JOURNAL OF MILITARY MEDICINE
Year:2010 | Volume:12 | Issue:3 (45)|Papers Count:16

Aims: Considering complicated health problems, rapid socioeconomic changes and important aims like efficiency and patient satisfaction, Health System confronts numerous challenges. The most important goal of managers’ development plan is to provide high quality services. Determining and establishing a proper model is necessary in order to reach this goal. This study was designed to identify influencing components in development of military force health managers.Methods: This is a comparative-analytical study which was done on 11 human resources management experts in year 2010. A researcher-made questionnaire was used as data gathering tool and Delphi technique was used for validation of the model. Research units were interviewed and their answers were documented in mentioned questionnaire. Data was analyzed using descriptive statistics by SPSS 17 software.Results: Most important influencing factors in development of health mangers include talent finding, substitution and organizational, professional, psychological, religious and Islamic support. Performance determinants include knowledge, skill, character, motivation, attitude, spirituality, intuition, wisdom, talent finding, substitution, organizational structure, design of managerial jobs, software, hardware, processes and management tasks.Conclusion: Emphasizing on individual and organizational aspects is required for development of military force health managers.

Aims: Increasing physical activity is one of the most effective ways of reducing the risk of some chronic noncontagious diseases. Various methods have been created and validated in order to assess the factors effecting physical activity. The most applied method for this purpose is the Trans-Theoretical Model (TTM). This study was performed with the aim of assessing the effect of educational program for increasing physical activity and physical capacity by using TTM in one of governmental centers employees.Methods: This quasi-experimental interventional study was performed on a defensive industry employees in year 2009. 60 male employees aged between 20- 57 years old were selected by simple random sampling. They were divided into two groups (each containing 30 employees), the experimental and the control group.Questionnaires were completed before and three months after intervention and physical capacity was measured by Ergo-meter bicycle. Educational programs were implied in experimental group. Data was analyzed by SPSS 13.Results: In stage of change after intervention, the experimental group had a significant positive progress (p=0.001). Mean physical capacity score had significant improvement after finishing educational program, in experimental group (p=0.016). Self-efficacy and total decisional balance and process of change scores were higher after intervention in experimental group (p<0.001).Conclusion: TTM based educational programs are effective in improving physical capacity and physical activity of governmental center employees.

Aims: Cutaneous leishmaniasis is one of the most important diseases transmitted by sand fly and has been one of the most important health problems in Iran. Determining the epidemiological aspects of disease is important for planning of control program. This study was carried out to describe the cutaneous leishmaniases situation in Damghan district.Methods: This descriptive-analytical survey was performed on all confirmed and recorded cutaneous leishmaniasis cases (465 people) diagnosed during 2006-09 in Damghan district. Patients’ information such as age, sex, nationality, habitat, number and sites of ulcer(s), month and years of incidence were registered and analyzed by Chi-square test using SPSS 12 software.Results: Of 465 under care patients, 263 cases (56.5%) were men and 202 people (43.5%) were women.148 patients (31.8%) resided in urban areas, while 317 (68.2%) lived in rural areas. The most frequent age group was 20-29 years old (22%). Hands and feet were the most common sites of ulcer (84%). 46% of the patients had two or more ulcers. Highest disease prevalence (84.8%) was observed in months October, December and November.Conclusion: Cutaneous leishmaniasis is an endemic disease in desert rural areas and is developing in suburban parts of Damghan; therefore, comprehensive planning for control and prevention of the disease is necessary.

Aims: Recognizing tooth health condition in each region is essential in order to take prevention measures. Dental exam is the most effective way of determining tooth health condition. The aim of this study was to determine decayed, missing and filled teeth (DMFT and dmft) indices and their related factors in 6-12 years children of military and non-military personnel.Methods: This cross-sectional descriptive-analytical survey was performed on 201 of 6-12 year old children of military and 200 of 6-12 year old children of non-military personnel referred to Imam Khomeini dental clinic in Tehran in year 2009. Dental exam was done by a dentist and results were recorded in world health organization standard form. Data was analyzed by SPSS 11.Results: Overall 9359 teeth were examined. Frequency of decayed, missing and filled teeth were 1224 (23%), 185 (4%) and 695 (13%), respectively. Frequency of decayed, missing and filled teeth were 238 (8%), 0 (0.0%) and 162 (4%), respectively. In general, mean dmft and DMFT were 5.29±3.52 and 1.01±1.47, respectively.Conclusion: Mean of DMFT and dmft indices don’t have a significant statistical difference in military and nonmilitary personnel’s children. Tooth decay has a significant correlation with age, parents’ educational level, birth order and primary prevention dental care. These factors should be considered extensively in order to keep children’s teeth healthy.

Aims: Neglecting patients’ bill of rights and patients’ dissatisfaction causes delay in recovery and irritability and also increases hospitalization period and costs. This study was done with the aim of evaluating patients’ satisfaction about implementation of patients’ bill of rights by health care team.Methods: This descriptive-analytic study was performed on 384 inpatients of Tehran Army Hospitals in year 2008. Research units were selected by quota sampling. Data was collected by interviewing patients and documenting the answers in a researcher-made questionnaire. Data were analyzed by SPSS 15.Results: 8% of patients were not satisfied with physicians and 17.2% of them were not satisfied with nurses. 62.5% of patients were satisfied with health care team of the morning shift. Increased hospitalization days reduced patients’ satisfaction with physician’s function (19%) and nurse’s function (50%). Patients who were hospitalized in open heart surgery wards had the highest level of satisfaction and patents with lower education levels (under diploma) had more satisfaction.Conclusion: Patients’ satisfaction depends on length of hospitalization, wards, members of medical team (physicians and nurses) and patients’ education level.

Aims: Salmonellae organisms are a large group of enteric bacteria and their infections present an important public health problem worldwide particularly in developing countries. Regretfully, Diagnosis and laboratory report of Salmonellae organisms is not performed correctly, due to a variety of reasons. This study was designed to determine the accuracy of laboratory reports of typhoid fever in Tehran during a two year period.Methods: This descriptive study was carried out on clinical samples diagnosed as Salmonella typhi received from a number of hospital laboratories in Tehran in years 2007 and 2008. Bacterial strains were diagnosed and identified by standard differential biochemical and serology tests using poly and mono specific Salmonella antisera. Results were then compared to those reported from the hospital laboratories.Results: Among 161 samples which were suspected to contain Salmonella typhi, 60 were reported as Salmonella typhi. Standard biochemical and serology test results revealed that although samples belonged to serogroup D of Salmonella, none of them had reacted with specific Salmonella antiserum; therefore, all nontyphoidal group D Salmonella strains had been misdiagnosed as Salmonella typhi.Conclusion: The precise laboratory identification of Salmonella typhi should be emphasized, because laboratory reports with misdiagnosed Salmonella typhi may prevent physicians from taking proper supportive and curative measures and impair the treatment process.

Aims: Post Traumatic Stress Disorder is a problem which affects both victims’ and their families’ quality of life and experiencing Injury by each family member can affect other members of the family. This study was performed to evaluate the symptoms of secondary Post Traumatic Stress Disorder among chemical warfare victims’ children.Methods: This descriptive-analytical cross-sectional study was performed on 528 residents of Sardasht in year 2009. All chemical warfare victims’ children of Sardasht were evaluated in order to enter the study as case group. 5 districts of Sardasht were selected using cluster random method, from which 600 families were selected using systematic random method. Totally, 528 were eligible to take part in the study (286 as case group and 242 as control group). Presence of secondary Post Traumatic Stress Disorder symptoms was evaluated in both groups, using Mississippi questionnaire. Data was analyzed by SPSS 14.Results: The total Mississippi score was 128.88±13.92 in chemical warfare victims' children and 108.34±22.70 in control group (p<0.05). The total Mississippi score in chemical victims (case group's fathers) was higher than control group's fathers (p<0.05). Scores showed no significant differences between different age groups and genders.Conclusion: Fathers’ Post Traumatic Stress Disorder due to chemical warfare transfers to their children and must be prevented and treated as a serious problem.

Aims: Human mitochondrial DNA (mtDNA) contains 16,569 nucleotide and changes in mtDNA HVSI region occur 10 times faster than genomic DNA. The aim of this study was to assess polymorphism, the rate of mutation, homoplasy, and frequency of haplogroups, haplotype variance and nucleotide diversity in HVSI region of mtDNA of Iranian ethnic groups.Methods: Blood samples were randomly obtained from 357 native non-relatives Fars, Azerbaijani, Gilaki, Kurdish, Baluch, Sistani, Turkmen and Arab volunteers. mtDNA was extracted and amplification of HVSI region was carried out. Automated DNA sequencing was carried out on a DNA Sequencer (ABI 310). The sequences were aligned based on the Cambridge reference sequence by Clustalx program and mutations and polymorphisms were determined. Haplogroups were determined according to mtDNA phylogenetic tree.Results: Highest and lowest homoplasy was observed in Fars people (40%) and Sistani people (13%) respectively. The lowest nucleotide diversity among all studied ethnic groups belonged to Fars people and it was 0.862. Haplotype variance was 0.87 in Sistani people which was the highest. The most common haplogroup among different ethnic groups was HV.Conclusion: Frequency of mtDNA unique haplotypes among different ethnic groups is higher than that of a single ethnic group. Lower nucleotide diversity in one of ethnic groups demonstrates that they do not marry people with different ethnicities. Higher variance of haplotypes in other ethnic group indicates the importance of mtDNA in detecting their identity in criminal cases. Higher mutations in one of ethnic groups demonstrate that they are the most ancient ethnic group in Iran.

Aims: Medical centers, especially hospitals need readiness in order to fulfill their mission in disasters as the most important settings for treatment of wounded and injured people. Therefore, this study was performed to assess the readiness level of some selected hospitals of Iran.ethods: This cross-sectional descriptive study was carried out in 30 selected hospitals of Iran in year 2009. Data was collected by a validated 220 questions checklist taken from a master degree thesis. Reliability of the checklist was confirmed with Kappa test. Data was analyzed by SPSS 15, using descriptive statistics and a fivesection Likert scale.Results: Mean scores of 10 units of hospitals such as admission, safety, evacuation and transport, staffing, communication, traffic, emergency, training, logistic, and management were respectively 21, 45, 49, 44.5, 54, 49, 64.5, 68.5, 70, and 80%. Generally, the average readiness score for all hospitals was 54.5%.Conclusion: Readiness level of studied hospitals is good in emergency, training, logistic and management units.Readiness level is medium in safety, evacuation and transport, staffing, communication and traffic and is weak in admission, according to Likert scale.

Aims: Post Traumatic Stress Disorder (PTSD) is an anxiety disorder which can develop after exposure to any event which results in psychological trauma. Cognitive-Behavioral Therapy (CBT) is the most commonly used treatment for the disease and Eye Movement Desensitization and Reprocessing (EMDR) is a more rapid, relatively recent method. This study was designed with the aim of comparing the efficacy of Cognitive-Behavioral Therapy and Eye Movement Desensitization and Reprocessing method on reduction of specific symptoms and recovery in patients suffering from PTSD due to war.Methods: This experimental study was performed in year 2008. 45 veterans suffering from PTSD were divided randomly into three CBT, EMDR and control groups. Each of the mentioned groups contained 15 members. Two questionnaires including PTSD checklist-military version and symptom checklist 90 revised were applied in order to collect data. Data was analyzed using inferential statistical tests by SPSS 16.Results: Scores of CBT group and EMDR group had a significant difference from control group scores.Conclusion: Both models are effective on reduction of symptoms in PTSD.