Journal of Military Medicine
Year:2018 | Volume:20 | Issue:5 |Papers Count:19

Obesity is considered a global epidemic, which, according to current evidence, is rising in military populations. It is now well established that the immune system and inflammation play a central role in the development of numerous chronic metabolic diseases including insulin resistance, type 2 diabetes, and obesity. Given the close relationships between adipose tissue and the inflammatory/immune system, obesity is considered an inflammatory chronic disease. Toll-like receptors (TLRs) are immune receptors that facilitate inflammation and induce insulin resistance, and are considered as a pivotal factor in the pathogenesis of obesity, possibly triggered by the activation of TLR4. There is evidence that TLRs may be involved in the link between a sedentary lifestyle, inflammation, and disease. Physical exercise elicits potent anti-inflammatory effects that are likely to account for many of the beneficial effects of regular exercise on chronic metabolic diseases. Recent studies have shown that exercise resulted in decreased monocyte cell-surface expression of TLRs. The precise physiological stimulus mediating an exercise-induced decrease in cell-surface TLR expression is not known; however, a number of possible signals have been implicated including anti-inflammatory cytokines, pituitary-hypothalamic-adrenal axis hormones, heat shock and acute-phase proteins and myokines secreted from active skeletal muscle (such as irisin). In this review, current knowledge about the TLRs, their signaling pathways, and their critical role in the innate immune system was summarized. Future human studies based on the close relationship between TLRs and types of sports activities may provide therapeutic methods to prevent the progression of obesity to metabolic syndrome and its complications.

Background and Aim: Military trauma has a ‘ multidimensional’ injury pattern and the management of traumatic wounds and the development of related knowledge is essential to maintain and enhance the readiness of military medical personnel. This research was conducted with the aim of investigating the trends and science mapping of military trauma papers in MEDLINE. Methods: This applied research was conducted using a scientometric approach and co-occurrence analysis. The descriptors of papers related to the search for the phrase "military trauma" in the medical subject heading (Mesh), which were indexed between the years 2000 and 2017 at the Medline Science and Citation Center, were extracted using the PubMed search tool. Data analysis was performed using the TF-IDF weighting scheme and co-occurrence analysis. Word Stat, N-vivo and VOS viewer software were used to perform scientific mapping. Results: The growth of scientific research in the field of military trauma indexed on MEDLINE database has a rising trend and the growth rate is relatively stable between the years 2000 and 2017. Based on the TFIDF index, general concepts such as veteran/war veterans, management and casualty wound and words including posttraumatic stress disorder, surgery, depression and fracture are the most frequently cited topics. The results of the co-occurrence analysis in the papers indicate the focus on PTSD, injury type, wound management, combat situations and war experiences such as those in Iraq and Afghanistan. Conclusion: The thematic structure of the scientific production of military trauma has changed over time and has been dynamically influenced by the problems of the military forces in the area of the damage and experiences of recent wars. The military trauma science mapping tool facilitates recognition of this important area and provides intelligence of the main issues to the users and authorities of military health systems. Given the widespread threat of asymmetric wars and terrorist incidents, the development of the knowledge of military trauma related to the subject matter of this map may prove useful in the military care system.

Background and Aim: Safety climate has been recognized as a powerful tool for predicting occupational accidents. However this has been ignored in some working environments. The aim of the present study was to develop a questionnaire for assessing safety climate among nurses. Methods: Using relevant literature, a pool of questions was drafted. Content validity of questions was assessed using the content validity index (CVI) and content validity ratio (CVR). Then, the questions were distributed among nurses with at least three months of experiences from several hospitals in Tehran, Iran, during the summer of 2017. The completed questionnaires were divided into two datasets: the first was used for exploratory factor analysis, and the second for confirmatory factor analysis. The reliability of questionnaire was assessed using Cronbach's alpha coefficient. The effects of safety climate dimensions on safety performance were assessed using the structural equation modeling (SEM) approach. Results: A total of 273 nurses (41 males and 232 females) participated in the study. Most of these nurses had work experience of one to five years and ranged from 25 to 30 years of age. The final questionnaire contained 19 questions and the exploratory factor analysis (EFA) revealed four dimensions; management commitment to safety; supportive environment; safety training; and perceived work pressure. The structure was confirmed to be acceptable by the following confirmatory factor analysis (CFA) (Chi-square/df=1. 01, RMSEA: 0. 018, TLI: 0. 993, and IFI: 0. 994). Supportive environment and management commitment to safety were rated as the two dimensions with the highest effects on the safety performance of nurses in hospitals. Conclusion: The management commitment to safety, supportive environment, safety training, and perceived work pressure were the main dimensions of safety climate in hospitals. Management commitment to safety and supportive environment were the best predictors of safety performance of nurses in hospitals.

Background and Aim: The emergency department is considered the most important hospital ward due to exposure to many patients, especially seriously ill patients. As a result, medical errors in this ward are very important and can affect all services and treatments received by the patients. Therefore, this study aimed to prediction of the medical errors in the emergency departments. Methods: This descriptive study was carried out in the first half of 2018. The study population consisted of physicians and nurses selected from 4 military hospitals of Tehran, Iran. The study consisted of two phases: Delphi technique was used in the first phase in order to identify the medical errors, and the prioritization of identified errors in the second phase was used by a researcher-made questionnaire and the TOPSIS technique. The collected data were analyzed using SPSS 21. 0 and TOPSIS software. Results: The medical errors of the studied emergency department were categorized into 6 main groups: diagnostic errors, medication errors, laboratory errors, care and nursing errors, medical equipment errors, and radiological errors. Medication errors (with CL= 0. 879) and radiological errors (with CL= 0) had the first and last priorities of the medical errors in the studied emergency department, respectively. Conclusion: Regarding the weight of medication errors of the studied emergency department, it is essential for managers to provide strategies to reduce them through correcting processes, providing appropriate training, and developing appropriate guidelines.

Background and Aim: Stress occurs frequently every day and has delayed effects. If the frequency of stress is too high and homoeostatic mechanisms cannot return the brain to the normal state, a person becomes prone to chronic stress. The aim of this study was to evaluate the survival of acute stress on electroencephalographic (EEG) changes along with hormonal changes and self-examination of stress in soldiers. Methods: A total of 24 healthy young men (soldiers) agreed to participate in the project. Before and 20 minutes after (recovery phase) performing the Trier social stress test (TSST); self-examination of stress, cortisol measurements in saliva and EEG recording were taken. Scores for emotional intelligence and IQ, and the depression, anxiety and stress score (DASS) were determined. Results: There was a significant negative correlation between emotional intelligence and the DASS score in soldiers. Analysis of repeated measures showed that the level of salivary cortisol and the self-reported stress score were increased after the TSST (p<0. 05). Whereas the cortisol level continued to increase, the self-report score was back to the pre-stress level after the recovery phase. The relative power of the alpha band in the closed eye was increased in most regions after stress, which was still high after recovery (P<0. 001). Nonlinear indices of the fractal dimension of Ketz and spectral entropy in the prefrontal channels were reduced only after TSST and patients had returned to pre-stress levels after recovery (P<0. 05). Conclusion: Increase of the alpha rhythm of almost all regions of brain and decrease of non-linear features, fractal Ketz and spectral entropy in the prefrontal region can be valid markers of stress in the brain.

Background and Aim: Lower back pain is one of the most prevalent and costly musculoskeletal disorders. This disease is an important factor in the use of health care, and a major reason for the long term disability in military forces, which affects the readiness of personnel and their return to work. The aim of this study was to determine the effect of educational intervention on the amount of pain and disability caused by low back pain in military personnel of an Air force organization. Methods: This study was a quasi-experimental study. One hundred six Air force personnel from a military organization with a non-specific chronic low back pain referred to a specialized clinic in 2015 were surveyed. The eligible participants in the study were randomly divided into two intervention (53) and control (53) groups. Instruments included the Oswestry Disability Questionnaire and the Visual Analog Scale (VAS). The training sessions consisted of three sessions of 45-minute theory and two sessions of one-hour exercise sessions. The control group received only therapeutic routine intervention. The data were collected in the pre-intervention stage within three months after the intervention, and then were analyzed using SPSS 17 software. Results: Patients (53 personnel of a military organization) in the intervention group had a 75% reduction in severity of pain compared with the control group. According to the low back pain disability questionnaire, the patients in the intervention group had 90% reduction in disability in daily activities compared with the control group, indicating an improvement in the intervention group (P <0. 001). Conclusion: Implementation of educational intervention to reduce back pain and level of disability of Air force staff of a military organization with chronic back pain is recommended as an effective method along with other interventions.

Background and Aim: Exposure to traumatic events in veterans can impair performance, such as the inability to work independently and the malfunctioning of self-care activities. Impairment and lack of self-care in patients with post-traumatic stress disorder (PTSD) leads to physical health problems and, consequently, a decrease in their quality of life. Self-care can be effective with the implementation of health measures in the process of recovery and health of these patients. The purpose of this study was to identify the preventive factors of self-care for war veterans with chronic PTSD. Methods: This qualitative research was conducted by conventional content analysis. Twelve veterans with chronic PTSD and their 13 caregivers participated, using purposive sampling. Data collection was carried out with 18 individual interviews and two group interviews, which were profound and semi-structured. The analyses included eight steps: typing interview texts; identifying semantic units; coding text; revising codes with text; classifying and developing categories; reviewing categories; identifying themes; and reporting findings. Results: The four main categories, included "dimensions and outcomes related to disease” , “ personality traits of the patient” , “ the nature and dimensions of the treatment of the disease” and “ inadequate organizational support” were extracted as self-care preventive factors. A total of 15 sub-categories emerged, which included severity of disease, involvement in the other chronic physical diseases, aggressive personality type, tendency to high-risk behavior, delayed onset of treatment, drug and therapeutic interactions, side effects of psychiatric drugs, inadequate access to some of certain medications, fatigue from long-term drug intake, missed doses of some medication, inadequate reliance on pure drug therapy, weakness of social worker activity, inadequate organization management, dissatisfaction with the organization and unexpected expectations of the organization. Conclusion: Planning and intervention to control the self-care barrier factors can help to achieve independence in caring for veterans with chronic post-traumatic stress disorder.

Background and Aim: Patient satisfaction in the emergency department is one of the important indicators to assess the quality of hospital services. This study aimed to investigate the factors affecting the triple dimensions of satisfaction (technical-professional care, trust, and patient education) in patients referred to the emergency department. Methods: This cross-sectional study was performed in 378 patients presenting at the emergency department of Zanjan hospitals, Iran, in 2017. Demographic data were recorded. A Patient Satisfaction Questionnaire was used to examine the patient's satisfaction in three dimensions: technical-professional care, trust, and patient education. Data were analyzed using SPSS version 18. Results: The mean age of the patients was 48. 2± 19. 6 years. Most patients were men and married. The mean± SD score of satisfaction in patients referred to the emergency department was 84. 57± 25. 69, which was considered moderate. In assessing the dimensions of satisfaction, technical-professional care had the highest mean, and training to the patient had the lowest score. There was a significant relationship between satisfaction and trust with hospitalization and age (p=0. 004). The variables of gender, marital status, education level and employment status with satisfaction and dimensions were not significant. Conclusion: Patient satisfaction was moderate. It seems that there is a need for planning in order to increase satisfaction and its dimensions in patients who have frequent visits.

Background and Aim: The problems that veterans face may have a negative impact on their children’ s individual, social and educational performance. Therefore, the implementation of appropriate intervention programs is necessary to improve their status. This study aimed to investigate lifestyle change intervention effect, with an emphasis on the academic lifestyle, and on the academic self-concept of war victims’ children, according to Alfred Adler theory. Methods: This is a quasi-experimental study designed as pre-test and post-test. The study population included war victims’ children studying in high schools of Ardakan city, Iran, in 2016. Thirty students were selected by available sampling and were randomly assigned to either the interventional or control groups. The participants completed the academic self-concept questionnaire in three time intervals: before, after, and follow up after two months, between the pre-test and post-test. Lifestyle change-based treatment sessions were performed according to Adler's theory, with an emphasis on the students' educational lifestyle for the intervention group in 7 sessions of 90 minutes, once a week. There was no intervention for the control group. Repeated measures ANOVA was used to analyze the data. Results: Participants were matched regarding demographic variables including age, family income, and parents’ education. The self-concept (F=25. 177) and its subscales including academic effort (F=15. 493), and academic self-confidence (F=26. 067) were improved in the post-test for the interventional group (p<. 001); this improvement continued in follow-up. Conclusion: Academic self-concept of war victims’ children can be improved via lifestyle change interventions, with an emphasis on the academic lifestyle, according to Alfred Adler theory.

Background and Aim: The complications of chemical agents not only affect health-related quality of life in chemical warfare victims but also has a negative impact on their families. Considering the role of family participation in care, empowerment programs for patients and their families is very important. The purpose of this study was to evaluate the effect of a family-centered empowerment model on the quality of life of chemical warfare veterans. Methods: This randomized controlled clinical trial was conducted in Tehran, Iran during 2013‒ 2014. Eighty veterans were selected based on inclusion criteria and then randomized into an interventional and a control group. The empowerment program was implemented for 3 months with 4 dimensions (perceived threat, self-efficacy, educational participation, and evaluation) for the intervention group. The data collection tool was a demographic information questionnaire and a specific questionnaire on the quality of life of chemical injuries. Data analysis was performed using SPSS software version 16, and descriptive and inferential statistics were calculated. Results: Based on the results, no significant differences with regards to demographic factors were observed between two groups before the intervention (P>0. 05). The mean and standard deviation of the three dimensions of physical, psychosocial, and spiritual aspects of quality of life in the interventional group and the control group were not significant before intervention (p <0. 05). Three months after the intervention, the mean and standard deviation in the physical (interventional group: 37. 91± 10. 32; control group: 30. 44± 9. 79), psychosocial (interventional group: 38. 31± 9. 99; control group: 31. 61± 10. 78) and spiritual (interventional group: 85. 45± 11. 55; control group: 80. 76± 13. 01) dimensions were, significantly different between the two groups (p <0. 05). Conclusion: Considering the low cost, safety and effectiveness of family-centered empowerment programs and the role of the family in health promotion, the veterans training program is recommended to nurses and caregivers in order to improve quality of life for all.

Background and Aim: Family training programs (FTPS) are considered an educational field for parentsstudents in the education system. This research has been carried out for the assessment and prioritization of educational needs for military parents that participated in FTPS at schools of a military town in Tehran, Iran. Methods: This is a mixed study that was conducted in two qualitative and quantitative phases in 2017. The research sample in the qualitative phase consisted of 10 mothers, 8 fathers and 10 adolescents (12‒ 17 years old) of military families who were selected by a purposeful sampling method. Qualitative data were gathered through semi-structured interviews and a brainstorming technique and analyzed by the Colaizzi method. In the quantitative phase for prioritizing data; 364 parents and students was selected through the cluster sampling method, and analyzed with SPSS-18, using descriptive and inferential statistics. Results: By analyzing the qualitative phase, 19 and 21 educational needs in junior and senior high schools were identified in four dimensions of socio-cultural, educational, religious, and physical-health. In the quantitative phase, the first priority of military parents educational needs in FTPS, from the perspective of both junior and senior high school students was: physical health needs (with a score of 7. 384) and educational needs (with a score of 5. 970), respectively. From the perspective of parents in both junior and senior high school, physical health needs (with mean 73. 3 and 75. 5) were identified as the first priority. Results also showed that boys have more severe physical-health needs than girls. |There was no significant difference between the views of mothers and fathers on the selection of educational needs. Conclusion: The educational needs prioritized in this study, physical health needs and educational needs, (within the framework family training program) can be considered as a basis for revising the educational content of these courses in military town schools.