The significance of "Gross National Happiness is more than Gross National Product" concept allow ... more The significance of "Gross National Happiness is more than Gross National Product" concept allow us understand the need for balance between spiritualism and materialism. Spirituality in Bhutan has a great significance in every walk of life for the people of Bhutan. However, GNH is not free from challenges against the powerful forces of modernization and globalization. This paper is exclusively the personal opinion of the author and any mistakes must have crept in from sheer ignorance.
Introduction: The practice of chewing of betel quid is deep-rooted age-old traditions of most Asi... more Introduction: The practice of chewing of betel quid is deep-rooted age-old traditions of most Asian countries including Bhutan. Health is an integral part of happy living and healthcare providers are generally looked up to as role models for healthier living. This paper focuses on the prevalence of ex-betel quid chewers and correlates of successful cessation of betel quid chewing among healthcare professionals in Thimphu, Bhutan. Methods: Data for this study was collected from six healthcare centres within Thimphu, during June – July 2016, using self-administered questionnaire. 478 questionnaires were handed over to the healthcare professionals, and 391 (82%) were returned. Statistical analysis was performed using statistical package for social science version 21.0. Results: The prevalence of ex-betel quid chewers was 16.9%. More than half (51.5%) of the ex-chewers discontinuedchewing betel quid because of fear of the ill effects of chewing it. About 29% gave up chewing betel quid b...
Dying with dignity is important in Western culture. The aim of this qualitative study was to expl... more Dying with dignity is important in Western culture. The aim of this qualitative study was to explore how Asian Buddhists, exposed to Western cultures, perceive death and dying with dignity, and examine their preferences for end-of-life care. We interviewed 15 Asian Buddhists living in Montreal (Canada). Participants regarded death as inevitable, while a good/dignified death had to be natural, peaceful, and, most of all, conscious. Most preferred palliative care to medical-aid-in-dying and emphasized death preparation through daily contemplation of impermanence. Care providers' understanding and respect of Buddhist patients' perception of a dignified death might help facilitate this important transition.
Objective: The purpose of this study was to investigate the prevalence and severity of the condit... more Objective: The purpose of this study was to investigate the prevalence and severity of the condition of lower urinary tract symptoms in Pakistani men, determine its predictors and assess its impact on the quality of life. Methods: A cross-sectional, population-based study was conducted among men aged 30 years and over in three districts of Punjab province, Pakistan. The modified Urdu version of the International Prostate Symptom Score was used to assess the prevalence and severity of lower urinary tract symptoms. Individuals with total symptom score ⩾8 were considered as having lower urinary tract symptoms. The data were analysed using SPSS version 22. The chi-square test and Mann-Whitney U test were used to assess the difference among categorical and continuous variables, respectively. Moreover, binary logistic regressions were performed to determine the predictors of lower urinary tract symptoms. Results: The overall prevalence of lower urinary tract symptoms in our sample was 33....
This study investigated links between adverse life experiences, health and quality of life (QOL) ... more This study investigated links between adverse life experiences, health and quality of life (QOL) among 391 older adults in Bhutan. Women and men aged between 60 to 101 years in four towns were interviewed. Good QOL was reported by most participants, although many encountered difficulties. QOL was associated with the absence of significant illness, spirituality, family harmony and close social connectedness. Adverse life experiences, including from childhood five to eight decades earlier, were linked with poor QOL. This first study in Bhutan to examine these issues yielded insights that may assist development of social services for older people.
Introduction: World Health Organization recommends using partograph to reduce maternal and neonat... more Introduction: World Health Organization recommends using partograph to reduce maternal and neonatal deaths due to obstetric complications. Proper utilization of partograph by health care providers was noted to be good when it is associated with better knowledge and a positive attitude towards partograph. There is a paucity of scientific study about knowledge, attitude and practice on the use of partograph among healthcare providers in Bhutan. Therefore, this study aimed to assess the knowledge, attitude and practice of nurse-midwives on the use and completeness of partograph in seven hospitals and one Basic Health Unit grade I. Methods: A descriptive study was carried out from September 2017 to February 2018. Non-probability sampling method was used to survey all nurse-midwives who attended deliveries in the selected health facilities using a standard semi-structured questionnaire. All partographs filled three months before the data collection was selected purposefully and reviewed ...
Cardiovascular disease is a leading cause of death in the Kingdom of Bhutan, and early detection ... more Cardiovascular disease is a leading cause of death in the Kingdom of Bhutan, and early detection of hypertension is critical for preventing cardiovascular disease. However, health-seeking behavior, including blood pressure measurement, is infrequently investigated in Bhutan. Therefore, this study investigated factors related to blood pressure measurement in Bhutan. We performed a secondary data analysis of a target population of 1,962 individuals using data from the “2014 Bhutan STEPS survey data”as a cross-sectional study. Approximately 26% of those with hypertension who were detected during the STEPS survey had never had their blood pressure measured. Previous blood pressure measurement was significantly associated with age and working status in men (self-employed [odds ratio (OR): 0.219, 95% CI: 0.133–0.361], non-working [OR: 0.114, 95% CI: 0.050–0.263], employee [OR: 1.000]). Previous blood pressure measurement was significantly associated with higher income in women (Quartile-2...
Cardiovascular disease is the leading cause of death in the Kingdom of Bhutan. Thus, the early de... more Cardiovascular disease is the leading cause of death in the Kingdom of Bhutan. Thus, the early detection and prevention of hypertension is critical for reducing cardiovascular disease. However, the influence of sociocultural factors on vulnerability to hypertension needs further investigation. This study performed secondary data analysis on 1,909 individuals in a cross-sectional study (the National survey for noncommunicable disease risk factors and mental health using World Health Organization (WHO) STEPS approach in Bhutan– 2014). Multivariate logistic regression demonstrated a significant association between gender with marital status and hypertension. Women had a higher odds ratio than men (Ref) when married (AOR: 1.27, 95% confidence intervals (CI): 1.23–1.31), and when separated, divorced, or widowed (AOR: 1.18, 95% CI: 1.12–1.26). People who speak the Tshanglakha language scored the highest odds (AOR: 1.24, 95% CI: 1.20–1.27), followed by Lhotshamkha (AOR: 1.09, 95% CI: 1.06–...
Introduction: Diabetes mellitus (DM) is increasing the risk of pulmonary tuberculosis (PTB) with ... more Introduction: Diabetes mellitus (DM) is increasing the risk of pulmonary tuberculosis (PTB) with concern over the convergence of these two diseases. Although screening for PTB among people with DM has been recommended by WHO, it has not been implemented in Bhutan yet. Objective: The aim of this study was to determine the prevalence and risk factors of PTB among people living with DM at the National Referral Hospital (NRH), Thimphu, Bhutan. Methods: This was a cross-sectional study conducted from 1st June – 9th October 2018. All 343 consenting DM patients were screened for PTB using the WHO recommended questionnaire and those with TB positive symptoms were tested for active PTB using sputum smear microscopy and Gene-Xpert. A descriptive statistical analysis was performed using SPSS 21. Results: The prevalence of PTB among people living with DM was 0.87% (95% CI: 0.20-2.50).The mean age was 54.95 (± 13.2 years) and all were DM type II. The median duration of diabetes was 4 years (rang...
Wellbeing is a complex combination of physical, psychological, emotional, and social health facto... more Wellbeing is a complex combination of physical, psychological, emotional, and social health factors of a person. Feeling of wellbeing is essential for the overall health of a person, and enables them to be successful and achieve what they want in life. There is paucity of study on the wellbeing of older adults in Bhutan. This study attempted to assess how older adults in Bhutan perceive their wellbeing and determine its socio-demographic correlates. World Health Organization Five Wellbeing Index was applied to measure wellbeing. Findings indicated above average wellbeing score with nature of relationship with children, education level, and employment status as an independent correlates. Efforts to enhance relationship between family members could be more relevant for the wellbeing of older adults. Further research on wellbeing is required to incorporate determinants other than socio-demographic variables.
In the Western world including Canada, grievous and irredeemable health conditions, which cause u... more In the Western world including Canada, grievous and irredeemable health conditions, which cause unbearable suffering, has given support to the legalization of medical aid in dying (MAiD). It is unknown how Asian Buddhists who are in contact with the Western culture perceive MAiD. In this qualitative study, 16 Asian Buddhists living in Montreal took part in a semi-structured interview. Contrary to general findings in the literature, religious affiliation do not always determine moral stances and practical decisions when it comes to MAiD. Some participants were willing to take some freedom with the doctrine and based their approval of MAiD on the right to self-determination. Those who disapproved the use of MAiD perceived it as causing unnatural death, creating bad karma, and interfering with a conscious death. End-of-life (EoL) care providers have to remain sensitive to each patient's spiritual principles and beliefs to understand their needs and choices for EoL care.
OBJECTIVE This cross-sectional study aimed to determine the prevalence of betel quid chewing and ... more OBJECTIVE This cross-sectional study aimed to determine the prevalence of betel quid chewing and related factors including general characteristics, behavioral pattern, perception and social influences among health care providers in Thimphu, Bhutan. MATERIAL AND METHOD A self-administered questionnaire was handed to 478 health care providers working in different units of health care centers in Thimphu during June-July 2010. A total of 391 (81.8%) questionnaires were returned. Chi-square test and multiple logistic regression were applied. RESULTS The prevalence of current betel quid chewers among this group was 26.6%. Males chewed betel quid more than females (29.5%, 23.9% respectively). Forty-two percent of current chewers had no specific reasons for chewing betel quid, although 18.2% declared that they were addicted. Both friends and family members were key persons involved in influencing betel quid chewing. Marital status was significantly associated with betel quid chewing, marrie...
The International Journal of Occupational and Environmental Medicine
Background: Collection of reliable and valid occupational history data is of utmost importanceto ... more Background: Collection of reliable and valid occupational history data is of utmost importanceto assess work-related exposures and their health effects. Few standardized questionnairesare available for the collection of occupational history data in low-and-middle incomecountries. Objective: To adapt and test a validated questionnaire developed in the United States by theNational Institute of Safety and Health, in order to assess occupational chemical exposuresamong health care workers in Bhutan. Methods: The questionnaire was first adapted to suit the Bhutanese context with the adviceof an expert review committee. 30 health care workers then completed the questionnaire atbaseline and 10–14 days later. Test-retest reliability was assessed by calculating Cohen's κand percentage agreement. Results: The questionnaire had high test-retest reliability. Cohen's κ ranged from 0.61 to1.00, and percentage agreement ranged from 86.7% to 100%. Further adaptations includedomitting questi...
Introduction: Health-related quality of life (HRQoL) is a multi-dimensional construct that assess... more Introduction: Health-related quality of life (HRQoL) is a multi-dimensional construct that assesses an individual’s and group’s perceived physical and mental health over time. Measurement of HRQoL is an important medical outcome study and its study among older adults in Bhutan is limited. Methods: This is a cross-sectional study aimed to assess HRQoL and its sociodemographic and health correlates, among older adults in Bhutan. Data for this study was collected from the four major towns of Thimphu, Phuntsholing, Gelephu, and Samdrupjongkhar, Bhutan, from November 2014 - February 2015, using structured questionnaire with face-to-face interview. A total of 337 Bhutanese older adults participated in this study. Statistical analysis was performed using statistical package for social science version 21.0. Results: The overall mean score for the HRQoL among older adults in this study was 0.67 (SD: 0.13) significantly different between the gender (p-value<0.001). A significantly low scor...
This study explored associations between quality of life (QOL), spirituality, social integration,... more This study explored associations between quality of life (QOL), spirituality, social integration, chronic diseases, and lifetime adversity among people aged 60 years and older in Bhutan. Adults aged 60 to 101 years (n = 337) completed face-to-face interviews. The main measure included the World Health Organization QOL questionnaire and Adverse Childhood Experiences International Questionnaire. The social relationships domain of QOL had the highest mean. Frequent back pain, memory decline, depression, mobility impairment, insomnia, and lung diseases were commonly reported and negatively related to QOL. Compared with women, men reported fewer physical and mental health problems and better QOL. Multivariate analysis revealed that cumulative health problems, psychological distress, and social connectedness contributed significantly to overall QOL. The measure of spirituality was negatively associated with QOL, which is not conclusive and suggests the need for more research especially when the influence of spiritualism is highly visible in the everyday lives of Bhutanese people. The significance of these findings is discussed in relation to care for elderly people in Bhutan.
The significance of "Gross National Happiness is more than Gross National Product" concept allow ... more The significance of "Gross National Happiness is more than Gross National Product" concept allow us understand the need for balance between spiritualism and materialism. Spirituality in Bhutan has a great significance in every walk of life for the people of Bhutan. However, GNH is not free from challenges against the powerful forces of modernization and globalization. This paper is exclusively the personal opinion of the author and any mistakes must have crept in from sheer ignorance.
Introduction: The practice of chewing of betel quid is deep-rooted age-old traditions of most Asi... more Introduction: The practice of chewing of betel quid is deep-rooted age-old traditions of most Asian countries including Bhutan. Health is an integral part of happy living and healthcare providers are generally looked up to as role models for healthier living. This paper focuses on the prevalence of ex-betel quid chewers and correlates of successful cessation of betel quid chewing among healthcare professionals in Thimphu, Bhutan. Methods: Data for this study was collected from six healthcare centres within Thimphu, during June – July 2016, using self-administered questionnaire. 478 questionnaires were handed over to the healthcare professionals, and 391 (82%) were returned. Statistical analysis was performed using statistical package for social science version 21.0. Results: The prevalence of ex-betel quid chewers was 16.9%. More than half (51.5%) of the ex-chewers discontinuedchewing betel quid because of fear of the ill effects of chewing it. About 29% gave up chewing betel quid b...
Dying with dignity is important in Western culture. The aim of this qualitative study was to expl... more Dying with dignity is important in Western culture. The aim of this qualitative study was to explore how Asian Buddhists, exposed to Western cultures, perceive death and dying with dignity, and examine their preferences for end-of-life care. We interviewed 15 Asian Buddhists living in Montreal (Canada). Participants regarded death as inevitable, while a good/dignified death had to be natural, peaceful, and, most of all, conscious. Most preferred palliative care to medical-aid-in-dying and emphasized death preparation through daily contemplation of impermanence. Care providers' understanding and respect of Buddhist patients' perception of a dignified death might help facilitate this important transition.
Objective: The purpose of this study was to investigate the prevalence and severity of the condit... more Objective: The purpose of this study was to investigate the prevalence and severity of the condition of lower urinary tract symptoms in Pakistani men, determine its predictors and assess its impact on the quality of life. Methods: A cross-sectional, population-based study was conducted among men aged 30 years and over in three districts of Punjab province, Pakistan. The modified Urdu version of the International Prostate Symptom Score was used to assess the prevalence and severity of lower urinary tract symptoms. Individuals with total symptom score ⩾8 were considered as having lower urinary tract symptoms. The data were analysed using SPSS version 22. The chi-square test and Mann-Whitney U test were used to assess the difference among categorical and continuous variables, respectively. Moreover, binary logistic regressions were performed to determine the predictors of lower urinary tract symptoms. Results: The overall prevalence of lower urinary tract symptoms in our sample was 33....
This study investigated links between adverse life experiences, health and quality of life (QOL) ... more This study investigated links between adverse life experiences, health and quality of life (QOL) among 391 older adults in Bhutan. Women and men aged between 60 to 101 years in four towns were interviewed. Good QOL was reported by most participants, although many encountered difficulties. QOL was associated with the absence of significant illness, spirituality, family harmony and close social connectedness. Adverse life experiences, including from childhood five to eight decades earlier, were linked with poor QOL. This first study in Bhutan to examine these issues yielded insights that may assist development of social services for older people.
Introduction: World Health Organization recommends using partograph to reduce maternal and neonat... more Introduction: World Health Organization recommends using partograph to reduce maternal and neonatal deaths due to obstetric complications. Proper utilization of partograph by health care providers was noted to be good when it is associated with better knowledge and a positive attitude towards partograph. There is a paucity of scientific study about knowledge, attitude and practice on the use of partograph among healthcare providers in Bhutan. Therefore, this study aimed to assess the knowledge, attitude and practice of nurse-midwives on the use and completeness of partograph in seven hospitals and one Basic Health Unit grade I. Methods: A descriptive study was carried out from September 2017 to February 2018. Non-probability sampling method was used to survey all nurse-midwives who attended deliveries in the selected health facilities using a standard semi-structured questionnaire. All partographs filled three months before the data collection was selected purposefully and reviewed ...
Cardiovascular disease is a leading cause of death in the Kingdom of Bhutan, and early detection ... more Cardiovascular disease is a leading cause of death in the Kingdom of Bhutan, and early detection of hypertension is critical for preventing cardiovascular disease. However, health-seeking behavior, including blood pressure measurement, is infrequently investigated in Bhutan. Therefore, this study investigated factors related to blood pressure measurement in Bhutan. We performed a secondary data analysis of a target population of 1,962 individuals using data from the “2014 Bhutan STEPS survey data”as a cross-sectional study. Approximately 26% of those with hypertension who were detected during the STEPS survey had never had their blood pressure measured. Previous blood pressure measurement was significantly associated with age and working status in men (self-employed [odds ratio (OR): 0.219, 95% CI: 0.133–0.361], non-working [OR: 0.114, 95% CI: 0.050–0.263], employee [OR: 1.000]). Previous blood pressure measurement was significantly associated with higher income in women (Quartile-2...
Cardiovascular disease is the leading cause of death in the Kingdom of Bhutan. Thus, the early de... more Cardiovascular disease is the leading cause of death in the Kingdom of Bhutan. Thus, the early detection and prevention of hypertension is critical for reducing cardiovascular disease. However, the influence of sociocultural factors on vulnerability to hypertension needs further investigation. This study performed secondary data analysis on 1,909 individuals in a cross-sectional study (the National survey for noncommunicable disease risk factors and mental health using World Health Organization (WHO) STEPS approach in Bhutan– 2014). Multivariate logistic regression demonstrated a significant association between gender with marital status and hypertension. Women had a higher odds ratio than men (Ref) when married (AOR: 1.27, 95% confidence intervals (CI): 1.23–1.31), and when separated, divorced, or widowed (AOR: 1.18, 95% CI: 1.12–1.26). People who speak the Tshanglakha language scored the highest odds (AOR: 1.24, 95% CI: 1.20–1.27), followed by Lhotshamkha (AOR: 1.09, 95% CI: 1.06–...
Introduction: Diabetes mellitus (DM) is increasing the risk of pulmonary tuberculosis (PTB) with ... more Introduction: Diabetes mellitus (DM) is increasing the risk of pulmonary tuberculosis (PTB) with concern over the convergence of these two diseases. Although screening for PTB among people with DM has been recommended by WHO, it has not been implemented in Bhutan yet. Objective: The aim of this study was to determine the prevalence and risk factors of PTB among people living with DM at the National Referral Hospital (NRH), Thimphu, Bhutan. Methods: This was a cross-sectional study conducted from 1st June – 9th October 2018. All 343 consenting DM patients were screened for PTB using the WHO recommended questionnaire and those with TB positive symptoms were tested for active PTB using sputum smear microscopy and Gene-Xpert. A descriptive statistical analysis was performed using SPSS 21. Results: The prevalence of PTB among people living with DM was 0.87% (95% CI: 0.20-2.50).The mean age was 54.95 (± 13.2 years) and all were DM type II. The median duration of diabetes was 4 years (rang...
Wellbeing is a complex combination of physical, psychological, emotional, and social health facto... more Wellbeing is a complex combination of physical, psychological, emotional, and social health factors of a person. Feeling of wellbeing is essential for the overall health of a person, and enables them to be successful and achieve what they want in life. There is paucity of study on the wellbeing of older adults in Bhutan. This study attempted to assess how older adults in Bhutan perceive their wellbeing and determine its socio-demographic correlates. World Health Organization Five Wellbeing Index was applied to measure wellbeing. Findings indicated above average wellbeing score with nature of relationship with children, education level, and employment status as an independent correlates. Efforts to enhance relationship between family members could be more relevant for the wellbeing of older adults. Further research on wellbeing is required to incorporate determinants other than socio-demographic variables.
In the Western world including Canada, grievous and irredeemable health conditions, which cause u... more In the Western world including Canada, grievous and irredeemable health conditions, which cause unbearable suffering, has given support to the legalization of medical aid in dying (MAiD). It is unknown how Asian Buddhists who are in contact with the Western culture perceive MAiD. In this qualitative study, 16 Asian Buddhists living in Montreal took part in a semi-structured interview. Contrary to general findings in the literature, religious affiliation do not always determine moral stances and practical decisions when it comes to MAiD. Some participants were willing to take some freedom with the doctrine and based their approval of MAiD on the right to self-determination. Those who disapproved the use of MAiD perceived it as causing unnatural death, creating bad karma, and interfering with a conscious death. End-of-life (EoL) care providers have to remain sensitive to each patient's spiritual principles and beliefs to understand their needs and choices for EoL care.
OBJECTIVE This cross-sectional study aimed to determine the prevalence of betel quid chewing and ... more OBJECTIVE This cross-sectional study aimed to determine the prevalence of betel quid chewing and related factors including general characteristics, behavioral pattern, perception and social influences among health care providers in Thimphu, Bhutan. MATERIAL AND METHOD A self-administered questionnaire was handed to 478 health care providers working in different units of health care centers in Thimphu during June-July 2010. A total of 391 (81.8%) questionnaires were returned. Chi-square test and multiple logistic regression were applied. RESULTS The prevalence of current betel quid chewers among this group was 26.6%. Males chewed betel quid more than females (29.5%, 23.9% respectively). Forty-two percent of current chewers had no specific reasons for chewing betel quid, although 18.2% declared that they were addicted. Both friends and family members were key persons involved in influencing betel quid chewing. Marital status was significantly associated with betel quid chewing, marrie...
The International Journal of Occupational and Environmental Medicine
Background: Collection of reliable and valid occupational history data is of utmost importanceto ... more Background: Collection of reliable and valid occupational history data is of utmost importanceto assess work-related exposures and their health effects. Few standardized questionnairesare available for the collection of occupational history data in low-and-middle incomecountries. Objective: To adapt and test a validated questionnaire developed in the United States by theNational Institute of Safety and Health, in order to assess occupational chemical exposuresamong health care workers in Bhutan. Methods: The questionnaire was first adapted to suit the Bhutanese context with the adviceof an expert review committee. 30 health care workers then completed the questionnaire atbaseline and 10–14 days later. Test-retest reliability was assessed by calculating Cohen's κand percentage agreement. Results: The questionnaire had high test-retest reliability. Cohen's κ ranged from 0.61 to1.00, and percentage agreement ranged from 86.7% to 100%. Further adaptations includedomitting questi...
Introduction: Health-related quality of life (HRQoL) is a multi-dimensional construct that assess... more Introduction: Health-related quality of life (HRQoL) is a multi-dimensional construct that assesses an individual’s and group’s perceived physical and mental health over time. Measurement of HRQoL is an important medical outcome study and its study among older adults in Bhutan is limited. Methods: This is a cross-sectional study aimed to assess HRQoL and its sociodemographic and health correlates, among older adults in Bhutan. Data for this study was collected from the four major towns of Thimphu, Phuntsholing, Gelephu, and Samdrupjongkhar, Bhutan, from November 2014 - February 2015, using structured questionnaire with face-to-face interview. A total of 337 Bhutanese older adults participated in this study. Statistical analysis was performed using statistical package for social science version 21.0. Results: The overall mean score for the HRQoL among older adults in this study was 0.67 (SD: 0.13) significantly different between the gender (p-value<0.001). A significantly low scor...
This study explored associations between quality of life (QOL), spirituality, social integration,... more This study explored associations between quality of life (QOL), spirituality, social integration, chronic diseases, and lifetime adversity among people aged 60 years and older in Bhutan. Adults aged 60 to 101 years (n = 337) completed face-to-face interviews. The main measure included the World Health Organization QOL questionnaire and Adverse Childhood Experiences International Questionnaire. The social relationships domain of QOL had the highest mean. Frequent back pain, memory decline, depression, mobility impairment, insomnia, and lung diseases were commonly reported and negatively related to QOL. Compared with women, men reported fewer physical and mental health problems and better QOL. Multivariate analysis revealed that cumulative health problems, psychological distress, and social connectedness contributed significantly to overall QOL. The measure of spirituality was negatively associated with QOL, which is not conclusive and suggests the need for more research especially when the influence of spiritualism is highly visible in the everyday lives of Bhutanese people. The significance of these findings is discussed in relation to care for elderly people in Bhutan.
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