JOURNAL OF MILITARY MEDICINE
Year:2019 | Volume:21 | Issue:3 |Papers Count:17

Background and Aim: Military staff are exposed to high levels of stress, and as such, and their mental health has long been an area of focus. The purpose of this study was to investigate and compare mental health promotion programs and strategies used in American, British and Russian military organizations, to those used in Iranian military organizations. Methods: This study was a systematic review that included all studies published in journal articles and books, in English and Persian, that were related to mental health programs in military organizations of the USA, Britain, Russia and Iran, from 1980 (1359 AH) to 2015 (1394 AH). A total of 154 articles were identified from 13 websites, and 137 were included in the study. After the data collection, programs and strategies of mental health promotion used in US, UK, Russia and Iran's Military Organizations were reviewed. Results were also classified on the basis of pre-determined framework. Results: The most important mental health promotion programs in American military organizations were: the army study to assess risk and resilience in Service members (Army STARRS), the Stigma mental health program, promotion of psychological resilience, the Mental Health Liaison Program, Stress management training for military trainees, Combat and operational stress control, and the Comprehensive Soldier and family Fitness Program. British programs and strategies for Mental Health with the highest importance included the Trauma risk management (TRiM), Battle mind training, Third-location decompression, community mental health for veterans, mental health support and the Medical Assessment Program. In Russia the most important programs used were military humanitarian programs, educational methods as a source of psychological support for soldiers, and social works in solving social problems of military personnel were. Iran's military organizations had two major mental health promotion programs, the Imam Reza plan and the adviser police. Conclusion: Mental Health Programs and Strategies in Iranian military organizations are, in general, in line with American, British and Russian programs. But regarding operational planning, mental health programs in Iranian military organizations are generally ambiguous, and lack targeted planning. Mental health programs in American and British military forces are largely research-based and needs-based. Therefore, it is necessary to identify the weaknesses in Iran's military organizations’ mental health programs and to take action to promote them.

Today personal protection measures against mosquitoes and other medically important arthropods have a significant role in integrated vector management programs. Personal protection technologies such as insecticidetreated clothes and nets are some of the most effective tools against mosquitoes. Permethrin, as a synthetic pyrethroid insecticide, with features such as having a knockdown, repellency and residual activity, and low human and mammalian toxicity, is widely used for impregnation of fabrics and clothes. The dose required is 1250 mg/m2, which has not caused toxic effects in users. Many methods have been developed to impregnate fabrics and clothes with permethrin or similar compounds. However, new impregnation methods such as polymer-coating and microencapsulation technologies which may prolong the activity of insecticides on clothing are currently under development. These methods have the advantage of helping to overcome the inevitable reduction in efficacy over time that occurs as a result of washing, ultraviolet light exposure, and the normal wear and tear of the fabric. The aim of this review is to investigate the evidence base for the use of insecticide-treated clothing and military uniforms for protection against bites from arthropods and its effect on arthropod-borne pathogen transmission. Although insecticide-treated clothing can provide some protection against biting insects, few studies have shown complet protection (100%) in using insecticide-treated clothing alone, but most studies have mentioned complete protection against biting insects from the simultaneous use of permethrin-impregnated clothing as well as repllents on exposed skin. The effectiveness of impregnated clothing in the prevention or reducing of insect-borne diseases is not yet fully understood and the level of protection provided varies according to the vectors, impregnated fabrics and location. In general, there is reliable evidence which suggest that impregnated fabric can provide effective protection against insect bites, and providing relative protection against vector-borne diseases in bites. Nonetheless, simultaneous use of impregnated clothes and insect repellents on the skin can provide complete protection against bites and consequent disease. This approach is recommended for protection of high-risk personnel such as soldiers and outdoor workers, as well as travelers and tourists to protect against biting insects and vectorborne diseases.

Background and Aim: Promoting productivity of military personnel has a key role in enhancing securitydefense capabilities and reducing costs. Musculoskeletal disorders are one of the most common causes of disability and lost productivity of military personnel. The aim of this study was to measure the lost productivity due to knee osteoarthritis and identify its influencing factors in military personnel. Methods: This was a descriptive-analytic study that included140 military personnel with knee osteoarthritis who visited the military physical therapy clinic in Tehran in 2018. Subjects were randomly selected and entered in the study after completing the informed consent form. All data related to days and hours of absenteeism, hours of work without productivity and disability in doing military tasks were collected using the Valuation of Lost Productivity (VOLP) questionnaire and analyzed by Stata software. Factors affecting lost productivity and its importance were investigated through the estimation ordered logistic regression and through calculation of odds ratio. Results: Of the participants, 63. 4% were male and more than half (59%) were37‒ 46 years old. 40% of patients had been absent from work in the past three months due to their knee osteoarthritis. The maximum length of time of work in this period was 5 days. A total of 104 participants (74. 3%) reported that due to knee osteoarthritis, in the last 3 months they have had difficulty at work, compared to their colleagues. 50% of participants (N=70) believed that they would be able to do their jobs in less time if they had no disease. The average amount of lost productivity due to knee osteoarthritis in a 3 month period was 76 hours, or 9 working days for each participant. The average value of lost productivity due to knee osteoarthritis in the past three months was estimated at 9, 527, 271 Rial or 226 US$ for each participant. This lost productivity was significantly affected by sex, household size, time of onset of illness and the level of teamwork (P<0. 05). Conclusion: Knee osteoarthritis leads to a significant reduction in working efficiency of military personnel. More attention should be paid to screening chronic diseases, especially the knee osteoarthritis, at the time of recruitment of military personnel. Strategies should be developed for the prevention and timely diagnosis of chronic diseases to reduce disability and occurrence of musculoskeletal disorders in the armed forces.

Background and Aim: Depression is a common psychiatric disorder with a high prevalence in military personnel. Recently, the relationship between depression and some hormones has been reported. In current study, the serum levels of anti-thyroid peroxidase (anti-TPO), triiodothyronine (T3), thyroxin (T4) and thyroidstimulating hormone (TSH) was assessed in people with depression and compared with healthy control adults. Methods: In this case– control study, 45 people with depression who were diagnosed using the Beck depression test and DSM5, were referred to a military hospital. A total of 45 healthy participants who were matched according gender and age with the depression group, were also enrolled. Levels of anti-TPO, T4, T3 and TSH were measured and compared in the two groups. Results: The mean ± standard deviation age was 36. 55± 11. 42 years in the case group and 35. 92± 11. 58 years in the matched control group. There was no significant difference in the mean serum level of antithyroid peroxidase, T3, T4 and TSH between the groups (P≥ 0. 05). There was no linear correlation between antithyroid peroxidase levels and depression severity. Conclusion: As there was not difference regarding anti-TPO antibody levels between the depressed and healthy groups, it appears that anti-TPO antibody may not have a role in depression.

Background and Aim: Assessing the quality and evaluation of university professors is important to provide feedback on basic decision making, educational analysis and comprehensive and strategic planning for education officials. The purpose of this study was to identify factors affecting the evaluation of teachers at a military university. Methods: This study was conducted using systematic and Delphi methods in the military university of Tehran in 2016. The study included all published papers related to teaching quality. A search was performed of the following databases: SID, IranMedex, IranDoc, Magiran, PubMed, Ovid, Medline, Science Direct, Scopus, Web of Science databases and Google Scholar. Different combinations of keywords were used, and the search was limited to articles published from 2000 to 2016. The Delphi method was used for finalized and categorized factors a military university were. Results: Out of the 838 articles, 56 papers were considered relevant and 50 effective factors in the evaluation of teachers were extracted according to the frequency of their repetition in the articles. The conceptual model of assessment of educational faculty includes 4 dimensions: "teaching quality", "individual characteristics", "educational rules" and "professional features". This was obtained using the Delphi method. The teaching quality included 20 factors, individual characteristics included 8 factors, educational rules included 5 factors and professional characteristics included 16 factors. Conclusion: Professors should pay attention to the factors that influence educational evaluation at a military university that may not directly affect their academic performance. Professors should also aim to acquire effective educational evaluation scores. Academic centers should familiarize faculty members with the perspectives, methods and innovations available in the field of teaching quality.

Background and Aim: Lower limb amputation and prosthesis use affect mobility and other aspects of amputees’ daily activities. Awareness of these effects may aid health-care and rehabilitation systems in improving quality of life and well-being of lower limb amputees. A questionnaire was used to collect data about the conditions resulting from lower limb amputation, mobility, low back pain, balance confidence in different activities, and quality of life. Methods: A survey composed of three standard questionnaires including part of Prosthesis Evaluation Questionnaire (PEQ), complete Activities-Specific Balance Confidence (ABC) Scale questionnaire, and complete Oswestry Disability Index (ODI) was designed and published online. The study’ s statistical population included lower limb amputees with any level of amputation who were aged >18 years. The questionnaire was publicised through the prosthetic clinic in the Comprehensive Rehabilitation center of Iranian Red Crescent in Tehran by colleagues working in the fields of amputee rehabilitation, social channels related to disabilities, and the social media of the “ Iranian Handicapped Society” . The questionnaire was available online in Persian. Data collection was performed over 16 months (August 2016‒ December 2017). Results: Of the 37 respondents (including 1 female and 1 bilateral amputee), many suffered from phantom limb sensation (21 participants/56. 8%), phantom limb pain (18 participants/48. 6%), stump pain (19 participants/51. 4%), intact-side pain (22 participants/59. 5%), falls during the last 12 months (22 participants/59. 5%) and worry about falling (28 participants/75. 7%), deficient balance confidence as measured by the ABC scale (26 participants/70%), and risk of future fallings (17 participants/46%). These problems negatively affected respondents’ ODI scores, ABC scores, mobility scores and quality of life (QoL) scores. However, despite the high rate of lower back pain (LBP) among respondents (22 participants/59. 5%), intensity of pain was mild and moderate for the majority. LBP was associated with lower scores of ABC scale, mobility, QoL and amputees satisfaction with prosthesis. According to the ODI, 24% and 32% of participants respectively had minimal and moderate disability due to LBP. Conclusion: Problems related to balance, pain in amputated and intact sides, and LBP were common among respondents. These issues likely impact their mobility and QoL. Accordingly, it is necessary for health care/ rehabilitation systems to include screening plans to monitor these problems and manage them appropriately.

Background and Aim: Personality may be studied to predict human behavior in military organizations. The aim of this study is to survey the relationship between personality characteristic of military commanders and violations of soldiers under command. Methods: This descriptive-survey study was carried out in middle and senior military commanders in military units of a Tehran military Headquarter in 2018. Samples were selected from all of the commanders in related units. The NEO Five-factor Inventory (NEO-FFI) was used to assess personality characteristics and a researchermade questionnaire was used to assess the violations of soldiers. The questionnaires were completed by the commanders and analyzed in the process. Results: A total of 102 middle and senior commanders responded to the research questionnaires. Findings from the NEO Five-factor Inventory (Neuroticism, Extroversion, Openness, Agreeableness and Conscientiousness) showed that a commander’ s personality characteristics is associated with an increase or decrease in the violations of soldiers. There was a significant and inverse relationship between Conscientiousness and Openness with violations of Soldiers (r=0. 553, P<0. 01) & (r=0. 471, P<0. 05). No significant relationship was found between the variables of Neuroticism, Extroversion and Agreeableness, and the violations of soldiers. Conscientiousness and Openness predicted 43% of variance violations of soldiers (R Square=% 43). Other results indicated a high personality score of Openness (mean: 25. 08) and a low score of Neuroticism (mean: 15. 08) among military commanders. The highest mean of violations in task soldiers refer to “ lack of respect for politeness” (Mean=2. 91), as well as "abuse of collective personnel" (Mean=2. 91), and the lowest mean of violations in task soldiers refer to “ slackness and negligence in performing the task and executing orders in logistical area" (Mean=1. 91). Conclusion: The relationship Between NEO Five-factor Inventory and decreases or increases in violations of soldiers justifies the need for continuous psychological training and (NEO-FFI) Personality Testing in order to recruit and deploy commanders appropriately at the level of units, companies and battalions.

Background and Aim: Suicide attempts have become a common phenomenon in recent years. The aim of this study was to investigate the relationship between quality of life and spiritual intelligence with suicidal thoughts in Sardasht soldiers. Methods: The study population was all soldiers in Sardasht city, including 246 people selected by the multistage cluster sampling method. Four battalions were included, and from each battalion, a group of soldiers was selected as the final sample of research. The World Health Organization's Quality of Life Questionnaire (1989), King's Spiritual Intelligence Questionnaire (2008) and Beck's Suicidal Thoughts Questionnaire were used. Results: Quality of life and its components (physical and psychological health, social relationships and living environment) can predict suicidal thoughts of soldiers, and 19% of the variance of suicidal thoughts is explained by physical and psychological health, social relationships and living environment. There is an inverse relationship between quality of life relationship and suicidal thoughts. Spiritual intelligence and its components (transcendental self-awareness, spiritual experiences, patience, and forgiveness) have an inverse relationship with suicidal thoughts, and about 18% of the variance of suicidal thoughts may be explained by transcendental self-awareness, spiritual experiences, patience, and forgiveness. Conclusion: Improving quality of life and strengthening spiritual intelligence in soldiers can reduce the risk of suicide in this group.

Background and Aim: Emotional Intelligence (EQ) can directly impact individuals’ ability in handling environmental stress and improving life satisfaction. The present study aimed to assess the relationship between EQ and life satisfaction among nurses working in selected military hospitals. Methods: This correlation study was done among nurses working in selected military hospitals over the summer of 2018. The demographic data questionnaire, Bar-On EQ Standard questionnaire and Dinner Life Satisfaction questionnaire were used to gather data. These questionnaires were distributed randomly among 384 nurses, and 325 completed questionnaires were analyzed. Results: Of the participants, 59. 7% were men. The mean age of participants was 28. 07± 4. 1 years, and 88. 6% of participants had bachelor’ s degree. Some EQ parameters such as happiness, independence, the ability to bear mental stress, realism and continence had a significant and direct relation with life satisfaction (p˂ 0. 001). The ability to bear mental stress and continence have a higher significance compared with other parameters. Conclusion: Paying attention to factors affecting emotional intelligence may be effective in improving mental health and increasing the level of life satisfaction in military nurses.

Background and Aim: Studies in sport, exercise and physical activity have shown that self-perceived physical fitness is an important predictor of behavior and plays an important role in continuing or stopping physical activity. The purpose of this study was to investigate the relationship between perceived and actual physical fitness in military personnel. Methods: A total of 77 military personnel were selected randomly and divided to four groups (group 1: 20‒ 30 years, group 2: 31‒ 40 years, group 3: 41‒ 50 years and group 4: 51‒ 60 years). Participants completed the questionnaire of study in 4 parts: personal information, self-perceived physical fitness scale, short form of Marsh Physical Self-Description Questionnaire and mental toughness questionnaire. Physical fitness tests were then performed according to the questionnaires. Results: The mean age of military staff was 38 years, the average height was 175 cm, and the average weight was 78 kg. There was a significant correlation between perceived and actual physical fitness. But this correlation was significant only in group 2 (31‒ 40 years). There was also a significant correlation between perceived physical conditions, perceived muscular condition and perceived physical scale in comparison with actual conditions. The correlation coefficient between perceived muscular condition and actual condition was higher than the other subscales. There was no significant relationship between perceived flexibility and actual flexibility. Partial correlation also showed that the relationship between self-perceived physical fitness and actual physical fitness is affected by mental toughness, physical self-perceived and level of physical activity. Conclusion: There is a relationship between perceived and actual physical fitness, but this relationship is not equal in all subscales. Perceived physical fitness is affected by age, psychological characteristics and the level of physical activity. It is necessary to consider perceived physical fitness according to importance of self-perceived in life.

Background and Aim: Clinical guidelines are categorized and provide information in order to help the decision-making of medical teams, with the aim of improving patients care. Therefore, this study aims to identify the factors influencing the implementation of clinical guidelines in Iran. Methods: This is a descriptive-analytical study performed in 2018‒ 2019. The study population consisted of managers and experts working in healthcare. A total of 470 subjects were chosen by the multi-stage sampling method. A researcher-made questionnaire was used to collect data. The validity of the questionnaire was investigated by means of the experts’ opinions, its reliability was assessed using the combined reliability test, and the internal consistency of the questionnaire was examined by Cronbach’ s alpha (0. 934). Exploratory factor analysis and SPSS-18 software were used for data analysis. Results: In the exploratory factor analysis, 47 variables were identified and divided into six components. In the component of the features of the clinical guidelines; the elimination of ambiguity and the existence of a clear protocol with a load factor of 0. 80, in the component of the organizational culture factors; informing the patient with a load factor of 0. 77, in the component of economic factors; the existence of budget and elimination of restrictions with a factor load of 0. 74, in the component of insurance factors; the insurance tariffs with a load factor of 0. 75, in the health system’ s trusteeship component; the existence of an evidence-based practical system with a factor load of 0. 69, and in the organizational factors component; the changed attitude of the staff and group work with a coefficient (factor load) of 0. 6 have had the greatest influence on the implementation of clinical guidelines in Iran. Conclusion: Accessibility to information, motivation creation and attitude change, effective management, creation of systematic vision and appropriate feedback, as well as the establishment of relevant standards for work processes are effective strategies for implementing guidelines.