Kinship care at community is better model to ensure psychosocial and economic security to orphans living with HIV than from care homes.

BACKGROUND: There were about 24,000 children affected by AIDS living in Nepal in 2010; of these 5,000 AIDS orphans were in need of immediate support. The objective of this study was to investigate which model of care and support is more appropriate for improving psychosocial and economic security of AIDS orphans. METHODS: With the documented 5200 cases of AIDS orphans from 42 districts at National Association of People Living with HIV, we purposively selected five districts - one from each development region, based on the highest number of AIDS orphans reported. From five districts, 56 HIV positive double orphans aged 8-18 years and their 42 caregivers were interviewed to find their psychosocial and economic situation. RESULTS: Thirty nine (70%) orphans were found living in kinship care, while 17(30%) were living in institutional care homes. Orphans living in kinship were more optimistic, as they were backed by their close relatives 35 (90%), had birth certificates 35 (90%), ensured inherent family property 21 (54%), obtained basic needs like food, education and shelter from grandparents 23 (59%), and had more than five friends who visited their homes 26 (67%). While, the orphans living in institutional care homes 17(30%) had no birth certificates, fewer contacts with siblings 2 (12%), and none had friends outside the care homes. CONCLUSIONS: Kinship care is better model for psychosocial and economic security for AIDS orphans in Nepal, rather than institutional care. Families can provide good protection to AIDS orphans if government provides minimum support to them.

Thyroid hormone levels in highlanders- a comparison between residents of two altitudes in Nepal.

BACKGROUND: The endocrine changes related to altitude adaptation in human have attracted physiologists around the globe for long. A number of high altitude studies to detect the physiological changes have been performed now and then. But, the study to see the hormonal changes to compare populations residing at different high altitudes is a scarce. Hence, we have performed a study in native populations of different high altitude comparing changes in thyroid hormones in western Nepal. The Jharkot population included in this study is at altitude of 3760 m and Jomsom population at 2800 m height from sea bed. OBJECTIVE: The study is to compare changes in thyroid hormones at two different high altitude natives. METHODS: To compare thyroid status between high altitude natives at two different altitudes a cross sectional study is performed by random sampling method. The blood sample was collected in a vacutainer from fifty eight individuals after obtaining the informed consent of participants. The blood collected from antecubital vein was centrifuged in an hour and the serum obtained was used for biochemical analysis of free triiodothyronine, free thyroxine and thyroid stimulating hormone. RESULTS: Mean free thyroxine (fT4) of Jharkot population is significantly larger (p = 0.001) than Jomsom population. Mean thyroid stimulating hormone (TSH) with p = 0.597, does not indicate the difference between this two population. There is no significant difference between mean free triiodothyronine (fT3) of Jharkot and Jomsom population (p = 0.345). CONCLUSION: The rise in free thyroid hormone at high altitude is not dependent on the thyroid stimulating hormone released from anterior pituitary. The rise in free thyroxine is found at higher altitude and no difference in fT3 level is detected in population studied at high altitudes.

Effect of sub-maximal exercise stress on cold pressor pain: a gender based study.

BACKGROUND: Analgesic effect of exercise is a well established fact; however available reports are contradictory on gender differences in pain perception following exercise stress test. OBJECTIVE: The current study is prospectively designed to evaluate and compare the effect of acute bout of sub-maximal exercise stress on cold pressor pain in normal adult males and females. METHOD: The experimental study design involved healthy adults (n= 41); females (n = 18) and males (n=23) aged between 18 to 25 years and included them into four sets of experiments: SET I (Control), "resting blood pressure, radial pulse and respiratory rate were recorded after 15 minutes of complete supine relaxation. SET II (Cold Pressor Pain Test): Pain Threshold, Pain Tolerance, and Pain Duration in seconds were taken. SET III (Exercise Stress Test): Sub-maximal exercise of 70 to 75% of maximum predicted heart rate was given for 6 minutes. SET IV (Cold Pressor Pain Test immediately after Exercise Stress Test): At 0 minute of recovery again the pain parameters; Pain Threshold, Pain Tolerance, and Pain Duration in seconds were taken. SET I, SET II were performed in order on the first day and SET III and SET IV on the second day to ensure only a single Cold Pressor Pain Test is performed in each day. RESULT: The data (Mean ± SD) analysis showed significant increased in pain threshold (males: 14.36 ± 10.6 Vs 21.47 ± 13 seconds, p< 0.001, females: 14.1 ± 11.5 Vs 23.81 ± 20.22 seconds, p<0.001) and pain tolerance time (males: 41.3 ± 19.31 Vs 54.1 ± 21.7 seconds, p<0.001) in both sexes after 6 min of acute bout of sub-maximal exercise stress test with comparable age, BMI and baseline resting values of pain parameters and pulse rate and blood pressure. The percentage increment pain tolerance time following the exercise stress in female is higher than male (78.6 Vs 68.9%). CONCLUSION: The result suggests that pain sensation decreases immediately after a brief period of exercise challenge irrespective of gender, and the analgesic effect of the acute bout of exercise in terms of pain tolerant time is more enhanced in females than males.

Health seeking behavior during pregnancy and child birth among Muslim women of Biratnagar, Nepal.

Maternal mortality remains one of the biggest public health challenges in Nepal. This paper explores the health seeking behavior, during pregnancy and child birth in certain ethnic group. The poverty, illiteracy, women's low status in the society, lack of access and difficult geographical terrain are major reasons for poor maternal health status in Nepal. Cross-sectional study was conducted among 200 Muslim women of ward # 7 of Biratnagar municipality. They were interviewed to understand their health seeking behavior during pregnancy and childbirth, factors associated with use of health services and their role in the family. Information's on usages of health services, education level, family stricture, and occupational status, information were collected using a pretested and structured questionnaire. The overall institutional delivery in study population was found 24.5%. Low socio-economic status, Illiteracy and poverty in women are the major challenging features of pregnancy and child birth.

Pheripheral airway responsiveness to sub-maximal exercise in asymptomatic cigarette smokers.

BACKGROUND: Cigarette smoking is one of the cardinal causes for the development of bronchial hyperresponsiveness among the smokers. OBJECTIVES: This study was perspectively designed to determine the peripheral bronchial responsiveness to sub-maximal exercise challenge in the asymptomatic smokers. METHODS: The subjects were between age of 18-25 years without any findings of cardiorespiratory diseases. We performed the 5 min step test exercise at intensity of 80 to 90% of maximum predicted heart rate in 42 young adult male asymptomatic smokers to examine the effect of cigarette smoking on airway responsiveness. Forced expiratory spirogram was recorded before and at 0, 5, 10, 15 min after the completion of exercise. Pre- to post exercise drop in Forced Expiratory Volume in first second ≥ 15% was considered hyperresponsive to the challenge. RESULT: The analysis of data (mean ± SE) indicated the bronchial hyper-responsiveness in 22 (52%) smokers. The post exercise recovery time pattern showed drop in forced expiratory spirogram from the resting baseline in the responsive smokers and the maximum percentage fall in the parameters or increase in airway resistance which reflect the peripheral airway integrity such as Forced Expiratory Flow 25% (20.30 ± 2.18 Vs 7.88 ± 3.23, p < 0.01), Forced Expiratory Flow 50% (18.46 ± 4.40 Vs 1.93 ± 2.78, p < 0.01), Forced Expiratory Flow 75% (23.94 ± 3.68 Vs 0.80 ± 4.72, p < 0.001) and Forced Expiratory Flow 25-75% (32.50 ± 4.79 Vs 3.64 ± 3.32, p < 0.001) was significantly higher in the responsive than non-responsive subgroup of the smokers. CONCLUSION: The occurrence of peripheral airway resistance is more in the responsive than nonresponsive subset of smokers to the exercise challenge and hence more prone to develop obstructive airway disease in the long run.