Nepal Journal of Health Sciences

Self-Directed Learning, its Implementation, and Challenges: A Review

Aashma Dahal — 2023-12-29

This narrative review discusses self-directed learning, its implementation, and the roles of various bodies, a guiding framework, and challenges to implementing it. It’s an educational method in which learners plan, implement, and assess their learning, align with those of 21st-century education. By becoming self-directed learners, individuals gain critical thinking skills, digital tool proficiency, and the ability to retrieve information efficiently, employ appropriate learning methods by developing a strategic approach to learning, and extend learning beyond the classroom. It nurtures a growth and lifelong learning mindset necessary to succeed in a rapidly changing world. Furthermore, it can be a powerful and effective tool for navigating the ever-demanding field challenges of the healthcare profession. Although accrediting standards worldwide have acknowledged their significance, many institutions do not adopt them due to a need for a change in mindset from traditional approaches. Students and educators accustomed to teacher-led methods may struggle with it. It can, however, be easily embraced and implemented by educators and students with deliberate planning and targeted training by institutions. An integrated approach is necessary to successfully integrate self-directed into healthcare education. Students' readiness should be assessed, their roles understood, and digital literacy encouraged.

Diabetes Self-Management Practices among Diabetic Patients Attending Chitwan Medical College Teaching Hospital

Harish Chandra Ghimire — 2023-12-29

Introduction: Diabetes is a new health issue that affects many people around the world. The majority of the diabetic population lives in low-and middle-income countries. Diabetes has badly affected individuals, families, and countries. This problem can be minimized and managed through effective self-management practices.

Objective: The present study aims to identify the level of self-management practices among type 2 diabetes mellitus patients.

Methods: A descriptive and analytical cross-sectional study design was used to assess diabetes self-management practices. A standard ‘Summary of Diabetes Self-Care Activity’ tool was adopted with few modifications after pretesting. This study was carried out among 191 samples with diabetes type-2 patients attending the outpatient department of Chitwan Medical College Teaching Hospital. The non-probability consecutive sampling method was adopted for data collection. Ethical principles were addressed during the study.

Results: Among the total participants, 51.8% had unsatisfactory diabetes self-management practices. Age, education, place of residence, religion, occupation, family history, comorbidity, duration of diagnosis, alcohol drinking, and smoking were associated with diabetes self-management practice. There were 55.5% male participants. The majority, 42.4% belonged to the age group 60 and above. The minimum age was 30, the maximum age was 94, and the mean age was 56.9 years. The majority (77%) of participants were literate.

Conclusions: This study revealed an unsatisfactory level of diabetes self-management practices. This finding implies that diabetes self- management practice-related education programs should be created and implemented for people who are impacted, as well as for those who provide care at home.

Depression, Anxiety and Stress among Undergraduate Medical Students of a Medical College in Nepal: A Descriptive Cross-Sectional Study

Sidarth Timsinha — 2023-12-29

Introduction: Medical school has a stressful environment where students are confronted with significant academic, psychological and existential stressors that are often under-recognized and undertreated. The Medical education system has been improving in Nepal; however, only limited research has been conducted concerning the mental health status of medical students.

Objective: To estimate the prevalence of depression, anxiety, and stress and their associated risk factors among medical students of a teaching hospital in Nepal.

Methods: This was a descriptive cross-sectional online questionnaire-based survey conducted over a period of one month from September to October 2020 in the Department of Forensic Medicine at Manipal College of Medical Sciences (MCOMS), Pokhara, Nepal. The study included undergraduate students from the first to the fifth year. The sample was collected using a convenience sampling method. The Depression Anxiety and Stress Scale (DASS-21) was used as a tool to evaluate depression, anxiety, and stress among medical students.

Results: The overall prevalence of depression, anxiety and stress among undergraduate medical students was 143(46.43 %), anxiety 180(58.44%) and stress 90(29.22%) respectively. Female students reported higher levels of depression 87(53.40%), anxiety104(63.80%) and stress 53(32.52%) than male students 56(38.60%),76(52.41%) and 37(25.52%) respectively. The major risk factors associated with depression, anxiety, and stress were a personal history of psychiatric illness and academic dissatisfaction.

Conclusions: Depression, anxiety, and stress were all prevalent among undergraduate medical students. Understanding mental problems among medical students would help develop and incorporate student wellness programs to prevent the negative effects of poor mental health.

Effectiveness of Structured Teaching Programme Regarding Prevention of Infection in Hospitalized Neonates Among Nursing Students

Laxmi Paudyal — 2023-12-29

Introduction: Neonatal infection presents with systemic signs of infection and the detection of bacteria or other pathogens in the bloodstream. Infants are particularly vulnerable to bacterial sepsis, and the incidence of sepsis in the neonatal intensive care unit surpasses that of any other hospital department. Educating caregivers through instructional programs can prove beneficial in preventing these infections.

Objective: The aim of the study was to assess the effectiveness of a structured teaching program in preventing infection in hospitalized neonates.

Methods: A study was conducted among 96 nursing students enrolled in a bachelor-level nursing program at a selected nursing college in Pokhara. The students were chosen using a complete enumerative sampling technique to ensure a diverse group. Data was collected from the nursing students using a self-administered semi-structured knowledge questionnaire. The collected data was analyzed using descriptive and inferential statistics.

Results: The findings indicate that 56.25% of the participants possess a moderately adequate level of knowledge, while 31.25% have an inadequate knowledge level in the pre-test. However, after the post-test, there was a significant increase in the knowledge score, with 75% of the respondents demonstrating an adequate level of knowledge. The structured teaching program proved to be effective in enhancing the knowledge level among nursing students, as evidenced by a t-test value of 16.89 (p<0.05).

Conclusions: A study found that implementing a structured teaching program effectively improves nursing students' knowledge level. This equips them with the necessary knowledge to prevent neonatal infections, reducing morbidity and mortality rates among new-borns.

Physical and Mental Health Problems among Elderly in Selected Geriatric Homes of Makawanpur District

Anu Bajracharya — 2023-12-29

Introduction: With the advancing age, there comes increased risk of medical illness, psychiatric problems and use of medication, all of which may adversely impact on the physical and mental health status of the elderly. Studies investigating physical and mental health problems among elderly in geriatric homes are rare in Nepal.

Objective: The objective of this study was to assess the physical and mental health problems among elderly of selected geriatric homes of Makawanpur district.

Methods: A descriptive cross-sectional research design was carried out among the old people of three geriatric homes of Makawanpur district. Data was collected through structured interview schedule consisting of demographic, medical history and social information including geriatric depression scale and geriatric anxiety scale. Data was analyzed by using SPSS version 16 using descriptive statics.

Result: A total of 84 respondents in the study, 90.2% of the respondents having physical symptoms. Among them pain (90.2%), weakness (26.6%), fatigue (18.3%) were the common symptoms. Furthermore, 76.8% of elderly were having physical health problems and more common problems were hypertension (55.55%), Diabetes (33.33%) and asthma (25.57%). Similarly 36.4% of the respondents had depression and 39% have anxiety.

Conclusion: Based on the findings, it is concluded that hypertension, diabetes and asthma were more common physical problems and depression, anxiety were more common mental health problems among old people. Therefore, provision of regular health check-up program for elders can enhance their physical as well as mental health so that complications can be prevented in time.

Quality of Life among Elderly People and its Associated Factors in Makwanpur District: A Descriptive Cross-Sectional Study

Sagun Kharel — 2023-12-29

Introduction: Aging is a universal process and it affects every individual, family, community, and society. It is a normal, progressive, and irreversible process.

Objective: To assess quality of life among elderly people at old age home of Makwanpur district, Nepal.

Methods: A descriptive cross-sectional study was conducted among 82 elderly people in old age home using complete enumeration sampling. A structured interview session was conducted by using WHOQOL-BREF tool. Data analysis was done in SPSS version 20 using descriptive statistics such as frequency, percentage, mean and standard deviation. Inferential statistics such as Chi square test was used to determine association.

Results: Out of 82 respondents, majority of the respondents perceived QOL as neither poor nor good. Among total respondent's, 36.6% were satisfied with overall perception of health. Also the study revealed the mean score was found higher in physical and psychological domain (50.609±11.75) and 50.304±12.13 respectively. The overall quality of life was found to be 71.292 which is good quality of life. There was significant association of age and religion with physical domain.
Conclusions: The study concludes the overall quality of life was good among elderly. The mean score was found to be higher in physical and psychological domain in comparison to environmental and social relationship domain. Significant association was found in physical domain with age and religion.

Empathy among Undergraduates in an Academy of Health Sciences in Hetauda, Nepal

Sanyukta Gurung — 2023-12-29

Introduction: Empathy is the ability to understand one’s perspective and experience, and further use this understanding to communicate with the other person. It has been incorporated as one of the learning objectives by the Association of American Medical Colleges. Empathy in a profession may decline with the pressure of a job or the other way may improve with experience.

Objectives: The objective of this study is to measure the empathy score among undergraduate students of an Academy in Hetauda.

Methods: This is a cross sectional analytical study conducted among 96 undergraduate students. Jefferson Scale of Empathy Health
Profession Students’ version was used to measure the empathy scores among the participants.

Results: The mean empathy score of the students in Madan Bhandari Academy of Health Sciences was 98.71±15.62. Mean empathy score was significantly higher among the female participants (103.56 ± 14.07 vears 93.43 ± 15.66). The highest mean empathy score was observed among the third semester students 110.18±11.28. A significant difference was observed among the mean empathy values in accordance with discipline where Bachelors of Public Health had the highest mean empathy value 107.95±12.65. In accordance with age the relatively younger age group had higher mean empathy value where males had a mean value of 104.03 ± 13.85 and females had a mean value of 95.83 ± 15.73.

Conclusion: Females had a higher mean empathy score than males. Students in the third semester had the highest mean empathy score. Relatively younger students had a mean higher empathy score.

Study of menopausal symptoms and perception about menopause among postmenopausal women residing in Mechinagar municipality

Bindu Nepal — 2023-12-29

Introduction: Menopause is the end of a woman's menstrual cycles and an important biomarker of both fertility loss and menopausal symptoms. Menopausal health has received limited attention in developing countries until more recent times. As women's status in society continues to improve, an increasing number of them are now seeking assistance for their menopausal issues.

Objective: To determine prevalence of menopausal symptoms and assess the perspectives of postmenopausal women regarding the menopausal experience.

Methods: A cross-sectional descriptive study was conducted on 162 women in postmenopausal phase, specifically those aged between 45 and 60 years, residing in Mechinagar municipality. The study included women who had not had a menstrual cycle in the previous year. The study employed convenient sampling technique. The study applied the Menopause Rating Scale (MRS) to find presence of menopausal symptoms and its severity.

Results: The participants had an average age of 55.72 (SD ± 4.401 ) years. The mean age for menopause was of 47.17 years, with a standard deviation of ±4.473. Among the women surveyed, the most frequently reported menopausal symptoms included somatic symptoms such as heart discomfort, urogenital symptoms like bladder problems, hot flushes, joint and muscular pain, , and psychological symptoms such as irritability. Majority 143 (88.3%) of the respondents had MRS score of less than 16. There was a predominantly positive perception of menopause.

Conclusion: The findings of this study indicated a high prevalence of menopausal symptoms, but these symptoms were generally of low severity. There was at least one menopausal symptom reported by each postmenopausal woman who participated in this study.

Bacterial Uropathogens causing Urinary Tract Infection at Hetauda Hospital

Ajay Yadav — 2023-12-29

Introduction: Urinary tract infection is the infection of the uroepithelium that mainly affects kidney, ureter, urinary bladder and urethra. The causative agents of urinary tract infections are bacteria and fungi. Among these, bacteria are the most causative uropathogens of urinary tract infections.

Objectives: The objective of this study is to isolate, identify, characterized and perform antibiotic sensitivity test from the bacterial isolates.

Methods: A descriptive cross-sectional study was conducted from March 2023 to May 2023. Ethical approval was obtained from Institutional Review Committee (IRC), Madan Bhandari Academy of Health Sciences, IRC-32-079. Total of 1120 urine samples were collected during this study. Convenient sampling technique was used for this study. Clean catch or mid-stream urine was collected in a sterile container. All urine samples were submitted to Department of Microbiology for culture. A set of biochemical tests were done for bacterial identification. Antibiotic sensitivity test was performed by Kirby-Bauer disk diffusion method.

Results: Total of 1120 urine samples were collected from patients suspected to Urinary Tract Infections. Total urine culture positive was 340 (30.36%). Of these bacterial isolates, Escherichia coli (248, 73%) was the most common species, followed by Klebsiella species (26, 7.6%), Staphylococcus saprophyticus (23, 6.76%) and Enterococcus fecalis (18, 5.3%).

Conclusion: As prevalence of bacteria causing urinary tract infections is increasing day by day; so its proper isolation, identification, characterization with their antibiotic profile is necessary as it forms the base line for the clinicians to choose appropriate antimicrobial agents for empirical as well as rational treatment for UTIs.

Level of Anxiety among Medical Students: A Descriptive Cross-Sectional Study

Binod Kumar Yadav — 2023-12-29

Introduction: Anxiety is one of the common psychological disorders showing more prevalence among medical students. Symptoms seen in the anxiety are excessive fear- worry and negative thoughts. In India and Pakistan have reported prevalence of anxiety consist of 66.9% and 44.7% % among undergraduate medical students, respectively. This study aims to find out the prevalence of anxiety among medical students.

Objective: To assess the prevalence of anxiety among medical students of fourth year MBBS students of National Medical College and Teaching Hospital, Birgunj, Nepal.

Method: A descriptive cross-sectional study was done to observe prevalence of anxiety in medical students of fourth year by using Hamilton Anxiety Rating Scale questionnaire. Data was entered and analyzed by the use of Statistical Package for Social Sciences version 20.0

Result: The prevalence of anxiety among the students was found to be 70.4%, where as 64.3% students had mild and moderate anxiety, 6.1% of them had severe anxiety. The prevalence of anxiety among male students was 53.6%.

Conclusion: Anxiety of prevalence was high among medical students. Rate of anxiety was more in male.

Oxidative Stress and Glycaemic Control in Type 2 Diabetes Mellitus

Tapeshwar Yadav — 2023-12-29

Introduction: There is growing evidence that excess generation of highly reactive free radicals largely due to hyperglycaemia cause oxidative stress which further exacerbates the development and progression of type 2 diabetes mellitus and its complications.

Objective: This study aims to assess glycaemic status and oxidative stress in type 2 diabetes mellitus patients.

Methods: Forty confirmed Type 2 diabetes mellitus patients registered with the General Medicine department of Mamata General Hospital, Khammam, Andhra Pradesh were selected for the study. Based on HbA1 c levels these patients were subdivided into two groups one with HbA1 c levels >8.5% was considered poor glycaemic control and the other with HbA1 c levels ≤8.5% was considered as good glycaemic control. Malondialdehyde and total antioxidant capacity were measured among the cases and controls.

Results: This study reveals the comparison of glycated haemoglobin, malondialdehyde, and total antioxidant capacity in 40 confirmed cases of Type 2 Diabetes Mellitus, which included 19 good glycaemic control and 21 poor glycaemic control. Firstly, the comparison of HbA1C (P value: 0.01), MDA (P value: 0.02) and TAC (P value: 0.04) revealed the significant difference between good glycaemic control and poor glycaemic control. Moreover, the Pearson correlation revealed a significant positive correlation of HbA1C with MDA (+0.72, 0.02) and a negative correlation with TAC (-0.01, 0.7) which was not statistically significant.

Conclusions: It is observed that poor glycaemic control has resulted in increased oxidative stress and decreased antioxidant capacity which can ultimately lead to complications. Antioxidant supplementation may help the patients in overall improvement and may delay the complications.

Knowledge, Attitude, and Practice of Ergonomics Principles among Undergraduates Studying Bachelor of Dental Surgery

Deepak Kumar Roy — 2023-12-29

Introduction: Ergonomics is the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance. Successful application of ergonomics, assures high productivity, evasion of illnesses and injuries, leading to increased satisfaction among workers. On the other hand, unsuccessful application can lead to work-related musculoskeletal disorders (MSDs) among dental professionals.
Objective: The objective of this study was to assess knowledge, attitude, and practice of ergonomics principles among undergraduates
studying bachelor of dental surgery.

Methods: A descriptive cross-sectional study design was carried out among 172 students studying bachelor of dental surgery at
Kathmandu Medical College, Kathmandu Nepal. Census technique was used to collect the data. A structured questionnaire was used as a data collection tool.

Results: The study revealed that nearly (69) 40% of the students had a knowledge about the ergonomic principles. Whereas, (112) 65%
students of all the years as a whole had a good attitude towards ergonomics. But only (34) 20% students as a whole were using the
principles of ergonomics into practice.
Conclusions: Although, (69) 40% had knowledge about ergonomics in dentistry. Only (34) 20% of the students had a practice
of ergonomics . Thus, improvement in the level of knowledge is required but more importantly the application of knowledge into practice is recommended for better dental practice.

Smile Revival: Hollywood Bridge Appliance for the Esthetic Rehabilitation in a Preschooler

Shreebindu Sharma — 2023-12-29

Dental caries affects people of all ages, often leading to early loss of teeth in children. Early childhood caries starts with the primary maxillary anterior teeth, then primary molars, with about 48% of preschoolers experiencing it worldwide. Rehabilitating a young child with multiple missing teeth due to caries or trauma is a challenging task for any pediatric dentist. Parents often seek aesthetic treatments to preserve their child's appearance and boost their self-confidence. In this case report, a 41⁄2-year-old girl was given a fixed Hollywood bridge appliance, enhancing her appearance, speech, and function while preventing harmful oral habits and boosting her confidence.