Search Results (133)

Background: Polyendocrine metabolic ovarian syndrome (PMOS/PCOS) is the most common hormonal disorder in women of reproductive age and is linked to infertility as well as long-term metabolic and psychological problems. In the Gulf Cooperation Council (GCC) region, rising obesity, dietary changes, and sedentary lifestyles may be increasing its burden. However, prevalence estimates remain highly inconsistent due to differences in diagnostic criteria and measurement methods rather than true variation in disease rates. Objective: This study aimed to describe the situation by systematically pooling available evidence on the prevalence of PMOS among women in GCC countries and by summarizing the range of clinical features reported across included studies. Methods: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. We searched five major bibliographic databases (PubMed, Scopus, Web of Science, Cochrane Library, and Embase) and the Google Scholar search engine for observational studies published up to 1 June 2026. Studies were eligible if they reported PMOS prevalence and related clinical features among women of reproductive age residing in GCC countries. After removing duplicates and screening 570 initially identified records, 25 studies met our inclusion criteria; 24 were included in the quantitative meta-analysis after excluding one high-risk study. Risk of bias was appraised using the Joanna Briggs Institute Checklist for Prevalence Studies. A random-effects meta-analysis using the DerSimonian-Laird method, combined with the Freeman-Tukey double arcsine transformation, was used to estimate the pooled prevalence. Heterogeneity was quantified using the I² statistic and Cochran’s Q test. Subgroup analyses explored differences by country, diagnostic method, study setting, and publication period. Meta-regression was used to identify study-level factors that explained between-study variability. Results: Across 24 studies involving 77,890 women, the pooled prevalence of PMOS was 17.59% (95% CI: 12.98–23.40%). Country-level estimates ranged from 6.56% in Oman to 23.0% in Saudi Arabia. Heterogeneity across all analyses was extremely high (I² = 99.6%), and meta-regression identified the diagnostic tool as the single most important source of variation, explaining 42.7% of between-study variance. Studies using structured clinical criteria (Rotterdam or NIH) yielded prevalence estimates around 13–14%, while those relying on self-report or physician diagnosis without standardized criteria reported considerably higher figures (20–37%). Common clinical features included menstrual irregularity (up to 100% of PMOS cases in clinical cohorts), hirsutism (5–100%), acne and oily skin (17–74%), and obesity (17–73%). Awareness of PMOS among women in the region was highly variable, ranging from under 3% to nearly 100%. Conclusions: PMOS is a significant public health concern across the GCC region. The markedly higher pooled prevalence combined with high rates of obesity and metabolic risk in this population calls for urgent, coordinated action. Standardizing diagnostic practices, investing in population-level screening, and developing culturally tailored awareness programs are essential steps toward reducing the clinical and social burden of PMOS. Full article

This bibliometric study examines the intellectual structure, evolution, and collaboration patterns of phytotherapy research within sports science to identify key themes and research gaps. Publications indexed in the Web of Science Core Collection from 1991 to 2024 were analyzed using a search strategy combining phytotherapy and sports medicine terms, yielding 3404 records, of which 368 met the inclusion criteria after systematic screening. Performance analysis assessed publication trends, citation impact, and author productivity, while science mapping techniques—including keyword co-occurrence, bibliographic coupling, and co-authorship network analysis—were conducted using Bibliometrix and VOSviewer. Thematic positioning was evaluated through Callon’s centrality-density framework. Results indicate steady growth in the field, with a CAGR of 11.83% and peak output in 2021, involving 2103 authors across 199 sources. International collaboration reached 22.55%, led by the United States, United Kingdom, and China. Dominant research themes include exercise, inflammation, oxidative stress, and phytochemicals such as curcumin and resveratrol. Thematic mapping highlights exercise performance and supplementation as central topics. Overall, the field demonstrates significant expansion, though increased international collaboration and clinical translation are needed. Full article

Methicillin-resistant Staphylococcus aureus (MRSA) remains a significant multidrug-resistant pathogen, frequently associated with persistent infections and biofilm formation, underscoring the urgent need for alternative antimicrobial strategies. Bioactive compounds derived from fungi have attracted considerable attention due to their structural diversity and demonstrated antibacterial activity against MRSA. This study employed a scientometric approach to assess global research trends, thematic evolution, and collaborative networks concerning fungi-derived anti-MRSA compounds. Bibliographic data were collected from the Scopus database, and a total of 1666 English-language articles and reviews published up to 2025 were analyzed using Bibliometrix/Biblioshiny and VOSviewer. The findings indicate a marked increase in research output after 2010, reflecting heightened scientific interest in fungal natural products for MRSA management. China and the United States emerged as leading contributors in terms of publication volume and international collaboration. Thematic analysis revealed a shift from broad antimicrobial screening to more specialized investigations, including antibiofilm activity, secondary metabolites, endophytic fungi, molecular docking, and antimicrobial resistance. Nonetheless, several challenges persist, such as insufficient mechanistic validation, limited toxicity and pharmacokinetic assessments, and a lack of clinically relevant in vivo studies. Overall, the field is increasingly multidisciplinary, integrating microbiology, natural product chemistry, and computational methodologies to advance the discovery of anti-MRSA agents. Full article

Bridge maintenance research has increasingly expanded toward Digital Twin (DT), Structural Health Monitoring (SHM), Artificial Intelligence (AI), sensing technologies, and object-based information management. As maintenance paradigms shift from reactive to preventive and prescriptive approaches, digital twins have gained attention as a means of integrating fragmented technological components. However, the growing emphasis on AI- and DT-based analytics raises questions about how object-based information structures, sensing systems, SHM, AI-based analytics, and interoperability mechanisms are thematically connected and structurally associated. This study conducted a scientometric analysis of publications retrieved from the Web of Science (WoS) database without year restrictions. To avoid predetermining the importance of any single information-modeling technology, the main search query excluded BIM-related terms and combined the bridge domain, DT-related technology layer, and maintenance domain. After applying document type, language, and research-area filters, 406 records were screened by title and abstract. Six records that were not directly related to bridge DT maintenance research were excluded, resulting in a final analytical corpus of 400 records. Among these, 77 records were identified as the BIM-related subset for sensitivity analysis. Using VOSviewer-based bibliographic coupling as the core method, supported by keyword co-occurrence, density and overlay visualization, and CiteSpace analysis, this study examined contemporary research structures and historical intellectual bases. The results show that bridge DT development is not detached from existing technological foundations but reflects the cumulative convergence of object-based information modeling, sensing, SHM, AI-based analytics, and interoperability mechanisms within integrated DT architectures. Full article

Background: Rural and remote health systems are diverse; while many of these settings face persistent workforce shortages and access gaps, not all are underserved. Nurses play a critical role in improving access, continuity, and quality of care in these contexts. However, evidence on their roles, the challenges they face, and the outcomes associated with their contributions remains fragmented. Objective: To map the roles, challenges, and reported outcomes of nurses working in rural and remote healthcare settings, and to examine the quality and scope of the available evidence. Design: This study employed JBI scoping review methodology and is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Methods: Eligible studies involved registered nurses (RNs) and nurse practitioners (NPs) providing care in rural or remote settings and reporting at least one outcome related to patients, services, or health systems. Six bibliographic databases (PubMed/MEDLINE, CINAHL, Embase, Scopus, Web of Science, Cochrane Library) plus Google Scholar for supplementary grey literature retrieval and targeted grey literature were searched (from 1 January 2000 to 30 September 2025). The lead author conducted screening and data extraction, supported by a 10% calibration pilot and structured peer debriefing. Design-specific critical appraisal was undertaken descriptively to inform interpretation but did not determine inclusion. Results: From 22 primary empirical studies (plus 2 contextual-only entries; 24 total, nurses’ roles clustered into direct clinical care, care coordination/navigation, telehealth facilitation, and health promotion. Reported outcomes were predominantly in access/utilization (e.g., time-to-care), quality and safety indicators, and patient-reported outcomes/experiences; clinical endpoints were less common. Conclusions: Nurses in rural and remote settings enact broad, adaptive roles that appear to support healthcare access and service continuity. The evidence base is predominantly descriptive, and causal claims about effectiveness cannot be drawn from the available studies. Standardized outcome frameworks, multi-reviewer methodologies, and effectiveness-focused primary research are needed to advance this field. Full article

Background: Heart failure (HF) has traditionally been interpreted through hemodynamic, neurohormonal, and cardiorenal frameworks. Although these models explain many aspects of clinical decompensation, they do not fully account for persistent tissue congestion, unresolved myocardial edema, chronic sterile inflammation, and progressive fibrosis despite optimized therapy. Objectives: To review the anatomy, physiology, and pathobiological relevance of the cardiac lymphatic system in HF and to evaluate whether cardiac lymphatic dysfunction constitutes a mechanistic bridge linking congestion, inflammation, and adverse remodeling. Methods: This narrative review was based on a structured literature search of PubMed/MEDLINE, supplemented by manual backward reference screening and bibliographic verification through journal webpages. The search covered January 2000 to 15 April 2026, with emphasis on 2018 onward and on seminal mechanistic studies. Search domains included cardiac lymphatics, heart failure, lymphangiogenesis, myocardial edema, congestion, inflammation, myocardial infarction, pressure overload, and HFpEF. Results: Cardiac lymphatics regulate myocardial clearance of interstitial fluid, proteins, cytokines, lipids, and immune cells. Preclinical experimental evidence, mainly derived from myocardial infarction, pressure-overload, and lymphatic-insufficiency models, indicates that impaired lymphatic transport or insufficient lymphangiogenic adaptation promotes myocardial edema, inflammatory persistence, fibroblast activation, collagen deposition, and ventricular dysfunction. Human observational and early translational studies suggest that lymphatic dysregulation may also be relevant in selected HF phenotypes, although direct clinical evidence remains limited. Conversely, lymphangiogenic and lymphatic-restorative strategies, especially through the VEGF-C/VEGFR-3 axis, reduce edema, enhance inflammatory resolution, attenuate fibrosis, and improve ventricular performance in preclinical models. Conclusions: Cardiac lymphatic dysfunction provides a compelling conceptual framework that links congestion and inflammation in HF. Rather than acting as a passive bystander, the cardiac lymphatic circulation appears to be an active determinant of myocardial homeostasis and disease progression. Recognition of lymphatic insufficiency as a pathogenic component of HF may open new diagnostic and therapeutic avenues, including tissue-focused decongestion, lymphatic phenotyping, and targeted lymphatic repair. Full article

This exploratory methodological study demonstrates an integrated workflow that combines systematic evidence collection Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA 2020), bibliometric mapping, and Transformer-based natural language processing (RoBERTa) to generate multi-layer insights from Circular Economy-related scholarship, using circular bioeconomy literature as a domain case (2017–2025). Searches across Scopus, ScienceDirect, Taylor & Francis, and SAGE retrieved 2643 records; after deduplication and screening, 50 studies were included (mean quality 13.2/16; 68% high quality). Bibliometric mapping (VOSviewer; Scopus subset n = 1468) revealed three thematic clusters that converge with five conceptual framings extracted via qualitative synthesis, providing cross-method validation of the pipeline’s structural and interpretive outputs. The NLP layer identified a predominantly positive discursive valence in the English-language title–abstract–keyword corpus derived from Scopus records, with declining polarity and increasing subjectivity over time. Because these estimates were obtained from composite bibliographic text fields rather than full-text discussion sections, they should be interpreted as indicators of narrative framing rather than as direct evidence of epistemic bias or empirical overstatement. Within that scope, the joint reading of polarity, subjectivity, hedging, and measurement gaps suggests a possible mismatch between acknowledged evaluative limitations and the caution used to communicate them. Full article

Purpose: This study presents an evidence gap map (EGM) of recent empirical survey-based research on decent work published between 2022 and 2025. The aim is to systematically visualize where empirical evidence has accumulated and to identify persistent knowledge gaps across key dimensions, populations, regions, outcomes, and methodological approaches, thereby informing future research agendas and evidence-informed policy development. Design/methodology/approach: A systematic mapping review was conducted following established guidance for evidence gap maps. Searches were performed in major bibliographic databases using a focused strategy to identify studies explicitly engaging with the decent work construct. Empirical quantitative studies based on survey methods were screened against predefined eligibility criteria. A total of 214 studies published between January 2022 and 2025 were included and coded using a structured framework covering decent work dimensions, population characteristics, geographic context, methodological design, and outcome variables. Evidence gap maps were constructed using matrix-based visualizations to display evidence density and gaps. Findings: Despite a substantial increase in publication volume since 2022, the evidence base remains unevenly distributed. Empirical research continues to concentrate on a limited subset of decent work dimensions and individual-level outcomes, while dimensions related to social dialogue and employment security receive comparatively little attention. Vulnerable worker populations—including persons with disabilities, domestic workers, and gig economy workers—remain critically underrepresented. Methodologically, cross-sectional designs predominate, with longitudinal and multilevel approaches still relatively scarce. Geographic coverage is similarly uneven, with research activity concentrated in a limited number of regions. Research limitations/implications: By systematically mapping recent empirical survey-based evidence, this study highlights persistent misalignments between theoretical ambitions, policy priorities, and empirical practice. The findings provide a structured basis for prioritizing future research and for aligning psychological research on decent work more closely with equity-oriented policy objectives. Originality/value: This study is the first evidence gap map focusing specifically on recent empirical survey-based research on decent work. By applying a rigorous EGM approach to post-2021 literature, it offers a structured overview of this segment of the evidence base and identifies priority areas where empirical knowledge remains limited. Full article

Given ongoing uncertainty about the benefits and harms of prostate-specific antigen (PSA) screening, this systematic review updates the evidence to inform guideline recommendations for adults aged ≥ 18 years in primary care. We searched multiple bibliographic databases from inception to 30 May 2022, with an update on 24 July 2024, for randomized controlled trials (RCTs) and comparative observational studies evaluating PSA-based screening with or without adjunctive technologies such as magnetic resonance imaging (MRI). Studies were selected in duplicate, with data extraction and quality assessment verified by a second reviewer; risk of bias and evidence certainty were assessed using study design-specific tools and GRADE. Four RCTs and one cohort study (17 articles) were included: ERSPC, PLCO and CAP compared PSA screening with no screening, while STHLM3-MRI evaluated a risk-based test combined with MRI targeted biopsy. Meta-analysis showed 0.96 fewer prostate cancer deaths per 1000 individuals invited to screen, corresponding to a 12% relative reduction over 9.5–22 years (RR 0.88, 95% CI 0.81–0.95). One trial estimated 2.3% to 10.3% overdiagnosis over 10–14 years. Overall certainty of evidence was low or very low. PSA screening may offer a small mortality benefit, but uncertainty and variable harms limit confidence, underscoring the need for high-quality evidence, particularly for MRI and risk-based screening strategies. Full article

The increasing global demand for sustainable water purification technologies has accelerated research on catalytic degradation and advanced oxidation processes for the removal of refractory pollutants. This study provides a comprehensive bibliometric analysis of global research trends in catalytic water and wastewater treatment from 2010 to 2025, combining quantitative mapping with a qualitative synthesis of emerging technological directions. Bibliographic data were retrieved from the Scopus database and screened using the PRISMA framework, followed by analysis using VOSviewer (v1.6.20) and OriginPro (version 2023, OriginLab Corporation, Northampton, MA, USA) to examine publication growth, citation patterns, international collaboration networks, and thematic evolution. A total of 1550 publications, including 1265 research articles and 285 review papers, were analyzed. The results show a significant increase in research output after 2015, reflecting growing global attention to water sustainability and environmental remediation. China, the United States, and India were identified as the leading contributors, with strong international collaboration networks. Keyword co-occurrence analysis revealed three dominant research themes: photocatalytic degradation and semiconductor engineering, Fenton and Fenton-like advanced oxidation processes, and emerging hybrid catalytic systems involving carbon-based materials and metal–organic frameworks. The analysis also indicates a recent shift toward multifunctional hybrid catalysts designed to improve efficiency, stability, and performance in complex wastewater systems. These findings highlight key scientific developments and suggest future research priorities, including green catalyst synthesis, reactor and process scale-up, AI-assisted catalyst design, and life-cycle sustainability assessment to support the transition from laboratory research to practical water treatment applications. Full article

Background/Objectives: Children and young people (CYP) with a learning disability are at higher risk of living with overweight and obesity and may consume fewer fruits and vegetables compared to the general paediatric population. They are more likely to experience eating and drinking difficulties, restrictive eating, and mealtime behavioural challenges. The school environment is considered an ideal setting to improve CYP’s dietary intakes. The primary objective was to identify existing interventions to support healthier food choices for CYP attending specialist schools. Secondary objectives considered intervention development, fidelity and outcomes. Methods: A scoping review and narrative synthesis. Eligible studies were identified from bibliographic databases (e.g., Medline, Embase, PsychInfo) and grey literature (e.g., Clinicaltrials.gov, the Cochrane Library). A two-stage screening process was used. Intervention components were mapped according to the TIDieR-PHP and AACTT frameworks. Results: Seven studies, reported in ten records, were included. Interventions included modifications to the dining environment, sensory exploration, health promotion and social reinforcement. Interventions were implemented across the school day: lunchtime (n = 2), breaktime (n = 3) and other times (n = 2). Studies mainly focused on adolescents. There was some mixed evidence of increased consumption of fruits and vegetables, whole grains and water. Due to small sample sizes and heterogeneity, definitive conclusions are limited. A key finding is the lack of interventions to improve CYP’s food choices in specialist schools. Conclusions: This review highlights a crucial need for the development of multi-component interventions co-produced with stakeholders to promote healthy food choices and improve the dietary intakes of CYP attending specialist schools. Full article

Generative AI systems increasingly mediate how students retrieve literature and generate citations, shifting methodological rigor toward the maintenance of an auditable evidence trail. This study audits the search stage of AI-assisted literature review work, focusing on retrieval performance and citation traceability rather than downstream screening or synthesis. Four widely accessible tools were compared across two retrieval postures, and Boolean queries were executed against Scopus and evaluated against a DOI-verified librarian baseline built from Scopus, Web of Science, and Google Scholar. Using a canonical prompt and a bounded top-k capture rule (k = 20), each bibliographic record was evaluated for DOI traceability, DOI resolution integrity, metadata accuracy, and run-to-run drift. Records were screened through staged title/abstract and full-text eligibility review, and the final set included 37 studies after quality appraisal was 37 studies. Across sixteen audit runs, natural-language prompting frequently produced under-target yields, recurrent integrity failures, and low overlap with the librarian benchmark. Boolean translation improved run completion and increased the proportion of auditable records, but reproducibility remained unstable across repeated runs. These findings show that correctness at the record level does not ensure stability at the evidence-set level. Limitations include the bounded tool set, the search-stage focus, and the absence of downstream screening or synthesis evaluation. Retrieval posture, therefore, emerges as a practical governance lever for AI-assisted literature review workflows and supports the use of a student-facing verification checklist anchored in DOI verification and transparent protocol capture. This research received no external funding. OSF registration: Open Science Framework, 10.17605/OSF.IO/U8NHT. The manuscript reports the final included set as n = 37, states no external funding, and lists the OSF registration DOI. Full article

Background/Objectives: Breast cancer awareness is essential for early detection and timely help-seeking among women and represents a key component of multidisciplinary breast cancer prevention. The Breast Cancer Awareness Measure (Breast-CAM) is widely used to assess awareness of breast cancer symptoms, risk factors, and screening behaviors. Its measurement quality across populations has not yet been comprehensively evaluated. As Breast-CAM is a population-reported measurement instrument, evaluation using a standardized framework for measurement properties is required. This systematic review and meta-analysis aimed to assess the psychometric properties of the Breast-CAM across diverse populations and cultural adaptations, in accordance with COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) methodological standards. Methods: Major bibliographic databases and trial registries were systematically searched for peer-reviewed English-language studies published between 2010 and 2025 that evaluated at least one psychometric property of the Breast-CAM in adult women. Methodological quality was assessed using the COSMIN Risk of Bias checklist. Measurement properties were evaluated according to COSMIN criteria, and the certainty of evidence was graded using a modified GRADE approach. Meta-analysis was performed when data were sufficiently comparable. Results: Seventeen studies met the inclusion criteria for narrative synthesis, of which eleven were included in a meta-analysis, representing fourteen cultural adaptations of the instrument. A descriptive random-effects meta-analysis of reported Cronbach’s α yielded a pooled estimate of 0.89 (95% confidence interval 0.85–0.92). This value should be interpreted cautiously, as structural validity was frequently insufficient across cultural adaptations, limiting interpretation of internal consistency according to COSMIN guidance. Other measurement properties, including reliability and measurement error, were frequently inadequately assessed or unreported. The certainty of evidence ranged from very low to moderate. Conclusions: Content validity was generally rated as sufficient, although certainty of evidence was low. Despite the high pooled α estimate, the reliability of Breast-CAM cannot be firmly established because structural validity was frequently insufficient across cultural adaptations. In accordance with the COSMIN ceiling rule, internal consistency was not considered sufficient in the absence of adequate structural validity. Key measurement properties, including test–retest reliability, measurement error, and responsiveness, were rarely evaluated. Further high-quality psychometric studies, particularly in culturally diverse populations, are needed to address these gaps and support appropriate use of the instrument in research and public health practice. Full article

Unintentional doping, often caused by contaminated supplements or misinterpreted therapeutic prescriptions, poses significant health, ethical, and regulatory challenges in competitive sports. Understanding the cardiovascular risks associated with performance-enhancing substances (PESs) and the preventive role of nutrition requires integrated analysis. A systematic review was conducted in accordance with PRISMA guidelines. Searches of comprehensive bibliographic databases yielded studies published between 2015 and November 2025. Inclusion criteria encompassed peer-reviewed research on doping prevalence, cardiovascular outcomes, nutritional strategies, and supplement regulation. Data extraction focused on prevalence estimates, odds ratios (ORs), hazard ratios (HRs), and effect sizes for nutritional interventions. Quality assessment employed GRADE and risk-of-bias tools. From 1320 records screened, 60 studies were included in the qualitative synthesis and 31 in the meta-analysis. Surveys using indirect questioning estimated that 30–45% of elite athletes may engage in doping, while official anti-doping reports indicated that approximately 20–25% of confirmed rule violations are classified as unintentional. Supplement contamination accounted for 10–15% of unintentional cases. PES use significantly increased cardiovascular risk (HR for arrhythmias and myocardial infarction up to 3.5). Nutritional strategies—such as carbohydrate loading, optimized protein intake, omega-3 supplementation, and hydration—improved endurance by 8–12%, reduced resting heart rate by ~3 bpm, and lowered LDL cholesterol. Unintentional doping remains a major contributor to ADRVs, primarily driven by supplement contamination. Evidence-based nutrition offers safe alternatives to PESs (evidence-based nutritional strategies and structured hydration protocols), enhancing performance and cardiovascular health. Forensic toxicology and pharmacogenomic screening are essential for accurate detection and interpretation. Regulatory reforms, mandatory third-party supplement certification, and athlete education are critical to mitigate unintentional doping and ensure fair competition. Full article

Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) are high-burden healthcare-associated pathogens that increase mortality, prolong hospitalisation, and drive substantial healthcare costs worldwide. These infections are associated with high morbidity, increased mortality, prolonged hospital stays, and significant costs, particularly among immunocompromised patients or those with extended hospitalizations. This systematic review was conducted and reported in accordance with PRISMA 2020, aiming to synthesise existing data on the epidemiology, resistance mechanisms, clinical manifestations, and strategies for the diagnosis, treatment, and prevention of MRSA and VRE infections. Data were qualitatively synthesised. A total of 113 records published between 2020 and 2025 met the inclusion criteria and were identified through searches in multiple bibliographic databases and publisher platforms (e.g., PubMed, Scopus, Web of Science). MRSA and VRE are implicated in numerous severe infections, including ventilator-associated pneumonia, catheter-associated urinary tract infections, endocarditis, and bacteraemia. Antimicrobial resistance is driven by the mecA, vanA, and vanB genes, while biofilm formation further complicates therapeutic efforts. Biofilm formation can promote antibiotic tolerance (slower killing without an increase in MIC) and persistence (survival of ‘persister’ cells), distinct from genetic resistance, and may complicate therapy in selected infections. Effective strategies include appropriate anti-MRSA/anti-VRE agents (e.g., ceftaroline for MRSA; linezolid or daptomycin for VRE), active screening, stringent infection prevention and control measures, and antimicrobial stewardship programmes. Implementation is often hindered by institutional barriers, limited resources, and insufficient staff training. A multidisciplinary, evidence-based approach is essential for the effective management of these infections. Reducing this burden requires coordinated implementation of rapid diagnostics, stringent infection prevention and control, and antimicrobial stewardship, supported by sustained institutional and public health investment. Full article