JOURNAL OF MILITARY MEDICINE
Year:2020 | Volume:22 | Issue:1 |Papers Count:13

Since December 2019, a new coronavirus, called the severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), triggers pneumonia outbreak from Wuhan (Huanan seafood market) across China, which now poses major health threats to public health. The Coronavirus Disease-2019 (COVID-19) epidemic by SARS-CoV-2 is spreading worldwide, and by March 1, 2020, 67 countries, including Iran, have been affected. According to worldwide statistics, the mortality rate is 3. 4%. Early symptoms of COVID-19 include pneumonia, fever, myalgia and fatigue. To date, no successful vaccine or antiviral agents has been clinically approved for COVID-19. Therefore, prevention and control of infection is a top priority for the general public. Extensive research into the SARS-CoV-2 is needed to fully elucidate its pathway and pathogenic mechanisms, and to identify potential therapeutic targets, which can be effective in developing common preventive and therapeutic measures. In this narrative review, based on evidences published until March 1, 2020, the epidemic and etiologic features of the SARS-CoV-2, its essential biological features, including its receptors and route of transmission, outline disease prevention and treatment approaches is provided. Given the origin of the Covid-19, it seems that the nutritional and health recommendations of Islam, especially Halal food and health observance, need to be addressed more throughout the world. Lack of inducing stress and anxiety among the people, besides advising and training people to abide by all the principles of health, is so important to fight against the disease. It is hoped that Covid-19 prevention, control and treatment will be achieved through vaccine and antiviral agents’ production as well as health care measures in the near future.

The current review aims to explore the applications of cognitive science in military science to answer the question of what cognitive science is currently used in the military. Cognitive science is an interdisciplinary and scientific study of the mind and its processes that examines the structure, process, and cognitive functioning of the mind. The main subcategories of cognitive science are cognitive modeling, cognitive psychology, cognitive neuroscience, cognitive linguistics, philosophy of mind and artificial intelligence. The applications of cognitive science in the military field are examined at two levels: first, at the level of human resources, and second, at the level of military equipment. At the level of human resources, increasing the energy efficiency of the soldiers' bodies and increasing the hours of continuous activity, increasing the speed of repairing war injuries, increased wakefulness, reduced fear and pain sensation in the nervous system, control of mind and behavior, night vision technology, the full integration of technology with the nervous system, the bolt project (eliminating the limitations Language differences), developing DNA diagnosis system, humanoid robots, hunter robots, transfer robots, Peteman Human Beatles, Nanobut Robots, Body Refactoring Project and Artificial Eye Project. The use of cognitive sciences in the field of military equipment includes: cognitive weapons, auxiliary skeleton, health trackers, cyber-insects, Exacto project, Heldes project, Earth project, Alpha-Doug project, one-Shot project, Z-Man project, Vulture project Stratospheric airship, UFP project and bird robot in Defense Advanced Research Projects Agency (Darpa). Cognitive science plays a crucial role in the development of military science and technology, both in the field of manpower and in the field of military equipment. Therefore, more research is needed on how to expand this science. We hope to see more growth and prosperity in the Armed Forces.

Background and Aim: Soldiering is a stressful period in which there is a possibility of self-harm, so it is necessary to consider ways to reduce it. The purpose of this study was to determine the effectiveness of resiliency training in reducing stress and self-injury and increasing the resiliency of soldiers. Methods: This study was quasi-experimental with pre-test, post-test and control group waiting for treatment in 2018. The statistical population consisted of 20 soldiers referred to the 505 Army Hospital in Tehran who were selected by convenience sampling and were assigned into two groups of 10 (experimental and control). The experimental group received resilience training in 10 sessions of 90 minutes, while the control group received no intervention. The instruments used in this study were Perceived Stress Questionnaire (PSS), Clonensky Self-Reporting Inventory and Conner Resilience Questionnaire (ISAS) and Davidson (CD-RIS). Multivariate analysis of covariance and SPSS software version 24 were used for data analysis. Results: The mean age of the soldiers in the experimental and control groups was 20. 6± 2. 3 and 20. 4± 1. 5 years, respectively, and the mean length of military service was 5. 3± 2. 5 and 7. 7± 4. 1 months, respectively. Resiliency training program significantly reduced stress (98%) and self-injury (91%) in soldiers in the intervention group and significantly increased resilience (98%) (p <0. 01). Conclusion: Resiliency training seems to be effective in improving stress and self-harm syndrome and resilience in soldiers and it can be used in garrison settings.

Background and Aim: Admission to the clinic is a key process from the patient referral to the doctor until he/she hospitalizes in the wards. In the reengineering approach, with the aim of continually improving processes and improving quality, existing processes are replaced by new ones. The purpose of this study was to reengineer the admission process from the clinic of a military hospital in Tehran in 2017. Methods: This was a qualitative case study that was conducted in a military hospital in Tehran from October 2017 to March 2018. Interviews were conducted with 12 staff and stakeholders involved in the admission process. Purposeful sampling was used for process owners and available sampling for patients. Data were collected through semi-structured interviews and focus group sessions. Edraw Max7 software and MAXQDA11 software were used for data analysis Results: Initially, the current admission process of the clinic was drawn up with 29 main activities, 14 procedure steps and 5 decision stages. Out of 109 codes extracted for the challenges in the process, seven general challenges (main theme) were taken: costs, deficiencies and disadvantages, training, inadequate utilization of the hospital information system, overcrowding, lengthy process and time taken. Finally, the process of charting the admission workflow diagram from the clinic was drawn with 29 main activities, 14 procedural cases, 3 decisionmaking steps, and elimination of the stopping and archiving phases, thereby reducing the new process time from 5 to 4 hours. Conclusion: Reducing the admission process steps, increasing the process of action and reducing decisionmaking and eliminating the delays and archive lead to reduce the time and improved satisfaction and drawing of new flowcharts for the admission process. The new process is more agile and efficient, improving hospital admission performance and ultimately increasing productivity.

Background and Aim: The impact of addiction on individual, family and social dimensions requires the identification of its predictive and preventive factors in individuals, especially soldiers. Therefore, the purpose of this study was to investigate the effectiveness of group problem solving skills training on soldiers' drug addiction potential. Methods: The research method was quasi-experimental with pre-test and post-test with control group. The study population included all soldiers in one of the training camps (garrison) of NAJA in Kermanshah in summer 2017. The sampling method was based on availability. After conduction the Mac Andrew scale on soldiers, 36 participants who achieved more than the cut-off point of 34 were selected as the study sample. Then they were randomly divided into two groups (18 in each group). In the pre-test, soldiers completed the Weed & Butcher Addiction Potential Scale. Then, problem solving skills training was conducted for the experimental group for 8 sessions, two sessions per week (two hours) and no program was performed for the control group during this period. At the end of the sessions, both groups were simultaneously administered post-test using Weed & Butcher Addiction Potential Scale and data were analyzed by SPSS-18 software. Results: Mean of pre-test of addiction potential scale were 42. 5± 4. 5 for experimental group and 42± 6. 1 for control group while the Mean of post-test of addiction potential scale were 31. 2± 5. 5 for experimental group and 40. 1± 5. 2 for control group, which indicates that problem solving training was effective in reducing potential for addiction. The results of analysis of covariance showed that the mean scores of addiction potential in the experimental group were significantly decreased by the training intervention (p=0. 001, F=37. 7), with a mean effect size of 0. 52. Accordingly, group training problem solving skills accounts for 52% of the total variance of the addiction potential variable. Also, the statistical power of 1. 00 indicates the sample size is sufficient. Conclusion: Training on problem solving skills by increasing psychological capacity helps soldiers to reduce their tendency to addiction by adapting to the environment. Therefore, it is suggested that problem solving skills training be included in the training program for soldiers in the barracks.

Background and Aim: Military nurses are in the first line to confront with various crises. Therefore, their ability to coordinate and collaborate with other professionals involved in crisis and providing appropriate performance will play an important role in crisis management. The purpose of this study was to evaluate the effectiveness of crisis management education based on inter-professional approach on the ability of military nurses to deal with crisis in the selected military hospitals in Tehran. Methods: The quasi-experimental study was performed by convenience sampling of nurses from the selected military hospitals in Tehran and assigned to 3 groups randomly. Sixty military nurses participated in this study and were equally divided into 3 groups including experimental group 1 (inter-professional education) and experimental group 2 (uni-professional education) and control group. Intervention was organized over two twodays workshops of crisis management education in two theoretical and practical sections. Theoretical section was crisis management basics of HICS and practical section was table maneuver based on crisis scenario, that were held for both experimental groups 1 and 2 with identical conditions (educational content and Professors). The data were collected by nursing staff empowerment questionnaire with reliability of0. 88 and analyzed by SPSS 22 software. Results: Sixty nurses with mean age of 34. 8 and standard deviation of 6. 9, with an average work experience of 11. 7 years and a standard deviation of 6. 6 were included in this study. 55% were male, 88. 3% had undergraduate degree and 11. 7% had master's degree. Nurses' ability to confront with crisis in the pre-test in all three groups was not statistically significant (P<0. 05), whereas in the post-test statistically significant difference has been created between the three study groups (P<0. 001). The mean of nurses' abilities with mean of 199. 5 and standard deviation 19. 17 was higher in experimental group 1 (inter-professional) than both experimental group 2 (uni-professional) and control group, with statistically significant difference. But no significant difference was observed between the control and experimental groups. Conclusion: Crisis management education based on interprofessional approach is effective in enhancing the capacity of the military nurses to deal with crisis and can be optimally used in educational planning in the military organizations.

Background and Aim: Suicide and self-mutilation are considered as two of the most unpleasant psychological and social events in adolescents and young people. It may become an important issue in some social conditions; therefore, the present study aims to identify the role of emotion regulation strategies in emotional disorders of soldiers with the history of self-mutilation behaviors. Methods: This is a descriptive study. The study population consisted of all soldiers who served in three military centers (Zanjan, Qazvin, and Tehran) from 2017 to 2018 (August 2017 to November 2018) and had a history of self-mutilation harming behaviors. 92 soldiers who reported at least one self-harm behaviors in the form of self-harm and drug abuse were included in a census. Data were collected using a computerized version of the Millon 3 Multivariate Clinical Trial Questionnaire and the Short Form of Cognitive Emotion Regulation Questionnaire. Results: 92 soldiers with mean age of 19. 33± 7. 5 years, and mean length of military service of 14. 50± 4. 9 months participated. More than 71% of them had diplomas. The results of stepwise regression showed that adaptive and maladaptive emotion regulation strategies can significantly predict the variance of depressive personality disorder (R2 = 0. 21) and anxiety (R2 = 0. 11) in soldiers with a history of self-mutilation behaviors. Conclusion: According to the findings, it can be concluded that maladaptive emotion regulation strategies can predict emotional disorders in soldiers with a history of self-harm behaviors. Therefore, it can be effective in preventing some unpleasant actions in these people.

Background and Aim: Given the holistic view of Iranian medicine and the importance of planning to reduce the clinical complications of bloating in the military, this study was conducted for the first time to develop and standardize the questionnaire of compliance with the principles of effective Iranian medicine on functional bloating. Methods: Initial questionnaires of 25 questions were extracted from authentic sources of Iranian medicine libraries by extracting the factors affecting functional bloating on lifestyle. Content validity of the questionnaire was calculated by calculating CVI and CVR indices and using the opinions of 25 Iranian medical experts. Exploratory factor analysis was also performed to evaluate the construct validity with 378 individuals enrolled in the study by cluster sampling. Test-retest and Cronbach's alpha coefficient were used to assess the reliability and stability of the questionnaire. Results: The content validity of the 15-item questionnaire was estimated to be 0. 92 by removing 10 questions from the set of questions and reviewing the other 10 questions. Exploratory factor analysis also revealed that the four domains of eating pattern, drinking pattern, sleep pattern and sexual activity were 49. 93% of the total variance. Eating pattern was the most important area of the questionnaire because with the highest number of questions, it accounted for 20. 85% of the total variance and had the strongest correlation with the total score of the questionnaire. The intra-cluster correlation coefficient of the test in the test-retest test was 0. 851 which indicates its stable consistency. Cronbach's alpha coefficient was 0. 793 and in the desired range. Conclusion: The questionnaire of compliance with the principles of Iranian medicine affecting functional bloating has a good reliability and validity and can be used as an appropriate tool to examine aspects of lifestyle affecting functional bloating and gastrointestinal discomfort in the military.

Background and Aim: Despite the inadequate resources allocated to the health sector, in most developing countries, the allocation and proper utilization of these limited resources is also not based on proper planning; therefore, the efficiency of the health sector is less than expected. The aim of this study was to determine the status of resource distribution and performance evaluation of Iranian military hospitals. Methods: This cross-sectional study involved all the military hospitals in Iran (57 hospitals). Data including hospital status and types of hospital beds, performance indicators, status of hospital resource access indexes, and staffing status in hospitals by separate organizations were extracted from the annual statistics and hospital information reported by the Deputy Minister of Health. Excel 2013 software was used to collect and calculate the data and ArcMap v. 10 software was used to design the geographical map and Pabon Lasso model was used to measure the efficiency. Results: The Armed Forces Organization has Iran's hospitals, active beds and stellar beds, with 5. 7%, 4. 2 % and 4%, respectively. It also has 4. 3 %, 3. 77 % and 4. 97 % of ICU, NICU and CCU beds, respectively. In 80 percent of border provinces, there is at least one military hospital, and Tehran province has the most military hospitals with 13. Military hospitals employ 1. 9%, 1. 46 % and 2. 37 % of hospital personnel, nurse and physician, respectively. Bed occupancy ratio and bed turnover index in military hospitals were higher than the national average and the average of length of stay index was lower than the national average, which indicates that hospitals affiliated with the Armed Forces perform better than other hospitals. However, according to the Pabon Lasso Model, 37 percent of Iran's military hospitals had good performance, 37 percent had poor performance, and 26 percent had moderate performance. Conclusion: Based on the results of the present study, the Armed Forces Organization as the fourth provider of hospital services and having a significant share of hospital resources in the country, despite acceptable performance, requires special attention to optimally utilize existing resources through increasing the hospitals efficiency.