Poudel-Tandukar, Kalpana
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Assistant Professor
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Poudel-Tandukar
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Kalpana
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Medicine and Health Sciences
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Nursing
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Introduction
Dr. Kalpana Poudel-Tandukar is an Assistant Professor at College of Nursing, University of Massachusetts Amherst. She received Certificate in General Medicine, Bachelors in Public Health and Masters in Public Health from Tribhuvan University (Nepal), Masters in Primary Health Care from Flinders University of South Australia (Australia), and PhD in International Health from the University of Tokyo (Japan). During her postdoctoral fellowship at the National Center for Global Health and Medicine, Japan, she published manuscripts on suicide working independently on a large scale data set of a longitudinal study of Japanese cohort. She worked as Principal Investigator and Co-Investigator on several research projects based in developing countries. She has several years of professional experience as a public health expert in different prestigious organizations like the United Nations Development Program, World Vision International, and Save the Children. She worked as a clinician in Bhutanese Refugee Camp in eastern Nepal during the emergency phase of the Program.
Dr. Poudel-Tandukar’s research interests lie in the area of behavioral and social science research on the causes and solutions to health disparities and social injustice among vulnerable populations including refugees, immigrants, and HIV-infected individuals. She is interested in analyzing various clinical, socio-cultural, behavioral, and environmental determinants of global health problems using multiple levels of analyses. She is also interested in applied and translational research on the development, testing, adaptation, and delivery of interventions to reduce health disparities using community based participatory approaches. Presently, she is studying the role of micronutrients on inflammation and mental health outcomes in HIV-infected individuals and designing mental health interventions for the refugee populations.
Complete List of Published Work in MyBibliography:
http://www.ncbi.nlm.nih.gov/sites/myncbi/1pufjr8T9-g5a/bibliography/49358686/public/?sort=date&direction=descending
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Publication Dietary intakes of α-linolenic and linoleic acids are inversely associated with serum C-reactive protein levels among Japanese men(2009-06-01) Poudel-Tandukar, Kalpana; Nanri, Akiko; Matsushita, Yumi; Sasaki, Satoshi; Ohta, Masanori; Sato, Masao; Mizoue, TetsuyaInvestigations suggest a protective role of n-3 polyunsaturated fatty acids (PUFA) but opposing roles of n-6 PUFA in inflammation, but the effects in vivo the human are not clear. We therefore tested the hypothesis that higher intakes of n-3 PUFA and n-6 PUFA are associated with lower levels of inflammation among a population consuming a diet high in PUFA. This study aimed to assess theassociation between PUFA intake and serum C-reactive protein (CRP) concentrations in a group of Japanese employees. The study subjects were 300 men and 211 women aged 21 to 67 years workingin 2 municipal offices of Japan. We measured the serum high-sensitivity CRP concentrations by the latex agglutination nephelometry method and assessed dietary habits by a validated selfadministered diet history questionnaire. We analyzed the data using multiple linear regression analysis with adjustment for potential confounding variables. Mean serum CRP concentrationstended to decrease as the intake of eicosapentaenoic acid, docosahexaenoic acid, or their combination increased in men and women, although none of these relationships was statisticallysignificant. In men, there were statistically significant inverse relationships between dietary intake of n-3 or n-6 PUFA and serum CRP concentrations (P for trend = .03 and .008, respectively).Among specific PUFA, only α-linolenic acid and linoleic acid showed clear inverse relationships (P for trend = .001 and .003, respectively) in men. The results suggest that increased intake of notonly α-linolenic acid (n-3 PUFA) but also linoleic acid (n-6 PUFA) has a beneficial effect on systemic inflammation in men.Publication Long chain n-3 fatty acids intake, fish consumption and suicide in a cohort of Japanese men and women — The Japan Public Health Center-based (JPHC) Prospective Study(2010-08-09) Poudel-Tandukar, Kalpana; Nanri, Akiko; Iwasaki, Motoki; Mizoue, Tetsuya; Matsushita, Yumi; Takahashi, Yoshihiko; Noda, Mitsuhiko; Inoue, Manami; Tsugane, ShoichiroObjective: Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have been implicated as protective against suicide. However, it is uncertain whether a higher intake of EPA and DHAor of fish, a major source of these nutrients, lowers suicidal risk among Japanese, whose fish consumption and suicide rate are both high. This study prospectively examined the relation between fish, EPA, or DHA intake and suicide among Japanese men and women.Method: Subjects were 47,351 men and 54,156 women aged 40–69 years who participated in the JPHC Study, completed a food frequency questionnaire in 1995–1999, and were followedfor death through December 2005. We used the Cox proportional hazards regression model to estimate the hazard ratio (HR) and 95% confidence interval (CI) for suicide by quintile of intake.Results: A total of 213 and 85 deaths from suicide were recorded during 403,019 and 473,351 person-years of follow-up formen and women, respectively. Higher intakes of fish, EPA, or DHAwere not associated with a lower risk of suicide. Multivariate HRs (95% CI) of suicide death for the highest versus lowest quintile of fish consumption were 0.95 (0.60–1.49) and 1.20 (0.58– 2.47) for men and women, respectively. A significantly increased risk of suicidal death was observed among women with very low intake of fish, with HRs (95% CI) for those in 0–5th percentile versus middle quintile of 3.41 (1.36–8.51).Conclusions: Our overall result does not support a protective role of higher intake of fish, EPA, or DHA against suicide in Japanese men and women.Publication Association between serum 25-hydroxyvitamin D and depressive symptoms in Japanese: analysis by survey season(2009-01-01) Nanri, A.; Mizoue, T.; Matsushita, Y.; Poudel-Tandukar, Kalpana; Sato, M.; Ohta, M.; Mishima, N.Both depressive symptoms and vitamin D insufficiency are common during winter. This study examined the association between serum 25-hydroxyvitamin D and depressive symptoms by survey season. Subjects were 527 municipal employees aged 21–67 years of two municipal offices in Japan. Overall, there was no measurable association. However, in the workplace surveyed in November, multivariate-adjusted odds ratios (95% confidence interval) of having depressive symptoms (Center for Epidemiologic Studies Depression score of X16) for the lowest through highest quartiles of serum 25-hydroxyvitamin D were 1.00 (reference), 0.84 (0.45–1.58), 0.83 (0.44–1.58) and 0.59 (0.30–1.15), respectively (trend P ¼ 0.14). The association with the severe depressive state was more pronounced. By contrast, there was no such association in the workplace surveyed in July. Overall, this study did not provide evidence linking higher blood vitamin D levels with decreased depressive symptoms. The suggestive inverse association in sun-deprived season warrants further investigation.Publication Dietary B Vitamins and Depression in Persons with Human Immunodeficiency Virus Infection: The Positive Living with HIV (POLH) Study(2016-01-01) Poudel-Tandukar, KalpanaB vitamins have beneficial roles in mental health functional impairments; however, research on the role of B vitamins in depression among HIV-infected persons is limited. This study assessed the association between dietary B vitamin intake and depressive symptoms in a cohort of HIV-infected persons. A cross-sectional survey was conducted among 314 HIV-infected persons (180 men and 134 women) aged 18 to 60 y residing in the Kathmandu, Nepal. The Beck Depression Inventory-I was used to measure depression, with a cutoff score of 20 or higher. Dietary intake was assessed using two nonconsecutive 24-h dietary recalls. The relationships between B vitamins and depressive symptoms were assessed using multiple logistic regression analysis. Twenty-six percent participants (men: 23%; women: 29%) were depressed. More than two thirds of participants’ B vitamins intake were below the estimated average requirements (EAR) level. Low intake of riboflavin was associated with an increased risk of depression in women but not in men. Multivariate OR (95% CI) for depression in the first, second, and third tertiles of riboflavin in total participants were 1 (reference), 0.87 (0.46–1.64), and 0.49 (0.24–0.98), respectively (p for trend = 0.048) and in women were 1 (reference), 0.94 (0.36–2.40), and 0.23 (0.07–0.77), respectively (p for trend = 0.020). No clear associations were seen between other B vitamins and depressive symptoms in either sex. Low intake of riboflavin was independently associated with an increased risk of depressive symptoms in all participants and in HIV-infected women. Further prospective studies are warranted to confirm the role of vitamin B vitamins in depressive symptoms among HIV-infected persons.Publication Reaching hard-to-reach migrants by letters: An HIV/AIDS awareness programme in Nepal(2006-01-01) Poudel, Krishna; Jimba, Masamine; Poudel-Tandukar, Kalpana; Wakai, SusumeWe assessed the impact of an HIV/AIDS programme for Nepalese migrants to India that involved writing letters. The programme created opportunities for sending HIV/AIDS-related messages to the migrants in India, and encouraging them practicing safer sex. Initially, they received the messages only from the programme, but later from their colleagues, spouses or other family members. They discussed the messages in groups, disseminated them, and sought more knowledge in their destinations. These findings indicated that using letters could be an effective way to reach inaccessible migrants at their destinations, and help them to improve their HIV/AIDS-related knowledge, and safer sex practices.Publication Association between serum ferritin concentrations and depressive symptoms in Japanese municipal employees(2011-01-01) Yi, Siyan; Nanri, Akiko; Poudel-Tandukar, Kalpana; Nonaka, Daisuke; Matsushita, Yumi; Hori, Ai; Mizoue, TetsuyaIt remains unclear whether levels of body iron store are related to milder forms of depression, which are more common among apparently healthy people. We examined the association between serum ferritin concentrations and depressive symptoms among 312 men and 216 women working in two municipal offices in Japan. Depressive symptoms were assessed by using the Center for Epidemiologic Studies Depression (CESD) scale. In men, increased prevalence of depressive symptoms (defined by using a cutoff value of ≥19) was significantly associated with decreased levels of serum ferritin. In age- and study-site-adjusted models, ORs (95% CIs) for depressive symptoms for men in first, second, third, and fourth quartiles of serum ferritin concentrations were 2.83 (1.01–7.94), 1.74 (0.87–3.49), 1.33 (0.71–2.47), and 1.00 (reference), respectively (p for trend=0.02). In multivariate-adjusted model, ORs (95% CIs) in first, second, third, and fourth quartiles of serum ferritin concentrations were 2.88 (0.93–8.91), 1.91 (0.90–4.05), 1.28 (0.66–2.49), and 1.00 (reference), respectively (p for trend=0.03). No significant association was detected in women. Our finding that men with lower levels of serum ferritin concentrations had a higher prevalence of depressive symptoms suggests that adverse psychological effects may be implicated in iron deficiency among middle-age Japanese workers.Publication Unsafe Sexual Behaviors among HIV-positive Men in Kathmandu Valley, Nepal(2008-01-01) Poudel, Krishna; Nakahara, Shinji; Poudel-Tandukar, Kalpana; Yasuoka, Junko; Jimba, MasamineWe assessed unsafe sexual behaviors of the Nepalese HIV-positive men and their knowledge about the consequences of unsafe sex. We interviewed 167 participants recruited conveniently in the Kathmandu Valley, Nepal. Of total, 125 participants (75%) had sex in the past 6 months, 47% of whom with multiple partners. Fiftyseven (46%) of 123 participants who had sex did not always use condoms; unsafe sex was common in seroconcordant or serodiscordant relationships or in serounknown relationships. Only 41% (50/123) participants knew about the possibility of HIV superinfection. Our results suggest the urgent need of HIV prevention interventions for the Nepalese HIV-positive men.Publication Factors influencing women’s use of health services for Sexually Transmitted Infections in eastern Nepal(2003-01-01) Poudel-Tandukar, Kalpana; Poudel, Krishna; MacDougall, ColinThis paper explores low levels of women’s health service utilization for Sexually Transmitted Infections (STIs) in Nepal.We interviewed 120 women individually and 53 in focus groups. Predictors of lower utilisation were self-medication, consultation with faith healers, inadequate knowledge of STIs, beliefs about causes, fear, social taboos and stigmatisation, women’s secondary status, and presence of male health professionals. Results indicate the importance of people’s beliefs in their decisions about health care. Strategies to improve access to health services in Nepal shouldsystematically investigate the role of all these factors to improve access to and utilisation of health services for STIs.Publication Social support and suicide in Japanese men and women e The Japan Public Health Center (JPHC)-based prospective study(2011-07-30) Poudel-Tandukar, Kalpana; Nanri, Akiko; Mizoue, Tetsuya; Matsushita, Yumi; Takahashi, Yoshihiko; Noda, Mitsuhiko; Inoue, Manami; Tsugane, ShoichiroAlthough the important role of social support in mental health is acknowledged, no prospective study has yet examined the relation of social support to suicide. Here, we investigated the associationbetween social support and suicide in a cohort of Japanese men and women. A total of 26,672 men and 29,865 women aged 40e69 years enrolled in the Japan Public Health Center-based prospective study in1993e1994 completed a self-administered questionnaire which included four items of social support, and were followed for death through December 2005. Hazard ratios (HRs) and 95% confidence intervals (95% CI) of suicidal death by social support index were estimated using a Cox proportional hazards regression model. A total of 180 suicidal deaths were recorded during an average of 12 years’ follow-up. Men and women with the highest level of social support had a significantly decreased risk of suicide, with HRs (95% CI) for the highest versus lowest social support group of 0.56 (0.33e0.94) and 0.38 (0.16e0.89) in men and women, respectively. Esteem support and having four or more friends were associated with a lower risk of suicide in women [0.32 (0.13e0.77)] and in both sexes [men: 0.56 (0.36e0.88); women: 0.65 (0.32e1.30)], respectively, whereas confident support was not. These findings suggest that socialsupport may be important for suicide prevention. Avoiding social isolation may decrease the incidence of suicide in men and women, and esteem support can provide additional benefit for women.Publication Serum 25-Hydroxyvitamin D Concentrations and Season-Specific Correlates in Japanese Adults(2011-01-01) Nanri, Akiko; Foo, Leng Huat; Nakamura, Kazutoshi; Hori, Ai; Poudel-Tandukar, Kalpana; Matsushita, Yumi; Mizoue, TetsuyaBackground: Several lines of evidence indicate an important role for vitamin D in the prevention of a range of diseases. Blood vitamin D levels show clear seasonal variation; however, data on the determinants of vitamin D status for each season are limited. We investigated the association between lifestyle and serum vitamin D concentration by season in Japanese workers. Methods: Subjects were 312 men and 217 women aged 21 to 67 years who worked in municipal offices in Northern Kyushu, Japan and participated in a periodic checkup in July or November. Multiple linear regression analysis was used to examine the association between serum 25-hydroxivitamin D concentrations and lifestyle factors for each season. Results: Mean serum 25-hydroxyvitamin D concentration was 27.4 ng/ml (68.4 nmol/L) and 21.4 ng/ml (53.4 nmol/L) for workers surveyed in July and November, respectively (P < 0.001); the prevalence of vitamin D deficiency ( both sexes) and nonsmoking and physical activity (in men) were significantly associated with higher concentrations of serum 25-hydroxyvitamin D. In summer, fish/shellfish intake was associated with higher serum 25- hydroxyvitamin D concentrations in women. Conclusions: Vitamin D deficiency is common in Japanese workers during seasons with limited sunlight. The lifestyle correlates of favorable vitamin D status in November were physical activity, dietary vitamin D intake, and nonsmoking.