ABSTRACT This study examines the associations between intergenerational family pressure, marital dissatisfaction, marital conflict, and spousal communication constraints among married women living in joint family systems in Bhakkar, Punjab, Pakistan. Using a cross-sectional survey design, data were collected from 841 participants. Structural equation modeling indicated that intergenerational family pressure was positively associated with marital dissatisfaction and marital conflict. In addition, spousal communication constraints were significantly associated with intergenerational family pressure and statistically mediated its associations with both marital conflict and marital dissatisfaction. Grounded in Family Systems Theory and Communication Privacy Management Theory, the findings illustrate how intergenerational dynamics and boundary regulation processes are linked to marital relationships within collectivist family structures. Overall, the study enhances understanding of how cultural and familial expectations relate to communication patterns, intimacy, and marital well-being, underscoring the importance of culturally sensitive approaches to marital counseling and relationship research.

Purpose The purpose of this paper is to examine how hybrid leadership enhances employee adaptive performance in Sierra Leone’s resource-constrained banking sector, testing psychological empowerment and employee resilience as mediating mechanisms and digital transformation stress (DTS) as a hierarchical boundary condition. Design/methodology/approach The study employed a cross-sectional survey design. Data were obtained from 303 employees across 8 commercial banks in Sierra Leone. Partial least squares structural equation modelling (PLS-SEM) was employed as the analytical tool to test the hypotheses of the study. Findings Hybrid leadership was positively related to adaptive performance. Psychological empowerment partially mediated this relationship, while employee resilience did not. However, resilience positively influenced empowerment, suggesting a protective-enabling role. Digital transformation stress significantly moderated the effects of hybrid leadership on both empowerment and resilience, yet adaptive performance remained stable, indicating team-level buffering. Age – but not tenure – was a significant predictor of adaptive performance. Practical implications Banking executives and HR professionals should train and appraise leaders who can integrate transactional and transformational behaviors contextually, operationalize empowerment through bounded autonomy and strengthen team-based adaptive supports such as cross-training, shared crisis protocols and peer coordination mechanisms to sustain performance under digital stress. Originality/value This study extends Full-Range Leadership Theory to non-WEIRD, resource-constrained contexts by empirically validating configurational hybridity as a stress-responsive, resource-regulating practice. It clarifies that psychological empowerment functions as the primary motivational conduit while employee resilience serves a protective-enabling rather than direct performance-driving role. Critically, it identifies DTS as a hierarchical stressor ceiling that differentially impacts psychological and behavioral outcomes – a novel contribution to digitalization and occupational health scholarship.

Excessive use of electronic devices can cause postural changes, pain, and negatively impact generation Z adolescents' quality of life (QoL). The goals of this study were to evaluate and compare between sexes the static posture, postural self-perception, screen time, musculoskeletal pain, and QoL in generation Z adolescents. Cross-sectional study with adolescents. Postural analysis was conducted using the Software SAPo, self-reported posture, back pain, and screen time were assessed with the BackPei-CA, and QoL was evaluated using the Kidscreen-27 questionnaire. Statistical analyses included t-test or Mann-Whitney U test, Spearman's correlation, and adjusted logistic regression, with correction for multiple comparisons (p≤0.05). 408 adolescents were included (204 of each sex), with a mean age of 14.58± 1.98years (males) and 14.56± 1.84years (females). Postural assessment revealed head anteriorization and pelvic misalignment, with females showing greater head and pelvic angular deviations. No significant associations were found between cell phone use and cervical or pelvic alignment. Cell phones/tablets were the most frequently used devices, with higher daily use among females. Musculoskeletal pain was highly prevalent, particularly in the cervical and lumbar regions, and more frequent in females; however, cell phone use was not independently associated with musculoskeletal pain after adjustment. The total sample of adolescents has a goodQoL. Adolescents, especially females, showed head anteriorization and pelvic misalignments, high screen time, and self-perceived inadequate postural habits. Musculoskeletal pain was frequent and more prevalent among females, despite good quality of life. Screen time alone was not associated with postural changes or pain, indicating a multifactorial etiology.

PurposeThe present study examined associations between adjustment and job satisfaction and multiple dimensions of mattering-including general mattering, mattering at work, anti-mattering experiences, and fears of not mattering-among working adults. A secondary, exploratory aim was to examine whether mattering-related outcomes differed as a function of personal COVID-19 infection history.MethodA cross-sectional study was conducted with 60 employees working primarily from home during the COVID-19 pandemic. Participants completed self-report measures assessing mattering, well-being, depression, social media addiction, and job satisfaction.ResultsGeneral mattering was positively associated with work mattering and affective job satisfaction, whereas anti-mattering was negatively associated with work mattering, well-being, and affective job satisfaction. Well-being was positively related to both work mattering and affective job satisfaction, supporting the protective role of perceived significance in the workplace. Social media addiction was positively correlated with non-mattering and depression, suggesting that diminished perceptions of mattering may be linked to maladaptive online behaviors and poorer mental health. Exploratory independent-samples t-tests indicated that individuals with a history of COVID-19 infection reported lower general mattering, work mattering, and affective job satisfaction, and higher anti-mattering, compared with those without infection.ConclusionThe findings highlight the importance of mattering as a resource for employee well-being and job satisfaction. Experiences of anti-mattering were associated with poorer mental health and greater vulnerability to problematic social media use. Exploratory differences linked to COVID-19 infection history suggest pandemic-related stressors may negatively influence employees' sense of value and satisfaction. These results underscore the need for organizational practices that foster employees' sense of mattering, particularly during periods of disruption.

Preliminary analyses have suggested that state-level abortion policy following Dobbs v Jackson Women's Health Organization (Dobbs) may affect the health care workforce, including residency applications. To assess disparities in the residency application rate to programs in abortion-restricted states compared with programs in nonrestricted states following the Dobbs decision by gender of applicants across all medical specialties and to compare how these differences may vary by specialty. This cross-sectional study with interrupted time-series analysis used anonymized program-level residency application data from the Association of American Medical Colleges Electronic Residency Application Service (ERAS) from 2019 to 2023. Residency programs across all medical specialties with complete application data across the study period were included. The application cycle immediately prior to the Dobbs decision, 2020-2021, was the base year for analysis. New or intensified state-level abortion restrictions enacted post-Dobbs in June until October 2022, the 2023 ERAS submission deadline. The primary outcome was the disparity in application rates to programs between restricted states and nonrestricted states. The application rate was calculated as the number of applications to each program per 100 000 total applications across all programs nationwide annually. Regression models explored the interaction between the exposure and application cycles, controlling for program fixed effects, program size, applicant degree type, and in-state applicants. Among 4315 residency programs with 24 193 864 total applications (43.9% from women and 56.1% from men), the disparity in the application rate to programs in abortion-restricted states changed by -0.38 (95% CI, -0.70 to -0.05) among women and -0.56 (95% CI, -0.95 to -0.17) among men applying to residency, reflecting an absolute difference of -7833.2 (95% CI, -14 429.7 to -1030.7) applications from women and -12 789.2 (95% CI, -21 695.9 to -3882.4) applications from men to programs in abortion-restricted states. Differences were greater among abortion-related specialties, including obstetrics and gynecology, family medicine, internal medicine, and emergency medicine (-1.17 [95% CI, -1.89 to -0.45] for women and -1.54 [95% CI, -2.39 to -0.69] for men), and decreased among the most competitive specialties (ie, dermatology; neurosurgery; orthopedics; ear, nose, and throat; and plastic surgery) (-0.02 [95% CI, -0.37 to 0.40] for women and -0.13 [95% CI, -0.44 to 0.18] for men). In this cross-sectional panel analysis of residency applications to 4315 programs, the Dobbs decision was associated with a significant decrease in residency applications in abortion-restricted states compared with nonrestricted states among both women and men. These findings provide early evidence that Dobbs may be associated with state-level disparities in the overall health care training pipeline and workforce.

Over the past 2 decades, virtual reality-based neuropsychological tasks have gained traction as tools for objectively assessing symptoms of attention-deficit/hyperactivity disorder (ADHD), offering enhanced ecological validity by simulating naturalistic environments. To complement realistic settings with an ecologically valid task, we recently developed the virtual email sorting task (VEST), which immerses participants into an office environment where they sort emails while being exposed to distractors. This study examined for the first time the VEST's sensitivity to medication effects and its specificity in differentiating ADHD from other psychiatric disorders that share overlapping cognitive symptoms, such as major depressive disorder (MDD). A total of 23 unmedicated individuals with ADHD, 23 medicated individuals with ADHD, and 16 unmedicated individuals with MDD completed the VEST. During alternating distractor phases (DP) and nondistractor phases (NDP), we recorded the participants' task performance; head, torso, and leg actigraphy; eye movements; and brain activity using functional near-infrared spectroscopy (fNIRS), and subjective symptom ratings. Correlational analyses of main objective and subjective task-related parameters were computed. Data were analyzed using mixed-design ANOVAs. Processing time variability increased over time in participants with MDD and unmedicated ADHD as indicated by a group × block interaction (P=.04; η2p=0.10), while a group × phase interaction (P=.009; η2p=0.15) revealed that medicated participants with ADHD showed an increase during DP compared to NDP. Moreover, both ADHD groups exhibited increased head movements during DP compared to NDP (trend group × phase interaction: P=.09; η2p=0.08), an effect not observed in the MDD group, and higher rotation during DP in unmedicated individuals with ADHD (P<.001; η2p=0.23). Also, scores in 3 out of 4 subjective symptom intensity ratings of inattention, impulsivity, and emotional dysregulation were higher in at least 1 of the ADHD groups compared to the MDD group. No significant group differences were found in actigraphy measures of the arm and torso, fNIRS brain activity, or eye-tracking data. Regarding correlational analyses, inattention was correlated to off-task gaze (r=0.28; P=.03), hyperactivity with mean processing time (r=0.33; P=.01) and head movement (r=0.35; P=.006), and impulsivity with error rate (r=0.35; P=.006), and various significant correlations between objective parameters were found. Our findings highlight the potential of the VEST to differentiate between ADHD and MDD, as well as to detect medication-related effects within ADHD. The results underscore the value of multimodal and ecological assessment approaches with distractors in the evaluation of attentional and behavioral symptoms. The VEST may offer a standardized way to investigate complex behavior in mental disorders in research settings and, potentially, in clinical practice. However, further studies with greater statistical power are needed to confirm these findings. German Clinical Trials Register DRKS00031259; https://www.drks.de/search/de/trial/DRKS00031259/details.

ABSTRACT The contemporary characteristics of mental health disorders (MHDs) among liver transplant (LT) survivors are not well understood. We aimed to describe the prevalence of post-LT anxiety, depression or post-traumatic (PTS) diagnoses and symptoms before and after LT and explore their association with post-LT health-related quality of life (HRQOL). In a cross-sectional study, participants presenting for post-LT care completed surveys measuring HRQOL (PROMIS-29), anxiety/depression (Hospital Anxiety and Depression Scale, HADS) and PTS (Impact of Event Scale-Revised, IES-R). Participants self-reported sociodemographics and a history of MHD diagnoses and treatment and clinical data on transplant course and prior MHDs and treatment were collected. Overall, 202 patients [58% male, 89% white, median age 63 years (IQR: 54–69)] consented to participate. Median time from LT was 4.4 years (IQR: 1.4–10.0). The prevalence of anxiety or depression after LT was 30% and PTS was 7%. There was a significant difference in HRQOL in those 5+ years vs. 0–1 years post-LT (MCS scores: 49.5 ± 8.8 vs. 45.8 ± 9.3, p = 0.03 and PCS scores: 44.7 ± 9.2 vs. 40.6 ± 8.8, p = 0.02). Active symptoms of anxiety, depression or PTS after LT were noted in 25.6% LT survivors; of these, 55% patients did not have a mental health diagnosis at the time of transplant. Active symptoms of anxiety, depression or PTS after transplant were associated with significantly worse HRQOL across multiple domains after adjusting for sociodemographic and clinical variables. Anxiety, depression or post-traumatic stress are common in LT survivors and associated with poor HRQOL. MHDs represent modifiable factors to improve patient-reported outcomes in LT survivors, including in patients without MHDs at the time of transplant.

Heart Palpitations and Lifestyle Habits Among Jordanian School Children: A Cross-Sectional Study.

Health care practices rarely assess or assist patients with social risks, thereby missing a crucial aspect of medical care. To assess the prevalence of social risks among adolescents and young adults (AYAs) with and without a history of cancer within an integrated US health system. This cross-sectional study analyzed data from AYA (aged 15-40 years) members of Kaiser Permanente Northwest (Oregon and Washington) who completed a social risk screener between January 1, 2022, and December 31, 2024. Cancer history identified via electronic health records. Four patient-reported social risk domains (financial hardship, food insecurity, housing instability, and transportation difficulties) were assessed as binary (yes or no) indicators. A composite binary variable was created to reflect the presence or absence of any social risk. Descriptive statistics and multivariable logistic regression models were used to compare prevalence and identify associated factors. Of 96 127 AYA patients (6.2% aged 15-19 years, 37.4% aged 20-29 years, and 56.4% aged 30 to 40 years; 63.3% female; 13.0% identifying as Hispanic, 63.4% as non-Hispanic White, and 23.6% as non-Hispanic other race and ethnicity), 1239 (1.3%) had a history of cancer, and these patients compared with those without cancer were older (aged 30-40 years, 82.6% vs 56.0%), were more likely to be female (81.4% vs 63.1%) and non-Hispanic White (74.3% vs 63.3%), and had more comorbidities (8.8% vs 3.9%). No significant differences were observed in household income, education level, or neighborhood deprivation between groups. Thirty percent of patients with cancer and 33% without cancer reported experiencing at least 1 social risk. Financial hardship was the most common issue, followed by food insecurity, housing instability, and transportation difficulties. Higher odds of social risks were observed among patients aged 20 to 29 years (odds ratio [OR], 1.58 [95% CI, 1.54-1.63]) and those with 3 or more comorbidities (OR, 1.79 [95% CI, 1.67-1.92]), prior medical financial assistance (OR, 2.10 [95% CI 1.99-2.22]), or identifying as Hispanic (OR, 1.14 [95% CI, 1.09-1.19]). Lower odds were found among female patients (OR, 0.91 [95% CI, 0.88-0.94]), commercially insured patients (OR, 0.32 [95% CI, 0.31-0.34]), longer Kaiser Permanente Northwest membership (OR, 0.99 [95% CI, 0.99-0.99]), and residents of less-deprived neighborhoods (neighborhood deprivation index [NDI] quartile 1: OR, 0.65 [95% CI, 0.62-0.67]; NDI quartile 2: OR, 0.74 [95% CI, 0.71-0.77]; NDI quartile 3: OR, 0.81; 95% CI, 0.78-0.84). This cross-sectional study found that regardless of cancer history, AYA patients may experience a high burden of social risks. These findings support the need to routinely assess and address social risks in AYA populations to improve equity in health care. Future research should investigate the association of social risks with health care use and long-term outcomes.

Prevalence, patterns, and associated factors of psychoactive substance use among people living with HIV in Lomé, Togo : a cross-sectional study.

BackgroundGut microbiota plays an essential role in metabolic and immune functions, and its composition is influenced by diet and probiotic intake. The Mediterranean diet (MD) improves microbiota diversity and health outcomes. However, the association between microbiota awareness, MD adherence, and probiotic consumption among adults is underexplored.AimThis study aimed to examine the relationship between MD adherence, microbiota awareness, and probiotic consumption among adults aged 18-64 years in the central district of Kırklareli, Türkiye.MethodsA cross-sectional survey was conducted with 420 individuals familiar with the term "probiotic." Data were collected via face-to-face interviews using a structured questionnaire including sociodemographic data, dietary habits, physical activity, anthropometrics, probiotic use, the Microbiota Awareness Scale (MAS), and the MD Adherence Scale. Descriptive and inferential statistics were used.ResultsAmong participants, 45% showed high MD adherence. Higher MAS scores were observed in females, those aged 26-35, with normal BMI, or prior nutrition education. Regular probiotic consumers had significantly higher MD adherence (p = 0.011) and MAS scores (p = 0.000). A weak but significant correlation was found between MAS and MD adherence (r = 0.120, p = 0.014). Awareness of probiotic microorganisms and consumption for digestive, immune, or cancer-related benefits were also associated with greater MAS and MD scores.ConclusionMicrobiota awareness is positively associated with probiotic consumption and MD adherence. Increasing microbiota literacy could potentially inform future dietary education strategies.

Associations Between Dietary Patterns, Inflammatory Biomarkers, and Behavioral Symptoms in Children With Autism Spectrum Disorder: A Cross-Sectional Case-Control Exploratory Study.

Despite biomedical explanations for diseases being increasingly accepted in sub-Saharan Africa, traditional African explanatory models of illness remain widespread. This study sought to understand local explanatory models for illness and patient experiences with different traditional health practitioners (THPs) among a population of rural women in Limpopo, South Africa. This was a cross-sectional qualitative study in which eighty-two in-depth interviews were conducted, and the data were thematically analysed. Study findings indicate that 68% of participants believed illnesses can be caused by bewitchment, and these diseases were often considered too taboo to even be discussed. High percentages of participants also believe that THPs can cure illnesses that medical doctors cannot treat. Additionally, several illnesses were identified related to traditional practices and cultural beliefs, which can only be cured traditionally, via THPs. While the hospital/clinic is often first approached, its failure to resolve illness can often be seen as a sign of the spiritual origin of the ailment. This study is a pre-context for more research around biomedical/traditional medicine collaborations.

ABSTRACT This study aimed to investigate the association between frailty and self-neglect and to examine the mediating roles of social networks and depression in this relationship among community-dwelling older adults. A cross-sectional descriptive design was employed, with a sample of 521 individuals aged 60 years and older recruited from community settings between July 2021 and February 2022. Analyses were conducted using IBM SPSS Amos 21.0. Structural equation modeling revealed that physical frailty (PE = 0.054) and cognitive frailty (PE = 0.148) were directly associated with self-neglect, as well as indirectly linked through pathways involving social networks and depression. In contrast, overall frailty, psychological frailty, and social frailty exhibited only indirect associations with self-neglect, operating exclusively through these mediators. These findings underscore the importance of early identification of frailty and targeted interventions to strengthen social networks and address depressive symptoms, which may significantly improve the management of self-neglect and enhance well-being in aging populations.

Nursing education emphasizes theory, skills, and literacy, but nursing students have insufficient learning engagement. Smartphone addiction may affect learning engagement via psychological mechanisms, and pathways of action need to be explored. A cross-sectional research design was used, and the study population was undergraduate nursing students. Data were collected through the Smartphone Addiction Scale-Short Version, Utrecht Work Engagement Scale for Students, Athens Insomnia Scale, and State Self-Control Capacity Scale. Partial least squares structural equation modeling was used to analyze the mediating mechanisms. Smartphone addiction was significantly negatively correlated with learning engagement (r = -.428, p < .001); insomnia (β = -0.145) and self-control (β = 0.232) acted as independent mediators between the two, with a chain mediating effect also present (β = -0.03, p < .001). The chain mediation of insomnia and self-control explains how smartphone addiction impairs learning engagement, highlighting the need for targeted interventions to enhance nursing education quality.

To evaluate the impact of applying the International Diabetes Federation (IDF) 1-hour plasma glucose (1h-PG) criteria on diagnosing dysglycaemia in young Chinese adults with obesity, and to validate the metabolic basis and diagnostic performance of these criteria in this high-risk population. This Cross-Sectional Study Included 2484 Obese Individuals (Aged 18-40 Years, BMI ≥ 28 kg/m2). Participants underwent a 75-g oral glucose tolerance test (OGTT). Glycaemic status was classified using both traditional American Diabetes Association (ADA) criteria (fasting and 2-hour PG) and the IDF criteria (1h-PG cutoffs: 8.6 mmol/L for intermediate hyperglycaemia, 11.6 mmol/L for diabetes). Insulin sensitivity, secretion and β-cell function indices were calculated. Reclassification patterns were assessed, and the diagnostic accuracy of the 1h-PG cutoffs was evaluated using receiver operating characteristic (ROC) curve analysis against the ADA criteria. Applying IDF criteria doubled the prevalence of diabetes (from 12.0% to 22.7%) and significantly increased total dysglycaemia. This newly identified dysglycaemic population exhibited an intermediate metabolic phenotype with worsening insulin resistance and impaired early-phase β-cell function. ROC analysis demonstrated excellent diagnostic accuracy for the IDF diabetes cutoff (11.6 mmol/L; AUC 0.927), which matched the population-optimal cutoff. The cutoff for intermediate hyperglycaemia (8.6 mmol/L) showed high sensitivity (86.8%) for detecting ADA-defined prediabetes. The IDF 1h-PG criteria uncover a substantial, previously unrecognised burden of dysglycaemia in young Chinese adults with obesity, supported by clear metabolic defects and strong diagnostic performance. These findings support the use of 1h-PG as a practical tool for earlier risk stratification in this vulnerable population.

Bipolar disorder (BD) is a chronic and heterogeneous condition associated with global and specific cognitive deficits, including but not limited to impaired executive function, memory, and processing speed. As cognitive impairment represents a therapeutic target, this systematic review aims to synthesize available evidence investigating the association between clinical markers of illness progression and cognitive decline in adults with BD. A systematic search was conducted in PubMed, OVID (PsycINFO), and Scopus from inception to September 27, 2025. Eligible studies included adults (≥ 18years) with BD (I, II, or mixed) that reported a direct comparison between subgroups of illness progression markers (illness duration and/or number of moodepisodes). Theprimary outcome was cognitive function assessed by validated neuropsychological tests. Eligible study designs were cross-sectional, longitudinal, case-control, cohort, or baseline clinical trial data. Available evidence from cross-sectional studies suggest that a higher number of mood episodes or longer illness duration was associated with decreased cognitive function, particularly in domains of executive function and verbal/visual memory. In contrast, several longitudinal studies reported no significant change in cognitive outcomes over time in persons with BD relative to healthy controls. Findings on the influence of illness progression markers on cognitive decline in BD is mixed. Future research should prioritize large-scale longitudinal designs and integrate biomarker and neuroimaging methods to investigate underlying mechanisms that may contribute to cognitive worsening in individuals with BD.

Diagnostic uncertainty is an important, yet understudied, driver of patient safety within pediatric emergency medicine. Understanding how uncertainty is experienced and communicated may reveal opportunities to optimize patient safety. This study aims to determine the frequency of physician-reported uncertainty at emergency department (ED) discharge for pediatric acute respiratory illness and to describe strategies and challenges in communicating uncertainty to caregivers. This was a cross-sectional study of children (<18y) discharged with acute respiratory illness from a tertiary care pediatric ED (April to May 2025). For each patient, the discharging attending physician completed a survey assessing diagnostic uncertainty (6-point Likert scale, dichotomized for analysis), and whether and how this was communicated to caregivers. Physicians indicated their general overall comfort communicating uncertainty. Wilson CIs were calculated around the prevalence of visits with uncertainty. Among 220 patients with acute respiratory illness, 68 (31%, 95% 25 to 37%) were discharged with diagnostic uncertainty. Uncertainty was communicated to 61 caregivers (90%) in the following ways: using terms such as "maybe," "probably," or "likely" (74%), provision of return precautions (59%), discussion of the differential diagnosis (56%), and discussion of diagnoses excluded (27%). Many (45% of 60 physicians surveyed) reported communication challenges, citing perceived caregiver expectations, anxiety, and risk communication concerns. Diagnostic uncertainty occurred in nearly one-third of ED discharges for pediatric acute respiratory illness. Communication approaches varied, and several challenges were noted. Future research engaging clinicians and families is needed to address these challenges and develop optimal methods of family-centered communication of uncertainty.

Cardiometabolic diseases (CMDs), including cardiovascular diseases (CVD), type 2 diabetes mellitus (T2DM), and metabolic syndrome, are major global health concerns. In Hungary, CVD mortality remains above the OECD average, and diabetes prevalence is increasing. This study examines the association between sociodemographic and lifestyle factors and the risk of CMDs among Hungarian adults, using population-based data collected between 2009 and 2019. A repeated cross-sectional design was used to analyze data from the European Health Interview Survey (EHIS) in Hungary for the years 2009, 2014, and 2019 (n = 16,480). CMD was defined as self-reported diagnosis of both CVD and diabetes. Weighted proportions, Pearson's chi-squared tests, and multiple binary logistic regression models were applied to identify associations between CMD and sociodemographic (sex, age, education, employment, income, residence), behavioral (BMI, smoking, alcohol use), and clinical risk factors (hypertension, hypercholesterolemia). Predicted probabilities were estimated using marginal effects. Prevalence of CMD fell by 27% in 2019 (OR = 0.73 [0.57-0.94], P = 0.013), with predicted probability declining from 5.6% to 4.1%. Younger age (< 35: OR = 0.01, P < 0.001; 35-64: OR = 0.68, P = 0.002), female sex (OR = 0.65, P < 0.001), and employment (OR = 0.32, P < 0.001) were protective. CMD risk was higher in urban areas (OR = 1.44, P = 0.048), alcohol users (OR = 1.35, P = 0.004), those with hypertension (OR = 3.83, P < 0.001), hypercholesterolemia (OR = 3.10, P < 0.001), mental illness (OR = 1.49, P = 0.027), and depression (OR = 1.63, P = 0.001). Normal BMI reduced risk (OR = 0.48, P < 0.001). The prevalence of CMD in Hungary decreased between 2009 and 2019, indicating progress in prevention and risk factor management. However, disparities persist among older adults, men, and urban residents. Targeted screening, lifestyle interventions, and mental health support are essential to strengthen the management of cardiometabolic diseases.

Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system often accompanied by psychological comorbidities such as depression and anxiety, which may aggravate physical disability. This study aimed to assess the relationship between depression, anxiety, and disability among patients with MS in western Iran. A cross-sectional analytical study was conducted among 180 MS patients attending the Boustan MS Clinic in Kermanshah, Iran. Participants completed the Persian versions of the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Disability was evaluated using the Expanded Disability Status Scale (EDSS). Data were analyzed using Spearman correlation and stepwise multiple regression. The mean age of participants was 41.33 ± 9.09 years, and 75% were female. The mean EDSS score was 3.28 ± 1.56, BDI score 19.87 ± 10.21, and BAI score 13.28 ± 9.96. Depression and anxiety were significantly correlated with disability (r = 0.404 and r = 0.399, respectively; p < 0.01), and with each other (r = 0.702, p < 0.01). Regression analysis showed that depression alone explained 17.6% of disability variance, which increased to 36.2% when anxiety was added. Lower education level and positive family history of MS were associated with higher psychological distress. Depression and anxiety are common and strongly associated with greater physical disability in MS patients. Integrating psychological assessment and intervention into MS management may help improve functional outcomes and quality of life.