Hence, existing techniques and strategies are needed to improve the reliability of the results. The review discusses the current state of sample preparation techniques, analytical methods, and instrumental technologies employed in pesticide residue analysis in medicinal plants. It highlights the challenges, limitations, and advancements in the field, providing insights into the analytical strategies used to detect and quantify pesticide residues. Reliable, accessible, affordable, and high-resolution analytical procedures are essential to ensure that pesticide levels in medicinal plants are effectively regulated. By understanding the complexities of pesticide residue analysis in medicinal plants, this review article aims to support the conservation of medicinal plant resources, promote public health, and contribute to the development of sustainable strategies for ensuring the safety and quality of medicinal plants in Nepal. The findings of this review will benefit researchers, policymakers, and stakeholders involved in the conservation of medicinal plant resources and the promotion of public health.

Impact of topical applications of sunflower seed oil on neonatal mortality and morbidity in southern Nepal: a community-based, cluster-randomised trial.

INTRODUCTION: Hospital-based studies have demonstrated topical applications of sunflower seed oil (SSO) to skin of preterm infants can reduce nosocomial infections and improve survival. In South Asia, replacing traditional mustard with SSO might have similar benefits. METHODS: 340 communities in Sarlahi, Nepal were randomised to use mustard oil (MO) or SSO for community practice of daily newborn massage. Women were provided oil in late pregnancy and the first month post partum, and visited daily through the first week of life to encourage massage practice. A separate data collection team visited on days 1, 3, 7, 10, 14, 21 and 28 to record vital status and assess serious bacterial infection. RESULTS: Between November 2010 and January 2017, we enrolled 39 479 pregnancies. 32 114 live births were analysed. Neonatal mortality rates (NMRs) were 31.8/1000 (520 deaths, 16 327 births) and 30.5/1000 (478 deaths, 15 676 births) in control and intervention, respectively (relative risk (RR)=0.95, 95% CI: 0.84, 1.08). Among preterm births, NMR was 90.4/1000 (229 deaths, 2533 births) and 79.2/1000 (188 deaths, 2373 births) in control and intervention, respectively (RR=0.88; 95% CI: 0.74, 1.05). Among preterm births <34 weeks, the RR was 0.83 (95% CI: 0.67, 1.02). No statistically significant differences were observed in incidence of serious bacterial infection. CONCLUSIONS: We did not find any neonatal mortality or morbidity benefit of using SSO instead of MO as emollient therapy in the early neonatal period. Further studies examining whether very preterm babies may benefit are warranted. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT01177111).

Traditional utilization of bamboo in the Central Siwalik region, Nepal.

Bamboo are the fastest growing perennial woody grasses that have versatile applications. Most of the local people inhabiting the riverine area of the Siwalik region of Nepal rely on bamboo products for economic benefits and medicinal uses. Our objective was to identify the diversity of bamboo species, their ethnomedicinal practices, and economic and ecological importance. Data were collected by direct observation, key informant interviews, participatory rural appraisal, inventory technique, focus group discussions, and a household survey using semi-structured and structured questionnaires. We recorded four genera and nine species of bamboo, of which eight species have been used for agriculture, five for medicine, four for construction, food, fodder, artifacts and religious purpose, three for river embankment, and two for ornamental purpose. As the local people in the study area were deprived of medical facilities, using traditional herbal medicine to cure various diseases was a common practice. The inhabitants responded that they use bamboo-based primary ethnomedicinal care even against snake and scorpion bites. Similarly, they use bamboo young culm for reducing body weight and control diabetes. The value of the informant consensus factor was found to be maximum for the bamboo against snake and scorpion bites (1.0) and minimum for weight loss (0.81). This study concludes that the traditional utilization of all kinds of bamboo in the region is vast despite their less diversity. The recorded bamboo species are used not only for food and fodder but also in preparing artifacts, soil nutrients restoration in the fallow land, construction materials for the rural people, river embankments, and religious and spiritual purposes. Therefore, if grown on a large scale, bamboo can provide sustainable benefits for the local users and ecological aspects. Bambusa tulda and Dendrocalamus strictus have a broad spectrum of pharmacological agents. Considering the multifaceted application of bamboo in the Siwalik area, it is worthwhile to encourage the local people to bamboo plantation, which would contribute to supplement their household requirements and be one of the alternative livelihood options.

Ethnomedicinal plants in Champadevi rural municipality, Okhaldhunga district, Nepal.

BACKGROUND: Okhaldhunga is a hilly district with fragile socioeconomic conditions, limited access to health care, social stigma, and poor resource management, where most people rely on medicinal plants for primary health care. The use of medicinal plants for primary health care varies with socioeconomic attributes. Following the intra-cultural analysis, we documented and tested the hypothesis that use of medicinal plants in Champadevi, Okhaldhunga, Nepal, depends on socioeconomic variables. METHODS: We interviewed 224 respondents, 53.12% female and 46.88% male, including 31 Brahmin, 157 Chhetri, 13 Dalit, and 23 Janajati, and conducted three focused group discussions and seven key informant interviews to record the ethnomedicinal plants used in Champadevi rural municipality, Okhaldhunga District. The relative frequency of citation (RFC) was computed to know the importance of the species. A generalized linear model (GLM) was used to see the relationship between medicinal plants reported with the sociocultural variables, which include age, gender, occupation, education, ethnicity, and religion. RESULTS: We documented 149 medicinal plants, including 69 herbs, 22 shrubs, nine climbers, 48 trees, and one parasitic plant, belonging to 68 families and 130 genera, and used to treat 48 distinct diseases and ailments. Plant parts, leaf, and digestive disorders were frequently treated during healing. Curcuma angustifolia was the most cited species with RFC 0.9554. The respondents' knowledge of medicinal plant use varied significantly with age (p = 0.0001) and occupation (p = 0.003). Changes in land use, population decline of medicinal plant species, and unsustainable harvesting practices constituted the local threats to medicinal plants and associated knowledge. Elders died without passing on their knowledge to the younger generations during sociocultural transformation, and youth disinterest coupled with the free availability of allopathic medicine led to knowledge erosion. CONCLUSIONS: The use of medicinal plants in Champadevi, Okhaldhunga, was significantly depended on two socioeconomic variables age and occupation. Ethnomedicinal plants are essential in the primary healthcare system in Nepal; however, their availability and practices are declining. Thus, plans regulating land use change and human migration, acknowledging traditional healthcare practices, and raising awareness of the significance of traditional medical practices as complementary healthcare practices should be strengthened.

Stigma, depression and quality of life among people affected by neglected tropical diseases in Nepal.

BACKGROUND: Stigma and poor mental health are important factors influencing the quality of life (QOL) of people with neglected tropical diseases (NTDs). This study examines the relationship between stigma, depression and QOL among people affected by leprosy and lymphatic filariasis (LF) in Nepal. METHODS: A cross-sectional community-based survey was conducted among 102 NTD-affected persons (70 leprosy and 32 LF) using interview-administered questionnaires measuring the level of stigma (5-QSI-AP), symptoms of depression (PHQ-9) and QOL (WHOQOL-8). Three different regression models were developed, each using the ordinary least squares and Poisson regression to evaluate the association between stigma and QOL, depression and QOL, and stigma and depression. RESULTS: The mean scores were 21.8±4.4 for QOL, 6.6±5.6 for depression and 3.0±2.8 for stigma. Almost 17% reported the prevalence of depression symptoms. Both stigma (ß=-0.65, p<0.001) and depression (ß=-0.32, p<0.001) were associated with lower scores for QOL, while there was a significant positive relationship between stigma and depression (ß=0.92, p<0.001). Similar results were obtained from the Poisson regression models. CONCLUSIONS: The study showed a considerable burden of depression, stigma and poor QOL among study participants with leprosy and LF in Nepal. A holistic package of care that addresses the physical, mental and psychological well-being of people with NTD is required. CONTEXTE: La stigmatisation et la mauvaise santé mentale sont des facteurs importants qui influencent la qualité de vie des personnes atteintes de maladies tropicales négligées (MTN). Cette étude examine la relation entre la stigmatisation, la dépression et la qualité de vie chez les personnes atteintes de lèpre et de filariose lymphatique au Népal. MÉTHODES UTILISÉES: Une enquête communautaire transversale a été menée auprès de 102 personnes atteintes de MTN (70 de la lèpre et 32 de la filariose lymphatique) à l'aide de questionnaires administrés par entretien mesurant le niveau de stigmatisation (5-QSI-AP), les symptômes de dépression (PHQ-9) et la qualité de vie (WHOQOL-8). Trois modèles de régression différents ont été développés, chacun utilisant les moindres carrés ordinaires et la régression de Poisson pour évaluer l'association entre : (i) la stigmatisation et la QV; (ii) la dépression et la QV; et (iii) la stigmatisation et la dépression. RÉSULTATS: Les scores moyens étaient de 21,8±4,4 pour la QV, 6,6±5,6 pour la dépression, et 3,0±2,8 pour la stigmatisation. Près de 17% des personnes interrogées ont signalé la prévalence de symptômes dépressifs. La stigmatisation (ß = -0,65, p<0 001) et la dépression (ß = -0,32, p<0 001) ont été associées à des scores plus faibles pour la qualité de vie, tandis qu'il existait une relation positive significative entre la stigmatisation et la dépression (ß = 0,92, p<0 001). Des résultats similaires ont été obtenus à partir des modèles de régression de Poisson. CONCLUSIONS: L'étude a montré une incidence importante de dépression, de stigmatisation et d'une mauvaise qualité de vie parmi les participants atteints de lèpre et de FL au Népal. Il convient donc de mettre en place un ensemble de soins holistiques pour ces patients qui prendrait en compte le bien-être physique, mental et psychologique des personnes atteintes de MTN. ANTECEDENTES: La estigmatización y la mala salud mental son factores importantes que influyen en la calidad de vida de las personas con enfermedades tropicales desatendidas. las personas con enfermedades tropicales desatendidas (ETD). Este estudio examina la relación entre el estigma, la depresión y la CdV entre las personas afectadas por lepra y lepra y la filariasis linfática en Nepal. MÉTODOS: Se realizó una encuesta comunitaria transversal entre 102 personas afectadas por ETD (70 de lepra y 32 de filariasis linfática) utilizando cuestionarios entrevistas para medir el nivel de estigma (5-QSI-AP), los síntomas de depresión (PHQ- 9) y la CdV (OMS- 9). 9) y la calidad de vida (WHOQOL-8). Se desarrollaron tres modelos de regresión diferentes regresión de Poisson para evaluar la asociación entre: (i) el estigma y (ii) la depresión. entre: (i) estigma y CdV; (ii) depresión y CdV; y (iii) estigma y depresión. RESULTADOS: Las puntuaciones medias fueron 21,8±4,4 para la CdV, 6,6±5,6 para la depresión y 3,0±2,8 para el estigma. Casi el 17% informó de la prevalencia de síntomas de depresión. Tanto el estigma (ß = -0,65, p<0 001), como la depresión (ß = -0,32, p<0 001) se asociaron con puntuaciones más bajas para la CdV, mientras que hubo una relación positiva significativa entre el estigma y la depresión (ß = 0,92, p<0 001). Se obtuvieron resultados similares en los modelos de regresión de Poisson. CONCLUSIONES: El estudio mostró una carga considerable de depresión, estigma y mala CdV entre los participantes del estudio con lepra y FL en Nepal. Se requiere un paquete holístico de atención que aborde el bienestar físico, mental y psicológico de las personas con ETD.

Development of disaster nursing in Nepal: Opportunities and challenges for advanced practice.

AIM: This article discusses the evolution of the field of disaster nursing in Nepal and its challenges and ways to protect the health and well-being of the community during disasters. It also discusses the alignment of field activities with the International Council of Nurses' (ICN) competencies in disaster nursing. BACKGROUND: Disaster nursing has become increasingly important due to the increasing frequency and impact of disasters on health. In Nepal, disaster nursing is a relatively new field, but it has grown over the years with nurses playing a vital role in providing holistic care during disasters, emergencies, and crises. SOURCES OF EVIDENCE: Literature review and experience from the field. DISCUSSION: Following the Nepal earthquake, the concept of the "epidemiology nurse" evolved in Nepal which trained local nurses with disaster nursing knowledge and skills using the digital information, communication, and technology (ICT) toolkit for collecting real-time information. Nurses monitored the environment, conducted physical and mental health assessments, identified the needs of vulnerable populations, provided basic aid, offered mental health support, and shared data with authorities. However, their competencies are not yet enough to fully align with those given by ICN nursing standards. CONCLUSION: Recognizing the valuable contributions of Nepalese nurses in the field, their initiatives can serve as a foundation for advancing their roles in disaster nursing. It is essential to implement national disaster plans and invest in specialized university courses for disaster nursing training. IMPLICATIONS FOR NURSING POLICY: The field experiences of disaster nursing reflected in this article can contribute to the development of policies and practices related to disaster management in adherence to the ICN' guidelines.

Supplementation with fortified balanced energy-protein during pregnancy and lactation and its effects on birth outcomes and infant growth in southern Nepal: protocol of a 2×2 factorial randomised trial.

INTRODUCTION: Many women in low and middle-income countries enter pregnancy with low nutritional reserves with increased risk of fetal growth restriction and poor birth outcomes, including small-for-gestational-age (SGA) and preterm birth. Balanced energy-protein (BEP) supplements have shown reductions in risk of stillbirth and SGA, yet variations in intervention format and composition and limited evidence on the impact of BEP during lactation on growth outcomes warrant further study. This paper describes the protocol of the Maternal Infant Nutrition Trial (MINT) Study, which aims to evaluate the impact of a fortified BEP supplement during pregnancy and lactation on birth outcomes and infant growth in rural Nepal. METHODS AND ANALYSIS: MINT is a 2×2 factorial, household randomised, unblinded, efficacy trial conducted in a subarea of Sarlahi District, Nepal. The study area covers six rural municipalities with about 27 000 households and a population of approximately 100 000. Married women (15-30 years) who become pregnant are eligible for participation in the trial and are randomly assigned at enrolment to supplementation with fortified BEP or not and at birth to fortified BEP supplementation or not until 6 months post partum. The primary pregnancy outcome is incidence of SGA, using the INTERGROWTH-21st standard, among live born infants with birth weight measured within 72 hours of delivery. The primary infant growth outcome is mean length-for-age z-score at 6 months using the WHO international growth reference. ETHICS AND DISSEMINATION: The study was approved by the Institutional Review Board (IRB) at Johns Hopkins Bloomberg School of Public Health, Baltimore, USA (IRB00009714), the Committee on Human Research IRB at The George Washington University, Washington, DC, USA (081739), and the Ethical Review Board of the Nepal Health Research Council, Kathmandu, Nepal (174/2018). TRIAL REGISTRATION NUMBER: NCT03668977.

Preliminary Study on the Antibacterial Activities and Antibacterial Guided Fractionation of Some Common Medicinal Plants Practices in Itum Bahal, Kathmandu Valley of Nepal.

The aim of this study was to evaluate the antibacterial activities of selected medicinal plant practices by a traditional healer of the Newar community in Itum Bahal, Kathmandu, Nepal. The antibacterial activities of the methanolic extract (1 mg/disc) of fifteen medicinal plants were screened against two Gram-positive bacteria (Staphylococcus aureus ATCC 25923 and Bacillus subtilis ATCC 6633) and two Gram-negative bacteria (Escherichia coli ATCC 25922 and Salmonella typhi CCM 5445) using the disc diffusion method. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were calculated for the different fractions (hexane, chloroform, ethyl acetate, acetonitrile, and acetone) of the plants having a significant antimicrobial effect. Only Quercus infectoria G. Olivier (galls) and Mallotus repandus (Willd.) Müll.Arg. (seeds) exhibited prominent antibacterial effects. The acetone fraction from Q. infectoria had the strongest antibacterial effect, with a 41.00 mm inhibition zone against S. aureus. In contrast, the ethyl acetate fraction in M. repandus exhibited the highest efficacy, producing a 29.00 mm inhibition zone against S. typhi. In a similar manner, in the case of Q. infectoria, the acetoe fraction depicted the lowest MIC (0.19 mg/mL) and MBC (0.98 mg/mL) values against S. aureus, whereas the ethyl acetate fraction of M. repandus was most significant, showing the lowest MIC and MBC of 0.25 and 0.53 mg/mL, respectively, against S. typhi. This study suggested that the acetone extract of Q. infectoria galls can be used as a potential source against Gram-positive bacteria, whereas the ethyl acetate extract of M. repandus seeds could serve as a useful source to inhibit Gram-negative bacteria. Furthermore, extensive scientific investigation is mandatory to ensure the proper use of folk medicines.

Pre-menstrual Syndrome and Pre-menstrual Dysphoric Disorder in Female Medical Students of Nepal.

Background Pre-menstrual Syndrome and Pre-menstrual Dysphoric Disorder can have negative impact on medical students and remains mostly underdiagnosed. Different treatment modalities like medications (doctor-prescribed or self-medicated), and alternative therapies are used by students to cope with pre-menstrual symptoms. Objective To estimate the prevalence and severity of Premenstrual Syndrome and Premenstrual Dysphoric Disorder among medical students in Nepal along with its impact in their quality of life, their health seeking behavior and treatment modalities used to cope with these disorders. Method A cross-sectional study was conducted among female medical students studying MBBS in various medical colleges in Nepal using a self-administered questionnaire from September 2020 to March 2021. Result The prevalence of Premenstrual Syndrome and Premenstrual Dysphoric Disorder among female medical students in Nepal was 64% and 36.3% respectively as per this study. Among the areas impacted by premenstrual symptoms, concentration in class was the most affected (68.1%), followed by distress (64.6%). Only 7.3% of the responding participants sought medical consultation for their symptoms. Among those who suffered from at least one symptom for any length of time, 34.8% of participants reported of using at least one medication (either prescribed or selfmedication). Similarly, alternative remedies were used by 44.4% of the participants. Conclusion Premenstrual syndrome and premenstrual dysphoric disorder were found to be common in female medical students of Nepal. However, very few students sought medical consultation despite a significant impact in their academic and other activities. Self-medication and traditional therapies were common modalities used for treatment of premenstrual symptoms.

Effect of Music Therapy on Intensity of Labor Pain among Primigravid Mothers admitted in a Tertiary Level Hospital.

BACKGROUND: Childbirth is a most welcomed and positive life experience for the majority of women, despite the pain. Most of them manage it well with minimal assistance while few of them require some intervention to reduce the pain. The objective of this study was to find out the effect of music therapy on intensity of labor pain among primigravid women. METHODS: A quasi-experimental pre-test post-test non-equivalent control group design was used. Sample consisted of 42 primigravid women admitted in labor room of a teaching hospital in Kathmandu. The intensity of labor pain was measured using Visual Analogue Scale and Behavior Rating Scale in latent and active phase of labor in both experimental and control groups. Then 30 minutes of music therapy was provided to the experimental group in the latent and active phase of labor. The post-test was carried out in both groups after the music therapy to experimental group during the latent and active phase using the same instruments. The collected data was entered in Statistical Package for Social Sciences version 16. Descriptive statistics and inferential statistics were used to describe the findings. FINDINGS: The mean difference of total pain between experimental and control groups during latent phase was 1.9 (t=2.31, p=0.023) in pre-test and 6.57 (t=3.91, p=0.000) in post-test. The mean difference of total pain between experimental and control groups during active phase was 1.00 (t=1.08, p=0.286) during pre-test and 6.95(t=3.744, p=0.001) during post-test. CONCLUSIONS: Music therapy tends to reduce labor pain both during the latent and active phase of labor.

Nepalese indoor cookstove smoke extracts alter human airway epithelial gene expression, DNA methylation and hydroxymethylation.

Household air pollution caused by inefficient cooking practices causes 4 million deaths a year worldwide. In Nepal, 86% of the rural population use solid fuels for cooking. Over 25% of premature deaths associated with air pollution are respiratory in nature. Here we aimed to identify molecular signatures of different cookstove and fuel type exposures in human airway epithelial cells, to understand the mechanisms mediating cook stove smoke induced lung disease. Primary human airway epithelial cells in submerged culture were exposed to traditional cook stove (TCS), improved cook stove (ICS) and liquefied petroleum gas (LPG) stove smoke extracts. Changes to gene expression, DNA methylation and hydroxymethylation were measured by bulk RNA sequencing and HumanMethylationEPIC BeadChip following oxidative bisulphite conversion, respectively. TCS smoke extract alone reproducibly caused changes in the expression of 52 genes enriched for oxidative stress pathways. TCS, ICS and LPG smoke extract exposures were associated with distinct changes to DNA methylation and hydroxymethylation. A subset of TCS induced genes were associated with differentially methylated and/or hydroxymethylated CpGs sites, and enriched for the ferroptosis pathway and the upstream regulator NFE2L2. DNA methylation and hydroxymethylation changes not associated with a concurrent change in gene expression, were linked to biological processes and molecular pathways important to airway health, including neutrophil function, transforming growth factor beta signalling, GTPase activity, and cell junction organisation. Our data identified differential impacts of TCS, ICS and LPG cook stove smoke on the human airway epithelium transcriptome, DNA methylome and hydroxymethylome and provide further insight into the association between indoor air pollution exposure and chronic lung disease mechanisms.

Methodological choices for an economic evaluation of a combined psychosocial and nutrition treatment intervention for children with severe acute malnutrition: The FUSAM trial in Nepal.

As a public health burden, severe acute malnutrition (SAM) among children has been increasingly studied to determine the optimal combination of treatment approaches. Among the new approaches is the addition of early childhood development sessions to standard nutrition-based treatment for SAM which can enhance both nutrition and development outcomes among young children. However, few studies demonstrate the relationship between the costs of such combined programs and the benefits accrued to the children and their caregivers. This article describes our experience of designing and conducting an economic evaluation alongside a cluster randomized controlled trial assessing a combined nutrition and psychosocial intervention for the treatment of SAM in children aged 6-24 months in Nepal. We present key lessons learned regarding methodological choices, the challenges of field data collection, as well as study adjustment when data analysis did not unfold as anticipated. With the view to transparency, this manuscript provides some clarifications on the evaluation processes for funders and policy makers on what economic evaluations entail and what information they convey for the purpose of supporting policy decision-making around limited resource allocation.

Impact of federalization for health financing and workforce in Nepal.

The adoption of its 2015 constitution has converted Nepal to a federal government while simultaneously resulted in significant reforms of the health system in Nepal in terms of both structure and commitment. In this commentary, we review evidence ranging from health financing to health workforce development to show that the impact of federalization on Nepal's health system and its efforts to achieve equitable and affordable universal health care have been mixed. On the one hand, careful efforts of the federal government to support subnational governments during the transition appears to have avoided serious disruption, subnational governments have successfully taken on the financial burden of the health system, and increase subnational control has allowed more flexible adaptation to changing needs than might have otherwise been possible. On the other hand, financing resource and ability disparities across subnational governments contributes to significant disparities in workforce development, and subnational authorities appear to have underestimated significant health issues (e.g. NCDs) in their budgets. We then provide three recommendations to improve the success of the Nepalese system: (1) to assess whether the services covered by health financing and insurance schemes like the National Health Insurance Program adequately address the needs of the rising burden of NCDs in Nepal, (2) to set clear minimum requirements on key metrics for subnational health systems, and (3) to extend grant programs to address resource disparities.

Pregnancy outcomes in women with gestational hypertension and preeclampsia at Paropakar Maternity and Women's Hospital, Nepal: A retrospective study.

INTRODUCTION: Gestational hypertension and preeclampsia are the most common types of hypertensive disorder in pregnancy and these conditions are associated with adverse maternal and fetal outcomes. This study aims to determine the differences in pregnancy outcomes in women with gestational hypertension and preeclampsia. METHODS: A retrospective study was done at The Paropakar Maternity and Women's Hospital, a tertiary level hospital, in the Kathmandu, Nepal. Pregnant women who had given birth at the hospital between September 17 and December 18 of 2017 were included. Data were obtained from the non-digitalized hospital records. The adjusted odds ratio (AOR) and 95% confidence interval were computed using logistic regression analysis. Multivariable analysis of pregnancy outcomes (cesarean sections, low birth weight, and preterm birth) was adjusted for maternal age, parity, twin birth, gestational age, calcium supplementation, and maternal co-morbidity. RESULTS: Preeclampsia was strongly associated with cesarean section compared to normal pregnancies (OR = 8.11, p<0.001). Whereas the odds of cesarean section among women with gestational hypertension was almost 2 times (OR = 1.89, p<0.001). Preterm birth was not significantly associated with gestational hypertension but was associated with preeclampsia (OR = 3.39, p<0.001). Gestational hypertension and preeclampsia were not associated with low birth weight. CONCLUSION: In Nepal, women who develop preeclampsia seem at higher risk of having adverse pregnancy outcomes than women with gestational hypertension. These findings should be considered by national health authorities and other health organizations when setting new priorities to improve pregnancy outcomes.

A Hermeneutic Phenomenological Study of Aesthetics in Nursing Practice Among Hospitalized Cancer Patients in Nepal.

Background: Aesthetics is the art of nursing that is expressive, subjective, and visible in the act of caring in nursing practice. Aesthetics in nursing practice satisfies holistic needs and achieves the quality of whole-person care. Purpose: The aim of this study is to describe the meanings of the lived experiences of cancer patients in terms of receiving care from the perspective of aesthetics in nursing practice. Methods: The hermeneutic phenomenological approach grounded on Gadamerian philosophy guided this study. Eleven Nepalese cancer patients who met the inclusion criteria shared their experiences through graphic illustrations (drawings) and interviews. Data were analyzed and interpreted following van Manen's phenomenological approach reflective of the four life worlds. The trustworthiness of findings was established following the criteria by Lincoln and Guba. Results: Thematic categories of the lived experience of cancer patients were revealed, reflecting the four life worlds: lived relation expressed as being nurtured as a family; lived space as appreciating the healing space; lived time as being hopeful; and lived body as receiving a new life. This experience was described as experiencing self and other while appreciating the healing space, being hopeful and nurtured as family and having a new life Implications for Practice: Aesthetics in nursing practice values on politely nurturing cancer patients as nurses' family members in a pleasant healing environment. Further, cancer patients experience having a new life.