A Systematic Review of Suicide Prevention Interventions in Military Personnel.

OBJECTIVE: In response to the increasing rates of suicide in military personnel throughout the world, there is an increasing focus on the development and implement of interventions aimed at preventing suicide among this group. Therefore, the goal of the present systematic review was to examine the effectiveness of interventions focused on preventing suicidal ideation and behavior in military personnel. METHOD: Search for articles was conducted in PsycINFO, PubMed, Web of Science, EMBASE, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), IranMedex, Scientific Information Database (SID), and MagIran. International databases were searched from June 2008 to May 2019, and Iranian databases were searched from their inception to May 2019. RCT and non-RCT studies focused on the effectiveness of preventive interventions for suicide in military personnel were included in the analysis. Narrative synthesis of results was the main strategy for data analysis. RESULTS: According to the inclusion and exclusion criteria, 18 articles were selected. Interventions were divided into four categories according to their nature: interventions based on psychotherapy, interventions based on crisis management, interventions based on pharmacotherapy, and community-based interventions. In addition, most studies had moderate methodological quality. CONCLUSION: Most of the preventive interventions were effective in reducing suicidal ideation and behavior in military personnel; however, in some cases, there were serious challenges in terms of effectiveness. Interventions based on cognitive-behavioral approaches constitute a significant portion of the interventions. Overall, RCTs and non-RCTs, especially community-based studies, need to use more rigorous examinations in order to gain research and clinical support. HIGHLIGHTSInterventions based on psychotherapy and community-based interventions were the most commonly used interventions, respectively.The majority of interventions based on psychotherapy came from cognitive-behavioral approaches.There are few evidence-based studies on prevention of suicide in military personnel.

Health literacy knowledge and experience survey: Cross-cultural adaptation and the psychometric properties of the Iranian nurse version.

BACKGROUND: Nurses' knowledge and Experience with Health Literacy can affect the treatment process, improving the quality of health care and effectively communicating with all clients. Evaluation of nurses' knowledge and experience requires a reliable instrument. This study aimed to translate cross-cultural adaptation and testing of Health Literacy Knowledge and Experience Survey (HL-KES). MATERIALS AND METHODS: This cross-sectional methodological study was done during 2018-2019. The study was carried out in two stages: the first phase was designed to obtain a translation and cross-cultural equivalent of the (HL-KES), based on the World Health Organization (2018) and the Sousa and Rojjanasrirat (2011) Guidelines in six steps: preparation, forward translation, reconciliation, back translation, back translation review and pretesting and cognitive debriefing of the translated questionnaires. The second phase was conducted to evaluate the psychometric properties of the questionnaire. RESULTS: The content validity index and content validity ratio values of all items were >0.62 and 0.79, respectively. Based on the Kuder-Richardson formula, the reliability of the knowledge dimension was reported as 0.7. Furthermore, split-half coefficient for inter-rather reliability and test-retest were 0.76 and 0.96, respectively. The reliability of their experiences with the HL-KES was measured using Cronbach's alpha, in which it was 0.82. CONCLUSIONS: The Persian version of the instrument for assessing nurses' knowledge and experience with health literacy had good validity and reliability. It is recommended that it should be used in educational, clinical environments, and also in future research studies.

Determinants of Lifestyle Behavior in Iranian Adults with Prediabetes: Applying the Theory of Planned Behavior.

OBJECTIVE: Prediabetic condition can lead to development of type 2 diabetes, especially in individuals who do not adhere to a healthy lifestyle. The aim of the present study was to investigate the socio-cognitive factors using the Theory of Planned Behavior (TPB) that may be associated with the choice of lifestyle in prediabetic patients. METHODS: A prospective study with one-month follow up was designed to collect data from 350 individuals with prediabetic conditions. A questionnaire was used to collect the information, including demographic variables, exercise behavior, food consumption, as well as the constructs of the TPB (attitude, subjective norms, perceived behavioral control, and behavioral intention) regarding physical activity and dietary choice. The correlations between TPB variables and the dependent variables (dietary choice, physical activity) were assessed using Spearman correlation and multiple regression models. RESULT: In total, 303 people participated. The mean age of the participants was 53.0 (SD 11.5) years and 42% were males. Significant correlations were found between all TPB constructs and both dependent variables (healthy eating and exercise behaviors) both at baseline and after one month (P < 0.01). The predictive validity of the TPB over time was proved for both dependent variables where past and future behaviors were significantly correlated with the constructs. Nearly 87% of the variance in exercise behavior and 72% of the variance in healthy eating behavior were explainable by TPB constructs. CONCLUSION: The TPB may be a useful model to predict behaviors of physical activity and dietary choice among prediabetic people. Therefore, it may be used to monitor lifestyle modification to prevent development of diabetes among people with prediabetic conditions.

An investigation into the effect of health belief model-based education on healthcare behaviors of nursing staff in controlling nosocomial infections.

BACKGROUND: Health-care acquired infections are significant given the risks and costs they impose. All previous studies indicate a poor level of knowledge and performance among the nurses in hospital infections; as such, educating nurses can play an important role in infection control. This study aimed at evaluating the effects of the health belief model (HBM) in making nurses adopting health-care behaviors needed to control nosocomial infections (Nis). MATERIALS AND METHODS: The participants of the study were 135 nurses from two hospitals in Mashhad, Iran. A self-administered questionnaire was used to collect data. The questionnaire consisted of seven parts. The intervention group received four 45 min educational programs, both in individual and collective forms. After a 2-month interval, a post-test was conducted to see whether any difference has been resulted. RESULTS: There was a significant relationship between knowledge (P = 0.001), perceived threat (P = 0.004), perceived benefits (P = 0.001), and practices (P = 0.001) in comparing to control and experimental groups after intervention. For the experimental and control groups, the most frequent cues to action at the preintervention stage were, respectively, related to the period of studying at university and in-service classes. CONCLUSION: According to this study, HBM-based education can increase knowledge, perceived threat, and perceived benefits of nurses. Additionally, it can reduce perceived barriers and improve the control of NIs among nurses.

Seroprevalence of hepatitis A virus among Iranian soldiers.

AIM: This study aims to investigate the seroprevalence of HAV immunity among Iranian soldiers and determine whether vaccination should be given to military draftees. BACKGROUND: Hepatitis A virus (HAV) is highly contagious in individuals living in crowded conditions such as military centers. To the best of our knowledge, there are limited data about HAV prevalence among Iranian soldiers. PATIENTS AND METHODS: In this cross-sectional study, a total of 1554 soldiers were recruited through a random clustering sampling. Serum anti-HAV antibody was measured by Enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed using SPSS. RESULTS: A total of 1554 male soldiers with age ranged from 18 to 34 years (mean age: 21.2±1.9 years) at baseline were evaluated. Overall, 80.3% of the analyzed specimens were anti-HAV seropositive. Seroprevalence rates significantly increased with the age. CONCLUSION: Our results suggest that vaccination for HAV is not necessary for Iranian military draftees. However, the vaccination is recommended for high-risk groups, including anti-HAV seronegative soldiers.

Predictors of Oral Health Behaviors in Female Students: An Application of the Health Belief Model.

BACKGROUND: Oral and dental health diseases can affect the general health of students. OBJECTIVES: The aim of this study was to identify the predictors of oral and dental health behavior using the health belief model (HBM) in female students in Teheran, Iran. PATIENTS AND METHODS: This was a cross-sectional study framed by the HBM, including 400 female students living in district 5 of Tehran, Iran. The sampling technique used in this study was multi-stage stratified random sampling. The data on the HBM constructs (perceived severity, perceived susceptibility, perceived benefits, perceived barriers, cues to action, and self-efficacy) and demographic characteristics were collected using a self-administered questionnaire. Descriptive statistics, bivariate correlations, and linear regression were performed to analyze the data, using the SPSS software, version 18. RESULTS: The results showed that there were relationships between the knowledge, perceived barriers, cues to action, and mother's education with oral health behaviors. A multivariate hierarchical regression analysis was conducted with the barrier entered at step one, knowledge at step two, and cues to action at step three. Finally, the three variables accounted for 17% of the total variance in the oral and dental health behavior. CONCLUSIONS: The current study provided evidence for the utility of the belief-based model in the prediction of oral health behaviors. It could be suggested that oral health behavior can be promoted by reducing the perceived barriers and enhancing the students' knowledge of oral and dental hygiene.

Efficacy of HBM-Based Dietary Education Intervention on Knowledge, Attitude, and Behavior in Medical Students.

BACKGROUND: Using various models of behavior change, a number of studies in the area of nutrition education have confirmed that nutrition habits and behaviors can be improved. OBJECTIVES: This study sought to determine the effects of education on patterns of dietary consumption among medical students at the military university of Tehran, with a view to correcting those patterns. METHODS: In this quasi-experimental study, 242 medical students from the Military University of Tehran were chosen by convenience sampling and then divided into control (n = 107) and intervention groups (n = 135) by block randomization. The self-administered questionnaire involving six categories of item (knowledge, perceived benefits, perceived barriers, perceived threats, self-efficacy and behavior) has been validated (Cronbach alpha > 0.7 for each). RESULTS: Following the educational intervention, the mean score of knowledge, health belief model (HBM) structure, and behavior of students in relation to healthy patterns of food intake increased significantly (P < 0.05). The mean pre-intervention knowledge score was 6.76 (1.452), referring to threats to HBM constructs including perceived threat 2.93 (1.147), perceived benefits 7.28 (1.07), perceived barriers 5.44 (1.831), self- efficacy 4.28 (1.479), and behavior 8.84 (2.527). The post-intervention scores all improved as follows: knowledge 8.3 (1.503), perceived threats 3.29 (1.196), perceived benefits 7.71 (0.762), perceived barriers 5.9 (1.719), self- efficacy 4.6 (1.472), and behavior 9.45 (2.324). This difference in mean scores for knowledge, health belief structures and employee behavior before and after educational intervention was significant (P ≤ 0.05). CONCLUSIONS: The significant improvement in the experimental group's mean knowledge, HBM structures , and behavior scores indicates the positive effect of the intervention.

Evaluation of Transtheoretical Model-Based Family Education Among Females of Zahedan (Southeast of Iran).

BACKGROUND: It cannot be denied that many improvements in female and child health have been achieved worldwide through international family planning programs. More than half of the females (57%) with unintended pregnancy admitted that they had not used birth control the month before conception. OBJECTIVES: The aim of this study was to promote family planning practice among females of Zahedan (southeast of Iran) through the transtheoretical model (TTM). PATIENTS AND METHODS: The current quasi-experimental study was conducted on 96 eligible females, who were allocated either to the case or the control group and were selected from homes in the border of Zahedan city (southeast of Iran) during 2010. Convenience sampling by door-to-door visits was used for finding eligible cases. A TTM-based self-administrated family planning questionnaire was used for data collection. Participants in the intervention group received education in two groups, based on their stage of change: precontemplation, contemplation, preparation, action, maintenance, and all groups were followed for three months. RESULTS: The result of the chi-square test did not show any significant difference in the stage of change: precontemplation, contemplation, preparation, action, maintenance before education between the control and intervention groups (P = 0.55). After education, subjects in the intervention group moved forward through stage of change and got at least one step closer to the family planning behavior., with this change being significant (P < 0.001), while the movement of participants through stage of change not being significant in control group (P = 1). The results of statistical tests illustrated that the mean knowledge of the intervention group was 7.5 ± 7.1 versus 0.5 ± 4 for the control group (P < 0.001), mean of attitude of the intervention group was 5.5 ± 5.41 versus 0.09 ± 2.04 for the control group (P < 0.001), and practicing family planning methods (P < 0.007) in the intervention group was higher than the control group after education based on TTM. CONCLUSIONS: According to this study, the educational plan based on TTM was effective in changing knowledge, attitude, and practice and directing females towards taking action. Moreover, self-efficacy, perceived barriers and benefits are factors that affect the use of family planning methods.

Factors predicting nutrition and physical activity behaviors due to cardiovascular disease in tehran university students: application of health belief model.

BACKGROUND: Disease preventing methods focus mostly on lifestyle factors such as physical activity, healthy diet and not smoking. Previous studies verified using theory and models to change unhealthy behaviors, so that health belief model (HBM) is a useful framework for describing the healthy nutrition behavior. OBJECTIVES: This study aimed to predict factors related to unhealthy nutrition and inactive life in students of Tehran University, Tehran, Iran based on the Health Belief Model (HBM). PATIENTS AND METHODS: In this cross sectional study, proportional quota sampling from three different educational levels was conducted from October to December 2012. A self-administered validated instrument based on the Health Belief Model (HBM) with 69 items and four sections was used to collect data. In this study through using linear and logistic regression, the effect of body mass index, age, gender, marriage, self-efficacy, cues to action, knowledge, perceived severity, susceptibility, benefits and barriers on nutrition and physical activity behavior were assessed. SPSS version 18 was used to analyze data. RESULTS: Totally, 368 students including 318 female students (86.4%) and 50 male students (13.6%) with a mean age of 24.9 years (SD = 4.55) took part in the study. Among all independent variables, gender (P < 0.001), knowledge (P = 0.023) and perceived barriers (P = 0.004) predicted nutrition behavior. In case of physical activity, knowledge (P = 0.011), perceived severity (P = 0.009), perceived barriers (P = 0.019) and self-efficacy (P = 0.033) had significance association with physical activity behavior. CONCLUSIONS: This study indicated that health belief model contrasts could predict the risky behavior of university students due to heart disease. However, more researches are needed to verify the predictors of high risky behaviors in students.

Nutrition and physical activity educational intervention on CHD risk factors: a systematic review study.

INTRODUCTION: Fast growing epidemic of chronic diseases causes many health challenges over the world. Regarding reported pros and cons, the aim of the current study is to review the effect of nutrition and physical educational intervention in decreasing cardiovascular risk factors. METHODS & MATERIALS: In this review study, searching has done through the English and Persian databases. Articles with other languages, lack of important information, and score 3 or less in the JADAD standard checklist were exluded from the study. FINDINGS: In the primary search, 194 articles have been found.Through four stages of secondary search and further evaluation, 43 articles were selected. These articles were published between 1989 to 2013. CONCLUSION: According to these findings, the majority of articles showed a positive effect of nutrition and physical activity educational interventions on cardiovascular risk factors- blood cholesterol, systolic and diastolic blood pressure, as well as smoking cigarette in high risk patients. These results, suggest the necessity of continiuting nutrition and physical educational intervention for individuals with cardiovascular risk factors.

Factor structure of the Iranian version of 12-item general health questionnaire.

BACKGROUND: The 12-Item General Health (GHQ-12) questionnaire is one of the most commonly used instruments in screening studies on mental health. OBJECTIVES: The current study aimed to examine the factor structure of the GHQ-12 questionnaire among the students in Iran. MATERIALS AND METHODS: It was a cross-sectional study in which 428 university students were recruited and completed the GHQ-12. Reliability of the GHQ-12 was evaluated using the Cronbach's alpha and the split-half method by applying the Spearman-Brown coefficient. Factor structure of the questionnaire was extracted by exploratory factor analysis (EFA). Confirmatory factor analysis (CFA) was conducted to assess how well the EFA extracted model fitted the observed data. RESULTS: The mean age of the participants was 22.83 years (SD = 3.09). Most of them were female (56.1%) and 81% were unemployed. The Cronbach's alpha coefficient for the Iranian version of GHQ-12 was 0.85. Using the split-half method, the alpha for the social dysfunction was found to be 0.77; it was 0.76 for the psychological distress. The principal component analysis revealed a two-factor structure for the questionnaire including social dysfunction and psychological distress that explained 48% of the observed variances. The confirmatory factor analysis was showed fit for the data. CONCLUSIONS: The current study findings confirm that the Iranian version of GHQ-12 has a good factor structure and is a reliable and valid instrument to measure psychological distress and social dysfunction.

Mental Health Levels and Incidence of Musculoskeletal Complaints among Speed Boat Crew Members.

BACKGROUND: The occupational health is an important issue. In some jobs, the working conditions contribute to musculoskeletal complaints and the overall health of the individual is compromised. Musculoskeletal complaints have gained credence in the public as one of the most important problems in the field of occupational diseases. Physical and mental health of crew members with critical jobs and stressful environments must be considered as well. OBJECTIVES: This study performed an assessment on levels of mental health and the correlation with the frequency of accompanying musculoskeletal complaints (such as neck, back and knee pain) of crew members of speed boats. MATERIAL AND METHODS: 149 onboard crew members of speed boats were recruited in a descriptive-correlation study by nonrandom sampling using conducted GHQ12, NMQ and demographic questionnaires. RESULTS: Although 63.8% (95 people) had what is conventionally defined as normal mental health, 36.2% (54 cases) had an inherent mental health condition. Overall, 61.1% (91 cases) suffered from back pain, 60.4% (90 cases) complained of knee pain, and 40.3% (60 patients) complained of neck pain. The combination of knee and back pain (48.3%) were the most common complaints whereas the combination of neck and knee pain (31.5%) were the least frequent; 28.2% complained of pain in all three areas. Interestingly, there was correlation between the presence of musculoskeletal complaints and less than optimum mental health. CONCLUSIONS: Due to the high number of musculoskeletal complaints and the compromised mental health conditions among one-third of the onboard crew members of speed boats, attention for maintaining and improving the health of these members must be considered.

Relationship between blood lead level and male reproductive hormones in male lead exposed workers of a battery factory: A cross-sectional study.

BACKGROUND: The reproductive system is one of the organs that are affected by lead. Lead can cause loss of libido and fertility in men, and menstrual disturbances and spontaneous abortion in woman. OBJECTIVE: The purpose of this cross-sectional study was assessment of dose-response relationship between blood lead level (BLL) and sex hormones levels in lead exposed male workers. MATERIALS AND METHODS: One hundred and thirteen male workers enrolled. All workers had at least 6 months of lead exposure and no history of diseases or conditions affecting reproductive system. Blood lead level and hormones levels measured with atomic absorption spectrophotometer and radioimmunoassay method, respectively. RESULTS: Average duration of exposure was 15.92±6.95 years. Mean BLL was 41.41µg/dl±16.99. All of the sex hormones values were in normal range. Pearson correlation showed that sex hormones levels had no significant correlation with blood lead level. Also, there was no significant difference in sex hormones levels between workers with BLL <40µg/dl and workers whose BLL was >40 µg/dl. CONCLUSION: This study showed that BLL cannot serve as a predictor of male sex hormonal changes. However, it is not possible to rule out the effect of lead on the reproductive system after long-term exposure.

Evaluation of Occupational Risk Factors in Non-Hodgkin Lymphoma and Hodgkin's Disease in Iranian Men.

BACKGROUND: Lymphoma is a malignancy, arises from lymphoid tissue. Nowadays, it is the ninth most common cancer in Iran. The risk factors of malignant lymphomas have not well determined, but since 20 years ago till now, too many epidemiological researches have been concerning either Non-Hodgkin Lymphoma (NHL) or Hodgkin's Disease (HD). It is a common usual hypothesis that idiosyncratic reaction to common physical, chemical, and viral agents could lead to lymphoma without obvious immune deficiency. Some occupations has reported to cause increasing "NHL" risks, such as rubber industry, veterinaries, uranium mining, metal working, asbestos exposing, farming, textile industry, and benzene exposing. The roles of ionizing radiation, benzene and other environmental agents have not been clear, because of the lack of confirmed evidences for relation between the occupational and environmental agents with "HD". METHODS: A case-control study with 150 cases of malignant lymphoma and 150 controls have performed in Tehran. Data have selected through face-to-face interviews about the medical and occupational histories. RESULTS: In this study, there was a significantly increased risk for Non-Hodgkin Lymphoma in these occupations; welders, metal workers, founders, aluminium workers OR=4.6 [Confidence Interval (CI): 1.47-14.35] and increased risk for Hodgkin's Disease in drivers OR=2.34 [(CI):0.86-6.35]. We have found out decreased NHL risk in office workers OR=0.54 [(CI):0.29-1.02] and also found out a non-significant increased NHL risk in farmers OR=1.58 [(CI):0.82-3.03]. In this study, we have found no relation between smoking and HD, or NHL. CONCLUSION: The results of this study suggest that several occupations could alter the risk of Non-Hodgkin Lymphoma and Hodgkin's Disease.

Experiences of stigma in healthcare settings among adults living with HIV in the Islamic Republic of Iran.

BACKGROUND: People living with HIV (PLHIV) sometimes experience discrimination. There is little understanding of the causes, forms and consequences of this stigma in Islamic countries. This qualitative study explored perceptions and experiences of PLHIV regarding both the quality of healthcare and the attitudes and behaviours of their healthcare providers in the Islamic Republic of Iran. METHODS: In-depth, semi-structured interviews were held with a purposively selected group of 69 PLHIV recruited from two HIV care clinics in Tehran. Data were analyzed using the content analysis approach. RESULTS AND DISCUSSION: Nearly all participants reported experiencing stigma and discrimination by their healthcare providers in a variety of contexts. Participants perceived that their healthcare providers' fear of being infected with HIV, coupled with religious and negative value-based assumptions about PLHIV, led to high levels of stigma. Participants mentioned at least four major forms of stigma: (1) refusal of care; (2) sub-optimal care; (3) excessive precautions and physical distancing; and (4) humiliation and blaming. The participants' healthcare-seeking behavioural reactions to perceived stigma and discrimination included avoiding or delaying seeking care, not disclosing HIV status when seeking healthcare, and using spiritual healing. In addition, emotional responses to perceived acts of stigma included feeling undeserving of care, diminished motivation to stay healthy, feeling angry and vengeful, and experiencing emotional stress. CONCLUSIONS: While previous studies demonstrate that most Iranian healthcare providers report fairly positive attitudes towards PLHIV, our participants' experiences tell a different story. Therefore, it is imperative to engage both healthcare providers and PLHIV in designing interventions targeting stigma in healthcare settings. Additionally, specialized training programmes in universal precautions for health providers will lead to stigma reduction. National policies to strengthen medical training and to provide funding for stigma-reduction programming are strongly recommended. Investigating Islamic literature and instruction, as well as requesting official public statements from religious leaders regarding stigma and discrimination in healthcare settings, should be used in educational intervention programmes targeting healthcare providers. Finally, further studies are needed to investigate the role of the physician and religion in the local context.