Browsing by Author "Risal, A"
Now showing 1 - 12 of 12
Results Per Page
Sort Options
Publication A Cross-Sectional Comparison of Drinking Patterns, Alcohol Use and Related Medical Morbidities in a Secondary Versus Tertiary Setting(Kathmandu University, 2013) Risal, A; Tharoor, HABSTRACT Background Alcohol Dependence exists in different spectrums at different settings and associated with various medical morbidities, disability and health care utilization costs. Objectives To study the drinking patterns, alcohol use disorders and alcohol related medical morbidities in patients diagnosed with Alcohol Dependence Syndrome (ADS) and attending out / in-patient psychiatry services at secondary and tertiary care centre. Methods A cross-sectional comparative study was done among the patients diagnosed with ADS attending psychiatry services at District hospital, Udupi and Kasturba Hospital, Manipal. Serial sampling was done. Patients having any other psychiatric illnesses were excluded. The two groups were compared in relation to socio-demographic variables, drinking related variables, patterns of drinking and alcohol related medical morbidities identified. Results Significant differences in some socio-demographic parameters among the patients from the two different treatment centers were found with secondary level hospital (N=50) having more illiterate, laborers and below the poverty line population in comparison to the tertiary level hospital (N=75). Maximum frequency of gastro- intestinal morbidities was seen in both the hospital population, irrespective of the patterns of drinking. Conclusion Alcohol use disorders and alcohol related medical morbidities show some variations in their presentations in the different treatment centers. KEY WORDS Alcohol dependence, medical morbidities, treatment centerPublication Common Mental Disorders(Kathmandu University, 2011) Risal, AABSTRACT Common mental disorders are a group of distress states manifesting with anxiety, depressive and unexplained somatic symptoms typically encountered in community and primary care settings. Risk factors for these disorders are mainly lower socio- economic status, psychological illnesses, poor reproductive health, gender disadvantage and physical ill-health. WHO has recommended that treatment of all these disorders should be based in primary care to be more effective and accessible to all the community people. The structure of mental health care in primary care is generally understood in terms of the “pathways to care” model and it plays a major role in countries like ours where community-based mental health services do not exist. Both the psychological and pharmacological therapies are found to be equally effective for treating these disorders. Integration of mental health into primary care can be considered as the stepping stone in the way forward to tackle the barriers and problems in effective management of common mental disorders in the community. The acute shortage of mental health professionals and the relatively low levels of awareness about mental disorders make it mandatory that primary health care should remain the single largest sector for mental health care in low and middle income countries like ours. KEY WORDS anxiety, depression, mental disordersPublication Measuring Neuroticism in Nepali: Reliability and Validity of the Neuroticism Subscale of the Eysenck Personality Questionnaire(Kathmandu University, 2015) Manandhar, K; Risal, A; Linde, M; Koju, R; Steiner, TJ; Holen, AABSTRACT Background The Neuroticism subscale of the Eysenck Personality Questionnaire Revised Short Form (12 items) (EPQRS-N) has proven to be a reliable and valid measure in multiple languages. Objective To develop a single-factor Nepali-language version of the EPQRS-N for use in the adult population of Nepal. Method The original English version of EPQRS-N was translated into Nepali using a forward- backward translation protocol. The first set of translated items was modified after testing by factor analysis with principal component extraction in an outpatient sample. Items with low factor correlations or poor semantic consistencies were reworded to fit the gist of the original items in a Nepali cultural context; the revised version was then tested in a representative random sample from the general population. Again, the same statistical procedures were applied. Results The first trial gave three factors. Based on the factor distribution of the items or their semantic quality, five were reworded. In the second trial, a two-factor solution emerged; the second factor had only one item with high correlation, which also had modest correlation with the first factor. Accordingly, a forced one-factor solution was chosen. This gave an internal consistency (Cronbach’s alpha) of 0.80, with item-to- factor correlations from 0.40 to 0.73, and item-to-sum correlations from 0.31 to 0.61. Conclusion The final Nepali version of EPQRS-N achieved satisfactory internal consistency. The item distribution coincided with the original English version, providing acceptable construct validity. It is psychometrically adequate for use in capturing the personality trait of neuroticism, and has broad applicability to the adult population of Nepal because of the diversity of the participant samples in which it was developed. KEY WORDS Eysenck personality questionnaire, global campaign against headache, item translation, Nepal, neuroticism, personality traits, trans-cultural psychiatryPublication Psychiatric Illness in the Paediatric Population Presenting to a Psychiatry Clinic in a Tertiary Care Centre(Kathmandu University, 2010) Risal, A; Sharma, PPABSTRACT Background A variety of psychiatric manifestations can be seen in children below the age of 18 years. Such cases rarely present directly to psychiatric care. Methods Retrospective study in Tertiary care hospital . The study population included all the patients of paediatric age group presenting to Psychiatry Outpatient Department of Dhulikhel Hospital directly or referred by a paediatrician or other specialists from October 2008 to October 2010. Results Among the paediatric population evaluated in the psychiatry clinic for two years from October 2008 to October 2010 (N=168), 66.7% were in the age group 15-18 years {mean = 14.77 (±2.99)}, 71.4% were female and 42.3% belonged to Brahmin cast. The highest number of (15%) patients was seen during the month of August 2010. Six months analysis of the psychiatric illnesses of the patients from April 2010 up to October 2010 (n=80) showed dissociative disorder (15%), and seizure disorder (15%) to be the most common diagnoses, followed by depressive disorder and intentional self harm (ISH) (13.8% each). 15% of patients were found to be treated by magico-religious means, with the majority of patients (66.7%) diagnosed as having dissociative disorder. Conclusion The majority of the paediatric population presenting to a psychiatry clinic were in the age group 15-18 years and of female sex. Dissociative disorder was the most common diagnosis followed by depressive disorders. The majority of patients with dissociative disorder had previously been treated by magico-religious means. Key Words dissociative disorder, paediatric population, psychiatric profilePublication Reliability and Validity of a Nepali-language Version of the Hospital Anxiety and Depression Scale (HADS)(Kathmandu University, 2015) Risal, A; Manandhar, K; Linde, M; Koju, R; Steiner, TJ; Holen, AABSTRACT Background In several languages and settings, the Hospital Anxiety and Depression Scale (HADS) has demonstrated reliable and valid screening properties in psychiatry. Objective To develop a Nepali version of HADS with acceptable reliability and construct validity for use among hospital patients and in the general population. Method The original English version was translated into Nepali using a forward-backward translation protocol. Psychometric properties were tested by factor analysis and Cronbach’s alpha. The translated scale was administered to three groups of adult in-patients in a university hospital in three trials, and to a sample of adults from the community in a fourth trial. Some of the 14 items were reworded reiteratively to achieve viable semantic and statistical solutions. Results The two-factor solution with anxiety and depression subscales eventually explained 40.3% of the total variance. Cronbach’s alpha was 0.76 for anxiety (HADS-A) and 0.68 for depression (HADS-D). All seven HADS-A items showed at least acceptable item-to-factor correlations (range 0.44-0.74), and full construct validity was achieved for this subscale. Item-to-factor correlations for six HADS-D items were also at least acceptable (range 0.42-0.70); one item (D4) had persistently low correlations throughout all trials, although construct validity was still satisfactory. Conclusion Reiterated rewording of items guided by statistical testing resulted in a Nepali version of HADS with satisfactory psychometric properties. KEY WORDS Item translation, psychometrics, psychopathology, screening, transcultural psychiatry.Publication Screening for Postpartum Depression and Associated Factors among Women who Deliver at a University Hospital, Nepal(Kathmandu University, 2015) Kunwar, D; Corey, E K; Sharma, P; Risal, AABSTRACT Background Postpartum depression (PPD) is a neglected area of maternal health care in developing countries like Nepal; not only in the treatment aspect, but also, in the areas of research. However, it is important to identify and treat postpartum depression because it can have grave consequences for both the mother and her children. Objective To determine the screening prevalence and risk factors of postpartum depression, among women who deliver at university hospital Nepal. Method This is a cross-sectional study investigating the relationship between postpartum depression and various factors. A total of 100 postpartum women who presented to a Dhulikhel hospital for delivery were interviewed on days 2-3 after delivery. The mothers were administered Edinburgh Postnatal Depression Scale (EPDS) as well as a proforma that included questions about the known risk factors (sociodemographic and sociocultural factors, and mother-related, pregnancy-related, and child related factors). Result The overall screening prevalence of depressive symptoms in the postnatal period (defined as EPDS=>13) was 29 %( 95% CI 20.1%-37.8%). On univariate analysis (chi square test), postpartum depression was significantly associated with pregnancy complications (p<0.01), infant’s health problems (p <0.001) and vaginal delivery (p <0.05). Conclusion Postpartum depression is common among Nepalese women and can be detected early in the postpartum periods; and many psychosocial factors like pregnancy complications, infant’s health problems and vaginal delivery are associated with it. It is recommended that mothers with high risk should be routinely screened for postpartum depression. KEY WORDS Developing countries, hospital delivery, infant welfare, prevalence, risk factorsPublication Study of Adherence Pattern of Antidepressants in Patients with Depression(Kathmandu University, 2017) Shrestha, Manandhar J; Shrestha, R; Basnet, N; Silwal, P; Shrestha, H; Risal, A; Kunwar, DABSTRACT Background Depression is one of the leading psychiatric disorders of the world affecting a person’s mood, physical health and behavior. It is not permanent and is neither a character flaw nor a lack in discipline for a person to be ashamed of. It is a disorder that is reliably diagnosed and successfully treated. Antidepressants are the standard and the most efficacious approach to treating people with depression. However, adherence to treatment is necessary for achieving effectiveness. The result of non- adherence is severe and may cause therapeutic failure resulting in poor quality of life. Objective To determine the medication adherence pattern in patients with depression and assess the factors associated with non-adherence to the prescribed antidepressant therapy. Method Patients meeting the inclusion criteria who were diagnosed with depression were taken for the study. Informed consent was taken from the patients or from their relatives in case of their incapability. They were then interviewed using structured questionnaire. Result Among the 60 patients included in the study, 78% of them were females. Most of the patients 43% (n=26) were prescribed with atypical antidepressants. Less number (37%) of the patients were adherent to the antidepressant therapy. 68% of the females were non adherent. 82% of housewives were not adherent to therapy. Forgetfulness was the main reason for missing dose in majority (50%) of the non- adherent patients. Conclusion Majority of the patients with depression were non-adherent to medication. Forgetfulness was the major reason for missing dose in these patients. KEY WORDS Adherence, Antidepressants, Depression, Non-adherencePublication Study of Depression among the Nursing Students in a University Medical College of Nepal(Kathmandu University, 2016) Risal, A; Sanjel, S; Sharma, PPABSTRACT Background Nursing students pass through many stressful situations during their academic course. Depression is frequently observed in this student group. Objective To quantify and compare the level of depression among the students undertaking undergraduate and graduate level nursing education in Kathmandu University School of Medical Sciences, Nepal. Method A questionnaire based cross-sectional study was carried out among all the students of Proficiency Certificate Level, Bachelor in Nursing Sciences and B.Sc. Nursing in Kathmandu University School of Medical Sciences, studying in different years during the academic year (2013-14) using Beck Depression Inventory. Descriptive statistics was used for computing scores of Beck Depression Inventory while Pearson correlation was used for analysis of association. Result Among the total 227 students consenting for the study, 212 were amenable for analysis. All of the participants were females, with mean age 20.10 (± 2.2). Almost 40% were found to be having depressive symptoms in variable degrees of severity (Mild-27.4%, Moderate-9%, Severe-1.4%). Frequency of depression was higher among the senior grade students. Agitation, fatigability and sadness were the items having highest mean score; (0.82 ± 0.72), (0.76 ± 0.63), and (0.74 ± 0.52) respectively, while weight loss and loss of libido had the least score, (0.10 ±0.33) and (0.19 ±0.55) respectively. Item on suicidal ideation was significantly correlated with age (p=0.038) and BDI score (<0.001). Conclusion Depression is common among the nursing students in Nepal; which may also be related to the multitude of stressors they experience during their studentship. KEY WORDS Academic, depression, nursing students, occupation, stress, suicidal ideationPublication Study of Depression, Anxiety and Stress among the Medical Students in two Medical Colleges of Nepal(Kathmandu University, 2016) Kunwar, D; Risal, A; Koirala, SABSTRACT Background Medical education is intended to prepare graduates for a promoting health and caring for the sick. Medical students are confronted with significant academic, psychological and existential stressors. There is insufficient information regarding psychological morbidity among Nepalese medical students. Objective To determine the prevalence of depression, anxiety and stress, among the medical students in Nepal, and its association with sociodemographic characteristics. Method A cross-sectional questionnaire based study was conducted including all students from first to fifth year of student using convenience method of sampling from Kathmandu University Medical School (KUSMS), Dhulikhel and Manipal College of Medical Sciences (MCOMS), Pokhara, Nepal. Depression, Anxiety and stress were assessed using Depression Anxiety and Stress Scale (DASS). Additional questions regarding demographic variables were also included in the survey. Data analysis was done on Statistical Package for the Social Sciences SPSS version 16. Result A total of 538 students participated in the study giving a response rate of 89.6%. Aamong them 56.5% were from age group 21-25 years, 42.2% were below 20 years and only 1.3% were above 25 years of age. Among them 52% were female and 48% were male. Our study found that the overall prevalence of depression was 29.9%, anxiety was 41.1% and stress was 27% among all participated medical students. Depression was significantly associated (OR 2.23, 95% CI 1.43-3.47, p<0.001) with living condition (living in hostel or rented house). Conclusion The higher level of psychiatric morbidity depression 29.9%, anxiety 41.1% and stress 27% among undergraduate medical students warrants needs for strategic plans to alleviate depression anxiety and the stressors right from the time they join medical school and has to be continued till they finish the course. KEY WORDS Anxiety, depressive disorder, medical students, NepalPublication Study of Poisoning Cases in a Tertiary Care Hospital(Kathmandu University, 2012) Karki, RK; Risal, AABSTRACT Background Poisoning is one of the leading causes of morbidity and mortality in Nepal and also a major public health problem worldwide. A thorough review of the risk factors helps to decrease the incidence and mortality. The study evaluates the cases admitted in Dhulikhel Hospital, Kavre, Various parameters like age, sex, marital status, time of ingestion, month of occurrence, agent responsible for incidence; type of poisoning, psychosocial problem, outcome and duration of treatment are analyzed. Objectives The objectives of this study are to determine the pattern and severity of poisoning cases admitted to Dhulikhel Hospital. Methods A hospital based study was carried out in the patient admitted to Dhulikhel Hospital with the history of poisoning for the period of one year between April 2011 to March 2012. Various parameters were analyzed and compared with other study. Results There were 137 cases during the one year duration and maximum case belonged to second and third decade of life. Most common manner of poisoning was suicidal and the incidence was mainly during evening hours. Organophosphorus was the most commonly abused substance. Most of the cases had arrived hospital after one hour of exposure and duration of hospital stay in many cases were less than four days. Conclusion Based on these findings preventive measures like precaution taken at various levels, restriction in free sale of the poisons and promoting Poison Information Centers along with public awareness and proper psychosocial management to decrease the incidence and mortality in poisoning cases can be suggested. KEY WORDS Poisoning, morbidity, mortalityPublication The Utilization of Health Care Services and their Determinants Among the Elderly Population of Dhulikhel Municipality(Kathmandu University, 2012) Sanjel, S; Mudbhari, N; Risal, A; Khanal, KABSTRACT Background Population ageing is a common problem faced in many countries world-wide. Due to physiological and biochemical changes in the elderly, increased incidence of diseases is observed. There is often low use of health services by the elderly for a variety of reasons. Objective To examine the status of health care utilization and to determine the factors associated with utilization of health care among the elderly population of Dhulikhel Municipality. Methods A quantitative descriptive-cross sectional study, with a total number of 200 elderly people residing in Dhulikhel Municipality, was selected for the study. Data were collected across the months of June - July 2011 applying two-staged cluster and systematic random sampling method. Both descriptive and inferential statistics were measured. Results Sixty eight percent of the elderly visited medical personnel in the past year. Eight percent of them visited the emergency department where most of them reported with symptoms attributed to heart disease. Among 200 elderly, 12.5% of them were admitted to the hospital and 53.0% utilized diagnostic services. Age, marital status, activities of daily living, and regular medication showed significant association with health services utilization at 95% level of confidence (p >0.05). Conclusion Marital status, daily living habits, existence of chronic disease, and regular medication demonstrated significant association with the utilization of health care. Social support services, informal education, and awareness programs targeting the senior citizens and studies covering a diverse population are recommended. KEY WORDS Elderly, Senior Citizens, Utilization of health carePublication Undertreated Hypertension and its Implications for Public Health in Nepal: Nationwide Population-Based Survey(Kathmandu University, 2015) Koju, R; Manandhar, K; Risal, A; Steiner, TJ; Holen, A; Linde, MABSTRACT Background Hypertension (HTN), a major risk factor for cardiovascular diseases (CVDs), is a substantial global public health problem. Occasional studies indicate a high prevalence of HTN in the Nepalese population, but no nationwide population-based data exist so far. We opportunistically used a survey of major disorders of the brain in Nepal to measure blood pressure (BP) in participants selected randomly from the adult general population. Objective To establish the prevalence of elevated BP (eBP), and factors associated with it, regardless of any antihypertensive therapy being taken. We took this to be indicative of unmet health-care need. Method This was a cross-sectional study, conducted by unannounced household visits, employing multistage random cluster sampling. To achieve representativeness, 15 districts out of 75 in the country were investigated: one district from each of the three physiographic divisions in each of the five development regions of Nepal. One adult aged 18-65 years was selected from each household and interviewed by structured questionnaire. BP was recorded in a standardised manner by digital device (Microlife 3BM1-3®). Result From 2,109 eligible households, 2,100 adults (99.6%) participated. The prevalence of eBP (>140/90 mmHg on ≥2 readings) was found to be 15.1%. Multivariate logistic regression showed significant and independent associations with demographic variables (higher age, male gender), with life-style factors (daily alcohol consumption, BMI ≥25), and with living at high altitude (≥2000 m). Conclusion In the context of the survey we could not collect data on antihypertensive therapy being taken but, clearly, whatever this might have been, it was failing to meet treatment needs. Almost one in six adults met criteria for hypertension, carrying risk implications for CVDs and their substantial public-health consequences. Two remediable associated factors were identified, although in a cross-sectional survey we could not prove causation. KEY WORDS Cardiovascular disease, coronary artery disease, hypertension