Search Results (764)

Background: Adolescents and young adults in Jordan experience high levels of psychological distress amid persistent stigma, limited mental health literacy, and shortages of specialist services. Although task-shared interventions have expanded access, their dependence on in-person delivery and sustained human resources constrains scalability. Guided digital interventions may extend reach, but evidence regarding their system integration and sustainability in low- and middle-income countries remains limited. Purpose: This study explored how the WHO-developed Scalable Technology for Adolescents and youth to Reduce Stress (STARS), a non-generative, rule-based chatbot intervention supported by trained e-helpers, was experienced and implemented in Jordan. It also examined the system-level tensions shaping its potential for sustainable scale-up. Methods: We conducted a qualitative multiple-case study nested within a randomized controlled trial of STARS in Jordan. Semi-structured interviews were conducted with 21 individuals, including STARS completers and non-completers, trained non-specialist e-helpers, a clinical supervisor, and policy and implementation stakeholders. Data were analyzed using a hybrid approach combining inductive thematic analysis with deductive coding informed by a system-innovation perspective and the culture–structure–practice framework. Results: Participants described STARS as culturally resonant, accessible, and adaptable to everyday life. Four recurring system-level tensions emerged: individualized support versus standardized protocols; privacy and anonymity versus institutional and parental trust; non-specialist support versus expectations for professionally qualified providers; and innovation within research settings versus integration into routine service systems. These tensions reflected competing priorities shaping implementation and perceptions of sustainable scale-up. Conclusions: STARS shows promise as a scalable guided digital mental health intervention for young people in Jordan. However, scale-up will require navigating recurring tensions across cultural, structural, and practice domains rather than addressing implementation barriers in isolation. This will require policy alignment, sustained investment in digital infrastructure and supervision, and cross-sector collaboration. Full article

Adolescent mental health is a high priority in low- and middle-income countries (LMICs), yet perspectives may differ among youth and adult providers responsible for supporting mental health within schools. These differences may create challenges for designing contextually appropriate school-based preventive strategies. This qualitative study compared adolescent and school guidance and counseling coordinator (GCC) perspectives on factors influencing adolescent mental health and support in all 12 public senior high schools in Tamale, Ghana. GCC data were collected through semi-structured interviews informed by the Consolidated Framework for Implementation Research, and adolescent data was through human-centered design workshops. Data were analyzed using rapid qualitative analysis and organized using the Social Ecological Model. At the individual level, adolescents linked emotional distress, stress, and substance use to mental health challenges, whereas GCCs more commonly framed these as behavioral or academic challenges. At the interpersonal level, both groups identified peer relationships and confidentiality as important influences on help-seeking; adolescents emphasized trusted peer relationships, while GCCs described challenges implementing peer counseling approaches within schools. At the organizational level, adolescents emphasized teacher attitudes and punitive school responses to student distress, while GCCs emphasized staffing shortages, limited infrastructure, and insufficient institutional support. At the community level, both groups identified stigma and gendered social norms as barriers to mental health support. Adolescents and GCCs identified similar concerns but differed in how they understood adolescent mental health and support within schools. Integrating both youth and provider perspectives may strengthen multilevel school-based preventive strategies in resource-constrained settings. Full article

Packaging plays an important role not only in protecting food and extending shelf life but also in shaping affordability, portability, storage, and the risk of spoilage at the household level. This study examines how flexible plastic and alternative packaging formats differ in retail price and how low-income U.S. households report they would respond to packaging-related changes that could affect food access and food waste. Two complementary approaches were used. First, an online and in-store retail audit compared 57 matched food products sold in flexible plastic and alternative packaging formats. Alternative format products were more expensive on average when prices were normalized by product weight, although the magnitude of the difference varied substantially across products. Second, a survey of 473 U.S. adults with annual household incomes below USD 40,000 examined responses to hypothetical changes in food price, carrying difficulty, storage fit, and spoilage. Ordered logit models showed that food-insecure households reported greater sensitivity to price increases, households facing transportation burdens reported greater difficulty with harder-to-carry packaging, and households with storage constraints reported greater difficulty with packaging that was harder to store. Shopping frequency was the strongest predictor of responses to faster spoilage. Together, the findings indicate that changes in packaging format may create different challenges across households depending on their financial, transportation, storage, and shopping constraints. Because the survey captures reported responses to hypothetical scenarios rather than observed purchasing or food waste behavior, the findings should be interpreted as evidence of household vulnerability to packaging-related changes rather than direct causal effects of packaging transitions or policy. Full article

Background: Hypertension is a major contributor to cardiovascular morbidity and mortality globally, with particularly poor control in disadvantaged communities. Although awareness is generally high, sustaining lifestyle changes and treatment adherence remains difficult. This study examined socioeconomic, behavioural, and health system factors associated with hypertension management and explored the role of community-engaged health education in strengthening primary health care. Methods: A cross-sectional descriptive study was conducted among 107 adults with hypertension attending public primary health care facilities. Data were collected using structured questionnaires covering socioeconomic status, health system access, medication adherence, lifestyle practices, and knowledge and attitudes. Descriptive statistics summarized participant characteristics, while chi-square tests and multivariable logistic regression identified factors associated with clinic attendance, dietary adherence, lifestyle practices, and self-management. Results: Awareness of hypertension (86.9%) and trust in clinic care (91.6%) were high; however, a clear knowledge practice gap was evident. Although 79.4% acknowledged the importance of lifestyle changes, only 45.8% followed a hypertension-specific diet. Structural barriers included low income (39.3% earning <R3 000/month) and long distances to clinics (46.7% living ≥5 km away). Health worker advice strongly predicted dietary adherence (OR = 6.36, p = 0.001), lifestyle adherence (OR = 4.24, p = 0.006), and overall self-management (OR = 12.46, p = 0.024), whereas knowledge alone did not. Conclusions: Hypertension management is constrained more by structural and health system factors than by lack of awareness. Strengthening primary health care counselling and community-based health education may improve sustained lifestyle change and outcomes. Full article

South Korea faces an imminent spent nuclear fuel (SNF) storage bottleneck that threatens reactor operations and the country’s low-carbon transition. Using data from a nationwide, stratified face-to-face survey conducted in late 2024, this study examines public acceptance of an interim SNF storage facility (ISF) in South Korea. The survey included 1000 adults aged 20–65. Public acceptance was measured using a 1–9 support scale. We investigate its associations with respondents’ socioeconomic, regional, and attitudinal characteristics using ordered probit and ordinary least squares specifications. Opposition (47.4%) exceeds support (35.4%). In the preferred baseline ordered probit model, acceptance is positively associated with residence in the Seoul Metropolitan Area, self-reported familiarity with SNF management, stated tariff-cost-sharing orientation, age, education, income, and household headship, and negatively associated with province-level residence in an area containing one or more NPPs and with life satisfaction. Partial ordinal models indicate that the statistical significance of Education, Income, and Satisfaction is not robust across specifications. This study is grounded in the broader literature on procedural fairness, information asymmetry, and distributive equity. Within this framework, the observed associations inform a set of policy considerations. These considerations span transparent risk communication, tariff-linked cost sharing, independent monitoring, and community-benefit arrangements. This nationally representative evidence informs sustainable SNF governance and practical regulatory design for maintaining electricity reliability during the energy transition. Full article

Background and Objectives: Despite long-standing MMR vaccination programmes, outbreaks of vaccine-preventable diseases continue to occur worldwide, raising concerns regarding waning immunity and susceptibility gaps in adult populations. Between 2017 and 2019 alone, WHO reported over 880,000 measles cases globally—a fourfold increase over the preceding two years—with outbreaks in both low- and high-income countries despite high childhood vaccination coverage. This study evaluated the seroepidemiology of measles, mumps, and rubella among adults in Türkiye over a nine-year period. Materials and Methods: A retrospective laboratory-based study was conducted using ELISA IgM and IgG results obtained between 2014 and 2022 at a tertiary-care university hospital. Seropositivity rates were analysed by year, age group, and sex. Temporal trends were assessed using the Cochran–Armitage trend test; factors associated with IgG seropositivity were assessed using multivariable logistic regression. Results: Among 10,407 adult test records, overall IgG seropositivity was 75.8% for measles, 94.9% for rubella, and 86.3% for mumps; IgM positivity remained low throughout (0.9%, 0.4%, and 1.9%, respectively). Measles IgG declined significantly from 78.4% in 2014–2019 to 62.6% in 2022 (p < 0.001), whereas Rubella IgG remained stable (93.2–95.7%) and Mumps IgG showed no significant temporal change. Seropositivity increased markedly with age for measles (18–29 years: 70.2% vs. ≥50 years: 93.4%; p < 0.001) and mumps (p = 0.030). Multivariable analysis confirmed that Measles IgG seropositivity was substantially lower in 2022 than in the pooled 2014–2019 period (OR = 0.432, 95% CI: 0.319–0.584, p < 0.001). Rubella seroprotection among women of reproductive age was 94.7% (95% CI: 93.9–95.5%), close to but not statistically distinguishable from the 95% population immunity benchmark used in rubella elimination frameworks. Conclusions: A significant measles immunity gap exists among younger adults in Türkiye, with Measles IgG seropositivity declining from 78.4% in 2014–2019 to 62.6% in 2022, consistent with a cohort effect whereby vaccine-era cohorts exhibit lower protection than older adults with naturally acquired immunity. Rubella immunity, by contrast, remained close to the 95% elimination benchmark throughout. These findings underscore the importance of targeted serological surveillance and evidence-based booster vaccination strategies. Full article

Glyphosate is an herbicide used to control plant growth and ripen specific crops. Glyphosate exposure has been associated with cancer, metabolic and neurological diseases, and reproductive issues in humans. A common element linking these disorders could be vitamin D deficiency. However, the relationship between glyphosate exposure and vitamin D status in the general population remains unclear. This analysis focused on the association between urinary glyphosate levels and serum 25-hydroxy vitamin D [25(OH)D] concentrations in a large representative sample of U.S. adults. Data from 4284 participants in the National Health and Nutrition Examination Survey (NHANES) between 2013–2018 were analyzed. Serum 25(OH)D levels were modeled using multivariable weighted linear regression, with adjustment for age, sex, race/ethnicity, body mass index, season, education, income, physical activity, smoking, and kidney function. Urinary glyphosate concentration was inversely associated with serum 25(OH)D in both the design-based univariate weighted analysis (β = −3.537, p = 0.035) and adjusted survey-weighted models for major confounding factors (β = −4.208, p = 0.009), using Taylor linearization for variance estimation to account for the complex NHANES survey design. In stratified analysis, the relationship between total vitamin D intake and serum 25(OH)D was found to be significantly modified by glyphosate exposure, with stronger dietary dependence observed in the high-exposure tertile (β = 12.88, p < 0.0066) than in the low-exposure tertile (β = 7.41, p < 0.0165). Higher urinary glyphosate concentration was associated with lower serum 25(OH)D levels in U.S. adults, suggesting it may represent an unrecognized risk factor for vitamin D deficiency. Longitudinal and experimental studies are needed to clarify causality, the underlying mechanisms, and public health implications. Full article

Background/Objectives: Trauma remains a leading global cause of mortality and morbidity, particularly in low- and middle-income countries. Multitrauma patients often require intensive care and exhibit high mortality rates. Prognostic scoring systems such as the Acute Physiology and Chronic Health Evaluation II (APACHE II) and Revised Trauma Score (RTS) are widely used to predict outcomes; however, their performance in middle-income settings like Turkey has not been well established. This study aimed to evaluate the prognostic accuracy of APACHE II and RTS in predicting intensive care unit (ICU) mortality among multitrauma patients. Methods: This retrospective observational study was conducted in the General ICU of Diyarbakır Gazi Yaşargil Training and Research Hospital between January 2022 and December 2024. Adult patients (≥18 years) with multitrauma involving at least two anatomical regions were included. Demographic data, clinical scores (APACHE II, RTS, Sequential Organ Failure Assessment [SOFA], Injury Severity Score [ISS], Trauma and Injury Severity Score [TRISS]), laboratory parameters, complications, and outcomes were recorded. Univariate and multivariate logistic regression analyses identified independent predictors of ICU mortality. Receiver operating characteristic (ROC) analysis assessed the discriminatory ability of prognostic scores. Results: A total of 145 patients were analyzed, with an ICU mortality rate of 13.1%. Non-survivors had significantly higher APACHE II (27 ± 4 vs. 13 ± 6, p < 0.001) and SOFA scores (7 [4–13] vs. 2 [1–6], p < 0.001) and lower RTS (4.2 ± 1.7 vs. 7.2 ± 1.1, p < 0.001). Acute kidney injury, sepsis, septic shock, and mechanical ventilation were more frequent among non-survivors (p < 0.01 for all). In multivariate analysis, APACHE II (odds ratio [OR]= 1.54, 95% confidence interval [CI] 1.16–2.04, p = 0.003) and RTS (OR = 0.36, 95% CI 0.16–0.81, p = 0.013) were independent predictors of ICU mortality. ROC analysis showed excellent prognostic performance for APACHE II (area under the curve [AUC] = 0.959) and RTS (AUC = 0.888). Conclusions: In this retrospective single-center cohort, APACHE II and RTS were independently associated with ICU mortality and demonstrated good discriminatory performance for early risk stratification in critically ill multitrauma patients. The lower mortality observed in our cohort should be interpreted cautiously, as it may also reflect differences in case-mix, injury severity, ICU admission practices, and referral patterns. These findings require external validation in larger multicenter cohorts before broader generalization. Future studies should also validate the identified cut-off values and further investigate the prognostic role of biomarkers such as procalcitonin. Full article

Background: Loneliness in older adults is a global public health problem. Although robust evidence exists regarding its consequences, the evidence base is marked by a bias towards high-income countries and urban contexts. The rural Peruvian Amazon is a territory virtually absent from the scientific literature on ageing and loneliness. Methods: We conducted a descriptive–interpretive qualitative study based on 34 semi-structured interviews with adults aged 60 years and over, recruited through Cáritas-Requena. Analysis followed the reflexive thematic analysis framework. Purposive sampling with maximum variation criteria was employed. The study was complemented by a quantitative characterisation using the Barthel Index, the LSNS-6 scale, and the DUKE-UNC-11 questionnaire. Results: Four themes emerged: (1) structural and functional conditions as the substrate of loneliness; (2) family reconfiguration driven by internal migration, with notable prominence of skipped-generation households (grandparents caring for grandchildren); (3) lived experiences of emotional and social loneliness, including a contextual pattern of feeling lonely despite the physical presence of others, which we descriptively label “paradoxical loneliness”; and (4) coping resources, including faith, work, neighbourhood networks, non-human companionship, and habituation. The descriptive relational measures showed different distributions: objective social isolation (LSNS-6 < 12) was observed in 12.5% of participants, whereas low perceived functional social support (DUKE-UNC-11 < 32) was observed in 68.8%; these measures assess distinct constructs and were used solely to contextualise the qualitative findings. Conclusions: Among the service-connected older adults included in this study, loneliness was shaped by the interaction of family reconfiguration, material and health-related conditions, and locally available coping resources. The experience of feeling lonely despite the physical presence of others was compatible with Perlman and Peplau’s cognitive discrepancy model and is presented here as a context-specific interpretive pattern rather than as an independent dimension of loneliness. Full article

Background/Objectives: Metabolic syndrome (MetS) and low socioeconomic status (SES) are each established drivers of coronary artery disease (CAD), a leading cause of acute cardiovascular presentations to emergency and acute care services. Whether SES modifies the long-term association between MetS and CAD in a universal health coverage setting is unclear. We examined the independent and joint associations of MetS and income-based SES with 20-year incident CAD. Methods: In this nationwide retrospective cohort study using the Korean National Health Insurance Service database, 489,521 adults aged 40–79 years who underwent a national health examination in 2005 and were free of CAD at baseline were followed through 31 December 2024 (up to 20 years). At baseline, the mean age was 54.1 ± 9.2 years, and 252,818 participants (51.6%) were men. MetS was defined by modified harmonized criteria, with body mass index (BMI) ≥ 25 kg/m² substituted for waist circumference. SES was measured by health insurance premium deciles and classified as high (deciles 8–10), middle (4–7), low income (1–3), and Medical Aid (decile 0). The outcome was incident CAD (myocardial infarction or angina pectoris). Multivariable Cox proportional hazards models were adjusted for age, sex, smoking, alcohol consumption, regular exercise, BMI, chronic kidney disease, alternate exposure, and estimated adjusted hazard ratios (aHRs); joint exposure and additive interaction (relative excess risk due to interaction, RERI) were assessed. Results: MetS prevalence was 30.6%. During follow-up, 48,428 participants (9.9%) developed CAD. MetS was independently associated with CAD (aHR 1.84; 95% CI 1.78–1.91), as was a graded socioeconomic gradient (Medical Aid vs. high SES aHR 1.62; 1.54–1.70). Incidence rates ranged from 3.13 (high-SES without MetS) to 11.40 (Medical Aid with MetS) per 1000 person-years. In the joint analysis, Medical Aid beneficiaries with MetS had the highest risk (aHR 2.92; 2.78–3.08 vs. high-SES without MetS; p for interaction < 0.001), with positive additive interaction (RERI 0.68). Conclusions: Over two decades, low SES amplified the CAD burden associated with MetS. Adults living in the most severe material deprivation who also had MetS constituted the highest risk group, of direct relevance to risk stratification and disparities in emergency and acute cardiovascular care. Full article

Background/Objectives: Pediatric solid tumors (PST) are a biologically distinct group of malignancies whose developmental origins and molecular drivers differ substantially from those of adult cancers, with direct implications for therapeutic strategy and clinical outcome. This review synthesizes current evidence on molecular pathogenesis, tumor microenvironment biology, and the structural conditions that shape access to care across select PST. Methods: A narrative review of peer-reviewed literature was conducted primarily using PubMed, supplemented by Google Scholar, covering publications from 2000 to 2025. Tumor types were selected based on their prevalence in the pediatric population and the availability of evidence addressing both molecular features and health disparities. Body: Across eight tumor types (neuroblastoma, Ewing sarcoma, pediatric brain tumors, rhabdomyosarcoma, Wilms tumor, retinoblastoma, osteosarcoma, and chondrosarcoma), recurrent molecular alterations including MYCN amplification, EWS-FLI1 fusions, PAX-FOXO1 rearrangements and IDH 1/2 mutations emerge as central determinants of disease behavior and eligibility for treatment. The tumor microenvironment manifests as a shared mediator of immune exclusion and therapeutic resistance across tumor types, with, but not limited to, tumor-associated macrophages, myeloid-derived suppressor cells, and checkpoint molecule expression, identified as recurrent features influencing treatment response. Immunotherapeutic strategies have shown variable efficacy across PST, with the most consistent clinical benefit established in neuroblastoma. A critical and underappreciated pattern stands out across tumor types: children carrying the most aggressive molecular subtypes are disproportionately those with the least access to therapies those subtypes demand, emphasizing an overlap of biological and structural disadvantage that is also amplified in low- and middle-income countries, where late-stage presentation, treatment abandonment and limited access to molecular diagnostics compound the biological disadvantage. Conclusions: Within the eight PST reviewed, the most aggressive molecular subtypes and the greatest structural disadvantages converge in the same children; those carrying MYCN amplification, PAX-FOXO1 fusions, or EWS-FLI1 fusions are disproportionately those with the least access to the therapies their biology demands. Genomic and immunologic advances will only reach their full clinical potential when paired with inclusive trial data, diversified genomic databases, and most importantly, equitable access to biomarker-specialized therapies across all populations. Full article

Background/Objectives: Multiple chronic conditions (MCCs) are highly prevalent among older adults and require effective collaboration between the patient and caregiver. Mutuality, reflecting the quality of the dyadic relationship, is associated with better self-care and health outcomes. However, the Mutuality Scale (MS) has not been validated on patient–caregiver dyads managing MCCs living in a low–middle-income country (LMIC). Aim: This study seeks to evaluate the structural and convergent validity and reliability of the MS among patient–caregiver dyads managing MCCs living in a LMIC. Methods: A cross-sectional study was conducted on MCC patients and their caregiver recruited from community and outpatient settings. The MS, Self-care of Chronic Illness Inventory (SC-CII) and Caregiver Contribution to self-care Inventory (CC-SCCII) were used for measuring mutuality, patient self-care, and Caregiver Contribution (CC) to patient self-care, respectively. Confirmatory factor analysis (CFA) was performed separately for patients and caregivers to evaluate the original four-factor structure of the MS. Convergent validity was examined through correlations with self-care and CC to patient self-care. Reliability was evaluated using composite reliability and the Global Reliability Index for multidimensional scale. Results: A sample of 406 patient–caregiver dyads was examined. Patients had a mean age of 73.9 (±6.2) years. Caregivers had a mean age of 47.8 (±15.5) years. The four-factor structure was supported in both samples, with acceptable model fit (patients: Comparative Fit Index (CFI) = 0.953 and Root Mean Square Error of Approximation (RMSEA) = 0.078; caregiver CFI = 0.945 and RMSEA = 0.085. The second-order CFA supported a hierarchical structure. Patient and caregiver mutuality scores were strongly correlated (r = 0.778, p < 0.01). Higher mutuality was associated with better patient self-care (r = 0.276–0.479) and CC to self-care (r = 0.174–0.556). Reliability indices ranged from 0.70 to 0.91 for patients and 0.66 to 0.89 for caregivers. Conclusions: The findings support the validity and reliability of the MS for assessing mutuality in patients and their caregivers managing MCCs in an LMIC characterized by limited healthcare resources and formal support. Its use provides empirical support for assessing relationship quality and facilitating dyadic care within this vulnerable population. Future longitudinal studies should evaluate its predictive validity, responsiveness, and measurement invariance across different groups and between patient and caregiver. Full article

Background: Depressive symptoms have become a significant public health issue faced by middle-aged and older adults in China. Although previous studies have primarily focused on demographic and socioeconomic factors, the association between modifiable lifestyle behaviors and depressive symptoms still requires further investigation. Objective: To examine the associations between sleep duration, physical activity, digital participation, social participation, and depressive symptoms as well as life satisfaction among middle-aged and older adults in China. Methods: A cross-sectional analysis was conducted using data from the 2020 China Health and Retirement Longitudinal Survey (CHARLS). Depressive symptoms were defined as CES-D-10 scores ≥10, with 13,576 individuals included in the analysis sample. Adjusted prevalence ratios (aPRs) were estimated using modified Poisson regression, while ordinal logistic regression was employed to analyze life satisfaction. The analysis controlled for covariates such as demographics, socioeconomic status, and health status, and accounted for the complex sampling design. Results: The weighted prevalence of depressive symptoms was 44.5%. Sleep deprivation (<7 h/day) was significantly associated with elevated depressive symptoms (aPR = 1.49, 95% CI: 1.33–1.68); participation in recreational activities was significantly associated with reduced depressive symptoms (aPR = 0.86, 95% CI: 0.77–0.96); adequate physical activity was associated with a higher prevalence of elevated depressive symptoms (aPR = 1.17, 95% CI: 1.04–1.32); watching videos (aPR = 0.87, 95% CI: 0.76–0.99) and playing online games (aPR = 0.65, 95% CI: 0.50–0.83) were significantly associated with reduced depressive symptoms; and overall internet use was correlated with lower life satisfaction (OR = 0.90, 95% CI: 0.81–1.00). Women, rural residents, and low-income groups exhibited higher prevalence of elevated depressive symptoms. Conclusion: Sleep deprivation, as well as different types of social engagement, physical activity, and digital behavior, exhibit distinct associations with depressive symptoms in middle-aged and older adults. Behavioral intervention strategies targeting sleep hygiene, leisure activities, and tailored digital behaviors warrant further attention. Full article

Background/Objectives: Structural inequalities in access to healthcare persist even within systems that have achieved near-universal coverage, reflecting the enduring influence of social determinants of health on service utilization. This study examines horizontal inequity in rehabilitation and specialist care in Türkiye and investigates whether access inequality mediates the well-documented income–depression gradient. Methods: Analyzing the nationally representative 2022 Türkiye Health Survey (adults aged ≥15; N = 22,742), we employed Latent Profile Analysis (LPA) to construct people-centered, multidimensional bodily burden profiles, and assessed need-adjusted access using survey-weighted logistic regression, Erreygers-corrected concentration-index decomposition, Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA), and restricted cubic splines, with measurement-invariance and classification-uncertainty sensitivity analyses. Statistical mediation was examined with natural-effect models and E-value sensitivity analysis. Results: Although the system demonstrated responsiveness to need—78.8% of the highest-burden profile accessed specialist services—only 13.7% of this same group reached dedicated physiotherapy or rehabilitation, revealing a profound structural bottleneck in care coordination for marginalized populations with the greatest functional impairment. A persistent pro-rich gradient was confirmed by an Erreygers-corrected concentration index of 0.058 (95% CI 0.043–0.072), driven additively by income and education. Access did not mediate the income–depression pathway (natural indirect effect OR 1.001, 95% CI 1.0003–1.002). Conclusions: The mental health burden of low income operates through pathways that equitable healthcare access alone cannot address. These findings call for macroeconomic and people-centered health system reforms—including direct physiotherapy access, transportation subsidies, and social protection interventions—to advance health equity in rehabilitation utilization. Full article

Background: Upper airway tract infections (UATIs) are among the most common infectious diseases worldwide, accounting for an estimated 12.8 billion episodes annually and more than 8 million disability-adjusted life years (DALYs). Despite their generally self-limiting nature, their cumulative clinical, socioeconomic, and public health burden remains substantial, particularly in children, older adults, and low- and middle-income countries (LMICs). Methods: We performed a structured narrative review of the peer-reviewed literature and reports from major international health organizations to summarize the current evidence on the epidemiology, etiology, clinical impact, socioeconomic burden, prevention strategies, and future challenges associated with UATIs. Particular attention was given to the influence of antimicrobial resistance, vaccination policies, and lessons learned from the COVID-19 pandemic. Results: UATIs remain one of the leading causes of healthcare utilization worldwide. Children experience the highest incidence, averaging 6–8 episodes annually, whereas vulnerable populations are at increased risk of complications and hospitalization. Marked geographical disparities persist, with LMICs experiencing a disproportionate burden due to limited healthcare access, lower vaccination coverage, and higher complication rates. Inappropriate antibiotic prescribing continues to accelerate antimicrobial resistance, while the COVID-19 pandemic profoundly altered the epidemiology of respiratory infections and demonstrated the effectiveness of non-pharmaceutical interventions. Advances in vaccination, antimicrobial stewardship, rapid diagnostics, and novel therapeutic strategies offer promising opportunities to reduce disease burden. Conclusions: Reducing the global burden of UATIs requires integrated public health strategies combining equitable vaccine access, effective antimicrobial stewardship, strengthened healthcare systems, and sustained surveillance. Lessons learned from the COVID-19 pandemic provide a unique opportunity to improve preparedness for future respiratory outbreaks while addressing persistent regional inequalities in prevention and care. Full article