مجله طب نظامی
سال بیستم شماره 4 (پیاپی 76، مهر و آبان 1397)

Nurses are one of the frontline workers after disasters, particularly after radiologic incidents. Despite their importance, little is known about the nurse’s competencies in facing these events. This mini-review was aimed to determine competency of nurses in radiologic incidents. This mini-review was conducted using scientific electronic databases and library resources such as Scopus, PubMed, Magiran, SID, IranMedex using the keywords competency, nurses, and radiologic incidents to identify published papers from 1990 to 2017. Total of 991 papers were identified, of which 14 of them were considered relevant and were included in this study. Studies have shown that nurses' competencies in radiation incidents has variation. The most important of these competencies are on factors including the use of protective equipment and measures for the removal of pollution, triage, management of vulnerable groups, care of trauma, and psychological support. Nurses have varying abilities in different factors in disasters. Therefore, it is necessary to implement care and treatment plans to equip nurses with useful knowledge regarding radiation accidents

Work is one of the most important activities in human life, and it is the hope for many that it gives positive experiences and performance enhancement. The aim of the present study was to develop and determine the reliability and validity of a work-related flow state questionnaire (WFSQ) among military personnel. The study population was military personnel in Tehran, Iran in 2017, of which 500 men, with a mean age of 42.2± 6.8 years and work experience duration of 17.7±6.7 years were chosen by accessible sampling. The participants completed questionnaires including the work-related flow state questionnaire (WFSQ), work-related flow inventory (WOLF), and positive and negative affect scale (PANAS). Exploratory factor analysis, Pearson's correlation coefficient, test-retest reliability, and Cronbach's alpha coefficient were used to analyze the data. The findings of the exploratory factor analysis using Varimax Rotation showed that WFSQ has an appropriate four-factor structure (absorption, enjoyment, intrinsic motivation, and perception of time), accounting for 52.92% of instrument variance. Results of convergent validity showed that all subscales and the total score of WFSQ had a positive significant correlation with WOLF and PA, and has a negative significant correlation with NA. Also, test-retest reliability within a two-week period (0.79‒0.82), and Cronbach's alpha coefficient (0.87) showed satisfactory test-retest reliability and the instrument’s consistency. The findings showed that the WFSQ had satisfactory reliability and validity and it is an appropriate tool for measuring flow state in military personnel

Manpower and their protection in war zones have special significance, and the lack of preservation of soldiers may lead to major changes in the outcome of the war. Due to the necessity to save lives, and to reduce human casualties caused by war wounds, it is necessary to provide self-aid facilities to soldiers before the medical team arrives. This can prevent aggravation of injuries and save lives. The main purpose of designing a self-aid bag is so soldiers can take immediate action toprotect their lives. This is a descriptive study using a hybrid analysis. For data collection, thematic literature was used, as well as the experiences of the research team. Modeling was performed and then the opinions of the experts collected using a questionnaire, and self-aid bag was designed. Based on the results of expert opinion, the new designed self-aid bag includes: a transmitter and receiver with the ability to encode data and send to support, a fentanyl patch (for skin absorption) to provide strong analgesia, a composite splint, anti-hemorrhage powder, a sterile eye pad dressing, a tourniquet, a rubber band, sterile gas, scissors, burn cream, sticking plasters, a triangular band, band types, chlorine pills and first aid blankets. The contents of the designed bag are packed and then vacuumed. The overall weight of the bag is 950 grams. This self-aid bag has been designed to be of an appropriate weight and made using durable material that is resistant to water and fire. Proper placement on the body level, and the selected contents, mean that this bag could provide a practical option for first aid in the field

Public-Private Partnerships (PPPs) have been constructively considered in recent years to reform health sectors in many countries. This study was conducted to survey the only example of experience for PPP implementation in the hospital sector in Iran (Moheb). This is a qualitative study conducted in 2015‒2016. A semi-structured interview was used to collect data. To this end, 18 experts and professionals working in the health system, and individual’s familiar with the partnership models and involved in the development of this model in hospital services participated. For data analysis and classification, content analysis methods and MAXQDA10 software were used. In the current study three main categories including: goals and reasons for the formation of Moheb, achievements and consequences of Moheb, and challenges of Moheb, along with 9 subthemes and 28 themes were identified. Implementation of PPP and experiences such as this example in Moheb experience are fundamental to overcoming that the need to provide optimal and quality treatment with reasonable costs in Iran. The localization of this model and its adaptation to conditions in Iran, development in the health sector can be achieved. This model can be developed and promoted across the country

In order to receive a sufficient amount of energy, military personnel are generally exposed to high-calorie diets (containing a high level of sugar and fat) which increase their chances of developing certain diseases such as diabetes, hyperglycemia, coronary disease and gastrointestinal disorders. In this study we aimed to prepare functional, low calorie cakes containing resistant starch and date syrup, to improve the gastrointestinal and coronary wellness of military personnel. Date syrup (15 and 30%) and resistant starch (10 and 20%) substituted sugar and flour from the original recipe, respectively. Rheological properties and the density of dough were investigated. In the cooked cakes, volume, specific density, moisture content, textural properties, calorimetric characteristics and organoleptic attributes were assessed. Fortification of sponge cakes with date syrup and resistant starch resulted in significant differences in terms of the dough and cake properties. Resistant starch and date sauce reduced the density and increase the viscosity of the dough. Cake enrichment with date syrup diminished the hardness of the cake from 651 to 557 g, while the addition of resistant starch conversely increased cake hardness from 651 to 776 g (P< 0.05). Calorimetric results showed a significant increase in the L value of cakes from 70.5 to 82.5 within the addition of resistant starch, while the reverse trend was observed for date syrup (P< 0.05). Organoleptic assessments revealed that the addition of 10% resistant starch and 15% date syrup in cakes was the recipe most preferred by military personnel. By replacing flour and sugar with of resistant starch and date syrup in the by a 10% and 15% ratio, a low-calorie product with functional properties can be achieved that could be well-liked by military personnel

  Patients with chronic obstructive pulmonary disease (COPD) have lung function impairment and reduced ability to perform physical activity, which together reduces the quality of their life. The aim of this study was to determine the health status of patients with COPD in the bronchoscopy section of a hospital in Kerman, Iran. In this cross‐sectional study included 96 patients (53 outpatients and 43 inpatients) with diagnosis of COPD who were admitted in the bronchoscopy ward of a hospital in Kerman, Iran. Sampling was performed randomly. For data collection, the individual information form and the COOP/WONCA questionnaire were used. Data analysis was performed using SPSS-18. The majority of patients with COPD were men and were 61‒80 years of age. Individuals with a diploma and higher education had higher health status. There was a significant positive correlation between all of the dimensions (physical function, mental status, daily activities, social activities, changes in health and general health status) of the questionnaire and the age and length of stay in hospital. Between mean scores of smokers, married and admitted patients, with all aspects of the questionnaire were significant (p<0.05) except changes in health. It seems that by measuring the changes in the health status of patients with COPD, assessing the impact of receiving treatment and further studies in this area, it would be possible to prioritize and plan large-scale programs to address them

Today, most of the hospital revenue comes from insurers. The aim of this study was to investigate the amount and causes of insurance deductions of the Armed Forces Medical Services Organization (Sakhad) in a military hospital in Tehran, Iran. This cross-sectional study was performed in Tehran, Iran in 2015. All inpatient files with deductions which had contracted with the armed services medical insurance were collected using a database. Medical records and documents were screened using a checklist assessing the amount and reasons for the deduction, month, division and specialty of the physician. Data were analyzed using SPSS-19 software. A total of 11,992 inpatient medical records were studied, yielding a total of 3517 medical records with insurance deductions. The total amount of insurance deductions was 2,383,423,209 Rials (79,447.4403 USD). The highest amount of deductions per month, department, physician's specialty and causes were in June (14.45%), men's surgery (39.78%), orthopedics (40.76%), and consumables (48.30%), respectively. There was a significant difference in deductions mean score and month, department, physician specialty and causes variables (p <0.0001). Considering the significant confirmation of the difference in the mean of deductions and the study variables, personnel familiarity with insurance laws, and using a hospital data system can help prevent insurance deductions

Posttraumatic Stress Disorder (PTSD) is a prevalent disorder in people with war experience, leaving them susceptible to secondary mental disorders. This study was conducted to assess the prevalence of PTSD symptoms in people with war experience from the imposed war by Iraq on Iran in Ilam province. In this cross-sectional study, 711 people with war experience who were aged over 35 years were enrolled, in Ilam province in 2016. Random cluster sampling was used as a sampling method. Persian version of Checklist – Military Version (PCL-M) was used to evaluate PTSD in participants. Data were analyzed with using SPSS 19th edition. The prevalence of PTSD symptoms was 15‒39 % in the study population. A significant relationship was observed between PTSD and age at the war, life‐threatening, and seeing relatives injured (p<0.001). There was not a significant relationship between PTSD and the experience of aerial bombardment, gender and the job of participants (p>0.05). PTSD prevalence in this study was higher compared to studies in the general population. We suggest interventional programs to reduce this rate in people with war experience

Non-adherence to a treatment regimen is an obstacle to achieving therapeutic goals. This is a problem in patients with chronic conditions, especially in those with spinal cord injuries. This study aimed to determine the effect of a self-care training program on adherence to a therapeutic regimen in veterans with spinal cord injury. This was a randomized controlled clinical trial with a pretest-posttest design. The study population was veterans with paraplegic spinal cord injury, who referred to Khatamalanbia hospital Tehran, Iran, in the second half of 2017. A total of 60 veterans were selected based on inclusion criteria and a purposive sampling method, and divided into two groups of intervention and control randomly by using a table of random numbers. For the intervention group, six sessions of 60‒45 minutes of self-care education were performed. The control group received only routine training. Patients completed the Modanlou Adherence to Therapeutic Regimen questionnaire before, and one week and one month after intervention. Data were analyzed by SPSS19 software. Two interventional and control groups were matched in demographic characteristics. The mean Modanlou Adherence to Therapeutic Regimen Score was 44.31±5.42 in the intervention group, and 43.40±3.96 in the control group before intervention, which increased to 47.63±2.64 and 43.63±3.88 one week, and 51.25±3.75 and 43.66±3.69 one month after implementation of the intervention. This difference was significant in the intervention group (p≤0.001). This self-care program training is effective in increasing adherence to a therapeutic regimen in veterans with spinal cord injury. Therefore, it can be suggested that nurses should recommend self-care programs used in this study as a simple, non-invasive, low-cost, and effective way to increase compliance with a treatment regimen in veterans with spinal cord injury

Military service is a critical period in a young person’s life. In this period, exposure to factors associated with anxiety causes increased psychosocial context formation, such as suicidal thoughts. The present study was conducted to determine the role of irrational beliefs, mindfulness and cognitive avoidance in predicting suicidal thoughts in soldiers. This was a descriptive and correlative study. The statistical population was all of the soldiers whose military service was run in Ardabil at 2016. By using stratified random sampling methods, 120 soldiers were selected. For data collection, the Irrational Beliefs Scale (Ahvaz), Mindfulness Scale (Ryan, Brown), Cognitive Avoidance Scale (Sexton, Dugas) and Suicidal Thoughts Scale (Beck) were used. Data were analyzed using SPSS-19. There was a significant relationship between irrational beliefs (r=0.39, p<0.01), mindfulness (r=-0.58, p<0.01) and cognitive avoidance (r=0.33, p<0.01) with suicidal thoughts. Results of the multiple regression analysis indicated that the irrational beliefs, mindfulness and cognitive avoidance in 0.58 can predict the suicidal thoughts of soldiers. Also, beta coefficients for predictor variables indicated that mindfulness was a stronger predictor in this analysis (p<0.05). Irrational beliefs, mindfulness and cognitive avoidance are considered predicting variables related to suicidal thoughts

Patient safety is one of the main components of the quality of health services and is one of the main priorities of health studies. The present study aimed to investigate the simultaneous effect of burnout and job satisfaction on patient safety using path analysis in military healthcare personnel This cross-sectional study was carried out on a sample of healthcare workers who worked in a military hospital in Tehran, Iran in 2016. Participants were selected using stratified random sampling. For data collection, the Maslach job burnout questionnaire, JSS job satisfaction questionnaire and patient safety culture questionnaire were used. SPSS and Amos software version 22 were used and path analysis was used to analyze the data. The study included 181 (73%) women and 67 (27%) men with a mean age of 37.3 ±8.7 year. The results of path analysis indicated the adequacy of the proposed model (RMSEA=0.026). Results tended to show the negative effect of shift work (β = -0.12), job burnout (β=-0.39), male gender (β -0.50) and positive effect of education (β = 0.01), work experience (β = 0.11) and job satisfaction (β = 0.13) on patient safety. Considering the negative effect of shift work and job burnout and the positive effect of job satisfaction on patient safety, the management of such variables is necessary in order to improve patient safety

Assessing the level of participation in one’s personal and social life and perceived problems associated with the extent to which a person can participate is widely regarded as a good indicator of health level. This study aimed to evaluate the perception of individuals with spinal cord injury (SCI) of their participation in daily life, to determine the association between participation and its associated perceived problems, and to investigate the effect of parameters such as age and gender on the perceived problems related to participation among veterans with SCI. In this descriptive cross-sectional study, 100 veterans who were members of the association of patients with SCI in Tehran, Iran, were selected via a simple randomization method. Data were collected using the Impact on Participation and Autonomy questionnaire developed by Cardol et al. Investigators were referred to the participants’ houses to complete interviews. SPSS, version 16, was used for data analysis. More than 80% of veterans reported that their participation in social relations, and more than 60% reported that their domestic independence was good or very good. Weak and very weak participations were reported in the areas of family life, autonomy outside the house, work, and education. Veterans believed that lesion most affected their participation in formal or voluntary work and mobility. Access to social support had the greatest role in predicting participation and perceived problems associated with participation compared to other demographic variables. In programs designed to enhance the participation and independency of veterans, it is necessary to direct special attention to the areas of family life, independence in the home, work and education, mobility, and occupational issues. Access to adequate social support can play an important role in improving veterans’ understanding of participation and reducing the associated problems