Incident Diuretic Use and Subsequent Risk of Bone Fractures: A Large Nationwide Observational Study of US Veterans.

OBJECTIVE: To investigate the association of incident use of diuretics with subsequent risk of incident bone fractures. PATIENTS AND METHODS: In a nationwide cohort of 863,339 US veterans receiving care from the VA health care system between October 1, 2004, and September 30, 2006, with follow-up through June 30, 2018, we examined the association of incident diuretic use (overall, and separately by thiazide, loop, and potassium-sparing diuretics) with subsequent risk of incident bone fractures using multivariable Cox regression models while minimizing confounding by indication using a target trial emulation approach. RESULTS: Patients were 63.3±12.9 years old; 93.5% (n=807,180) were male; and 27.1% (n=233,996) were diabetic. Their baseline estimated glomerular filtration rate was 84.4±16.5 mL/min per 1.73 m2. Among 863,339 patients, 424,386 (49.2%) newly initiated diuretics, of which 77.4% (n=328,524), 22.5% (n=95,457), and 0.1% (n=405) were thiazide, loop, and potassium-sparing diuretic users, respectively. After multivariable adjustments, incident diuretic use (vs non-use) was significantly associated with higher risk of incident fracture (adjusted HR [aHR], 1.14; 95% CI, 1.11 to 1.16). The association was most pronounced for loop diuretics (aHR, 1.39; 95% CI, 1.35 to 1.44) but less evident for thiazide diuretics (aHR, 1.08; 95% CI, 1.06 to 1.10) and was not significant for potassium-sparing diuretics (aHR, 0.97; 95% CI, 0.62 to 1.52). The diuretic-fracture association was more evident in younger (vs older) patients, those with (vs without) corticosteroid use, and those with lower (vs higher) serum sodium levels. CONCLUSION: Incident use of diuretics, particularly loop diuretics, was independently associated with higher risk of incident bone fractures. Our findings suggest distinct pathophysiologic contributions of diuretics to bone metabolism and the need for careful attention to skeletal outcomes when initiating diuretics.

Anti-Tumor Necrosis Factor Therapy and Risk of Kidney Function Decline and Mortality in Inflammatory Bowel Disease.

Importance: Inflammatory bowel disease (IBD) is associated with adverse clinical outcomes, including chronic kidney disease and mortality, due in part to chronic inflammation. Little is known about the effects of anti-tumor necrosis factor (TNF) therapy on kidney disease progression and mortality among patients with new-onset IBD. Objective: To examine the association of incident use of TNF inhibitors with subsequent decline in kidney function and risk of all-cause mortality. Design, Setting, and Participants: This retrospective cohort study used data from the US Department of Veterans Affairs health care system. Participants were US veterans with new-onset IBD enrolled from October 1, 2004, through September 30, 2019. Data were analyzed from December 2022 to February 2024. Exposures: Incident use of TNF inhibitors. Main Outcomes and Measures: The main outcomes were at least 30% decline in estimated glomerular filtration rate (eGFR) and all-cause mortality. Results: Among 10 689 patients (mean [SD] age, 67.4 [12.3] years; 9999 [93.5%] male) with incident IBD, 3353 (31.4%) had diabetes, the mean (SD) baseline eGFR was 77.2 (19.2) mL/min/1.73 m2, and 1515 (14.2%) were newly initiated on anti-TNF therapy. During a median (IQR) follow-up of 4.1 (1.9-7.0) years, 3367 patients experienced at least 30% decline in eGFR, and over a median (IQR) follow-up of 5.0 (2.5-8.0) years, 2502 patients died. After multivariable adjustments, incident use (vs nonuse) of TNF inhibitors was significantly associated with higher risk of decline in eGFR (adjusted hazard ratio [HR], 1.34 [95% CI, 1.18-1.52]) but was not associated with risk of all-cause mortality (adjusted HR, 1.02 [95% CI, 0.86-1.21]). Similar results were observed in sensitivity analyses. Conclusions and Relevance: In this cohort study of US veterans with incident IBD, incident use (vs nonuse) of TNF inhibitors was independently associated with higher risk of progressive eGFR decline but was not associated with risk of all-cause mortality. Further studies are needed to elucidate potentially distinct pathophysiologic contributions of TNF inhibitor use to kidney and nonkidney outcomes in patients with IBD.

Factors associated with miscarriage in Nepal: Evidence from Nepal Demographic and Health Surveys, 2001-2016.

BACKGROUND: Miscarriage is a major public health concern in low and middle-income countries (LMICs) like Nepal. This study aims to examine the factors associated with miscarriage among pregnant women of reproductive age (15-49 years) in the past 15 years. METHODS: There were a total of weighted sample of 26,376 cross-sectional pregnancy data from Nepal Demographic and Health Surveys (NDHS) 2001, 2006, 2011, and 2016 combined together, which was used in the study. Multilevel logistic regression analysis that adjusted for cluster and survey weights was used to identify factors associated with miscarriage among pregnant women of reproductive age in Nepal. RESULTS: The results showed that maternal age, contraception, tobacco smoking, wealth index, respondents' educational status, and, caste/ethnicity were found to be strong factors of miscarriage in Nepal. The likelihood of having a miscarriage among older women (≥40 years) was more than 100% (aOR = 2.12, 95% CI [1.73, 2.59]), among non-users of contraception was 88.9% (aOR = 1.88, 95% CI [1.68, 2.11]) (p<005) and non-smoking women had a 19% lower odds of miscarriage (aOR = 0.81, 95% CI [0.69, 0.95]). Respondents from the richest wealth index had 50% (aOR = 1.50, 95% CI [1.22, 1.85]) higher likelihood of miscarriage. Mothers with only primary education had a 25% higher chance of miscarriage (aOR = 1.25, 95% CI [1.09, 1.44]) compared to those with secondary and higher secondary education. In relation to caste/ethnicity, Dalits had 13% lesser likelihood (aOR = 0.87, 95% CI [0.74, 1.02]) and Janajatis had 26% lower chances of a miscarriage than Brahmin/Chettri (aOR = 0.74, 95% CI [0.64, 0.85]). CONCLUSION: Findings from this study show that miscarriages are associated with maternal age, use of contraception, smoking, wealth index, caste, and ethnicity. Interventions aimed to improve use of contraceptives, avoiding smoking and pregnancy planning on the basis of maternal age, are needed to prevent miscarriage. Also, women from Brahmin ethinicity and those with the highest income index require greater attention when it comes to miscarriage prevention strategies in Nepal.

Association of long-term aspirin use with kidney disease progression.

Background: Chronic microinflammation contributes to the progression of chronic kidney disease (CKD). Aspirin (ASA) has been used to treat inflammation for centuries. The effects of long-term low-dose ASA on CKD progression are unclear. Methods: We examined the association of long-term use of newly initiated low-dose ASA (50-200 mg/day) with all-cause mortality using Cox proportional hazard models; with cardiovascular/cerebrovascular (CV) mortality and with end stage kidney disease (ESKD) using Fine and Gray competing risk regression models; with progression of CKD defined as patients' eGFR slopes steeper than -5 mL/min/1.73m2/year using logistic regression models in a nationwide cohort of US Veterans with incident CKD. Among 831,963 patients, we identified 385,457 who either initiated ASA (N = 21,228) within 1 year of CKD diagnosis or never received ASA (N = 364,229). We used propensity score matching to account for differences in key characteristics, yielding 29,480 patients (14,740 in each group). Results: In the matched cohort, over a 4.9-year median follow-up period, 11,846 (40.2%) patients (6,017 vs. 5,829 ASA users vs. non-users) died with 25.8% CV deaths, and 934 (3.2%) patients (476 vs. 458) reached ESKD. ASA users had a higher risk of faster decline of kidney functions, i.e., steeper slopes (OR 1.30 [95%CI: 1.18, 1.44], p < 0.01), but did not have apparent benefits on mortality (HR 0.97 [95%CI: 0.94, 1.01], p = 0.17), CV mortality (Sub-Hazard Ratio [SHR]1.06 [95%CI: 0.99-1.14], p = 0.11), or ESKD (SHR1.00 [95%CI: 0.88, 1.13], p = 0.95). Conclusion: Chronic low-dose ASA use was associated with faster kidney function deterioration, and no association was observed with mortality or risk of ESKD.

Association of oral iron replacement therapy with kidney failure and mortality in CKD patients.

Background: Oral iron is the predominant route of iron replacement (IRT) but its benefits and safety are unclear in patients with chronic kidney disease (CKD). Methods: We examined the association of oral IRT vs no IRT with end-stage kidney disease (ESKD) and mortality in a national cohort of US Veterans. We identified 17 413 incident new users of oral IRT with estimated glomerular filtration rates <60 mL/min/1.73 m2 and 32 530 controls who did not receive any IRT during 2004-18. We used propensity score-overlap weighting to account for differences in key baseline characteristics associated with the use of oral IRT. We examined associations using competing risk regression and Cox models. Results: In the cohort of 49 943 patients, 1616 (3.2%) patients experienced ESKD and 28 711 (57%) patients died during a median follow-up of 1.9 years. Oral IRT was not associated with ESKD [subhazard ratio (HR) (95% confidence interval, CI) 1.00 (0.84-1.19), P = .9] and was associated with higher risk of all-cause mortality [HR (95% CI) 1.06 (1.01-1.11), P = .01]. There was significant heterogeneity of treatment effect for mortality, with oral IRT associated with higher mortality in the subgroups of patients without congestive heart failure (CHF), anemia or iron deficiency. In patient with blood hemoglobin <10 g/dL oral IRT was associated with significantly lower mortality. Conclusion: Oral IRT was associated with lower mortality only in patients with anemia. In patients without anemia, iron deficiency or CHF, the risk-benefit ratio of oral IRT should be further examined.

Association of iron therapy with incidence of chronic kidney disease.

OBJECTIVE: We investigated the association of oral iron replacement with the incidence of chronic kidney disease (CKD) in a population with normal kidney function to study the effects of iron replacement on the development of new onset CKD. METHODS: In a national cohort of US Veterans with no pre-existing CKD, we identified 33 894 incident new users of oral iron replacement and a comparable group of 112 780 patients who did not receive any iron replacement during 2004-2018. We examined the association of oral iron replacement versus no iron replacement with the incidence of eGFR <60 mL/min/1.73 m2 and the incidence of urine albumin creatinine ratio (UACR) ≥30 mg/g in competing risk regressions and in Cox models. We used propensity score weighing to account for differences in key baseline characteristics associated with the use of oral iron replacement. RESULTS: In the cohort of 146 674 patients, a total of 18 547 (13%) patients experienced incident eGFR <60 mL/min/1.73 m2 , and 16 117 patients (11%) experienced new onset UACR ≥30 mg/g. Oral iron replacement was associated with significantly higher risk of incident eGFR <60 mL/min/1.73 m2 (subhazard ratio, 95% confidence interval [CI]: 1.3 [1.22-1.38], p < .001) and incident albuminuria (subhazard ratio, 95% CI: 1.14 [1.07-1.22], p < .001). CONCLUSION: Oral iron replacement is associated with higher risk of new onset CKD. The long-term kidney safety of oral iron replacement should be tested in clinical trials.

A comprehensive review of the production, adoption and sustained use of biomass pellets in Ghana.

Ghana's Renewable Energy Master Plan of 2019 includes the production and use of biomass pellets. However, pellets have neither been developed commercially nor included in Ghana's energy mix. This paper reviewed the prospect of production, adoption and sustained use of pellets in Ghana. Besides having abundant biomass resources, Ghana has high market demand and relevant policies for pellet development. The production of pellets can significantly replace traditional household biomass demand and improve environmental and health quality. However, the production and use of pellets are limited due to technical, financial, social and policy issues. Our estimates show that 3% of the annual national average household income will be spent on pellet demand for cooking, with the highest burden on rural households in Ghana. Practical measures are required since the cost of pellets and gasifier stoves may limit pellet adoption and use in Ghana. Based on study findings, it is recommended that the government of Ghana establishes a robust supply chain and provides infrastructure for pellet production and use. Existing renewable energy policies should be reviewed to remove ambiguities, attract investment, and build capacity in the renewable energy sector. Apart from raising public awareness of the benefits of pellets use, the government of Ghana should ensure that continuous and thorough impact assessments are undertaken to assess the implications of pellet production and use. This review will inform policymaking on achieving sustainable production, adoption and use of pellets and assess Ghana's contribution to achieving the United Nations' sustainable development goals.

Field assessment of straw pellet combustion in improved heating stoves in rural Northeast China.

Straw pellets are widely promoted and expected to be a cleaner alternative fuel to unprocessed crop residues and raw coal in rural China. However, the effectiveness of these dissemination programs is not well evaluated. In this field study, emission characteristics of burning straw pellets, raw coal, and unprocessed corn cobs in heating stoves were investigated in a pilot village in Northeast China. Emission measurements covering the whole combustion cycle (ignition, flaming, and smoldering phases) shows the promotion of improved heating stoves and straw pellets could reduce pollutant emissions (e.g., SO2 and CO), but increase NOX and PM2.5 emissions compared to the initial stove-fuel use pattern in the studied area. There is a significant variance in emission characteristics between different combustion phases. The normalized emission concentrations of the different stove-fuel combinations were higher than the limits in the Chinese national standard for heating stoves, indicating that the standard is not met for real-world emissions. Coal consumption was lower than official data. Household surveys were conducted to identify the barriers to fuel and stove access associated with existing promotion strategies, management, and policies. The pilot program was of the typical "subsidy-and-policy-dependence" pattern and was unlikely to be implemented on a large scale. Technological innovation, operational optimization, and proper policies considering the local socioeconomic factors are needed to sustain the promotion of biomass straw pellets and stoves.

Cystic dilatation of the ventriculus terminalis: A narrative review.

Introduction: The terminal ventricle, also known as the fifth ventricle, is a tiny relic cavity in the conus medullaris of the human spinal cord. Our purpose in bringing attention to this condition is to get the word out about the signs and symptoms, diagnostic hurdles, and therapeutic options available for it. Methods: All relevant studies involving patients diagnosed with ventriculus terminalis (VT) were retrieved from PubMed, Google Scholar, and Scopus. Studies published in complete English language reports were included. The terms VT, terminal ventricle, and 5th ventricle. Age, gender, presenting symptoms, magnetic resonance imaging findings, treatment, and outcome of patients with ventriculus terminalis were all included and recorded. Results: The average age of the patients was 39 years, and there were 13 men among them (14.4%). Motor deficits and sciatica were the most commonly reported symptoms in 38 and 34 patients (42.2%, 37.7%), respectively. In 48 patients (53.3%), cyst fenestration was performed, and in 25 patients (27.7%), myelotomy was performed. Fifty-eight patients (64.4%) saw a reduction in cyst size after surgery. The majority of patients reported an improvement in their symptoms in 64 cases (51.1%), with only three cases (3.3%) reporting a worsening. Conclusions: In cases where the VT is the source of symptoms such as motor, sensory, or bladder dysfunction, surgical intervention is recommended. This review compiles information from the available literature to shed light on the anatomy, clinical presentation, imaging, and treatment options for this variant. It also aims to pinpoint any potential drawbacks or restrictions connected to the surgical techniques.

Association of Uric Acid-Lowering Therapy With Incident Chronic Kidney Disease.

Importance: Uric acid is a waste metabolite produced from the breakdown of purines, and elevated serum uric acid levels are associated with higher risk of hypertension, cardiovascular disease, and mortality and progression of chronic kidney disease (CKD). Treatment of hyperuricemia in patients with preexisting CKD has not been shown to improve kidney outcomes, but the associations of uric acid-lowering therapies with the development of new-onset kidney disease in patients with estimated glomerular filtration rate (eGFR) within reference range and no albuminuria is unclear. Objective: To examine the association of initiating uric acid-lowering therapy with the incidence of CKD. Design, Setting, and Participants: This cohort study included patients with eGFR of 60 mL/min/1.73 m2 or greater and no albuminuria treated at US Department of Veterans Affairs health care facilities from 2004 to 2019. Clinical trial emulation methods, including propensity score weighting, were used to minimize confounding. Data were analyzed from 2020 to 2022. Exposure: Newly started uric acid-lowering therapy. Main Outcomes and Measures: The main outcomes were incidences of eGFR less than 60 mL/min/1.73 m2, new-onset albuminuria, and end-stage kidney disease. Results: A total of 269 651 patients were assessed (mean [SD] age, 57.4 [12.5] years; 252 171 [94%] men). Among these, 29 501 patients (10.9%) started uric acid-lowering therapy, and 240 150 patients (89.1%) did not. Baseline characteristics, including serum uric acid level, were similar among treated and untreated patients after propensity score weighting. In the overall cohort, uric acid-lowering therapy was associated with higher risk of both incident eGFR less than 60 mL/min/1.73 m2 (weighted subhazard ratio [SHR], 1.15 [95% CI, 1.10-1.20; P < .001) and incident albuminuria (SHR, 1.05 [95% CI, 1.01-1.09; P < .001) but was not associated with the risk of end-stage kidney disease (SHR, 0.96 [95% CI, 0.62-1.50]; P = .87). In subgroup analyses, the association of uric acid-lowering therapy with worse kidney outcomes was limited to patients with baseline serum uric acid levels of 8 mg/dL or less. Conclusions and Relevance: These findings suggest that in patients with kidney function within reference range, uric acid-lowering therapy was not associated with beneficial kidney outcomes and may be associated with potential harm in patients with less severely elevated serum uric acid levels.

Scaling up tobacco cessation within TB programmes: findings from a multi-country, mixed-methods implementation study.

BACKGROUND: Brief behavioural support can effectively help tuberculosis (TB) patients quit smoking and improve their outcomes. In collaboration with TB programmes in Bangladesh, Nepal and Pakistan, we evaluated the implementation and scale-up of cessation support using four strategies: (1) brief tobacco cessation intervention, (2) integration of tobacco cessation within routine training, (3) inclusion of tobacco indicators in routine records and (4) embedding research within TB programmes. METHODS: We used mixed methods of observation, interviews, questionnaires and routine data. We aimed to understand the extent and facilitators of vertical scale-up (institutionalization) within 59 health facility learning sites in Pakistan, 18 in Nepal and 15 in Bangladesh, and horizontal scale-up (increased coverage beyond learning sites). We observed training and surveyed all 169 TB health workers who were trained, in order to measure changes in their confidence in delivering cessation support. Routine TB data from the learning sites were analysed to assess intervention delivery and use of TB forms revised to report smoking status and cessation support provided. A purposive sample of TB health workers, managers and policy-makers were interviewed (Bangladesh n = 12; Nepal n = 13; Pakistan n = 19). Costs of scale-up were estimated using activity-based cost analysis. RESULTS: Routine data indicated that health workers in learning sites asked all TB patients about tobacco use and offered them cessation support. Qualitative data showed use of intervention materials, often with adaptation and partial implementation in busy clinics. Short (1-2 hours) training integrated within existing programmes increased mean confidence in delivering cessation support by 17% (95% CI: 14-20%). A focus on health system changes (reporting, training, supervision) facilitated vertical scale-up. Dissemination of materials beyond learning sites and changes to national reporting forms and training indicated a degree of horizontal scale-up. Embedding research within TB health systems was crucial for horizontal scale-up and required the dynamic use of tactics including alliance-building, engagement in the wider policy process, use of insider researchers and a deep understanding of health system actors and processes. CONCLUSIONS: System-level changes within TB programmes may facilitate routine delivery of cessation support to TB patients. These strategies are inexpensive, and with concerted efforts from TB programmes and donors, tobacco cessation can be institutionalized at scale.

User behavior, influence factors, and impacts on real-world pollutant emissions from the household heating stoves in rural China.

Household heating stoves are commonly used for heating in rural China during winter and are responsible for a large portion of the particulate matter in the atmosphere. Pollutant emissions from household stoves are influenced by user behaviors in actual use, in addition to purely technological reasons (i.e., type and age of appliance) and installation conditions (i.e., the natural draft of chimney system). The variability in user behavior is one of the reasons for uncertainty in household emission inventories. In this study, household stove user behaviors, including ignition frequency, heating with or without cooking, smoldering duration, and fuel-adding times, were investigated through face-to-face surveys in Shanxi province, north China. The survey of user behaviors showed that the majority of the RHS users (81.3%) and approximately half of the WHS users (49.4%) used their stoves for both cooking and heating, whereas the remaining users used their stoves just for heating. Approximately 80% of surveyed households (97.4% for water heating stove and 68.7% for radiant heating stove) kept the stoves smoldering at night, whereas the remaining users ignited their stoves every day. The highest frequency of smoldering duration and highest frequency of fuel-adding operation were 8-9 h and 4-7 times, respectively. Principal component analysis showed that stove type, permanent population, and annual income are the potential influencing factors of user behavior. The smoldering duration was positively related to indoor air pollutant concentrations and fuel-adding times had a significant impact on outdoor PM2.5 emission factors. The results from this research will be beneficial for understanding the cause of fluctuation in emissions and designing heating appliances for real-life operations.

In-use emissions and usage trend of pellet heating stoves in rural Yangxin, Shandong Province.

The use of coal in Chinese households for winter heating emits harmful pollutants that severely affect indoor air quality and climate. Therefore, China has made efforts to transition into clean heating using improved heating stoves and biomass pellets. Although the economic and policy implications of such demonstration projects have been extensively investigated, little has been done to understand the real-world performance and adoption trends of such stoves. This study measured in-use emissions from nine different pellet stoves used for heating among 52 rural households in Yangxin, Shandong Province. The temperature of the stove chimney of 21 households was monitored and 56 households were surveyed to explore the stove use trend. The particulate and gaseous emission concentrations for most of the stoves exceeded the limits specified in the Chinese national standard. The measured fuel energy-based emission factors (mean ± standard deviation) for CO2, CO, NOx, and PM2.5 were 103 ± 3, 1.41 ± 1.19, 0.336 ± 0.237, and 0.146 ± 0.108 g/MJ, respectively. Between January to February, the average daily heating duration was 8.71 h, and the sustained use of heating stoves was seen among over 85% of the households. On average, the households used their heating stoves for 3.28 months and the estimated annual pellets consumption for a household was 2.7 tons. Besides inherent variabilities associated with user habits, the stove's design-related shortcomings and low-grade pellets hindered the performance and effectiveness of pellet stoves. This study provides insights into opportunities and challenges for the promotion of cleaner fuels and heating technologies. Furthermore, it will provide information on emissions from rural residential sources to build the emission inventory and inform policymaking for successful stove promotion programs.

"Change Really Does Need to Start From Home": Impact of an Intimate Partner Violence Prevention Strategy Among Married Couples in Nepal.

Approximately 54% of women in rural Nepal report lifetime physical or sexual violence. The Change Starts at Home project is a primary prevention strategy to reduce and prevent marital intimate partner violence (IPV). This study analyzed in-depth interviews with 17 married couples (n = 34 individuals) at intervention midline and end line. Case-based analysis and thematic summaries were used to assess change, couple concordance, and gendered reporting patterns at midline. Individual changes included husband's alcohol use and roaming tendencies. Relationship-level changes comprised labor roles, communication, decision making, conflict resolution, and experience of IPV. End line interviews were analyzed to understand sustenance of change within these same individual and relationship dynamics. Results indicate promising shifts in men's individual behavior and marital dynamics, which underpin IPV risk.

Diffusion in social norms change about violence against women: A longitudinal analysis of intervention data from a cluster randomised trial.

This study examines the diffusion effects of a Social and Behaviour Change Communication intervention in Nepal targeting gender equity and violence against women. The Change trial involves weekly radio programming, listening and discussion groups (LDGs), and community engagement. This longitudinal study analyses a repeated cross-sectional two-armed, pair-matched, single blinded cluster trial of a 9-month intervention. We used probability proportionate to size methodology to identify 72 wards in the Terai region, half of which were randomly assigned to the intervention. For the community-based survey, 20 women per ward were chosen using simple random sampling (N = 1440). Ten women from each intervention ward (N = 360) were also selected to participate in radio LDGs. Injunctive norms were measured with the Partner Violence Norms Scale-PVNS. Each one person increase in diffusion was associated with a 0.04 (SE = 0.01, p-value < 0.01) higher endline norms score, adjusting for confounders. There was evidence of effect modification with a significant baseline norm by diffusion interaction term (Estimate = -0.12, p-value = 0.04). Findings demonstrated that diffusion was related to endline norms only in communities with lower baseline levels of gender equitable norms. Study findings support the importance of diffusion as a pathway to intervention scale-up and norms change.

The Influence of Organised Diffusion on Social Norms Change: Addressing Intimate Partner Violence in Nepal.

Intimate partner violence (IPV) is a significant global health issue. Organised diffusion has potential to influence changes in norms that perpetuate harmful practices by spreading anti-IPV messaging throughout social networks. The Change Starts at Home intervention in Nepal leverages radio programming and community mobilisation to address the perpetration of IPV. This qualitative analysis of couple interviews at the 18-month follow-up (N = 35 individuals) seeks to evaluate how the intervention messaging diffused into the community using organised diffusion as a framework, and how this influenced any changes in norms related to the perpetration of IPV. Overall, this study provides evidence that the Change at Home Intervention effectively diffused into the community and began to promote changes around IPV norms, especially among relationships that were socially and geospatially close. This analysis demonstrates the potential for organised diffusion to facilitate social norms change around IPV.

A qualitative examination of alcohol use and IPV among Nepali couples in a violence prevention intervention.

Intimate partner violence (IPV) impacts the physical and mental health of one in three women globally, with equally high rates in rural Nepal. The risk of physical violence, stalking, harassment, and homicide between intimate partners increases when alcohol is used by the perpetrator. This study evaluates the impact of Change Starts at Home, a nine-month intervention to prevent IPV in which 360 married couples in the Terai region of Nepal listened to a serial radio drama and engaged in Listening Group Discussions. A sub-sample of 18 couples were selected for individual in-depth interviews that were taken at the end of the intervention and 16 months later. Participants strongly and consistently associated alcohol use with IPV against women in their own and others' relationships. Husbands and wives agreed that men sustained reductions in alcohol use, conflict, and perpetration of IPV, attributed to improvements in communication, conflict resolution, and a reduction in alcohol expenditure following the intervention. The results of this study suggest that integrating programming on alcohol reduction within IPV prevention interventions in the Terai region of Nepal has benefits on couple functioning, alcohol consumption, and IPV perpetration.

Triclosan: antimicrobial mechanisms, antibiotics interactions, clinical applications, and human health.

The large-scale applications of Triclosan in industrial and household products have created many health and environmental concerns. Despite the fears of its drug-resistance and other issues, Triclosan is still an effective drug against many infectious organisms. Knowing the cross-interactions of Triclosan with different antibiotics, bacteria, and humans can provide much-needed information for the risk assessment of this drug. We review the current understanding of the antimicrobial mechanisms of Triclosan, how microbes become resistant to Triclosan, and the synergistic and antagonistic effects of Triclosan with different antibiotics. Current literature on the clinical applications of Triclosan and its effect on fetus/child development are also summarized.

Synergistic and antagonistic interactions of triclosan with various antibiotics in bacteria.

Triclosan (TCS), a well-studied antimicrobial compound and an environmental pollutant, is present in many household products. A systematic survey of TCS-antibiotic-bacteria interactions is lacking. We wish to understand the origin of such interactions by testing 16 phylogenetically well-characterized bacteria for their sensitivities to 6 different classes of antibiotics with or without the presence of TCS. Our results show that TCS interacts synergistically with some antibiotics against some Bacilli species. TCS could also interact antagonistically with other antibiotics against certain bacteria, including pathogens such as Pseudomonas aeruginosa and Stenotrophomonas maltophilia. Antagonism between drugs often coincided with the concomitant enhanced removal of Ethidium bromide (EtBr) from the cells. Enterococcus faecalis shows a unique response to TCS. High levels of TCS inhibits E. faecalis. Cells survive at lower TCS concentrations, and these cells can remove EtBr more readily than unexposed cells. At even lower TCS concentration, cell-growth is inhibited again, causing the culture to exhibit a unique extra inhibition zone around the TCS-disk. The TCS-antibiotic-bacteria interaction profiles of some bacteria do not follow their bacterial phylogenetic relations. This suggests that such interactions may be related to horizontal gene transfer among different bacteria.