Water, Health, and Social Technologies: One Million Cisterns Programme Case Study.

Background: This paper focuses on the impacts of climate change on vulnerable ecosystems and its implications for the health and well-being of populations. It specifically examines the semi-arid region of Brazil, where the introduction of a social climate adaptation tool, cisterns, has brought about significant positive changes. Cisterns, a low-cost climate adaptation technology, can be replicated globally, reducing the negative health impacts of frequent droughts, especially for vulnerable groups in remote rural areas. Objective: We analyze the impact of the "One Million Cisterns Program" (P1MC) on health by synthesizing the literature and modeling its interactions with climatic and environmental factors with the Driving Force-Pressure-State-Exposure-Effect-Action (DPSEEA) framework. Methods: Our case study employs a multidisciplinary approach, focusing on two key objectives: (i) synthesizing the literature on the implementation of the P1MC and its association with health outcomes, using search criteria that specifically target articles linking the program to health impacts; and (ii) developing a conceptual framework to model the relationship between climatic and environmental factors, adaptive ecosystems, and health outcomes. The DPSEEA framework evaluates the structural connections between climate change and human health. Findings: The study found a significant gap in the literature concerning the relationship between P1MC and health outcomes. Cisterns target the pressure/state linkages related to contextual factors and health effects, addressing the root causes of drought-related health issues. This framework also provides a foundation for collaboration among health, environmental, and policy sectors to address shared challenges, such as water security and health outcomes. Conclusion: We offer a multidisciplinary analytical framework that can be used to explore various perspectives-environmental, social, and health-related-with experts and stakeholders to develop and improve adaptive social technology strategies for living in the era of climate change. This framework also facilitates the implementation of qualitative and quantitative well-being and health assessments

Combined training is the most effective training modality to improve aerobic capacity and blood pressure control in people requiring haemodialysis for end-stage renal disease: systematic review and network meta-analysis

Questions: Do aerobic, resistance and combined exercise training improve aerobic capacity, arterial blood pressure and haemodialysis efficiency in people requiring haemodialysis for end-stage renal disease? Is one exercise training modality better than the others for improving these outcomes? Design: Systematic review with network meta-analysis of randomised trials. Participants: Adults requiring haemodialysis for end-stage renal disease. Intervention: Aerobic training, resistance training, combined training and control (no exercise or placebo). Outcome measures: Aerobic capacity, arterial blood pressure at rest, and haemodialysis efficiency. Results: Thirty-three trials involving 1254 participants were included. Direct meta-analyses were conducted first. Aerobic capacity improved significantly more with aerobic training (3.35 ml/kg/min, 95% CI 1.79 to 4.91) and combined training (5.00 ml/kg/min, 95% CI 3.50 to 6.50) than with control. Only combined training significantly reduced systolic (−9 mmHg, 95% CI −13 to −4) and diastolic (−5 mmHg, 95% CI −6 to −3) blood pressure compared to control. Only aerobic training was superior to control for haemodialysis efficiency (Kt/V 0.11, 95% CI 0.02 to 0.20). However, when network meta-analysis was conducted, there were some important different findings. Both aerobic training and combined training again elicited greater improvements in aerobic capacity than control. For systolic blood pressure, combined training was superior to control. For diastolic blood pressure, combined training was superior to aerobic training and control. No modality was superior to control for haemodialysis efficiency. Combined training was ranked as the most effective treatment for aerobic capacity and arterial blood pressure. Conclusion: Combined training was the most effective modality to increase aerobic capacity and blood pressure control in people who require haemodialysis. This finding helps to fill the gap created by the lack of head-to-head comparisons of different modalities of exercise in people with end-stage renal disease. Registration: PROSPERO CRD42015020531. Key words: Chronic kidney failure, Renal dialysis, Exercise, Network meta-analysis, Physical therap

International Sanctions as a Primary Institution of International Society

This chapter explores international sanctions as a practice for states to collectively punish the violation of important international norms through the institutionalized authority of international organizations. More than instrumental foreign policy tools, sanction are ways for states to reaffirm core constitutive principles of international society, stigmatize transgressors and deter future norm violations. The chapter discusses the development of international sanctions since the Concert of Europe and traces how sanctioning as an international practice has shaped the institutions of great power management and war. In so doing, it shows how ‘secondary’ institutions, primarily in this case the United Nations, through institutionalized practices such as international sanctions, can change the understanding or shape the transformation of certain primary institutions