Neglected Tropical Diseases (NTDs) impact over one billion people worldwide and affect poor and marginalized communities the most. Infectious diseases, including bacteria, viruses, fungi, parasites, and toxins, lead to extreme health complications like blindness, developmental problems, and chronic disabilities. Because of this heavy burden, NTDs get less attention and resources, thus worsening the already challenging economic and healthcare scenarios in these regions.

The World Health Organization has classified 21 different conditions as NTDs. These diseases mainly thrive in tropical and subtropical climates and are linked to poor sanitation, lack of clean water, and inadequate healthcare infrastructure. Unlike other infectious diseases, NTDs have been largely ignored by the pharmaceutical industry due to their concentration in low-income populations, making treatment and prevention efforts even more challenging.

Although progress has been achieved in controlling some NTDs through global health initiatives, for instance dengue, much more is needed to eradicate them completely. This requires collaboration among governments, healthcare organizations, and the pharmaceutical industry to develop low-cost treatments, expand vaccination programs, and improve sanitation in high-risk areas.

Common Types of Neglected Tropical Diseases

NTDs range from mild to severe, and permanent disability or even death can occur, according to the NIH. The most common of these are the following:

Ascariasis

This NTD is caused by the roundworm Ascaris lumbricoides. This infection is found mainly in places where sanitation is very poor. Though most people have no symptoms at all, more serious cases cause extreme pain in the abdominal region, vomiting, and sometimes even death.

Buruli Ulcer

Caused by a bacterium, Mycobacterium ulcerans, Buruli ulcer results in painful ulcers on the skin, which if not treated can extend into the bones, leading to permanent disability.

Chagas' Disease (American Trypanosomiasis)

Distributed through blood-feeding "assassin bugs," this parasitic disease may lead to swollen lymph nodes and even fatal damage to the organs if not treated.

Dengue Fever

A mosquito-borne viral infection, dengue fever causes high fever, joint pain, and in severe cases, hemorrhagic fever leading to shock and death.

Leprosy (Hansen's Disease)

Caused by Mycobacteria, Leprosy results in nerve damage with severe disfiguring effects of the condition that leaves individuals greatly stigmatized.

Lymphatic Filariasis (Elephantiasis)

Spread by mosquitoes, this parasitic disease results in painful swelling of the limbs and genitals with increasingly severe disabilities, leading to gross disfigurement.

Onchocerciasis (River Blindness)

This parasitic disease, which is transmitted by black flies, causes severe itching, skin lesions, and permanent blindness.

How Do NTDs Affect Health?

According to Dr. Vivek MS, MBBS MD Microbiology, "NTDs disproportionately affect the world's poorest communities, leading to chronic illness, disability, and social stigma. Despite their devastating impact, these diseases do not receive adequate attention compared to other global health issues."

NTDs contribute to a cycle of poverty by impairing children's development, reducing adult productivity, and burdening healthcare systems. Conditions such as malnutrition, poor education, and limited access to medical care further exacerbate their impact, making it difficult for affected populations to escape poverty.

Preventive Measures To Adopt

Hygiene and Sanitation

Dr. Vivek MS says, "Improving hygiene and sanitation is one of the most effective ways to prevent NTDs. Access to clean water and proper sanitation facilities can significantly reduce the transmission of diseases like cholera, trachoma, and soil-transmitted helminths."

Vaccination

Vaccination is a critical tool in preventing diseases such as dengue and yellow fever. Large-scale immunization programs help protect vulnerable populations and reduce the spread of infection.

Awareness

Community education plays an important role in controlling NTDs. "Information on causative agents, symptoms and prevention of NTDs promotes behavioral changes in improved health practice, and early intervention," said Dr. Vivek MS.

Healthcare Systems Strengthening

Access to healthcare should be scaled up and expanded to the regions affected. Investments in local healthcare infrastructure, staff capacity building, and reasonably priced medicines can greatly reduce the burden of NTDs.

Dr Vivek MS is a MBBS MD with specialisation in Microbiology at Apollo Spectra Hospitals, Bangalore in India

Returning to shared spaces—like schools or offices—also means returning to public restrooms. For some individuals, this transition comes with more than just minor discomfort. The anxiety around using public toilets, especially for defecation or urination, can be so intense that it interferes with daily functioning. This condition is medically recognized as parcopresis (shy bowel syndrome) and, in some cases, paruresis (shy bladder syndrome).

What Is Shy Bowel and Shy Bladder Syndrome?

Parcopresis refers to the difficulty or inability to defecate in the presence of others, especially in public restrooms. Similarly, paruresis describes the difficulty in urinating under similar circumstances. These conditions are not simply a preference for privacy—they are marked by psychological and physiological barriers that inhibit normal bodily functions.

Individuals with parcopresis often find themselves unable to initiate or complete a bowel movement unless they are in a perceived safe, private, and predictable environment, typically at home. The same applies to paruresis, where individuals may only be able to urinate in the comfort of familiar surroundings.

In public or semi-public restrooms, anxiety can trigger the sympathetic nervous system—the body’s fight-or-flight response—which disrupts the relaxation of pelvic muscles required for urination or defecation. As a result, individuals may freeze mid-process, feel pressured to rush, or avoid the restroom altogether, leading to discomfort or medical complications such as constipation or urinary retention.

The Psychological Link

Both shy bladder and shy bowel syndromes are linked to social anxiety disorder. The fear is not necessarily of the act itself but of being heard, judged, or perceived negatively by others. This can create a feedback loop: the more one worries about not being able to go, the harder it becomes.

Over time, this anxiety can escalate to significant social avoidance. People may plan their day around access to private restrooms, avoid travel, limit hydration or food intake, and even decline job opportunities or social engagements. In severe cases, this avoidance behavior can lead to agoraphobia—a fear of being in places where escape might be difficult.

Possible Contributing Factors

While psychological in nature, these syndromes may be more pronounced in individuals with pre-existing physical conditions. For instance, inflammatory bowel disease, irritable bowel syndrome, urinary tract infections, or prostate conditions can exacerbate restroom-related anxiety due to urgency or frequency, increasing the likelihood of distress in public settings.

Management and Treatment

Despite the challenges, both conditions are treatable. The first step is a medical evaluation to rule out or address any underlying physical health issues. Once physical causes are excluded or managed, psychological approaches become central to treatment.

Cognitive-behavioral therapy (CBT) is considered the gold standard. It helps individuals identify and challenge negative thought patterns and gradually exposes them to anxiety-inducing situations—a process known as exposure therapy. In this case, it may involve slowly increasing comfort with public restroom use.

Relaxation techniques, including deep breathing and mindfulness, can help regulate physiological responses to anxiety. In some cases, short-term use of anti-anxiety medications may be recommended to support behavioral therapy.

With the right interventions and support, individuals affected by shy bladder or bowel syndromes can regain confidence and return to normal daily functioning—including using public restrooms without distress.

In a controversial move with far-reaching health consequences, the U.S. House passed the Trump administration’s sweeping domestic agenda legislation—dubbed the “Big Beautiful Bill”—just before the July 4 deadline set by the president.

While its proponents claim it will make the country “stronger, safer and more prosperous,” leading health experts warn the bill is a dangerous and unethical setback for public health in the U.S.

With major cuts to Medicaid, significant changes to the Affordable Care Act (ACA), and reduced access to basic nutrition and reproductive services, the legislation’s health implications are vast and immediate.

What’s at Stake

At the heart of the bill is a $930 billion cut to Medicaid funding over the next decade—the deepest reduction to the program in its history.

In addition, for the first time, work requirements will be imposed on certain able-bodied adults aged 19 to 64 to retain their Medicaid benefits. Parents of children aged 14 and older must also meet this 80-hours-per-month rule through employment, training, volunteering, or school.

Dr. Jason M. Goldman, president of the American College of Physicians (ACP), as reported in healio.com, called the cuts “devastating” and warned they would cripple the U.S. health care system and worsen public health outcomes.

Similar concerns were echoed by the American Medical Association (AMA), the American College of Obstetricians and Gynecologists, and the Emergency Nurses Association, all of whom opposed the bill.

Dr. Arthur L. Caplan, founding head of the Division of Medical Ethics at NYU Grossman School of Medicine, called the bill “immoral, unethical, and tragic,” also reported in healio.com.

“Slashing Medicaid and imposing work requirements is punishing our poorest, most vulnerable, and mentally ill populations,” Dr. Caplan said.

“It’s unconscionable that the solution to economic reform is to cut basic health care.”

No Access To Affordable Care Act

The bill also weakens the Affordable Care Act (ACA), which could lower enrollment rates and disrupt access to care. One of the major changes is the elimination of automatic re-enrollment in ACA plans. Policyholders must now update their information annually, and the open enrollment window has been shortened by a month.

For individuals applying outside the open enrollment period—due to life events like job loss or family additions—advance premium subsidies will no longer be available immediately. Under current rules, applicants get up to 90 days of help while their paperwork is processed. The new law forces applicants to wait for full documentation approval before receiving assistance.

According to the Congressional Budget Office (CBO), the result will be catastrophic: an estimated 11.8 million more uninsured Americans by 2034.

“These patients don’t disappear,” Dr. Caplan said. “They flood emergency rooms with preventable issues—headaches, infections, chest pain—overburdening a system already stretched thin.”

Emergency Rooms on the Brink

With millions projected to lose insurance, ERs may become the default safety net—a role they are not equipped to handle.

“Hospitals will close. Services will shrink. Waiting times will skyrocket,” Dr. Caplan warned. “And it won’t just affect the poor—it will affect everyone.”

He also criticized the bill for ignoring the root cause of health care costs in the U.S.

“We have the most expensive, inefficient system in the world. Yet instead of tackling pricing, this bill cuts access,” he said.

SNAP Benefits, Nutrition & Health Impact

The bill also drastically alters the Supplemental Nutrition Assistance Program (SNAP), affecting roughly 42 million Americans. The age for work requirements has been raised from 54 to 64, and overall benefits will be reduced.

Many families will now receive less support—$292 for an individual and $975 for a family of four.

Nutrition is a cornerstone of preventive health, and public health experts say this rollback will contribute to higher rates of malnutrition, particularly among older adults and low-income families.

Reproductive Health and Planned Parenthood Defunded

In another blow to health access, the bill defunds Planned Parenthood, making it ineligible to serve Medicaid patients. According to the Contraceptive Access Initiative, 10% of Medicaid-covered women who received family planning services in 2021 did so through Planned Parenthood.

The move will severely limit access to contraception, STD testing, cancer screenings, and reproductive counseling, particularly in underserved areas.

Physician Payments, Rural Hospitals, and more

To soften the backlash, the bill includes a 2.5% temporary increase to Medicare Physician Fee Schedule rates in 2026, and reinstates certain telehealth flexibilities, as noted by the American Telemedicine Association.

However, experts like Dr. Caplan argue that these are inadequate responses to a much deeper crisis.

“That’s like saying the ship is sinking, but we’ve added two lifeboats,” he said. “Increased reimbursement won’t matter if your patient population loses coverage.”

A new UK-based study published in ERJ Open Research, has found that women who work permanent night shifts face a significantly higher risk of developing moderate to severe asthma compared to those who work during the day.

The findings add to the growing body of evidence that shift work, particularly night shifts, can have adverse effects on health—this time, with a gender-specific warning.

How Was The Study Conducted?

The study, conducted by researchers using data from over 280,000 participants in the UK Biobank, observed that 5.3% of the cohort had asthma, and 1.9% had moderate to severe asthma. Among these, female night shift workers stood out: those who worked permanent night shifts were found to have 50% higher odds of developing moderate-severe asthma than female day workers.

Interestingly, this association was not observed among male shift workers.

Circadian Disruption and Lung Health

Dr. Sunil Kumar K, Lead Consultant - Interventional Pulmonology at Aster CMI Hospital, Bangalore, explained how circadian rhythm disruption could increase respiratory risk.

“When our body’s natural rhythm is thrown off by night shifts or irregular sleep, it impacts not just our sleep cycles but also lung function,” he explained.

“The lungs don’t get the recovery time they need. Over time, this can impair breathing, reduce oxygen levels, weaken immunity, and elevate the risk of serious respiratory issues—especially in those already predisposed to asthma or COPD.”

The Hormonal Link

The researchers also suggested that hormone levels—specifically testosterone and sex hormone-binding globulin (SHBG)—may play a protective role against asthma. Women, especially post-puberty, tend to have lower levels of these hormones, possibly explaining their greater vulnerability.

Dr. Sunil noted that recent studies have reinforced the protective role of testosterone in reducing airway inflammation, which is a key concern in asthma management. “This could explain why asthma tends to be more severe in women after puberty,” he said. While hormone testing is not standard in asthma diagnosis yet, he believes that advancing research may soon shift clinical protocols.

Gender-Specific Vulnerability

The study further found that women who had undergone hysterectomies—with or without oophorectomies—also faced a higher risk of moderate to severe asthma, suggesting that hormonal changes could further exacerbate vulnerability.

“Female biology is more sensitive to circadian disruption,” Dr. Sunil pointed out. “Estrogen may worsen airway inflammation when sleep cycles are disturbed, while testosterone seems to offer some protection—something men naturally benefit from.”

He added that these findings should encourage workplaces to consider flexible schedules or regular lung health screenings for female night shift workers.

Underdiagnosed, Underdiscussed

Women working night shifts also reported more frequent symptoms such as wheezing or chest whistling and had greater odds of obstructed lung function compared to their male counterparts.

“In practice, we often see female patients with wheezing and breathlessness, but the link to lifestyle factors like night shifts is rarely discussed,” Dr. Sunil said. “These patterns are crucial for early diagnosis and management but remain under-addressed.”

Could HRT Be a Solution?

Given the hormone connection, researchers suggested that hormone replacement therapy (HRT) might be explored as a preventive measure for postmenopausal women doing night shifts.

“HRT could help balance hormone levels, protect lung function, and reduce inflammation,” Dr. Sunil said. “But it must be approached cautiously, given known risks like blood clots or heart disease. Tailored care strategies and careful risk assessment are key.”