Journal of Military Medicine
Year:2020 | Volume:22 | Issue:9|Papers Count:9

Background and Aim: Neck pain is a common disease and a relatively early disorder among military personnel. Neck pain causes disability, reduced quality of life, productivity, combat readiness of forces, and increased health care costs. The purpose of this study was to investigate the risk factors associated with neck pain in male military Personnel. Methods: In this case-control study, 200 male military personnel with chronic neck pain and 200 healthy military personnel were evaluated by simple random sampling. A three-part questionnaire (demographic, occupational and clinical information) with closed questions, NDI (Neck Disability Index), Job Related Physical Demands questionnaire (JRPD), Health Risk Appraisals questionnaire (HRA) was used as the tools. For both groups, four questionnaires were completed, then the relationship between risk factors associated with neck pain in both groups was determined. Results: The demographic data (age, height, weight, work experience) was matched between both groups. Among the factors studied, there were positive significant relationships between neck pain with hard job titles (p=0. 010), prolong work experience (p=0. 002), heavy and continuous physical activity (p=0. 011), exercises of neck-shoulders and shoulder belt (p=0. 002), movements associated with lifting a heavy load of more than 25 kg (p=0. 002), daily working hours (p=0. 007), deformity in dorsal and cervical spine (p=0. 002), movements with bending and righting (p=0. 002), neck rotation (p=0. 005), movements accompanied by heavy load displacement from the height above the shoulder (p=0. 002) and awkward posture (p=0. 004). Also, there were negative significant relationships between neck pain with attendance in exercise programs (P=0. 003), body mass index (p=0. 025) education level (p=0. 003), smoking (p=0. 017), duration of neck pain (p=0. 002), history of neck pain (p=0. 010) carrying heavy bags and objects by shoulder belt (p=0. 002), and duration of exercise in male military Personnel. Conclusion: By identifying the risk factors associated with neck pain and reducing the amount of these factors, new lesions or their expansion can be prevented and the level of efficiency of military forces can be improved.

Background and Aim: The mental health of soldiers is a vital issue that has posed many challenges today. The aim of this study was to review the mental health of Iranian soldiers and its influencing factors. Methods: In this systematic review study, papers published over a period of 15 years between the years 2004-2019 were reviewed. Electronic search in Persian and English with the keywords; soldiers' health, military mental health, soldiers' mental disorders, army, armed forces and soldiers in Scopus, Pubmed, Google Scholar, SID, iranMagiran, Medlib and Iranmedex was done. In the initial search; 615 papers related to soldiers’ mental health were obtained. In the screening stage, 286 papers were retrieved and according to the exclusion and inclusion criteria, 18 papers were selected. Results: According to the studies, it can be said that the mental health status of Iranian soldiers is dependent on two general categories of external (family environment, economic, cultural and psychological factors) and internal factors (existing facilities, commanders' approach, type of duty). And the manner of training). The results of this study showed that some Iranian soldiers suffer from mental disorders such as depression, anxiety, sleep disorders, drug addiction, personality problems including paranoid, mania, schizophrenia, hysteria and narcissism. Numerous factors including individual, family, social, economic, cultural, managerial and organizational factors affect their mental health status. Conclusion: The increase in mental disorders among young people, especially soldiers, makes it necessary to provide effective strategies to improve their mental health. In this regard, assessing the personality traits of soldiers upon entering military bases and holding confrontation workshops can prevent possible damage as much as possible.

Background and Aim: Veterans and disabled individuals are often exposed to problems such as social discrimination, lack of independent living, and inability to participate in daily activities. The purpose of the current study was to designing and validation of the Disability Impact Scale (DIS) for veterans and disabled individuals. Methods: This is a descriptive-correlational study carried out in 2018. A total of 280 veterans and disabled individuals in Isfahan, Iran were selected by the available sampling method. Data gathered by DIS, witch designed based on literature and interview with veterans, Rosenberg Self-Esteem Scale, Beck self-concept scale, and inferiority scale. Data were analyzed by exploratory factor analysis (EFA) and Pearson’ correlation using SPSS version 21. In order to investigate the reliability, the test-retest method and Cronbach's alpha coefficient were calculated. Results: DIS had appropriate content and face validity. The EFA showed from initials items, 54-items were remained and saturated with 14 factors such as inferiority, fantasy, family support, avoidance, social isolation, hopelessness, relationship with others, emotional deprivation, acceptance of disability, others attitudes, empowerment, responsibility, helplessness. Also, DIS had significant convergent validity with the Rosenberg selfesteem scale (0. 47) and Beck self-concept scale (0. 31) and had divergent validity with inferiority scale (-0. 57) (p<0. 01). One week interval test-retest reliability was significant (r=0. 83, p<0. 01) and the Cronbach’ s alpha was 0. 87 which implies an appropriate internal consistency. Conclusion: It can be concluded that DIS has appropriate validity and reliability in veterans and disabled individuals and it can be used as an appropriate scale to investigate the impact of disability on the individual and social life and self-concept of veterans.

Background and Aim: The role of the lung microbiome in respiratory complications associated with chemicals such as sulfur mustard or chlorine gas has yet to be determined. The aim of this study was to compare the structure and composition of the lung microbiome in chemically injured and healthy individuals in order to understand the relation between the population of the lung microbiota and respiratory complications caused by exposure to these chemicals. Methods: To study lung microbiota, the bronchial alveolar lavage (BAL) fluids were collected from 17 chemically injured and 15 healthy cases during the bronchoscopy procedure. The diversity of lung bacteria present in BAL samples was explored using 16S rRNA gene sequencing. Results: The lung microbiome dominated by members of phyla Firmicutes, Bacteroidetes, Proteobacteria, Actinobacteria, Fusobacteria and Synergistetes which collectively accounted for > 95% of sequences. At the genus level, members of the genera Prevotella, Leptotrichia, Atopobium, Aggregatibacter, Catonella, and Oribacterium showed more than 2-fold increase in abundance in the lung microbiome of chemically injured patients. Comparing lung bacterial community at the species level, however, revealed an increased prevalence of members of Rothia mucilaginosa (3-fold), Prevotella melaninogenica (2. 7-fold), Prevotella pallens (3. 5-fold), Actinobacillus parahaemolyticus (2. 5-fold), Veillonella parvula (2. 5-fold), and Neisseria subflava (1. 5-fold) in these patients. Conclusion: An increased abundance of bacterial species known to associate with airway inflammation suggested their implications in respiratory failure in chemically injured patients. Monitoring and maintaining the homeostasis of the microbial population colonizing lung of chemically injured patients will pave the way to develop a more targeted treatment for these patients.

Background and Aim: Lack of attention to hospital efficiency, in addition to increasing medical costs, limits public access to health care. The purpose of this study was to draw a picture of the resource efficiency status of inpatient units and its changes over the years 2015 to 2018 in a large specialized hospital in Tehran, Iran. Methods: This is a multiple cross-sectional and applied study. The efficiency of inpatient services was evaluated using the Pabon Lasso model in four periods (2015-2018). The study population consisted of all hospitalized units (36 inpatient units) that all were studied. In this study, hospital performance indicators were collected using a data collection form. Excel 2019 software was used to draw Pabon Lasso charts. Results: On average, in 4 years, only 24% of inpatient units were fully efficient. Over the 4-year period, there were positive changes in the efficacy of internal gynecology, obstetrics, men general surgery, and NICU1. In addition, the efficacy of vascular and thoracic surgery, kidney transplant, NICU2 and VIP1 units had declined over the study period. There was no change in the efficiency status of the other units (27 units). Conclusion: Many of the hospital units are far from the optimal performance point. Given the sporadic movement of hospital units towards efficiency, it is necessary to study separately the causes of positive and negative efficiency changes in each hospital unit. In this context, the use of the Pabon Lasso model is suggested monitoring changes in the efficiency of inpatient units.

Background and Aim: Incident reporting systems are one possible way to learn from mistakes. One of the obstacles to this system are the deficit in common standards for collecting, classifying, analyzing and interpreting events. Therefore, in this study, the compliance of the content of incident reporting systems in Iranian hospitals with the minimal information Model for Patient Safety Incident Reporting Systems (MIMPS) of the World Health Organization (WHO) was compared. Methods: This is a cross-sectional and applied study. Five out of 31 provinces of Iran were randomly selected by cluster sampling method. All 128 university hospitals in 5 provinces were investigated. To collect data, the incident reporting system of each hospital during the first quarter of 2019 was reviewed using the MIMPS of WHO. Results: In the incident reporting system, Iranian hospitals have paid more attention to the topics of "incident identification and type of incident" with an average of 1. 4 and 1. 2 more than other topics in the MIMPS and the lowest level of compliance with the MIMPS were in "incident detection" and "measurements after the incident" with an average of 0. 07 and 0. 01. It seems that the incident reporting systems in Iranian hospitals do not collect and record these data at all. Among the provinces, the hospitals of Yazd province with a mean of 0. 78 and a standard deviation of 0. 25 (p = 0. 003) had a better performance than other provinces in adapting to the MIMPS. Conclusion: The incident reporting system in Iranian hospitals does not follow the global standard model of MIMPS and it seems that in order for the data to be reliable, it must move towards standardization. Using the MIMPS can be a coordinated model in the country to respond to this problem and facilitate better access and analysis of data.

Background and Aim: Given the high prevalence of self-mutilation during military service as an important and sometimes stressful period for young people, it is essential to identify the interventions that prevent or reduce this problem. This study aimed to investigate the effectiveness of Emotional Schema Therapy on improving cognitive emotion regulation in the soldiers with self-mutilation attempts. Methods: This study was conducted following a pretest-posttest quasi-experimental study design in 2019. The participants in this study consisted of 20 soldiers who referred to (505 Army Psychiatric Hospital) and were selected using availability sampling assigned to two groups, the experimental group and the control group awaiting treatment (10 in each group). Participants in the experimental group received 10 sessions of Emotional Schema Therapy for 90 minutes per week, and participants in the control group awaiting treatment did not receive any intervention. The instruments used in this study included Inventory of statements about self-injury (ISAS), Cognitive Emotion Regulation Questionnaire (CERQ), Leahy Emotional Schema Scale (LESS), and a researchermade demographic information questionnaire. Results: The mean ages of soldiers in the experimental and control groups were 19. 7± 1. 6 and 19. 5± 1. 7 years old, respectively. All participants were male and single. The results obtained from Multivariate Analysis of Covariance (MANCOVA) confirmed the effect of Emotional Schema Therapy on reducing self-mutilation attempts (75%) and increased cognitive emotion regulation (76-89 percent) in soldiers (P<0. 01). Conclusion: According to the findings of the present study, it is suggested that Emotional Schema Therapy was effective and psychologists in military counseling centers after completing the necessary training courses, use the emotional schema therapy approach to treat and reduce self-mutilation attempts in soldiers.

Background and Aim: Post-traumatic growth is a relatively new concept in psychology, and refers to the positive interpersonal changes that occur after a person is exposed to traumatic events. The purpose of this study is to develop and validate the post-traumatic growth protocol for war veterans. Methods: This cross-sectional study was conducted in 2018. The statistical population included Iranian veterans of eight years of holy defense who referred to Tehran medical centers. 406 veterans from this community were selected by convenience sampling. Data was collected by the Tedeschi and Calhoun Post-Impact Growth Index (PTGI) and the demographic information questionnaire, then analyzed by SPSS-21 software. The protocol developed by the Appraisal of Guidelines for Research & Evaluation (AGREE) was reviewed by expert panels. Also, the content validity index (CVI) and Content Validity Relative (CVR) were calculated in this protocol. Results: Protocol validation show 97. 77% vision and goal, 91. 66% stakeholder participation, 98. 09% accuracy and methodology of formulation, 97. 5% explanation and presentation, 96. 66% usability, 100% editing independence. In the final evaluation section, 90% of experts recommended the use of this protocol. Also, the CVI was 94% and the CVR was 86%. Conclusion: The results showed that the post-traumatic growth protocol designed for war veterans for 8 sessions and each session for 120 minutes has the appropriate validity and reliability and can be used by psychologists and experts to help the well-being of veterans.

CrossFit is an exercise program designed to provide general and inclusive physical fitness and improves fitness in all 10 areas including cardiovascular and respiratory endurance, muscle endurance and strength, power, flexibility, speed, coordination and agility. This is especially important for the military population, which must be physically fit to respond to specific occupational and combat missions. Findings show that the CrossFit program and other functional fitness programs present the U. S. Army with unique opportunities to improve Soldiers’ fitness levels as well as trigger the acute cardiovascular training response and a significant increase in fitness (ie, aerobic and anaerobic performance). Research has shown that CrossFit workouts significantly increases the bone mineral content of legs and trunk in men and women. The results of limited studies in CrossFit workouts show that this exercise improves the physical fitness of the participants. According to the available documentation, if CrossFit workouts is done with the proper intensity, duration, and monitoring, its physiological changes may be helpful for the combat forces. Carbohydrate diets are particularly important, according to recent studies, CrossFit workouts with low-carbohydrate diets leads to reduced body fat and with high-carbohydrate diets result in improving performance. Studies showed that Crossfit workouts are associated with improved intrinsic motivation to improve the enjoyment of exercise, satisfaction, motivation, mood, and reduce stress. Injuries related to CrossFit workouts have a similar or even lower profile than other sports and improve overall fitness same or even better than traditional distance running and strength training. Therefore, available studies, it can be said that CrossFit workouts along with other physical fitness programs may help military combat readiness, but further studies are needed.