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The Health Thread

Dietary Pattern and Nutritional Status among Healthcare Professionals

Dr. Mukti Thapaliya

Written by Kamala Shrestha, BN ( Nursing) , MA ( Nutrition )

Kamala Shrestha is a public health researcher with a focus on nutrition and lifestyle behaviors among healthcare professionals. She holds a degree in Home Science and has a passion for exploring the intersection of work environments, dietary habits, and health outcomes. This article is based on the findings of her thesis, which she submitted as part of her academic journey.

Healthcare professionals (HCPs) are often seen as the torchbearers of health and wellness, guiding patients toward better dietary choices and healthier lifestyles. Yet, behind the scenes, many HCPs struggle to maintain their own nutritional well-being. This article is the article version of the thesis I submitted, and I am sharing what I found during my research. A study conducted among 171 healthcare professionals in Nepal sheds light on this paradox, revealing alarming trends in dietary patterns and nutritional status that demand immediate attention.

The study, conducted across three healthcare institutions in Gokarna Municipality, found that more than half (52.03%) of HCPs worked grueling shifts of 8-12 hours daily. This demanding schedule took a toll on their eating habits, with 72.73% admitting to occasionally skipping meals. Breakfast, often hailed as the most important meal of the day, was the most frequently missed, with 31.97% of participants forgoing it altogether.

The consequences of these irregular eating patterns were evident in the dietary choices of the participants. A staggering 71.34% reported regular consumption of fast food, while an overwhelming 91.97% admitted to consuming sugary drinks. These habits, coupled with limited water intake and high stress levels, contributed to a concerning nutritional profile. Nearly half (48.17%) of the participants were classified as “Overweight” or “Pre-Obese,” and 50.84% faced high health risks based on their Body Mass Index (BMI).

The Hidden Struggles of Healthcare Professionals

Healthcare professionals are often perceived as paragons of health, but the reality is far more complex. Their jobs are inherently stressful, involving long hours, emotional strain, and physically demanding tasks. These factors, combined with irregular shifts, make it difficult for HCPs to prioritize their own health. As one nurse participating in the study shared, “When you’re rushing from one patient to another, grabbing a quick snack or skipping a meal becomes the norm rather than the exception.”

This sentiment is echoed globally. A 2023 study by Gołabek et al. found that midwives working shift schedules in Poland faced similar challenges, with irregular meal patterns and high consumption of processed foods being common. The study also highlighted the impact of such diets on micronutrient deficiencies, which can further exacerbate fatigue and reduce cognitive function.

The Role of Sociodemographic Factors

The study also highlighted the role of sociodemographic factors in shaping dietary patterns and health outcomes. Younger HCPs, particularly those aged 20-25, were more likely to exhibit unhealthy eating behaviors and face obesity-related risks. This aligns with findings from Karthijekan and Angela (2020), who noted that younger individuals often prioritize convenience over nutrition, leading to poorer dietary choices.

Marital status also played a significant role. The findings of this research indicated that married HCPs were found to be obese, with a higher waist-to-hip ratio and  single HCPs, especially those living alone, were more prone to relying on fast food and skipping meals. Smoking and low water intake were additional risk factors, with both behaviors significantly associated with higher BMI and Waist-to-Hip Ratio (WHR) risks.

Interestingly, gender differences were also observed. Female HCPs had a higher prevalence of WHR-related health risks, consistent with findings from Gupta (2017) and the Chinese Nutrition Society (2020). This could be attributed to biological factors, such as differences in fat distribution, as well as societal pressures that may lead women to adopt restrictive or unhealthy diets.

The Caloric Conundrum

One of the most striking findings of the study was the imbalance in caloric intake among HCPs. Over 40% of participants consumed either insufficient or excessive calories, both of which can have serious health implications. Insufficient caloric intake can lead to fatigue, weakened immunity, and impaired cognitive function, while excessive intake is a key driver of obesity and metabolic disorders.

This caloric imbalance is not unique to Nepal. A 2022 study by Ydyrysheva et al. found that medical workers in shift-based roles often struggle with maintaining a balanced diet, leading to similar patterns of over- or under-eating. The study also noted that shift work disrupts circadian rhythms, further complicating dietary habits and increasing the risk of metabolic syndrome.

The Ripple Effect on Patient Care

The implications of poor nutrition among HCPs extend far beyond individual health. Research by Lemaire et al. (2010) has shown that inadequate nutrition can impair cognitive function, reduce energy levels, and negatively impact decision-making abilities. For healthcare professionals, whose jobs require precision, focus, and empathy, these effects can be particularly detrimental.

In low-resource settings like Nepal, where healthcare systems are already under strain, the well-being of HCPs is critical to sustaining effective healthcare delivery. As Dr. Chen (2021) aptly noted in his study on the dietary health of medical workers, “When healthcare professionals are unhealthy, the entire healthcare system suffers.”

A Call to Action: What Can Be Done?

The findings of this study underscore the urgent need for interventions at both the individual and institutional levels. Workplace wellness programs that prioritize nutritional education, stress management, and access to healthier food options could go a long way in improving dietary habits among HCPs. For example, hospitals could establish on-site cafeterias offering balanced meals, or provide HCPs with meal vouchers for healthier options.

Policies that encourage regular meal breaks and reduce time constraints are also essential. As Simkhada et al. (2011) noted in their study on civil servants in Nepal, even small changes in workplace policies can have a significant impact on employees’ health and productivity.

Moreover, future research should incorporate comprehensive nutritional assessments, including laboratory tests for micronutrient levels, lipid profiles, and glucose levels, to provide a more holistic understanding of HCPs’ nutritional status. Such data could inform targeted interventions, such as personalized nutrition plans or supplementation programs.

The Bigger Picture: A Healthier Future for Healthcare Professionals

The study serves as a timely reminder that healthcare professionals are not immune to the challenges of maintaining a healthy lifestyle. In fact, their unique circumstances—long hours, high stress, and irregular shifts—make them particularly vulnerable to poor dietary habits and their associated health risks.

Addressing these challenges is not just a moral imperative but a practical necessity. Healthier healthcare professionals mean healthier patients—and a healthier society. As the study concludes, “Ensuring the well-being of HCPs is not just an investment in their health, but an investment in the health of the communities they serve.”

In a world where HCPs are often too busy caring for others to care for themselves, this study is a wake-up call. It’s time to prioritize the health of those who dedicate their lives to healing others. After all, a healthier healthcare workforce is the foundation of a healthier world.

REFERENCES

  1. Chen, W. (2021). Dietary health of medical workers: Who’s taking care of it? Hepatobiliary Surgery and Nutrition, 10(2), 232-234. https://doi.org/10.21037/hbsn-2021-9
  2. Gołabek, K.D., Chmielewska, A., Karoluk, E., & Regulska-Ilow, B. (2023). A multifaceted assessment of the nutritional status, diet, and eating habits of midwives working on a shift schedule in Wrocław, Poland: Evaluation of macronutrients, vitamins, and minerals in the diets of midwives participating in the study. International Journal of Occupational Medicine and Environmental Health, 36(5), 618-631. https://doi.org/10.13075/ijomeh.1896.02117
  3. Gupta, S. (2017). Dietary practices and nutritional profile of female nurses from government hospitals in Delhi, India. Iranian Journal of Nursing and Midwifery Research, 22(5), 348-353. https://doi.org/10.4103/ijnmr.IJNMR_167_16
  4. Karthijekan, K., & Angela, A.A. (2020). Nutritional status and dietary practices among university students in Sri Lanka. International Journal of Scientific and Research Publications, 10(10), 359-370. http://dx.doi.org/10.29322/IJSRP.10.10.2020.p10648
  5. Lemaire, J.B., Wallace, J.E., Dinsmore, K., Lewin, A.M., Ghali, W.A., & Roberts, D. (2010). Physician nutrition and cognition during work hours: Effect of a nutrition-based intervention. BMC Health Services Research, 10, 241.n https://doi.org/10.1186/1472-696310-241
  6. Simkhada, P., Poobalan, A., Simkhada, P.P., Amalraj, R., & Aucott, L. (2011). Knowledge, attitude, and prevalence of overweight and obesity among civil servants in Nepal. Asia Pacific Journal of Public Health, 23(4), 507-517. https://doi.org/10.1177/1010539509348662
  7. Ydyrysheva, K.K., Magzumova, R.Z., & Sazonov, V. (2022). Impact of shift work on dietary habits and health of medical workers. Science & Healthcare, 24(2), 71-78. https://doi.org/10.34689/SH.2022.24.2.017

Prevention of Cyberbullying in Nepal

Dr. Kishor Adhikari

Written By Sonika Parajuli, Bachelor of Arts in Social work, 4th year  ( Major – Psychology ) Xavier International College

Sabina Maharjan

Reviewed by Sabina Maharjan, Clinical Psychologist(M.Phil, IOM TUTH), Bsc Nurse

Introduction

Cyberbullying, a new form of bullying has been defined as “willful and repeated harm inflicted through aggressive actions through the use of computers, cell phones, and other electronic devices.” (Hutson, 2016, p. 13). It is important to know that cyberbullying can happen to anyone. Relatively little can be said about a typical cyber target or a typical cyberbully: they can be rich kids or poor kids, left-out kids or popular ones, A-students or struggling students, majority or minority students, someone who has been bullied before of someone who rarely uses technology, it can be someone who uses technology to pass their free time by browsing and chatting, but also someone who mostly uses it for online learning, research, time management or school.

Some of the World wide data:

According to a report by National Information Technology, Centre, more than 1,000 cases of cybercrime were reported in Nepal in 2020. The most common forms of online harassment and cyberbullying include cyberstalking, revenge porn, online scheming, online shaming and trolling. Cyberbullying behaviours are not limited to name-calling; they can include other forms of teasing, defamation, intimidation, rumour spreading, displaying unflattering or compromising photos without consent, hacking into individual’s computer, spreading virus. (Aricak et al., 2008).

There are several forms of cyberbullying including:

  • Flaming- It involves sending angry or vulgar messages to an individual or group.
  • Harassment- The act of sending insulting messages, making threats, stalking, or engaging in other forms of unwelcome communication or conduct to an individual.
  • Denigration- This means sending untrue or unkind statements about someone to other people.
  • Cyberstalking- Threatening to harm someone or using intimidation tactics is known as cyberstalking.
  • Masquerading- The process of impersonating someone and sending information that puts that person in danger or casts them in a negative light is called masquerading.
  • Outing and trickery- accessing embarrassing information about an individual and releasing it to the public.
  • Exclusion- It involves purposefully excluding an individual from an online platform.
  • Catfishing- an individual creates a fabricated identity on the internet with the aim of manipulating and harming a victim through various means, often by exploiting the victim’s emotions.
  • Cyberflashing- When an individual receives sexually explicit image without their consent, they have experienced cyber flashing. This can happen through peer-tp-peer Wi-Fi networks or Bluetooth Airdrop, both within and outside of school settings.
  • Ghosting- When individuals stop talking to someone online without explanation, it is called ghosting. Frequently, instead if directly addressing the matter, individuals opt to simply ignore the person they are targeting.
  • Griefing- The repetitive behaviour of intentionally bothering or annoying others by deliberately eliminating your character, steal your game possessions, or harass you through chat is called griefing.
  • Hate pages- On social media platforms like Instagram, teens make fake accounts to bully others. They post embarrassing photos, share secrets, or spreads mean messages. This is called hate pages.
  • Outing- This happens when someone shares another person’s gender identity or sexual orientation without their permission. It is especially harmful for teens who already struggle with mental health and may be more likely to harm themselves.

According to Stop Bullying (2020), the following are the most common places where cyberbullying occurs:

  • Social Media, such as Facebook, Instagram, Snapchat, and Tik Tok
  • Text messaging and messaging apps on mobile or tablet devices.
  • Instant messaging, direct messaging, online chatting over the internet.
  • Online forums, chat rooms, and message boards, such as Reddit.
  • Online gaming communities.

Cyberbullying can take many forms. It can include harassment (insults or threats), spreading rumours, impersonation, outing and trickery (gaining an individual’s trust and then using online media to distribute their secrets) or exclusion (excluding an individual from activities). These activities can be performed via e-mail, instant messaging, text message, social networking sites such as Facebook or Tumblr, and other websites (Peebles E.,2014).

Short Message Service (SMS), which is more commonly known as text messaging, is also a vehicle for cyberbullying. Text messaging appears to be the most widely used platform for cyberbullying among middle and high school students, followed by online gaming (Smith et al., 2008). DePaolis and Williford (2015), found that 11% of elementary school children under the age of ten reported weekly victimization through online gaming. The social media sites used for 8 cyber victimization included Facebook, Twitter, and Instagram. The least utilized platforms for cyberbullying included instant messaging, email, and chat rooms.

Some References of Case Studies of Nepal

One of the disturbing cases was of Goma Karki, a 16-year-old girl from Nepal, who committed suicide after discovering someone had created a fake Facebook account in her name and posted offensive content. Goma’s family filed a complaint with the Cyber Crime Bureau, which tracked the cell phone number used to create the account and arrested Yubaraj Karki, who confessed to creating the fake profile.

  • Rita Khadka’s Facebook account was compromised in August 2019. She didn’t learn about it until her friends alerted her to the pornographic photographs being shared from her account. She quickly reported the posts to Nepal Police’s cybercrime division and deleted them from her account.
  • According to a study by the Nepal Telecommunications Authority, 26% of students in Kathmandu reported experiencing cyber bullying.

How does Cyberbullying occur?

The exact reason of why people do cyberbullying is unknown.

  • Lack of empathy.
  • A desire for power and control.
  • To take revenge
  • Peer pressure
  • Deficient digital communication skills
  • Escapism, which according to Cambridge dictionary mean a way of avoiding an unpleasant or boring life, especially by thinking, reading, etc. about more exciting but impossible activities.
  • Seeking entertainment
  • Inadequate regulation
  • Lack of parental supervision over children’s Internet use or their computer activities.
  • To boost their egos.
  • To entertain themselves and their friends.
  • To get attention.
  • Some do it because people around them are doing it as well.

Effects of Cyber bullying

Psychological Impacts

  • Victims of cyberbullying are likely to experience Anxiety, Depression, and the feeling of low self esteem
  • Low confidence
  • More susceptible to developing Post Traumatic Stress Disorder.
  • Developing thoughts about suicide and harming oneself.
  • Constant feeling of fear and stress
  • Feeling ashamed, nervousness, anxious and insecurity regarding what people say or think about you.

Physical Impacts

  • Headaches
  • Stomach aches and sleeping problems

Social Impacts

  • Victims of Cyberbullying are at higher risk of being marginalised and stigmatised by society.
  • They might feel ashamed or embarrassed about the harassment, leading them to avoid social activities and relationships.
  • Social isolation.
  • Their peers might not accept them.
  • They do not easily trust other people and are always suspicious of others.
  • For adult: could able to go for work and could not do the routine work

Academic Impacts

  • They struggle to fit in at school and perform poorly academically.
  • Drop in grades
  • Skips school.
  • Gets into trouble at school
  • Loses interest in School
  • Avoid going to school.

(Pradhan, 2023)

Possible signs of cyber bullying

  • Mentally – Feeling upset after messaging or being on the internet, embarrassed, stupid, even afraid or angry most of the time, low self-esteem, reluctant to talk or secretive about their online activities and mobile phone use.
  • Emotionally – feeling ashamed or losing interest in the things you love, feeling upset after using the internet or their mobile phone, anger and irritable.
  • Physically – tired (loss of sleep), or experiencing symptoms like stomach aches and headaches.

Socially- Avoiding formerly enjoyable social situations, not wanting to go to school and/or avoiding meeting friends and school mates, significant increase or decrease in time spent in texting, gaming or using social media.

Internet safety for children

  • Be careful what pictures or videos you upload.
  • Only add people you know and trust to friends/followers lists online.
  • When talking to strangers, keep your personal information safe and location hidden.
  • Keep your password to yourself and change it regularly.
  • Block or report someone who is behaving badly.
  • Do not reply to offending e-mails, text messages or online conversations.
  • Always keep a copy of offending e-mails, text messages or a screen grab of online conversation
  • Make sure you tell an adult you trust, for example, a parent, a carer, a teacher, or the anti-bullying co-ordinator or call a helpline.
  • Do not share your last name, home address, school name or telephone number. You don’t know how the person will use your information.
  • While creating screen name, do not include personal information like your last name or date of birth.
  • Do not share your passwords with anyone and when you use a public computer, make sure your logout of the accounts you have accessed before leaving the terminal.
  • Do not agree to meet an online friend, until you have your parents’ permissions sometimes people pretend to be someone and turb out to be someone else and they recognize the people better.
  • Do not buy anything online without talking to your parents first. Some ads may try to trick you by offering free things as a way of collecting your personal information.
  • Talk to your parents before you open an email attachment or download software as the attachments sometimes might contain virus and make sure not to open an attachment from someone you don’t know.
  • Make sure that you have control over who can access your information online by activating and improving privacy setting on all your social media accounts.
  • Keep in mind that when you use a public internet connection, you cannot know how secure it is. It is best to avoid doing any online banking, sharing sensitive information while using public Wi-Fi.

How can the parents keep their children internet safe?

  • Monitor child’s social media use.
  • Being involved and talking to children. Once a picture is shared online it cannot be taken back.
  • Remind your children that they never know who they really are. They might seem friendly, but because you can’t see them in real life, it is best to be careful.
  • Advise them to never share their email or social media password with anyone, even their best friend.
  • Help them determine what is and is not appropriate to share online.
  • Set hours and limit access to using technology online.
  • Create a code of conduct for your children, such as they will not use social media to humiliate or embarrass other people, even if they are being targeted by cyberbullying.
  • Establish that if your child experiences cyberbullying and shares that with you, their use and access to technology won’t be restricted. However, if your child demonstrates cyberbullying behavior and you find out, identify consequences for your child.
  • If your child is being bullied online, be supportive of your child. Let them know that you will work together to take steps to stop bullying.

How can the Teachers keep the children internet safe?

  • Promote a positive and safe classroom culture. Provide resources in the classroom to help students identify, respond to, and avoid cyberbullying.
  • Step up when you encounter a teachable moment related to cyberbullying or respectful online communication,
  • Encourage students to pay attention to “red flag moments”—when something happens on digital media that makes them feel uncomfortable, worried, sad, or anxious.
  • Explain to students the three ways they can and should respond if they witness cyberbullying: support the target of the bullying (be an ally); try to stop the cyberbullying (be an upstander); and/or tell a trusted adult (report it). It may not be part of your lesson plan, and it may set you off track for a bit, but every time you reinforce anti-cyberbullying messages, you’re doing the critical work of cyberbullying prevention.
  • Incorporate lessons on cyberbullying into your existing curriculum.
  • Talk to parents if encountered any inappropriate cyberbullying.

How can the Adult keep themselves internet safe and reduce the cyberbullying?

  • Make sure you are up to date with the privacy settings. Social media regularly update their privacy options. Stay informed about these changes.
  • Limit access of your contact details. Avoid sharing your email or phone number with unfamiliar individuals.
  • Avoid sharing inappropriate images or videos. Keep in mind that a current romantic partner could be and ex in the future. So it is essential to prevent the possibility of someone possessing and potentially posting compromising material of you online.
  • Refuse friend or follower requests from unknown individuals. If you are unfamiliar with the person sending the request, simply ignore it.
  • Avoid immediate responses to cyberbullying. Cyber bullies often aim to provoke emotional reactions from their targets. When faced with negative online comments, unappealing photos or tags, or any form of unkind behaviour, consider stepping away from your device for at least an hour. Utilize this time to create emotional distance and carefully contemplate your response.
  • Capture screenshots to document instances of cyberbullying. This method ensures you have a record of any harmful comments or photos.
  • Use reporting and blocking features available on social media platforms to address cyberbullying effectively.

Who helps in Nepal?

  • Child Safe Net

Child safe net has been established with the vision of enhancing the safety of digital technology for children and young individuals. They raise awareness about using the internet and devices safest to protect young people from issues like Internet Addiction, Online sexual abuse, and exploitation, cyberbullying, and gaming addiction, while also promoting digital literacy, since 2018.

  • Nepal Police Cyber Bureau

Toll free Emergency Child Helpline- 1098

Toll free Nepal Police Hotline- 100

Nepal Police Cyber Bureau- 9851286770

REFERENCES