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1.
PLOS Glob Public Health ; 3(4): e0001783, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37027365

RESUMO

Internet gaming disorder (IGD) has been rising in recent years. The COVID-19 pandemic has led to a noticeable shift in the way people interact with technology, which could have further contributed to an increase in IGD. Post-pandemic, the concern for IGD is likely to continue as people have become increasingly reliant on online activities. Our study aimed to assess the prevalence of IGD among the general population globally during the pandemic. Relevant studies that assessed IGD during COVID-19 were identified using PubMed, EMBASE, Scopus, CINAHL, and PsycNET between 2020, Jan 1 and 2022, May 23. We used NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies to assess the risk of bias, and GRADEpro for the certainty of the evidence. Three separate meta-analyses were performed using Comprehensive meta-analysis software and Revman 5.4. In total, 362 studies were identified, of which 24 observational (15 cross-sectional and 9 longitudinal) studies among 83,903 population were included in the review, and 9 studies in the meta-analysis. The risk of bias assessment showed an overall fair impression among the studies. The meta-analysis for a single group of 3 studies showed the prevalence rate of 8.00% for IGD. Another meta-analysis of 4 studies for a single group showed a pooled mean of 16.57 which was lower than the cut-off value of the IGDS9-SF tool. The two-group meta-analysis of 2 studies showed no significant difference between the groups before and during COVID-19. Our study showed no clear evidence of increased IGD during COVID-19 due to limited number of comparable studies, substantial heterogeneity, and low certainty of evidence. Further well-designed studies are needed to provide stronger evidence to implement suitable interventions to address IGD worldwide. The protocol was registered and published in the International Prospective Register for Systematic Review (PROSPERO) with the registration number CRD42021282825.

2.
BMJ Open ; 13(3): e067312, 2023 03 30.
Artigo em Inglês | MEDLINE | ID: mdl-36997254

RESUMO

OBJECTIVES: To determine the prevalence of, and understand the factors associated with, hypertension among the nomadic Raute hunter-gatherers of Western Nepal. DESIGN: A mixed-method study. SETTING: The study was carried out at Raute temporary campsites in the Surkhet District of Karnali Province between May and September 2021. PARTICIPANTS: The questionnaire-based survey included all males and non-pregnant females of the nomadic Raute group aged 15 years and above. In-depth interviews were conducted among purposively selected 15 Raute participants and four non-Raute key informants to help explain and enrich the quantitative findings. OUTCOME MEASURES: The prevalence of hypertension (defined as brachial artery blood pressure of systolic ≥140 mm Hg and/or diastolic ≥90 mm Hg) and its sociodemographic, anthropometric and behavioural covariates. RESULTS: Of the 85 eligible participants, 81 (median age 35 years (IQR: 26-51), 46.9% female) were included in the final analysis. Hypertension was found in 10.5% of females, 48.8% of males and 30.9% of the total population. Current alcohol and tobacco use were high (91.4% and 70.4%, respectively), with concerning high rates among youths. Males, older people, current drinkers and current tobacco users were more likely to have hypertension. Our qualitative analysis suggests that the traditional forest-based Raute economy is gradually transitioning into a cash-based one that heavily relies on government incentives. Consumption of commercial foods, drinks and tobacco products is increasing as their market involvement grows. CONCLUSION: This study found a high burden of hypertension, alcohol and tobacco use among nomadic Raute hunter-gatherers facing socioeconomic and dietary transitions. Further research is needed to assess the long-term impact of these changes on their health. This study is expected to help appraise concerned policymakers of an emerging health concern and formulate context-specific and culturally sensitive interventions to limit hypertension-related morbidities and mortalities in this endangered population.


Assuntos
Hipertensão , Masculino , Adolescente , Humanos , Feminino , Idoso , Adulto , Nepal/epidemiologia , Estudos Transversais , Hipertensão/epidemiologia , Consumo de Bebidas Alcoólicas/epidemiologia , Uso de Tabaco , Prevalência , Fatores de Risco
3.
PLOS Glob Public Health ; 3(3): e0000671, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36962974

RESUMO

Positive deviance is an approach wherein learnings from persons who fare better than their peers under similar circumstances are used to enable behavioral and social change. Such behaviors and solutions are likely affordable, acceptable, sustainable, and fit into the socio-cultural milieu. Despite the wide use of positive deviance in many public health programs and research, it has yet to be used to study frontline workers in the context of COVID-19. Therefore, this study aimed to explore the positive deviance traits among frontline health workers during the early days of the COVID-19 pandemic in Nepal. This qualitative study followed a grounded theory approach. The data was collected through in-depth interviews among the 17 identified participants representing different cadres of the health workforce, types of health facilities, and regions across Nepal purposively. The findings are structured around four major themes: challenges, finding solutions and innovations, positive lessons, and motivations. The personal challenges included fear and anxiety about the uncertainties. The professional challenges included stigma, infection control, and changing work style with the use of personal protective equipment. Despite the challenges, they managed available resources and innovated low-cost, technological, and practice-based solutions. They were able to reflect upon the positive lessons learned, such as self-sustainability, teamwork, and policy direction and research, and self-reflection of personal growth and patient care. The intrinsic motivation included their inherent value system, and the extrinsic motivation included appreciation and acknowledgment, family and social support, psychosocial support from peers, and support from higher authorities. This study provides insights into how the positive deviance approach can help identify the solution amid the most challenging circumstances, such as the COVID-19 pandemic in low-resource settings. However, more extensive studies are warranted to explore deeper into positive deviance and its long-term effects in bringing positive outcomes during the pandemic.

4.
PLoS One ; 16(12): e0261524, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34969043

RESUMO

INTRODUCTION: The COVID-19 pandemic has affected the health systems in many ways. It has put unprecedented strain on health systems worldwide and exposed gaps in public health infrastructure. A health system comprises all institutions and resources working towards improving and maintaining health. Among the different aspects of health system strengthening, a patient's experiences and expectations play a crucial role in determining how well the health facilities function. This study aims to explore health system strengthening's implications based on experiences and feedback provided by COVID-19 patients admitted to a government tropical and infectious disease hospital in Nepal. METHODS: In this qualitative study, we collected the voluntary handwritten feedback by the admitted COVID-19 patients to document the feedback and experiences from a book, maintained by the hospital. We performed thematic content analysis using the World Health Organization's six building blocks of health system as a theoretical framework which included service delivery, health workforce, information, leadership and governance, financing, and access to medicines. RESULTS: Most patients in this study had positive experiences on service delivery and health workforce. Some also highlighted the gaps in infrastructure, cleanliness, and hygiene. Many suggested positive experiences on other dimensions of the health system such as financing, governance and leadership, and access to medicines reflected upon by the patients' thankfulness to the hospital and the government for the treatment they received. The responses also reflected the inter-connectedness between the different building blocks of health system. CONCLUSION: This study approached a unique way to strengthen the health system by exploring patients' feedback, which suggested an overall positive impression on most building blocks of health system. However, it also highlighted certain gaps in infrastructure, cleanliness, and hygiene. It reinforces the hospital management and government's role to continue its efforts to strengthen the health system.


Assuntos
COVID-19/epidemiologia , Atenção à Saúde , Pandemias , Medidas de Resultados Relatados pelo Paciente , Programas Governamentais , Hospitais , Humanos , Nepal/epidemiologia , Pesquisa Qualitativa , Inquéritos e Questionários
5.
BMC Med Ethics ; 22(1): 109, 2021 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-34353314

RESUMO

BACKGROUND: Importance of awareness of medical ethics and its integration into medical curriculum has been frequently highlighted. Study 1 aimed to assess the knowledge, attitude, and reported practices of medical ethics among clinicians at Patan Academy of Health Sciences, a tertiary care teaching hospital in Nepal. Study 2 was conducted to assess whether there was a difference in knowledge, attitude, and reported practices of medical ethics among doctors who received formal medical ethics education during undergraduate studies and those who did not. METHODS: Two cross-sectional surveys using self-administered questionnaires were conducted. Study 1 included 72 participants; interns, medical officers, and consultants working at Patan Academy of Health Sciences. Study 2 was a comparative study conducted among 54 medical officers who had received formal medical ethics education (Group 1) and 60 medical officers who did not (Group 2). RESULTS: Participants who had completed post-graduate education had higher knowledge (p = 0.050), practice (p < 0.001), and overall combined scores (p = 0.011). Participants with ethics education had higher knowledge (p < 0.001), attitude (p = 0.001), practice (p < 0.001), and overall score (p < 0.001). Most participants preferred consulting colleagues if an ethical dilemma arose. Fewer participants had heard of the Declaration of Helsinki. Most participants thought doctors to be most capable of judging what is best for the patient (Study 1: 70.42%, Study 2 Group 1: 42.59%, Group 2: 80%). Case scenarios in which participants demonstrated poor practice were ethical issues concerning truth-telling, end-of-life decisions, treating HIV/AIDS patients, treating a minor, and reporting colleague's errors. CONCLUSIONS: This study found that participants who have received medical ethics education have higher knowledge, attitude, and practice scores. The results further justify the need for medical ethics education to be a part of the core medical curriculum. A blame-free environment where seniors can be approached for advice should be created. Research ethics should also be given attention. During medical ethics training, ethical issues where doctors perform poorly should be given more priority and should be discussed in a country-specific context.


Assuntos
Ética Médica , Conhecimentos, Atitudes e Prática em Saúde , Estudos Transversais , Currículo , Hospitais de Ensino , Humanos , Nepal , Inquéritos e Questionários , Ensino
6.
JNMA J Nepal Med Assoc ; 58(230): 751-757, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34504358

RESUMO

INTRODUCTION: The government issued a country-wide lockdown in Nepal as a measure to curb the spread of COVID-19 pandemic. This has resulted in various difficult experiences which includes financial loss, separation from loved ones, grief, uncertainty over disease status and loss of freedom. During these stressful situations, interpersonal violence is likely to be aggravated. To avoid the occurrence of adverse events such as impulsive acts, homicide, or suicide, it is important to identify high-risk individuals. METHODS: This is a descriptive cross-sectional, questionnaire-based, online survey by convenience sampling. The prevalence of different types of interpersonal violence with socio-demographic factors, substance use, and overall mental wellbeing was assessed by using descriptive statistical tests. RESULTS: Out of total 556 participants included in the analysis, 50.9% (283) were male and 48.7% (271) were female. There were 100 (18.0%) participants who reported being a victim of interpersonal violence and 101 (18.2%) participants who reported being a perpetrator during the lockdown. The victims of violence were more likely to be living with their spouse alone. The victims and perpetrators were also more likely to have increased alcohol and tobacco use. More number of victims and perpetrators had lower mental wellbeing scores on the WHO wellbeing index. CONCLUSIONS: There was prevalence of interpersonal violence during the COVID-19 lockdown. In addition to the fear regarding pandemic, victims have to face domestic violence placing them at a double injustice. Identification of vulnerable groups and proper management of survivors must be prioritized given the unanimous consensus on the rise of interpersonal violence during periods of heightened stress.


Assuntos
COVID-19 , Violência Doméstica , Controle de Doenças Transmissíveis , Estudos Transversais , Feminino , Humanos , Masculino , Nepal/epidemiologia , Pandemias , SARS-CoV-2
7.
JNMA J Nepal Med Assoc ; 58(230): 744-750, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34504359

RESUMO

INTRODUCTION: COVID-19 pandemic has profoundly affected all aspects of society, including mental and physical health. Often missed is the fact that the pandemic is occurring against the backdrop of a very high prevalence of mental health issues. Protecting the mental health of people and healthcare workers is important for long-term positive health outcomes and proper control of the outbreak. METHODS: This is a descriptive cross-sectional, questionnaire-based, online survey by convenience sampling. Ethical approval was obtained from the institutional review committee of Nepal Health Research Council (reference no. 2467). Open access, pre-validated questionnaires were used. Participants with significantly poor Mental wellbeing were identified using the WHO well-being index threshold score. Descriptive statistical analysis was carried out. RESULTS: Five hundred and fifty-six participants were included in the analysis. Forty percent of the participants reported a WHO well-being index score of below 13, indicative of poor mental wellbeing and a need for further assessment for depression. Poor Mental wellbeing was more prevalent among participants less than 30 years of age, female gender, never married, diagnosed mental disorder, living alone and those using informal sources for COVID-19 related information. More participants with lower sleep quality score and higher perceived stress score reported poor Mental wellbeing. CONCLUSIONS: Combating this challenge requires integration across disciplines. One potential part of the solution is psychological intervention teams. An emerging positive connotation to the pandemic is that it needs to be harnessed as a tool for improving health facilities, community participation, and fighting misinformation.


Assuntos
COVID-19 , Pandemias , Controle de Doenças Transmissíveis , Estudos Transversais , Feminino , Humanos , Nepal/epidemiologia , SARS-CoV-2
8.
JNMA J Nepal Med Assoc ; 58(232): 1046-1051, 2020 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-34506372

RESUMO

INTRODUCTION: Nepal government enforced a lockdown as a social distancing measure to curb the COVID-19 pandemic. The lockdown has led to compromises in day to day choices like food, exercise, sleep, self-care routines and utilization of healthcare facilities - directly and indirectly influencing aspects of health. Identification of compromised health choices can assist in better planning of inevitable future crises. METHODS: This is a cross-sectional descriptive study based on an online self -administered questionnaire, done using CHERRIES criteria, conducted from March 30, 2020, to July 31, 2020. Ethical approval for the study was obtained from the Institutional Review Committee of Nepal Health Research Council (Registration number: 2119; 300/2020 P). Descriptive statistics was used for analysis. RESULTS: Our study had 340 (51%) female and 325 (48.7%) male participants. A total of 112 (67.9%) reported decreased consumption of tobacco and 178 (53.6%) reported decreased consumption of alcohol during the lockdown period. Participants who reported that they would have visited a hospital if they had a flu-like illness increased from 151 (22.6%) pre-pandemic to 391 (58.6%) post-pandemic. Increase in news consumption was reported by 528 (79.2%). Out of 43 (6.4%) participants with a chronic condition, 30 (69.8%) reported having missed follow up due to the lockdown. CONCLUSIONS: The health of an individual is determined by various choices s/he makes on a day to day basis. Many of those choices are in turn influenced by the availability and accessibility of commodities. Lessons learned from the affected lives due to COVID-19 can be used in proper planning of inevitable future crises.


Assuntos
COVID-19 , Pandemias , Controle de Doenças Transmissíveis , Estudos Transversais , Feminino , Humanos , Masculino , SARS-CoV-2
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