Per Kallestrup - Academia.edu (original) (raw)
Papers by Per Kallestrup
PubMed, 2018
In 2014, Institute for Human Rights published the report "Equal access to healthcare - an analysi... more In 2014, Institute for Human Rights published the report "Equal access to healthcare - an analysis of general practitioners' meeting with patients from ethnic minorities". General practice may contribute to equal access to healthcare for this group of patients. This is, however, a challenge for general practitioners, and they cannot resolve this alone. We recommend that more research is performed in this topic, that general practice focuses on these challenges, that more knowledge is provided, and that the cooperation between general practice, local municipalities, regions and the secondary sector is optimized.
PubMed, 2003
On the basis of structured interviews with 146 parents, this study describes why and when parents... more On the basis of structured interviews with 146 parents, this study describes why and when parents of acutely ill children seek the out-of-hours service, what actions they might have taken beforehand, and their expectations as to the outcome of the consultation. A total of 46% of the parents did not consider their child's condition to be serious, but 12% throught that their child was very ill. Parents sought medical advice because of what they perceived to be a lack of control of the condition (49%), fear of a serious disease (17%), and for symptom relief (34%). All except three parents expected there to be an examination of their child, and 79% expected an explanation or a diagnosis. Only 13% spontaneously mentioned that they expected a prescription. It is clinical and communicative skills that prevail in promoting successful consultations in this setting.
Research Square (Research Square), Jan 13, 2021
Background: Previous studies suggest that health intervention designed to increase cervical cance... more Background: Previous studies suggest that health intervention designed to increase cervical cancer screening has been effective to reduce cervical cancer incidence and mortality. The aim of this study is to determine the effect of a home-based health education intervention for increasing cervical cancer screening uptake delivered by trained Female Community Health Volunteers (FCHVs), a category of community health worker in Nepal. Methods: A community-based, open-label, two-armed, cluster-randomized trial [seven clusters (geographical wards) randomized for the intervention, and seven for the control arm]. The participants are recruited from a population-based survey with a sample size of 884. Based on population proportion size, 277 women will be recruited for the intervention group and 413 women recruited for the control group. A 12-month community-based health education intervention will be administered mobilizing the FCHVs, based on the Health Belief Model. The primary outcome measure of the study will be the difference in percentage of cervical cancer screening uptake between the two study arms. The primary outcomes will be modelled by using mixed-effect logistic regression analysis. Discussion: COBIN-C is the rst study investigating the effect of a community-based health education intervention by FCHVs on increasing cervical cancer screening uptake among women in Nepal. The purpose of this study is to develop and implement a home-based, culturally sensitive program to increase cervical cancer screening coverage at the community level.
British Journal of General Practice
BackgroundThe COVID-19 pandemic has altered the provision of health care and expanded telehealth ... more BackgroundThe COVID-19 pandemic has altered the provision of health care and expanded telehealth consultations.AimTo study the effect of the COVID-19 pandemic on contact patterns in general practice, and to identify patient groups at risk of losing care.Design and settingRegister-based study of Danish general practice, including daytime and out-of-hours (OOH) services.MethodAll individuals residing in Denmark from 1 January 2017 to 31 October 2020 were included. The incidence rate for six contact types in general practice and adjusted incidence rate ratio were calculated by comparing the incidence rate in the pandemic period with the adjusted expected incidence rate based on the incidence rate in the pre-pandemic period.ResultsThe number of face-to-face in-clinic consultations declined during the lockdown in March 2020. A subsequent increase in the number of clinic consultations was observed, rising to a level above that of the pre-pandemic period; this increase resulted mainly from...
Danish Medical Journal, Mar 23, 2022
INTRODUCTION Women with ovarian cancer (OC) have a poor prognosis. An improved prognosis was obse... more INTRODUCTION Women with ovarian cancer (OC) have a poor prognosis. An improved prognosis was observed when the pathway to diagnosis begins in general practice. We aimed to investigate patient characteristics among women diagnosed with OC whose diagnostic pathway begins in general practice. METHODS This was a population-based retrospective cohort study among Danish patients with a first-time OC diagnosis, using questionnaire data and national registers. RESULTS The GP was involved in the diagnosis in 91.1% of the 313 included women with OC. Women aged 60-74 years had statistically significantly higher odds of having GP involvement than women younger than 60 years (odds ratio (OR) = 2.97 (95% confidence interval (CI): 1.09-8.08)). Women with high comorbidity had statistically significantly lower odds of having GP involvement than women with no comorbidity (OR = 0.25 (95% CI: 0.09-0.66). CONCLUSIONS This study found higher odds of GP involvement in the diagnosis of OC in women aged 60-74 years and lower odds of GP involvement in women with high comorbidity. The remaining patient characteristics had no significant influence on the first place of presentation for OC patients. Knowledge hereof may potentially inform future initiatives as health campaigns or postgraduate GP training thereby increasing the awareness among women and GPs alike of OC symptoms. However, the study was restricted to a limited number of patients, and future research is warranted to underpin our findings. FUNDING none. TRIAL REGISTRATION not relevant.
Journal of Hypertension, 2018
s e339 to create awareness and screen potential clients including; house hold visits, small group... more s e339 to create awareness and screen potential clients including; house hold visits, small group sessions, bus terminus, work places and other locations. Results: Evaluations, involving population surveys and hypertension registers, have shown that population risk-factor levels have greatly reduced and consequently the disability adjusted years increased. The results showed that awareness among the general population increased and treatment was more effective than in the reference period. Prevalence of smoking and alcohol decreased in treated hypertensive patients and normotensives. Conclusion: Ignorance of the general population as to the nature of elevated BP, its morbid effects and the methods of maintaining control is widespread and contributes to the large percentage of undetected and untreated subjects in a community. Utilization of CHVs to screen and refer hypertensive clients while providing health education messages is a proven intervention towards the control of hypertension. Additional regular program data review and supportive supervision is important to inform change of strategies, messaging and follow up modalities to ensure adoption and maintenance of best practices.
Ugeskrift for Læger, 2012
BMC Psychiatry, Sep 12, 2019
Background: Harmful use of alcohol is a global public health problem. Differences in alcohol cons... more Background: Harmful use of alcohol is a global public health problem. Differences in alcohol consumption patterns may add valuable information to the design of public health interventions to prevent excessive use of alcohol, which is yet missing in Nepal. Hence, the purpose of the study is to determine the prevalence, patterns of alcohol consumption and socioeconomic correlates of lifetime alcohol consumption and binge drinking in the semi-urban area of Pokhara Municipality. Methods: The cross-sectional data used in this study were collected as part of the COBIN study to understand alcohol consumption patterns and frequency and to determine correlates of lifetime alcohol consumption and binge drinking in the semi-urban area of Pokhara Municipality, Nepal. Results: Out of 2815 study participants, 35.6% had ever used alcohol in their lifetime (Male 67.2% and Female 18.9%). Among 571 respondents who drank alcohol within the past 30 days, 77.1% male, and 46.9% female reported binge drinking behaviour. On average, males consumed 8.8 ± 0.3 standard alcohol drinks on one occasion, while females consumed only 4.4 ± 0.3 alcoholic drinks. Male (OR = 16; 95% CI: 12.1-21.1), older adults (OR = 1.5; 95% CI: 1.2-1.7) and people belonging to disadvantaged ethnic group (OR = 6.1; 95% CI: 4.9-6.3) had higher odds of lifetime alcohol consumption than their respective counterparts. Whereas, male (OR = 7.9; 95% CI: 4.3-14.6), having higher educational status and agriculture as the occupation had higher odds of binge drinking. Conclusion: Alcohol consumption frequency was significantly higher among males than females in Western Nepal. Although national program and policies should recommend reducing alcohol consumption in general, targeted interventions are needed for males aged 45-65 years of age and certain ethnic groups (Dalit and Janajati).
The Lancet Global Health, Oct 1, 2014
e567 1 UN. Political declaration of the high-level meeting of the general assembly on the prevent... more e567 1 UN. Political declaration of the high-level meeting of the general assembly on the prevention and control of non-communicable diseases. http://www.who.int/nmh/events/ un_ncd_summit2011/political_declaration_ en.pdf (accessed Sept 5, 2014). 2 WHO. Density of physicians (total number per 1000 population, latest available year). http:// www.who.int/gho/health_workforce/ physicians_density/en/ (accessed Sept 5, 2014). 3 WHO. World health statistics 2011. http:// www.who.int/whosis/whostat/2011/en/ accessed Sept 5, 2014). 4 Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high income countries: an overview of their history, recent evolution and current eff ectiveness.
COPD: Journal of Chronic Obstructive Pulmonary Disease, May 4, 2021
Abstract Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality... more Abstract Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality in Nepal. It is a progressive lung disease and has a significant impact on the quality of life of patients. Health‐related quality of life (HRQOL) reflects the health‐ and disease‐related facets of quality of life. Limited studies have assessed the impact of COPD on HRQOL and associated factors in Nepal. This study is based on a cross-sectional household survey data from a semiurban area of Western Nepal. A validated Nepali version of St George’s Respiratory Questionnaire (SGRQ) was used to measure the HRQOL. COPD was defined together with post-bronchodilator airflow obstruction and the presence of respiratory symptoms. Post-bronchodilator airflow obstruction was defined as Forced Expiratory Volume in 1st second (FEV1) to Forced Vital Capacity (FVC) ratio < 0.70. COPD was diagnosed in 122 participants, and their median (IQR) total score of HRQOL was 40 (26 − 69); the score of symptoms, activity, and impact area were 53 (37 − 74), 57 (36 − 86), and 26 (13 − 62), respectively. The overall HRQOL was significantly different in terms of age, occupational status, physical activity, and comorbidities. Disease severity and the presence of respiratory symptoms had a significant difference in HRQOL (p = 0.0001). Appropriate measures to improve conditions and addressing the associated factors like respiratory symptoms and enhancing physical activity are necessary and important.
Current developments in nutrition, Jun 1, 2019
Objectives High salt (sodium chloride) intake is associated with an increased risk of hypertensio... more Objectives High salt (sodium chloride) intake is associated with an increased risk of hypertension, which is a major risk factor for cardiovascular diseases. Current consumption of salt in Nepal is unknown. The objective of this study was to estimate average salt intake in a Nepalese population from 24-hr urine collection in a population-based survey. Methods Participants (n = 499) were recruited from the Community-Based Management of Non-Communicable Diseases in Nepal (COBIN) cohort in the peri-urban area of Pokhara municipality from July to December 2018. The modified version of STEPS survey of non-communicable diseases (NCD) risk factors was administered. Salt intake was estimated from a single 24-hr urine collection. Multivariate linear regression was used to estimate differences in salt intake (g) associated with a variety of factors including demographics, lifestyle, health care, and health literacy. Results Mean (SD) age was 50.0 (9.7) years; mean salt intake was 13.0 (4.8) g/person/d. Male gender, younger age, and higher body mass index were significantly associated with higher salt intake (Table). Although 55% of respondents thought that they consumed just the right amount of salt, 96% were consuming more than the WHO-recommended level of less than 5 g/d. Almost half of the respondents reported that they consumed processed food containing high amounts of salt. In multivariate analyses, systolic blood pressure was 0.4 mmHg (95% CI: 0.05, 0.7) higher per 1-gram increase in salt intake. Conclusions Daily intake of salt in this Napalese population was over twice the WHO recommended upper limit, indicating a substantial need to reduce salt across the entire population. Community-based interventions for behavior modification through health education and dietary counseling may be effective in this population where salt is added during cooking. Still, interventions targeting the marketing, availability, and labeling of processed foods is also important, as intake of processed foods was also commonplace in Nepal. Funding Sources PHI through financial support from Centers for Disease Control and Prevention (CDC), USA; Jayanti Memorial Trust (JMT), Nepal; Nepal Development Society (NEDS), Nepal. Supporting Tables, Images and/or Graphs
Journal of Hypertension, Oct 1, 2018
s e339 to create awareness and screen potential clients including; house hold visits, small group... more s e339 to create awareness and screen potential clients including; house hold visits, small group sessions, bus terminus, work places and other locations. Results: Evaluations, involving population surveys and hypertension registers, have shown that population risk-factor levels have greatly reduced and consequently the disability adjusted years increased. The results showed that awareness among the general population increased and treatment was more effective than in the reference period. Prevalence of smoking and alcohol decreased in treated hypertensive patients and normotensives. Conclusion: Ignorance of the general population as to the nature of elevated BP, its morbid effects and the methods of maintaining control is widespread and contributes to the large percentage of undetected and untreated subjects in a community. Utilization of CHVs to screen and refer hypertensive clients while providing health education messages is a proven intervention towards the control of hypertension. Additional regular program data review and supportive supervision is important to inform change of strategies, messaging and follow up modalities to ensure adoption and maintenance of best practices.
Global heart, Sep 1, 2017
Background: Health literacy and attitudes of female community health volunteers (FCHV) toward hyp... more Background: Health literacy and attitudes of female community health volunteers (FCHV) toward hypertension management in the context of Nepal are not well understood. Therefore, it is important to explore the potential for the effectiveness for blood pressure screening and perceptions on their likely ability to promote a blood pressure reduction at community level. Objective: The study aims to explore the knowledge and attitudes of FCHV related to hypertension prevention and control. Methods: A cross-sectional survey was conducted with FCHV located inside Lekhnath municipality. A total of 113 FCHV were interviewed in the survey using a questionnaire on knowledge and attitudes related to hypertension and risk factors. Results: The percentages of FCHV with low, medium, and high levels of knowledge about hypertension were 43%, 24%, and 31%, respectively. Almost all of the respondents considered hypertension a major problem in their community and they would like to receive training for blood pressure screening. No significant differences were observed in the knowledge and attitudes related to hypertension in relation to demographic characteristics of FCHV. A majority of FCHV agreed that smoking (69.8%), alcohol (77.8%), low physical activity (42.4%), high salt intake (65.4%), high fat intake (78.7%), and genetics (53.9%) are major risk factors for hypertension. Conclusions: Our study demonstrates that there is a background need to improve the health literacy for blood pressure management. There is also a need for development and implementation of a community-based intervention aimed at mobilizing female community health volunteers for detection and management of hypertension at the community level in Nepal. Our study demonstrated a high level of interest and readiness for blood pressure prevention, control, and management in community settings.
Social Science Research Network, 2022
Ugeskrift for Læger, 2012
The Lancet Global Health, Jul 1, 2023
Scandinavian Journal of Public Health, Jun 2, 2022
Je m m a a n d Ryo m, Kn u d 2 0 2 2. S t u d y d e si g n of 'Mov e M o r e': D ev elo p m e n t... more Je m m a a n d Ryo m, Kn u d 2 0 2 2. S t u d y d e si g n of 'Mov e M o r e': D ev elo p m e n t a n d fe a si bility of a s o ci al-p r e s c ri bi n g in t e rv e n tio n t o in c r e a s e p h y sic al a c tivity a m o n g in a c tiv e D a n e s.
Women & Health, Jul 9, 2020
The global incidence of cervical cancer is approximately 570,000 cases and 311,000 deaths annuall... more The global incidence of cervical cancer is approximately 570,000 cases and 311,000 deaths annually. Almost 90% of cervical cancer deaths occur in low and middle income countries. Screening is the most effective tool in prevention, early diagnosis, and treatment of cervical cancer. Nepal has no national cervical cancer screening programme, and data from 2003 showed that only 2.8% of Nepalese women had ever been screened. We conducted a qualitative study to obtain better insight into barriers and facilitators to cervical cancer screening among women in Nepal to generate data to inform interventions. In February 2019, four focus group discussions with previously screened and non-screened women, and Female Community Health Volunteers and four in-depth interviews with health workers were conducted in Pokhara Metropolitan City. Semi-structured interview guides were used, interviews were audio-recorded, transcribed verbatim, and analyzed using grounded theory approach with open coding. This resulted in five main themes: 1) lack of husband's support for screening, 2) prevalent stigma and discrimination, 3) lack of awareness about screening options, 4) getting screened, and 5) health care providers. We encourage policymakers and stakeholders apply these findings to improve awareness, access to information, and better screening services in Nepal.
PubMed, 2018
In 2014, Institute for Human Rights published the report "Equal access to healthcare - an analysi... more In 2014, Institute for Human Rights published the report "Equal access to healthcare - an analysis of general practitioners' meeting with patients from ethnic minorities". General practice may contribute to equal access to healthcare for this group of patients. This is, however, a challenge for general practitioners, and they cannot resolve this alone. We recommend that more research is performed in this topic, that general practice focuses on these challenges, that more knowledge is provided, and that the cooperation between general practice, local municipalities, regions and the secondary sector is optimized.
PubMed, 2003
On the basis of structured interviews with 146 parents, this study describes why and when parents... more On the basis of structured interviews with 146 parents, this study describes why and when parents of acutely ill children seek the out-of-hours service, what actions they might have taken beforehand, and their expectations as to the outcome of the consultation. A total of 46% of the parents did not consider their child's condition to be serious, but 12% throught that their child was very ill. Parents sought medical advice because of what they perceived to be a lack of control of the condition (49%), fear of a serious disease (17%), and for symptom relief (34%). All except three parents expected there to be an examination of their child, and 79% expected an explanation or a diagnosis. Only 13% spontaneously mentioned that they expected a prescription. It is clinical and communicative skills that prevail in promoting successful consultations in this setting.
Research Square (Research Square), Jan 13, 2021
Background: Previous studies suggest that health intervention designed to increase cervical cance... more Background: Previous studies suggest that health intervention designed to increase cervical cancer screening has been effective to reduce cervical cancer incidence and mortality. The aim of this study is to determine the effect of a home-based health education intervention for increasing cervical cancer screening uptake delivered by trained Female Community Health Volunteers (FCHVs), a category of community health worker in Nepal. Methods: A community-based, open-label, two-armed, cluster-randomized trial [seven clusters (geographical wards) randomized for the intervention, and seven for the control arm]. The participants are recruited from a population-based survey with a sample size of 884. Based on population proportion size, 277 women will be recruited for the intervention group and 413 women recruited for the control group. A 12-month community-based health education intervention will be administered mobilizing the FCHVs, based on the Health Belief Model. The primary outcome measure of the study will be the difference in percentage of cervical cancer screening uptake between the two study arms. The primary outcomes will be modelled by using mixed-effect logistic regression analysis. Discussion: COBIN-C is the rst study investigating the effect of a community-based health education intervention by FCHVs on increasing cervical cancer screening uptake among women in Nepal. The purpose of this study is to develop and implement a home-based, culturally sensitive program to increase cervical cancer screening coverage at the community level.
British Journal of General Practice
BackgroundThe COVID-19 pandemic has altered the provision of health care and expanded telehealth ... more BackgroundThe COVID-19 pandemic has altered the provision of health care and expanded telehealth consultations.AimTo study the effect of the COVID-19 pandemic on contact patterns in general practice, and to identify patient groups at risk of losing care.Design and settingRegister-based study of Danish general practice, including daytime and out-of-hours (OOH) services.MethodAll individuals residing in Denmark from 1 January 2017 to 31 October 2020 were included. The incidence rate for six contact types in general practice and adjusted incidence rate ratio were calculated by comparing the incidence rate in the pandemic period with the adjusted expected incidence rate based on the incidence rate in the pre-pandemic period.ResultsThe number of face-to-face in-clinic consultations declined during the lockdown in March 2020. A subsequent increase in the number of clinic consultations was observed, rising to a level above that of the pre-pandemic period; this increase resulted mainly from...
Danish Medical Journal, Mar 23, 2022
INTRODUCTION Women with ovarian cancer (OC) have a poor prognosis. An improved prognosis was obse... more INTRODUCTION Women with ovarian cancer (OC) have a poor prognosis. An improved prognosis was observed when the pathway to diagnosis begins in general practice. We aimed to investigate patient characteristics among women diagnosed with OC whose diagnostic pathway begins in general practice. METHODS This was a population-based retrospective cohort study among Danish patients with a first-time OC diagnosis, using questionnaire data and national registers. RESULTS The GP was involved in the diagnosis in 91.1% of the 313 included women with OC. Women aged 60-74 years had statistically significantly higher odds of having GP involvement than women younger than 60 years (odds ratio (OR) = 2.97 (95% confidence interval (CI): 1.09-8.08)). Women with high comorbidity had statistically significantly lower odds of having GP involvement than women with no comorbidity (OR = 0.25 (95% CI: 0.09-0.66). CONCLUSIONS This study found higher odds of GP involvement in the diagnosis of OC in women aged 60-74 years and lower odds of GP involvement in women with high comorbidity. The remaining patient characteristics had no significant influence on the first place of presentation for OC patients. Knowledge hereof may potentially inform future initiatives as health campaigns or postgraduate GP training thereby increasing the awareness among women and GPs alike of OC symptoms. However, the study was restricted to a limited number of patients, and future research is warranted to underpin our findings. FUNDING none. TRIAL REGISTRATION not relevant.
Journal of Hypertension, 2018
s e339 to create awareness and screen potential clients including; house hold visits, small group... more s e339 to create awareness and screen potential clients including; house hold visits, small group sessions, bus terminus, work places and other locations. Results: Evaluations, involving population surveys and hypertension registers, have shown that population risk-factor levels have greatly reduced and consequently the disability adjusted years increased. The results showed that awareness among the general population increased and treatment was more effective than in the reference period. Prevalence of smoking and alcohol decreased in treated hypertensive patients and normotensives. Conclusion: Ignorance of the general population as to the nature of elevated BP, its morbid effects and the methods of maintaining control is widespread and contributes to the large percentage of undetected and untreated subjects in a community. Utilization of CHVs to screen and refer hypertensive clients while providing health education messages is a proven intervention towards the control of hypertension. Additional regular program data review and supportive supervision is important to inform change of strategies, messaging and follow up modalities to ensure adoption and maintenance of best practices.
Ugeskrift for Læger, 2012
BMC Psychiatry, Sep 12, 2019
Background: Harmful use of alcohol is a global public health problem. Differences in alcohol cons... more Background: Harmful use of alcohol is a global public health problem. Differences in alcohol consumption patterns may add valuable information to the design of public health interventions to prevent excessive use of alcohol, which is yet missing in Nepal. Hence, the purpose of the study is to determine the prevalence, patterns of alcohol consumption and socioeconomic correlates of lifetime alcohol consumption and binge drinking in the semi-urban area of Pokhara Municipality. Methods: The cross-sectional data used in this study were collected as part of the COBIN study to understand alcohol consumption patterns and frequency and to determine correlates of lifetime alcohol consumption and binge drinking in the semi-urban area of Pokhara Municipality, Nepal. Results: Out of 2815 study participants, 35.6% had ever used alcohol in their lifetime (Male 67.2% and Female 18.9%). Among 571 respondents who drank alcohol within the past 30 days, 77.1% male, and 46.9% female reported binge drinking behaviour. On average, males consumed 8.8 ± 0.3 standard alcohol drinks on one occasion, while females consumed only 4.4 ± 0.3 alcoholic drinks. Male (OR = 16; 95% CI: 12.1-21.1), older adults (OR = 1.5; 95% CI: 1.2-1.7) and people belonging to disadvantaged ethnic group (OR = 6.1; 95% CI: 4.9-6.3) had higher odds of lifetime alcohol consumption than their respective counterparts. Whereas, male (OR = 7.9; 95% CI: 4.3-14.6), having higher educational status and agriculture as the occupation had higher odds of binge drinking. Conclusion: Alcohol consumption frequency was significantly higher among males than females in Western Nepal. Although national program and policies should recommend reducing alcohol consumption in general, targeted interventions are needed for males aged 45-65 years of age and certain ethnic groups (Dalit and Janajati).
The Lancet Global Health, Oct 1, 2014
e567 1 UN. Political declaration of the high-level meeting of the general assembly on the prevent... more e567 1 UN. Political declaration of the high-level meeting of the general assembly on the prevention and control of non-communicable diseases. http://www.who.int/nmh/events/ un_ncd_summit2011/political_declaration_ en.pdf (accessed Sept 5, 2014). 2 WHO. Density of physicians (total number per 1000 population, latest available year). http:// www.who.int/gho/health_workforce/ physicians_density/en/ (accessed Sept 5, 2014). 3 WHO. World health statistics 2011. http:// www.who.int/whosis/whostat/2011/en/ accessed Sept 5, 2014). 4 Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high income countries: an overview of their history, recent evolution and current eff ectiveness.
COPD: Journal of Chronic Obstructive Pulmonary Disease, May 4, 2021
Abstract Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality... more Abstract Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality in Nepal. It is a progressive lung disease and has a significant impact on the quality of life of patients. Health‐related quality of life (HRQOL) reflects the health‐ and disease‐related facets of quality of life. Limited studies have assessed the impact of COPD on HRQOL and associated factors in Nepal. This study is based on a cross-sectional household survey data from a semiurban area of Western Nepal. A validated Nepali version of St George’s Respiratory Questionnaire (SGRQ) was used to measure the HRQOL. COPD was defined together with post-bronchodilator airflow obstruction and the presence of respiratory symptoms. Post-bronchodilator airflow obstruction was defined as Forced Expiratory Volume in 1st second (FEV1) to Forced Vital Capacity (FVC) ratio < 0.70. COPD was diagnosed in 122 participants, and their median (IQR) total score of HRQOL was 40 (26 − 69); the score of symptoms, activity, and impact area were 53 (37 − 74), 57 (36 − 86), and 26 (13 − 62), respectively. The overall HRQOL was significantly different in terms of age, occupational status, physical activity, and comorbidities. Disease severity and the presence of respiratory symptoms had a significant difference in HRQOL (p = 0.0001). Appropriate measures to improve conditions and addressing the associated factors like respiratory symptoms and enhancing physical activity are necessary and important.
Current developments in nutrition, Jun 1, 2019
Objectives High salt (sodium chloride) intake is associated with an increased risk of hypertensio... more Objectives High salt (sodium chloride) intake is associated with an increased risk of hypertension, which is a major risk factor for cardiovascular diseases. Current consumption of salt in Nepal is unknown. The objective of this study was to estimate average salt intake in a Nepalese population from 24-hr urine collection in a population-based survey. Methods Participants (n = 499) were recruited from the Community-Based Management of Non-Communicable Diseases in Nepal (COBIN) cohort in the peri-urban area of Pokhara municipality from July to December 2018. The modified version of STEPS survey of non-communicable diseases (NCD) risk factors was administered. Salt intake was estimated from a single 24-hr urine collection. Multivariate linear regression was used to estimate differences in salt intake (g) associated with a variety of factors including demographics, lifestyle, health care, and health literacy. Results Mean (SD) age was 50.0 (9.7) years; mean salt intake was 13.0 (4.8) g/person/d. Male gender, younger age, and higher body mass index were significantly associated with higher salt intake (Table). Although 55% of respondents thought that they consumed just the right amount of salt, 96% were consuming more than the WHO-recommended level of less than 5 g/d. Almost half of the respondents reported that they consumed processed food containing high amounts of salt. In multivariate analyses, systolic blood pressure was 0.4 mmHg (95% CI: 0.05, 0.7) higher per 1-gram increase in salt intake. Conclusions Daily intake of salt in this Napalese population was over twice the WHO recommended upper limit, indicating a substantial need to reduce salt across the entire population. Community-based interventions for behavior modification through health education and dietary counseling may be effective in this population where salt is added during cooking. Still, interventions targeting the marketing, availability, and labeling of processed foods is also important, as intake of processed foods was also commonplace in Nepal. Funding Sources PHI through financial support from Centers for Disease Control and Prevention (CDC), USA; Jayanti Memorial Trust (JMT), Nepal; Nepal Development Society (NEDS), Nepal. Supporting Tables, Images and/or Graphs
Journal of Hypertension, Oct 1, 2018
s e339 to create awareness and screen potential clients including; house hold visits, small group... more s e339 to create awareness and screen potential clients including; house hold visits, small group sessions, bus terminus, work places and other locations. Results: Evaluations, involving population surveys and hypertension registers, have shown that population risk-factor levels have greatly reduced and consequently the disability adjusted years increased. The results showed that awareness among the general population increased and treatment was more effective than in the reference period. Prevalence of smoking and alcohol decreased in treated hypertensive patients and normotensives. Conclusion: Ignorance of the general population as to the nature of elevated BP, its morbid effects and the methods of maintaining control is widespread and contributes to the large percentage of undetected and untreated subjects in a community. Utilization of CHVs to screen and refer hypertensive clients while providing health education messages is a proven intervention towards the control of hypertension. Additional regular program data review and supportive supervision is important to inform change of strategies, messaging and follow up modalities to ensure adoption and maintenance of best practices.
Global heart, Sep 1, 2017
Background: Health literacy and attitudes of female community health volunteers (FCHV) toward hyp... more Background: Health literacy and attitudes of female community health volunteers (FCHV) toward hypertension management in the context of Nepal are not well understood. Therefore, it is important to explore the potential for the effectiveness for blood pressure screening and perceptions on their likely ability to promote a blood pressure reduction at community level. Objective: The study aims to explore the knowledge and attitudes of FCHV related to hypertension prevention and control. Methods: A cross-sectional survey was conducted with FCHV located inside Lekhnath municipality. A total of 113 FCHV were interviewed in the survey using a questionnaire on knowledge and attitudes related to hypertension and risk factors. Results: The percentages of FCHV with low, medium, and high levels of knowledge about hypertension were 43%, 24%, and 31%, respectively. Almost all of the respondents considered hypertension a major problem in their community and they would like to receive training for blood pressure screening. No significant differences were observed in the knowledge and attitudes related to hypertension in relation to demographic characteristics of FCHV. A majority of FCHV agreed that smoking (69.8%), alcohol (77.8%), low physical activity (42.4%), high salt intake (65.4%), high fat intake (78.7%), and genetics (53.9%) are major risk factors for hypertension. Conclusions: Our study demonstrates that there is a background need to improve the health literacy for blood pressure management. There is also a need for development and implementation of a community-based intervention aimed at mobilizing female community health volunteers for detection and management of hypertension at the community level in Nepal. Our study demonstrated a high level of interest and readiness for blood pressure prevention, control, and management in community settings.
Social Science Research Network, 2022
Ugeskrift for Læger, 2012
The Lancet Global Health, Jul 1, 2023
Scandinavian Journal of Public Health, Jun 2, 2022
Je m m a a n d Ryo m, Kn u d 2 0 2 2. S t u d y d e si g n of 'Mov e M o r e': D ev elo p m e n t... more Je m m a a n d Ryo m, Kn u d 2 0 2 2. S t u d y d e si g n of 'Mov e M o r e': D ev elo p m e n t a n d fe a si bility of a s o ci al-p r e s c ri bi n g in t e rv e n tio n t o in c r e a s e p h y sic al a c tivity a m o n g in a c tiv e D a n e s.
Women & Health, Jul 9, 2020
The global incidence of cervical cancer is approximately 570,000 cases and 311,000 deaths annuall... more The global incidence of cervical cancer is approximately 570,000 cases and 311,000 deaths annually. Almost 90% of cervical cancer deaths occur in low and middle income countries. Screening is the most effective tool in prevention, early diagnosis, and treatment of cervical cancer. Nepal has no national cervical cancer screening programme, and data from 2003 showed that only 2.8% of Nepalese women had ever been screened. We conducted a qualitative study to obtain better insight into barriers and facilitators to cervical cancer screening among women in Nepal to generate data to inform interventions. In February 2019, four focus group discussions with previously screened and non-screened women, and Female Community Health Volunteers and four in-depth interviews with health workers were conducted in Pokhara Metropolitan City. Semi-structured interview guides were used, interviews were audio-recorded, transcribed verbatim, and analyzed using grounded theory approach with open coding. This resulted in five main themes: 1) lack of husband's support for screening, 2) prevalent stigma and discrimination, 3) lack of awareness about screening options, 4) getting screened, and 5) health care providers. We encourage policymakers and stakeholders apply these findings to improve awareness, access to information, and better screening services in Nepal.