مجله طب نظامی
سال بیست و دوم شماره 12 (پیاپی 97، اسفند 1399)

Due to the high prevalence of anxiety and depression symptoms in veterans, the present study aimed to compare the effectiveness of metacognitive therapy as a new treatment with long-term exposure therapy as a recommended and conventional treatment in the treatment of war veterans with chronic PTSD and symptoms of anxiety and depression as comorbidity.

This quasi-experimental study with a control group (waiting for treatment) was performed as a pre-test and post-test with a follow-up of 3 months on 57 veterans referring to some psychiatric wards of military hospitals in Tehran, Iran. Seventeen people were randomly assigned to the experimental group 1 (receiving metacognitive therapy), 17 to the experimental group 2 (receiving long-term exposure therapy) and 23 to the control group. Research tolls included, Post Traumatic Stress Disorder Index (PCL-M - Military Edition), Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI-II), and a demographic Researcher-made questionnaire.

By considering the matching of the groups, the findings showed that the effectiveness of both interventions on reducing depression and anxiety symptoms was the same. However, there was a significant difference between the groups receiving metacognitive therapy and long-term exposure therapy with the control group in the field of variables, which indicates the effectiveness of both therapeutic interventions on the variables (P=0.001).

The current findings showed that metacognitive therapy can also be considered one of the most effective new therapeutic interventions in the field of chronic PTSD caused by war along with other psychological therapies of PTSD (long-term exposure therapy).

Patientschr('39') perspectives as a reliable source can be considered for the evaluation of health services. The purpose of this study was to evaluate the satisfaction of patients with COVID-19 from the services provided in Baqiyatallah Hospital, Tehran, Iran in 2020.

In this cross-sectional study, 73 patients with COVID-19 discharged from Baqiyatallah Hospital, Tehran, Iran were selected by the available sampling method. The data collection tool was a patient satisfaction questionnaire consisting of 48 questions which were adjusted based on the Likert scale and its validity and reliability were confirmed. The questionnaire assessed patient satisfaction in two aspects of medical (nursing, physician, health and hygiene) and non-medical services including nutritional status, welfare facilities, admission services, staff behavior, discharge and religious observance. Data were analyzed using SPSS software version 18.

Patientschr('39') satisfaction with the medical aspect was 86% and in the non-therapeutic aspect was 84.15% (excellent level). There was no statistically significant relationship between demographic variables such as age, sex, marital status, hospitalization, type of insurance and the reason for hospital selection with patient satisfaction. (p>0.05).

Due to the high satisfaction of patients in the hospital, especially in the medical aspect, it is possible to strengthen the positive points and also analyze the reasons for patient dissatisfaction, especially in the non-medical aspect, to improve hospital services and performance and increase patient satisfaction.

Assessing the spiritual health of professors (soft war officers) is essential to deepen the spirituality of the university environment and counteract cultural invasion. The professional spiritual health assessment should be done without measuring religiosity and inquisition. The purpose of this study was to design and validate a self-assessment questionnaire for the professional spiritual health of professors (soft war officers).

This was a sequential exploratory study of instrument making. Data were collected in sequential chronological order. In the results interpretation part, data correlation was performed. In qualitative phase using the concept analysis method of Schwartz and Kim hybrid model with deductive/inductive analysis approach was done in three stages: a theoretical review of religious and scientific evidence, fieldwork with in-depth individual interviews and discussion in focus groups, final data analysis based on "Contractual Content Analysis Method", the initial version of the questionnaire was developed in the form of 73 initial measurable items. To determine the validity of the questionnaire, face validity, qualitative and quantitative content (CVR and CVI), structural validity, to determine reliability of internal consistency (Cronbachchr('39')s alpha) and stability were performed.

The CVR score in 67 items was higher than the Lewsheh table number (0.33). Five items without the required score were removed from the questionnaire. The results of CVI calculation showed that all items received a CVI score higher than 0.79. The final questionnaire had 67 items. The results of exploratory factor analysis showed the existence of a 7-factor model (model of spirituality, courage, kindness, wisdom, modesty, self-respect, justice) in the structure of items. Internal consistency of the questionnaire (with Cronbachchr('39')s alpha of 0.9) showed that all items had a high correlation and were significant at the level of p <0.05.

Using this questionnaire allows professors (soft war officers) to examine professional spiritual distress and diagnose spiritual problems. The use of spiritual care guidelines, daily self-calculation, enables cultivation so that they, in the position of spiritual mentors, can achieve the Islamization of the university and the fight against soft war.

Malnutrition is a common problem for hemodialysis patients, leading to reduced quality of life, increased hospitalization, and increased mortality. Evaluation of nutritional status is one of the main determinants of the clinical status. The aim of this study was to investigate the effect of oral nutritional supplements (Iso Whey) on the nutritional status of hemodialysis patients.

In this clinical trial, 44 hemodialysis patients during random allocation divided into two Iso-whey and control groups. In intervention groups, Iso Whey protein powder was consumed for two months. The control group continued their routine diet. In all groups, before and after the intervention, nutritional status was evaluated based on Dialysis Malnutrition Score (DMS) and Malnutrition-Inflammation Score (MIS) scale.

Both groups were matched in demographic variables and nutritional status before intervention (P>0.05). After the intervention, there was a significant difference between the groups in nutritional status based on DMS and MIS scale (P<0.05).

The findings showed that the intake of oral nutritional supplements resulted in improving hemodialysis patientschr('39') nutritional status. Therefore, using oral nutritional supplements under the supervision of a nutritionist with an educational program and regular assessment of nutritional status can be recommended to improve the nutritional status.

The crisis of Rohingya Muslim refugees has become one of the challenging issues of the last decade. The organized massacre of Rohingya people in Myanmar has forced them to relocate to Bangladesh, creating the worldchr('39')s largest refugee camp. The purpose of this study is to assess the health status of these refugees.

The present study was conducted using a systematic review method. The keywords Rohingya, Bangladesh, Myanmar, Bruma, and their combinations have been searched in international databases regardless of the time period. Finally, 42 papers were selected according to the inclusion and exclusion criteria.

An evaluation of papers related to the health status of Rohingya Muslims showed that these refuge facing different types of health problems at Cox’s Bazar camp. Lack of basic health equipment and resources such as safe drinking water, high prevalence of infectious diseases, lack of food security, social constraints, mental issue, high rates of behavioral violence, as well as poor health conditions of pregnant women are some of the Rohingya Muslims health difficulties.

The various health problems of Rohingya refugees in Bangladesh indicate the emergency need of accelerating humanitarian aid delivery to these people in order to prevent a humanitarian catastrophe.

Non-suicidal self-injurious behaviors could strongly predict future suicide attempts. To better understand this behavior and related and mediating factors, this study was conducted to determine the mediating role of self-compassion in the relationship of Alexithymia and symptoms of Borderline Personality with non-suicidal self-injury behaviors in soldiers.

The study design was descriptive-correlational through structural equation modeling. The sample of the study (n=254) was selected by convenience sampling method among all the army soldiers in Tehran, Iran in 2019. The soldiers completed the scales including the Deliberate Self-harm Inventory (DSHI), Borderline Personality Scale (STB), Self-Compassion Scale (SCS) Short-Form, Cognitive Flexibility Inventory (CFI), and The Perth Alexithymia Questionnaire. Data were analyzed via Pearson correlation coefficient and the path analysis of structural equation modeling using SPSS-20 and Lisrel-8.80.

The NNSI is significantly correlated with a general score of Alexithymia (p=0.01, r=0.39) and borderline symptoms (p=0.01, r=0.64). However, it has a negative correlation with self-compassion score (p=0.01, r=-0.60). The self-compassion score is also negatively correlated with the general score of Alexithymia (p=0.01, r=-0.41) and borderline symptoms (p=0.01, r=-0.60). Moreover, the results of the path analysis showed that self-compassion acts as a mediator between the relation of NSSI with Alexithymia and borderline symptoms.

Self-compassion could be a protective factor against the negative effects of Alexithymia and borderline symptoms. In other words, the critical Alexithymia and borderline symptoms leading to NNSI behaviors are mediated by self-compassion. Thus, including this protective factor in preventive and therapeutic programs for NNSI in soldiers is highly recommended.

Military service is a period that can be a source of tension and psychological trauma for some soldiers. The purpose of this study was to investigate the effectiveness of mindfulness therapy on positive emotion regulation strategies and executive function.

This study was a quasi-experimental study with pre- and post-test with control and post-test groups. The study population consisted of soldiers in Imam Reza (AS) Northeast Air Defense Center in Mashhad. Forty soldiers were selected by convenience sampling and were assigned randomly into two groups. The tools used in this study were the Emotional Adjustment Strategies Questionnaire and the Tower of London Questionnaire.

The mindfulness interventions had a significant effect on increasing the mean score of the experimental group in executive function (P<0.001) and improving the level of emotion regulation strategies (P<0.001).

Considering the significant effect of mindfulness on research variables, it seems that implementation of this treatment at the broader levels of the community of soldiers can improve the mental health of this community.

Physical fitness is a major contributor to combat readiness, and current military tests do not measure it appropriately. The purpose of this study was to design a combat readiness test that could reliably and consistently determine the level of physical fitness distinctly required prior to deployment into the battlefield.

The subjects of this study were military personnel with an average age of 30.5±4.14 years. After the initial design of the test, content, criterion and discriminant validity were assessed. The reliability was evaluated through the test-retest method. Physiological parameters such as heart rate and blood lactate as well as Borg Rating of Perceived Exertion (RPE) were used to determine the severity of the designed test. Data analysis was done by SPSS-18.

The test was designed in a circuit and consisted of 11 items. After validity assessment, questions with CVI (content validity index) and CVR (content validity ratio) of less than the limit were modified and corrected. The validation process was repeated until the desired amount of CVR of 0.56 and the CVI greater than 0.79 were obtained. There was a positive correlation between the time of the designed test and the time of the American army combat readiness Test (ACRT). The time taken to complete the test was significantly different between elite and non-elite volunteers was significantly different. A significant correlation was found between test and retest results.

Results indicate that the test has acceptable content validity, criterion, discriminant validity, and reliability. The physiological variables of heart rate and blood lactate concentration and RPE before and after the test showed that the severity of the test was maximal.

Hospital wastes are considered hazardous wastes due to their potential impact on environmental pollution and health hazards. The aim of this study was to determine the quantitative status of hospital wastes in selected hospitals of the Armed Forces in Iran and examine the adaptability of the current waste management practice with the fourth-generation accreditation model.

In this cross-sectional study, the amount of waste generated in eight hospitals of the Iranian Armed Forces were weighed daily for each hospital in 2019. The accreditation data were collected using the observation method following the standard fourth-generation accreditation checklist. Staff training time was determined by referring to hospital documents. The data were analyzed using the SPSS software (Version16.0).

The total daily waste production per active bed in the Iranian army hospitals was on average at 6.06 kg. There was a significant difference between various waste types (i.e., infectious, non-infectious, sharp, and chemical wastes) in the studied hospitals. The mean daily waste generated in hospitals with the open-heart operating rooms was also significantly different from the other hospitals (P<0.001). Evaluation of these results based on the fourth-generation accreditation standards revealed that the examined hospitals achieved 89% of the scores of waste generation indicators. In this study, there was no significant relationship between the training and the amount of waste.

The fourfold difference between the minimum and maximum daily waste production per active bed in the Iranian army hospitals indicates that there has been non-compliance with waste production standards in some hospitals. With proper training and continuous monitoring, waste generation can be reduced to a minimum.

Nursing is one of the stressful professions in which the development of stress management skills is necessary to reduce stress. The aim of this study was to investigate the effect of educational intervention based on participatory methods on stress management in cardiac surgery nurses.

The present study is a randomized controlled trial with a pre-test and one-month post-test follow-up. The statistical population included 42 nurses working in the departments of cardiac surgery, operating room, and heart ICU of Afshar Hospital in Yazd in 2019, who were randomly assigned to two tests and control groups. Data were collected using demographic and the Nursing Stress Scale (NSS) questionnaires. Consultation with the test problem-solving approach was conducted during 2 sessions in 8 hours as a workshop with the test group. Data were analyzed by SPSS software version 16.

The mean score of nursing job stress dimensions in the test group was 6.88 ± 2.36 and in the control group was 11.65 ± 5.13, which showed a statistically significant decrease compared to the control group in one month after the intervention (P ˂ 0.004). Indeed, nurses involved in stress management training programs reported lower job stress.

The nurseschr('39') participation in stress management training programs reduced the job stress of nurses working in the cardiac surgery departments. Therefore, it is recommended that nursing managers hold stress management programs in the workplace and thereby improve the quality of nursing services.