JOURNAL OF MILITARY MEDICINE
Year:2018 | Volume:20 | Issue:3 |Papers Count:15

Performance-enhancing substances include anabolic agents, hormone peptides, stimulants and sedatives, pharmaceutical or nutritional compounds used to improve any activity in humans. Since World War II, in the world's armed forces, the use of these compounds in the military field has been widespread and has been used in various wars. Reports from the world's military research centers have shown that stimulant compounds and sedative compounds are the most widely used groups that have been used to increase the military's performance. There are some questions about the use of instructions, the degree of effectiveness, and the limitation on the use and concerns about the side effects of these drug interventions on the normal functioning of the body under operating conditions. Hence, this review examines the practical use of these compounds in real or simulated operational conditions in military or military research centers. Data was extracted through targeted searches of the Google Scholar, PubMed, Medline and Scopus databases without time range limitations. A total of 71 articles from 1965 to 2017 were included in this study. The results of this review indicate the relative success of drug interventions in improving soldier performance. The use of new synthetic or natural compounds such as modafinil, caffeine, melatonin and tyrosine which have no specific side effects, will reduce concerns and limitations.

Background and Aim: Medical error is an important challenge for health systems. Developing reporting systems and addressing the obstacles to reporting errors is essential in order to improve the quality of health care services. This study aimed to survey the factors affecting the refusal to report medical errors from the nurses’ point of view using the Analytical Hierarchy Process (AHP) in selected military hospitals of Tehran, Iran. Methods: This is a descriptive, analytical and cross-sectional survey conducted in 2017. Data were collected using a systematic review and then a quantitative phase. The research population included nurses from 3 military hospitals, of which 269 were selected using Cochran's formula. The data gathering tool was a researcher-made questionnaire. Data analysis was performed using descriptive statistics and hierarchical analysis process using SPSS21. 0 and Expert Choice 10. 0 software. Results: Based on the systematic review findings, the factors influencing the refusal of reporting on medical errors were classified into three groups of management, process and nursing factors. Results indicate the most important reasons for refusal to report medical errors are: managerial factors (with importance coefficients of 0. 669), factors related to the nurse (0. 224), and factors related to the process of reporting (0. 888). Conclusion: Due to the high weight of management factors in refusing to report medical errors, hospital managers, and especially nursing directors, should remove these obstacles by expanding the culture of encouraging reporting in the organization.

Background and Aim: Since the lifestyle of each individual and society is influenced by the teachings of the beliefs and values of the society, it is essential to obtain the knowledge about the concept of lifestyle and religious beliefs and the interaction of these two categories with spiritual well-being. This study aims to investigate the influence of Islam on lifestyle education to promote spiritual health among military personnel (soldiers) at the military base in Tehran, Iran. Methods: This is a quasi-experimental study. The study population consisted of all soldiers under the supervision of a military university and the selected barracks in Tehran, Iran during 2016. Participants were 160 soldiers divided into two groups (80 in the experimental group and 80 in the control group). To measure the variables of the study, the spiritual well-being scale (SWB) by Paloutzian and Ellison (1982), Kaviani’ s Islamic life style questionnaires and the spiritual health questionnaire developed by center of medicine and religion of Baqiyatallah university were all used before and after the intervention. The experimental group underwent 8 hours of direct Islamic lifestyle training by a spiritual mentor during two days with educational multimedia. Questionnaires were completed before and after the intervention by the two groups. Results: The positive effect of Islamic lifestyle intervention on spiritual well-being was statistically significant (P<0. 001). Education effect on variables including the relationship between man and God, about man and last life, personal and social ethics, the relationship between man and the living world, human relationship and others and total scores of spiritual health were statistically significant (P<0. 001). The effect of educational intervention on Islamic lifestyle variables was significant (P<0. 01) but in the social scale; beliefs, ritual, family and security and defense were not significant (P>0. 05). Conclusion: The effect of Islamic life style training on the components of the spiritual health and the spiritual well-being was significant and thus direct educational interventions with the help of educational programs can cause a spiritual health’ s indicators upgrade in soldiers.

Background and Aim: Dental services are costly and sensitive services that constitute a significant portion of healthcare costs in developing countries. Unfortunately, spending alone cannot be guaranteed to receive dentist services with high technical quality. The purpose of this study was to identify and prioritize factors affecting the quality of dental services. Methods: This is an exploratory study and was conducted at the Army 600 dental center during Jan 2016 – Sep 2017. The study population consisted of 200 dentists from the Army 600 Dental Center. Data collection in the qualitative phase involved using semi-structured interviews and then using the FAHP questionnaire in the quantitative phase. To analyze the qualitative data, Atlas. ti 5. 2 software was used and FAHP solver2015 software was used to analyze the fuzzy hierarchy. Results: The results showed that factors affecting the quality of dental services based on priority include therapeutic factors, human factors, structural factors, education and research, and patient-based factors. The most important indicators of therapeutic factors were high quality treatment, specialization, treatment and health care and infection control, and monitoring and evaluation. The most important indicators of human factors were personal dentist's characteristics, dental team competencies, dental interactions, motivation and job satisfaction of the team of dentistry and professional ethics. The most important indicators of structural factors include tariffs and ability to pay fees, factors of delivery, proper management, performance indicators and management of dental facilities and prevention. The most important indicators of education and research included patient education, dental team training and research. Finally, the characteristics of patient-based factors included patient satisfaction, patient collaboration and participation, and attention to the patient. Conclusion: The technical quality of dental services is affected by several factors. Improving the technical quality of dental services through the proposed strategies can have an impact on the level of oral and dental health in the community.

Background and Aim: War as a stress factor has economic, social, cultural and psychological consequences that have a significant impact on the relations of community members over the generations. The aim of this study was to compare the post-traumatic growth and coping with stress in chemical and non-chemical veterans in the city of Sardasht, Iran. Methods: This was a causal-comparative research. A sample of 100 veterans (50 chemical and 50 nonchemical veterans) were selected by convenience sampling method in the city of Sardasht, Iran. Post-traumatic Growth was assayed by Post-traumatic Growth inventory, and coping with stress was assayed by Endler & Parker coping scale of stressful situations. Results: Analysis of data by using multivariate analysis of variance and an independent t-test at a significant level of 0. 05 showed that there was a significant difference between chemical and non-chemical veterans with post-traumatic growth with regard to problem-focused and emotion-focused coping styles. Conclusion: According to the findings, it seems that mental health in veterans exposed to chemical agents have been affected by long-term harmful effects.

Background and Aim: Pain or defect of the masticatory system decreases masticatory ability and subsequently causes poor general health and quality of life. This study was aimed to determine psychological stress level and assess its correlation with masticatory system health among military pilots and non-pilot officers and compare the outcomes between these two populations. Methods: This analytical cross-sectional study was conducted on 86 military pilots and 86 non-pilot officers in 2014. After completion of 12-item General Health Questionnaire to determine the stress level and the questions about the masticatory system health, full examination of the teeth, muscles and temporomandibular joint was performed by one dentist for the entire study population. The collected data were analyzed by SPSS (version 16) using the Chi-square, independent t-test, Mann-Whitney U tests and Pearson correlation coefficient (P-values ≤ 0. 05). Results: The number of pilots with high stress was 47 (55%) and the number of non-pilots with high stress was 56 (65%). There was no significant difference in stress level between the two groups (p = 0. 16). There were significant positive correlations between the stress level of the total study population and orofacial pain, neck muscles pain, bruxism, clenching, reduction in maximum mouth opening, and temporomandibular joint disorders. Also, a significant positive correlation was observed between dental problems on flying and stress level among the pilots. Conclusion: High stress levels, especially in pilots because of the sensitivity of their job, can cause serious damages to masticatory system health, thereby reducing the efficiency of the masticatory system.

Background and Aim: Evidence-based medicine is the systematic process of assessing the most reliable evidence from clinical research for decision making in clinical care. The variety of assessment criteria and confusion in selecting the reliable scientific resources has challenged users. Therefore, the current study was conducted with the aim to rank evidence-based medical databases using Ovid's assessment criteria through hierarchical analysis method. Methods: The current study is an applied descriptive-survey research conducted using field and crosssectional studies in the first six months of 2017 in libraries of Tehran city medical universities (Tehran, Shahid Beheshti, Iran, and Baqiyatallah). Data were provided through systematic review based on Ovid assessment criterion, and collected in the form of paired comparison questionnaire by 20 experts' opinions. After that, data were analyzed using hierarchical analysis technique and Expert Choice 11 software. This criterion includes 6 main measures and 48 sub-measures. Results: According to the obtained results of the study, a search criterion with the weight of 0. 247, guides criterion with the weight of 0. 172, services criterion with the weight of 0. 166, display criterion with the weight of 0. 156, link criterion with the weight of 0. 151, and performance criterion with the weight of 0. 109 were put in the first, second, third, fourth, fifth, and the last or sixth priority with inconsistency rate of 0. 10, respectively. The Cochrane database with the coefficient of 0. 491 and Up to Date database with the coefficient of 0. 224, assigned the highest and the lowest priority to themselves amongst the databases. Conclusion: In order to develop and improve the activities of medical evidence-based databases, authorities should pay attention to the users' desired criteria and apply their recommendations. Moreover, the users must be taught how to use databases.

Background and Aim: Electromagnetic waves consist of a combination of two perpendicular magnetic and electrical fields that do not require a material environment to propagate. Exposure to electromagnetic radiation in different occupations can increase tissue heat and damage to the health of individuals. The aim of this study was to determine the ability of a protective layer made of aluminum metal in the sheet and net mode to reduce electromagnetic radiation. Methods: This study was a descriptive-interventional study with a laboratory method in 2016. In this study, a non-ionizing radiation generator used to create electromagnetic waves at 900 MHz to radiate on the aluminum layers in sheet and net shapes in the same laboratory conditions. The wavelength of the aluminum metal was measured using anelectromagnetic radiation measuring apparatus. Data were analyzed using SPSS-18 software. Results: The findings showed that electromagnetic waves in laboratory conditions of aluminum are less than that of the lattice. The aluminum network with a 1 mm pore size is more potent than the ratio of the network with 5 mm pores in reducing the transmission of waves with a frequency of 900 MHz. Conclusion: The behavior of radio waves varies in different frequencies. In general, with increasing thickness, the ability to protect against the passage of waves increases very slightly. The aluminum network has less power compared to its laminar mode for electromagnetic waveguide protection at a wavelength of 900 MHz.

Background and Aim: The application of social networks in psychological interventions is novel, but tends to rapid increase. People who have a need for psychological interventions may benefit from such modern technologies. In the present study, we aimed to study the effectiveness of positive psychotherapy on the quality of life of paraplegic veterans through social networks. Methods: This was a semi-experimental pre-test-post-test with the control group. The population consisted of all paraplegic veterans in Khuzestan province in 2017. A total of 36 veterans were randomly selected and randomly assigned to experimental and control groups. Questionnaires used included “ Health-related quality of life (HRQOL)” , “ Pittsburgh Sleep Quality Assessment (PSQI)” and “ Beck's Depression Inventory (BDI)” , which were completed by both groups before the intervention. Then, a positive psycho-therapeutic intervention was performed on the experimental group during 14 sessions, while the control group did not receive any intervention. Both groups completed the questionnaires again post-test. Data were analyzed using analysis of covariance (ANCOVA). Results: Positive psychotherapy through social networks has a significant effect on improvement in quality of life (in physical, psychological, and environmental health) (P<0. 05) and decreasing sleep disorders and depression of veterans (P<0. 001). This intervention did not have a significant impact on social health, this impact was achieved at a moderate level (between 23 to 71 percent). Conclusion: Positive psychotherapy through virtual networks can improve the quality of life of paraplegic veterans. Modifying beliefs, increasing social interactions and increasing intellectual and physical activity for doing homework led to improvement in quality of life. There are challenges to the application of this technique.

Background and Aim: Disseminated intravascular coagulation (DIC) is a pathologic activation of the blood coagulation system in various organs of the body, which is one of the most common paraclinical disorders in intensive care unit (ICU) patients. In this study, the incidence of DIC-like syndrome and its effect on mortality rate and hospitalization days in patients in the intensive care unit were evaluated. Methods: This study included a historical cohort in which demographic and clinical data of patients admitted to the ICU of the Imam Hossein Hospital between 2013 and 2017 years was collected from the ICU database. The incidence of DIC-like syndrome was calculated and reported 48 hours after the patient entered the ICU. Mortality rate or discharge was the primary outcome. Duration of hospitalization in the ICU was a secondary outcome and was recorded in all patients. Results: A total of 1257 patients admitted to the ICU were evaluated and the incidence of DIC-like syndrome in these patients was 5. 7% (n=72). Of the 72 patients with DIC-like syndrome, 43 were men, 58 of whom were over 40 years of age. Most patients had an Apache score of 15-20. The mean number of hospitalization days were 22. 8 days for patients with DIC syndrome (72 patients) and 18 days for other patients (1, 185 patients) (P = 0. 06), and most patients with DIC syndrome were admitted to the ICU for more than 28 days. Mortality was significantly higher in patients with DIC-like syndrome than in other ICU-treated patients. There was no significant relationship between DIC-like syndrome and age and sex variables, and APACHE scores. In other reported data, no significant difference was found between DIC-like syndrome patients and other ICU patients. Conclusion: The incidence of DIC-like syndrome leads to an increase in mortality rates in ICU patients. This suggests that any coagulation disorder, even limited to laboratory results, should be immediately followed and treated.

Background and Aim: Investigations generally show that military employees may be more exposed to mental trauma than civilians. This study aimed to recognize the relationship between resiliency and the practice of religious beliefs with the anxiety and depression among soldiers. Methods: This is a correlation study including all military service soldiers (18─ 29 years old) with at least a diploma degree who were in military service in spring and summer of 2014, in Qom city, Iran. These soldiers were selected by cluster random sampling. Questionnaires for anxiety, practice of religious beliefs, Connor and Davidson resiliency (CD-RISk) and Beck's depression test, were completed by soldiers. Data were analyzed by SPSS 16. Results: The mean± SD age of the 215 soldiers included in the study was 21. 6± 2. 5 years old. An indirect relationship between resiliency and practice of religious beliefs, with anxiety and depression in soldiers was observed. In soldiers, by reducing one unit in resiliency, anxiety increased by 0. 386. By increasing a unit in resiliency, depression decreased by 0. 375. Conversely, by increasing a unit in the practice of religious beliefs, depression decreased by 0. 108 and by reducing one unit in practice of religious beliefs, the anxiety increased by 0. 278. Conclusion: This findings showed that resiliency and practice of religious beliefs has a major role in reducing anxiety and depression in soldiers. The effectiveness of religious beliefs and resiliency on mental health of soldiers should be addressed in practices of the military.

Background and Aim: The use of nuclear technology in various industrial, medical, and basic science fields has been expanded over recent years. Since the Possibility of nuclear accidents and injuries is an inevitable fact, this study aimed to assess the knowledge and preparedness of the medical staff at teaching hospitals in the city of Arak, Iran, toward potential nuclear injuries. Methods: This cross-sectional descriptive study was carried out in 2015 to assess the knowledge and preparedness of 700 medical staff at the teaching hospitals in the city of Arak, Iran, toward potential nuclear injuries and their diagnosis and treatment. Based on the protocols of International Atomic Energy Agency and World Health Organization, two separate questionnaires for physicians and nurses were devised and provided to them after verifying their validity and reliability. The collected data were analyzed using SPSS16. Results: A total of 630 nurses and 70 physicians participated in this study. The results showed that 50. 8% of the participants had a basic knowledge of nuclear accidents and 45. 6% of them had no information in this regard. More than 67. 1% of the physicians and 77. 6% of the nurses admitted that they knew nothing about the protocols for decontamination and treatment of nuclear injuries. Conclusion: In this study, the preparedness of the hospitals and knowledge of the nurses and physicians were evaluated as poor. Since this project was conducted with experts, the results are striking. Therefore, considering the development of peaceful uses of nuclear technology and its localization in Iran, the authorities should pay special attention to this issue and take quick and serious measures and strategies to enhance knowledge and performance of medical staff.