To determine the effectiveness of topical vancomycin in reducing the incidence of sternal wound infections (SWI) in patients undergoing coronary artery bypass graft (CABG) surgery.

Pakistan's rapid population growth has a significant impact on its capacity to address climate change. The migration of individuals to urban areas in search of better amenities leads to the expansion of urbanization and a rise in human-induced activities, leading to the formation of urban heat islands and warmer climatic conditions.1,2 This urban development further intensifies the trend of rising temperatures in key cities such as Karachi, Lahore, Islamabad, Peshawar, and Quetta, disturbing the usual climate patterns. Moreover, the demographic dividend, if not effectively utilized, can contribute to environmental deterioration and climate change challenges, thus impeding the achievement of sustainable development objectives. The substantial growth in population strains available resources, escalates emissions, and poses obstacles to the implementation of measures for climate resilience, underscoring the critical necessity of strategic policies to tackle these interconnected issues3. The increase in the population of Pakistan has noteworthy environmental implications on agriculture and food security. Challenges faced by the agricultural sector of the nation include erratic weather patterns, substandard crop yield, and degradation of soil fertility.4 The impact of climate change further complicates these challenges, as elevated temperatures and diminished water availability negatively influence crop output and water efficiency.5 Moreover, insufficient investments, unequal land allocation, and limited water resources impede consistent agricultural development, thereby affecting food security. Projections for the future indicate a necessity for a 40% enhancement in food production by 2025 to fulfill the demands of the growing population, underscoring the critical need for sustainable agricultural methodologies and adaptive measures to alleviate the detrimental consequences of population growth on agriculture and food security in Pakistan.6 Addressing Pakistan's population growth requires a multifaceted approach that encompasses education, healthcare, women's empowerment, and access to family planning services. Education, especially for girls, plays a pivotal role in empowering individuals to make informed choices about family size and reproductive health. By investing in education and promoting gender equality, Pakistan can empower women to participate more fully in the workforce, delay marriage, and make decisions regarding family planning, leading to lower fertility rates and improved maternal and child health outcomes.7,8 Furthermore, access to affordable and high-quality healthcare services, including family planning and reproductive health services, is essential for enabling individuals to plan their families according to their desired family size. Pakistan must prioritize the expansion of healthcare infrastructure, training of healthcare professionals, and dissemination of accurate information about contraception and family planning methods to ensure universal access to reproductive healthcare services.9,10 Pakistan, due to the significant impact of climate change, is confronted with various challenges such as extreme weather events, water scarcity, and food insecurity. It is imperative to prioritize investments in climate-smart infrastructure, sustainable agriculture, and disaster preparedness to bolster climate resilience. The implementation of sustainable strategies such as crop diversification and agroforestry play a vital role in enhancing resilience, ensuring food security, and mitigating greenhouse gas emissions. Given that the agricultural sector serves as a major source of employment, it is crucial for it to embrace climate-resilient practices to effectively adapt to shifting climates and mitigate environmental degradation. Additionally, the allocation of resources towards renewable energy sources like solar and wind power can diminish dependence on fossil fuels, decrease emissions, generate employment opportunities, stimulate economic development, and improve energy accessibility in remote regions.11,12 However, addressing Pakistan's population growth and climate change requires concerted efforts and collaboration among government agencies, civil society organizations, the private sector, and the international community. It demands political will, commitment to sustainable development goals, and long-term planning to achieve meaningful results. By investing in education, healthcare, women's empowerment, sustainable development, and climate resilience, Pakistan can chart a sustainable path forward those balances population dynamics with environmental sustainability. The time to act is now, and Pakistan must seize the opportunity to build a more resilient and prosperous future for its people and the planet.

Expanding access to modern contraceptives, particularly long-acting reversible contraceptives (LARCs), is crucial for reducing unmet need, unintended pregn

Background/Objectives: School-based nutrition education provides a platform that could help in the promotion of healthy eating habits among adolescents. Nonetheless, information about the factors influencing the success of these interventions in low- and middle- income countries is still lacking. The objective of the study was to identify facilitators and barriers to effective implementation of school-based nutrition education by applying the Consolidated Framework for Implementation Research (CFIR) and interpreting findings across levels of the Social Ecological Model (SEM). Methods: A qualitative study was conducted after eight to ten weeks of nutrition education intervention in an urban school setting. Data were collected through two focus group discussions with sixteen students (eight students in each group), in-depth interviews with four teachers, six parents and key informant interviews with two school administrators. A semi-structured, CFIR- and SEM-based guide was used to conduct the data collection. Thematic analysis was conducted following Braun and Clarke’s six-phase approach, with deductive and inductive coding conducted independently by two researchers and reconciled through consensus. Results: Five themes were aligned with CFIR domains, including intervention characteristics, outer setting, inner setting, character of individuals, and implementation process. In general, the stakeholders agreed to the importance of relevance and contextualization of the intervention and the use of multi-mediums (classroom-based and online) to deliver the intervention, which they perceived to support improved knowledge of nutrition among adolescents. Implementation of the programme faced challenges arising from the incongruence between messages delivered in classrooms and those served in the school canteens, economic hurdles from home, cultural practices related to food consumption, social influence on peers and media, lack of time among staff, and largely passive parent participation. Conclusions: Nutrition education was perceived as inadequate on its own to support sustainable behaviour related dietary change. Factors that may influence whether nutrition messages can be translated into practice were identified by the study participants and include the school food environment (canteen), the development of the curriculum, policy integration, and shift in parental participation from passive learning to active collaboration.

Suicidal ideation and attempts among adolescents constitute a significant public health challenge globally, with varying prevalence rates influenced by soc

Urbanization with increasing proportion of the population living in cities limits access to nature and increases exposure to environmental hazards, such as air and noise pollution. Green spaces offer solutions by increasing the quality of urban settings, promoting sustainable lifestyles, and improving both the health and the well-being of urban residents. Aim of the study was to assess perceived advantages and disadvantages of urban green spaces (UGS). A cross sectional study, was conducted on the 200 residents of Mirpur district of Azad Jammu and Kashmir Pakistan. There were 54.5% of males and 44.5% of females in the study sample and 79% (n=79) of them were of age between 31-40 years. 164 (82%) individuals in the collected sample fall into high educational level. For positive attributes of urban green spaces most visitors reported strongly agree response. The highest strongly agree response (62%) is for importance of parks. Promotion of elders’ and physical health also showed strongly agreed responses of 60% and 58% respectively. The agreed response was the highest for ‘neighbors’ meetup’ (43.5%) and for the rest it was mental health (40%), people likeness (37%) and property value (38.5%). Commercial encroachment was the highest strongly agreed response (30.5%) and time wastage was the highest strongly disagreed response (21.5%). Visitors reported strongly agree response to scenic beauty (67.5%), air quality (49%) and reduce heat wave (40.5%). Agreed responses were topped by environmental conditions (37%) followed by almost equal responses for rainfall source (25.5%), biodiversity and noise pollution (23%). Fast and unplanned urbanization is threatening UGS. Our study highlighted visitors’ perception about UGS which would help in their development and improved quality.