مجله طب نظامی
سال چهاردهم شماره 2 (پیاپی 48، تابستان 1391)

Health tourism covers any trip for health promotion and as one of the dimensions of tourism, results in development and leads to dynamic economics. It could also be a national strategy towards increasing the national income and is also considered as a national security aid. This study was carried out to investigate the current status of health tourism in Iran and the specific potentials of the country. This descriptive review article was done in two stages. First, the research data was extracted from the resource library and scientific websites and then the experts’ viewpoints were added to it. Data were investigated and analyzed using the pattern of factors that create competitive advantage and their relationships. Iran has many strength points, including expert physicians, up-to-date medical technology and natural healing regions to attract health tourists; however, weaknesses and challenges such as poor coordination among the organizations responsible for medical tourism and inappropriate planning. Iran could make use of its potentials in the field of health tourism and achieve the goals and visions of “Iran in 1404”, through increasing emphasis on the strength points and introducing them as its unique capabilities, comprehensive planning and operational requirements of field units and provide leadership in this industry.

Approximately 40% of every adult human body mass is composed of skeletal muscle. Skeletal muscle diseases range from the debilitating to crippling and even to death. The residing satellite stem cells are few in numbers. The ability to take a few cells from an adult human and produce a large mass of functional skeletal muscle would be of invaluable benefit to humankind. As of today it seems that designing and construction of a skeletal muscle substitute with similar functional properties is a little far out of mind; because no yet exists an effective and executable method for construction of a skeletal muscle substitute that be large enough and mature and live fibers aligned in it with proper concentration and regularity similar to natural muscle.

Organizational structure has key role in the implementation of organizational goals and strategies. The purpose of this study was to provide a military healthcare structure model based on the characteristics of asymmetric in order to achieve a proper organizational structure. This mixed method study was conducted in 2009. The qualitative phase was done by in-depth interviews with 18 top managers of the healthcare system who were selected by purposeful sampling. Qualitative data were evaluated by qualitative content analysis. Then, structural models were established by focused group discussion. In the quantitative phase, the opinions of 95 military healthcare senior executives were compared considering flexibility, accuracy, decision-making and compatibility of the structural models with asymmetric war. Four organizational structure models were extracted. The “Staff-base” model gained the highest score (68.5% and 63.8% respectively) in the field of flexibility and accuracy and the “Command-base” model gained the highest score (76.3%) in the field of decision-making. There was significant relationship among all mentioned fields (p=0.007, 0.003, 0.023). Investigating the overall compatibility with asymmetric war, there was no significant relationship between the four models (p=0.9), but the “focused” model gained the maximum score (61.6%). Although there isn’t complete agreement on a specified structure to ensure all needs of asymmetric war conditions, the “command-based” structures seems more appropriate due the high speed of decision-making.

Obesity (OB) is one of the health problems that may lead other diseases. Many risk factors make OB that one of them is working on Shift Work (SW). In the present research, we are going to study the relationship between SW and OB by controlling confounding factor and with use of multilevel modeling, the powerful method for modeling correlated and longitudinal data. The data were extracted is annual observation from workers who worked at Isfahan’s Mobarakeh Steel Factory (ISCF) that collected in health and safety executive between 2001 until 2010 for longitudinal study. In this research we study the effect of SW on OB with controlling blood pressure, age, and education level. MLwiN programmer version 2.1 was used to apply a multilevel modeling. Total person who participate in this study was 6713 with 7 repetitions and range 10. The 45.2%, 6%, 48.8% of participation were day worker, weekly shift worker and routine shift worker respectively. In this study with controlling confounding factor WSW was shown significance relationship with OB (p=0.005) and more result shown decreasing BMI in routine shift worker rather than day worker. Since in most studies SW Mentioned as increasing factor for OB it can be something of a pattern in how the work schedule, pay and bonuses as a suitable model of ISCF can be used to reduce the effect on OB on SW.

Suicide is not a random event among soldiers and happens as a result of a course of thoughts, behaviors, circumstances and inter-personal relations which mostly originate from some time before the military training period. The goal of the present research was to determine the background factors of suicide and self-mutilation among soldiers of a military unit. This descriptive cross-sectional study was carried out on all soldiers of a military unit that had attempted suicide or self-mutilation from 2004 to 2007. Samples were selected by census method. The data collection tool was a researcher-made questionnaire. The required data were extracted from the suicide and self-mutilation files and were analyzed by SPSS 17 software using descriptive statistical methods and analytical tests such as Chi-Square test. 44% of the studied individuals had the history of self-mutilation or committing suicide. The most frequent background factors of self-mutilation and suicide were mental disorders (37.2%). family problems (36.7%), challenges with co-workers and work environment (13.8%). Majority of suicides were committed in winter. The suicide methods were use of firearms (49.9%), stabbing (25.2%), taking drugs (18.5%), hanging up (4.4%), taking oil and hand-washing liquid (1.2%) and a jumping from height (0.9%). According to the obtained background factors, soldiers should be screened by the time of arrival at military environments and at regular intervals. Preventive interventions such as training, consultation and psychotherapy should be also performed.

Comparative invetigation of satisfaction rate in the subunits of big organizations will result in recognition of the factors influenced by the managers of each subunit. The aim of this study was to compar thr job satisfaction level between health and treatment deputy staff in East Azerbaijan province, Iran. This descriptive-analytical study was performed on 420 health and treatment personnel in East Azarbaijan, Iran in 2011. Samples were selected by 3-stage cluster sampling. Data were collected by a researcher-made job satisfaction questionnaire that measured 5 aspects of job satisfaction including structural and manageral, individual, social, job nature, environmental and welfare factors. Data were analyzed by descriptive statistical methods and analytical tests including Friedman test and MANOVA using SPSS 11 software. The difference of job satisfaction mean was statistically significant between the GPs and midwifes of healthcare centers and hospitals in all dimentions (p<0.05). Hospital GPs and healthcare center midwifes reported a higher level of job satisfaction and healthcare center GPs and hospital midwifes repotted a lower level of job satisfaction. Health and treatment staff had the highest satisfaction average in individual factors and the lowest average in environmental and welfare factors. Job satisfaction mean does significanlty differ between the health and treatment personnel. Environmental and welfare factors may be targetted to improve job satisfaction in public health care system.

Investigating the different psychological aspects and the life quality of navy forces is important for improving their military power and efficiency and therefore improving the military power. The aim of this study was determining the psychological effects of long term naval missions on the family members of the Iranian Navy staff. This descriptive cross-sectional study was carried out in 2011, on 20 military families residing in one of the towns of the navy’s 1st area in Bandar-Abbas city and had at least experienced three naval missions. Then the occupational history, life biography, marriage status, the number of children and the history of psychological hurt due to job conditions and war missions were investigated based on free interviews. Questions were designed based on ENRICH Inventory, the Occupational Stress Questionnaire and the job satisfaction questionnaire. The remaining psychological effects of long term missions on families were correlated with age, education level, marriage age and the number of children, job experiences, military responsibility, mission location and duration and the possibility of fighting adversaries. Having a positive view about the necessity of missions was an important factor in tolerating problems. Understanding the psychological effects of naval missions would result in finding appropriate solutions such as teaching life skills with the aim of lowering and preventing these effects.

In large organizations, supporting entrepreneurial behavior at all hierarchal levels for growth and increasing competitive advantages, is necessary. The aim of this research was to study of relationship between emotional intelligence and entrepreneurial behavior in a medical sciences university. This study is a descriptive and cross-sectional study conducted in the second half of 2011 in a medical sciences university. Sampling included 96 people. Standard questionnaire of Wong & Law has used for gathering data regarding emotional intelligence and entrepreneurial behavior. Samples selected randomly and used spearman correlation and Mann-Whitney tests to examine statistical significance by SPSS 17. Findings showed that there is a significant relation between all dimensions of emotional intelligence including self-emotional appraisal, other's emotional appraisal, and regulation of emotion and use of emotion and entrepreneurial behavior (p<0.01). Analyses demonstrated that other’s emotional appraisal, regulation of emotion and also uses of emotion have high effects on entrepreneurial behavior. Furthermore findings indicated that there is no significant difference among men and women (p>0.05). Nowadays, entrepreneurial behavior in organizations cant be ignored. Employees that have high level of emotional intelligence can control their feelings. Therefore they can experience better behavior in the workplace that enables them to act entrepreneurial.

The Social Security Organization is the largest provider of health services throughout the country after the Ministry of Health. Lack of the classification and referral system will lead to treatment withdrawal, patients’ confusion, immethodical visits and waste of resources. This study was carried out with the aim of proposing a proper model for the management of patients’ referral system in the direct care unit of the Social Security Organization. This comparative study was carried out in 2009. Two separate meetings of the Expert Panel in developing the proposed model were utilized for codification of the model. Then, the thematic and pivotal codes were extracted through framework analysis and the model was proposed according to the research objectives and research findings. This model was approved by experts through three rounds of Delphi method. The classification of services and patient referral system is more comprehensive in US, Canada, Britain, South Korea and Chile due to the presence of national medical system. The referral system is not followed seriously in France. In Austria, there is a universal social insurance structure, but the social insurance system has been partially applied in Turkey. The patient referral system hasn’t been performed in the direct care unit of the Iranian Social Security Organization and only the Patient Guidance Staff is responsible for referring the patients to specialized services. The proposed model of managing the referral system in this study is based on a semi- open referral system and the constant presence of family physician with voluntary membership. Financial leverage is used in this model for optimal administration of the referral system.

Sleeping is one of the basic physiological needs of human beings and has an important effect on people’s everyday activities. One of the prevalent disorders in humans is sleeping disorder. This disorder can have serious effects on humans such as increasing human errors during work, especially during driving. This study was designed to evaluate the quality of sleep and its related factors in Kerman inter-city bus drivers. This cross-sectional study was done in 2011. One hundred inter-city bus drivers were chosen by simple random sampling. Sleep quality was evaluated by the standard Petersburg Questionnaire and data were analyzed by independent T-test, ANOVA, Pearson correlation and Chi-square test using SPSS 15 software. The mean driving hours of each driver was 7.71±0.81 hours a day and the mean score of sleep quality in the drivers was 6.98±0.34 from 21 scores, and 61% of them had poor sleep quality. There was a significant relationship between the quality of sleep and age (p=0.01) and job satisfaction (p=0.001). The drivers that had had an accident in the last 5 years were more likely to have poor sleep quality (p=0.013). The sleep quality is not satisfactory among the majority of Kerman inter-city bus drivers. Certain initiatives should be implemented for improving drivers’ sleep quality and timely and adequate rest and restricting their work hours in order to prevent accidents and save passengers from harm.

Salmonella spp. is one of the most common pathogenic bacteria responsible for gastroenteritis in human. Among Salmonella spp., S. typhimurium has many hosts other than humans and its prevalence rate is high in society. The aim of this study was to determine the ribotype diversity of S. typhimurium stains isolated in some hospitals of Tehran, Iran. In this descriptive study, clinical samples were collected from different hospitals in Tehran were investigated. Bacterial isolation was carried out by standard procedures in selective culture media and identification was achieved through biochemical and serological methods. DNA extraction was performed by phenol-cholorophorm methods. Ribotyping was used for molecular typing of S. typhimurium clinical isolates. The sizes of the ribotyping bands ranged from 1.4 to 16.8 kb in all ribotypes. The S. typhimurium isolates were divided into 7 clusters based on the diversity of ribosomal genome areas. Most isolates (5 strains) belonged to the cluster 2b. Three isolates belonged to the 6b cluster and for the rest of isolates, each belhonged to one of other clusters. S. typhimurium strains circulating in the studied hospitals of Tehran, do not belong to a specific ribotype and have ribotype diversity, but other molecular typing methods should be implemented in order to make a more precise judjement about the presence of whether limited or widespread clones and the relationship among the different strains of this serotype.

Tractors are one of the most important sources of noise exposure in agriculture. This study aimed to investigate noise exposure in Romanian tractor drivers and bystanders’ when it’s operating at different engine speeds and gears. This cross-sectional study was carried out on Romanian tractor (M-650) available in agriculture college field of Bahonar University of Kerman in 2011. According to international standards a 20m×3m field was chosen and then the noise levels for two positions, the driver’s ear and bystanders, were measured in two conditions, static (neutral) and moving (at different gears and engine speeds). To define the characteristics of the tractor’s noise, frequency analysis was also performed. Data analysis was done by descriptive statistical methods using Excel software. While working in place, bystanders near the exhaust had the highest noise exposure and an increase in motor speed from 850 to 1700 rounds per minute led to an increase in noise for the driver’s ear from an average of 5.8 to 9.3db and for the bystanders from an average of 2.3 to 10.3 db. The mean sound level at lower frequencies was higher than middle and high frequencies. When the tractor is moving, at 850 rounds per minute the driver’s exposure to noise in all gears is less than standard, but at 1700 rounds per minute the noise level is higher than the Iranian and ACGIH standard and controlling measures seems to be necessary.

Ants with the ability of biting and injecting poison to human body are called sting ants. This study was conducted to identify and determine the ant types and the prevalence of ant sting and related epidemiological factors in three Greater Tunb, Lesser Tunb and Abu-Musa islands, Iran. This descriptive cross-sectional study was performed during Jan-July 2010 in Greater Tunb, Lesser Tunb and Abu-Musa islands on 318 military individuals who were selected by random sampling method. The ant collection was done by active hand-catch method. The ant sting prevalence and related epidemiological factors were determined by questionnaire. Data were analyzed by descriptive statistical methods including Chi-square test, Mann-Whitney test and Spearman and Gamma correlation by SPSS 12 software. The species of sting ant was Pachycondyla sennaarensis Mayr, 1862. The mean prevalence of sting was 70.1%. The seasonal incidence of sting in three islands had the same pattern and was more common in spring and summer. 84.4% of ant sting had occurred in limbs. The main symptoms caused by the ant stings include pain, severe itching and local inflammation and blisters in some cases. Although sting bite is not much dangerous in the studied islands and does not lead to anaphylactic shock and death, the pain and itching and burning would cause discomfort for soldiers and reduce their efficiency. Therefore, preventive measures and control of these ants should be considered.

Efficiency depends on individuals’ talent, training and also their work environment. To determine the efficiency, one’s performance must be measure and the result should be compared to a standard measure. This study was carried out with the aim of investigating the effects of double work and distraction on the efficiency level among the personnel of a crisis management center in Tehran This pretest-posttest study was performed in 2011, on 68 employees of a crisis management center in Tehran, Iran. Samples were selected by simple randomized sampling method and Toulouse- Piéron test was applied to verify their talent and performance. The forms were collected and checked after performing the seven stages of the test. Data were analyzed by binominal nonparametric test using SPSS 18. Double work significantly decreased the individuals’ efficiency and efficiency was more in women at both normal circumstances and double working. Distraction also decreased the output. The effect of distraction was not the same as double work and double work had more severe impact on efficiency compared to distraction. Double work has impacts on efficiency and reduces the efficiency to about half, but distraction does not decrease the efficiency as double work. Employees are suggested not to do two tasks at the same time. They also shouldn’t work in environments that cause distraction.