A report by Swachh Bharat Mission says that 74.5 per cent of public places are equipped with toilets. Another report by the Ministry of Jal Shakti states that there are 2.23 lakh Community Sanitary Complexes built across all States and UTs under the Swachh Bharat Mission (SBM) since October 2014. Over 92 lakh toilets have been constructed since the launch of SBM Gramin (SBM (G)) in April 2020.

While toilets are there, are they accessible? This is the question one should ask. The National Family Health Survey (NFHS) focuses on 131 health indicators, but not until the NFHS 5 survey did they include the question of accessibility of toilets in the survey. This happened after the inputs from the Department of Drinking Water and Sanitation (DDWS) and the Ministry of Health & Family Welfare questioned the accessibility.

One might ask, why is the question of accessibility so important? The answer is quite simple. Access to water, sanitation and hygiene is the most basic human need and is also included under the Sustainable Development Goals by the UN.

Are These Numbers Real?

This thought crossed my mind because back in 2021, I went on a solo trip, on a bus to Udaipur from Delhi. There, the bus made two stoppages. This was done so people could get a quick dinner and freshen up, relieve themselves and be prepared for the rest of the journey. This was a nightmare. The bus only stopped for 10 minutes. While some men used the washroom, others went to the bushes.

For the women, there were three cubicles. One of them was broken, and the other one did not have a light bulb, which meant only one was usable. There was a long queue for that cubicle, and time was short. There was no point in trying to find an isolated corner, because it was past midnight, in an unknown area.

I waited anxiously. When finally, my turn came, I saw an overused, dirty washroom. The toilet seat is in a horrible condition. I wanted to touch nothing there. But I had to pee. So, I used my mask to cover my nose from the odour, folded my pants so they did not touch the floor and squatted. It was quite a task to balance.

On my way back to Delhi, I made sure to not drink any water for over a 13-hour bus journey. I dehydrated myself so I did not have to use the washroom. When I did reach, I was severely dehydrated and was sick for three days.

I shared my experience with my friends only to realise that many women have faced the same. There are no washrooms for women.

A friend of mine told me that it is because these roads and dhabas are mainly designed to serve men. They are the ones who travel at night or are on the roads most of the time. As a result, the few women who do travel or are on the road suffer.

Health Risks Women Are Prone To

Well, it is true, but partially. While holding your pee for too long can lead to health risks, peeing on a dirty toilet seat cannot lead to infections unless your urethra is in contact with the bacteria present on that toilet seat. However, nobody wants to sit on a dirty toilet seat, even if you do not get an infection. A safe and hygienic toilet is a basic need.

One of the regular saleswomen, Usha, who visits my house shared her experience with me. “Being on the road constantly means I must use the dirty public washrooms. But I do not want to use them. So, sometimes I ask my regular customers to let me use their washrooms. Some say yes, and some say no. I understand they are also concerned about their safety and privacy,” she says. As a result, Usha spends most of her day not drinking enough water and holding her pee when she is at work. Due to this, she also suffered from a Urinary Tract Infection (UTI).

Her friend, Halima too faced similar problems and due to increased levels of uric acid in her body, she suffered from Hyperuricemia.

Other health risks are kidney stones and other kidney problems, headaches, dull skin, xerostomia or dry mouth, fatigue, and urinary incontinence, which means losing control over your pelvic floor muscles leading to uncontrolled leakage of urine, seizures and weakness.

What Can You Do?

Wear comfortable clothes and capris. Capri pants are comfortable and are short in length, which means this won’t touch the toilet floor when you squat or sit.

Carry Essentials

Even though you cannot get a UTI alone from sitting on a toilet seat, it is always safe to carry a toilet seat sanitiser. If nothing, it can help you get rid of the bad odour so you can use your stand and pee device inside the toilet. You can also use disposable toilet seat covers if your knees are weak, and you cannot squat. Always flush with your seat down.

Always keep disposable gloves, a portable bidet (fill it with water before use), a pocket liquid handwash, wet wipes, tissues and sanitiser handy. Do not forget to keep extra sanitary pads. It might sound a lot, but I promise that it all fits in one pouch. Use this travel-friendly pouch every time you are on the road, or using a public washroom.

What Can We Learn From Others?

However, in case we do not get these technologically advanced toilets here, you can always pack a travel-friendly toilet kit!

Low-dose naltrexone has received plenty of attention as a strong candidate for treating people with chronic fatigue after COVID-19. But a new randomised clinical trial has found no significant improvement in fatigue, pain or any other symptoms when compared to a placebo.

The study, posted on medRxiv, examined low-dose naltrexone (LDN) in adults with post-COVID fatigue syndrome. The findings challenge hopes that an existing repurposed drug could provide relief for people whose symptoms have not subsided months after infection.

The paper has not yet undergone peer review, which means its findings have not been independently evaluated in a formal manner.

Study Based On 160 Adults With Long COVID

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160 adults aged 19 to 69 from British Columbia and Ontario, Canada participated in the trial. Participants had developed symptoms that resembled myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) after a SARS-CoV-2 infection.

Researchers randomly assigned participants either low-dose naltrexone or a placebo for 16 weeks. The naltrexone dose began at 1 milligram daily and increased to a maximum of 4.5 milligrams, depending on how participants tolerated the treatment.

The main outcome was fatigue severity, which was measured using the Fatigue Severity Scale. At the end of the study, the average fatigue score was 4.2 in the LDN group and 4.4 in the placebo group.

The difference between the groups was not statistically significant, meaning the trial proved that the drug did not improve fatigue.

Researchers also found no significant differences between the groups in pain, overall ME/CFS symptoms, daily step counts or any other health aspects related to quality of life.

These results suggest that LDN did not provide any measurable benefit for the participants. The study also found that LDN was generally well tolerated over the 16-week period.

However, adverse events classified as grade 3 or higher were reported in five participants in the LDN group, or 6.2%, compared with three participants in the placebo group or 3.8%.

Why Has Low-Dose Naltrexone Attracted Interest?

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Naltrexone is an established medicine used at standard doses to treat alcohol use disorder and opioid use disorder. At much lower doses, it has been tested for conditions involving chronic pain, inflammation and fatigue.

LDN’s effects on immune signalling and inflammatory conditions have sparked interest in its potential use for long COVID, a condition that can involve fatigue, cognitive difficulties, pain, breathlessness and symptoms affecting several biological functions.

Researchers Caution

The findings apply specifically to adults with post-COVID fatigue syndrome who met the study’s criteria for ME/CFS-like symptoms.

Long COVID refers to symptoms that occur after a SARS-CoV-2 infection and cannot be explained by another diagnosis. Symptoms vary widely and may include fatigue, cognitive difficulties, breathlessness, sleep disturbances and problems with everyday activities.

Some people improve over time, while others experience prolonged illness that affects their ability to lead routine lives.

The results do not mean that long COVID symptoms are untreatable. Instead, they highlight how difficult it can be to identify effective treatments for a condition with varied symptoms.

There are currently no FDA-approved medicines specifically for long COVID, and care often focuses on managing individual symptoms.

People taking or considering naltrexone should discuss its benefits and risks with a healthcare professional rather than starting or changing treatment on their own.

Low-dose aspirin could play a key role in lowering the risk of dementia significantly in some older adults, according to a new genetic analysis. However, the benefit does not come without a complication: major bleeding.

The study, led by researchers at Monash University in Australia, is based on data from more than 13,500 participants in the ASPREE trial, which investigated the effects of low-dose aspirin in older adults. The study was published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.

Researchers found that the benefit was mostly seen among people with a specific genetic trait linked with platelet count.

70% Lower Dementia Risk Was Seen Among Older Adults

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Platelets are small blood components that help form clots and stop bleeding. Researchers have previously examined how aggregation of platelets might contribute to dementia, but the role of genetically influenced platelet counts still remains unclear.

The researchers examined genetic scores related to platelet count and compared dementia results among participants who were either assigned aspirin or placebo.

Among people in the highest 20% of platelet count genetic scores, dementia developed in 1% of those taking aspirin, compared with 3.3% of those receiving a placebo. This represented approximately a 70% lower risk.

Lead author Dr Peter Fransquet, a research fellow at Monash University's School of Public Health and Preventive Medicine, said, “Previous trials found aspirin didn't prevent dementia when everyone was considered together.”

“Our findings suggest there may be more to the story,” he said.

Risk Of Bleeding Increased

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The benefit was accompanied by a safety concern. Among participants in the same genetic subgroup, major bleeding occurred in 4.4% of those assigned to aspirin, compared to 2.1% of those given a placebo. That is a difference of 2.3 percentage points in both dementia cases and major bleeding events. In other words, the lower dementia rate cannot be considered in isolation from the increased bleeding risk.

Aspirin reduces the ability of platelets to form clots. This can be useful for certain people who need to take precaution against cardiovascular events, but it can also increase the risk of serious bleeding, including bleeding in the gastrointestinal tract or brain.

The study therefore does not prove that aspirin offers a favourable overall balance of benefits and harms for people with this genetic profile.

Could This Help Personalise Dementia Prevention?

The researchers found that the genetic signal was not linked to established genetic risk factors for Alzheimer's disease and dementia. Instead, it pointed towards platelet factor as a possible direction for further research.

“What's particularly interesting is that the signal wasn't linked to the established genetic risk factors for Alzheimer's disease and dementia,” Fransquet said. “Instead, it's pointing us towards platelet biology and gives us a new avenue to investigate.”

The findings could contribute to more personalised approaches to dementia prevention, in which treatments are tailored to characteristics that influence how individuals respond. But the results need to be replicated in other populations and tested in a clinical trial specifically designed for people with the identified genetic profile.

Fransquet said, “People shouldn’t start taking aspirin to prevent dementia on the basis of this study without consulting with their doctor, particularly given the increased risk of serious bleeding,” he said.

High blood pressure can be managed with medication and dietary changes. But recent research suggests that certain mental health habits can also help fight hypertension.

Mental health practices like mindfulness, optimism and gratitude may also support cardiovascular health, partly by helping people manage stress better and maintain healthier habits.

Hypertension affects nearly half of adults in the United States. While lifestyle changes like reducing salt intake, exercising regularly, maintaining a healthy weight and limiting alcohol remain crucial, the emerging study says that psychological wellbeing can also have a beneficial effect on blood pressure.

“Stress contributes to hypertension,” said Willie E. Lawrence Jr., a cardiologist and spokesperson for the American Heart Association. “It’s hard to get all the stress out of your life, but there are things that you can do to lower blood pressure, like mindfulness.”

According to the researchers, here are three mental health habits that may help:

Mindfulness

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Mindfulness refers to paying attention to thoughts, emotions and physical sensations in the present moment without judging them. It may help alleviate stress and improve behaviours that affect blood pressure like dietary choices and physical activity.

Eric Loucks, professor of epidemiology and director of the Mindfulness Center at Brown University, developed a mindfulness-based blood pressure reduction programme that teaches participants all about self-awareness, attention control and emotional regulation. The programme teaches people to apply these skills to everyday decisions like choosing healthier foods.

“There can be energy that comes up to act on those insights,” Loucks said. “So if we decide we want to eat more healthily, can we be there with that energy in the grocery store, selecting the food for the week?”

Optimism

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Optimism means expecting positive outcomes while recognising that challenges exist. Research has linked an optimistic outlook with better cardiovascular health, but evidence that it lowers blood pressure in people who already have hypertension is limited.

A study based on more than 100,000 active-duty US Army personnel without hypertension found that the most optimistic participants were less likely to develop high blood pressure during an average follow-up of three and a half years.

Julia Boehm, professor and chair of psychology at Chapman University said that practising optimism does not mean ignoring difficulties. Instead, people can identify realistic, achievable actions that support their health, such as choosing nutritious meals or becoming more physically active.

“This might mean something concrete like, ‘Am I going to choose to eat the salad or the french fries at lunch?’ and thinking optimistically that my choices in any given moment are going to translate into measurable effects in the long run,” Boehm said.

Gratitude

Gratitude involves acknowledging the people, experiences and acts one appreciates. Some research suggests it may affect cardiovascular responses to stress.

One study found that writing a gratitude letter changed how systolic blood pressure responded during a stress test. Systolic pressure, the upper number in a blood pressure reading, measures pressure when the heart contracts.

Mindfulness, optimism and gratitude should complement established hypertension treatment, not replace it. Medication, regular physical activity, a balanced diet and screening remain essential.

As Boehm cautioned, “You can’t ignore the doctor’s advice to either take your medications or engage in physical activity or eat fruits and vegetables. It’s just one piece of a larger strategy to bolster health.”