The mental well-being of physicians is increasingly recognized as vital, both for their personal health and the quality of care they provide to patients. Physicians face a variety of mental health challenges, including depression, anxiety, and burnout, which have become prevalent issues globally. These mental health concerns are like those found in the general population but are particularly significant in the demanding healthcare setting.

This review aims to explore the prevalence and correlates of depression, anxiety, and burnout among physicians and residents in training.

A comprehensive literature review was conducted, searching databases such as Medline, PubMed, Scopus, CINAHL, and PsycINFO. The review focused on studies published from 2021 to 2024 that addressed the prevalence of these mental health conditions in physicians and residents. The findings, in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, were summarized in detailed tables.

Following titles and abstracts screening, 196 publications were selected for full-text review, with 92 articles ultimately included in the analysis. The results revealed significant variability in the prevalence of burnout, depression, and anxiety. Burnout rates among physicians ranged from 4.7 to 90.1% and from 18.3 to 94% among residents. Depression prevalence ranged from 4.8 to 66.5% in physicians and from 7.7 to 93% in residents. Anxiety rates were between 8 and 78.9% in physicians and 10 to 63.9% in residents. Notably, women reported higher rates of all three conditions compared to men. Key factors influencing these mental health conditions included demographics (age, gender, education, financial status, family situation, occupation), psychological conditions, social factors (stigma, family life), work organization (workload, work conditions), and COVID-19-related issues (caring for COVID-19 patients, fear of infection, working in high-risk areas, concerns about personal protective equipment (PPE), and testing positive).

This review indicates a high prevalence of burnout, depression, and anxiety among physicians and residents, with female participants consistently showing higher rates than males. These findings can guide policymakers and healthcare administrators in designing targeted programs and interventions to help reduce these mental health issues in these groups.

Prevalence estimates for autism spectrum disorder (ASD) in the Middle East and North Africa (MENA) region are not readily available, amid a lack of recent evidence. In this study, we estimated the prevalence of ASD in the MENA region by synthesising evidence from published studies.

We conducted a systematic review and meta-analysis, searching PubMed, EMBASE, Scopus, and CINAHL for studies assessing ASD prevalence in the MENA region. Risk of bias was assessed using the Newcastle Ottawa scale. A bias-adjusted inverse variance heterogeneity meta-analysis model was used to synthesize prevalence estimates from included studies. Cochran's Q statistic and the I² statistic were used to assess heterogeneity, and publication bias assessed using funnel and Doi plots.

Of 3,739 studies identified, 19 met the inclusion criteria, published during the period 2007-2025, from Iran, Oman, Libya, Egypt, Saudi Arabia, Lebanon, United Arab Emirates, Bahrain, and Qatar, Iraq. Country specific prevalence estimates ranged from 0.01% in Oman in 2009 to 6.50% in one study from Iraq in 2024. The overall prevalence of ASD in the MENA region was 0.14% (95%CI 0.02- 0.36%), with significant heterogeneity (I² = 99.8%). Overall ASD prevalence was 0.04% (95%CI 0.00-0.13, I² = 99.4%) for studies done before 2015 and 0.45% (95%CI 0.17-0.87, I² = 99.4%) for studies after 2015. Overall ASD prevalence was high in studies that used the Modified Checklist for Autism in Toddlers (M-CHAT) only [1.66% (95%CI 0.15-4.33, I² = 97.5%)] while the overall ASD prevalence was 0.14% (95%CI 0.00-0.46, I² = 99.9%) for studies that used the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for diagnosis.

Estimates of the prevalence of ASD vary widely across the MENA region, with variability in ASD prevalence estimates by diagnostic methods and sampling approaches. While the data suggest a possible increase in prevalence during the study period, this observation warrants further investigation through more robust, longitudinal, and methodologically consistent studies.

PROSPERO registration ID CRD42024499837.

The combined predictive value of type 2 diabetes mellitus (T2DM) and coronary microvascular dysfunction (CMD) in rotational atherectomy (RA) patients during the PCI remains unclear. The study examined whether the co-occurrence of DM and CMD, determined by angiography-derived index of microcirculatory resistance in RA patients influences clinical outcomes.

This was a retrospective, multicenter, observational study involving 452 patients at 3 medical centers. The primary endpoint was the occurrence of major adverse cardiac events (MACEs) at 24 months after the procedure, encompassing cardiac death, myocardial infarction, target vessel revascularization, and readmission for unstable angina.

The post-PCI angio-IMR was lower in the non-DM group compared to the DM group (17.40 [13.86-21.34] vs. 18.53 [14.63-23.01], p = 0.037). Patients with DM had a higher risk of MACEs at 24 months than those without DM (17.42% vs. 9.49%, p = 0.011). CMD was defined as post-PCI angio-IMR ≧ 25.Patients with CMD demonstrated a statistically significant elevated risk of MACEs at the 24-month follow-up, when compared to individuals without CMD (26.77% vs. 10.54%, p < 0.001). In comparison to others, patients with both DM and CMD had the highest incidence of MACEs. Specifically, DM combined with CMD was the strongest independent predictor of MACEs (DM + CMD; HR: 5.61, 95% CI, 2.606-12.083, p < 0.001).

This study reveals that both T2DM and CMD are associated with the risk of MACEs in RA patients during the PCI. Combing T2DM and CMD can further improve the accessibility to predict the risk of MACEs.

Objective: To investigate the impact of blood pressure outcomes on the risk of arteriosclerosis in non-hypertensive populations. Methods: This study was a retrospective cohort study. All data were derived from Kailuan Cohort. Non-hypertensive individuals who completed two brachial-ankle pulse wave velocity (baPWV) measurements between January 2014 and December 2019 (using the first measurement as the baseline and the second as the follow-up) were enrolled, and clinical data such as blood pressure and baPWV were collected. According to the blood pressure level at baseline and follow-up, participants were divided into new-onset hypertension group (no hypertension at baseline but diagnosed at follow-up) and non-hypertension group (no hypertension at both baseline and follow-up). Multiple linear regression and multivariate logistic regression were used to analyze the impact of new-onset hypertension on arteriosclerosis progression. Subgroup analysis further classified participants into six blood pressure transition categories: normal-maintained, normal-to-high-normal, normal-to-hypertensive, high-normal-to-normal, high-normal-maintained, and high-normal-to-hypertensive groups. Multivariate logistic regression analysis was used to assess the impact of different blood pressure outcomes on arteriosclerosis progression. Results: A total of 7 049 participants were enrolled, with the age of (40.45±9.04) years, including 3 645 males (51.71%). There were 800 cases in the new-onset hypertension group and 6 249 individuals in the non-hypertension group. During follow-up, arteriosclerosis occurred in 2 154 cases (30.56%). Multivariable linear regression analysis revealed a positive correlation between new-onset hypertension and baPWV levels. The baPWV in the new-onset hypertension group was significantly higher by 63.94 cm/s compared to the non-hypertension group (β=63.94, P<0.01). Additionally, the risk of arteriosclerosis in the new-onset hypertension group was 2.09 times that of the non-hypertension group (OR=2.09, 95%CI: 1.77-2.46, P<0.01). Subgroup analysis revealed significantly higher arteriosclerosis risks in normal-to-high-normal (OR=1.65, 95%CI 1.38-1.98, P<0.01), normal-to-hypertensive (OR=2.47, 95%CI 1.70-3.59, P<0.01), high-normal-maintained (OR=1.50, 95%CI 1.21-1.86, P<0.01), and high-normal-to-hypertensive groups (OR=2.86, 95%CI 2.20-3.73, P<0.01) than normal-maintained group, except for a non-significant difference in high-normal-to-normal group (OR=0.95, 95%CI 0.74-1.20, P>0.05). Conclusion: Blood pressure outcome in non-hypertensive populations is closely related to arteriosclerosis risk. Progression to or maintenance of high-normal blood pressure or higher levels substantially increases arteriosclerosis risk, while regression from high-normal to normal blood pressure shows no significant increase in arteriosclerosis risk.

For ending the epidemic of TB by the year 2030, along in line with Sustainable Development Goals, it is essential to address the TB associated co-morbidities. Prevalence of diabetes influencing TB incidence and mortality is higher when compared to other co-morbidities like HIV infection, smoking, alcoholism and malnutrition. Therefore, this study was conducted with the following objectives: 1.To evaluate the effectiveness of the intervention on implementation of TB-DM collaborative activity using four symptom complex strategy and to explore the patient and healthcare providers related factors that contribute in implementation of the activity.

The present study was undertaken by Department of Community Medicine, Sri Manankula Vinayagar Medical College and Hospital, Puducherry for a period of 18 months in the Out Patient Departments of General Medicine, General Surgery, Obstetrics and Gynecology, Orthopedics, DOTS center and Designated Microscopy Centre. It was an embedded sequential experimental study, done among the health care professionals (CRRI, Postgraduates and staff nurse) who were involved in process of 4s complex screening for DM patients and the stakeholders who were involved in implementation of NTEP activity. The study was conducted in three phases.

baseline survey and identification of intervention strategies, Phase II: implementation of the intervention and Phase III: end line survey.

Manual content analysis was done for Qualitative data. The Quantitative data were entered into Epi Info software (version 7.2.2.6) and analyzed in SPSS software (version 24). Comparison of knowledge among the health care professionals before and after sensitization was calculated using Mc nemar test. It was considered statistically significant when the p value was <0.005. The analysis of free list and pile sort data was undertaken using Anthropac 4.98.1/X software.

Challenges obtained from stakeholders in implementing the activity were categorized as patient related factor, health care professional related factor and screening and reporting related factor. Suggested solutions were generating awareness at patient level, display of IEC tools, periodical sensitization for the staff, inter-departmental co-ordination, monitoring and re-enforcing the activity in core-committee meetings. After sensitization, the knowledge on joint TB-DM collaborative activity was significantly improved among the health care professionals. By implementing the four symptom complex screening activity in NCD clinic, 6480 DM patients were screened and 176 (2.7%) presumptive TB cases were identified. Of which, 136 of them reached DMC for sputum examination. Among them 44 (35.4%) had active TB infection. The Number Needed to Screen to yield a case of TB was 147.

We found improvement in identification of TB cases using ICF approach with minimal resources. Thus, we recommend a support group to maintain and strengthen the ongoing activity. The challenges and solutions identified may help in optimizing the screening process. Implementing the activity in special clinics like oncology OPDs, nephrology OPDs, antenatal clinics can be recommended.

The increased prevalence of noncommunicable diseases (NCDs) in Malaysia has strained its public health services. Lifestyle changes remain a critical part of the management of NCDs. Primary care doctors are expected to provide lifestyle advice during consultations. Perception and expectations of these consultations directly affect the health-modifying behaviours of patients and the outcome. Understanding patients' expectations in various contexts helps in tailoring good and effective consultations. The Health Belief Model (HBM) is a theoretical framework widely used to predict health behaviours. The authors hypothesise that a good doctor's consultation should cover all six domains of HBM to trigger patients to change their health behaviour.  Methods: This was an exploratory qualitative study using semi-structured interviews with patients recruited using purposive sampling, at three different government health clinics in the Hulu Langat district of Selangor, Malaysia. Data were analysed deductively utilising HBM as the theme for patients' views, and an inductive approach for patients' expectations.  Results: Consultations positively influenced participants' health behaviour. However, the perception of their NCD severity was found to be superficial. Self-efficacy in sustaining changes was a notable barrier. Expectations included comprehensive health advice, empathy, and professionalism. There is a subset of patients who had no expectations coming into these consultations.

Consultations were perceived to improve health behaviour but lack depth in understanding severity and self-efficacy. Patients expect comprehensive, empathetic, and professional consultations. Some had no expectations, which may reflect passivity or trust.

Overconsumption of unhealthy, discretionary, foods and beverages are associated with an increased risk of weight gain and non-communicable diseases, including diabetes, heart disease, and cancer. This cross-sectional study explored preferences for setting goals to reduce discretionary food and beverage consumption. The online survey included items about discretionary food and beverage intake, goal setting preferences to reduce intake, habit strength, personality traits, and demographic characteristics. A total of 2664 Australian adults completed the survey. The sample was mostly female (65.9%), half (52.8%) were aged between 30-49 years, and the median intake of discretionary food and beverages was 4.9 (IQR: 3.6 to 7.2) serves per day. Multinomial logistic regression and ordinal logistic regression models were used to explore demographic and psychological predictors of the helpfulness of long-term and short-term goals, elimination and gradual goals, specific food goals, specific eating occasion and food goals, self-set goals, collaboratively set goals, and assigned goals. The results showed participants with higher habit strength had greater odds of finding short-term (OR 1.40, 95% CI 1.06-1.86), gradual (OR 1.14, 95% CI 1.01-1.29), specific (OR 1.35, 95% CI 0.84-1.76), assigned (OR 1.38, 95% CI 1.14-1.66) and collaborative goals (OR 1.24, 95% CI 1.01-1.53) helpful. The results also indicated that age and gender were important predictors of goal setting preferences, particularly for long-term goals, elimination goals, broad goals, and collaborative goals. Interventions to reduce discretionary food and beverage intake are needed and consideration of goal setting preferences could be a novel way to developing more tailored and effective dietary interventions.

Numerous simple lifestyle scores have been developed for specific non-communicable diseases (NCDs). This research aimed to investigate and compare the associations of various lifestyle scores with the incidence and mortality of NCDs. In 76,399 participants from the UK Biobank, we investigated the associations of 13 lifestyle scores with the incidence and mortality of cancer, cardiovascular disease (CVD), type 2 diabetes (T2D), and a composite of these NCDs. Cox proportional-hazards regression models were used to estimate hazard ratios (HRs) for associations between lifestyle scores and NCD outcomes. During a median follow-up time of 10.5 years, 12,214 incident NCD cases and 2250 NCD deaths were documented. Higher lifestyle scores were generally associated with a reduced risk of overall NCDs (HRs ranging from 0.65 to 0.89) and NCD mortality (0.51-0.92). Cancer (HRs ranging from 0.72 to 0.98) and CVD (0.55-0.87) risk were less dependent on lifestyle behaviors than T2D (0.18-0.74). Notably, the top three scores associated with cancer outcomes included smoking as a component, and those for T2D included body mass index (BMI). For overall NCD outcomes, lifestyle scores including both smoking and BMI showed the strongest associations. Healthy Lifestyle Score and the Chronic Disease Risk Index were the overall best-performing scores to predict NCD risk and mortality. These findings suggest that the use of lifestyle scores designed for a single disease group can be extended for predicting multiple NCDs and mortality. Both smoking and BMI should be included in lifestyle scores aiming to predict overall NCD risk and mortality for future research and recommendations.

Optimal infant and young child feeding is essential for child health, development and social wellbeing. Breastfeeding is the foundation of early nutrition, and powerfully protects infants and young children against both infectious and non-communicable diseases. The commercial milk formula industry systematically undermines breastfeeding through pervasive marketing and influence over science, education and policy, despite international guidance, including the World Health Organization (WHO) International Code of Marketing of Breast-milk Substitutes. Biased industry-sponsored research supports misleading claims about formula efficacy, while industry funding of nutrition regulators, professional education and healthcare practitioners creates conflicts of interest. To protect public health, stronger regulations, full implementation of the WHO Code and clear boundaries between the formula industry and health sectors are needed. We propose policy actions, including a binding global treaty and transparency measures, to counteract commercial influence and safeguard child health.

The triglyceride-glucose (TyG) index is a validated marker of insulin resistance (IR) and predictor of cardiovascular outcomes. However, the prognostic utility of integrating TyG with body mass index (BMI) as the TyG-BMI index in elderly patients with severe heart failure (HF) and type 2 diabetes mellitus (T2DM) remains unestablished. We aimed to evaluate associations between TyG-BMI and all-cause mortality at multiple time points in this high-risk cohort.

This retrospective cohort study analyzed 4,523 elderly patients (aged >65 years) with severe HF and T2DM from the MIMIC-IV database. Participants were stratified into TyG-BMI quartiles (Q1-Q4) at ICU admission. Primary outcomes were 60-, 90-, 180-, and 365-day all-cause mortality. Associations were assessed using Kaplan-Meier analysis, Cox proportional hazards models, and restricted cubic splines (RCS).

The cohort (mean age 72.79 ± 7.84 years; 41.5% male) demonstrated graded mortality reductions with increasing TyG-BMI quartiles. Compared to Q4, Q1 (lowest TyG-BMI) had significantly higher mortality at 90 days (58.70% vs. 48.45%; p = 0.008) and 365 days (80.54% vs. 73.91%; p < 0.001), with similar 60-day trends (58.79% vs. 39.34%; p = 0.059). Adjusted Cox models confirmed progressively lower mortality risk in higher quartiles (365-day HR for Q4 vs. Q1: 0.74, 95% CI: 0.68-0.93). Subgroup analyses demonstrated a consistent inverse TyG-BMI-mortality association across all strata (age, cardiac function, comorbidities), with pronounced risk reduction in HFrEF (LVEF ≤40%; all-timepoint HR >1, p<0.05) and patients without prior myocardial infarction (365-day aHR 0.69 vs. 0.81 with infarction). RCS analysis identified nonlinear thresholds (TyG-BMI = 148.73 for 60-day; 163.38 for 365-day mortality), below which each unit increase conferred greater protective effects.

Lower TyG-BMI independently predicted increased short-, intermediate-, and long-term mortality in elderly patients with severe HF and T2DM. This composite index-integrating metabolic (TyG) and nutritional (BMI) dimensions-provides practical risk stratification, particularly within identified threshold ranges.