Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 53 1 2024 01 01 116 125 EN Heakyong Lee Graduate School of Alternative Medicine, Kyonggi University (Seoul Campus), Seoul, Republic of Korea Jaehee Kim Graduate School of Alternative Medicine, Kyonggi University (Seoul Campus), Seoul, Republic of Korea 2022 08 12 2023 01 15 Background: Positive and negative emotions have recently revealed a link with primary dysmenorrhea in adults. Among them, roles of stress and self-esteem have been less studied specially in adolescents and the direction of causality has not been clearly established. Therefore, this study investigated whether stress and self-esteem independently affect primary dysmenorrhea after adjustment for the known risk factors in adolescents. Additionally, indirect effects of stress and self-esteem were determined using mediation analyses. Methods: This survey was conducted in adolescent girls aged 15-18 yr in metropolitan regions in South Korea in 2021. The survey included general, menstrual, and lifestyle characteristics, menstrual pain and symptom, perceived stress, self-esteem, depression, and state-trait anxiety. Results: Stress, depression, and anxiety were associated positively with menstrual pain and symptom (all P<0.001) in adolescent girls (n=519). Self-esteem was also associated inversely with negative emotions and dysmenorrhea (all P<0.001). Additionally, stress independently affected frequency and severity of menstrual symptom (both P<0.05), but not pain intensity after adjustment for covariates. Stress also had indirect effect through depression and anxiety on menstrual pain and symptom. Effect of self-esteem vanished after adjustment for covariates, but indirectly reduced menstrual pain and symptom through mediations of stress, depression, and anxiety. Conclusion: Mental health such as stress and self-esteem are important for managing menstrual pain and symptom in adolescents. It should be considered in managing dysmenorrhea. https://ijph.tums.ac.ir/index.php/ijph/article/view/29542 https://ijph.tums.ac.ir/index.php/ijph/article/download/29542/8136

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 53 1 2023 12 31 1 11 Rui Sun Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, 410013, Hunan, China Juan Tao Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, 410013, Hunan, China Na Tang Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, 410013, Hunan, China Zhijun Chen Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, 410013, Hunan, China Xiaowei Guo Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, 410013, Hunan, China Lianhong Zou Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan 410013, P.R. China Junhua Zhou Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, 410013, Hunan, China 2023 09 27 2023 11 26 Background: Influenza is the first infectious disease that implements global monitoring and is one of the major public health issues in the world. Air pollutants have become an important global public health issue, in recent years, and much epidemiological and clinical evidence has shown that air pollutants are associated with respiratory diseases. Methods: We comprehensively searched articles published up to 15 November 2022 in PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), Database of Chinese sci-tech periodicals, and Wanfang Database. The search strategies were based on keyword combinations related to influenza and air pollutants. The air pollutants included particulate matter (PM2.5, PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), and ozone (O3). Meta-analysis was performed using the R programming language (R4.2.1). Results: A total of 2926 records were identified and 1220 duplicates were excluded. Finally, 19 studies were included in the meta-analysis according to inclusion and exclusion criteria. We observed a significant association between partial air pollutants (PM2.5, NO2, PM10 and SO2) and the incidence risk of influenza. The RRs were 1.0221 (95% CI: 1.0093~1.0352), 1.0395 (95% CI: 1.0131~1.0666), 1.007 (95% CI: 1.0009~1.0132), and 1.0352 (95% CI. 1.0076~1.0635), respectively. However, there was no significant relationship between CO and O3 exposure and influenza, and the RRs were 1.2272 (95% CI: 0.9253~1.6275) and 1.0045 (95% CI: 0.9930~1.0160), respectively. Conclusion: Exposure to PM2.5, NO2, PM10, and SO2 was significantly associated with influenza, which may be risk factors for influenza. The association of CO and O3 with influenza needs further investigation.  https://ijph.tums.ac.ir/index.php/ijph/article/view/33316 https://ijph.tums.ac.ir/index.php/ijph/article/download/33316/8126

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 53 1 2024 01 01 246 247 Fatemeh Shaygani Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran Milad Ahmadi Marzaleh Department of Health in Disasters and Emergencies, Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran Soodeh Jahangiri Endocrine and Metabolism Research Institute, Iran University of Medical Sciences, Tehran, Iran 2022 11 23 2023 01 22 No Abstract No Abstract No Abstract https://ijph.tums.ac.ir/index.php/ijph/article/view/30467 https://ijph.tums.ac.ir/index.php/ijph/article/download/30467/8149

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 53 1 2024 01 01 126 135 Xinlong Zhang Department of Outpatient, Sanmenxia Central Hospital, Sanmenxia, Henan, China Shaolei Lang Department of Outpatient, Sanmenxia Central Hospital, Sanmenxia, Henan, China Fei Liu Department of Outpatient, Sanmenxia Central Hospital, Sanmenxia, Henan, China 2023 11 21 2024 01 01 Background: Gastric cancer patients often feel physically tired and weak, lacking confidence and enthusiasm for relevant treatments. We aimed to explore the impacts of health education based on the theory of protective motivation on the emotional state, cancer-related fatigue, and hope levels of gastric cancer patients. Methods: A total of 160 gastric cancer patients admitted to the Sanmenxia Central Hospital, Henan, China, from May 2019 to March 2022 were selected as subjects. The control group (n=80) received routine health education, while the observation group (n=80) received health education based on the theory of protective motivation. Intervention evaluations included the Morisky medication compliance score, Plain Mood State Scale (POMS), Cancer Fatigue Scale (CFS), Herth Hope Scale (HHI), and Simple Health Survey Scale (SF-36). Results: After intervention, both groups showed an improvement in Morisky’s medication compliance score, HHI scale score, and SF-36 scale score (all P<0.05). Additionally, the observation group exhibited greater improvement than the control group (P<0.05). There were no significant differences in POMS scale score and CFS scale score between the two groups before and after intervention. However, after intervention, both groups experienced a decrease in POMS scale score and CFS scale score (both P<0.05), with the observation group showing a more significant decrease compared to the control group (P<0.05). Conclusion: Health education based on the theory of protective motivation effectively enhances the mood state, reduces cancer-related fatigue, and increases hope levels among gastric cancer patients, thereby improving their medication compliance and overall quality of life. https://ijph.tums.ac.ir/index.php/ijph/article/view/33824 https://ijph.tums.ac.ir/index.php/ijph/article/download/33824/8137

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 53 1 2023 12 31 12 24 Sry Suryani Widjaja Department of Biochemistry, Medical Faculty, Universitas Sumatera Utara, Medan, Sumatera Utara, Indonesia Rusdiana Rusdiana Department of Biochemistry, Medical Faculty, Universitas Sumatera Utara, Medan, Sumatera Utara, Indonesia Tengku Mardani Helvi Department of Biochemistry, Medical Faculty, Universitas Sumatera Utara, Medan, Sumatera Utara, Indonesia Rostime Simanullang Department of Nursing School, University of Murni Teguh, Medan, Sumatera Utara, Indonesia Vito Filbert Jayalie Department of Radiation Oncology, Murni Teguh Memorial Hospital, Medan, Sumatera Utara, Indonesia Rina Amelia Department of Community Health, Medical Faculty, Universitas Sumatera Utara, Medan, Sumatera Utara, Indonesia Jessie Arisa Department of Wellness, Murni Teguh Memorial Hospital, Medan, Sumatera Utara, Indonesia 2023 01 06 2023 07 21 Background: Cell aging is associated with changes in telomeres due to DNA damage arising from chronic inflammation in obese patients. The aim of the systematic review and meta-analysis was to find the relationship between obesity and aging or senescence. Methods: The systematic review was conducted through PRISMA guideline, beginning with literature search within 2012-2022 in several databases (PubMed, EBSCOHost, Science Direct, Scopus, and Cochrane) followed by screening process using predetermined PICO criteria. Original studies on the topic of obesity and senescence (aging), from preclinical studies to clinical research (cohort or cross-sectional studies) that were published within the last ten years. All studies were appraised using SYRCLE risk of bias tool for preclinical studies and Newcastle-Ottawa Scale (NOS) for cross-sectional and cohort studies. The data extraction on the studies’ characteristic and outcome on aging or senescence were followed by quantitative analysis using MetaXL process on prevalence ratio and hazard ratio of obesity to comorbidities and mortality. Results: Fifteen studies were enrolled. Obesity and white adipose tissue cause increased levels of pro-inflammatory and pro-senescence cytokine and macrophage whilst the aging process lowers metabolism with increased insulin resistance and linked to increased risk of obesity. Obesity occurs in 22% (95% CI 18%-26%) of elderly population with higher prevalence rate in the women population. Obesity is associated with significant increased risk of multimorbidity by 56% (OR = 1.58 [95% CI 1.48-1.96]). Conclusion: The obesity and aging or senescence has reciprocal relationship between each other.   https://ijph.tums.ac.ir/index.php/ijph/article/view/30855 https://ijph.tums.ac.ir/index.php/ijph/article/download/30855/8127

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 53 1 2024 01 01 248 250 Albert Thomas Anastasio Department of Orthopedic Surgery, Duke University Medical Center, Durham, USA Ardalan Shariat Department of Digital Health, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Mikhail Bethell Department of Orthopedic Surgery, Duke University Medical Center, Durham, USA Gholamreza Hassanzadeh 1. Department of Digital Health, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 2. Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 3. Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran 2023 02 06 2023 04 07 No Abstract.No Abstract No Abstract https://ijph.tums.ac.ir/index.php/ijph/article/view/31152 https://ijph.tums.ac.ir/index.php/ijph/article/download/31152/8150

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 53 1 2024 01 01 136 144 Jeonga Kwon Department of Elementary Education, College of First, Korea National University of Education, Cheongju, Korea Young-Vin Kim Department of Sports and Leisure, School of Arts and Health Care, Myongji College, Seoul, Korea 2023 10 03 2024 01 01 x https://ijph.tums.ac.ir/index.php/ijph/article/view/33360 https://ijph.tums.ac.ir/index.php/ijph/article/download/33360/8138

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 53 1 2023 12 31 23 34 Jie Wei Department of Pediatrics, The First People's Hospital of Huzhou, First Affiliated Hospital of Huzhou Normal University, Huzhou 313000, Zhejiang Province, China Yueer Wang Department of Outpatient, The First People's Hospital of Huzhou, First Affiliated Hospital of Huzhou Normal University, Huzhou 313000, Zhejiang Province, China 2023 06 24 2023 11 07 Background: Intensive insulin regimens are recommended to achieve glycemic goals in children and adolescents with type 1 diabetes. Fast-acting insulin aspart (faster aspart) is a new formulation of insulin aspart (IAsp) in which L-arginine and niniversity of Niš, Niš, Serbia 2. Center for Informatics and Biostatistics in Health Care, Institute of Public Health Niš, Niš, Serbia 2023 03 07 2023 09 18 Background: We aimed to evaluate the quality of the cause of death (COD) concerning mortality patterns and completeness of death registration to identify areas for improvement in Serbia. Methods: COD data collected from the mortality register in Serbia from 2005 to 2019 (1540615 deaths) were analyzed with the software Analysis of National Causes of Death for Action. The Vital Statistics Performance Index for Quality (VSPI(Q)) is estimated for the overall COD data quality. Results: The completeness of death certification was higher than 98%. Usable underlying COD was registered in 57%, 24.1% with an unusable and 18.6% with insufficiently specified COD. The VSPI(Q) was 67.2%, denoting medium quality. The typical error was using intermediate COD (24.7% of all deaths), while 13.2% and 8.5% of all garbage codes (GC) belonged to the Very High and High Severity classes. The leading underlying COD is unspecified cardiomyopathy. The analysis revealed that 39.1% of GC has been redistributed to non-communicable diseases, 2.5% to external causes and 1.1% to communicable diseases. Conclusion: In the 15 years' worth of data analyzed, the true underlying COD, in many cases, was ill-defined, indicating that COD data at the national level could be distorted. The additional and continuous professional education of medical students as well as physicians is needed. It should focus on the most common GC among the leading COD and acquiring skills in certifying external causes of death. https://ijph.tums.ac.ir/index.php/ijph/article/view/31410 https://ijph.tums.ac.ir/index.php/ijph/article/download/31410/8285

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 53 7 2024 07 07 1496 1507 EN Arman Karimi Behnagh Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran Maryam Eghbali Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran Fereshteh Abdolmaleki Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran Omolbanin Asadi Ghadikolaei Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran Parisa Rezazadeh Asl Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran Mandana Afsharpad Cancer Control Research Center, Cancer Control Foundation, Iran University of Medical Sciences, Tehran, Iran Sara Cheraghi Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran Maryam Honardoost Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran 2023 05 31 2023 12 19 Background: BRAF V600E mutation is proved critical in the progression and invasion of thyroid cancer, and as a prognostic biomarker. As anaplastic thyroid cancer (ATC) is a rare and aggressive form of thyroid cancer, this study was conducted to provide a view on prevalence of BRAF V600E as well as the best molecular diagnostic method in ATC patients. Methods: A comprehensive literature search was performed from their inception to Oct 2022 in PubMed, Scopus, Google Scholar, and Web of Science (WoS). The data of the prevalence of ATC were extracted. Moreover, the diagnostic feature of the available diagnostic tools was extracted to measure the sensitivity and specificity. To pool the prevalence data, we used meta-proportion analysis and diagnostic meta-analysis was conducted to determine the specificity and sensitivity of the immunohistochemistry method in detecting BRAF V600E mutation among patients with ATC. Results: Overall, 34 studies were included in this meta-analysis. The incidence of BRAF V600E was shown 33% in the 978 patients. The sensitivity and specificity of IHC in detecting BRAF V600E were detected 78.9% (95%CI: 60.1-97.2), and 69.7% (95%CI: 41.2-98.1), respectively. Conclusion: IHC had an acceptable prognostic profile for detecting BRAF V600E in ATC patients. The diagnosis of BRAF mutation is critical in clinical trials and may be helpful for choosing proper-targeted therapy strategies in ATC patients. https://ijph.tums.ac.ir/index.php/ijph/article/view/32167 https://ijph.tums.ac.ir/index.php/ijph/article/download/32167/8282

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 53 7 2024 07 07 1691 1692 Zahra Kiani Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Masoumeh Simbar 1. Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2. Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2023 10 02 2023 12 10 No Abstract No Abstract No Abstract https://ijph.tums.ac.ir/index.php/ijph/article/view/33351 https://ijph.tums.ac.ir/index.php/ijph/article/download/33351/8303

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 53 7 2024 07 07 1537 1548 EN Boya Fan Department of Otolaryngology Head and Neck surgery, The 306th Hospital of PLA- Peking University Teaching Hospital Gang Wang Department of Otorhinolaryngology Head and Neck Surgery, PLA Strategic Support Force Characteristic Medical Center Wei Wu Department of Otolaryngology Head and Neck surgery, The 306th Hospital of PLA- Peking University Teaching Hospital 2023 02 25 2023 08 14 Background: Occupational hearing loss of workers exposed to impulse noise and workers exposed to steady noise for a long time may have different clinical characteristics. Methods: As of May 2019, all 92 servicemen working in a weapon experimental field exposed to impulse noise for over 1 year were collected as the impulse noise group. As of Dec 2019, all 78 servicemen working in an engine working experimental field exposed to steady noise for over 1 year were collected as the steady noise group. The propensity score matching (PSM) model was used to eliminate the imbalance of age and working time between the two groups of subjects. After propensity score matching, 51 subjects in each group were finally included in the study. The machine learning model is constructed according to pure tone auditory threshold, and the performance of the machine learning model is evaluated by accuracy, sensitivity, specificity, and AUC. Results: Subjects in the impulse noise group and the steady noise group had significant hearing loss at high frequencies. The hearing of the steady noise group was worse than that of the impulse noise group at speech frequency especially at the frequency of 1 kHz. Among machine learning models, XGBoost has the best prediction and classification performance. Conclusion: The pure tone auditory threshold of subjects in both groups decreased and at high frequency. The hearing of the steady noise group at 1 kHz was significantly worse than that of the impulse noise group. XGBoost is the best model to predict the classification of our two groups. Our research can guide the prevention of damage caused by different types of noises. https://ijph.tums.ac.ir/index.php/ijph/article/view/31323 https://ijph.tums.ac.ir/index.php/ijph/article/download/31323/8286

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 53 7 2024 07 07 1693 1694 Mohammadreza Maleki Department of Healthcare Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran Niusha Shahidi Sadeghi Department of Healthcare Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran Bahram Mohaghegh Department of Public Health, School of Health, Qom University of Medical Sciences, Qom, Iran Hassan Abolghasem Gorji Department of Healthcare Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran Ali Ghadakchi Deputy of Management Development and Resources, Ministry of Health, Tehran, Iran 2020 08 30 2020 10 14 No Abstract No Abstract No Abstract https://ijph.tums.ac.ir/index.php/ijph/article/view/22032 https://ijph.tums.ac.ir/index.php/ijph/article/download/22032/8304

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 53 7 2024 07 07 1549 1559 Anwar Daud Department of Environmental Health, University of Hasanuddin, Makassar, Indonesia Hasanuddin Ishak Department of Environmental Health, University of Hasanuddin, Makassar, Indonesia Erniwati Ibrahim Department of Environmental Health, University of Hasanuddin, Makassar, Indonesia Basir Basir Department of Environmental Health, University of Hasanuddin, Makassar, Indonesia Agus Birawida Department of Environmental Health, University of Hasanuddin, Makassar, Indonesia Rizky Syam Department of Health Promotion and Behavioral Sciences, University of Hasanuddin, Makassar, Indonesia Andi Arundana Faculty of Medicine and Health, University of Sydney, Sydney, Australia Abdul Gafur Department of Environmental Health, Moslem University of Indonesia, Makassar, Indonesia 2023 07 28 2023 10 20 Background: The increasing accumulation of plastic waste is the most serious threat to the marine ecosystem. People who still have the habit of disposing of solid waste, especially plastic-type waste, in the marine environment have led to the discovery of microplastic content in various marine biota such as fish and shellfish. We aimed to assess the environmental health risks of microplastics due to consumption of marine life in the coastal area. Methods: We used an observational method with the Environmental Health Risk Assessment (EHRA) design to analyze the health risks of humans consuming fish and shellfish containing microplastics. This research was conducted in the coastal area of ​​Takalar Regency, Indonesia in 2022. The samples used consisted of human (n = 30) and marine biota (fish, n=20; shellfish, n=20) samples. The data were obtained from observations, physical measurements of biota, laboratory tests, polymer type identification by Fourier Transform Infrared (FTIR) spectroscopy, and microscopy. Results: The average concentration of microplastics containing styrene compounds in shellfish was 2.01 mg/kg. The abundance of MPs in the fish and shellfish samples was 0.01 particles/g or 10 particles/kg in fish and 7 particles/individual in shellfish. The MPs were found in line, fragment, film, and pellet forms, with different size and color variations. The average MPs exposure risk level (RQ value) for both fish and shellfish was 0.02. Conclusion: All samples had RQ values < 1, which means that the microplastic-containing tofu shellfish were still safe for consumption by people living in the Takalar coastal area. https://ijph.tums.ac.ir/index.php/ijph/article/view/32708 https://ijph.tums.ac.ir/index.php/ijph/article/download/32708/8287

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 53 7 2024 07 07 1560 1568 Yeting Chang Department of Cardiology, The Second Affiliated Hospital of Dalian Medical University, Dalian 116000, China Qin Yu Department of Cardiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, 116000, China 2023 09 04 2024 07 07 Background: To investigate the effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on blood pressure, blood glucose and blood lipid in diabetic patients with hypertension. Methods: A total of 300 diabetic patients and essential hypertension admitted to our hospital from January 2021 to December 2022 were selected, and divided into an observation group and a control group using a random number table method. The control group was treated with conventional antihypertensive drugs, hypoglycemic drugs, and lipid-lowering drugs. The observation group was supplemented with liraglutide on the basis of the control group. Blood pressure, blood glucose and blood lipid of the two groups were compared at the initial stage of medication and after 4 weeks and half a year, and the influencing factors of patients with persistent hypertension were further analyzed through Logistic regression. Results: After 4 weeks and 6 months of medication, inter group comparisons showed that systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG) and glycated hemoglobin (HbA1c), as well as total cholesterol (TC), triacylglycerol (TG), and plasma arteriosclerosis index (AIP) in the observation group were significantly lower than those in the control group (Ρ <0.05). Multivariate Logistic regression model analysis showed that age, smoking history, drinking history, taking conventional antihypertensive drugs, taking hypoglycemic drugs, taking lipid-lowering drugs, BMI, FBG, HbA1c and LDL-C were independent influencing factors for persistent hypertension (Ρ<0.05). Conclusion: GLP-1RAs can effectively improve the indexes including blood pressure, blood glucose and blood lipid in diabetic patients with hypertension. https://ijph.tums.ac.ir/index.php/ijph/article/view/33123 https://ijph.tums.ac.ir/index.php/ijph/article/download/33123/8288

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 53 7 2024 07 07 1569 1577 EN Abdurrahman Gülmez Istanbul Basaksehir Cam and Sakura City Hospital, Medical Microbiology Laboratory, Istanbul, Turkey Özgür Appak Department of Medical Microbiology, Faculty of Medicine, Virology Unit, Dokuz Eylul University, Izmir, Turkey Arzu Nazlı Zeka Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey Nuran Esen Department of Medical Microbiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey Ayça Arzu Sayıner Department of Medical Microbiology, Faculty of Medicine, Virology Unit, Dokuz Eylul University, Izmir, Turkey 2022 12 08 2023 09 18 Background: We aimed to evaluate the performance of the current algorithm the HIV diagnosis that has been performed for four years. Results of HIV Ag/Ab tests, anti-HIV 1/2 confirmatory tests, HIV-1 RNA tests and the time for official results to be approved were evaluated. Methods: The relationship of HIV Ag/Ab tests, anti-HIV 1/2 confirmation tests and HIV-1 RNA PCR tests, their result times and suitability to the algorithm were examined at Izmir Dokuz Eylül University between May 2017 and June 2021. Results: HIV Ag/Ab ELISA was reactive repetitively in 165/54628 (0.30%) serum samples. Anti-HIV 1/2 confir-mation test was reactive in 54.42% (80/147) of samples. The most common pattern (18.2%) in the con-firmation tests was the positivity of the antibodies against gp160 - gp41 envelope glycoproteins together. The mean reporting time of the confirmation test result was 3h 50 min after the ELISA test. The mean reporting time of the HIV-1 RNA PCR was 12.79 d (±10.22) after the ELISA test and 12.63 (± 10.12) day after the confirmation test. In ROC analysis, the estimated rate of the ELISA test for the confirmation test was highest when S/CO was >13.16 (sensitivity: 97.59 %, specificity: 97.59%). Conclusion: The confirmation test in the current algorithm enabled the rapid test results, early diagnosis of HIV and early antiretroviral therapy. To use the new algorithm effectively, decentralization of the validation tests would be appropriate. https://ijph.tums.ac.ir/index.php/ijph/article/view/30604 https://ijph.tums.ac.ir/index.php/ijph/article/download/30604/8289

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 53 7 2024 07 07 1578 1587 Eui-Jin Han Department of Airline Service, Honam University, Gwangju, Republic of Korea Lei Cai Department of Airline Service, Honam University, Gwangju, Republic of Korea 2024 06 02 2024 07 07 Background: We analyzed the effects of psychological capital on organizational commitment and turnover intention among flight attendants at a Korean airline and the mediating effect of organizational commitment. Methods: Data were collected through a 2022 survey of Korean flight attendants, yielding 297 responses. Model reliability and validity were assessed to confirm hypotheses. Results: Hope had a significant negative effect on turnover intention P<0.05), whereas optimism and resilience did not have significant effects on turnover intention. Additionally, hope had a significant positive effect on normative and continuance commitment, unlike optimism and resilience, which did not have significant effects on normative commitment or continuance commitment. Both normative commitment and continuance commitment negatively influenced turnover intention. Organizational commitment mediated the relationship between psychological capital and turnover intention, reinforcing the positive impact of psychological capital on reducing turnover intention. Conclusion: This study underscores the significance of psychological capital in shaping organizational commitment and reducing turnover intention among Korean flight attendants. Strengthening psychological capital and fostering organizational commitment can bolster airline stability, competitiveness, and service quality. https://ijph.tums.ac.ir/index.php/ijph/article/view/35698 https://ijph.tums.ac.ir/index.php/ijph/article/download/35698/8290

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 53 7 2024 07 07 1588 1597 Zhiqin Zhang Department of Physical Education, Anhui Jianzhu University, Hefei 230601, China Renwei Yang Department of Physical Education, Public Basic Course, Shanghai University of Finance and Economics Zhejiang College, Jinhua 321013, China Gang Sun School of Physical Education and Health Science, Zhejiang Normal University, Jinhua 321004, China Yong Wang Department of Physical Education, Donghua University, Shanghai 201620, China 2024 05 02 2024 07 07 Background: A decline in adolescent health holds significant repercussions for public health. Promoting exercise is essential to improve physical and mental health among youth. This study aimed to explore the effect of CrossFit training programs on the physical health and sociogenic somatic anxiety of adolescents. Methods: In March 2023, 100 adolescents were openly recruited from eight middle schools in Jinhua, China. The participants, wt> https://ijph.tums.ac.ir/index.php/ijph/article/view/32015 https://ijph.tums.ac.ir/index.php/ijph/article/download/32015/8363

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 53 10 2024 09 30 2307 2317 Dujuan Mao Department of Anesthesiology, Huanggang Central Hospital Affiliated to Yangtze University, Huanggang 438000, Hubei, China Shan Li Department of Anesthesiology, Huanggang Central Hospital Affiliated to Yangtze University, Huanggang 438000, Hubei, China Xiufang Li Department of Anesthesiology, Huanggang Central Hospital Affiliated to Yangtze University, Huanggang 438000, Hubei, China Lijuan You Department of Anesthesiology, Huanggang Central Hospital Affiliated to Yangtze University, Huanggang 438000, Hubei, China Jiaqi Yu Department of Anesthesiology, Huanggang Central Hospital Affiliated to Yangtze University, Huanggang 438000, Hubei, China Yaohua Wu Department of Anesthesiology, Huanggang Central Hospital Affiliated to Yangtze University, Huanggang 438000, Hubei, China Quanshui Hao Department of Anesthesiology, Huanggang Central Hospital Affiliated to Yangtze University, Huanggang 438000, Hubei, China Heng Du Department of Gastrointestinal Surgery, Huanggang Central Hospital Affiliated to Yangtze University, Huanggang, 438000, Hubei, China 2024 03 25 2024 08 07 Background: Rheumatoid arthritis (RA) and osteoarthritis (OA) are prevalent chronic joint disorders with immunological pathogenesis. However, the causal relationships between circulating immune cells and them remain largely unknown. Therefore, we conducted a bidirectional two-sample Mendelian randomization (MR) study to determine their causal relationship. Methods: Genome-wide association study summary statistics were extracted from publicly available databases regarding immune cell phenotypes, RA, and OA. MR analysis was conducted using five MR methods, with inverse-variance-weighted (IVW) as the primary analysis method. False discovery rate correction (FDR) was used to reduce the likelihood of type 1 errors. We also conducted MR-Egger intercept tests to evaluate horizontal pleiotropy. Results: After FDR adjustment of the P values for the IVW method, the CD27 expression on memory B cells was negatively related to the risk of RA (P < 0.001), and the human leukocyte antigen (HLA)--DR expression on CD14+ monocytes was negatively related to the risk of OA (P < 0.001). We also found that RA was negatively associated with the expression of HLA-DR on myeloid dendritic cells (P < 0.001), but significant horizontal pleiotropy was observed. Conclusion: Our study demonstrates a causal relationship between specific immune cell traits and RA as well as OA, providing further insight into the role of immune cells in the pathogenesis of these disorders. https://ijph.tums.ac.ir/index.php/ijph/article/view/34985 https://ijph.tums.ac.ir/index.php/ijph/article/download/34985/8371

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 53 10 2024 09 30 2239 2250 EN Abraham Gebrehiwot Yihdego 1. Department of Economics, Aksum University, Axum, Tigray, Ethiopia 2. Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Maryam Tajvar Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Ali Akbari Sari Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 2023 09 20 2024 04 02 Background: We aimed to review the effect of community-based health insurance on health-related outcomes in Ethiopia. Methods: A systematic review was undertaken utilizing a major relevant published literature review from September 2017 to June 15, 2023. PubMed, Scopus, Web of Science, Science Direct, Google Scholar, Semantic Scholar, EMBASE, ProQuest, Hinari, and the Cochrane Library were used to search for relevant literature. Moreover, the Prisma flow model was used to select eligible findings. Results: Overall, 72% of the articles employed cross-sectional comparative study designs and procedures, and 36% of them employed samples ranging in size from 501 to 1000 participants. Furthermore, 76% were studied using descriptive statistics and logistic regression, whereas fewer utilized a random model, a probity model, or a correlation model. Similarly, 32% of the research used two-stage stratified sampling methods, and around 40% of the data revealed that the scheme increased healthcare utilization services. About 72 % of the reviewed study results showed that the scheme reduced catastrophic health expenditure and increases utilization of healthcare services. And the 20% reviewed studies stated that the CBHI boosts household satisfaction level. Moreover 12% of the reviewed studies stated that, CBHI increased QoL (quality of life). Conclusion: Most of the studies provide evidence of the positive effect of CBHI in Ethiopia. Mainly, its membership improved the utilization of health services and decreased the incidence of catastrophic health expenditures. Thus, all actors should cooperate to strengthen it to solve the effective attribute of the deprived value of health care and continuity of care delivery system related to the country's new policy. https://ijph.tums.ac.ir/index.php/ijph/article/view/33250 https://ijph.tums.ac.ir/index.php/ijph/article/download/33250/8364

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 53 10 2024 09 30 2318 2327 Cemil Çelik İstanbul Forensic Medicine Institute, Kahramanmaraş Forensic Medicine Department, Kahramanmaraş, Turkey Uğur Ata Tekirdag Namık Kemal University, Department of Forensic Medicine, Tekirdağ, Turkey Naile Saka Tekirdag Namık Kemal University, Department of Forensic Medicine, Tekirdağ, Turkey 2023 12 26 2024 02 05 Background: Examining death statistics at regular intervals is highly useful for assessing public health. This study aimed to analyze cause-specific mortality statistics, to ascertain their distribution over the years, and to offer remedial solutions to enhance public health outcomes. Methods: In this retrospective descriptive study, an analysis was conducted on data sourced from the "Death and Cause of Death Statistics" provided by the Turkish Statistical Institute between 2017 and 2022. Results: While the crude mortality rate remained stable from 2017 to 2019, a discernible increase in mortality rates has been observed since 2020, attributed to the impact of the pandemic. The crude death rate was the highest in the <5 yr and ≥65 yr age groups. Approximately 70% of the total mortality cases in Turkey were attributed to cardiovascular diseases, cancers, respiratory diseases, and diabetes. Conclusion: Given the world's rapidly aging population, an increase in deaths related to the four major noncommunicable diseases is foreseen. Therefore, there is an imperative need to enhance efforts aimed at preventing and controlling these diseases. https://ijph.tums.ac.ir/index.php/ijph/article/view/34122 https://ijph.tums.ac.ir/index.php/ijph/article/download/34122/8372

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 53 10 2024 09 30 2328 2340 EN Zi Yin 1. Department of Pathology, School of Basic Medicine, Hubei University of Medicine, Shiyan, China 2. Clinical Pathology Test and Consultation Center, Hubei University of Medicine, Shiyan, China Jue Wang Clinical Pathology Test and Consultation Center, Hubei University of Medicine, Shiyan, China Changqing Zhu 1. Department of Pathology, School of Basic Medicine, Hubei University of Medicine, Shiyan, China 2. Department of Pathology, Shiyan Renmin Hospital, Hubei University of Medicine, Shiyan, China Chenli Xu 1. Department of Pathology, School of Basic Medicine, Hubei University of Medicine, Shiyan, China 2. Forensic Judicial Appraisal Institute, Hubei University of Medicine, Shiyan, China Juan Fang 1. Department of Pathology, School of Basic Medicine, Hubei University of Medicine, Shiyan, China 2. Clinical Pathology Test and Consultation Center, Hubei University of Medicine, Shiyan, China Qiaoqin Li 1. Department of Pathology, School of Basic Medicine, Hubei University of Medicine, Shiyan, China 2. Clinical Pathology Test and Consultation Center, Hubei University of Medicine, Shiyan, China 2023 10 25 2024 02 21 Background: We aimed to explore the prediction value of disulfidptosis-related long noncoding RNAs (lncRNAs) on the prognosis and immunotherapy efficiency of patients with head and neck squamous carcinoma (HNSCC). Methods: Clinical and RNA-seq information were collected from The Cancer Genome Atlas (TCGA) and Genome Data Sharing (GDC) portal. The Pearson correlation analysis, univariate COX regression analysis, the least absolute shrinkage and selection operator (LASSO) COX regression were employed to construct the disulfidptosis-related lncRNAs (DRLs) prognostic model. The Kaplan-Meier survival curve, principal component analysis (PCA), receiver operating characteristic (ROC) curves and areas under the curves (AUCs) were used to examine the accuracy of the prognostic model. ssGSEA, mutation and functional and gene set enrichment analysis was performed to quantify the immune cell infiltration, immune function and functional enrichments. Finally, the mRNA expression of the DRLs was verified by real‑time PCR (RT-PCR) in HNSCC cells. Results: A new DRLs prognostic model (AC083967.1, AC106820.5, AC245041.2, AL590617.2, AP002478.1, and VPS9D1-AS1) with an independent prognostic value of HNSCC patients was successfully identified. In addition, the DRLs prognostic model was related with immune signature and drug therciences, Isfahan Uni-versity of Medical Sciences, Isfahan, Iran 2023 08 23 2024 02 12 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. https://ijph.tums.ac.ir/index.php/ijph/article/view/32987 https://ijph.tums.ac.ir/index.php/ijph/article/download/32987/8340

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 53 9 2024 09 03 2113 2120 EN Abbas Bahrampour Department of Biostatistics and Epidemiology, Faculty of Health, Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Mohammad Reza Baneshi Australian Women and Girls’ Health Research Centre, School of Public Health, The University of Queensland, Herston, Queensland, Australia Ali Karamoozian Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Navisa Sadat Seyedghasemi Department of Biostatistics and Epidemiology, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran Abbas Etminan Physiology Research Center, Departments of Nephrology, Urology and Renal Transplantation, Kerman University of Medical Sciences, Kerman, Iran Mostafa Eghbalian Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran 2023 10 23 2024 01 13 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. https://ijph.tums.ac.ir/index.php/ijph/article/view/33553 https://ijph.tums.ac.ir/index.php/ijph/article/download/33553/8350

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 53 9 2024 09 03 2020 2029 Nader Salari Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran Mehrab Ahmadi Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran Hooman Ghasemi Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran Reza Yarani Interventional Regenerative Medicine and Imaging Laboratory, Department of Radiology, School of Medicine, Stanford Uni-versity, Palo Alto, CA 94304, USA Masoud Mohammadi Research Center for Noncommunicable Diseases, Jahrom University of Medical Sciences, Jahrom, Iran 2023 10 09 2024 01 13 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. https://ijph.tums.ac.ir/index.php/ijph/article/view/33423 https://ijph.tums.ac.ir/index.php/ijph/article/download/33423/8341

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 53 9 2024 09 03 2121 2129 Shohreh SeyyedHosseini Deapartment of Medical Library and Information Science, School of Paramedicine, Bushehr University of Medical Sciences, Bushehr, Iran Mohammadreza Yazdankhahfard Department of Nursing, School of Nursing and Midwifery, Bushehr University of Medical Sciences, Bushehr, Iran Maryam Azargoon Department of Knowledge and Information Science, Shahid Chamran University of Ahvaz, Ahvaz, Iran Reza BasirianJahromi Department of Medical Library and Information Science, School of Paramedicine, Bushehr University of Medical Sciences, Bushehr, Iran 2023 09 07 2024 02 12 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. https://ijph.tums.ac.ir/index.php/ijph/article/view/33155 https://ijph.tums.ac.ir/index.php/ijph/article/download/33155/8351

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 53 9 2024 09 03 2130 2139 Riaz Alaei Kalajahi Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Mohammad Ghorbani Department of Mathematics and Mathematical Statistics, Umeå University, Umeå, Sweden Mohammad Arab Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Ebrahim Jaafaripooyan Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Mehdi Yaseri Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 2022 09 09 2023 02 02 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. https://ijph.tums.ac.ir/index.php/ijph/article/view/29764 https://ijph.tums.ac.ir/index.php/ijph/article/download/29764/8352

Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 53 9 2024 09 03 2140 2149 Mohammad Fararouei HIV/AIDs Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Farzaneh Mobasheri Research Center for Social Determinants of Health, Jahrom University of Medical Sciences, Jahrom, Iran Abbas Rahimi Jaberi Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Jafar Hasanzadeh Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran 2023 11 06 2024 01 14 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 fa