مجله طب نظامی
سال بیست و یکم شماره 5 (پیاپی 83، آذر و دی 1398)

Military nurses have acquired valuable experiences from caring for patients in war zones. Analysis of these experiences can create valuable knowledge for health care providers. The purpose of this study is to explore and analyze the lived experiences of military nurses from the war extracted from published papers.

In this mini-review, an extensive search was conducted using different combination of keywords including “War”, “Nurse”, “Military”, “Qualitative Research”, “Lived Experience” and “Phenomenology” from the ProQuest, Science Direct, CINAHL, Ovid, PubMed, Scopus, Web of Science, Google Scholar, Sid, MagIran, and Irandoc databases from 2000 to 2018. The literature was independently reviewed by two authors.

The databases search yielded 30 records. According to inclusion and exclusion criteria, 9 papers were analyzed. After reviewing 9 records, 6 areas related to the lived experiences of military nurses from war included war stress, adaptation to war conditions, professional growth, nurses exposed to injury, ethical dilemmas, and management and leadership were extracted.

Military nurses experience a lot of difficulties during war. These experiences can be used to identify problems and challenges and provide appropriate solutions in similar situations. These experiences can also be used to generate knowledge in the field of training and preparing military nurses to face unconventional and critical situations.

Cutaneous leishmaniasis (CL) is the main vector-borne disease in Iran. There are two types of rural and urban CL which are transmitted by Phlebotomus papatasi and Phlebotomus sergenti. Military forces are more susceptible to this disease than other people due to their job conditions. In case of infection, according to the commune period, they can spread the disease to other parts of the country. In this review, the prevalence of the disease in Iran, especially in military areas as well as in a number of Middle Eastern countries, is addressed. In addition, the importance of awareness of military personnel with clinical symptoms and methods of prevention, diagnosis, and treatment of CL are mentioned.

In this narrative review, 302 articles were selected (1980 to 2018) by searching scientific databases such as Science Direct, PubMed, Google Scholar, Iran Medex, Scopus, SID, and Magiran using different combination of keywords including CL, diagnosis and control, vector, reservoir, epidemiology, middle-east, Iran and military areas. Then, unrelated articles were removed and the necessary data was extracted from 113 articles.

In this review, clinical signs of the disease, sampling and diagnostic methods including direct, culture, molecular, histology, immunohistochemistry, isoenzymes and new methods such as High resolution melt (HRM) and Nucleic acid sequence based assay (NASBA), also therapeutic strategies and control of the reservoirs and carriers have been presented.

Considering the increasing trend of CL in recent years in different parts of Iran and neighboring countries, it is necessary for the health authorities of the armed forces to have sufficient knowledge about the recognition of clinical signs, reservoirs, carriers, and methods of control and prevention, diagnosis and treatment of the disease. This knowledge enables military personnel to provide training in how to control the disease in the military and other areas of the country, and prevent the spread of the disease through accurate planning.

Chromosomal abnormalities are able to produce genetic instability, which is the main cause of many diseases. Cytogenetics is analysis of any kind of chromosomal abnormalities. Chromosomal alterations can be divided into structural and numerical abnormalities, both of which play a significant role in the development of many diseases, particularly cancer. Today, most cytogenetic analyzes are performed by traditional methods (such as karyotype, banding and micronuclei testing) as well as modern techniques (such as M-FISH, SKY, and CGH). The factors causing chromosomal abnormalities can be classified into both external and internal groups. External factors that play an important role in causing anomalies in war can be classified into two physical (including different types of rays) and chemical agents. In this review, we explain a general model for development of chromosome abnormalities with emphasis on the method of production of abnormalities using chemical agents. According to this general model, each phase of DNA replication can convert any existing abnormalities to a higher degree of abnormality. This general theory can also be employed for chemicals, according to which chemicals producing chromosomal abnormalities can be classified into two main groups of non-delayed and delayed chemicals in terms of their effects. Non-delayed chemicals consist of gaps and breaks and delayed chemicals cause chromatid changes. Finally, some common types of chemicals used in military wars (including Agent Orange, depleted uranium, and mustard gas), with its cytogenetic effects and chromosomal aberrations caused by them, are discussed.

Organophosphorus compounds are widely used in pesticides, insecticides in agriculture and as nervous chemical agents. These chemicals inhibit the acetylcholinesterase enzyme activity that is responsible for the nervous impulse in organisms. This effect leads to an increase in acetylcholine level and finally neuronal complications.
Many methods are used to degrade and decontaminate these compounds, such as: the use of chemicals, burial of toxins, burning and biodegradation. The chemical and physical methods are often toxic, allergic, corrosive and nonspecific and harmful for the environment and are not usable in war spaces. Biodegradation is an effective and safe method that is performed under controlled conditions for the decomposition of various constituents, including organophosphorus compounds, by biological agents. Biodegradation is performed using microbes to detoxify and decompose contaminants. These strains contain broad substrate-degrading enzymes.
Although the use of natural strains as vital catalysts is an interesting method for the treatment of organophosphorus compounds, the inability of organophosphorus compounds to cross the membrane width reduces the total catalytic power, so the use of recombinant enzymes for the decomposition of organophosphorus compounds can be of great help in removing contaminants, especially in war environments. Many enzymes have been identified and used for this purpose, but most notably include: Diisopropyl-fluorophosphatase (DFPasae), Organophosphorus acid anhydrolase (OPAA) and Organophosphorus Hydrolase (OPH).
In this review, in addition to describing the organophosphorus compounds and their effects, biodegradation especially by use of enzymes was considered. The understanding and mastering of this knowledge could help researchers in the use of chemical degrading enzymes, especially organophosphates, in spray and enzymatic ointments in military environments.

Although there is quantitative research on the impact of war on psychological, social and emotional aspects of veterans, there is little qualitative research on the effect of war in veterans’ family and life. The aim of this research was to analyze the psychological and emotional needs in daughters of veterans.

This is qualitative research with descriptive phenomenology approach, which was done in 2018. Data gathering was done by semi-structured interview. Participants were daughters of veteran father in Martyrs and Veterans Foundation, Tehran, Iran. The research data reached theoretical saturation by interviewing 19 daughters. The data were analyzed using Colaizzi's seven-step content analysis method.

Qualitative analysis showed that the psychological and emotional needs of girls were obtained in four main themes, namely: "suffering and negative experiences in life, feelings of happiness and pride in having a veteran father, negative and biased viewpoint from society, interaction of father's values and beliefs with daughter". The main theme or concept was "living in the stages of suffering and honor".

 The father's physical and psychological conditions affect the physical and mental health of the family and lead to a decrease in effective family interaction with each other. There is a sharp conflict between the sense of pride in having a veteran father on the one hand and the feeling of mental exhaustion in despair and sadness on the other as experienced by their daughters.

There is little evidence about the relationship between temperamental and characterological dimensions of personality and emotion regulation (ER), and the nature of these relationships is not exactly clear. In other words, it is still unclear whether ER strategies have essentially biological basis or are influenced by learning. Therefore, the purpose of this study was to investigate the relationship between temperament and character of personality with ER, and also to determine the predicting role of those in ER.

This cross-sectional study was carried out from October 2016 to June 2017 in Tehran. The sample was conveniently selected from patients with emotional disorders who were recruited to psychological and psychiatricic clinics of Iran, Tehran and Shahid Beheshti medical sciences universities (n=262, male=52.9 %). The data were gathered by TCI-R and ERQ questionnaires, and analyzed using correlation and regression analysis. All calculation done via R version 3.4.0.

Among the temperamental and characterological dimensions of personality, persistence had significant correlation (P< 0.05) with ER strategies, i.e. reappraisal (r =.14) and suppression (r = -.20). According to regression analysis, it was found that persistence had a significant role in predicting ER.

There is a relationship between the temperamental traits of personality - the traits that have genetic and biological basis - and ER strategies. This finding confirmed the biological foundations of ER and indicates the need to pay attention to biological aspects of emotional disorders in the treatment, especially chronic emotional disorders.

Fatigue is one of the most common and debilitating symptoms of respiratory disorders in chemical veterans which affects many aspects of patient's life. This study was conducted to determine the effect of applying the energy conservation techniques on the fatigue of chemical veterans with respiratory disorders.

This clinical trial study was conducted on 49 chemical veterans with respiratory disorders by convenience sampling method. Then patients were divided into experimental and control groups by randomization. Energy conservation techniques were taught to the experimental group for one month and they applied these techniques for two months in daily activities. The fatigue of patients in two groups was assessed before, immediately after and one month after applying the techniques by Fatigue Severity scale.

The mean age of patients in control group was 57.32±9.60 years, and in experimental group was 54.79±7.27 years. There was no significant difference between the two groups in terms of demographic data (P>0.05). The mean of fatigue in the experimental group decreased immediately and one month after the intervention compared to before that and the differences were significant. However, the mean of fatigue in the control group increased after one month, and these differences were not significant. Also, there was a significant difference between the two groups in the mean of fatigue scores in different measurement periods (P<0.001).

According to the current research findings, applying energy conservation techniques led to reduction of fatigue in veterans with respiratory disorders. Therefore, this method can be easily used as a non-pharmacological and effective method in the control of fatigue in this group of patients.

Low back pain (LBP) is a multidimensional disorder which is common among military personnel. It may cause disability, reduced productivity and combat readiness of forces, and increased health care costs. Therefore, the aim of this study was to assess the risk factors associated with LBP in male military personnel.

This study is a case-control study of 250 military personnel with chronic LBP and 250 healthy military men were assessed through simple nonprobability sampling. A three-part questionnaire (demographic, occupational and clinical data) was used for both groups with closed questions, Job Related Physical Demands questionnaire (JRPD), and Health Risk Appraisals questionnaire (HRA). Evaluation of relationship between risk factors associated with low back pain in both groups was done.

Age, height, weight, and work record were not significantly different between the two groups of military personnel. Among the factors studied, there was a positive significant relationship between LBP and hard job titles (p=0.012), prolonged work experience (p=0.002), heavy and continuous physical activity (p=0.015), and awkward posture (0.034) (p=0.003). Also, attendance in exercise programs (P=0.003), body mass index (p=0.025) education level (p=0.005), smoking (p=0.011), duration of LBP (p=0.003) spine deformity (p=0.002), history of LBP (p=0.011) showed significant negative correlation. No significant relationship was found between the variables of severity of pain, and having diffuse pain with low back pain.

The hard job titles, high work history, heavy and consecutive physical activity, poor posture, lack of exercise, high BMI, smoking, duration of back pain, deformity in the spine, and history of previous pain are risk factors associated with low back pain in in male military personnel. It seems possible to reduce the amount of these factors by preventing new lesions or expanding them, and improving the level of military personnel efficiency.

Preparing the skin for surgery with antiseptics is a standard measure to reduce surgical site infection. This study aimed to evaluate the effect of skin preparation at the surgical site with povidone-iodine 7.5% and povidone-iodine 10% antiseptics with chlorhexidine and povidone-iodine 10% on the microbial count.

This clinical trial study was performed on 80 patients with elective abdominal surgery. Patients were divided into two groups by simple random methods and proportional allocation of skin preparation with povidone-iodine 7.5% and 10% antiseptics or chlorhexidine and povidone-iodine 10% antiseptics. On the day of surgery, the culture sample was taken before the primary skin preparation, then the primary preparation was done with povidone-iodine 7.5% or chlorhexidine in alcohol, then the second culture was taken, the secondary skin preparation was done in both groups with povidone-iodine10% and then the third culture was taken. Specimens of cultures were taken on a blood agar plate and McConkey plate for the examination of microbial count and type, were immediately transferred to the laboratory.

The mean differences in microbial counts before and after skin preparation with povidone-iodine 7.5% and povidone-iodine 10% antiseptics were significant (P=0.001). Also, mean differences in microbial counts before preparation with after skin preparation with chlorhexidine in alcohol antiseptics and povidone-iodine 10% were significant (P<0.001) and in general, both antiseptic groups significantly reduced microbial counts. In comparing the effect of the two groups on the mean microbial count, although the skin preparation with chlorhexidine in alcohol and povidone-iodine 10% antiseptics was better than povidone-iodine 7.5% and povidone-iodine 10% antiseptics, the difference between the two groups was not significant (P=0.324).

Both antiseptic groups were able to significantly reduce the mean microbial counts. Therefore, it is recommended that both antiseptic groups be used to prepare skin for surgery.

Due to the increase in accidents and disasters in terms of quantity and severity, it is necessary to respond effectively in the form of crisis management, activation and removal of barriers affecting the rapid reaction of emergency centers. The aim of this study was to investigate the barriers affecting the rapid reaction of emergency operation centers in a branch of the Red Crescent Society in Tehran.

The present study is an analytic study which has been conducted in branches of Red Crescent Society in Tehran, Iran during the first half of 2108. The Study population was the managers of the Red Crescent Society. Data collection was done using the Nominal Group Technique (NGT) and researcher-made questionnaire. Data analysis was done using descriptive statistics and DEMATEL technique using SPSS 18.0 and MATLAB software.

Based on the results of One-Sample T-test, all nine indicators were approved. The results of the DEMATEL model showed that the barriers "lack of proper operational vehicles" and "shortage of medical and relief medical personnel" with the coordinates (2.19: 26.68) and (2.09/27.11) were the most affecting and effected barriers, respectively.

Based on the results, to compensate for the shortage of operational vehicles and medical and relief personnel, repairing and equipping used operational vehicles, use of private sector capacities, professional training and operational standards in dealing with crises and accidents, and cooperation with specialized medical teams in other relief agencies are suggested.

Preparedness of hospitals against disasters is one of the key components of governmental planning to counter, control or minimize the consequences. The aim of this study was to assess the hospital preparedness and managers’ awareness against disasters in Southeast Iran.

This applied, descriptive and cross-sectional study was conducted in 2017. The study population consisted of all State hospitals affiliated to Sistan and Baluchestan and Kerman Universities of Medical Sciences (hospitals=33, managers=264). The data were collected using a standard disaster preparedness checklist and managers' awareness questionnaire via in-person referral and distribution among statistical population. Data were analyzed through SPSS 17 and related statistical tests.

Managers' awareness (66.43%) and preparedness of hospitals (61.66%) against disasters were moderate. The highest and lowest levels of awareness were related to nursing managers (69.92%) and medical records (63.16%), respectively. The highest and lowest levels of preparedness were associated with management of disaster planning (77%) and planning of reduced construction risks (37.74%). There was a significant relationship between managers’ awareness and hospital preparedness against disaster (p<0.001).

The preparedness of the studied hospitals was moderate, which improved preparedness against disaster and crisis through observing standards of hospital infrastructure, holding training classes for all hospital groups, securing hospital equipment and so on.