स्वास्थ्य सम्बन्धी सम्पूर्ण जानकारी

جميع المعلومات المتعلقة بالصحة

Lahat ng impormasyong may kaugnayan sa kalusugan

स्वास्थ्य संबंधी सारी जानकारी

Semua maklumat berkaitan kesihatan

ကျန်းမာရေးဆိုင်ရာ အချက်အလက်အားလုံး

ຂໍ້ມູນທີ່ກ່ຽວຂ້ອງກັບສຸຂະພາບທັງໝົດ

Dhammaan macluumaadka la xiriira caafimaadka

स्वास्थ्यसम्बद्धाः सर्वाणि सूचनानि

Alle gezondheidsgerelateerde informative

Tota la informació relacionada amb la salut

ሁሉም ከጤና ጋር የተያያዙ መረጃዎች

ព័ត៌មានទាក់ទងនឹងសុខភាពទាំងអស់។

صحت سے متعلق تمام معلومات

Mọi thông tin liên quan đến sức khỏe

The Health Thread Logo

The Health Thread

Gateway to universal access to SRHR is human right to health

The human right to health is not a privilege, tt is a legal obligation – rooted in international human rights law – and must form the foundation of all efforts toward universal access, equity, and justice. Protecting, implementing, and enforcing this right is essential for the wellbeing of women, girls, and all gender-diverse peoples.

 Yet, across the world, sexual and reproductive health, rights and justice (SRHRJ) are increasingly under threat. Regressive policies, shrinking civic space, and a weakening of global solidarity are rolling back hard-won gains, particularly for those already on the margins.

 According to UN Women, nearly one-in-four countries experienced a backlash against women’s rights in 2024 alone. From abortion restrictions and defunding of SRHRJ programmes to rising attacks on gender-diverse peoples, the erosion of rights has become systemic. The urgency to act – and to act together – has never been greater.

Translate rights into access and principles into practice

“Operationalising the demands of the right to health requires more than commitments on paper,” said Alison Drayton, Assistant Secretary General, CARICOM, Guyana, stressing the need for systems, partnerships, and accountability mechanisms. CARICOM refers to the Caribbean Community, a grouping of 21 countries (15 member countries and 6 associate members) in the Americas and the Caribbean.

“Through our multilateral cooperation on universal health coverage, gender equality, and reproductive and sexual health, we must collectively translate rights into access and principles into practice. We are investing in integrated primary healthcare, gender-responsive budgeting, and data systems that make inequities visible and actionable. But this journey is not easy,” she said.

For Alison, the core challenge is ensuring that people remain at the centre of health systems. “Health is not a privilege – it is the foundation of humanity and sustainability. Every woman should be able to give birth safely, every adolescent should have access to accurate information, and every person – regardless of gender, income, or geography – should be able to lead a healthy life. Let us be bold in our vision and reaffirm that health, equity, and rights are indispensable – and that our collective responsibility is to make them real for every community we serve.”

What does the right to health mean?

“The right to health is not simply an obligation – it is a deep commitment,” explained Dr Haileyesus Getahun, founder and Chief Executive Officer of the Global Center for Health Diplomacy and Inclusion (CeHDI). Dr Getahun also leads HeDPAC (Health Development Platform for Africa and the Caribbean) that works with like-minded governments, particularly in Africa and the Caribbean regions, to forge South-South partnerships that address pressing health challenges and achieve universal health coverage. He earlier served the UN health agency, the World Health Organization (WHO) for over two decades, and was the founding Director of Quadripartite Joint Secretariat on Antimicrobial Resistance (AMR). AMR is among the top 10 global health threats.

Dr Getahun underscored that the right to health has been enshrined in several international treaties, including the International Covenant on Economic, Social and Cultural Rights, ratified by 174 countries.

“It entails three key obligations for governments,” he said. “First, they must respect by not interfering with citizens’ enjoyment of their health and wellbeing. Second, they must protect by ensuring that no harm is brought to this enjoyment. And third, they must fulfill these obligations by establishing administrative systems that ensure every person in their country can realise this right.”

 Dr Getahun describes the right to health as the gateway to universal health coverage, encompassing all services for all people without discrimination. “Sexual and reproductive health is an integral part of that right,” he said.

 International instruments like the legally-binding treaty adopted in 1979 – the United Nations Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), further reinforce these commitments.

 “We need to remind our governments that they have signed these international obligations,” he said. “Countries like Brazil, Canada, Cuba, Mexico, and El Salvador have shown how partnerships and learnings can lead to real progress. We can do more, we can do better, if we work together.”

Brazil’s rights-based model

One of the countries that has made notable progress in advancing the right to health through rights-based approaches is Brazil. Dr Ana Luiza Caldas, Brazil’s Vice Minister of Health shared how her country’s community-based primary healthcare approach has strengthened universal health coverage. “For the past 35 years, we have focused on connecting with the people we serve. Listening to communities and understanding what people actually need helps us design responsive SRH programmes – like providing free condoms in schools and health units.”

She stressed that access to quality healthcare is a human right, not a privilege. “Policies must be shaped by people’s needs. When we listen, we build trust and inclusion.”

“Access to quality healthcare should never be a privilege – it is a human right,” she re-emphasised. “By working in partnerships and staying close to the people, we can make that right real.”

Long walk to gender justice

For Aysha Amin, Founder of Baithak (Challenging Taboo) Pakistan, the right to health remains a distant dream for women and girls in marginalised communities. “Despite SRHRJ being so crucial for everyone, especially young girls and women, it is still not a priority. This is not just a health issue – it is a gender justice issue,” she said.

She highlighted how gender inequality and climate change intersect to compound vulnerability. “In communities most affected by climate disasters, health systems collapse. Floods wash away medical facilities. Women give birth in unsafe, makeshift conditions. Adolescent girls manage menstruation without facilities for water, sanitation and hygiene – often under open skies, risking infections and gender-based violence. This is a serious violation of dignity and safety.”

For Amin, the path forward requires centring the lived experiences of women and girls. “We need to create safe spaces where young women not only receive information but also reflect, question, and demand their rights. Building leadership among women and girls is essential so they can hold local governments accountable – especially in times of disaster.”

She also called for a shift in male engagement strategies, which often remain superficial. “In countries like Pakistan, decisions about women’s bodies are still made by men. We need to engage men as allies – challenging patriarchal norms and rethinking masculinity – thus helping to create space for women in decision-making, not take those spaces away. Male engagement must move beyond tokenism to transformative change.”

Amin also underscored the need for qualitative data to complement statistics. “Numbers alone cannot show what it means when an unmarried woman is denied care, or when a transgender person is refused access, or when a woman with disability is unable to access healthcare. Their stories reveal the intersectional inequalities that health systems must address.”

Countering media silence and anti-rights narratives

In many societies, SRHRJ remains taboo – not because people do not experience these issues, but because they are deemed unfit for public discourse.

“In my country, Indonesia, we cannot talk openly about comprehensive sexuality education,” said Betty Herlina, an Indonesian journalist and Founder Editor of Bincang Perempuan (Bahasa-language media focussed on gender justice). She is also a noted SRHRJ advocate. “If I distribute a condom in public, people would say that I am ‘promoting free sex.’ That is the bias we must break.”

Herlina urged media professionals to frame SRHRJ as a public health and human rights issue, not a moral or political one.

Patriarchy and harmful gender biases within and through media 

Herlina noted that media indifference is part of the problem. “Not all media houses want to cover SRHRJ – it is not seen as an ‘attractive’ topic.” She urged media professionals to frame SRHRJ as a public health and human rights issue, and not as a moral or political one.

“While reporting on unplanned pregnancies or abortion, journalists must remember that women still have the right to medical care. It is our duty to verify government claims and bring evidence-based narratives to the public,” said Herlina.

She added that data-driven journalism can counter misinformation around SRHRJ and push for policy change. “We need to document stories of people affected by restrictive policies to humanise these issues.”

We need to counter harmful gender biases, norms and stereotypes and challenge patriarchy within and through media.

Betty Herlina was also conferred upon the 1st Prize in Asia Pacific Region: SHE & Rights Media Awards 2025 at the International Conference on Family Planning (ICFP 2025) in Bogota, Colombia. SHE & Rights is together hosed by CeHDI, ICFP 2025, IPPF, ARROW, WGNRR, CNS and partners. Sai Jyothirmai Racherla, Deputy Executive Director of Asian-Pacific Resource and Research Centre for Women (ARROW) conferred the award citation to Betty Herlina at ICFP Live Stage in presence of Dr Haileyesus Getahun and others.

Reclaiming health as a human right

For Dr Tlaleng Mofokeng, UN Special Rapporteur on the Right to Health, this right is far from abstract – it is a living testimony to justice, autonomy, and equity.

“Our health systems must be inclusive, gender-responsive, and grounded in human rights. But around the world, access to SRH services is being restricted, healthcare workers are being silenced, and ideology is replacing evidence,” she said.

She cautioned that conditional funding – where financial aid depends on limiting support for certain groups – undermines human rights. “Funding cannot be conditional. Maternal health, SRH, and universal health coverage must not be seen as competing agendas. They are interconnected and part of the same promise of human dignity,” she asserted.

Dr Mofokeng urged governments and global institutions to invest in equity and intersectionality. “We must ensure that adolescents, LGBTIQ+ persons, people with disabilities, migrants, and others at the margins are not left behind. Health diplomacy must serve justice, not conditionality. Our movements need comprehensive, unrestricted resources to continue their work.” 

The way forward

The Right to Health provides a moral and legal compass for achieving gender equality. But realising it requires political will, inclusive governance, collective action and sustained investment. As the world grapples with climate crises, rising inequalities, and anti-rights movements, reaffirming health as a human right becomes a powerful act of resistance and hope.

Ensuring that no one is left behind means building systems that listen to communities, amplify marginalised voices, and turn commitments into action. The right to health is not merely about survival – it is about freedom, justice, and the promise of a fairer world.


Shobha Shukla – CNS

(Shobha Shukla is a feminist, health and development justice advocate, and an award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service). She was also the Lead Discussant for SDG-3 at United Nations inter-governmental High Level Political Forum (HLPF 2025). She is a former senior Physics faculty of prestigious Loreto Convent College; current President of Asia Pacific Regional Media Alliance for Health, Gender and Development Justice (APCAT Media); Chairperson of Global AMR Media Alliance (GAMA received AMR One Health Emerging Leaders and Outstanding Talents Award 2024); and Host of SHE & Rights (Sexual Health with Equity & Rights). Follow her on Twitter/X @shobha1shukla or read her writings here www.bit.ly/ShobhaShukla)

@Shobha1Shukla, @CNS_Health

World’s largest TB prize illuminates Indian Molbio’s tech innovation reaching the unreached

World’s largest prize devoted to TB, the coveted Kochon Prize, was awarded to India’s Molbio Diagnostics for its technological innovation which is helping over 90 governments worldwide to reach the unreached with best of diagnostics (molecular tests). This is the third time India won Kochon Prize with previous two recipients being 2006-head of Indian government’s TB programme Dr LS Chauhan, and country’s apex medical research body – Indian Council of Medical Research (ICMR) in 2017.

On 29th October 2025, the United Nations OPS hosted Stop TB Partnership in Geneva and Korean Kochon Foundation conferred upon the prestigious Kochon Prize to Molbio’s founder head Sriram Natarajan in Manila on 29th October 2025. Along with global recognition, Kochon Prize consists of a medal and a US$ 65,000, that is the largest prize globally devoted to TB.

Molbio became the first private innovator company worldwide to receive the much sought-after Kochon Prize.

 It all begins with an idea!

Making highly specialised diagnostics simpler

 When Molbio was founded 25 years ago (in 2000), the gold standard polymerase chain reaction (PCR) test was only restricted to bio-safety level-3 laboratories (BSL-3) where those entering had (and still have) to wear hazmat suits with high-low air pressure controls and several other essential infection prevention and control mechanisms. Of course, stable power supply and air-conditioning and other highly specialised laboratory infrastructure were, and is, essential to run such a diagnostic facility. No surprise that PCR laboratories were confined only to a few laboratories in tertiary care hospitals or medical teaching institutions.

 Team Molbio had an idea

“An idea whose time has come”

Researchers at team Molbio embarked on an insane exploration: to transform PCR molecular diagnostics in a way that it can be deployed in a setting that serves the underserved, without stable electricity, air-conditioning or other resource-intensive laboratory infrastructure. Can we innovate to develop RT-PCR in a way which is not dependent on electricity, air-conditioning or laboratory infrastructure and still test for a range of disease-causing pathogens with high sensitivity and specificity? would have been the research question that perhaps drove them – to impact change – and inspire.

 It took them almost one and a half decade (and a lot of belief, undeterred conviction, grit, insanity, drive, motivation and investment) to develop a RT-PCR molecular test Truenat that was highly sensitive and specific for several disease-causing pathogens.

 In 2017, Indian government’s ICMR validated Truenat, soon after which Indian government’s Ministry of Health began its deployment in remote or peripheral settings across the country. And then, thanks to Geneva-based FIND (Foundation for Innovative New Diagnostics), the United Nations apex health agency – the World Health Organization (WHO) endorsed it in 2020 after rigorous validation studies conducted worldwide.

 Truenat became WHO’s first truly point-of-care, decentralised, laboratory independent and battery powered (with solar charging capabilities) molecular test for TB – and a range of ~40 other diseases, such as human papilloma virus (HPV), hepatitis B virus, hepatitis C virus, sexually transmitted infections, COVID-19, among others.

 “Unless best of health technologies reach those who are most underserved and need them most, how will we reduce human suffering and avert untimely deaths? Technologies must be made to serve those who need them most. If health technologies cannot be deployed in resource-constrained settings, then they would remain inaccessible to those in acute need. Point-of-care technologies are not enough, we need to deploy them too at point-of-need,” said Tariro Kutadza, a noted community rights activist and defender from Zimbabwe. She leads TB People (Zimbabwe) and was in Manila meet when Kochon Prize was conferred upon Molbio Diagnostics.

 Truenat has enabled progress on keeping the promise

 Truenat has made it possible to deliver on the promise of Find.Treat.All (initiative first launched in 2018 by the highest level leadership of the WHO, Stop TB Partnership and others) by completely replacing microscopy with upfront molecular testing – especially in low- and middle-income countries. This promise was also echoed by the World Leaders at the UNHLM on TB 2023 political declaration to be met by 2027.

 Unless we stop missing TB cases among those who take a TB test, and unless we reach the unreached populations with equity and rights with WHO recommended diagnostics (and full cascade of TB care services in a person-centred manner), we would not be able to stop the spread of the infection as well as fail to reduce avoidable human suffering and untimely deaths due to TB.

 As Truenat is a multi-disease molecular testing platform, with its growing deployment (especially in the Global South), we are also strengthening the laboratory infrastructure for key and other vulnerable populations so that they can access highly sensitive and specific diagnostics for over 40 diseases closer to their communities. Early and accurate diagnosis is not only an entry-gate to right treatment but also prevents misuse and overuse of medicines (which is vital to prevent antimicrobial resistance).

 Solar powered molecular test Truenat

Several countries, such as, Democratic Republic of the Congo (DRC), have deployed Truenat molecular test in remote peripheral settings where there is no stable power supply to recharge the battery. So, solar power capabilities became a lifesaver in such circumstances.

Last year in December 2024, Nigeria launched the largest rollout of Truenat and Molbio’s Prorad artificial intelligence (AI) enabled X-Rays on African continent. Each of these point-of-care diagnostics have been deployed in remote and peripheral settings.

Likewise, over 90 countries now benefit from Truenat when they deploy it to reach the underserved communities – and bring best of diagnostics closer to the most-at-risk peoples and communities.

India led from the front

Indian government came forward to support in-country scientific validation studies for Truenat, thankfully. 

“Research for validating new tools, designing new tools and relying on Made-in-India tools for screening and diagnosing TB and not depending on the outside, has made a phenomenal difference,” had said Dr Urvashi B Singh, Indian government’s head of National TB Elimination Programme, Ministry of Health and Family Welfare; and a distinguished scientist and microbiologist (who had an illustrious inning as Microbiology Professor and in-charge TB at Indian government’s prestigious All India Institute of Medical Sciences (AIIMS), Delhi). She was speaking at World Health Summit Regional Meeting earlier this year.

 Truenat is the largest used molecular test for TB in government’s programme since several years now.

When point-of-care tools are deployed at point-of-need, impact happens. Recently, India launched a massive 100-days campaign (7 December 2024 to 24 March 2025) to screen everyone among high-risk populations of 347 districts with ultraportable and handheld X-Rays which were powered with artificial intelligence (AI) computer-aided detection (CAD) of TB (as far as possible). The concept note of this campaign on a government website states that those with presumptive TB should be offered an upfront Truenat. 

The concept note of 100 days campaign states that point-of-care screening tool (X-Ray) and diagnostic test (Truenat) should be taken in a ‘Nikshay Vahan’ van to point-of-need where high-risk populations reside.

In a span of 100 days, India could screen over 120 million people across the country from high-risk groups. More importantly, India found 285,000 people with active TB disease who had no symptoms (asymptomatic or sub-clinical TB). These people would not have been found with TB disease if an X-Ray was not done. Imagine the public health impact of finding 285,000 asymptomatic people with TB disease early on, and putting them on effective treatment – so that not only infection stops spreading to others but also they get on the path of healing and recovery.

Now, after 24 March 2025, India has expanded this science-backed campaign nationwide.

Confirmed Dr Urvashi at WHS-RM: “Based on evidence, Indian government’s National TB Elimination Programme adopted Truenat in 2018. Today India has a network of over 9000 NAAT systems across the country – deployed at the level of primary health centres, community health centres and even at the block levels.” Developing, standardising and validating made-in-India health technologies and deploying them “is about making the country self-reliant,” said Dr Singh. “Today, Truenat is in fact, getting exported to 82 countries. So, that is where our Indian indigenous technology, which was supported by ICMR, has reached.”


Shobha Shukla, Bobby Ramakant – CNS

(Shobha Shukla is the founding Managing Editor of CNS (Citizen News Service) and Bobby Ramakant works as CNS Health Editor. Both are on the boards of Global Antimicrobial Resistance Media Alliance (GAMA) and Asia Pacific Media Alliance for Health, Gender and Development Justice (APCAT Media). Follow them on Twitter/X: @Shobha1Shukla, @BobbyRamakant, @CNS_Health

Study proves strong impact of taking molecular TB diagnostics closer to the people

Urgent call to replace sputum microscopy completely with true point-of-care molecular tests to #FindAllTB

An important scientific study published in The Lancet shows the strong public health impact of deploying molecular diagnostics closer to the people.

This multi-country randomised controlled study shows that if we deploy battery-operated, laboratory independent and true point-of-care molecular test Truenat at the primary healthcare level, then same day test and treat can become a reality. Diagnosing TB early and accurately is a critical pathway towards right treatment as well as stopping the spread of infection.

The study enrolled around 4000 participants in 29 primary healthcare clinics of Tanzania and Mozambique during August 2022 and June 2023. In one study-arm, 2007 participants were accessing primary healthcare clinics equipped with point-of-care molecular test Truenat. In the second study-arm, 1980 people were served by primary healthcare clinics with no molecular test, but their samples were collected and sent to a laboratory with molecular test Gene Xpert (11-16 km away) and their test reports transported back. Both these molecular tests are WHO recommended ones.

Same day test and treat becomes a reality for 4-in-5 TB patients when POC tests deployed

The study found that 97% of TB patients could begin treatment within 7 days when point-of-care Truenat was deployed at the primary care level. But only 63% could do so when samples were sent to a remote lab where Gene Xpert was deployed.

More importantly, 82.2% of the TB patients who were diagnosed with Truenat at the primary care level, could be initiated on right TB treatment on the same day – so, same day test and treat could become a reality in remote peripheral settings. But only 3% could get same day treatment initiation if tested by Gene Xpert deployed in a remote lab.

Study authors categorically state that “this study provides strong evidence supporting the placement of low complexity molecular TB diagnostics at primary care level, to enable same-day diagnosis and treatment initiation.”

TB deaths were 3-fold among those who were in the study-arm where samples were to be sent to a remote lab equipped with Xpert (2.1%) compared to those who were in the study-arm with Truenat deployed at the primary care level (0.7%). Eliminating diagnostic delays and delays between diagnosis and treatment can save lives.

By not deploying point-of-care molecular TB tests we are programming to fail on “same day test and treat” too – and thereby failing to reduce unnecessary human suffering and risk of untimely death due to TB. Also, we cannot break the chain of infection transmission unless we diagnose TB early and accurately and initiate right treatment without any delay.

1.5 times more people began treatment within 7 days when POC molecular test deployed at primary care level

Study authors observed that “we found that the placement of the Truenat platform with MTB Plus and MTB-RIF Dx assays at clinics combined with rapid communication of results and same-day TB treatment initiation led to a 1.5 times higher proportion of people starting treatment for microbiologically confirmed TB within 7 days.”

It is also important to note that study researchers had found major problems with sputum transport systems which negatively impacted the TB programme. Study authors noted that “study site assessments revealed operational issues [with Gene Xpert] (for example, sputum container stockouts and delays in sample transport) leading to occasional referral of patients instead of samples. To address this issue, sputum containers were stocked throughout, and samples were collected at least twice weekly. Off-site laboratories received Xpert MTB/RIF Ultra cartridges for sample testing.”

So, even if so-called hub-and-spoke model or sputum referral system works ‘perfectly’ (like in this study) then too TB programme outcomes are majorly compromised. One can imagine when real life problems mar this hub-and-spoke model then TB programme outcomes would be getting even more compromised.

In the study-arm where Truenat was deployed at the primary care level, it took an hour to find if a person has active TB disease (and if so, then whether the TB bacteria is resistant to one of the two most effective anti-TB medicines, rifampicin). The person was asked to wait for one hour and if found positive for TB, then treatment could be initiated on the same day for over 82% patients.

This Lancet publication co-authored by Dr Celso Khosa of Instituto Nacional de Saúde in Mozambique, Dr Adam Penn-Nicholson of FIND in Geneva, and other researchers from several medical and scientific institutions, is among the very few studies that have compared the difference it makes by deploying molecular diagnostics at primary care level with off-site remote laboratory with centralised or semi-centralised molecular testing (and samples sent to the lab and reports back to the peripheral clinic). Most other studies have compared the difference between a bad TB upfront test (sputum microscopy, which badly underperforms in diagnosing TB) at primary care level with off-site molecular testing.

Truenat molecular test is also the largest used molecular test deployed in India – a nation home to world’s largest number of people with TB. It is deployed in over 90 countries now. For example, the largest rollout of Truenat in Africa took place last year in Nigeria with AI-enabled handheld X-Rays and solar-power charging capabilities in remote peripheral areas.

Replace microscopy with 100% upfront POC molecular TB test

Ahead of the world’s biggest TB and lung disease conference (Union World Conference on Lung Health) that will be held next month, this study published in the Lancet provides potentially groundbreaking scientific evidence for high TB burden countries on the major difference it makes by deployment of WHO recommended point-of-care molecular test Truenat at the primary care level.

If we are to serve the underserved, take best of healthcare and social support services with equity, rights and human dignity.

If we are to end TB we cannot afford any delays – be they diagnostic delays or delays spanning many days between diagnosis and initiation of treatment. Moreover, deploying point-of-care health technologies at the point-of-need helps break the barriers people face in accessing centralised healthcare services.

All world leaders at the United Nations General Assembly High Level Meeting on TB in 2023 had committed to completely replace microscopy with upfront molecular TB tests by 2027. With the light this study shines on bringing molecular tests to the primary care level, all efforts must be full throttle to replace microscopy with point-of-care molecular tests that are deployable in high-burden settings.

Do away with hub-and-spoke model when every spoke can be a hub

Study authors stated: “Although Xpert MTB/RIF, endorsed by WHO in 2011, revolutionised TB and rifampicin resistance detection, its impact has been limited. High costs and operational requirements (eg, stable electricity, temperature control, and dust-free environments) have confined its use to centralised laboratories in hub-and-spoke models. New molecular and point-of-care diagnostics are emerging that might be deployed in primary care clinics or even in communities. Portable battery-operated molecular testing platforms, such as the Molbio Truenat platform (endorsed by WHO in 2020), offer the potential to further decentralise molecular testing.”

This randomized control study provides pathbreaking science to call for transforming every ‘spoke’ into a hub by deploying WHO recommended point-of-care molecular tests like Truenat which are battery-operated (with solar power recharging capabilities), laboratory independent, and decentralised. More importantly, it is a multi-disease molecular testing platform for over 40 diseases, such as TB, HIV (including viral load, testing) hepatitis B and C virus, human papilloma virus (HPV – which causes a lot of cervical cancers), several sexually transmitted infections, leprosy, vector-borne diseases like malaria, among others.

Earlier this week while launching an important WHO report on antimicrobial resistance, WHO Director General Dr Tedros Adhanom Ghebreyesus too had underpinned the importance of “rapid and point-of-care molecular testing” for preventing AMR – because correct and timely diagnosis for multiple diseases must be made accessible to all equitably – especially those who are underserved. Linkage to standard treatment, care and support also should be made accessible to all if we are to prevent AMR, along with optimal infection prevention and control, vaccination, water, sanitation and hygiene, and other health and social support. 


Shobha Shukla, Bobby Ramakant – CNS

(Shobha Shukla is the founding Managing Editor of CNS (Citizen News Service) and Bobby Ramakant works as CNS Health Editor. Both are on the boards of Global Antimicrobial Resistance Media Alliance (GAMA) and Asia Pacific Media Alliance for Health, Gender and Development Justice (APCAT Media). Follow them on Twitter/X: @Shobha1Shukla, @BobbyRamakant, @CNS_Health

Rising Heat and Our Minds: The Overlooked Link Between Climate Change and Mental Health

Written by Liza Nagarkoti , Public Health Researcher | Nutrition Specialist,  BSc Nursing, MA(Nutrition), Project Officer (Health) LWF Nepal

In today’s world, where climate change is increasingly evident, the link between environmental changes and human health has become a crucial topic of discussion. One often overlooked but important aspect is how extreme heat affects our mental well-being. As global temperatures continue to rise, the effects of this heat on both our bodies and minds are becoming a serious public health concern (Khan et al., 2023).

When we are exposed to high temperatures for long periods, our bodies react by increasing our heart rate and sweating more to stay cool. While these responses help maintain our body temperature, they also have a surprising impact on our mental state. Research shows that prolonged heat exposure can heighten stress and irritability, while also disrupting our sleep—something that can lead to fatigue and trouble thinking clearly (Khan et al., 2023).

The physical impacts of heat on our health range from minor discomfort to life-threatening conditions. Dehydration, which happens when the body loses more fluid than it takes in, is one of the most basic ways heat affects us. This can start with simple thirst and dry mouth, but in severe cases, it can lead to confusion, disorientation, and even coma (Khan et al., 2023).

Recent studies underscore the strong link between extreme heat and mental health issues. For example, one study found that hospital admissions for mental and behavioral disorders increased during heatwaves. Aguglia et al. discovered that the risk of being hospitalized for mood disorders like depression and mania went up by about 40% during these periods of intense heat (Khan et al., 2023).

Another study by Hu et al. highlighted that suicide rates also rise as temperatures climb. They found that for each 1°C increase in average monthly temperature, suicide rates increased by 1% (Khan et al., 2023). Long-term exposure to high temperatures can worsen existing mental health issues or even spark new ones. Moreover, it can affect our ability to remember things, stay focused, and think clearly (Khan et al., 2023).

In Adelaide, South Australia, Hansen and colleagues (2008) looked at how heatwaves impacted hospital admissions and deaths linked to mental, behavioral, and cognitive disorders from 1993 to 2006. They reported a 7.3% rise in hospital admissions for mental health conditions when temperatures went above 26.7°C. This included conditions such as dementia, mood disorders, stress-related issues, and developmental disorders (Lõhmus, 2018).

Excessive heat during everyday activities can also lead to dehydration and physical health problems like heat exhaustion, cramps, or even heat stroke. Beyond these physical effects, heat stress has been shown to worsen mood and psychological distress, while also reducing key aspects of mental performance (Tawatsupa et al., 2012).

Given these findings, it’s clear that proactive strategies to manage heat stress can go a long way in supporting mental wellness. This means not just focusing on physical comfort but also paying close attention to how heat affects our minds and taking steps to reduce these risks.

In conclusion, as our climate continues to warm, addressing the mental health impacts of heat exposure is crucial for public health efforts. By recognizing the connection between extreme heat and mental well-being, and implementing measures to reduce heat stress, we can better protect both our physical and mental health in the face of a changing climate.

 

REFERENCES

  1. Khan Rony, M. K., & Alamgir, H. M. (2023). High temperatures on mental health: Recognizing the association and the need for proactive strategies—A perspective. Health Science Reports, 7(3), e1729. https://doi.org/10.1002/hsr2.1729
  2. Lõhmus, M. (2018). Possible biological mechanisms linking mental health and heat—A contemplative review. International Journal of Environmental Research and Public Health, 15(7), 1519. https://doi.org/10.3390/ijerph15071519
  3. Tawatsupa B, Yiengprugsawan V, Kjellstrom T, et al (2012). Heat stress, health and well-being: findings from a large national cohort of Thai adults. BMJ Open ;2:e001396. doi:10.1136/bmjopen-2012 001396
  4. Motesaddi Zarandi, S., Yarahmadi, R., Nasiri, R., Bayat, M., Nasiri, H., Amini, A., Motlagh, M. E., & Rasoulzadeh, H. (2021). Impact of climate change on adipose-derived stem cells: A molecular and histological study. Environmental Research, 197, 111001. https://doi.org/10.1016/j.envres.2021.111001

Antibiotic resistance: A Global threat and an unseen pandemic

Sanjogta Thapa Magar

Written By Sanjogta Thapa Magar, Food Microbiologist, Kathmandu Metropolitan Office

Introduction

People have been using medicine to combat infectious diseases for ages, and it is widely used in medical practices; however, now it has become ineffective against microorganisms as they have developed resistance to the drugs. This unresponsiveness exhibited by microbes towards antibiotic medications is known as antimicrobial resistance (AMR). A breakthrough in antibiotic research in the 20th century marked a turning point in medical history, safeguarding millions of lives from pathogenic diseases. However, at present, it has become a persistent global public health concern, as it is anticipated to cause 10 million deaths per year by 2050. Throughout the past three decades, a considerable disparity has been documented in the enhancement of antimicrobial drugs, leading to a decline in the antibiotic revolution period due to antimicrobial resistance (AMR). Microorganisms (bacteria, fungi, viruses, and parasites) have adapted and developed tolerance against antibiotics that used to abolish them. Antibiotics were dominant against them; however, in the current scenario, the microbes are showing lower sensitivity or resistance. Therefore, a concentration exceeding typical levels of the same drug is required to have the same effect in similar cases. Recent studies have confirmed that AMR exists because of escalated use and misuse of antibiotics over the years, giving rise to a threat to global public health as a silent pandemic.

Why is it alarming?

Antimicrobial resistance (AMR) is a widely recognized health issue with public ramifications, causing high mortality rates and escalating healthcare costs. It erodes the efficacy of antimicrobial medicines, resulting in being unable to control diseases. When bacteria or other pathogens become resistant, infections are prolonged, leading to harder treatment and further expanding the probability of them spreading. The cost of treatment will rise to an exorbitant level since standard drugs no longer work. Novel medical procedures like organ transplants and cancer treatments likely rely on antibiotics, which leads to resistance. In addition, endurance against antibiotics depends on the types of pathogens (like bacteria and fungi) and is directed by variables including the quality of hygiene and sanitation. Another factor that elevated the spread of resistant pathogens is global trade and tourism across borders. As a result, developing countries may suffer economically due to reduced import and export activities linked to AMR concerns.

Examples of antibiotic resistance

When a drug is incompetent to inhibit bacterial growth effectively, it results in AMR. Microbes become ‘resistant’ and carry on with their growth despite being under the influence of antibiotics. After the introduction of new antimicrobial compounds, the evolution of AMR was monitored. AMR has occurred as a nature’s filter process where nature empowers all bacteria with low-level resistance For example, a has study confirmed that sulfamethoxazole and trimethoprim (TMP-SMZ), ampicillin and tetracycline were commonly used in former years for treatment, but now they are capable of treating non-cholera diarrhea disease in Thailand. Another study carried out in Bangladesh indicated the impact of the same drugs in treating them effectively. It shows that the resistance was reported even before the commencement of the application of antibiotics for infection treatment. Therefore, the drug tolerance demonstrated by microbes is largely due to the misuse of antibiotics.

In 1937, sulfonamides were introduced as therapeutic agents. However, now it has exhibited resistance in contrast to the microbes’ mechanism. Vancomycin was introduced 44 years ago; however, in 2002, Vancomycin-resistant Staphylococcus aureus (VRSA) was documented.

In the long run, bacteria acquire several resistance traits and become resistant to vast groups of antibiotics. As one example, Staphylococci are resistant to aminoglycosides due to chromosomal mutations, inefficient transport, and enzyme modifications. Resistance does not develop against one specific drug, but against structurally similar compounds of the same class. For example, microbes showing tolerance to tetracycline may show a sign of resistance to oxytetracycline, chlortetracycline, doxycycline, and minocycline. Analysis indicates that resistance genes developed even before antibiotics were clinically used, implying that antibiotics exhibit resistance genes that are able to withstand their antimicrobial products.

Current scenario

AMR was explicitly responsible for 6,400 deaths in Nepal in 2019, and also 23,200 deaths were registered where AMR played a role. According to the World Health Organization, Nepal ranks 52nd in the highest mortality rate due to AMR out of 204 countries. Antibiotic-resistant bacterial infections affect over 2 million people annually in the U.S due to AMR. Yearly, 33000 people die in the EU because of antibiotic-resistant bacteria.

The System behind Antibiotic Resistance Development

There are several processes used by microorganisms to become an AMR. Some mechanisms are:

  1.  Inactivation of an antimicrobial agent by an enzyme.
  2. There is a production of alternative functional protein over time for the enzyme inhibited by the antimicrobial.
  3. Inhibition of antimicrobial agent binding due to a mutation in its target.
  4. Antimicrobial agents are modified after transcription or translation in a way that inhibits their binding to their targets.
  5. The antimicrobial agent is less likely to be absorbed.
  6. An antimicrobial agent is actively effluxed.
  7. An increase in the production of the antimicrobial agent’s target.
  8. In contrast to in vitro expression, in vivo suppression of a gene.
  9. Mechanisms that have never been recognized before.
  10. Microbial characteristics, environmental or human reservoirs, in which resistance genes or resistant organisms are found.

Factors that Cause AMR

Various factors assist in AMR in microorganisms. Some factors are:

  1. The dose of antibiotics used, the act of continuous prescribed dose, non-judicial use of medicine, and in some cases, patients asking to prescribe drugs to physicians without a valid reason, lead to the escalation of AMR.
  2. The Lower antibiotic concentrations and long-term treatment contribute to the rise of AMR.
  3. In addition to poor hygiene by hospital staff and mechanical ventilation, underlying diseases have also played a role in spreading resistant organisms.
  4. Antimicrobial resistance escalates when counterfeit medications contain sub therapeutic antibiotic concentrations.
  5. Inappropriate wastewater treatment by some pharmaceutical companies results in large amounts of antibiotics being released into the environment, resulting in the spread of antimicrobial resistance.
  6. Antibacterial components and antiseptics may also be contributing to AMR.
  7. As a contributing factor to antibiotic resistance, inappropriate antibiotic use in livestock is also found to be an underlying cause.
  8. It is also possible to develop a natural resistance to antibiotics. An environmental resistome is a gene that gains resistance to the environment. Resistance to antibiotics may be caused by the transfer of these genes from non-pathogenic to pathogenic microbiomes.
  9. This global public health hazard may also be caused by heavy metals and other pollutants.

Antimicrobial Resistance Associated with Food Producing Animals

There is a substantial relationship between the utilization of antibiotics in medicine, veterinary medicine, and agriculture and the outbreak and spread of antibiotic resistance. To be specific, for the growth stimulation of food animals, antibiotics are used widely in commercial-scale which is the main factor in the transmission of antibiotic-resistant bacteria. A significant majority of antimicrobial resistance is acquired explicitly from animals or humans that produce food. It can also be acquired obliquely through the food chain or exposure to habitats containing high levels of antimicrobial resistance pollution (such as hospitals, nosocomial acquisitions, manure, waste water, and agricultural land).

In agriculture, antibiotics are often used in the same or similar ways to antibiotics used in clinical conditions, contributing to the advancement of drug resistance. Through the food chain, antibiotic-resistant bacteria are mainly transmitted throughout animal and human populations. In some developed countries, the intake of antibiotics in food, water, or parenterally by animals is responsible for the development of antibiotic-resistant microbes.

There is an example where the use of antibiotics in cattle feed as growth promoters has increased antibiotic resistance. The evidence shows that poultry or pork might be a possible source of quinolone-resistant Escherichia coli in rural Barcelona villages, where a fourth of Juveniles harbor these organisms fecally. Quinolones, however, were never administered to these children.

Measures Taken to Overcome AMR

There are several approaches to mitigate AMR

  1. Educating people about antimicrobial resistance.
  2. The rational use of antimicrobials should be educated to the public.
  3. A minimum use of antimicrobials in animals, improved sanitization, and regulated use of probiotics in vaccinations and feed are vital to control common animal diseases.
  4. Antibiotics can be stopped safely 72 hours after symptoms have resolved.
  5. AMR needs to be brought to the attention of nurses and other health care providers, as they are in direct contact with patients and ultimately responsible for infection transmission.
  6. By granting pharmaceutical companies’ incentives for developing new antimicrobials.
  7. Pharmaceutical companies should follow the standards of advertising and promotion for drugs. Pharma companies should also be held accountable for encouraging the misuse of antimicrobials.
  8. New antibiotic categories and diagnostic technologies can only be identified through collaborative national and international academic networks.
  9. In addition to using antibiotics for a short period of time, regular rechecks with the doctor are necessary. As most people do not complete the entire course of treatment when no signs of clinical infection are present, the course must be stopped if no signs of infection are seen.
  10. Antimicrobials that are substandard or counterfeit must be controlled. New vaccines and drugs can be developed as inducements.

Combating Foodborne Antimicrobial Resistance (AMR) in Nepal: A Youth-Led Advocacy and Capacity Building Initiative

The government is taking a One Health approach (Illness, death, and their impact on the economy). Nepal has officially sanctioned the National Action Plan (NAP) to counter the escalating threat of Antimicrobial Resistance (AMR). Through a One Health approach, the Government of Nepal has aimed to deal with AMR. They are working across human health, animal health, and environmental sectors to mitigate the perilous risk associated with AMR. The NAP emphasizes mitigating the morbidity, mortality, and socio-economic burden pertinent to AMR through five strategic foundations:

  1. Enhancing awareness and education of the food chain.
  2. Consolidating integrated surveillance systems for data generation, analysis, and utilization.
  3. Restricting infection statistics through robust prevention and control strategies.
  4. Managing the utilization of antimicrobials in human, animal, and environmental sectors.
  5. Promoting sustainable investment, research, and innovation for AMR containment.

The transmission of drug-resistant microbes to humans through food is a critical concern. Therefore, it is a necessity for prudent antimicrobial use in agriculture and livestock sectors, as well as the significance of integrating national practices with international standards. To aid countries in handling foodborne AMR, the Codex Alimentarius has initiated an assortment of guidelines, standards, and recommendations. Despite that, various countries, including Nepal, face hardship in executing these standards due to limited resources, technical expertise, and public awareness. To overcome this, the Action to Support the Implementation of Codex AMR Texts (ACT) Project, funded by the Republic of Korea, has been implemented in Nepal by the Department of Food Safety and Quality Control (DFTQC) with technical support from FAO Nepal, has been active since 2022. The project focuses on:

  • Promoting the adoption and implementation of Codex AMR texts.
  • Enhancing AMR surveillance systems.
  • Establishing national capacity for evidence-based governance.
  • Assist in policy creation and regulatory frameworks through data-driven recommendations.

The World Food Forum (WFF) Nepal National Chapter, a part of a Global initiative, encourages young leaders in the agri-food sector through policy dialogue, advocacy, and community initiatives, where it is fostering Youth Empowerment in tackling AMR.

Conclusions and Future Perspectives

Antibiotic resistance has reached record-breaking global levels. Despite multiple programs initiated by WHO member countries, the utilization of antibiotics in humans, animals, and agriculture continues to surge. This has formed a considerable fiscal pressure on healthcare systems, the need for isolation wards, strict infection control measures, and treatment failures. Antibiotics are extensively employed in animals, which is known to be the eliciting aspect for a surge in antibiotic resistance in people. It is obligatory to use antibiotics meticulously and implement policies to ensure their accurate application, to prohibit the outbreak and spread of diseases transmitted from zoonotic epidemics. Health policymakers must develop an all-inclusive surveillance system that operates both nationally and internationally, with data analysis and obligatory reporting of antibiotic resistance cases. AMR generates a critical worldwide danger. Immediate and synchronized worldwide action is necessary.

REFERENCES

  1. Annunziato, G. (2019). Strategies to overcome antimicrobial resistance (AMR) making use of non-essential target inhibitors: A review. International Journal of Molecular Sciences, 20(23). https://doi.org/10.3390/ijms20235844
  2. Cantas, L., Shah, S. Q. A., Cavaco, L. M., Manaia, C. M., Walsh, F., Popowska, M., Garelick, H., Bürgmann, H., & Sørum, H. (2013). A brief multi-disciplinary review on antimicrobial resistance in medicine and its linkage to the global environmental microbiota. Frontiers in Microbiology, 4(MAY), 1–14. https://doi.org/10.3389/fmicb.2013.00096
  3. Chandra, H., Bishnoi, P., Yadav, A., Patni, B., Mishra, A. P., & Nautiyal, A. R. (2017). Antimicrobial resistance and the alternative resources with special emphasis on plant-based antimicrobials – A review. Plants, 6(2), 457–462. https://doi.org/10.3390/plants6020016
  4. Chandra, S., Prithvi, P. R., Srija, K., Jauhari, S., & Grover, A. (2020). Antimicrobial resistance: Call for rational antibiotics practice in India. Journal of Family Medicine and Primary Care, 9(5), 2192. https://doi.org/10.4103/JFMPC.JFMPC_1077_19
  5. Davies, R., & Wales, A. (2019). Antimicrobial Resistance on Farms: A Review Including Biosecurity and the Potential Role of Disinfectants in Resistance Selection. Comprehensive Reviews in Food Science and Food Safety, 18(3), 753–774. https://doi.org/10.1111/1541-4337.12438;CTYPE:STRING:JOURNAL
  6. Gudata, D., & Begna, F. (2018). Antimicrobial Resistance: Review. International Journal of Research -GRANTHAALAYAH, 6(11), 77–93. https://doi.org/10.29121/granthaalayah.v6.i11.2018.1091
  7. Imran, M., Jha, S. K., Hasan, N., Insaf, A., Shrestha, J., Shrestha, J., Devkota, H. P., Khan, S., Panth, N., Warkiani, M. E., Dua, K., Hansbro, P. M., Paudel, K. R., & Mohammed, Y. (2022). Overcoming Multidrug Resistance of Antibiotics via Nanodelivery Systems. Pharmaceutics, 14(3), 1–25. https://doi.org/10.3390/pharmaceutics14030586
  8. Kshatri, J. S., Satpathy, P., Sharma, S., Bhoi, T., Mishra, S. P., & Sahoo, S. S. (2022). Health research in the state of Odisha, India: A decadal bibliometric analysis (2011‑2020). Journal of Family Medicine and Primary Care, 6(2), 169–170. https://doi.org/10.4103/jfmpc.jfmpc
  9. Panda, B., Rath, P. K., Mishra, B. P., Mishra, J., Jena, B., Mishra, P. S., Chakraborty, A., Hota, D., & Jena, M. K. (2024). Novel Insights into the Antimicrobial Resistance and Strategies to Curb the Menace. Journal of Pure and Applied Microbiology, 18(1), 1–15. https://doi.org/10.22207/JPAM.18.1.42
  10. Tang, K. W. K., Millar, B. C., & Moore, J. E. (2023). Antimicrobial Resistance (AMR). British Journal of Biomedical Science, 80, 1–11. https://doi.org/10.3389/bjbs.2023.11387
  11. Vidovic, N., & Vidovic, S. (2020). Antimicrobial resistance and food animals: Influence of livestock environment on the emergence and dissemination of antimicrobial resistance. Antibiotics, 9(2). https://doi.org/10.3390/antibiotics9020052
  12. World Health Organization: WHO. (2024, December 16). Reaching beyond health to accelerate the fight against AMR in Nepal
  13.  Zaman, S. Bin, Hussain, M. A., Nye, R., Mehta, V., Mamun, K. T., & Hossain, N. (2017). A Review on Antibiotic Resistance: Alarm Bells are Ringing. Cureus, 9(6). https://doi.org/10.7759/cureus.1403
  14. Zhou, G., Shi, Q. S., Huang, X. M., & Xie, X. B. (2015). The three bacterial lines of defense against antimicrobial agents. International Journal of Molecular Sciences, 16(9), 21711–21733. https://doi.org/10.3390/ijms160921711

Defective Sperm and Pregnancy Complications: Understanding the Connection and Its Impact

The Health Thread Favicon

Written By THT Editorial Team

Dr. Asmita Pandey

Reviewed by Dr. Asmita Pandey, Fertility Expert, M.D. (OB/GYN) 

Infertility and pregnancy complications are major concerns for couples trying to conceive, with male infertility playing just as important a role as female factors. Recent studies have shown that defective sperm can significantly affect pregnancy outcomes, highlighting the need to address male fertility as part of overall reproductive health. This essay examines the role of defective sperm, its connection to pregnancy complications, and what this means for reproductive health.

What Determines Sperm Quality?

Sperm quality is a key factor in male fertility. It includes factors like sperm count, movement (motility), shape (morphology), and, most importantly, the integrity of the sperm’s DNA. Research shows that DNA integrity is crucial for successful fertilization and healthy embryo development (Panner Selvam et al., 2020). When sperm DNA is damaged—such as having breaks or other issues—it can lead to problems like miscarriages or developmental issues in the embryo (Alvarez et al., 2023).

Recent Research on Defective Sperm

A study in Human Reproduction found that sperm with frequent DNA damage is linked to higher risks of pregnancy complications, including miscarriage, preterm birth, and low birth weight (Willerslev, 2023). These findings remained consistent even after accounting for factors like the mother’s age and lifestyle, suggesting that sperm quality is an independent factor in pregnancy success. The study analyzed sperm samples from men whose partners had pregnancy complications and found that higher levels of sperm DNA damage were associated with worse pregnancy outcomes (Zini et al., 2008).

How Defective Sperm Leads to Pregnancy Complications

The ways in which defective sperm causes pregnancy complications are complex. Damaged sperm DNA can lead to chromosomal abnormalities in the embryo, problems with placental function, and poor fetal growth (Zheng et al., 2018). When an egg is fertilized by sperm with damaged DNA, the embryo may develop genetic issues, which can disrupt normal growth and lead to complications. Additionally, defective sperm can cause inflammation in the female reproductive tract, which may interfere with implantation and proper placental development (Bernal et al., 2019). This inflammation can contribute to conditions like preeclampsia and restricted fetal growth (Musson et al., 2022).

What This Means for Reproductive Health

The link between defective sperm and pregnancy complications has important implications for reproductive healthcare, especially in infertility treatments and assisted reproductive technologies (ART) Advanced tests, like the sperm chromatin structure assay (SCSA) and the TUNEL assay, can now measure sperm DNA damage more accurately (Dutta et al., 2020). These tools help doctors assess male fertility beyond traditional measures like sperm count and motility.

Improved Treatments: Addressing sperm DNA damage may involve lifestyle changes, antioxidant therapy, or medical treatments. Antioxidants like vitamins C and E, coenzyme Q10, and selenium can help reduce oxidative stress and improve sperm DNA quality (Romano et al., 2024).

Assisted Reproductive Technologies (ART): For couples using ART, selecting sperm with intact DNA can improve the chances of a successful pregnancy. Techniques like intracytoplasmic sperm injection (ICSI) combined with DNA testing can help identify the healthiest sperm for fertilization (Esteves et al., 2021).

Prevention: Educating men about factors that harm sperm DNA—such as smoking, excessive drinking, and exposure to environmental toxins—can encourage healthier habits and reduce the risk of defective sperm (Leslie, Soon-Sutton, & Khan, 2024).

Conclusion

The connection between defective sperm and pregnancy complications emphasizes the importance of evaluating and treating male fertility as part of reproductive healthcare. By focusing on sperm DNA integrity, doctors can improve pregnancy outcomes, offering hope to couples struggling with infertility and reducing the risk of complications. Ongoing research will continue to enhance our understanding of male infertility, leading to more personalized treatments and better support for families worldwide.

For further information about reproductive health, please book your consultation with fertility expert here.

REFERENCES

  1. Panner Selvam, M. K., Sengupta, P., & Agarwal, A. (2020). Sperm DNA fragmentation and male infertility. In M. Arafa, H. Elbardisi, A. Majzoub, & A. Agarwal (Eds.), Genetics of male infertility (pp. 195-207). Springer. https://doi.org/10.1007/978-3-030-37972-8_9B
  2. Alvarez, J.G., García-Peiró, A., Barros, A. et al. Double strand DNA breaks in sperm: the bad guy in the crowd. J Assist Reprod Genet 40, 745–751 (2023). https://doi.org/10.1007/s10815-023-02748-5
  3. Willerslev, E. (2023). Influence of diet and exercise on sperm and its epigenome. Human Reproduction, 38(Suppl. 1), dead093.001. https://doi.org/10.1093/humrep/dead093.001
  4. Zini, A., Boman, J. M., Belzile, E., & Ciampi, A. (2008). Sperm DNA damage is associated with an increased risk of pregnancy loss after IVF and ICSI: systematic review and meta-analysis. Human Reproduction, 23(12), 2663–2668. https://doi.org/10.1093/humrep/den321
  5. Zheng WW, Song G, Wang QL, Liu SW, Zhu XL, Deng SM, Zhong A, Tan YM, Tan Y. Sperm DNA damage has a negative effect on early embryonic development following in vitro fertilization. Asian J Androl. 2018 Jan-Feb;20(1):75-79. doi: 10.4103/aja.aja_19_17. PMID: 28675153; PMCID: PMC5753558.
  6. Musson R, Gąsior Ł, Bisogno S, Ptak GE. DNA damage in preimplantation embryos and gametes: specification, clinical relevance and repair strategies. Hum Reprod Update. 2022 May 2;28(3):376-399. doi: 10.1093/humupd/dmab046. PMID: 35021196; PMCID: PMC9071077.
  7. Dutta, S., Henkel, R., & Agarwal, A. (2020). Comparative analysis of tests used to assess sperm chromatin integrity and DNA fragmentation. Andrologia. https://doi.org/10.1111/and.13718
  8. Romano, M., Cirillo, F., Spadaro, D., Busnelli, A., Castellano, S., Albani, E., & Levi-Setti, P. E. (2024). High sperm DNA fragmentation: do we have robust evidence to support antioxidants and testicular sperm extraction to improve fertility outcomes? A narrative review. Human Reproduction Update
  9. Esteves SC, Zini A, Coward RM, Evenson DP, Gosálvez J, Lewis SEM, Sharma R, Humaidan P. Sperm DNA fragmentation testing: Summary evidence and clinical practice recommendations. Andrologia. 2021 Mar;53(2):e13874. doi: 10.1111/and.13874. Epub 2020 Oct 27. PMID: 33108829; PMCID: PMC7988559.
  10. Leslie, S. W., Soon-Sutton, T. L., & Khan, M. A. B. (2024). Male infertility. In Author Information and Affiliations. Last update: February 25, 2024. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK562258/

 

Supporting and Educating Strategies for Children with Autism Spectrum Disorders

Dr. Mukti Thapaliya

Written by Dr. Mukti Thapaliya, RTLB Cluster 9, Ph.D. in Education

Introduction

This article describes the meaning of Autism Spectrum Disorders (ASD), the characteristics of ASD, the diagnosis process of ASD, ASD diagnosis instruments, and the strengths and interests of children with ASD. The article also presents supporting and educating techniques, behaviour management strategies and communicating strategies for students with ASD.

Understanding Autism Spectrum Disorders

Before the publication of the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) (APA, 2013), various terms were used to refer to children with complex neurodevelopmental conditions (e.g., ASD, atypical autism, childhood psychosis, childhood schizophrenia, and autism). The term “autism” was defined differently from childhood schizophrenia and other psychoses, such as “pervasive developmental disorders” (PDDs), after the publication of DSM-III. Moreover, DSM-IV included several subtypes of PDD: autism, AS, PDDNOS, Rett syndrome, and disintegrative disorder (APA, 2013). After the DSM-5, the subcategories were eliminated and replaced with the single diagnosis of “ASD” and the DSM-5 revised the diagnostic criteria for children with autism spectrum disorders (APA, 2013). The term ‘ASD’ is used throughout this article – consistent with DSM-5 diagnostic criteria.

Characteristics of students with ASD

Students with autism may experience difficulties in the following areas. Table 1 presents characteristics of students with autism.

Table 1 characteristics of students with autism

Communication Social interaction Restricted and repetitive patterns of behaviour

●      delay in speech and language

●      have trouble understanding other people

●      hard communicating what they want

●      could use body parts or objects to indicate what they want to say

●      may have an unusual tone, pitch, or accent

●      may not understand non-verbal communication (e.g., facial expressions, body language, and gestures)

●      may have difficulty following instructions

●      Sometimes may appear not to hear at all

 

●      may not join in play with other students and may appear disinterested in other people

●      may prefer to play or be alone

●      may not play as often as same-aged peers

●      rarely bring toys and objects to share with other students

●      may not respond to other people’s greetings or smiles

●      may experience difficulty with social situations and understanding social rules

●      may not understand others’ emotions, thoughts, or actions

●      difficulty with eye contact

 

●      A strong preference for routine and order

●      get very upset if their routines are interrupted

●      may have trouble with transitioning to new environments

●      may have a special interest that they enjoy talking about a lot

●      may use behaviour including challenging behaviour as a way of communicating

●      may appear to be clumsy and have poor motor skills

●      may make unusual movements or sounds

●      may have poor problem-solving or organisational skills

●      hyper or hypo-sensitive to various stimuli (link to sensory)

(Altogether Autism, 2023; APA, 2013).

Strengths and interests of students with ASD

Students with ASD excel in various learning styles, including acquiring knowledge. Specifically, they may be good at:

  • rote learning
  • remembering information for extended periods
  • detailed and chunk-based learning
  • paying close attention to small details
  • concentrating on narrow topics of interest
  • using visual information meaningfully
  • using concrete information, understanding and following rules
  • actions and thought logical processes
  • follow strict rules

Diagnosis process for students with ASD

There are several theories about the causes of ASD, but none of them have been scientifically proven (Autism New Zealand, 2020; Thapaliya, 2023a, 2023b). Researchers are still investigating varied factors that might contribute to the development of ASD. Some studies suggest that people with ASD may have genetic predispositions, whereas other research signals viral infections, structural and functional brain abnormalities, and dysfunctional immune systems (APA, 2013).

The diagnostic process requires input from multiple professionals (e.g., child psychologists, educational psychologists, pediatricians, clinical psychologists, audiologists, and teachers) and parents (APA, 2013). Professionals also involve an evaluation process. Specifically, the following criteria are commonly used to diagnose ASD:

  • assessments of multiple areas of functioning (e.g., intellectual and communication skills, a review of developmental history)
  • parental input
  • medical tests (a loss of hearing test and eye test before considering a diagnosis of ASD)
  • assess multiple areas of functioning
  • collect information from a variety of settings
  • provide a single coherent view
  • provide implications for adaptation and learning
  • liaison with schools and other agencies to support the implementation of recommendations
  • developmental history
  • diagnostic assessment of speech, language and communication
  • sensory and motor skills assessments
  • medical evaluations

Figure 1 presents the two diagnosis domains of ASD based on DSM-5:  communication and repetitive patterns of behaviour (APA, 2013).

(APA, 2013)

Diagnostic instruments

The following diagnostic tools may be used to diagnose autism spectrum disorder.

  • Diagnostic and Statistical Manual of Mental Disorders (DSM)- 5
  • Asperger Syndrome Diagnostic Interview (ASDI)​
  • Asperger Syndrome Screening Questionnaire (ASSQ)​
  • Australian Scale for Asperger syndrome (ASAS)​
  • Autism Behaviour Checklist (ABC)​
  • Autism Diagnostic Observation Schedule (ADOS) and ADOS-G​
  • Autism Screening Questionnaire (ASQ)​
  • Autistic Diagnostic Interview (ADI, and also ADI-R)​
  • Childhood Asperger Syndrome Test (CAST)​
  • Childhood Autism Rating Scale (CARS)​
  • Child Communication Checklist (CCC)​
  • Checklist for Autism in Toddlers (CHAT)​
  • Diagnostic Interview for Social Communication Disorders (DISCO)​
  • Gilliam Autism Rating Scale (GARS)​
  • Parent Interview for Autism​ (PIR)
  • Pervasive Developmental Disorders – mental retardation (PDD-MR)​
  • Social Response Scale (SRS)​
  • Treatment and Education of Autistic and related Communications Handicapped Children (TEACCH) checklist​
  • Wing Autistic Disorder Interview Checklist​ (WADIC)

Teaching and learning strategies for students with ASD

Researchers recommend a wide range of teaching approaches, methods, and techniques to teach students with autism, such as structured teaching programmes, social stories, visual cues, sensory corners in the classroom, and using assistive technology to deliver course content in the classroom (Autism New Zealand, 2020; Bevan-Brown & Dharan, 2016; Thapaliya, 2023). The following section describes key teaching strategies for students with ASD.

Rules of 5 (Fewer than 5 words, wait 5 seconds)

In this strategy, teachers have to present the information in sentences that only have five words. Teachers can give students five seconds to comprehend each statement so they can focus on and understand what you said. For example,

  • Stay in your seat
  • Hand on pencils only
  • Use friendly words
  • Raise your hand to speak
  • Focus on your task

Use the student’s name first

Saying the student’s name first gets the students’ attention and allows them to work out that the teacher is speaking to them. For instance, teachers can frequently remind them to do the task. Tom, time for math.

Giving positive direction

Teachers need to give positive direction while instructing students with autism in the classroom because students with autism may have trouble when they hear the word ‘no’. For example, ‘Please use a tissue, instead of saying ‘Stop picking your nose!’.

First-then strategies

A first-then strategy may provide the students with a visual means of introducing a new task in a way that they can understand. This technique helps to establish a routine and controlled environment for students with autism. Specifically, teachers can use a first-then strategy to increase independence, provide predictable environments/activities, clarify expectations while providing sequencing of events, support transitions (activity to activity or between locations), reduce verbal information (prompts) provided to a child and increase motivation for completing an adult-directed task/activity (MoE, 2023). For example, first reading a passage, then having a break time.

Give warnings before an activity finish

It is recommended to give students prior warnings before ending a favourite activity to prevent anger. Three warnings, accompanied by visual cues, are the usual practice (Autism New Zealand, 2020; MoE, 2023). For example,

  • Hunter, you have ten minutes left to complete your math task.
  • Hunter, you have five minutes left to complete your math task.
  • Hunter, math time is finished.

Use assistive technology

Using assistive technology (e.g., computers, iPads), can help reduce learning barriers in the classroom while teaching students with autism spectrum disorders (Autism New Zealand, 2020; MoE, 2023; Thapaliya, 2023a). Using computers can be a useful tool for teaching literacy and language skills (e.g., listening, speaking, reading, and writing) and numeracy skills. Jacklin and Farr (2005) reported the benefit of using computers with students with autism spectrum disorders in the classroom because they provide a “visual impact on what they are learning” (p. 208). While completing academic tasks, students with autism spectrum disorders may gain a sense of predictability, confidence, and self-control (Murray, 2015).

Learner profile

A learner profile includes everything about students’ learning needs, strengths, and individual needs in the classroom. In other words, the learner profile can assist schoolteachers, school psychologists, and school staff in understanding the perspectives of ākonga (student) and their whānau/parent), forging relationships with them, and tailoring instruction to fit the needs of individual students (MoE, 2023). Specifically, a learner profile can provide information about students (e.g., how to communicate with students, likes, and dislikes) (Thapaliya, 2023b).

Provide visual support

Visual support refers to a shared set of tools that are employed for a variety of tasks and are more permanent than words. Visual support consists of objects that are used to visually enhance a person’s understanding of the information, physical environment, social situation, and abstract concepts (Rutherford, et al., 2020).

Visual support may assist expressive communication by serving as a substitute for words, signs, gestures, and physical acts. Visual support can support people in meeting their developmental stage by offering a variety of skills (e.g., skill acquisition, motivation to learn, and utilizing their new learning). Similarly, visual support can offer students with ASD the structure, routine, and sequence they need to participate in everyday tasks (Thapaliya, 2023b).

. For instance,

Social story support

Researchers claim that social skills are the most effective way to manage students with ASD behavioural issues if they are taught within the natural environment (Fleury et al., 2014; Murray, 2015; Ostmeyer & Scarpa, 2012). Social skills can provide an opportunity for imitative skills and observation skills for students with autism spectrum disorders, as well as help them get support from their peers and tutors.

There are three types of story support (Autism New Zealand, 2020) to improve students with ASD behaviour:

  1. Story for self-esteem provides a positive story of student’s behaviour and learning. Also, it was applied to enhance students’ self-esteem and confidence.
  2. Story for information offers practical information (e.g., how to brush teeth), calming strategies to reduce their anxiety, and a new classroom timetable.
  3. Story for understanding is used to explain misunderstood communication and enhance students’ comprehension of course content.

Sensory regulation

Sensory overload sensitivity is a component of the autism spectrum diagnosis. This does not imply that all autistic students will be sensitive to sensory stimuli (APA, 2013). Students with ASD may have sensitivities to sights, sounds, smells, tastes, touch, and balance. They can experience both hyper- and hyposensitivity (under-reactivity) to a variety of stimuli. Most people combine the two in some way.

Acoustics, lighting, noise-cancellation headphones, low-arousal workspace, and scheduling regular breaks are some suggested strategies to prevent sensory overload for students with autism (Autism New Zealand, 2022). If teachers provide frequent breakout time throughout the day and calming and self-managing activities for students with autism, these activities will help students with autism cope with the classroom environment (e.g., prevent overload anxiety issues). For instance,

  • Give students frequent break
  • Check in- and check-out times
  • Curate a reading corner and breakout space with toys and sensory cushions

Lego therapy

LEGO-based therapy may help to develop social skills in children with autism spectrum disorder (Autism New Zealand, 2020; MoE, 2023; Thapaliya, 2023). Initially, Lego- therapy was designed to help children with ASD, but now it has been used to help kids with various social and communicative issues. In Lego-based therapy, there will be three people:

Engineer: reads the visual instructions and designs

Supplier: finds the pieces as directed by the engineer

Builder: builds the pieces

Lego-based therapy may help to:

  • promote social interaction
  • develop turn-taking skills and share with others
  • collaborate with others for problem-solving
  • develop language and motor skills
  • increase motivation and self-esteem
  • improve participation and engagement skills
  • feel calm and relaxed

Universal Design for Learning

Universal support approach refers to the Universal Design for Learning (UDL). The UDL has three principles and guidelines that assist in enhancing learning, including for students with ASD. According to students’ interests and learner variability, teachers can select certain guidelines to apply in their teaching and learning activities (Rao & Torres, 2016). The UDL framework has three principles: i) multiple means of engagement; ii) multiple means of representation; and iii) multiple means of action and expression (CAST, 2018)

The multiple means of engagement principle offer choices for developing likes, purposes, and self-regulation among students. The multiple means of representation principle is structured to assist learning through recognition networks and provide multiple ways of representing the curriculum. The multiple means of action and expression connect to strategic networks in the brain, and they play a key role in language learning and skill development (CAST, 2018).

Behaviour managing strategies

Students with ASD might display problematic, challenging, and aggressive behaviour (e.g., difficulty in listening to their teachers and following instructions, self-harm, difficulty following classroom rules, and repetitive disruptive behaviour). Instructional and behavioural support from behavioural therapists, educational psychologists, and clinical psychologists is put in place to assist students with spectrum disorders (Fleury et al., 2014). The use of technological interventions such as iPads is an effective intervention for decreasing challenging behaviours in the classroom. The following section describes Applied Behaviour Analysis (ABA), Functional Behavioural Analysis (FBA), and Cognitive Behaviour Therapy (CBT) to manage behaviour of students with autism spectrum disorders.

Communication managing strategies

Augmentative and Alternative Communication (AAC)

Augmentative Alternative and Communication (ACC) refers to a range of tools and techniques that assist people with complex communication needs. Students with cerebral palsy, autism spectrum disorders, developmental disabilities, childhood apraxia of speech, language delays, and other medical conditions that result in speech loss can benefit from the use of augmentative and alternative communication (ACC) (Mitchell & Sutherland, 2020).

In other words, the term ‘augmentative’ refers to resources that support and improve the existing communication abilities of a student. For instance, a student with ASD may use an iPad with communication software that produces a synthetic voice in response to a selected image. ‘Alternative’ describes communication systems that are designed to substitute for learners’ lost language and speech or are unlikely to develop in the future. For example, communicating effectively with students who have severe ASD can be challenging, especially in social situations, classrooms, and in their future endeavours where speech is a necessity. However, a high-tech system with speech output could be a temporary solution to serve as their primary means of communication.

There are three types of ACC solutions: No-tech, low-tech, and high-tech.

  • No-tech AAC is widely known for utilizing voluntary motor movements (e.g., sign language and facial expression analysis) to convey non-verbal messages.
  • Low-tech AAC utilizes simple resources such as books and whiteboards with large lexicons of words and images to support communication. For example, Pictogram Ideogram Communication (PIC), Rebus Signs, Picture Communication Symbols (PCS) and Picture Exchange Communication System (PECS) are some examples of low-tech ACC. In preschools and schools, PECS is very popular. PECS is a functional communication system that is used as a communication tool for students with speech and language difficulties. PECS teaches students to select cards with line drawings, symbols, or photos of desired items or activities and then give them to another person (e.g., communicative partner, peer, teacher, or parent) to receive the object or task.
  • High-tech AAC involves the use of electronic devices (e.g., iPads, laptops, computer applications and mobile phones) and speech generating devices (e.g., Proloquo2go) to achieve an AAC goal. Similarly, students with a range of difficulties (e.g., people with visual impairment) and neurological conditions may benefit from software programmes such as text- to- speech output options.

Conclusion

This article explored the meaning of autism, characteristics of students with ASD, and the diagnosis process for ASD. It presented supporting and teaching strategies. managing challenging behaviour and communication strategies for students with ASD.

REFERENCES

  1. Altogether Autism, (2023). Autism, what is it? https://www.altogetherautism.org.nz/what-is-autism/.
  2. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5). American psychiatric association.
  3. Autism New Zealand. (2020). Tilting the Seesaw Handbook (Ed.) Wellington: Author.
  4. Bevan-Brown, J., and Dharan, V. M. (Eds.). (2016). Autism spectrum disorder in Aotearoa New Zealand: Promising practices and interesting issues (pp. 155-168). Wellington: NZCER Press.
  5. Center for Applied Special Technology (CAST). (2018). UDL and the learning brain. Wakefield, MA http://www.cast.org/products-services/resources/2018/udl-learning-brain-neuroscience
  6. Fleury, V. P., Hedges, S., Hume, K. Browder, D. M., Thompson, J. L., Fallin, K., and Vaughn, S. (2014). Addressing the academic needs of adolescents with autism spectrum disorder in secondary education. Remedial and Special Education, 35(2), 68-79. doi:10.1177/0741932513518823.
  7. Jacklin, A., and Farr, W. (2005). The computer in the classroom: A medium for enhancing social interaction with young people with autistic spectrum disorders? British Journal of Special Education, 32(4), 202-210.
  8. Ministry of Education, (2023, April). Resource Teachers: Learning and Behaviour Service.  https://www.education.govt.nz/school/student-support/special-education/resource-teachers-learning-and-behaviour-service 
  9. Murray, J. (2015). Practical Teaching Strategies for Students with Autism Spectrum Disorder: A Review of the Literature. BU Journal of Graduate Studies in Education, 7(2), 68-75.
  10. Ostmeyer, K., & Scarpa, A. (2012). Examining school-based social skills program needs and barriers for students with high-functioning autism spectrum disorders using participatory action research. Psychology in the Schools, 49(10), 932-941. doi:10.1002/pits.21646
  11. Rao, K., & Torres, C. (2016). Supporting academic and affective learning processes for English language learners with universal design for learning. TESOL Quarterly, 51(2), 460–472. https://doi.org/10.1002/tesq.342.
  12. Rutherford, M., Baxter, J., Grayson, Z., Johnston, L., & O’Hare, A. (2020). Visual supports at home and in the community for individuals with autism spectrum disorders: A scoping review. Autism, 24(2), 447-469.
  13. Thapaliya, M. (2023a). Exploring Inclusive Practices for Students with Autism Spectrum Disorders in Mainstream Classrooms: A Case from New Zealand. Psychology Research and Practice2(2). DOI: 10.37155/2972-3086-0202-2.
  14. Thapaliya, M.P. (2023b). Teaching Children with Autism Spectrum Conditions in Mainstream Classrooms. Kathmandu University. (Face-to-face workshop contribution

Micro plastics: A Silent Threat to Reproductive Health and Fertility

The Health Thread Favicon

Written By THT Editorial Team

Dr. Asmita Pandey

Reviewed by Dr. Asmita Pandey, Fertility Expert, M.D. (OB/GYN) 

Microplastics, often abbreviated as MPs, are small plastic particles under 5 millimeters that are now widely recognized as an environmental issue. They have made their way into our water systems and the broader food chain, prompting extensive studies on how they might affect reproduction in different species, humans included. This article explores the possible ways in which microplastics could be affecting reproductive health and fertility.

Oxidative stress

Oxidative stress is a cellular phenomenon that happens when there’s a mismatch between the creation of free radicals, like reactive oxygen species (ROS), and the body’s antioxidant defenses that neutralize their damaging effects This mismatch can cause harm to cells and tissues, playing a role in various diseases and the aging process. (Pizzino et al., 2017).

When it comes to microplastics (MPs), oxidative stress is a major issue. MPs can cause oxidative stress by interfering with the cells’ electron transfer processes, which results in an excess of ROS. These ROS can harm important cellular components such as lipids, proteins, and DNA, all vital for cell health and function (Abdal Dayem et al., 2017). For example, research has indicated that MPs exposure can increase ROS in oyster sperm, leading to reduced fertilization success. Likewise, studies on rats have shown that polystyrene MPs (PS-MPs) can induce oxidative stress in ovarian cells, affecting ovulation (Ferrante et al., 2022)

Hormonal Havoc: Disrupting the HPG Axis

The Hypothalamic-Pituitary-Gonadal (HPG) Axis is an essential hormonal system that controls reproductive functions. It’s a network involving the hypothalamus, pituitary gland, and gonads (ovaries or testes), which are responsible for producing and regulating sex hormones vital for reproductive health. (Mikhael et al., 2019)

Microplastics (MPs) have been identified as disruptors of the HPG Axis, causing hormonal imbalances that could impact fertility. Research has indicated that exposure to polystyrene MPs (PS-MPs) in male mice can lower testosterone levels and affect the balance of other important hormones such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These hormonal alterations can hinder the growth and maturation of reproductive organs, adversely affecting the development of offspring (Zhang et al., 2022). In female mice, exposure to MPs has resulted in similar hormonal disturbances, with changes observed in FSH and estradiol levels. (Liu et al., 2021)

Regarding reproductive success, it’s known to be an energy-demanding process that relies on ample resources for the creation of gametes, fertilization, and embryo growth. MPs pose a threat to an organism’s energy metabolism, which can influence reproductive success.

Evidence suggests that MPs can modify the patterns of food intake and energy distribution within organisms, which may lead to a decrease in reproductive output (Jewett et al., 2022). For example, studies on oysters have shown that MPs can reduce the activity of enzymes that are crucial for energy production during sperm development. This reduction could lead to sperm quality issues and, consequently, affect the viability of the offspring. (Sussarellu et al., 2016)

Microcirculation Woes: A New Frontier

Microcirculation is the process of blood flow through the body’s tiniest vessels, like capillaries. It’s crucial for supplying tissues with nutrients and oxygen and for eliminating waste. Any interference with microcirculation can greatly affect reproductive health.

Recent research has shown that microplastics (MPs) can negatively impact microcirculation. This can cause developmental issues and raise the mortality rate of embryos in water-dwelling species such as zebrafish. For instance, exposure to MPs and nanoparticles (NPs) has been linked to microcirculation damage, especially in vital areas like the tail, which is important for proper growth. (Zhang et al., 2022)

Human Health Implications

The increasing concern about microplastics (MPs) and their effect on human reproductive health is quite substantial. There has been a noticeable decrease in male semen quality over the last 80 years, and environmental pollutants, including MPs, are suspected to be contributing factors. Insights from animal studies have highlighted potential mechanisms through which MPs may influence health, such as oxidative stress, inflammation, and hormonal disturbances.

Direct research on the impact of MP exposure on male infertility in humans is not yet available, but animal studies have suggested a minimum human equivalent dose of MPs that could result in poor semen quality. This dose is estimated to be 0.016 mg/kg/day. The proximity of this figure to the levels of MP exposure observed in some countries points to a possible threat to human reproductive health. It underscores the importance of ongoing research to fully understand the effects and to develop appropriate exposure guidelines.

Conclusion

The research collectively points to a considerable risk that microplastics (MPs) present to reproductive health in various species. It’s vital to grasp the damaging mechanisms—like oxidative stress, hormonal imbalance, energy shortage, and microcirculation problems—to devise ways to lessen their effects. With MPs increasingly becoming a part of our environment, it becomes more pressing to confront their reproductive consequences. This calls for thorough policy-making and additional studies to safeguard human health. 

For further information about reproductive health, please book your consultation with fertility expert here.

REFERENCES

  1. Pizzino G, Irrera N, Cucinotta M, Pallio G, Mannino F, Arcoraci V, Squadrito F, Altavilla D, Bitto A. Oxidative Stress: Harms and Benefits for Human Health. Oxid Med Cell Longev. 2017;2017:8416763. doi: 10.1155/2017/8416763. Epub 2017 Jul 27. PMID: 28819546; PMCID: PMC5551541.
  2. Abdal Dayem A, Hossain MK, Lee SB, Kim K, Saha SK, Yang GM, Choi HY, Cho SG. The Role of Reactive Oxygen Species (ROS) in the Biological Activities of Metallic Nanoparticles. Int J Mol Sci. 2017 Jan 10;18(1):120. doi: 10.3390/ijms18010120. PMID: 28075405; PMCID: PMC5297754.
  3. Ferrante MC, Monnolo A, Del Piano F, Mattace Raso G, Meli R. The Pressing Issue of Micro- and Nanoplastic Contamination: Profiling the Reproductive Alterations Mediated by Oxidative Stress. Antioxidants (Basel). 2022 Jan 19;11(2):193. doi: 10.3390/antiox11020193. PMID: 35204076; PMCID: PMC8868557.
  4. Mikhael S, Punjala-Patel A, Gavrilova-Jordan L. Hypothalamic-Pituitary-Ovarian Axis Disorders Impacting Female Fertility. Biomedicines. 2019 Jan 4;7(1):5. doi: 10.3390/biomedicines7010005. PMID: 30621143; PMCID: PMC6466056.
  5. Zhang C, Chen J, Ma S, Sun Z, Wang Z. Microplastics May Be a Significant Cause of Male Infertility. American Journal of Men’s Health. 2022;16(3). doi:10.1177/15579883221096549
  6. Liu, Z., Zhuan, Q., Zhang, L., Meng, L., Fu, X., & Hou, Y. (2021). Polystyrene microplastics induced female reproductive toxicity in mice. Journal of Hazardous Materials, 416, 125912. https://doi.org/10.1016/j.jhazmat.2021.125912
  7. Jewett E, Arnott G, Connolly L, Vasudevan N, Kevei E. Microplastics and Their Impact on Reproduction-Can we Learn From the C. elegans Model? Front Toxicol. 2022 Mar 24;4:748912. doi: 10.3389/ftox.2022.748912. PMID: 35399297; PMCID: PMC8987311.
  8. Sussarellu, R., Suquet, M., Thomas, Y., et al. (2016). Oyster reproduction is affected by exposure to polystyrene microplastics. Proceedings of the National Academy of Sciences, 113(9), 2430-2435. https://doi.org/10.1073/pnas.1519019113

 

Exercise and aging: maintaining mobility and independence

The Health Thread Favicon

Written By THT Editorial Team

Reviewed by Liza Nagarkoti , BSc Nursing, MA(Nutrition), Project Officer (Health) LWF Nepal

As we age, maintaining mobility and independence become increasingly important. Exercise is an effective way to promote these qualities and to prevent age-related health problems. In this article, we will explore the role of exercise in aging, the benefits of exercise for older adults, and how to safely and effectively exercise as you age.

The Benefits of Exercise for Older Adults

Exercise is essential for maintaining physical and mental health as we age. Regular exercise can help:

Improve balance and coordination – This can help prevent falls, which are a common cause of injury and loss of independence in older adults.

Maintain muscle mass and bone density – Regular strength training can help maintain muscle mass and bone density, which can decrease the risk of osteoporosis and fractures.

Improve cardiovascular health – Regular aerobic exercise can improve cardiovascular health, lower blood pressure and reduce the risk of heart disease.

Improve mood and cognitive function – Exercise has been shown to improve mood, reduce anxiety and depression, and improve cognitive function. Safe and Effective Ways to Exercise at Home

Start slow and gradually increase intensity – If you are new to exercise or have not exercised in a while, start with low-impact activities like walking or yoga, and gradually increase intensity as your fitness improves.

Choose activities you enjoy – The best exercise is the one that you will stick with. Choose activities that you enjoy and that are appropriate for your fitness level.

Incorporate strength training – Strength training is important for maintaining muscle mass and bone density. Use weights, resistance bands, or bodyweight exercises to improve strength.

Be mindful of your body – Listen to your body and be mindful of any pain or discomfort. If something doesn’t feel right, stop the exercise and consult with your doctor or a qualified fitness professional.

Incorporate balance and flexibility exercises – Balance and flexibility exercises are important for maintaining mobility and preventing falls. Yoga, tai chi, and stretching exercises can help improve balance and flexibility.

Exercise and Aging: Maintaining Mobility and Independence

As we age, our bodies change, and we may experience a decrease in mobility and independence. Exercise can help slow down these changes and improve overall health and well-being. Recent research has shown that regular exercise can help older adults maintain their ability to perform daily tasks and improve their quality of life.

A study published in the Journal of the American Geriatrics Society found that a program of moderate-intensity exercise, including strength and balance training, improved mobility and prevented disability in older adults. Another study published in the Journal of Aging and Physical Activity found that regular exercise improved balance, gait, and mobility in older adults with Parkinson’s disease.

In conclusion, exercise is an essential component of healthy aging. By incorporating safe and effective exercise into your daily routine, you can improve your physical and mental health, maintain your mobility and independence, and improve your quality of life. Consult with your doctor or a qualified fitness professional before starting any exercise program, especially if you have a medical condition or are taking medication.

REFERENCES

 

  • Centers for Disease Control and Prevention. Physical Activity and Health. https://www.cdc.gov/physicalactivity/basics/older_adults/index.htm
  • Rikli RE, Jones CJ. Development and validation of a functional fitness test for community-residing older adults. Journal of Aging and Physical Activity. 1999; 7:129-61.
  • Keysor JJ. Does late-life physical activity or exercise prevent or minimize disablement? A critical review of the scientific evidence. Am J Prev Med. 2003; 25:129-36.
  • Pahor M, Blair SN, Espeland M, et al. Effects of a physical activity intervention on measures of physical performance: Results of the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) study. J Gerontol A Biol Sci Med Sci. 2006; 61:1157-65.
  • Petruzzello SJ, Landers DM, Hatfield BD, et al. A meta-analysis on the anxiety- reducing effects of acute and chronic exercise. Sports Med. 1991; 11:143-82.
  • Fiatarone MA, O’Neill EF, Ryan ND, et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med. 1994; 330:1769-75.
  • Campbell AJ, Robertson MC. Rethinking individual and community fall prevention strategies: A meta-regression comparing single and multifactorial interventions. Age Ageing. 2007; 36:656-62.2.

Tubal Blockages and Infertility: Understanding Causes, Diagnosis, and Treatment Options

The Health Thread Favicon

Written By THT Editorial Team

Dr. Asmita Pandey

Reviewed by Dr. Asmita Pandey, Fertility Expert , M.D. (OB/GYN) 

Infertility is a complex and emotionally charged issue that affects many couples worldwide. Among the various causes, tubal factor infertility is a key concern, as it involves blockages in the fallopian tubes which are crucial for egg transportation and fertilization. This article explores the intricacies of tubal blockages, including their causes, methods for diagnosis, and the treatment options available.

Understanding the Causes of Fallopian Tube Blockages

Fallopian tube blockages can arise from a variety of medical conditions:

  • Female Genital Tuberculosis (FGTB):Tuberculosis can lead to both primary and secondary infertility, with a significant percentage of FGTB cases resulting in tubal blockages. The disease can cause unilateral and bilateral blockages, damage to the tubal cilia, and adhesions that affect fertilization and implantation (Sharma et al., 2018).
  • Pelvic Inflammatory Disease (PID):This infection of the female reproductive organs is often caused by sexually transmitted infections like chlamydia or gonorrhea. The inflammation and scarring from PID can lead to obstructions in the fallopian tubes. (Jennings & Krywko, 2018)
  • Endometriosis:A condition where tissue similar to the lining of the uterus grows outside of it, endometriosis can lead to the formation of adhesions and blockages in the fallopian tubes. (Smolarz, Szyłło, & Romanowicz, 2021)
  • Prior Surgeries:Surgical procedures in the abdominal or pelvic area, such as those for appendicitis or ectopic pregnancies, can result in scarring that may constrict the fallopian tubes. (Ghobrial, Ott, & Parry, 2023)
  • Hydrosalpinx:This occurs when a blocked fallopian tube fills with fluid, often as a result of infection, endometriosis, or past surgeries. (Lai, Masten, & Markese, 2024)

Diagnosing Tubal Factor Infertility

To diagnose tubal factor infertility, several methods are employed:

  • Hysterosalpingogram (HSG):An X-ray procedure that uses a special dye to reveal blockages or structural irregularities in the fallopian
  • Sonosalpingogram (SSG):This technique uses ultrasound imaging and a saline solution to evaluate the health of the fallopian tubes and uterus.
  • Laparoscopy:A minimally invasive surgical procedure that allows for the direct visualization of the fallopian tubes to detect blockages, scar tissue, and endometriosis.
  • HyCoSy:An ultrasound technique that assesses whether the fallopian tubes are open or blocked by using a fluid containing small bubbles (Women’s Imaging, n.d.).

Treatment Options to Restore Fertility

The treatment for tubal blockages varies based on the severity and location of the obstruction:

  • Salpingectomy:The surgical removal of one or both fallopian tubes, which can improve the chances of successful IVF treatment (Strandell et al.1999).
  • Selective Tubal Cannulation:A nonsurgical technique that uses X-ray guidance to clear blockages near the uterus. This method is an excellent alternative to microsurgical tubal anastomosis (Watrelot & Chauvi, 2011)
  • Tubal Reanastomosis and Fimbrioplasty:Surgical procedures that either reverse a tubal ligation or repair damaged parts of the fallopian tube (Alberta Health Services, n.d.).
  • Salpingostomy:A procedure that creates a new opening at the blocked end of the fallopian tube, often near the ovary. (Singhal, 2022)
  • In Vitro Fertilization (IVF):A process where eggs are retrieved from the ovaries and fertilized in a lab, with the resulting embryos transferred to the uterus, bypassing the fallopian tubes.

The Future of Tubal Factor Infertility Treatment

Research continues to advance in the field of reproductive medicine:

  • 3D Imaging and Robotic Surgery:These technologies are improving the precision of surgical procedures for tubal repair (Alkatout et al., 2024).
  • Tissue Regeneration:Strategies are being explored to regenerate damaged fallopian tube tissue, offering a potentially less invasive approach to restoring fertility (Sethi et al., 2024).

Conclusion

Choosing the optimal treatment for tubal blockages is a highly personalized decision. It requires the expertise of a fertility specialist who can navigate the best options, taking into account factors such as the woman’s age, the extent of tubal damage, and the cause of the blockage.

For further information, please book your consultation with expert here.

REFERENCES

  1. Sharma JB, Sharma E, Sharma S, Dharmendra S. Female genital tuberculosis: Revisited. Indian J Med Res. 2018 Dec;148(Suppl):S71-S83. doi: 10.4103/ijmr.IJMR_648_18. PMID: 30964083; PMCID: PMC6469382.
  2. Jennings, L. K., & Krywko, D. M. (2018). Pelvic Inflammatory Disease. StatPearls Publishing. Retrieved from https://europepmc.org/article/MED/29763134
  3. Smolarz B, Szyłło K, Romanowicz H. Endometriosis: Epidemiology, Classification, Pathogenesis, Treatment and Genetics (Review of Literature). Int J Mol Sci. 2021 Sep 29;22(19):10554. doi: 10.3390/ijms221910554. PMID: 34638893; PMCID: PMC8508982.
  4. Ghobrial S, Ott J, Parry JP. An Overview of Postoperative Intraabdominal Adhesions and Their Role on Female Infertility: A Narrative Review. J Clin Med. 2023 Mar 15;12(6):2263. doi: 10.3390/jcm12062263. PMID: 36983263; PMCID: PMC10051311.
  5. Lai JM, Masten M, Markese A. Development of Hydrosalpinx After Prior Vaginal Hysterectomy and Bilateral Salpingectomy. Cureus. 2024 Jan 19;16(1):e52573. doi: 10.7759/cureus.52573. PMID: 38371103; PMCID: PMC10870105.
  6. Strandell A, Lindhard A, Waldenström U, Thorburn J, Janson PO, Hamberger L. Hydrosalpinx and IVF outcome: a prospective, randomized multicentre trial in Scandinavia on salpingectomy prior to IVF. Hum Reprod. 1999 Nov;14(11):2762-9. doi: 10.1093/humrep/14.11.2762. PMID: 10548619.
  7. Watrelot, A., & Chauvi, G. (2011). Current practice in tubal surgery and adhesion management: A review. Reproductive BioMedicine Online, 23, 53–62. doi:10.1016/j.rbmo.2011.05.010
  8. MyHealth Alberta. (n.d.). Fallopian tube procedures for infertility. Retrieved from https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=hw203637
  9. Singhal, S. (2022, August 24). What is Salpingostomy? Birla Fertility & IVF. Retrieved from https://birlafertility.com/blogs/what-is-salpingostomy/
  10. Women’s Imaging. (n.d.). Hystero-Salpingo Contrast Sonography (HyCoSy). Retrieved from https://womensimaging.net.au/what-we-do/gynaecology/hysterosalpingo-contrast-sonography/