Background: Low back pain (LBP) is a prevalent health issue that imposes heavy burdens on personal health status and social healthcare. Dynamic Neuromuscular Stabilization (DNS)/Vojta therapy has demonstrated effectiveness in managing conditions related to musculoskeletal system. However, its effects on individuals with LBP remain incompletely understood. We aimed to evaluate the effects of DNS/Vojta therapy on pain intensity and physical function in individuals with LBP.
Methods: A search of studies was conducted on several academic databases from inception through April 13, 2023. This study included clinical trials that evaluated the effects of DNS/Vojta therapy on the outcomes in individuals with LBP. The methodological quality of studies was assessed using PEDro scale, Cochrane Collaboration tool, and ROBINS-I scale. Meta-analysis was performed using Review Manager software (RevMan version 5.4.1, The Cochrane Collaboration, 2020).
Results: This systematic review and meta-analysis identified twelve eligible studies, which demonstrated that DNS/Vojta therapy significantly alleviated pain intensity (SMD=-1.09; 95%Cl [-1.74, -0.44]; Z=3.28; P=0.001), reduced disability severity (SMD=-0.91; 95%Cl [-1.48, -0.34]; Z=3.12; P=0.002), and improved quality of life (SMD=1.05; 95%CI [0.14, 1.96]; Z=2.27; P=0.02) in individuals with LBP, while no significant improvements were observed in static and dynamic balance ability or spine flexibility.
Conclusion: DNS/Vojta therapy is a promising approach for providing great benefits for individuals with LBP, particularly in terms of reducing pain intensity and disability severity, and improving quality of life, which is worth further in clinical application.

Background: Type 2 diabetes mellitus (T2DM) is associated with a wide range of health outcomes, including an increased risk of depression and anxiety and a decline in quality of life. Even though the significance of biopsychological factors in the mental health status of T2DM patients has been discussed in other studies, the role of environmental factors has been lacking. Therefore, this review aimed to identify the relationship between environmental factors and mental health status among T2DM patients.
Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews was utilized in this study. Using predetermined keywords, a systematic search was conducted on three electronic databases from 2005 to 2023, namely, Web of Science, Scopus, and PubMed. Articles written in English, and studies focusing on the research question are among the inclusion criteria. Ten articles were extracted that were relevant to the research question.
Results: Poor socioeconomic status, urban areas, the influence of neighborhood, greenness, and air pollution had associations with mental health status among T2DM patients.
Conclusion: The possible implications of these factors for mental health demand further research and policy consideration.

Background: Phosphorus metabolism might be associated with tumor initiation and progression. We aimed to screen out the phosphorus metabolism genes related to bladder cancer and construct a clinical prognosis model.
Methods: The dataset used for the analysis was obtained from TCGA database. GO and KEGG enrichment analyses were subsequently applied to differentially expressed genes. Consensus clustering was utilized, and different clusters of the tumor immune microenvironment and other features were compared. The phosphorus metabolism-related genes involved in prognosis were screened out by univariate Cox regression, LASSO regression and multivariate Cox regression analysis, and a nomogram was constructed. The performance of the nomogram was validated using TCGA dataset and the GEO dataset, respectively.
Results: Overall, 405 phosphorus metabolism-related differentially expressed genes from TCGA database were identified, which were associated with phosphorylation, cell proliferation, leukocyte activation, and signaling pathways. Two clusters were obtained by consistent clustering. After tumor immune microenvironment analysis, significant differences in immune cell infiltration between cluster 1 and cluster 2 were found. Four phosphorus metabolism-related genes (LIME1, LRP8, SPDYA, and MST1R) were associated with the prognosis of bladder cancer (BLCA) patients. We built a prognostic model and visualized the model as a nomogram. Calibration curves demonstrated the performance of this nomogram, in agreement with that shown by the ROC curves.
Conclusion: We successfully identified four phosphorus metabolism-related genes associated with prognosis, providing potential targets for biomarkers and therapeutics. A nomogram based on these genes was developed. Nevertheless, this study is based on bioinformatics, and experimental validation remains essential.

Background: We aimed to examine how electroacupuncture and manual acupuncture affect treatment results, pain levels, and joint function in individuals with knee osteoarthritis.
Methods: Research was carried out in various databases including PubMed, Medline, Embase, CENTRAL, and CNKI. Following the "Cochrane manual", the risk of bias of included RCTs was assessed. A funnel plot was utilized to evaluate any potential bias in the publications. The impact size was indicated by the average discrepancy along with its 95% confidence interval.
Results: The EA group showed a higher effectiveness rate (P = 0.001) and a lower WOMAC pain score (P < 0.00001) compared to the control group. The EA group had a lower WOMAC pain score compared to the SA/exercise group and the group that received manual acupuncture. The WOMAC pain score was significantly lower in the EA group compared to the manual acupuncture group under intense electroacupuncture stimulation (P < 0.0001). The WOMAC pain score was significantly lower in the EA group compared to the manual acupuncture group when weak current acupuncture was applied (P = 0.0001). However, no significant difference in WOMAC function score between EA and control group.
Conclusion: Comparison to manual acupuncture, placebo acupuncture, and exercise training, electroacupuncture enhanced the effectiveness of treating KOA and decreased the WOMAC pain score in patients with KOA. The level of pain relief achieved may be linked to the strength of the current stimulation. However, electroacupuncture had no significant effect on WOMAC function score.

Background: The global SARS-CoV-2 pandemic has disrupted health systems and put a huge strain on hospitals and healthcare workers. Prioritizing COVID-19 patients in hospitals caused irreversible harm to cardiac patients. Although multiple studies have shown that ST-segment elevation myocardial infarction (STEMI) patients have worse admission circumstances than before the pandemic, the hospital outcomes of these patients have remained limited. This systematic review and meta-analysis examined STEMI patient outcomes during the COVID-19 epidemic.
Methods: We conducted systematic searches of MEDLINE (through PubMed), Web of Science, Scopus, and Embase through Jan 10, 2021. All studies with reporting in-hospital mortality, length of stay, and door-to-balloon time with over twenty participants were included. Articles without clear definitions or results were excluded. The study followed PRISMA guidelines. The outcomes of interest were door-to-balloon time, death, and hospital stay during COVID-19 pandemic compared prior.
Results: Our meta-analysis included 12 studies and 21170 people (115-6609). The pooled analysis showed significantly more pandemic mortality (OR=1.24; 95% CI: 1.07-1.43). Ten studies (13,091) recorded door-to-balloon times. Door-to-balloon time (in minutes) significantly increased during the pandemic (Standardized Mean Difference [SMD]= 0.46; 95% CI: 0.03-0.89). The length of hospital stay was reported by five studies (n=9448). Length of hospital stay (in days) was not significantly longer during the pandemic than before the outbreak (SMD= 0.04; 95% CI: -0.19-0.26).
Conclusion: The COVID-19 pandemic is associated with increased mortality and door-to-balloon delay that might be attributable to the strict infection control measures in outbreak. Studies with a longer follow-up time are needed to investigate the outcomes of STEMI patients.

Background: Inflammatory bowel disease (IBD) patients who cease anti-tumor necrosis factor (TNF) therapy are at risk of relapse, which is a matter of concern for the medical community. This study aimed to determine the relapse rate of IBD in patients who cease anti- TNF therapy.
Methods: A systematic search of international databases (Medline, Web of Sciences, Scopus, and EMBASE) was conducted until Mar 9th, 2022. The random effects model was used to calculate the IBD relapse rate, accompanied by a 95% confidence interval.
Results: The IBD relapse rate in patients who discontinued anti-TNF therapy was 44%. The pooled IBD-UC and IBD-CD relapse rate in patients who stopped anti-TNF therapy were 43% and 46%, respectively. The studies using infliximab (IFX) showed a pooled IBD relapse rate of 45%, and the IBD relapse rate in the IFX/ADA (Adalimumab) group was 42%. The IBD relapse rate for papers with treatment durations of less than or equal to 12 months was 51%, while for articles with treatment durations of more than 12 months, it was 30%.
Conclusion: This study emphasizes the need for careful evaluation and monitoring of IBD patients who cease anti-TNF therapy, as well as further investigation of alternative treatments for those who exhibit intolerance or inadequate response to anti-TNF therapy.

Background: MicroRNAs (miRNAs) are implicated in several biological processes, such as control of tissue homeostasis, cell signaling, differentiation, proliferation, neoplastic transformation, and activation/inhibition of apoptotic mechanisms. In this systematic review, we evaluated the changes in the expression pattern of miRNAs in salivary gland tumors (SGTs).
Methods: A comprehensive search was conducted in PubMed, and Scopus with no language and date restrictions in Feb 2023. All the studies on SGTs that evaluated miRNA profiling were included. Relevant data regarding the overexpression and down-regulation of the miRNAs were extracted. The quality of the included studies was evaluated with Newcastle–Ottawa checklist. The altered expression of miRNAs was evaluated between SGTs and normal cases, benign and malignant tumors, and primary and high-grade tumors.
Results: Thirteen studies were included in this systematic review. There were considerable differences between malignant and benign tumors regarding the miRNAs expression level. In the five studies, the miRNA profile of the primary tumors was compared with metastatic tumors to reveal the involvement of the miRNA in the prognosis of the salivary tumors. The miRNAs expression changes were correlated with tumor size, stage, recurrence, and occurrence of solid components. Perineural invasion and lymph node metastasis were also reported in ACC-LM cell line and recurrence of adenoid cystic carcinoma (ACC) tissues.
Conclusion: The miRNA profiling confirms their prognostic value in salivary gland tumors. Significant alternations of the miRNAs expression are useful for distinguishing different types of salivary tumors and malignant tumors from benign types. The miRNA expression changes also affect the prognosis of salivary tumors.

Background: One of the upcoming challenges in hospital accreditation is using the same and similar standards for all types of hospitals in size and type of activity. We aimed to identify the accreditation modules for all types of hospitals in size (small hospitals) and type of activity (special hospitals).
Methods: This research was conducted as a scoping review from Mar to May 2023. "Arsky and O'Malley" six-step protocol was used to conduct this study. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) was used to identify, evaluate, and select research articles. The "framework analysis" method was used to analyze the data.
Results: Of 14 articles, 64% have been published in peer-reviewed scientific journals. Moreover, 36% of them were accreditation organizations' standards at the national level. The accreditation modules of small hospitals are Responsibilities of Management, Care of Patients, Management of Medication, Patient Safety, Infection Control, Continuous Quality Improvement, Patient Rights and Education, Blood and Blood Products, and Partnering with Consumers. The accreditation modules of special hospitals are Governing Body and Administration, Clinical Management, Prevention and Health, Care and Treatment, Diagnostic Services, Patient Rights, and Quality Improvement.
Conclusion: Identifying the main modules of accreditation for small and special hospitals can help policymakers and hospital managers improve the quality and safety of their hospitals by using appropriate standards and help improve the services provided to patients and increase their satisfaction.

Background: We aimed to determine the prevalence of sedentary time in diabetes and metabolic syndrome worldwide via a systematic review and meta-analysis study.
Methods: This study was conducted using the systematic review method following PRISMA 2020 criteria. Searches were conducted in PubMed, Scopus, ScienceDirect, Web of Science, and Google Scholar from January 2000 to December 2022. The heterogeneity of studies was measured using the I² test.
Results: The prevalence of sedentary time in diabetic patients was 52.3% (CI 95 %:46.2-58.2) and the prevalence of sedentary time in metabolic syndrome was 43.3% (95% CI: 31- 56.5).  Also, the results of subgroup analysis show that the prevalence of inactivity in diabetic women was 60.3% higher than that of diabetic men. The prevalence of inactivity in patients with metabolic syndrome was 28.6% in men and women, respectively.
Conclusion: Sedentary time has a very high prevalence in metabolic syndrome and diabetic patients. In other words, almost half of these patients experience their life patterns. Therefore, effective and efficient efforts to improve activity and exercise in patients with diabetes and metabolic syndrome will have a more effective therapeutic effect and improve their quality of life.

Background: Advanced maternal age decreased success of pregnancy rate in the assisted reproductive technology (ART) treatment. We aimed to investigate the association between age and miscarriages in women who required ART for conception.
Methods: A cohort study was conducted using a 10-year sample of 14,898 pregnancy cycles with ART treatment in Xi’an, China. The effects of women’s age on miscarriage were assessed using Poisson regression models. The threshold effect between age and miscarriage was explored through curve fitting.
Results: Compared with lower than 30 years, the risks of early miscarriage and miscarriage were higher in the older age groups (early miscarriage: [35-37 years: RR=1.48, 95% confidence interval (CI): 1.26 to 1.74; ≥38 years: RR=2.25, 95% CI: 1.87 to 2.72]; miscarriage: [35-37 years: RR=1.45, 95%CI: 1.24 to 1.69; ≥38 years: RR=2.17, 95%CI: 1.82 to 2.60]). The nonlinear relationship between age and early miscarriage and miscarriages were observed. The risk of early miscarriage and miscarriage rapidly increased with age after the turning point (age=33 years) (<33 years: [early miscarriage: RR=1.02, 95% CI: 1.00 to 1.04; miscarriage: RR=1.02, 95% CI: 1.00 to 1.03]; ≥33 years: [early miscarriage: RR=1.11, 95% CI: 1.08 to 1.13; miscarriage: RR=1.10, 95% CI: 1.07 to 1.13]).
Conclusion: Among pregnancy cycles undergoing ART, advanced age is associated with higher risk of early miscarriage and miscarriage, and nonlinear relationship between age and early miscarriage and miscarriage were found. More attention should be paid to the risk of pregnant women with older than 33 years in ART treatment.

Background: Certain lifestyle characteristics, such as dietary patterns, physical activity, and maintenance of recommended body weight, low-risk alcohol consumption and non-smoking are associated with the lower likelihood for the development of chronic-non communicable disease in the general population. These lifestyles are called health promoting behaviors (HPBs). We aimed to examine the prevalence of the HPBs among the women of reproductive age in Serbia and the factors associated with the compliance with four or more of these behaviors.
Methods: The study was the secondary analysis of the data from the National Health survey in Serbia from 2019 that examined social, health status, mental health (using PHQ-8) and lifestyle characteristics of the general population in Serbia.
Results: The prevalence of compliance with four or more HPBs was 22%. Among the HPBs the most frequent was a non-risky alcohol consumption reported by 2585 participants (99.2%), followed by normal weight (2018-69.2%) and non-smoking (1469-69%), daily fruit and vegetables intake (969-33.2%) and sufficient aerobic PA (216-7.9%). Multivariate logistic regression analysis with four or more HPBs as an outcome variable showed that the association of compliance with four or more HPBs with tertiary education (OR 1.91, 95% CI: 1.32-2.76) use of prescription medications (OR: 0.62, 95% CI: 0.44-0.87) and score on PHQ-8 (OR: 0.88, 95% CI: 0.79-0.98).
Conclusion: There is a need for deeper promotion of health-related behaviors among all educational and vocational groups, including health promotion activities at the primary health care level, which is available to the entire population.

Background: Long non-coding RN (lncRNAs) have been implicated in lung cancer, but the mechanisms stay unclear. We investigated the theatrical role and mechanism of lncRNA Lung cancer associated transcript 1 LUCAT1 in the malignant progress of lung cancer.
Methods: From May 2022 to March 2023, a total of thirty normal and cancerous tissues were collected from patients diagnosed with non-small cell lung cancer at Zhongke Gengjiu Hospital in Anhui Province, China. The human SPC-A1 and A549 cell lines were chosen as the subjects for the relevant cellular experiments in this study. LncRNAs were expressed in a different manner identified by bioinformatics methods, and the expression levels in lung cancer tissues as well as cells were verified by the qRT-PCR assay. The biological role of LUCAT1 in NSCLC was determined by CCK-8, EdU, and transwell assay.
Results: The regulation of ubiquitin of P53 by LUCAT1 was studied, which showed that LUCAT1 was significantly elevated in NSCLC cell lines and patients’ tissues (P<0.05). High levels of LUCAT1 promoted the proliferation, invasion, and migration of NSCLC cells. Mechanism studies showed that LUCAT1 was mainly located in the nucleus, which bound to P53 and mediated the ubiquitinated degradation of P53. Meanwhile, LUCAT1 knockdown attenuated the ubiquitination process of P53. In addition, rescue experiments illustrated that LUCAT1 induced the proliferation and invasion of NSCLC cells, and played a key role in the survival and tumorigenicity of NSCLC cells by mediating the ubiquitination of P53.
Conclusion: Collectively, LUCAT1 activated the malignant phenotypes of NSCLC cells via regulating P53 ubiquitination, which provided a new idea for the diagnosis and treatment of NSCLC.

Background: As a health vulnerable group, people with disabilities require more health-promoting behavior than non-disabled people. We aimed to identify the types of health behavior of disabled people and to track the trajectories of stress by the type of health behaviors.
Methods: Data came from the Panel Survey of Employment for the Disabled Second Wave by the Employment Development Institute (EDI) in Korea. We used dataset from the first 6 years of the 2nd wave of PSEDSW (2016-2021). The current study analyzed 3,991 subjects. The types of health behavior were identified through latent class analysis (LCA) and the trajectories of stress were estimated through multi-group latent growth modeling using Mplus 8.0.
Results: Two types of groups in health behaviors, smoking-drinking group (SD), nonsmoking-less drinking group (NLSD) were derived. Depending on the types of health behavior, the trajectories of stress appeared significantly different: the NLSD had significantly lower stress than the SD in the first year, and this low-level stress trajectory was maintained continuously for 6 years.
Conclusion: Health behaviors could be suitable as a stress coping method for people with disabilities. This study suggests that it is necessary to make efforts to create an environment that supports people with disabilities to learn healthier ways to cope with stress.

Background: Dietary habits are influenced by environmental factors. Among these environmental factors are the place of residence, cultural characteristics, food accessibility, and economic status, which can all contribute to changes in the dietary pattern. Migration is another factor that can influence changes in the aspects mentioned above. We aimed to assess the dietary habits of individuals who have migrated from Turkey to Germany in comparison to those living in Turkey.
Methods: In this descriptive and cross-sectional study, 254 individuals were enrolled with 102 individuals in Germany and 152 individuals in Turkey between April 2022 and July 2023. The data collection tools included Socio-demographic Characteristics Forms, Dietary Habits and Health Status Forms, and Food Consumption Frequency Forms. The data was collected online via Google Forms.
Results: There were statistically significant differences in the consumption frequency of processed meats, meat and poultry, sweetened beverages, sugar, desserts and pastries, vegetables, fruits, eggs and grains, olive oil, sunflower oil, hazelnut oil, grains, dairy products, coffee, starch, and carbonated beverages between the two groups (P<0.05). Statistically significant differences were not found in terms of butter and tea consumption frequency.
Conclusion: Overall, the study results have revealed significant differences in dietary habits between Turks living in Germany and those living in Turkey. The most noteworthy dimension of these differences is that individuals living in Turkey exhibit a stronger adherence to the Mediterranean dietary pattern, while those living in Germany tend to follow a Western dietary pattern.

Background: We aimed to explore the role of C-X-C motif chemokine ligand 12 (CXCL12) and cytokine-cytokine receptor interaction signaling pathway in the radiotherapy and chemotherapy resistance as well as cell stemness in colorectal cancer (CRC).
Methods: Bioinformatics analysis was used to identify the differentially expressed mRNAs and signal pathways closely related to differentially expressed mRNAs have also been analyzed in March 2022 at the Jinhua Central Hospital, China. Then, the expression of CXCL12 was detected by qRT-PCR in colorectal cancer cells and testing the effects of transfecting CXCL12 into different CRC-derived cell lines. The effects of CXCL12 on cell proliferation were evaluated by chemosensitivity assay and radiation sensitivity assay.
Results: Bioinformatics analysis of DEGs found a total of 2429 differentially expressed genes, THBS3 and CXCL12 genes are two abnormally highly expressed genes in the CRC. KEGG analysis showed the correlative signaling pathway, cytokine-cytokine receptor interaction, which is related to cell stemness. Furthermore, the expression of CXCL12 in CRC cells was detected and an increasing trend was obtained in CRC cells. In addition, the chemosensitivity and radiotherapy tolerance were elevated after transfected with CXCL12.
Conclusion: CXCL12 could be a potential promote biomarkers in CRC and also promote the chemosensitivity and radiotherapy tolerance.

Background: Glioblastoma multiforme (GBM) is one of the most invasive types of brain cancer. LncRNAs can be considered a new prognostic and diagnostic biomarker in GBM. This study comprehensively explored the interaction of lncRNAs with mRNAs in the TCGA database and proposed a novel promising biomarker with favorable diagnostic and prognostic values.
Methods: The public data of RNA-seq and related clinical data were downloaded from the TCGA database. Differential expression analysis was conducted in R. GO and KEGG signaling pathways were used for enrichment. The STRING database was used for PPI analysis. CE-network was constructed by STAR database. Kaplan-Meier survival analysis and ROC curve analysis to indicate the biomarkers' diagnostic and prognostic values.
Results: Differentially expressed data illustrated that 4428 mRNAs were differentially expressed in GBM. The GO and KEGG pathway analysis showed that the differentially expressed mRNAs were enriched in critical biological processes. The PPI showed that WEE1, BARD1, and CDK6 were the important PPI hubs. The ceRNA network data demonstrated critical lncRNAs. The data revealed that the lncRNA CRNDE, LINC00957, AC072061.1, AC068888.1, and DBH-AS1 are potential diagnostic prognostic biomarkers in the GBM patients.
Conclusion: Altogether, we demonstrated lncRNA, and mRNA interaction and mentioned regulatory networks, considered a therapeutic option in GBM. In addition, we proposed potential diagnostic and prognostic biomarkers for the patients.

Background: Tuberculosis is caused by a bacterium called Mycobacterium tuberculosis, which is a contagious and infectious disease; in the first stage, it destroys the lungs and in the next stage other body organs, such as the spine and long bones. This disease is transmitted through an infected person and due to the weakness of the immune system, the infection intensifies. Tuberculosis has two stages: low activity and high activity. In this article, we have discussed the signs of tuberculosis destruction with high intensity on the bones of prehistory human remains.
Methods: The examples of our research are related to human remains from the ancient cemetery of 4000 years ago from Sagezabad region of Qazvin Province of Iran. That period of history coincides with the Iron Age 2 and 3 in the region. People inside the Sagezabad cemetery were very near to early urban (the late rural) society.
Results: By matching the form of bone destruction with international atlases for tuberculosis, we have reached a satisfactory result in this article. Due to the strong penetration of the infection into the bones, destruction in the remains was high, so it has simplified the diagnosis for us.
Conclusion: We found tuberculosis among the bones. This common ancient disease existed even among Neanderthals.

Background: Along with the increasing prevalence of ESRD in developing countries, the use of more up-to-date statistical models is highly recommended. It is crucial to control potential cure pattern and heterogenicity among patients.
Methods: In this longitudinal study, the data of 170 hemodialysis patients who visited the dialysis department of Shafa Hospital in Kerman from 2006 to 2016 were collected. To provides robust estimates the time to event data (death) were analyzed with a gamma frailty mixed cure Weibull model (MC-WG) using Bayesian inference.
Results: About 49% of patients experienced the death and median survival time was 37.5 months. Older patients (0.264), female patients (0.269), and patients with higher mean serum urea levels (0.186) had a higher risk of death. Moreover, we observe a decrease in death with increase in Creatine (Cr).
Conclusion: In the MC-WG Bayesian model, the diabetes, AST, calcium, phosphorus and uric acid variables had a significant effect on the survival of hemodialysis patients, while they were not significant in the Cox PH model. The results of MC-WG Bayesian model are more consistent with other studies.

Background: Nowadays, blended learning in medicine (BLM) has gained the attention of most experts as an invaluable approach to improving the quality of medical education. The level of attention to articles in this field on social networks is substantial. This study aimed to study the effectiveness of published articles in blended learning, indexed in Scopus and Web of Science databases between 2013 and 2022, from an altmetrics perspective.
Methods: The research is descriptive-analytical, with a scientometrics approach (using the Altmetrics index). The population includes all the articles on blended learning in medicine, indexed in Scopus and Web of Science databases, two well-known citation databases worldwide. Data were extracted using the Altmetrics bookmarklet tool and analyzed with descriptive statistics methods in Excel software.
Results: Out of 1327 articles, 136 articles (10.25%) did not have a digital object identifier (DOI) or PMID number. Mendeley, X (previously Twitter), and Dimensions were the most widely used social networks in blended learning. The United States, the United Kingdom, and Australia had the highest number of tweets in blended learning in medicine.
Conclusion: The number of articles with altmetrics indicators, categorized by publication year, demonstrates an improvement in the familiarity and use of social media by blended learning researchers in medicine. Blended learning researchers are advised to carefully select reputable journals - preferably with DOI - to increase the visibility and attention to their articles on social media.

Background: We aimed to investigate Tehran’s University of Medical Sciences (TUMS) affiliated hospitals organizational readiness toward implementing the ‘Autonomous Hospitals’ program as a change initiative from a managerial perspective in 2020.
Methods: A census covering all eligible managers working in TUMS affiliated hospitals, Tehran, Iran (350 individuals) was carried out. Overall, 281 questionnaires were returned (a 30% non-responsiveness rate). A standard construct was adopted for data collection which was validated through a process of translation- back translation, face validity, and content validity (CVI=0.86, CVR=0.76). The reliability was acquired using Cronbach’s alpha coefficient (0.87 and over 0.7). Both descriptive and inferential statistics were employed to draw conclusions .SPSS 26 was used for data analysis.
Result: Total organizational readiness for change (TORC) in hospitals was 60.75%±10.11 showing a state of medium to upper-medium readiness status. Also, the 'Clear mandate and centralized leadership' theme scored the lowest mean (53.02%±15.78) for ORC. 'Hospital accreditation level' (r=-0.14, P≤0.05), ‘bed occupancy rate’ (r=-0.19, P ≤0.05), and 'leadership status' (r=0.26, P≤0.001), also showed significant association with TORC. In addition, 'standardized bed occuPancy rate' (P≤0.05, B=-2.41), a 'male' leader (P ≤0.05, B=3.42), and 'academic affiliation' (P≤0. 1, B=-9.52), were good Predictors of TORC based on ‘Backward Multiple Linear Regression’ analysis.
Conclusion: Full support from hospital and headquarters executives, delegation of sufficient decision-making authority to hospital managers, and implementation of comprehensive performance evaluation criteria were prerequisites for robust hospital autonomy in TUMS-affiliated hospitals.

Background: Several health, environmental, and lifestyle-related factors have been separately linked to multiple sclerosis (MS) by different studies. However, these studies did not adequately account for the temporal association of these factors with MS while considering the influence of other variables in the analysis. A comprehensive investigation of these factors remains scarce.
Methods: A hospital-based case-control study was carried out between Jun 2020 to Mar 2021 on 525 cases and 1050 controls frequently matched by age and sex. Cases and controls were selected at the same time and from the same centers (Motahari and Imam Reza referral centers) in Shiraz (the capital of Fars Province). Health, socio-demographic, and lifestyle status during adolescence were studied in this case-control study.
Results: The likelihood of having a history of autoimmune disease(s) (OR_yes/no=15.67, P<0.001) and family history of MS (OR_yes/no=11.57, P<0.001) were higher in cases. In addition, the likelihoods of reporting a history of head/neck traumas (OR_{having a history/no history}=9.16, P<0.001), smoking (OR_{regular/other} =2.24, P=0.008), and stressful events (OR_yes/no=1.47, P=0.007) were higher among the case group. On the other hand, the odds of sun exposure (OR_{most the time/seldom} =0.14, P<0.001), physical activity (OR_{active/inactive}=0.45, P<0.001), and good quality sleep (OR=0.93, P<0.001) were significantly lower in the case group.
Conclusion: This study provided a broad picture of the factors associated with MS, most of which were modifiable. Positive alterations to these factors through social and health educational programs are likely to reduce the burden of MS in Iran.

Background: Pornography, encompassing explicit images, videos, audio, and written content, has adverse impacts on individuals' well-being. We aimed to explore the relationship between mental health and communication quality with parents and the use of pornography, considering the moderating effect of gender.
Methods: Quantitative data collection and descriptive-correlation analysis were employed. The study included university students in Tehran, Iran during the 2021-2022 academic year. Through purposive sampling, 210 participants completed an online questionnaire on Porsline. The survey assessed pornography use, quality of communication with parents, and general health. SPSS 23 software facilitated correlation and hierarchical regression analysis.
Results: Gender significantly influenced pornography use (β=0.557). Anxiety symptoms (β=0.45) and social dysfunction (β=0.351) had significant positive effects on pornography use. Moreover, quality of relationships with parents, both mother (β=-0.47) and father (β=-0.27), exhibited negative associations with pornography use (P=0.01).
Conclusion: High quality relationships with parents, lower anxiety and social dysfunction could potentially decrease the likelihood of pornography use on the internet. It is recommended that educational efforts and cultural interventions focus on protecting young adults from the negative effects of pornography use. Such interventions may include psychoeducational training on effective communication skills, mental health literacy, and stress management skills.

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