Browsing by Author "S, Sharma"
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Publication HIV and AIDS: the global perspectives and the challenges for Nepal(Kathmandu University, 2004) S, SharmaNAPublication Hormone Replacement Therapy in menopause: current concerns and considerations(Kathmandu University, 2003) S, SharmaIt has been estimated that one third of postmenopausal women in the U.S. use Hormone Replacement Therapy (HRT) to treat symptoms of menopause and prevent chronic conditions. In developing countries HRT use is not so common but there is an increasing trend in its use. It has been seen that women with better socio-economic status, higher education and urban population use HRT. It is important that benefits and harms of HRT based on scientific evidence should be considered when prescribing HRT. The health care workers should prepare themselves for a better dialogue with women including information about alternative treatment. Objective: To review the available evidence on benefits and harms of HRT. Methodology: A Medline search was done for papers published in English language between 1990 to 2003, with abstracts available. The limitations set were original articles and reviews. The key words used were Menopause, Hormone Replacement, HRT, and ERT. The local libraries were searched and email requests were sent for full text articles. 10 full text articles were available, mostly review and large studies, which were studied in more detail. Some textbooks and reference books for gynaecology were also reviewed. Results: Beneficial effects of HRT on vasomotor symptoms have been supported by various studies, but HRT to treat negative mood is not recommended. A systematic review of Cochran database showed little evidence regarding the effect of hormone replacement therapy or oestrogen replacement therapy on overall cognitive function in healthy postmenopausal women. Oestrogens and androgens have significant beneficial effects on skin collagen, but do not prevent the effect of aging on elastic tissue and have limited use in the prevention and treatment of skin changes of menopause. Short-term benefits have been shown for urogenital atrophy. Recent evidences suggest that benefits of HRT include prevention of osteoporotic fractures, and colorectal cancer while prevention of dementia is uncertain. Harms include Coronary Heart Disease (CHD), stroke, thromboembolic events, breast cancer, with 5 or more years of use, and cholecystitis. It is recommended that the regimen should not be initiated or continued for primary prevention of coronary heart disease. In women with CHD, it should not be used for secondary prevention of CHD events. Active living, alternative therapies and consumption of food rich in phyto-oestrogens are some areas, which need to be explored in more detail. Conclusion: Patient preferences as well as evidence are important to initiate and/or continue HRT. Benefits and harms need to be re-addressed periodically to apply newly published evidence and to reassess emerging risk, co-morbidities and need of individuals.Publication Publication Publication Measuring life skills of adolescents in a secondary school of Kathmandu: an experience(Kathmandu University, 2003) S, SharmaObjective: The objective of this study was to develop a scale to measure life skills and to assess the levels of life skills in adolescents of a secondary school at Kathmandu. Methodology: a descriptive, cross sectional survey of adolescents from class VIII, IX, and X of a public co-educational secondary school of Kathmandu was done with the help of self-administered questionnaires prepared in English and translated into Nepali. Focus Group Discussions consisting of boys only, girls only and a mixed group comprising of one student from each section of each class were conducted to confirm the results of the study. All the data obtained from the questionnaire survey were edited, coded and entered into EPI info Version 6. Results: A total of 347 adolescents participating in the study. 176 adolescents (51%) had life skill scores above the mean, and was termed as having “high level” of life skills and 171(49%) , had “low level” of life skills scores. Mother’s education was significantly associated with increased level of life skills in adolescents (P=.001). Conclusion: Most of the teachers were not aware of the concept of life skills. Maternal education was significantly associated with higher life skill levels in adolescents. Connectedness and family support were other important factors influencing the level of life skills in the adolescents. Keywords: Life skill, adolescence, scale measuring life skillPublication Reproductive Rights of Nepalese Women: Current Status and Future Directions(Kathmandu University, 2004) S, SharmaNA