Articles

Hypertension remains a leading cause of cardiovascular morbidity and mortality. Although effective antihypertensive therapies are available, sustained blood pressure control remains suboptimal due to inconsistent medication use. Most adherence research is quantitative and offers limited understanding of how individuals interpret lifelong treatment within daily life, particularly in culturally grounded contexts. To explore the lived experiences of Filipino adults taking antihypertensive medication. A qualitative study grounded in Heideggerian interpretive phenomenology was conducted. Ten Filipino adults diagnosed with hypertension were purposively recruited from outpatient clinics in Manila, Philippines. In-depth semi-structured interviews were transcribed verbatim and analyzed using the six-step IPA framework. Analysis revealed six interconnected themes describing how participants interpreted and sustained medication use: (1) Diagnosis as Disruption; (2) Medication as Protection and Responsibility; (3) The Paradox of the Silent Illness; (4) Everyday Barriers to Sustained Treatment; (5) Constructing Routine and Adaptive Self-Management; and (6) Family as Anchor within Cultural Contexts. These themes reflected emotional adjustment, symptom-driven adherence, financial and work-related barriers, adaptive coping strategies, and strong family-centered motivation. Medication-taking was experienced as an ongoing negotiation shaped by bodily cues, daily demands, and relational obligations. Conclusion: Antihypertensive medication use is shaped by relational, cultural, and socioeconomic contexts, underscoring the need for family-inclusive and culturally responsive hypertension care.

This literature review delves deeply into the epidemiology, structural and cultural challenges, and management strategies of status epilepticus (SE) in sub-Saharan Africa (SSA). Incidence rates of SE vary significantly between countries, with notable disparities associated with socio-economic contexts, healthcare infrastructures, and cultural perceptions of epilepsy. The management of SE in this region is often hindered by constraints in medical infrastructure, inadequate access to specialist diagnostics such as electroencephalogram, and limited availability of essential anti-epileptic drugs, which are frequently out of reach for rural populations. These challenges are further exacerbated by the social stigma and cultural beliefs surrounding epilepsy, impeding access to care and widening inequalities. Moreover, the scarcity of qualified medical personnel undermines the efficient and prompt management of this neurological emergency. The review underscores the pressing need to enhance healthcare infrastructures, boost the capabilities of healthcare professionals, and conduct community awareness initiatives to destigmatize epilepsy and lessen prejudice. Additionally, practical recommendations are put forward for enhancing local capacity, fostering equity in care access, and mitigating regional health disparities in SSA.

Smallholder farmers play a pivotal role in global food security; however, they remain exceptionally vulnerable to the impacts of climate change due to their reliance on natural resources and limited adaptive capacities. This narrative review synthesizes a wide range of global sources to explore the intersection of smallholder agriculture and climate adaptation strategies. The review examines adaptation practices, agroecological methods, and the adoption of climate-resilient crop varieties. It reveals that the implementation of these strategies is frequently hindered by systemic barriers such as financial constraints, limited technological access, and institutional inefficiencies. Recognizing that previous studies have addressed isolated aspects of adaptation or relied on secondary data, this review highlights research gaps and offers a comprehensive synthesis of relevant literature. This review uses a narrative synthesis model suitable for integrating evidence from agronomy, economics, and social science to capture the complex challenges faced by smallholder farmers. The review emphasizes the importance of policy frameworks and participatory approaches that empower smallholder communities. This review synthesizes current evidence to inform potential directions for targeted interventions and future field-based studies, while recognizing the limitations of relying on secondary data. These recommendations aim to facilitate integrated policy reforms and drive research initiatives, ultimately strengthening the resilience and adaptability of smallholder agriculture in the face of ongoing climate change.

“To Be Twice as Good to Get Half” is a common mindset among high aspiration and ambition Black individuals in the U.S., capturing the lived reality of Minorities’ Diminished Returns (MDRs). This paper explains that MDRs reflect how, even with high levels of ambition, self-efficacy, education, and income, Black individuals and other marginalized groups do not experience the same protective benefits for health and well-being as White populations. Systemic obstacles embedded within U.S. society weaken the expected returns on socioeconomic achievements for racialized individuals, creating a reality where “being twice as good” still results in lesser outcomes. High-SES Black individuals, for instance, continue to face significant risks for adverse outcomes, such as depression and chronic disease, due to structural inequities across domains like labor market discrimination, segregation, and accumulated disadvantage from childhood. Our analysis identifies key mechanisms—including interpersonal discrimination, lower-quality education, and structural racism in sectors like banking, policing, and real estate—that erode the protective effects of SES across racial lines. Mediating factors, such as chronic stress, allostatic load, and epigenetic changes over the life course, further compound these diminished returns, weakening the expected physical and mental health benefits. Drawing on extensive evidence from U.S. national and local datasets and corroborated by international studies, this paper underscores the necessity of policies that dismantle structural barriers rather than relying solely on SES improvements. Recommendations include implementing multi-sectoral policies, recognizing the unique challenges of middle-class non-White populations, and approaching policy with humility, acknowledging that achieving equity is a long-term endeavor. By challenging the “bootstraps” narrative, this paper advocates for structural interventions aimed at genuine health and economic equity for all racial and socioeconomic groups. While we provide an in-depth analysis of MDRs’ phenomena, mechanisms, mediators, and policy implications, the experience is often distilled as, “I have to be twice as good to get half.”

<b>Background:</b><b> </b>School characteristics — including poverty levels, teacher experience, graduation rates, and college enrollment — are essential determinants of students’ academic outcomes and long-term success. Families often use their socioeconomic resources, such as parental education and household income, to secure access to high-quality schools with favorable attributes. However, Minorities’ Diminished Returns (MDRs) theory suggests that Black families may not experience the same benefits of high family SES due to structural barriers. This study examines the association between family SES and school characteristics, focusing on racial disparities in access to high-quality educational environments. <b>Objective:</b><b> </b>To investigate the relationship between family SES (parental education and household income) and multiple school characteristics (poverty, teacher experience, graduation rates, and college enrollment), and to assess racial differences in these associations. <b>Methods:</b><b> </b>Data from the Adolescent Brain Cognitive Development (ABCD) study, a national sample of US adolescents, was analyzed. We used multivariate regression models to examine associations between family SES and school characteristics and to test for interactions by race, specifically comparing Black and White adolescents. <b>Results:</b><b> </b>Higher family SES was associated with positive school characteristics overall, including lower school poverty, greater teacher experience, and increased graduation and college enrollment rates. However, these positive effects of high family SES on school characteristics were significantly weaker for Black adolescents than for White adolescents. Black adolescents from high-income families were more likely than White adolescents from similar backgrounds to attend schools with higher poverty rates, less experienced teachers, and reduced graduation and college enrollment rates. <b>Conclusion:</b><b> </b>Our findings highlight persistent racial inequities in access to educational opportunities, even among families with comparable socioeconomic resources. The diminished returns of family SES for Black adolescents underscore the role of structural barriers in limiting access to high-quality schools. These findings emphasize the need for policy interventions to address systemic inequalities that hinder Black families from fully leveraging their SES to access favorable educational environments.

The COVID-19 pandemic has had a significant impact on individuals worldwide, affecting not only their educational futures but also their mental health. This paper aims to explore college students' perceived barriers to accessing mental health services during the pandemic. The study finds that there is a significant difference between stigma-related and non-stigma-related barriers, with non-stigma items being rated higher on average. The most commonly reported non-stigma barriers include wanting to solve the problem independently, financial constraints, and the belief that the issue will resolve itself. Stigma-related barriers include feeling embarrassed or ashamed, concern about having a mental health problem on medical records, and fear of being seen as crazy or weak. This research sheds light on the challenges students face in seeking mental health care during the pandemic and highlights the need to address these barriers.

The objective of this study was to examine the barriers to effective solid waste management in the Komenda-Edina-Eguafo-Abrem Municipality in the Central Region of Ghana. This study adopted the cross-sectional descriptive survey research design. The population for the study comprised all residents of 18 years or older as well as waste management agencies in the KEEA Municipality. A simple random sampling technique was used to select 380 residents together with 45 staff of the Zoomlion Company Ltd in the KEEA Municipality for the study. The questionnaire was the main instrument used for the data collection. Frequencies, percentages, means and standard deviations were used to analyse the questionnaire items on the research questions. This was done with the use of the Statistical Package for Service Solutions (SPSS) version 21. There were a number of barriers to effective solid waste management practices. Some of the barriers were inadequate environmental education; inadequate logistics and funds; inadequate depots, skips and dustbins; lack of adequate skilled personnel to manage services efficiently; and apathetic attitude/inertia on the part of some of the residents. Some other barriers included: irregular collection of waste by waste management companies; lack of appropriate sites for waste disposal; unwillingness of some households to pay for the collection and appropriate disposal of solids; and refuse dumps located very far from home. It is recommended that the government through the Ministry of Local Government should provide adequate logistics and funds for the procurement of dustbins in order to ensure proper solid waste management. The Assembly should ensure that Zoomlion collects waste regularly. The Assembly should encourage residents to pay for the collection of waste and sanction recalcitrant residents who do not adhere to appropriate solid waste management practices.

Even patients from developed nations have trouble staying on top of their drug compliance. When it comes to improper medicine use, there is an odd parallel between underdeveloped, emerging nations and the so-called developed world in the West. The key factor influencing whether patients stick to their treatment plan is their understanding and perception of the disease.

The study sought to examine the socio-economic and cultural factors that affect women’s participation in local level governance in selected districts in the Central Region of Ghana. The qualitative approach was employed for this study, and an interview guide was used to gather data from 11 women assembly members and two of their husbands, making a total of 13 participants. The participants were sampled using purposive, snowball and convenient sampling techniques. The data was analysed thematically. The study identified lack of self-confidence, limited funds, unsupportive family, abuse and harassment, political affiliations in the Assembly and unsupportive religious organizations as the socio-economic and cultural barriers to women participation in local level governance in Agona West, Gomoa West and Gomoa Central Districts in the Central Region of Ghana. The findings showed that despite the barriers, some of the women were able to surmount such challenges and became successful in the District Assembly elections. The study recommended that special fund should be set up by the government to support Assembly women to perform their roles and responsibilities within their communities regularly. Such funds may help them fulfil their campaign promises, which may encourage them to seek re-election in the District Assemblies. Also, female politicians should mentor potential female politicians. The mentors may support them to build the confidence required to engage in local level politics and to aspire higher positions in political office.