Of these nutritional indices, IA and IT are the most commonly used to assess the composition of fatty acids as they outline significant implications and provide clear evidence. EPA + DHA is commonly used to assess the nutritional quality of marine animal products. All indices have their advantages and disadvantages; hence, a rational choice of which to use is critical.Dietary fats are generally fatty acids that may play positive or negative roles in the prevention and treatment of diseases. In nature, fatty acids occur in the form of mixtures of saturated fatty acid (SFA), monounsaturated fatty acid (MUFA), and polyunsaturated fatty acid (PUFA), so their nutritional and/or medicinal values must be determined. Herein, we do not consider the classic indices, such as ∑SFA, ∑MUFA, ∑PUFA, ∑n-6 PUFA, ∑n-3 PUFA, and n-6 PUFA/n-3 PUFA; instead, we summarize and review the definitions, implications, and applications of indices used in recent years, including the PUFA/SFA, index of atherogenicity (IA), the index of thrombogenicity (IT), the hypocholesterolemic/hypercholesterolemic ratio (HH), the health-promoting index (HPI), the unsaturation index (UI), the sum of eicosapentaenoic acid and docosahexaenoic acid (EPA + DHA), fish lipid quality/flesh lipid quality (FLQ), the linoleic acid/α-linolenic acid (LA/ALA) ratio, and  FAs are generally derived from triglycerides and phospholipids, and are the main components of dietary fats. Most naturally occurring FAs have an unbranched chain of an even number (4–28) of carbon atoms. According to the number of double bonds, the FA catalogue includes saturated fatty acids (SFAs), monounsaturated fatty acid (MUFA), and polyunsaturated fatty acid (PUFA).Fatty acids (FAs) are organic acids with at least one carboxyl (–C(=O)OH, –COOH, or –COFAs are distributed to cells where they serve as fuel for muscular contraction and general metabolism. As biological compounds, FAs play critical roles in human metabolism, health, and disease. Epidemiological studies and clinical trials showed that fatty acids are associated with cardiovascular diseases ,2,3,4,5,FAs play positive or negative roles in the prevention and treatment of diseases. For example, SFAs may increase the risk of developing multiple sclerosis (MS) as well as disease progression, whereas PUFAs may have beneficial effects in MS patients . As anotIn this mini-review, we collated the literature related to fatty acid profile analysis that was published in recent decades since 2000 to understand the implications and applications of various nutritional indices. We did not consider the classic indices such as ∑SFA, ∑MUFA, ∑PUFA, ∑n-6 PUFA, ∑n-3 PUFA, and n-6 PUFA/n-3 PUFA. The present review may help researchers to evaluate the nutritional value of fatty acids and to explore their potential usage in disease prevention and treatment. It may also help newcomers to the field of fatty acid profile analysis to quickly and accurately select appropriate indices.In this review, we screened articles and summarized the nutritional indices. The results are shown in PUFA/SFA is an index normally used to assess the impact of diet on cardiovascular health (CVH). It hypothesizes that all PUFAs in the diet can depress low-density lipoprotein cholesterol (LDL-C) and lower levels of serum cholesterol, whereas all SFAs contribute to high levels of serum cholesterol. Thus, the higher this ratio, the more positive the effect. cis (oleic acid), the most common MUFA in dietary food increases the activity of low-density lipoprotein receptors (LDLRs) and decreases the cholesterol concentration in serum [All that was missing was MUFA. According to Dietschy’s study on dietary FAs and their regulation of plasma LDL-C concentrations in 1998, C18:1 n-9 in serum . Not allin serum .Notably, not all of the main classes of PUFA positively affect the prevention of cardiovascular disease (CVD). Short-term supplementation with docosahexaenoic acid (DHA)-rich fish oil may modulate the activity of peroxisome proliferators-activated receptor-gamma (PPAR-γ) to protect the cardiovascular system from the unhealthy effects of atherosclerotic lesions . Recent Gracilaria changii), meat (0.11–2.042), fish (0.50–1.62), shellfish (0.20–2.10), and dietary products (0.02–0.175). Chan and Matanjun determined the FA profiles of red seaweed Gracilaria changii a mangrove area of Malaysia, and used PUFA/SFA to assess the nutritional quality, finding a value of 6.96 ± 0.98 [PUFA/SFA is the most commonly used index for evaluating the nutritional value of dietary foods such as of seaweed  was developed by Ulbritcht and Southgate in 1991, and characterizes the atherogenic potential of FA . As the The IA indicates the relationship between the sum of SFAs and the sum of unsaturated fatty acids (UFAs). The main classes of SFAs, which include C12:0, C14:0, and C16:0, with the exception of C18:0, are considered pro-atherogenic  ,68,113. trans fatty acids was not considered due to conflicting evidence [Although the IA is more reasonable than the simple PUFA/SFA ratio for assessing the degree of atherogenicity, there are still some imperfections in the proposed IA formula, which were pointed out by Ulbritcht and Southgate. First, stearic acid (C18:0) should appear in the denominator if sufficient evidence shows that it can reduce the level of LDL-C in human blood plasma in the future. Second, not all PUFAs should be weighed equally. Third, the impact of evidence .Penaeus notialis) using the IA as an index, and reported values of 0.71 to 0.82 [The IA has been used widely for evaluating seaweeds, crops, meat, fish, dairy products, etc. Nantapo et al. analyzed the fatty acid composition of milk during different stages of lactation and found that milk with lower IA is important, and the IA ranges from 4.08 to 5.13 in different stages of lactation . Akintol to 0.82 . Detailed information about the literature related to the IA is shown in The index of thrombogenicity (IT) was developed by Ulbritcht and Southgate  togethertrans fatty acids increases. The IT characterizes the thrombogenic potential of FAs, indicating the tendency to form clots in blood vessels and provides the contribution of different FAs, which denotes the relationship between the pro-thrombogenic FAs  and the anti-thrombogenic FAs (MUFAs and the n-3 and n-6 families) . TherefoSargassum seaweeds, where the IT was used as one of the nutritional indices to evaluate the potential effects of four Sargassum on CVH. The results showed that the IT was between 0.46 and 1.60 [Lupinus albus  and the IT was used due to the correlation between fatty acids and human health [The IT has been used in many FA composition studies to assess the degree of thrombogenicity. Chen et al. conducted comparative studies on the fatty acid profiles of four different Chinese medicinal and 1.60 . Calabròn health . Gracilaria salicornia, which had an IT value of 5.75 [Detailed information of the literature related to the IT is provided in  of 5.75 . The ranIn brief, both the IA and the IT can be used to assess the potential effects of FA composition on CVH. A FA composition with a lower IA and IT has a better nutritional quality, and its consumption may reduce the risk of coronary heart disease (CHD), but no organization has yet provided the recommended values for the IA and IT. As our comprehensive understanding of the function of FA molecular species deepens, the accuracies of the IA and IT formulas are expected to increase, which might be modified by taking advantage of the massive amount of available data and advanced computer technology.The hypocholesterolemic/hypercholesterolemic (HH) ratio is an index used in the FA profile of lamb meat first proposed by Santos-Silva et al. in 2002 . Due to cis-C18:1 and PUFA) and hypercholesterolemic FA. Because there was no C12:0 detected in the lambs, Santos-Silva et al. concluded that the formula only includes C14:0 and C16:0 in hypercholesterolemic FA. Later, Mierliță optimized the formula by adding the C12:0 in hypercholesterolemic FA during the studies of sheep milk [Basic on research about dietary FA and the regulation of plasma LDL-C , the HH eep milk . The forCompared with the PUFA/SFA ratio, the HH ratio may more accurately reflect the effect of the FA composition on CVD. The HH ratio has certain limitations. Similar to the IA and IT, the HH might include more kinds of fatty acids such as other molecular species of MUFA and different weights can be assigned to different molecular FA species., and other fields [Camelina sativa) oils using the HH as a nutritional quality index. A relatively high HH was reported, ranging from 11.7 to 14.7, with a low IA and IT contributing to a decrease in the incidence of CHD [The HH was first used in research on ruminants ,77,91, wr fields ,48,52,62r fields . Ratusz Loxechinus albus. It is possible that the main food source of Loxechinus albus is algae, leading to a high proportion of SFA, so its HH is only 0.21, lower than in other species [Opisthonema oglinum, which has an HH value of 0.87 [Detailed information about the literature related to the HH is shown in  species . For fis of 0.87 . For meaThe health-promoting index (HPI) was proposed by Chen et al. in 2004 to assess the nutritional value of dietary fat , which fThe HPI is the inverse of the IA. It is currently mainly used in research on dairy products such as milk ,93,94 anThe UI indicates the degree of unsaturation in lipids and is calculated as the sum of the percentage of each unsaturated FA multiplied by the number of double bonds within that FA . The calUnlike ∑UFA and ∑PUFA, different unsaturated FAs have different weights in the UI. This index indicates the impact of highly unsaturated FA and does not ignore the impact of FAs that have a low degree of unsaturation. In general, the UI more comprehensively reflects the proportion of FA with different degrees of unsaturation in the total FA composition of a species.The UI is commonly used to determine the composition of macroalgal FA. It can be used as a standard for judging the content of high-quality PUFA, in which macroalgae may be used as alternative sources of high-quality PUFA instead of fish or fish oil . ColomboDetailed information about the literature related to the UI is listed in EPA and DHA are n-3 long-chain PUFAs that play essential roles in biological processes in the human body. They can reduce the risk of CVD, hypertension, and inflammation. DHA is a critical component of the retina and the neuronal system and is involved in visual functioning and cognitive functioning in humans ,116. The13C-ALA as a part of their habitual diet. The results indicated that the subjects had a limited capacity to convert ALA to EPA, and 13C-labeling of DHA was not detected [EPA and DHA can be synthesized from α-linolenic acid in the human body, but exogenous supplementation is still needed when insufficient. α-linolenic acid  can be converted to EPA and DHA by desaturase and elongase, respectively. EPA and DHA can be supplemented by ingesting ALA. Burdge et al.  studied detected . Brenna detected . Althougdetected . TherefoEPA + DHA is an index that is recognized worldwide. Recommendations for EPA + DHA intake can be found in various dietary guidelines. According to the Food and Agriculture Organization of the United Nations (UN FAO), the recommended amount is 0.250–2 g/day. Due to the low EPA and DHA contents in terrestrial plants and animals, this index is mostly used to evaluate the nutritional value of seafood and seafood products, particularly fish, which makes it an important nutritional index for seafood. Rincón-Cervera et al. studied the fatty acid composition of fish and shellfish captured in the South Pacific, and the results showed that EPA + DHA ranged between 115.15 and 1370.67 mg/100 g in all studied fish species and between 63.61 and 522.68 mg/100 g in all studied shellfish species . DetaileFLQ was originally use for fish lipid quality ,108 or fSparus aurata) harvested in different seasons using FLQ as the lipid quality index. FLQ was lowest in April [FLQ is more suitable for marine products given their higher proportions of EPA and DHA. This index may be considered a supplement to EPA + DHA since the absolute quantity for EPA and DHA is more important. Until now, FLQ has only been used to assess the quality of lipids in fish. Senso et al. examined the fatty acid profile of the fillet of farmed sea bream /α-linolenic acid  ratio was developed for guiding infant formula. LA and ALA compete for the same desaturase and elongase enzymes, which they use to synthesize long-chain unsaturated fatty acids. Due to the low conversion rate of ALA, reducing the LA/ALA ratio only provides a modest improvement in the levels of some n-3 long-chain PUFAs; however, the balance may be the most important factor when long-chain PUFAs are not present in infant formulas. The Definitions & Nutrient Composition section of the Guidelines for Infant Formula published by Food Standards Australia New Zealand (FSANZ) sets the minimum and maximum proportions of LA and ALA, and specifies an LA/ALA ratio within 5:1–15:1.The LA/ALA ratio has a higher reference value when judging the nutritional value of baby food and infant formula. Tissues of adults have a lower rate of synthesis of n-3 long-chain PUFAs than those of infants, so the LA/ALA ratio in the diet does not have too much of an impact on adults. In the literature we reviewed, the LA/ALA ratio was used in research on ruminants and dairy products as well ,55,109. cis configuration. However, trans fatty acid (TFA) is present in the human diet as well. According to the Food and Drug Administration (FDA), TFA is defined as the sum of all unsaturated fatty acids that contain one or more isolated  double bond(s) in a trans configuration [trans-MUFA or trans-PUFA. Trans-PUFAs have at least one trans double bond and may therefore also have double bonds in the cis configuration. Conjugated fatty acid (CLA) is separated from TFA as an independent section by the EFSA. CLAs may have health benefits that are different from those of TFAs, such as anti-cancer [Most unsaturated FA in the human diet have a guration ,119. Thei-cancer ,121 and i-cancer  activitiAccording to the EFSA, TFAs may originate from various sources, including of bacterial conversion of unsaturated fatty acids in the rumen of ruminants, industrial hydrogenation , deodorization of unsaturated vegetable oils  with a high content of polyunsaturated fatty acids (a necessary step of refining), and heating and frying oil at excessively high temperatures (>220 °C) . Trans-MUFA is the most common TFA in the human diet. A few clinical trials with normotensive subjects proved that trans-MUFA from hydrogenated oil has no effect on systolic or diastolic blood pressure [TFA does not play a positive role in any vital functions. On the contrary, the intake of TFA may harm human health. Evidence suggests that ruminant-derived TFA has similar adverse effects on blood lipids and lipoproteins as TFA from industrial sources. Sufficient evidence is still needed to reveal whether a difference exists between equivalent amounts of ruminant and industrially produced TFA in terms of risk of CHD . Trans-Mpressure . Prospecpressure .trans fatty acid to as low as possible by limiting their consumption of foods that contain synthetic sources of trans fats. There is no need to eliminate meat and dairy products that contain small quantities of natural TFA from the diet. In the United Kingdom, the recommended intake of TFA is less than 2% of total daily energy or 5 g/day.According to population nutrient intake goals from the World Health Organization (WHO)/FAO, the intake of TFA should constitute less than 1% of total energy. For pregnancy and lactation, the lowest possible intake of industrially-produced TFAs is required. According to the EFSA, TFA in the diet is provided by several sources that contain essential FAs and other nutrients , TherefoCarassius gibelio) fillets with and without skin; the share of TFA was the same in both types [The TFA index is currently used in seaweed , lamb 4, milk 7, fish 3, and plath types . Mishra th types . The resth types . DetaileIn this review, we summarized 10 FA indices that have been commonly used in the literature to characterized FA composition. Among them, PUFA/SFA, IA, IT, HH, HPI, and UI are the most frequently used indices and are widely used to evaluate a variety of research materials, mainly related to CVH. PUFA/SFA is a basic index that simply considers ∑PUFA and ∑SFA. IA, IT, HH, HPI, and UI were derived based on revising PUFA/SFA, which consider the contribution of different molecular species of SFA, as well as MUFA. However, all of these six indices do not reflect the influence of different molecular species of PUFA. For instance, n-3 PUFA and n-6 PUFA exhibit different effects on CVH. EPA + DHA and FLQ are used in the analysis of fish or shellfish, which are rich in n-3 PUFA. The LA/ALA ratio is an important index for baby food and infant formula. TFA is an indicator of food safety because it has a negative effect on many vital functions. Due to the lack of systematic integration of clinical evidence and literature data related to FA, suggesting ideas and proposals for the update of indices is difficult. Besides, CVH is the main assessment of FA indices used at present. As FA functions continue to be revealed, more indices that can be used for other diseases are expected. With the present review, we aimed to help researchers evaluate the nutritional value of FAs and to explore their potential usage in disease prevention and treatment, and to help newcomers to the field of FA analysis to quickly and accurately select appropriate indices. The human body is complex, so a reasonable selection of indices can help researchers to more comprehensively evaluate the research materials. The purpose of using an index is only to assess the potential nutritional and/or medicinal value of the research materials; they should not be considered gold standards. The indices should not be used indiscriminately, and the results obtained with the indices should be interpreted with caution. After a reasonable assessment using the indices, a more systematic and complex research process should be used to reach a conclusion about the nutritional effect of the research object on the human body. We recommend that researchers apply these indices to help compare several research objects to select one or more objects of interest for further in-depth research.


Burnout and compassion fatigue are closely related concepts. Burnout is thought to develop from occupational stress while compassion fatigue results from being in a caregiver role leading to inability to get engaged in a caring relation. The objective of the current study was to investigate research trends, themes, citations, and key players of publications on burnout and compassion fatigue among healthcare providers.A validated search query was developed and implemented in the Scopus database. The study period was all times up to 2019.n = 248; 5.6%) and the UK . Mayo Clinic was the most active institution  followed by Harvard University  and University of Washington, Seattle . A total of 16,108 authors participated in publishing the retrieved documents, an average of 3.6 authors per article. Shanafelt, T.D. was the most active author  followed by Dyrbye, L.N. , and West, C.P. . A total of 472 (10.7%) articles declared funding.Research query found 4416 publications. Publications started in 1978. Steep growth in the number of publications was observed in the last decade. There were seven research themes in the retrieved publications; six for burnout and one for compassion fatigue. Approximately 36% of the retrieved publications were about nurses; 36% were about physicians, 10% were about medical residents and the remaining did not include a specific profession. The retrieved publications received an average of 22.2 citations per article. Four of the top 10 active journals were in the field of nursing and two in the field of general medicine, one in public health, one in neurology, one in psychology, and one was multidisciplinary. The USA ranked first with 1292 (29.3%) articles followed by Spain (The current study was carried out to draw attention to the wellbeing of healthcare providers. Retrieved literature was dominated by high-income countries. Lack of information from low- and middle-income countries will hinder planning for interventional strategies and will negatively affect the health system and the patients. Health researchers in low- and middle-income countries need to focus on burn out and compassion fatigue. Burnout (BO), the opposite of wellbeing, is defined as an emotional and behavioral impairment in response to the prolonged and high level of exposure to occupational stress , 2. BurnPhysicians, nurses, and other healthcare providers are subject to high levels of occupational and psychological stress. For example, healthcare providers have to deal with death issues, to observe patients’ sufferings, to cope up with the demands of patients’ families, to make ethical decisions, to make critical and quick life-saving decisions, to adjust and endure the long working hours and night shifts, and to adapt to under-staffing or conflict issues in a certain country , 16–20. A substantial volume of literature on BO and CF has been published in a wide range of jobs and professions including nursing, physicians, residents, neurologists, psychotherapists, surgeons, orthopedics, paramedics, and others. According to the Global Citizen website, investing in healthcare workers is one of 13 most pressing global health issues for the coming decade . The WorSciVerse Scopus, owned by Elsevier, was used for the merits it has over other databases. Scopus is the largest scientific database available. It has more than 23,000 indexed journals in all disciplines. It is 100% inclusive of Pubmed and it has almost double the number of journals indexed in Web of Science . Scopus The search query was developed based on keywords related to BO and CF with keywords related to healthcare workers/professionals. The search was carried out using the title search to avoid irrelevant publications. The keywords used were obtained from the basic definitions of BO and CF. Examples of keywords related to BO and CF included the followings: “burnout”, “burn - out”, “compassion fatigue”, “burning out”, “burn out”, “occupational stress”, “professional *stress”, “emotional *stress”, “emotional exhaustion”, “secondary trauma*”, “vicarious trauma*”, “psychological *stress”, “empathy”, “physical exhaust*”, “depersonalization”, “feeling* of cynicism”, detachment, “depletion of energy”, “wellbeing”. The quotation marks were used to indicate the specific keyword or phrase while asterisk was used as a wild card to retrieve similar terms. Examples of keywords or phrases related to healthcare providers included: health*, nurs*, physician, doctor, pharmac*, “healthcare”, “medical”, resident, clinician*, paramedic, hospital, “ICU”, emergency, surgeon, orthopedic, residency, surgical, oncology, neurology, neurologist, “medicine”, oncologist, psychiatrist, midwife, clinic. These keywords were followed by an exclusion step. In the current study, all documents on medical or nursing students were excluded since the focus was on healthcare providers and medical or nursing students are not yet an official healthcare provider. The current study was limited to journal publications. Therefore, books, book chapters, and conference abstracts were all excluded. The study period was defined as all times until 2020. Supplementary material 1 is a flow chart of the search query while Supplementary material 2 is the exact keywords used in each step in the flow chart.Shanafelt, T.D.; Dyrbye, L.N.; and West, C.P. were among top 10 active authors and were used in the validation step by comparing the number of publications retrieved for each one of them  with the actual number of relevant publications present in their personal Scopus profile. This process was carried for the top 10 active authors and yielded a significant and strong correlation  between the number of publications retrieved and the actual numbers present in active authors’ profiles. This validation step was adopted from previously published articles on research analysis [The search query was finalized based on certain validation criteria. Therefore, the search query was fine-tuned until the validation criteria were met. The criteria included the absence of any false-positive (irrelevant) publication in the top 200 cited publications and the absence of false-negative (missing publications) publications. The search query utilized title search and therefore the presence of false-positive results was minimum. The use of certain phrases such as “depletion of energy” was associated with certain false-positive results. To avoid this, a certain constraint was added with the phrase “depletion of energy”. The constraint was the presence of the keyword “burnout” or “compassion fatigue” in the abstract of the publications having the phrase “depletion of energy” in the title. Validation for the absence of false-negative results (missing data) was carried out using the profile of most active authors in this field. In the current study, analysis .The validated search query was applied in the advanced search function using appropriate Boolean operators and the retrieved publications were exported to programs used for data analysis and presentation. The exported data to Microsoft Excel included annual growth of publications, subject areas of the retrieved publications, types of publications, languages, countries involved in publishing the retrieved publications, journals, authors, institutions, funding, and citations. A “CSV” file of all publications was exported from Scopus to VOSviewer for mapping purposes.The following scientific indicators were presented: the annual growth of publications, the top 10 active countries, the top 10 active institutions, the top 10 active authors, the top 10 cited publications, map of most frequent terms and author keywords, and top 10 active journals.n = 3564; 80.7%) was the most common type followed by review articles , letters , notes , editorials , and conference papers . Of the 33 different languages encountered in the retrieved publications, English was the most common  followed by Spanish , French , German , Portuguese , and Italian .The search query found 4416 publications. There were eight different types of documents in the retrieved publications. Research articles  followed by nursing subject area , psychology subject area , social sciences , biochemistry/genetics/molecular biology , and business, management and accounting .Most of the retrieved documents were published within the subject area of medicine . The map showed seven overlapping clusters representing specific research themes in the retrieved publications. The clusters included a research theme (yellowish-green cluster) about compassion fatigue, palliative care, cancer, and oncology. A second research theme (light blue) was about occupational stress, coping, and social support. The third research theme (orange) was about stress, anxiety and depression. The fourth research themes (red) was the largest and focused on burnout, resilience, mindfulness, wellbeing, empathy, residents, and quality of care. The fifth theme (blue) was about the physician’s burnout and Maslach Burnout Inventory (MBI). The sixth theme (light purple) focused on professional burnout, nursing, and mental health. The seventh theme (green) focused on burnout, nursing, personality, job satisfaction, and quality of life.Author keywords with a minimum occurrence of 50 times were mapped Fig. . The keyBased on title analysis, the retrieved publications included 1594 (36.0%) documents about nurses/nursing, 1634 (37.0%) about physicians/doctors/clinicians, 418 (9.5%) about medical residents, 42 (1.0%) about pharmacists/paramedics, and 768 (17.4%) about healthcare workers/providers/staff/employees in general and without reference to a specific profession. There was an overlap in certain documents because they discussed BO and CF among more than one profession. The total number of documents based on the title search for professions did not add up to 4416. There were at least 106 (2.4%) documents in which the title did not have any of the professions or terms listed above.Journal of the American Medical Association (JAMA) in 2002 [Annals of Internal Medicine and concluded that “Burnout was common among resident physicians and was associated with self-reported suboptimal patient care practices” [JAMA and two were published in Annals of Surgery.The retrieved publications received 98,016 citations, an average of 22.2 citations per article. The top-cited article was published in the Journal of Advanced Nursing . Four of the top 10 active journals were in the field of nursing, two in the field of general medicine, one in public health, one in neurology, one in psychology, and one was multidisciplinary. Mapping active journals for bibliographic coupling showed that articles published in journals related to neurology, psychiatry, psychology, and medicine had similar citation pattern while articles published in journals related to nursing, public health, and psycho-oncology had similar citation pattern  and the UK . The top 10 active countries were distributed geographically in Northern America, Latin America, Europe, and the Western Pacific region (Table Authors in the top 10 active countries contributed to publishing 2868 (64.9%) articles. The USA ranked first with 1292 29.3%) articles followed by Spain  followed by Harvard University  and University of Washington, Seattle . The top active list of institutions included seven academic institutions and three clinical institutions  followed by Dyrbye, L.N. , and West, C.P. . Six of the top 10 active authors were from the USA, two from Spain, one from Australia and one from the Netherlands.Sixteen thousand one hundred eight authors participated in publishing the retrieved documents, an average of 3.6 authors per publication. A total of 820 (18.6%) documents were single-authored. The top 10 active authors were listed in Table n = 52; 1.2%) was the most active funding sponsor followed by Agency for Healthcare Research and Quality in the USA , and Mayo Clinic in the USA .A total of 472 (10.7%) published articles declared funding. The National Institutes of Health in the USA  used in assessing the prevalence of burnout. The MBI has been extensively used since its introduction in 1981 [The current study showed the presence of several themes in the retrieved publications. One of the themes is the  in 1981 . The MBI in 1981  and is n in 1981 . In the  in 1981 . Several in 1981 , 44. A t in 1981 , 46. Int in 1981 , 47, 48.The current study indicated that approximately 36 and 46% of the retrieved publications were about nurses and physicians respectively. If we exclude publications on medical residents (~ 10.0%), the percentage of publications on burnout or CF among nurses and physicians would be equal (~ 36%). Studies on BO among nurses were mainly published in few specialized nursing journals. In contrast, documents on physicians were published in a wide range of journals including general medicine, health services, surgery, public health, psychiatry, and health management. This is one possible reason for the presence of four specialized nursing journals in the top 10 active journals.The current study indicated that high-income countries in North America and Europe dominated the list of active countries, institutions, and authors. This was expected given the gap in research capabilities and funding between these countries and other ones in low- and middle-income category. The high number of publications in these countries does not mean that the prevalence of burnout or compassion fatigue among healthcare providers is higher than that in other countries. It might be the opposite. The work load of healthcare providers in low- and middle-income countries is high given the limited number of physicians and nurses in these countries. Furthermore, the lack or inadequate technology in some low- and middle-income countries adds the burden of documentation and follow up for healthcare providers in these countries. The limited resources and the volatile political and economic situations in many of these countries add up to the stress among healthcare workers in these countries. The limited number of publications from low- and middle-income countries could be attributed to lack of research experts, funding, or absence of an observatory health body concerned with the efficacy of the health system and satisfaction of the patient with reasonable cost –52.In the current study, the average number of citations per document was higher than that reported for other medical topics such as epidermal parasitic skin disease , AIDS-reThe current study gave an overview of BO and CF documents published in peer-reviewed journals. There are a few similar previously published documents. For example, a study on CF was carried out using Web of Science database  while anThe current study has a few limitations. Despite the tremendous effort to include all relevant terms and the validation process, the presence of missing data or false-positive results remains a possibility. Efforts have been done to minimize errors through different validation approaches. There many health-related journals in low- and middle-income countries that are not indexed in Scopus. Therefore, the research activity from certain regions in the world was underestimated due to the limited number of national journals from those regions indexed in Scopus.The current study was carried out to analyze research trends, research themes, active key players, and citations of publications on BO and CF. The recent rapid growth in the number of publications and the high citation pattern are important signals for the necessity of intervention policies and programs at all levels to manage this issue. The idea that little information is available from many low- and middle-income countries might be mistakenly understood and research in this field is important in every country to determine risk factors and appropriate intervention strategies.Additional file 1. Flow diagram of study selection using Scopus database.Additional file 2. Keywords and phrases used in the search strategy.


It is difficult to present a single definition of physical therapy because physical therapy is defined in different ways in various countries, depending on the length of education required and legal circumstances. However, the World Federation of Physical Therapists defines physical therapists as “persons engaged in healthcare related to providing functional enhancement, damage prevention, rehabilitation treatment, intervention, and recovery service, while maintaining and developing motion and functional capabilities when individuals’ movements and functional capabilities are impaired by age, damage, disease, disability, environmental factors, etc.” . The KorTo cope with the changing healthcare environment, it is necessary to investigate the essential competencies in the clinical practice of physical therapists and to reflect these results in the physical therapy training process. Therefore, in this study, we aimed to provide basic data for the training of physical therapists and policy development by analyzing perceptions of the importance of physical therapists’ competencies and the frequency of the utilization of those competencies.Informed consent was obtained from all participants.This was a survey-based descriptive study.We surveyed licensed physical therapists in Korea who had clinical experience in physical therapy using a Google questionnaire on mobile devices and PCs. A total of 296 (99.0%) of the 299 subjects responded to the survey questionnaires from September 16, 2019 to September 30, 2019 . The chaThe survey items consisted of 4 areas: basic medicine (30 questions), diagnosis and evaluation (38 questions), interventions (43 questions), and other competencies (9 questions) including communication capabilities, professional education and development capabilities, and health personnel’s ethical and interpersonal capabilities . The 120The data were analyzed using SPSS for Windows ver. 15.0 . Frequency analysis was conducted to identify the general characteristics of the research subjects, and repeated-measures analysis of variance (ANOVA) was performed to analyze the differences in the importance and frequency of utilization of competencies according to the 4 categories . To examine the statistical significance of differences in scores according to category, a follow-up test was conducted using the least significant difference (LSD) method. The statistical significance level was set at 0.05.diff]=0.30, P<0.01), other competencies versus interventions , and other competencies versus diagnosis and evaluation  , with the following mean and standard deviation (SD) scores: diagnosis and evaluation (4.45±0.48), interventions (4.42±0.50), other competencies (4.36±0.52), and basic medicine (4.06±0.50 ) . The LSD P<0.01) .diff=0.30, P<0.01), other competencies versus interventions , and other competencies versus diagnosis and evaluation   .Previously, physical therapy in Korea focused on treatment using basic medical techniques using physical materials, such as electricity, light, water, air, sound, and exercise therapy, as well as various instruments and machines, due to the limitations of the medical system wherein interventions are conducted under the guidance of doctors . HoweverAs the role of Korean physical therapists is based on the International Classification of Functioning, Disability, and Health, which integrates the individual and social models of disability, should be taken to identify the multidimensional effects of disease, social participation, and health status. In addition, appropriate treatment interventions and measures should be presented according to the results of analyses using more diverse approaches. Therefore, it is estimated that the frequency of utilizing competencies in the diagnosis and evaluation category and in the category of other competencies  was higher than that of the competencies in the category of interventions . Among tIt is necessary to increase the proportion of credits in university education for diagnosis and evaluation–related competencies, which were recognized to be highly important and frequently utilized, as shown in this study, and to develop evaluation criteria that can enhance physical therapy capabilities by reflecting these considerations in the standards for national examination questions.


Though the domains of physical health, psychological health and environment showed a significant association with the academic performance of students, the social domain had no such relationship. The overall quality of life has a positive connection with the academic performance of students in medical and health professions. Therefore, universities and all stakeholders involved in health professions need to play a critical role to ensure the students in health professions maintain a high QOL. At the same time, there is a great need for extra attention for students who showed poor academic performance in the previous semester to bring them on track.Quality of life (QOL) is a broader concept which represents experiences, states, appraisals, behaviors, capacities and emotional reactions to circumstances. The study aimed to evaluate the differences in various domains of QOL among the students of five schools  and an optometry unit in the Faculty of Medical Sciences, Trinidad and Tobago. Further, the study evaluated the factors (sociodemographic variables and academic performance) predictive of physical, psychological, social and environment domains of quality of life. The research tool consisted of a validated questionnaire which had two sections; (1) sociodemographics inclusive of students’ cumulative grade point average and (2) the shorter version of WHO quality of life (WHOQOL-BREF). The data were transformed into a linear scale and exported into the IBM SPSS version 24 where t-tests, one-way ANOVA and stepwise regression were performed. Of the total 535 participants, most 383 (71.6%) were females. While comparing the differences in the domains of QOL that existed based on the schools (professions) they were enrolled, significant differences were recorded for physical ( WHO defstudents . The lowstudents ,9. In thAre there any differences in the domains of QOL based on students studying in different schools/unit?Are the domains of QOL as a dependent variable associated with the sociodemographic variables inclusive of GPA of students of Faculty of Medical Sciences, The University of the West Indies, St Augustine?The research questions of the study were as follows:The study was conducted among the students of the Faculty of Medical Sciences (FMS) at The University of the West Indies, St. Augustine, Trinidad and Tobago. A convenience sampling method (a type of non-probability sampling) was used where participants were selected because of their convenience, ease of accessibility and nearness to the researcher . The incThe study sample composed of students currently enrolled in any of the five schools,  and 383 were females (71.6%). Each participant’s questionnaire was assigned a number code to ensure the anonymity of participants and the confidentiality of the obtained information.The questionnaire consisted of two sections; (1) sociodemographics and (2) the shorter version of WHO quality of life (WHOQOL-BREF). The sociodemographic part included age, gender, marital status, school of study, nationality, ethnicity, family type and the number of siblings. It also included the respondents’ cumulative grade point average (CGPA), which was used to measure academic performance.The second section consisted of the shorter version of WHOQOL-BREF, which comprises of 26 items and measures four domains: physical health, psychological, social relations and environment . The toot-test was performed to find out any difference between male and female students in the domains of QOL. One-way ANOVA was performed to determine the differences in the domains of QOL based on students enrolled in different professional programs followed by the Bonferroni post hoc test. A p-value less than or equal to 0.05 was set as the threshold for statistical significance. The correlations between variables were calculated using Pearson correlation coefficients. A stepwise regression model was developed, with sociodemographic, students studying in different schools and GPA as independent variables and the QOL scores of four domains as dependent variables, to assess the adjusted relationship between the QOL and independent variables.The data collected was imputed into an excel sheet and then exported into the IBM SPSS Statistical software version 24. Frequency analysis was performed on the demographics to determine the number of participants and their variables such as age, gender, marital status, school, nationality, ethnicity, GPA, family type and the number of siblings. Student’s A total of 535 students from the FMS responded to the questionnaire . Most ofp = 0.05) among male students (53.84 ± 23.47) compared to female students (49.16 ± 25.52). Similarly, a significant difference was found between male and female students for the environment domain as well (p = 0.03).p < 0.05), psychological (p < 0.05) social (p < 0.05) and environmental domains (p < 0.05). Comparison of the mean score of students from different schools of FMS in the domains of QOL is shown below ; psychological domain: MBBS and pharmacy, MBBS and nursing, MBBS and optometry, dental and optometry, veterinary and pharmacy, veterinary and nursing, veterinary and optometry, pharmacy and optometry, nursing and optometry (p < 0.05); social domain: veterinary and pharmacy; environmental domain: MBBS and dental, MBBS and veterinary, MBBS and nursing, MBBS and optometry (p < 0.05).Bonferroni post hoc test for ANOVA shows a significant difference in the physical domain: MBBS and dental, dental and veterinary, dental and pharmacy, dental and nursing, dental and optometry (p < 0.05), school  and GPA , were shown to be significant predictors of QOL—physical domain. For QOL—psychological domain, the regression analysis identified five independent variables, marital status , ethnicity , nationality , siblings , and GPA  were shown to be the significant predictors. For QOL social domain, marital status  and family type  were identified as significant predictors. In further regression, GPA , ethnicity , family type , age  and school  were shown to be significant predictors of QOL—environmental domain. Of the four regression models reported in Pearson correlation coefficients were calculated to find out the correlations between variables . Furtherp = 0.05) domain of the WHO-QOL-BREF questionnaire. Males were found to have a markedly higher mean score than females in the domain of social relations. This is comparable to the Brazil study that also found males to have considerably greater mean scores in three out of the four domains evaluated, including the domain of the social relations [The findings that medical students were more frequent victims of academic stress than non-medical students were expected, considering the more intensive study demands compounded by other background problems in a medical program compared to other programs. While the WHOQOL-BREF QOL scores for both males and females showed that the highest mean was seen in the environment domain, the social domain presented the lowest mean scores, which is contrasting to a Brazil study  which stelations . A studyelations . In contelations  are moreelations . Additiop < 0.05), psychological (p < 0.05) social (p < 0.05) and environmental domains (p < 0.05). In the physical domain, Optometry students had the highest mean score (65.59) followed by veterinary medicine (63.57) and medicine (MBBS) (62.21) students. Whereas in psychological and social domains, Pharmacy students had the highest mean scores (72.62) and (60.83) followed by Nursing students (70.98) and (57.23). Further, concerning the environmental domain, MBBS students had the highest mean score, followed by the students from Pharmacy and other schools. Our findings are similar to those of several studies from India [While comparing the differences in the domains of QOL existed based on the students studying in different schools of FMS, significant differences were recorded with respect to physical  62. studentsom India ,23,24.In the stepwise regression analysis for physical, psychological, social and environmental domain of QOL , the indFor QOL—psychological domain, the regression analysis identified five independent variables, marital status, ethnicity, nationality and siblings were shown to be the significant predictors. Additionally, the academic performance of students is significantly associated with the psychological domain. Few other studies ,27 have p < 0.05 level. In further regression, ethnicity, family type, age and school were shown to be significant predictors of QOL—environmental domain. Research from Pakistan [For QOL—social domain, marital status and family type were identified as significant at the Pakistan  comparedPakistan  reportedPakistan . Of the Pakistan . A studyPakistan  in the CIn summary, the WHOQOL-BREF proved to be an excellent and reliable tool in this study of QOL. The domains of physical, psychological health and environment showed a significant correlation with the academic performances of students while social domain did not show any in our study. The overall QOL has a relationship with the academic performance of health professions students and thus educational institutes, universities, ministries of higher education and all stakeholders involved in medical and health professions education has a pivotal role in maintaining high QOL of students in health professions.


Background. Recent worldwide estimates are of 53 million users of opioids annually, and of 585,000 drug-related deaths, of which two thirds are due to opioids. There are considerable international differences in levels of drug death rates and substance abuse. However, there are also considerable variations within countries in drug misuse, overdose rates, and in drug death rates particularly. Wide intra-national variations characterize countries where drug deaths have risen fastest in recent years, such as the US and UK. Drug deaths are an outcome of drug misuse, which can ideally be studied at a relatively low spatial scale . The research literature suggests that small area variations in drug deaths to a considerable degree reflect contextual (place-related) factors as well as individual risk factors. Methods. We consider the role of area social status, social cohesion, segregation, urbanicity, and drug supply in an ecological regression analysis of county differences in drug deaths in the US during 2015–2017. Results. The analysis of US small area data highlights a range of factors which are statistically significant in explaining differences in drug deaths, but with no risk factor having a predominant role. Comparisons with other countries where small area drug mortality data have been analyzed show differences between countries in the impact of different contextual factors, but some common themes. Conclusions. Intra-national differences in drug-related deaths are considerable, but there are significant research gaps in the evidence base for small area analysis of such deaths. The United Nations Office on Drugs and Crime (UNODC) estimates that there are 53 million users of opioids annually and that 585,000 people die annually worldwide (as a contributory or direct cause) due to drug misuse . Two thiThere are considerable international differences in drug misuse prevalence, drug use patterns, and drug-related death rates. For example, the recent upturn in drug deaths in the US and Canada has been linked to growing use of fentanyl, a synthetic opioid with potentially lethal effects at low doses . By contVariations in drug-related deaths within countries are also pronounced and generally less well documented. Research into reasons for such variations is also relatively limited. Where data are available, they show wide disparities. For example, drug overdose mortality rates in US states 2017 data) vary 7-fold, from 8.1 per 100 thousand in Nebraska to 57.8 per 100 thousand in West Virginia . In Scot data varAs discussed in the literature on risk environments ,9, such In some ways, the contextual–compositional distinction may be reductionist, and recognition of broader influences on individual behaviours is needed ,13. For Below, we discuss in more detail the main themes in the research literature on small area variations in drug-related deaths and summarize the findings of the ecological (area-based) studies on the factors associated with such variation. As an illustrative example of the issues involved, we then consider variation in drug deaths between 3141 US counties during the period 2015–2017. We use a Bayesian regression method )The urban status of small areas may also be relevant to drug-related deaths. The broader literature on drug deaths suggests that drug-related mortality may be lower in rural areas, especially after area socio-economic status is allowed for . Urban physical environments may affect levels of drug abuse and drug deaths ,37, e.g.Supply side factors may also influence drug death levels, with higher mortality associated with easier access. For example, Monnat  investigThe US has had one of the world’s fastest growth rates in drug-related deaths generally and opioid-related deaths in particular. Drug deaths involving any form of opioid—prescription opioids, other synthetic opioids (such as fentanyl), and heroin—rose from 18,515 in 2007 to 47,600 in 2017, before declining slightly to 46,802 in 2018. The majority (around 70%) of deaths were among males. The age-standardized rate for all drug-related mortality rose from 6.1 per 100,000 in 1999 to 21.7 in 2017 .We consider a regression relating drug-related deaths in US counties between 2015 and 2017 to area characteristics. Drug deaths were defined with ICD10 codes X40–X44, X60–X64, X85, and Y10–Y14 . SpecifiWe also study whether regression coefficients vary over the USA. If there were such variability, then this would be an example of geographic heterogeneity. Classical methods to investigate this include geographically weighted regression ,48, wherSpatial correlation in relative risks of drug deaths is to be expected ,52, and 1 to X7, postulated as risk factors for drug deaths. We consider two alternative specifications for X1, the variable used to measure employment opportunities. The first specification uses the 2016 county unemployment rate, while the second uses the percent point difference between unemployment in 2016 and in 2006. There are seven variables, X2 serves both as an indicator of area socio-economic status and a measure of within county income disparities. It is an index of concentration at extremes, abbreviated as ICE [i − (t.low)i]/Ti, where Ti is total households in county i, (t.high)i is the number of households with incomes over $150,000 and (t.low)i is the number of households with incomes below $15,000. The highest and lowest scores on this index are for Loudoun (Virginia) and Holmes county (Mississippi), respectively. This variable was found to be a clearer measure of area socio-economic status in the regression than county poverty rates. Xd as ICE , obtaine3 is a measure of social capital based on the index of Rupasingha et al. [4 is a measure of urban-rural status, namely the 2010 Census proportion of county population living in rural areas. X5 is a measure of racial-ethnic segregation from the County Health Rankings ; this is an index of dissimilarity where higher values indicate greater residential segregation between non-white and white county residents.Xa et al. . X4 is a6 and X7 are measures of drug availability and supply and are at state level. X6 is an indicator of illicit supplies of fentanyl [7 is a measure of legal opioid prescribing [Xfentanyl  calculatfentanyl . X7 is ascribing , though scribing . As notescribing , prescriWe use the program WINBUGS  (MRC BioThe risk factors listed in The highest coefficients (in absolute terms) are for social capital and area income disparities (high vs. low income groups). High levels of social capital in a county reduce the risk of drug-related death, and the same applies to counties with high percentages of households with incomes over $150,000 and/or low percentages of households with incomes under $15,000. Remaining risk factors all have significant effects  but have lesser impacts than social capital and area income contrasts.As discussed above, we can assess the extent of spatial clustering in risks of drug-related deaths. A simple summary of spatial clustering is provided by Moran’s I , obtainRegarding Bayesian estimation of LISA clusters, as part of the estimation process, we can determine which counties have an over 95% probability of being high risk  for drug-related mortality. Similarly, we can determine which areas have a more than 95% probability of being high risk cluster centers; that is, not only is the county itself a high risk area but so also is the set of counties adjacent to it. This is a “high mortality area near high mortality” in the terminology of Wilt et al. . AnalogoHigh risk counties near other high risk counties account for the majority (429 out of 585) of high risk counties. There are a relatively small number of counties (125) which are spatial outliers, namely high risk themselves but surrounded by counties which are not definitively high or low risk. There is also a small number (31) of high-low counties, where a high risk county is surrounded by low risk areas. There is evidence from other studies that rates of drug-related death are elevated among males . Here, wWhen geographic heterogeneity in covariate impacts is allowed for (in the better fitting unemployment model), we find a major gain in fit, with the WAIC reduced to 18,329. It can be seen that the average effects of unemployment and segregation are attenuated as compared to Analysis of small area contrasts in drug-related deaths has raised differing themes according to the country where research takes place. In the US, where there is extensive ecological research into drug-related deaths, different phases  have been identified ,65. Thus, Zoorob  highlighIn terms of implications for intervention and funding, drug law enforcement , and druThe clustering analysis in our US study is conditional on a particular regression model. In this model, relative risks of drug death in different US counties are modeled as a function of income disparity within counties, job availability, social capital, levels of rurality, racial segregation, and measures of supply. None of these risk factors have a predominant influence. By contrast, many explanations are predominantly uni-causal. For example, the “deaths of despair” concept places a strong emphasis on the loss of traditional employment opportunities.Regarding the research evidence on employment availability, a number of US studies find unemployment, or unemployment increases, to be associated with drug-related mortality or related outcomes ,67, and However, the analysis here, while finding unemployment, and increases in unemployment, to have a significant influence on raising drug-related deaths , does not show an overwhelming impact for these variables. Rather, factors such as social capital, income levels, race segregation, and drug supply are also important. An urban bias to US drug-related deaths is also confirmed. Thus, the evidence here is of a set of relevant area risk factors, as against a uni-causal explanation.Support for a more nuanced multifactorial explanation of US trends is provided by recent overviews ,70,71, sThe same relevance of social environment is true of other high-income countries where ecological studies of drug death have been carried out. A study of drug deaths in Scotland , where dThe analysis in this paper has had to allow for a relatively high rate of missing data . The counties affected are mainly rural counties with small populations. One strategy  is to omPronounced intra-national variations in drug-related mortality parallel international differences; see, for example, the studies ,76 on CaThe present study on US small area variations supports a multifactorial explanation, with area income levels (and income disparity within areas) and social capital as paramount influences. Rurality is also a significant influence and has a negative impact when other area risk factors are controlled for . The analysis here downplays the impacts of unemployment or unemployment change, especially when geographic heterogeneity in predictor impacts is allowed for in a spatially varying coefficients model. We also find a considerable geographic skew in the location of high risk clustering in the US .The analysis is subject to certain limitations. The first, and one that must always be acknowledged with regard to ecological (area) studies, is that causal influences regarding individual health risk factors cannot be inferred from ecological studies. On the other hand, there is strong evidence that place  effects per se, and interactions between individuals and environments, are relevant to explaining geographic variations in drug deaths ,79. A further caveat to making international comparisons in contextual effects is that the international evidence base on contextual variation in drug-related mortality is relatively limited. There are considerable research gaps in the small area study of drug-related deaths, with the great majority of studies being for the US. Other caveats with regard to the US analysis concern especially the available data. First, and as noted by , “the me


Some of the current challenges faced by the food industry deal with the natural ripening process and the short shelf-life of fresh and minimally processed products. The loss of vitamins and minerals, lipid oxidation, enzymatic browning, and growth of microorganisms have been the main issues for many years within the innovation and improvement of food packaging, which seeks to preserve and protect the product until its consumption. Most of the conventional packaging are petroleum-derived plastics, which after product consumption becomes a major concern due to environmental damage provoked by their difficult degradation. In this sense, many researchers have shown interest in edible films and coatings, which represent an environmentally friendly alternative for food packaging. To date, chitosan (CS) is among the most common materials in the formulation of these biodegradable packaging together with polysaccharides, proteins, and lipids. The good film-forming and biological properties  of CS have fostered its usage in food packaging. Therefore, the goal of this paper is to collect and discuss the latest development works (over the last five years) aimed at using CS in the manufacture of edible films and coatings for food preservation. Particular attention has been devoted to relevant findings in the field, together with the novel preparation protocols of such biodegradable packaging. Finally, recent trends in new concepts of composite films and coatings are also addressed. Recently, it was estimated worldwide that more than 66 million tons of petroleum-based plastics were manufactured specifically for food packaging, including trays, cups, and bottles . The manChitosan (CS) is a natural biopolymer derived by deacetylation (N-acetyl-D-glucosamine to D-glucosamine unit) of chitin see , which h2) that are positively charged [2 groups, with other molecules, such as metals, surfactants, proteins, and polyanions [CS is a viscous polysaccharide that forms more structured gels when its MW increases; furthermore, it is considered as a pseudoplastic material since its viscosity is a function of concentration, temperature, and rate of shear . The sol charged . Dependi charged . CS can lyanions .Bioactivity is defined as the ability of a material to chemically interact with compounds, microorganisms, or pathogens . The bio2 groups in the alkaline medium [The intrinsic properties can be modified by varying the temperature and time of exposure when CS is in dispersion . The ante medium ,20. CS ce medium , and some medium , howevere medium . RegardiAccording to the insights documented by several authors, the antibacterial effect of CS on prokaryotic cells  depends on the electrostatic interactions between the biopolymer and bacterial cell wall components , altering stiffness and eventually entering into the cell . The antThanks to its demonstrated bioactivity, CS has become an alternative in post-harvest food treatment to control the decomposition and extend shelf-life by the inhibitory effect against bacteria, fungi, and viruses. One of the feasible ways of applying CS has been as a film due to its filmogenic properties , allowinEdible films and coatings are made of any biopolymeric material dispersed in an aqueous phase with additives  . Once thThe materials used in edible films and coatings must have the ability to form rigid matrices ,34, and As mentioned previously, CS is likely one of the most explored biopolymers in the manufacture of edible films and coatings. w/v)) and drying temperatures (from 2 up to 40 °C). The moisture content (from 10.8% up to 31.3%) was mainly affected by drying temperature, which means that a higher temperature conducted to a lower moisture content. The effect on the mechanical properties (such as tensile strength and elongation at break) did not show a linear relationship with respect to the variation of CS concentration and temperature; however, the highest tensile strength (656 MPa) was obtained with the highest concentration and temperature  and the highest elongation at break (42.4%) occurred with a medium concentration and lowest drying temperature , while the water vapor permeability of the CS-based films decreased gradually (from 72.5 to 0.27 × 10−11 g m−1 s−1 Pa−1) with the increase of the CS concentration. Nevertheless, Zhang et al. [w/v) influenced the increase in tensile strength (from 16 up to 28.5 MPa) and the decrease in elongation (from 10.5% down to 9.4%), while the increase in drying temperature (from 20 up to 80 °C) reduced the tensile strength (from 18.6 down to 12.2 MPa) and elongation (from 12.3% down to 9.7%). However, the authors noted that the addition of a plasticizer, such as glycerol (from 0% up to 1% w/w), decreased the water vapor permeability in CS-based films from 5 to 4.36 g·cm m−2·h−1·kPa−1 and water solubility about 25%. Interestingly, the application of a plasticizer does not always result in a beneficial factor on the mechanical and permeable properties of edible films and coatings, for example, the study reported by Farahnaky et al. [As a starting point, most of the research has been focused on evaluating different preparation conditions, incorporation of additives, polymer blending, embedding of bioactive compounds, natural extracts, among others, aiming to improve and extend the application of CS-based films and coatings. For instance, Homez-Jara et al.  evaluateg et al.  showed ty et al.  showed t−1) and noted that higher electrical intensity resulted in a greater crystallinity of the films, and consequently improved the tensile strength and elongation at break. This is, perhaps, due to the fact that the energy emitted modifies the molecule charges, allowing more physical, chemical, and hydrogen bonds between molecules, and thus a strong three-dimensional matrix is generated.The drying temperature and humidity are the main driving forces during the dehydration of materials and products ; howeverRegardless of the drying method  or the film-forming materials  , severalStaphylococcus aureus and Bacillus cereus, as reported by Kanatt et al. [To extend the application and functionality of the CS-based films and coatings, the incorporation of biologically active compounds extracted from naturals extracts into CS film formulations has been reported. The use of plants and their extracts has been carried out empirically since ancient times, particularly for the treatment of infectious diseases; however, it was later discovered that the alleviation of symptoms was linked to the antimicrobial and antioxidant activity of such bioactive molecules . Active t et al. , who addEssential oils are defined as complex mixtures of more than 300 volatile chemical compounds with low molecular weight (<1000 Da) , and theAspergillus niger and Penicillium digitatum in CS-based films by enriching with essential oils from oregano or cinnamon. While, Hafsa et al. [Escherichia coli by 474%, 1969%, and 1895% respectively, and Staphylococcus aureus by 575%, 3619%, and 2427%, respectively. Additionally, essential oils slightly decreased the water vapor permeability by 5.3%, 2.4%, and 5.0% respectively, while the water solubility was decreased by 51%, 28%, and 34%, respectively. The elongation at break was also negatively affected by 54%, 31%, and 42% respectively, but the essential oils increased the opacity in CS-based films by 601%, 272%, and 281%, respectively. When essential oils were blended in mixture, some studied properties were significantly affected; for example, the tensile strength, opacity, and water solubility decreased by about 25%, 784%, and 26% respectively, but the antimicrobial activity against Escherichia coli and Staphylococcus aureus increased by 1511% and 2089%, respectively. The inhibition is thanks to the phenolic content of essential oils since they are responsible for neutralizing reactive species and interacting with the membrane components of microorganisms by the contribution of electrons [Avila-Sosa et al.  proved aa et al.  found tha et al.  noted thlectrons ,131.Escherichia coli was not affected. Unlike Pereda’s work [As a current trend in the field, the design for tailoring single, composite, or multilayer films is a latent way of film fabrication. Pereda et al.  generatea’s work , Zhang ea’s work  reporteda’s work . In thisa’s work .In principle, the main objective of using edible films and coatings in food products pursues their preservation, serving as an alternative to conventional packaging . Of courStaphylococcus aureus, Listeria monocytogenes, and Salmonella [By keeping in mind that food spoilage is influenced by oxygen, water content, temperature, relative humidity, and pH , the phylmonella . For thi−1, as well as increased antioxidant capacity from 5% up to ~70%, which in fact was dependent on the concentration of CS and tea extract. Similarly, using strawberries as a model, Perdones et al. [Botrytis cinerea and Rhizopus stolonifer) [Apriyanti et al.  applied s et al.  proved ts et al.  covered lonifer) .Curcuma longa L. essential oil. A good interaction between the two biopolymers was improved by the essential oil addition; in general, the coatings inhibited the native flora of the fruit and concurrently extended its shelf-life for 5 days without refrigeration. Similarly, Azevedo et al. [Lippia gracilis essential oil to protect strawberries, noting that the essential oil increased the antimicrobial and antifungal effect against yeasts, molds (up to 99.8%), and psychotropic bacteria (up to 98.7%), maintaining a bacteriostatic effect on total and thermo-tolerant coliforms according to the most probable number (<3 MPN g−1).More recently, Yusof et al.  coated so et al.  used CS-By preparing a composite film, Velickova et al.  used thrListeria monocytogenes, however, simple additives and chemicals, such as lactic acid, hydrogen peroxide, lauric arginate, and sodium caprylate, have also been recognized for their effectiveness in inhibiting Listeria monocytogenes in broth and whole milk. Therefore, Brown and co-workers analyzed the further antimicrobial effect of hydrogen peroxide, lauric arginate, and calcium sulfate into CS when utilized before or after surface contamination at refrigerated storage. After evaluation, the authors concluded that such formulated films successfully controlled the growth of Listeria monocytogenes and extended the shelf-life of the cheese up to 35 days with refrigeration. Fajardo et al. [Aspergillus niger. By releasing the fungicide, a suitable inhibition of the strain was reached, controlling its growth, and the shelf-life increased from 7 days (at 25 °C) up to 37 days (at 4 °C). In previous studies, the success has been mainly attributed to the additives that synergistically improved the biological activity of CS acting against pathogenic organisms. CS also offers the possibility to be blended with protein materials, as shown by Di Piero et al. [2/Nitrogen (N2).In some other perishable products, such as cheeses and meats, the nutritional content and the water content are the most sensitive parameters during their storage since they allow the proliferation of microorganisms and the degradation of the product . In the o et al.  used CS-o et al. . Here, tTrachyspermum ammi extract.Ruiz-Cruz et al.  have verBio-packaging made from biodegradable materials is a current trend in the field of preservation of food products, however, it is still an important challenge for food technicians since the materials must meet specific requirements to protect food products. CS-based edible films and coatings have successfully demonstrated their ability to fabricate different concepts of monolayer or composite films.The ability of CS to form edible films is mainly due to its polycationic nature that allows it to work in conjunction with other biopolymers and additives. This synergy causes strong physical interactions between all the components, which reflects the improvement of the physical, mechanical, and permeability properties. In addition, the bioactive potential of CS-edible films is originated by its intrinsic properties such as antimicrobial, antifungal, and antioxidant capacities. These features make CS potentially interesting compared with other biomaterials.The evidence on CS-edible films and coatings shows that they meet the requirements to be part of the so-called "green" bio-packaging and be an alternative to synthetic packaging. However, this type of technology is highly targeted towards characteristics that must be adequate and specific for the type of food to be protected, making the area of edible films or coatings have a great potential for study. Finally, since several bioactive compounds extracted from natural sources are providing various benefits to human health, it is likely that CS will continue to be explored as a support for the incorporation of new functional edible films.Beyond the ecological aspect that CS represents within the food and packaging industries when used for "green" bio-packaging, it must be specified that it is a highly important polysaccharide due to its availability in nature to acquire it. For instance, it is believed that the global chitin and chitosan market could reach $4.2 billion by 2021 from $2.0 billion in 2016 at a compound annual growth rate (CAGR) of 15.4% , while mToday, intelligent packaging is a complex system generated mostly from petroleum-based plastics according to available development works. However, trends clearly show that bio-packaging will also improve to become part of these systems to monitor, generate, and display relevant information about the product. Therefore, the nature of CS and its compatibility with various materials make it a candidate to evolve into these new packaging technologies.


Down syndrome (DS) is associated with various congenital anomalies and metabolic alterations, such as dyslipidemias, that can lead to cardiovascular disease in adulthood. This study was designed to describe the lipid concentrations and the frequency of dyslipidemias in children with DS.The sample included 386 patients, 52.4% male. The study was carried out on children with DS, aged 2–18 years old, who were patients at the Mexican National Institute of Pediatrics between May 2016 and June 2017. Their height and weight were recorded, and their serum cholesterol, HDL cholesterol, and triglyceride levels were determined.Of the total patients included, 57.5% had some type of dyslipidemia, 32.6% isolated and 24.9% combined. The most common alteration, considering both isolated and combined dyslipidemias, was low HDL, in 45.9%, followed by hypertriglyceridemia, in 26.2%. Among those with combined dyslipidemia, high TG with low HDL-c was the most common, in 17.9%. A significant association was found between dyslipidemia and obesity, as well as between dyslipidemia and central obesity. The percentiles of lipid values are reported.The presence of an unfavorable lipid profile is common in pediatric patients with Down syndrome, especially low HDL cholesterol and high triglycerides.The online version contains supplementary material available at 10.1186/s12887-021-02542-1. Down syndrome (DS) is the most common human chromosomopathy, with a frequency of 1 in 700 live births –5. GivenA prospective, observational, cross-sectional study was designed of patients with Down syndrome, aged 2–18 years, at the Instituto Nacional de Pediatría (INP), during the period from May 2016 to June 2017. A total of 386 participants were included, of which 204 (52.8%) were male. Parents or guardians of participants provided written informed consent, and whenever possible participants themselves provided informed assent. Potential participants were excluded who had complex congenital cardiopathies, hypothyroidism under treatment, diabetes mellitus, nephrotic syndrome, chronic renal insufficiency, chronic malnutrition, or who were being treated with systemic steroids at the time.2). Waist size was measured with a tape measure on the uncovered abdomen at the midpoint between the edge of the lower rib and the iliac crest, with the measurement taken after exhalation. The instruments were calibrated, and the personnel taking the measurements were standardized. All participants fasted at least 12 h before laboratory studies, which included the following: Hematic biometry, a general urine examination, and blood chemistry were taken. Total cholesterol (TC), HDL cholesterol (HDL-c), and triglycerides (TG) were analyzed using enzymatic methods, according to the manufacturer’s specifications, with a Beckman Coulter multiplier, DxC 700 AU; LDL cholesterol (LDL-c) was calculated with Friedewald’s formula: [Height and weight of patients at the INP Down syndrome clinic are measured routinely before each visit. Weight was measured with a Tanita BC-585F Fitscan Body Composition Monitor, in underwear, without shoes, to the nearest tenth of a kilogram. Height was measured with a Harpenden stadiometer, without shoes, in cm and mm. These measurements were used to calculate body mass index  of them male. The anthropometric data and lipid values are summarized in Table 2.8% of tPeople with Down syndrome have been found to have less favorable lipid profiles than those without this condition –5. BecauThere are few studies of the frequency of dyslipidemia in Mexican children and adolescents. Bibiloni et al.,  in a stuOur results show that the most prevalent type of dyslipidemia was hypoalphalipoproteinemia (low HDL-c), in 45.9% of participants; the most prevalent of the combined dyslipidemias was high TG with low HDL-c, in 17.9%. This prevalence of dyslipidemias is greater than that reported by De la Piedra for children with DS in Chile,  althoughLow levels of HDL-c are generally associated with central obesity and are also related to tobacco use, physical inactivity, and diets low in monounsaturated fats. HDL-c is an excellent marker of the risk of arteriosclerosis and especially of coronary disease, and in a large number of epidemiological studies it is the lipid risk factor with the greatest predictive power: it is the most frequent lipid disorder in persons with premature coronary disease. When low HDL-c accompanies elevated LDL-c, that is, when the LDL-c/HDL-c quotient is greater than 5, the atherogenic risk is very high, and is doubled in the presence of hypertriglyceridemia . Commonlp = .023) and between central obesity and dyslipidemia (p = .029); we also found a positive correlation between triglyceride levels and BMI. In Mexico, Arjona-Villicaña et al., [There is no previous data on the frequency of overweight and obesity in the pediatric population with DS in Mexico. In our study, 10.6% of the participants were overweight and 4.7% obese, fewer than reported by Buonuomo et al.  the prev et al.,  in a stu et al., . Our resIn addition to having dyslipidemia and obesity, people with DS are often sedentary, malnourished, and are predisposed to diabetes mellitus: these factors should be considered potential comorbidities that increase the risk of cardiovascular disease. The increased lifespan of people with DS has also changed the incidence of chronic illnesses, which creates concern for their long-term health and in particular the appearance of non-transmissible diseases like cardiovascular atherosclerosis. In the past they were considered “free of atheromas,” but recent data from two large-scale studies of people with DS suggests that they may have a greater risk of mortality from ischemic cardiopathy and cerebrovascular disease than the general population , 20.The most convincing evidence of the grouping of risk factors in young people is from Bogalusa’s autopsy study, which reports the relationship between hyperlipidemia in childhood and increased cardiovascular risk in adulthood, as well as a greater percentage of fatty streaks on the surface of the aortic intima . These fAlthough the current guidelines for monitoring the health of children with DS emphasize the importance of preventive interventions for different conditions, there are no specific recommendations with respect to scheduled testing of the lipid profile. We suggest a systematic analysis of lipids in regular health exams from the age of 2 years, as well as specific preventive strategies including a low-fat diet, increased physical activity, and a reduction in exposure to tobacco smoke. In Table There are no data demonstrating how cardiovascular comorbidities or risk factors in children with DS can affect the incidence of cardiovascular events; long-term monitoring is thus crucial to establish whether an unfavorable lipid profile can mean an increase in morbidity and mortality as the result of cardiovascular disease.The frequency of dyslipidemia is high in children and adolescents with DS, especially of hypoalphalipoproteinemia and hypertriglyceridemia. Routine evaluation of the lipid profile is recommended in this population from the age of 2 years.Additional file 1.Additional file 2.Additional file 3.


Data was extracted from the Web of Science (WoS) platform and later bibliometric analysis performed using the “R-Bibliometrix” package. A wide range of indicators was explored to measure the quantity and quality of the publications related to diabetes from KSA.  Saudi Arabia was 28th in rank with 2600 documents . Articles were the main document type (76%). The total number of authors was 9715 from 104 countries. Three authors showed >50 publications and >100 total citations while 2 authors showed an H-index of ≥20. The USA, UK, and Egypt were other leading contributive countries in terms of corresponding authors and total citations per country. King Saud University was the major contributing affiliation followed by King Abdulaziz University. Among 865 sources, Saudi Medical Journal was the leading and consistent source over the years. Diabetes, Diabetes Mellitus, and Type 2 Diabetes were the most frequently used keywords.  This study provides a macroscopic overview of diabetes-related research output from KSA. Overall, similar identifications and trends of top authors were observed in terms of productivity, impact, international collaborations, and organizational affiliations. Generally, an increasing productivity trend was observed with the majority published in the last 5 to 10 years. Study findings can benefit relevant stakeholders to better understand the trends and performance of diabetes-related regional research. Diabetes Mellitus (DM) is considered one of the leading and rapidly growing global health issues related to both morbidity and mortality. Worldwide, more than 425 million people suffer from diabetes with a global prevalence of 8.8% among adults. Furthermore, according to the World Health Organization (WHO), diabetes has also established a role as a major cause of cardiovascular diseases, blindness, kidney diseases, and limb amputations , 2. It hChanging lifestyle is one of the major factors related to this alarming progression that includes unhealthy diet, lack of exercise, overweight, and obesity. In the last few decades, many socioeconomic variations have happened in KSA along with the trend of even more cases of diabetes found in urban as compared to rural settings. The development came with noticeable deviations in population lifestyle. Eating habits showed reduced use of fruits and vegetables along with an enlarged consumption of junk food with sugar-rich and carbonated drinks. Concurrently, scientific advancements such as automobiles, elevators, and escalators contributed to the diminution of physical activities and presumably, it has execrably contributed to the rise of diabetes .Worldwide, the diabetes-related economic burden is assumed to be around 673 billion USD . PromineHealth services improvement is known to be dependent on healthcare research , which aInterestingly, it has been reported that high-income non-Arab Middle East countries are doing better than high-income Arab Middle East countries in biomedical research . A studyAssessing diabetes-related research and publication trends in KSA might be the need of the time and may serve as a key to achieve the required readiness to cope with this rising health issue. Therefore, the purpose of our study was to analyze conducted research and available literature on WoS, relevant to diabetes from KSA. Moreover, this study also explored the distribution of diabetes research publications according to time, location, and institutions besides determining the topics taken up by researchers. In this way, research performance evaluation might assist higher authorities to better understand the situation and thus facilitate in decision-making so that strategic changes can be adapted. Bibliometrics is a gateway to evaluate such proceedings and fill the knowledge gap , 19. ThiThis was a descriptive exploratory study that is aimed at providing a snapshot to get a complete overview of diabetes-related publications from KSA. According to the World Bank, the KSA with a population of 32.94 million is considered to be among the high-income Arab countries having a gross domestic product (GDP) and gross national income (GNI) per capita of $683.8 billion and $20,080, respectively [There are numerous databases available for researchers and academicians, such as Scopus, EBSCO, Science Direct, ProQuest, and PubMed. The most relevant and commonly used database, Web of Science (WoS), was selected along with appropriate criteria, search topics, and keywords identified from the literature, to retrieve relevant documents. Although it is a Clarivate Analytics- (formerly Thomson Reuters-) maintained platform, WoS is considered the most precise and comprehensive source for scientific exploration and appraisal with the highest quality indexing. It is also assumed to be more appropriate for evaluating the research output of different regions, authors or organizations , 22. It Plans were made for this study to use a wide range of indicators that measure the quantity and quality of the publications and provide a critical picture of national and international contributions to literature related to diabetes from KSA. King Abdul Aziz University (KAU) online library and digital resources were used to access information. This research was conducted using scientometric techniques with efforts made to assure the quality of data at both initial extraction and later processing phases. The research analyzed all published documents specifically focusing on Diabetes between 2000 and 2019 in WoS. The following search strategy was used: TITLE: (“Diabet∗” OR “DM”) Refined by ADDRESS: (Saudi∗) Timespan: 2000–2019. Indexes: SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, ESCI. The use of “Diabet∗” in the above strategy means all kinds of derivatives of the Diabetes search term, such as Diabetes, Diabetes Mellitus, and Diabetic are also assessed and the records retrieved. When search was conducted using “Diabet∗” and “DM” separately from Saudi Arabia, 2592 and 38 documents were identified, respectively. All 38 documents with “DM” in the title were individually explored by two researchers independently to assess their appropriateness. Thirty-six (36) documents were found to have “Type DM I,” “Type II DM,” and/or “Diabet∗” in the title. Only two documents, an article (2016) and a meeting abstract (2006), were found to be not relevant and excluded. No language limitation was imposed. The search was done on 20th March 2020. All types of publications  were included. Data was extracted from WoS in plain text files and later bibliometric analysis at the author, source, and document levels was performed using the “R-Bibliometrix” package . The infThe total number of documents focused on diabetes research indexed in WoS from 2000 to 2019 was 314,686 from 9627 sources and >200 countries with the USA, England, China, Japan, and Germany representing around 52% and contributing 26.3%, 7.7%, 7.5%, 5.4%, and 5%, respectively. Documents were found to be related to 148 research areas and 238 WoS categories. Articles (50.5%) were found to be the leading document type followed by meeting abstracts and reviews. The total number of authors' appearances was >100,000, while the total number of group authors found was 6397 with >96% of documents not showing any groups. Around 68.5% of documents did not show any funding source, and 31%  were in the open access category. When explored for this study objective, KSA was 28th in terms of contribution with 2600 documents representing around 0.83% of the global share. Regarding the type of publications being indexed from KSA, the most common publication types in the field of diabetes research are as follows: articles, representing around 76% (1979); meeting abstracts, representing around 10.7% (278); and review papers, representing around 7.7% (201).The summary of the study is shown in In diabetes research, KSA collaborated with authors from 104 countries. The top three contributing countries other than KSA were Egypt, USA, and UK with 468, 327, and 225 documents, respectively. Around 1655 (63.7%) of the corresponding authors were from KSA followed by 149, 136, and 81 from Egypt, USA, and UK, respectively. A similar trend was observed for total citations per country with 13945, 3886, 1911, and 1429 from KSA, USA, UK, and Egypt, respectively. Around 62.6% of Saudi corresponding authors published single-country publications.Based on publication output from KSA, highly cited papers were also evaluated, and the top 20 cited documents are shown in In total, 4086 keywords and 4604 keywords plus (ID) were used. One goal of Saudi Vision 2030 is to have five Saudi universities among the world's top 200 universities . AdditioThis study provides a macroscopic overview with baseline information on diabetes-related research output from KSA. A bibliometric analysis was conducted for all 2600 published documents to assess the progress of diabetes-related research over the last two decades (2000-2019) from KSA using WoS as a source of data. Sources of these documents were around 9% of the total sources in the study scope while open access category documents were 5% from KSA, also relatively much lower than 31% among the total on the study scope globally. Generally, similar identifications and trends of top authors were observed in terms of productivity, impact, international collaborations, and organizational affiliations with few exceptions. An increasing trend in terms of numbers of publications was observed over the years with the majority published in the last 5 to 10 years. A resemblance was observed in global and KSA trends; for example, articles were the most frequent document type followed by meeting abstracts and reviews. Interestingly, the proportion of articles in KSA was much higher (76%) than the proportion of articles globally (50.5%) within the study scope.Findings show that the top three productive authors  have >50 publications, and they also have ≥1000 citations and generally higher H-index, thus displaying consistency both in terms of productivity and impact. Findings suggest that in diabetes research, KSA collaborated with authors from 104 countries comprising around half of the countries contributing globally on the topic. Nearly two-thirds of the corresponding authors were from KSA. Surprisingly, the majority (62.6%) of these Saudi corresponding authors published single-country publications, which probably suggests that more effort should be put in multicountry publications. Other than KSA, Egypt, USA, and UK contributed more corresponding authors.A relevant study conducted on diabetes mellitus research in Middle East countries found similar author collaboration trends with the UK, USA, and Germany as leading contributors .Also, a similar trend was observed for total citations per country. Nearly half of the top authors showed that their starting year of publication was within the last 10 years (2010-2019). Around 70% of the 20 top-cited documents were published in the last 10 years (2010-2019).More than 2400 institutes/organizations contributed to produce 2600 publications in the study scope. Obvious major contributors in terms of affiliations were King Saud University and King Abdulaziz University. Both universities are among the oldest and highest-ranked universities in the region. Among the top authors, Tuomilehto J showed relatively more contributions with King Abdulaziz University, while the other two authors (Abu El-Asrar AM and Al-Daghri NM) contributed with a King Saud University affiliation; interestingly, both were found to be the leading corresponding authors. Author “Al-Daghri NM” was also reported to be among the leading authors in a previous study conducted in the Middle East region . An instThe top 3 cited documents were mainly from the Nature publishing group, and all were published in the last 6 years. Remarkably, a local journal  also showed a document with >300 citations. Besides, it was also the source of one of the only 2 documents that were cited >100 times. The Saudi Medical Journal was also found to be the leading source with relatively consistent contributions over the last two decades. These findings suggest that the journal has a leading role in diabetes-related publication performance from the region. It would also be interesting to explore if such local well-reputed journals have the same standards of performance for other prevalent diseases. Diabetes, Diabetes Mellitus, Type 2 Diabetes, Type 2 Diabetes Mellitus, and Saudi Arabia were the top 5 most frequent keywords. This finding also verifies the validity of the study search strategy. Moreover, a relatively diverse and complex trend of topics was observed in the recent decade showing the evolution of more publications in various diabetes-related issues.The analysis was based on data extracted from WoS only, and this may limit the generalizability of the findings to global diabetes research productivity. Nevertheless, findings from the analysis of the most frequent keywords strengthen the validity of the study search strategy. Documents that mentioned Deanship of Scientific Research (DSR) as a funding source with no specific information for identifying and verifying organizations/universities were categorized separately, as most of the local universities have their separate Deanship of Scientific Research units. Moreover, scarcely available literature in the study context also limited the comparison with previous decades and from other sources. Secondly, limitations in WoS along with continuous changes and updates may show different publication data to be analyzed depending upon the date of search and time frame. However, metadata from other sources and time frames might be beneficial to complement this study and provide a comprehensive context on the subject.Saudi Arabia ranked 28th in terms of contribution with 2600 documents representing around 0.83% of the global share. Overall, similar trends of top authors were observed in terms of productivity, impact, international collaborations, and organizational affiliations with few exceptions. Generally, an increasing trend in terms of numbers of publications was observed over the years with the majority published in the last 5 to 10 years. Articles were found to be the most frequent document type. Findings suggest that in diabetes research, Saudi Arabia collaborated with authors from 104 countries. Nearly two-thirds of the corresponding authors were from Saudi Arabia with the majority showing single-country publications. Egypt, USA, and UK were the other leading countries contributing in terms of corresponding authors and total citations per country. King Saud University and King Abdulaziz University were major contributors. Additionally, King Saud University appeared to be the major source of funding and leading corresponding authors. The Saudi Medical Journal was the leading and consistent source over time. In conclusion, the bibliometric findings of this study can benefit relevant stakeholders and particularly researchers to better understand the performance and trends of diabetes-related research from KSA and plan with better-informed decisions with the help of these findings.