Nobel Academy

<title>Abstract</title> <bold>Background:</bold> Research on healthcare access barriers among people with hearing loss in Nepal is limited, and studies focusing on Deaf adolescents are particularly scarce in low- and lower-middle-income countries. This study explored healthcare access barriers among Deaf adolescents whose primary mode of communication is sign language. <bold>Methods:</bold> A descriptive, cross-sectional study using quantitative and qualitative methods was conducted at Dhaulagiri Deaf Residential Secondary School in Baglung, Nepal, the only secondary-level institution offering a diploma in computer engineering and enrolling students from across the country. A total of 135 Deaf students from grade eight to diploma level completed structured questionnaires. In-depth, face-to-face interviews were conducted with 10% of diploma-level students, randomly selected by lottery. Four barrier categories were assessed: structural, communication with healthcare providers (HCPs), attitudes of HCPs, and financial. <bold>Results:</bold> Participants had a mean age of 19.9 years (SD 2.85); 70.4% were male and 53.3% were diploma students. Most participants (90.4%) did not use assistive listening devices, and 74.1% reported congenital hearing loss. Structural barriers included long waiting times (64.4%) and transportation challenges (11.9%). Communication barriers were frequent: 25% had access to interpreters, and 37.8% reported easy communication with HCPs. Attitudinal barriers were reported, with only 31.1% finding HCPs friendly and 27.4% comfortable during interactions, while 15.6% even experienced mistreatment by HCPs. Financial barriers included cost-related difficulties, limited awareness of health insurance (37%), and low coverage (4.4%). Qualitative interviews highlighted difficulties in understanding rapid speech, raising doubts regarding medications. Participants felt that HCPs seemed unaware of their challenges in comprehending communications. <bold>Conclusions:</bold> Communication difficulties and HCPs’ attitudes were the most prominent barriers to healthcare access among Deaf adolescents. These findings highlight the pressing need for deafness awareness programs for HCPs to improve healthcare accessibility for Deaf and hard-of-hearing people.

Background: Minimum dietary diversity for children (MDD-C) is a benchmark developed by the World Health Organization (WHO) to assess diet diversity in infants and young children worldwide. The lack of such diet diversity among growing children, which often leads to malnutrition, has been considered a significant public health concern in Nepal. This study is to assess the dietary diversity and associated factors among children aged 6-59 months in wards 2 and 3 of Madhyapur Thimi Municipality. Methods: A cross-sectional descriptive study was carried out by measuring the research variables in 2023 among the residents of wards number 2 (Jatigaal) and 3 (Kaushaltar) of Madhyapur Thimi Municipality. The survey was created and administered by the researchers themselves. The sample size of the study was 385. The survey includes a structured questionnaire to assess dietary diversity and associated factors among children aged 6-59 months. The association between the factors was measured by using Fisher’s Exact test. Results: 73.5% of the study population fulfilled the minimum requirement of dietary diversity. Factors such as the mother’s educational status (p=0.002), mother’s ethnicity (p=0.015), monthly expenditure on food (p=0.001), awareness of communicable diseases (p=0.001), feeding times a day (p=0.001), personal hygiene practices status (p=0.004), and awareness of junk foods (p=0.001) showed a significant association with MDD-C. Conclusion: Increasing mothers’ awareness about junk food, communicable diseases, and the importance of their hygiene practices via formal or informal education campaigns is necessary to increase the proportion of children meeting the MDD-C benchmark and prevent malnutrition.

Introduction: Carbapenem resistance, due to the production of carbapenemase enzymes in various bacteria, is responsible for numerous outbreaks and is significantly associated with healthcare-associated infections.Metallo--lactamases (MBLs) are carbapenemases that hydrolyze all -lactam antibiotics except monobactams.The most prominent bacteria exhibiting this resistance mechanism include members of the Enterobacteriaceae family and Pseudomonas aeruginosa.Therefore, this study aims to assess the prevalence of MBL production among Gramnegative bacteria at Kirtipur Hospital.Methods: This study was conducted at Kirtipur Hospital from June 26, 2022, to September 28, 2022.Organisms were isolated and identified from clinical samples including urine, blood, wound swabs, sputum, tissues, pus, catheter tips, and other body fluids, following standard laboratory protocols.Carbapenemase production was detected using the modified Carbapenem Inactivation Method (mCIM), with metallo--lactamase (MBL) production confirmed by the EDTA-modified Carbapenem Inactivation Method (eCIM) test.Results were interpreted according to the Clinical and Laboratory Standards Institute (CLSI) guidelines, M100, 31st ed., 2021.Results: From 1988 clinical samples, 388 Gram-negative bacteria were isolated, with Escherichia coli, Klebsiella pneumoniae, and P. aeruginosa being the predominant species.Antibiotic susceptibility testing revealed that Amikacin was the most effective against Enterobacteriaceae, exhibiting a susceptibility rate of 84.05%.In contrast, Cefepime was the most effective against non-Enterobacteriaceae Gramnegative bacteria with susceptibility rate of 60%.Screening identified 23.40% (84/359) of isolates as potential carbapenemase producers, with 15.32% (55/359) confirmed as carbapenemase producers via mCIM.Of these, 56.36% (31/55) were MBL producers, representing 8.63% (31/359) of all screened isolates.Among confirmed carbapenemase producers, P. aeruginosa exhibited the highest MBL production rate at 77.78% (7/9 isolates), followed by K. pneumoniae at 73.68% (14/19), E. coli at 41.18% (7/17), C. koseri at 33.33% (2/6), and P. mirabilis at 25% (1/4).Conclusion: This study underscores the significant threat posed by MBL-producing E. coli, K. pneumoniae, and P. aeruginosa in this healthcare setting.Therefore, implementing routine screening for MBL-producing organisms in diagnostic laboratories is crucial for controlling the spread among hospital patients and guiding effective antibiotic therapy.

Unemployment is an important issue in the economy, especially in Bangka Belitung Province which faces challenges in absorbing high school graduates into the job market. This analysis aims to evaluate the influence of the workforce and labor force on the unemployment rate in the area. This study uses secondary data analyzed using the multiple regression method through SPSS software. The variables analyzed include the workforce and labor force as independent variables, with the unemployment rate as the dependent variable. The t-test is used to test the significance of the influence of each independent variable, while the F-test is used to evaluate the overall significance of the regression model. The determination test (R²) is applied to assess how much of the variation in the unemployment rate can be explained by the model. The results of the t-test indicate that the workforce and labor force each have a significant influence on the unemployment rate. A positive coefficient for the workforce indicates that an increase in the workforce is associated with an increase in the unemployment rate, while a coefficient for the labor force indicates that an increase in the labor force is associated with a decrease in the unemployment rate. The F-test shows that the multiple regression model as a whole is significant in explaining the variation in the unemployment rate. The R² value indicates that this model can explain most of the variation in the unemployment rate

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

Materiovigilance (Mv) has the same purpose and approach in ensuring patient safety as pharmacovigilance but deals with medical devices associated with adverse events (MDAEs) and their monitoring. Mv has been instrumental in recalling many defective or malfunctioning devices based on their safety data. All MDAEs, such as critical or non-critical, known, or unknown, those with inadequate or incomplete specifications, and frequent or rare events should be reported and evaluated. Mv helps to improve medical devices’ design and efficiency profile and avoid device-related complications and associated failures. It alerts consumers and health professionals regarding counterfeit or substandard devices. Common events reported through Mv are device breakage and malfunction, entry- and exit-site infections, organ perforations or injuries, need for surgery and even death, and life cycle assessment of devices. Health authorities globally have developed reporting frameworks with timeframes for MDAEs, such as MedWatch in the USA, MedSafe in New Zealand, and others. Health professionals and consumers need to be made aware of the significance of Mv in ensuring the safe use of medical devices and getting familiar with the reporting procedures and action plans in case of a device-induced adverse event.

Abstract Healthcare waste management (HCWM) is a coordinated and holistic approach starting from the generation of wastes to their safe disposal to protect the health professionals, patients, caretakers, and the community people from their health and environment hazards. The chapter aimed to provide information on health care waste (HCW) categories and their management scenario, pre- and post-COVID scenarios of HCWM, and important legislative measures for HCWM in Nepal. Relevant articles were extracted from PubMed, Google Scholar, ResearchGate, and relevant websites using the key terms such as “healthcare waste management” OR “medical waste management” OR “biomedical waste management” OR “clinical waste management” AND “COVID-19” OR “Coronavirus” OR “SARS-CoV-2” in Nepal. Public hospitals generated more HCWs than the private hospitals due to the high patient flow in the former. Liquid wastes are generated from different departments of hospitals such as operation theaters, medical laboratories, medical wards, gynecology-obstetrics procedures, and other sources. Nepal has banned purchase and use of mercury devices in all healthcare facilities to minimize or avoid the mercury hazards on health and environment. Government of Nepal introduced some guiding principles for COVID-19 related HCWM and some interim guidance documents in Nepal for the management of HCWs in the COVID periods.KeywordsHealth care waste managementCOVID-19LegislationHealth and environment HazardsNepal