Social Change, Out-migration, and Exit from Farming in Nepal.

Though international out-migration is widespread, little evidence exists regarding the consequences for economic change in sending countries, particularly in the densely populated agricultural areas of Asia. We examine associations between labor out-migration, remittances, and agricultural change in Nepal. Existing studies of this important population-environment relationship generally ignore the role of local community context, which is known to shape demographic behavior and likely exit from farming as well. Research offers opposing views of the consequences of out-migration for agricultural change - (1) loss of farm labor reduces engagement in agriculture, versus (2) loosening credit constraints from remittances increases engagement in agriculture - and indicates that both mechanisms likely operate simultaneously. Both of these mechanisms are likely to be shaped by changes in local context. Using multilevel dynamic models, we estimate associations between out-migration and remittances by household members and subsequent exit from farming, controlling for variations in community context. Results suggest international out-migration is associated with higher odds of exit from farming and simultaneously remittances are associated with lower odds of exit from farming. Results are robust against several key variations in model specification, including controls for household characteristics and local community context. However, local community context exerts an important independent influence on the hazard of exit from farming.

Ethno-Caste Influences on Migration Rates and Destinations.

While studies commonly show differences in out-migration between ethnic groups, ethnicity most often features no more than a side note in the emigration literature, and we have very little insight about why people from different ethnic groups migrate at different rates. Understanding ethnic differences in migration rates and destination choice has important implications for the present-day and future potential for either dampening or exacerbating ethnic discrimination and opportunity structures. Building on existing migration theory, we identify three possible mechanisms through which ethnicity might influence out-migration rates and destination choice: human and economic capital, contemporary discrimination, and historical legacies that are perpetuated through social networks. Our empirical investigation uses longitudinal panel survey data from Nepal and we find that all three of these mechanisms likely influence out-migration and destinations of the five major ethno-caste groups. However, we show that historical legacy and human and economic capital emerge as the key drivers of ethnic differences in out-migration here. We discuss what these results mean for migration studies as well as the potential for the institution of migration to affect patterns of ethno-caste-based disadvantage in Nepal. The theoretical basis and empirical evidence from our study also suggest ways to understand the reasoning for and consequence of ethnic and racial differentials in migration patterns in other areas of the world.

When does Social Capital Matter for Migration? A Study of Networks, Brokers, and Migrants in Nepal.

The study of social capital has been one of the strongest areas of recent advance in migration research, but there are still many questions about how it works and why it has varying effects in studies of different places. In this article, we address the contextual variation in social capital's effects on migration by considering migration brokers. We argue that destinations for which migration is logistically difficult to arrange give rise to brokerage industries and hypothesize that brokers in turn substitute for the informational capital typically provided by social networks. Our empirical tests in Nepal support this narrative, showing that social networks matter for migration to destinations where brokers are not available and have little discernible effect on migration to brokered destinations. Our results suggest that migration research should consider the growing role of brokerage agencies, that theorizations of social capital more broadly must contend with how it is delimited by brokers, and that social scientists might also consider other consequences that can arise from these migration brokers that are increasingly common in many countries and provide a marketized replacement for social capital in some cases.

A Novel Technique in Fibrin Gluing of Intercostal Nerves: Splint and Weld.

Splint and weld technique ensures a sound coaptation of intercostal and musculocutaneous nerves with minimal introduction of synthetic suture through the neural tissue.

Influences of Material Aspirations on Migration.

In this article, we investigate the influences of material aspirations on migration in Nepal, positing that material aspirations may have important influences on decisions to migrate and where to locate. We discuss a theoretical model explaining how these aspirations might be key influences in the migration decision. Using detailed continuous migration histories from the 2008-2012 Chitwan Valley Family Study, we estimate logistic and alternative-specific conditional logit models to examine how material aspirations in Nepal influence migration rates and destinations. Our empirical analyses provide strong evidence that material aspirations have large effects on overall rates of migration and affect destination-specific migration rates, particularly for relatively wealthy Western and Asian destinations. We also show an interaction effect between material aspirations and destination-specific expected earnings in influencing people's migration choices. It is the people with high aspirations who migrate to destinations with high earning potentials.

Postmarital Living Arrangements in Historically Patrilocal Settings: Integrating Household Fission and Migration Perspectives.

This study integrates theory and research on household fission (or partition) and migration to better understand living arrangements following marriage, especially in historically patrilocal and primarily agricultural settings. Using panel data from the Chitwan Valley Family Study to analyze the sequential decision-making process that influences men's living arrangements subsequent to first marriage, we demonstrate the importance of distinguishing among extended family living, temporary migration, and the establishment of an independent household. We find that community economic characteristics, such as access to markets or employment, as well as household wealth affect the initial decision to leave the natal home. Household resources and use of farmland, along with the young men's own education, media exposure, travel, and marital behavior, influence the decision to make the departure from the natal home permanent. Our findings explain why previous results regarding household fission and those focused on migration have provided such mixed results, and we establish a new framework for thinking about how families and individuals manage living situations.

Factors affecting institutional delivery in rural Chitwan district of Nepal: a community-based cross-sectional study.

BACKGROUND: Health facility delivery is considered a critical strategy to improve maternal health. The Government of Nepal is promoting institutional delivery through different incentive programmes and the establishment of birthing centres. This study aimed to identify the socio-demographic, socio-cultural, and health service-related factors influencing institutional delivery uptake in rural areas of Chitwan district, where high rates of institutional deliveries co-exist with a significant proportion of home deliveries. METHODS: This community-based cross-sectional study was conducted in six rural Village Development Committees of Chitwan district, which are characterised by relatively low institutional delivery rates and the availability of birthing centres. The study area represents both hilly and plain areas of Chitwan. A total of 673 mothers who had given birth during a one-year-period were interviewed using a structured questionnaire. Univariate and multivariable logistic regression analysis using stepwise backward elimination was performed to identify key factors affecting institutional delivery. RESULTS: Adjusting for all other factors in the final model, advantaged caste/ethnicity [aOR: 1.98; 95% CI: 1.15-3.42], support for institutional delivery by the husband [aOR: 19.85; 95% CI: 8.53-46.21], the decision on place of delivery taken jointly by women and family members [aOR: 5.43; 95% CI: 2.91-10.16] or by family members alone [aOR: 4.61; 95% CI: 2.56-8.28], birth preparations [aOR: 1.75; 95% CI: 1.04-2.92], complications during the most recent pregnancy/delivery [aOR: 2.88; 95% CI: 1.67-4.98], a perception that skilled health workers are always available [aOR: 2.70; 95% CI: 1.20-6.07] and a birthing facility located within one hour's travelling distance [aOR: 2.15; 95% CI: 1.26-3.69] significantly increased the likelihood of institutional delivery. On the other hand, not knowing about the adequacy of physical facilities significantly decreased the likelihood of institutional delivery [aOR: 0.14; 95% CI: 0.05-0.41]. CONCLUSION: With multiple incentives present, the decision to deliver in a health facility is affected by a complex interplay of socio-demographic, socio-cultural, and health service-related factors. Family decision-making roles and a husband's support for institutional delivery exert a particularly strong influence on the place of delivery, and this should be emphasized in the health policy as well as development and implementation of maternal health programmes in Nepal.

Management of Isolated Musculocutaneous Injury: Comparing Double Fascicular Nerve Transfer With Conventional Nerve Grafting.

PURPOSE: To compare the functional outcomes of nerve grafts and nerve transfers in the management of isolated musculocutaneous nerve (MCN) injuries. METHODS: We performed a retrospective case-control study of isolated MCN injury managed at a tertiary care center. The study group was composed of 12 patients managed with double nerve transfer whereas the 8 patients in the grafted group constituted the control group. RESULTS: In the study group, stab and missile injuries constituted most cases with a denervation period ranging between 3 and 9 months. Eleven patients in this group experienced a full range of active elbow flexion whereas one had antigravity flexion of 120°. Electromyography revealed the first sign of reinnervation of biceps at 10 ± 2 weeks, compared with 20 ± 2 weeks in the grafted group. The overall trend was for patients in the study group to have earlier return of active elbow flexion and better restoration of elbow flexion strength and range of (presumably active) elbow motion than those treated with grafting, although none of these measures reached statistical significance. CONCLUSIONS: We found that distal nerve transfer was a superior method of managing isolated MCN injury compared with conventional nerve grafting.

Negative pressure wound therapy as an adjunct in healing of chronic wounds.

Negative pressure wound therapy (NPWT) has emerged as a cutting-edge technology and provides an alternative solution to the problem of wounds. This study was undertaken to assess the efficacy of this technique in the treatment of chronic wounds. A prospective clinical study was used to evaluate our experience in use of NPWT in the healing of pressure ulcers and chronic wounds over 2 years. The primary end point of the study group was the time taken for appearance of healthy granulation tissue and full reepithelialisation without drainage. All patients with sepsis were excluded from the study. The statistical analysis of the data was carried out. Of the 60 patients studied, 41 had associated comorbidities including diabetes mellitus. The commonest site of occurrence was the lower limb. Coverage in the form of a flap was required at presentation in 63·33% of patients. However, after initiation of NPWT, none of them required the procedure and they healed spontaneously either by secondary intention or by skin grafting. The time taken for appearance of healthy granulation tissue was 14·36 ± 4·24 days. Complete healing of wounds occurred by 33·1 ± 10·22 days. There was a statistically significant difference in the volume of the wounds before and after the intervention (P = 0·000). Complications resulting from NPWT were minimal. This technique is an excellent adjunct to surgical debridement.

Recent advances in the management of brachial plexus injuries.

Management of brachial plexus injury is a demanding field of hand and upper extremity surgery. With currently available microsurgical techniques, functional gains are rewarding in upper plexus injuries. However, treatment options in the management of flail and anaesthetic limb are still evolving. Last three decades have witnessed significant developments in the management of these injuries, which include a better understanding of the anatomy, advances in the diagnostic modalities, incorporation of intra-operative nerve stimulation techniques, more liberal use of nerve grafts in bridging nerve gaps, and the addition of new nerve transfers, which selectively neurotise the target muscles close to the motor end plates. Newer research works on the use of nerve allografts and immune modulators (FK 506) are under evaluation in further improving the results in nerve reconstruction. Direct reimplantation of avulsed spinal nerve roots into the spinal cord is another area of research in brachial plexus reconstruction.

Developmental Idealism and Migration: Theorizing their Relationship and an Empirical Example from Nepal.

This paper brings together both theoretically and empirically two strands of social science research: migration and developmental idealism. The paper is motivated by the fact that there are extensive bodies of research about migration and about developmental idealism, but almost no discussion in the literature about how they might be interconnected. We present theoretical arguments concerning the influence of migration in distributing developmental idealism around the world and in developmental idealism being a force influencing the migration decisions of people. We also provide an empirical investigation of how variation in developmental idealism may have been an influence on migration and choice of migration destinations in Nepal. Thus, we extend the developmental idealism literature to include migration and the migration literature to include developmental idealism.

Yoga and music intervention to reduce depression, anxiety, and stress during COVID-19 outbreak on healthcare workers.

AIM: To investigate impact of Yoga and Music Intervention on anxiety, stress, and depression levels of health care workers during the COVID-19 outbreak. METHODS: This study was conducted to assess psychological responses of 240 healthcare workers during COVID-19 outbreak. We used Yoga and Music Intervention in normal and abnormal subjects based on Depression Anxiety and Stress Scale-42 (DASS-42). RESULTS: Of all 209 participants, 105 (50.23%) had symptoms of depression (35.88%), anxiety (40.19), and stress (34.92%) alone or in combination. The data suggest that there is significant improvement in test scores after intervention. Majority of persons with abnormal score exhibited improved DASS-42 score on combined interventions of Yoga and music compared to control group. Even subjects without abnormalities on DASS-42 score also showed improved DASS-42 scores in intervention (n = 52) group compared to nonintervention (n = 52) group. CONCLUSIONS: Our findings highlighted the significance of easily available, simple, inexpensive, safe nonpharmacological interventions like Yoga and Music therapy to overcome stress, anxiety, and depression in present times.

Dorsal approach in transfer of the distal spinal accessory nerve into the suprascapular nerve: histomorphometric analysis and clinical results in 14 cases of upper brachial plexus injuries.

PURPOSE: The spinal accessory nerve (SAN) is conventionally transferred to the suprascapular nerve (SSN) through an incision in the supraclavicular region (the anterior approach) to improve shoulder function in brachial plexus injuries. This approach carries a risk of partial denervation of upper trapezius muscle. Here we describe how dorsal nerve transfer through an incision placed directly over the scapular spine preserves the proximal branches to the upper trapezius muscle and allows nerve transfer close to target muscles. METHODS: We report our experience with the dorsal approach in 14 cases managed between February 2007 and January 2008. Results were compared with 21 control cases treated by the anterior approach. In addition, we submitted proximal cut ends of the SAN in 10 cases from the experimental group for histomorphometry. RESULTS: A total of 11 patients had C5 and C6 injuries, whereas 3 had associated C7 injuries. The denervation period ranged between 3 and 10 months. In all cases, the distal SAN could be transferred to the SSN without a graft. Histomorphometry revealed an average of 1,671 myelinated axons. Shoulder abduction and external rotation were restored in 13 and 9 cases, respectively, compared with 16 and 12, respectively, in the control group. Electromyography revealed the first sign of reinnervation of infraspinatus muscle at 23 ± 4 weeks, compared with 30 ± 4 weeks in the control group. Initial evidence of shoulder abduction appeared earlier in the study population (28 ± 4 vs 34 ± 4 weeks). Shoulder abduction and external rotation in the study group ranged between 70° and 170° and 30° and 80°, compared with 65° and 160° and 22° and 55° in the control group. Using the Medical Research Council (MRC) grading system, at 6 months postreconstruction, 13 patients had M4 power in the trapezius muscle, whereas 1 had M3, compared with 5 in the control group who displayed grade 3 weakness. CONCLUSIONS: A dorsal approach for transfer of the distal SAN into the SSN is an alternative and effective technique in restoring shoulder function in upper brachial plexus injuries. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.

Fascicular selection for nerve transfers: the role of the nerve stimulator when restoring elbow flexion in brachial plexus injuries.

PURPOSE: Restoration of elbow flexion is an important goal in brachial plexus injuries. Double nerve transfers using fascicles from ulnar and median nerves have consistently produced good results without causing functional compromise to the donor nerve. According to conventional practice, these double nerve transfers are dependent on the careful isolation of ulnar and median nerve fascicles, which are responsible for wrist flexion, using a handheld nerve stimulator. Here we suggest that fascicular selection by nerve stimulation might not be a necessity when executing double nerve transfers for restoration of elbow flexion in brachial plexus injuries. METHODS: This is a retrospective case control study in 26 patients with C5, C6 brachial plexus injuries that were managed with double nerve transfers between March 2005 and January 2008. Our technique consisted of transferring 2 fascicles, one each from the ulnar and the median nerve, directly onto the biceps and brachialis motor branches. Contrary to the standard practice, the ulnar or median nerve fascicles were selected without using a handheld nerve stimulator. Results were compared to 21 cases (control group) in which a nerve stimulator was used for fascicular selection. The denervation period ranged from 3 to 9 months. RESULTS: Twenty-four patients of the study group experienced full restoration of elbow flexion, and 2 had an antigravity flexion of 120° and 110°. The EMG revealed the first sign of reinnervation of biceps and brachialis muscle at 9 ± 2 weeks and 11 ± 2 weeks, as compared to 9 ± 2 weeks and 12 ± 4 weeks in the control group. After surgery, the appearance of initial evidence of elbow flexion, the range and mean of elbow flexion strength, and the difference between preoperative and postoperative grip and pinch strengths were comparable in both groups. At 24 to 28 months follow-up, 19 patients of the study group had M4 power and 7 had M3, compared to 18 and 3 cases, respectively, in the control group. The P values for Medical Research Council grade, strength of elbow flexion, and range of elbow flexion between the 2 groups did not reveal any significant statistical difference. CONCLUSIONS: Double nerve transfer is a reliable technique for restoring elbow flexion in brachial plexus injuries. There is no advantage of using a nerve stimulator in selecting fascicles before performing the nerve transfer.

Study of Migration and Later Life Health in Nepal.

PURPOSE: This study investigates long-term consequences of individual migration experience on later life health, specifically self-rated health and functional difficulty. DESIGN/METHODOLOGY/APPROACH: The study uses multiple community-, household-, and individual-level data sets from the Chitwan Valley Family Study (CVFS) in Nepal. The CVFS selected a systematic probability sample of 151 neighborhoods in Western Chitwan and collected information on all households and individuals residing in the selected sample neighborhoods. This study uses data from multiple surveys featuring detailed migration histories of 1,373 older adults, and information on their health outcomes, households, and communities. FINDINGS: Results of the multi-level multivariate analysis show a negative association between number of years of migration experience and self-rated health, and a positive association between migration and functional difficulty. These findings suggest a negative relationship between migration experience and later life health. RESEARCH LIMITATIONS/IMPLICATIONS: Although we collected health outcome measures after the measurement of explanatory and control measures-a unique strength of this study-we were unable to control for baseline health outcomes. Also, due to the lack of time-varying measures of household socioeconomic status in the survey, this investigation was unable to control for measures associated with the economic prosperity hypothesis. Future research is necessary to develop panel data with appropriately timed measures. PRACTICAL IMPLICATIONS: The findings provide important insights that may help shape individual's and their family's migration decisions. ORIGINALITY/VALUE: This research provides important insight to individuals lured by potential short-term economic prospects in destination places, as well as to scholars and policy makers from migrant-sending settings that are grappling with skyrocketing medical expenses, rapid population aging, and old age security services.

Farm Exit among Smallhoder Farmers of Nepal: A Bayesian Logistic Regression Models Approach.

To leave or not to leave farming? This is a dilemma facing a large number of farm households in a rural agrarian setting of Nepal where nearly two-thirds of the population is small holder farmers. Using the uniquely detailed retrospective panel data collected in 2015 from farming households, we examine the influence of the access to cultivated land holding and land tenure on subsequent farm exit. We address the statistical modeling issue of complete separation by developing a robust Bayesian predictive model to predict the probability of farm exit. We use the Bayesian framework with weakly informative prior to carry out the logistic regression model and compare it with other available binary response models. Our results show that the size of cultivated land has a strong negative influence on farm exit, net of all other controls. Moreover, farmers who rented farmland from others or who rented farmland to others were significantly more likely to exit farming. We estimate that a farm household required at least 5 Katha of land (one sixth of a hectare) per year to stay in farming.

Family Obligation Attitudes, Gender, and Migration.

This study focuses on attitudes related to fulfilling family obligations and their relationships to migration behavior. We hypothesize that men who highly value fulfilling family obligations will be more likely to migrate in order to fulfill material obligations while women who highly value fulfilling family obligations will be less likely to migrate in order to fulfill care obligations. The empirical analysis examines data from the Chitwan Valley Family Study, located in south-central Nepal. We test whether variation in how much individuals value putting family needs before individual needs and caring for their adult parents matter for whether they migrate at all and if so, to which specific destinations. Our results provide only moderate support for these hypotheses but uncover patterns in how these attitudes toward family obligations are related to migration destinations. Men with strong attitudes toward family obligations are more likely to migrate internationally but especially to nearby India, sacrificing some level of economic returns for proximity. For women, the effect of attitudes is consistent: putting family needs first is negatively related to migration, while caring for adult parents is positively related to migration to India but not domestic or other international destinations. The findings suggest that our conventional typology of gendered labor and gender expectations for masculine breadwinning and feminine care might too strictly dichotomize the reality of how people actually care and provide for their families, obfuscating how they negotiate these competing demands.

Fatalistic Beliefs and Migration Behaviors: A Study of Ideational Demography in Nepal.

We investigate influences of fatalistic beliefs on domestic and international migration in Nepal, positing that fatalistic beliefs may affect decisions to migrate and where to locate. Fatalism is the belief that human outcomes are preordained by forces outside of one's power and control. Because of its relationship with effort and innovation, fatalism may be an important factor in people's decision to migrate and destination choice. We expect that fatalistic beliefs encourage or discourage migration depending upon societal expectations to migrate and the relative ease of migration to different destinations. Our empirical analysis relies on migration histories of respondents from the Chitwan Valley Family Study. Results from multinomial logistic regression models provide evidence that fatalistic beliefs increase overall migration propensity and has both positive and negative destination-specific effects. Fatalistic beliefs increase Nepalis' odds of migrating to destinations that are, relatively speaking, easier to access, but decrease the odds of migrating to destinations with higher barriers to entry.

Household migration and children's diet in Nepal: an exploratory study.

OBJECTIVE: Individuals from low-income countries often migrate abroad for employment. The association between such migration and investment in education as well as other societal and familial outcomes has previously been examined. However, we have a limited understanding of the association between migration and children's nutrition. We aim to determine the extent to which migration of household members influences children's diet in a semi-urban region of Nepal. RESULTS: In our study setting, children in households with a migrant had higher dietary diversity scores, 0.69 on average, than their counterparts in households without a migrant. These children were approximately 43% points more likely to meet a minimum requirement for dietary diversity. These differences originated primarily from higher consumption of meat (41% points) and eggs (20% points). Approximately 37 percent of children in the sample consumed processed food during the 24 h preceding the survey. However, we found no evidence that migration was associated with the consumption of processed foods or with reduced frequency of breastfeeding. Our finding that migration is associated with higher consumption of meat and eggs is particularly encouraging, given that the protein deficiency in Nepal is estimated to be nearly 43 percent.

Strategies for origin-based surveying of international migrants.

This paper addresses methodological challenges of investigations of international migration, including difficulties in obtaining information about representative samples of migrants and both their origin and destination location. Our project used an origin-based sample with a destination focused survey and interviewed 91% of migrants from a community in Nepal to any destination and shares techniques employed. Our procedures and high response rate constitute a significant improvement in survey methods that permit the creation of unbiased data on migrants and allow the study of migration in conjunction with origin communities.