مجله طب نظامی
سال بیست و یکم شماره 6 (پیاپی 84، بهمن و اسفند 1398)

This narrative review evaluates the intergenerational transmission of Post-Traumatic Stress Disorder (PTSD) from father to offspring in families. PTSD is the most important mental disorders in persons rescue from war. This impairment causes many problems and stressful conditions. Recently, the definition of PTSD contains not only those affected by the catastrophe but also those who have witnessed it suffering from PTSD. This review focuses on which fathers have a more tendency to transmit mental distress to their offspring. According to accept transmission, we should find out, which factors make intergenerational transmission and what is the mechanism of transmission during generation. Moreover, some clues indicate some offspring are more potentiated to PTSD. Most of the studies aim to find a specific gene for PTSD were failed, but the studies showed the intergenerational effect of the PTSD. Epigenetic mechanisms that contain both genetic and environmental factors provide a wide psychological aspect in the intergenerational effect of the PTSD. The theory of epigenetics assumes that the biological and psychological factors act closely and there has been promising research on the role of epigenetic modification in reducing sustained environmental effects, especially in the early stages of growth. There is a great deal of information indicating that some offspring have a greater potential for the disorder. This review study shows that family members and extramarital systems play an important role in the intergenerational transmission of PTSD.

With the growth of science production in the world, it is crucial to analyze the status of the produced knowledge for use in scientific policymaking. The scientometric method is one of these analytical tools. Given the special circumstances of Iran and the extent of the impact of the imposed war on the Iranian people, one of the scientific fields that can strongly produce knowledge in the region and the world in the field of military psychology and psychiatry. The purpose of this study was to investigate the status of science production in the field of military psychology and psychiatry in Iran.

The present review has a scientometrical approach and the keywords related to the field of military psychology and psychiatry were determined according to the purpose of the study. Then, the Scopus database was selected as a valid scientific reference for the search of Iranian scientific products. Following the instructions of this database, the search was set by a different combination of keywords. The published sources were extracted and analyzed until September 27, 2018.

data production of military psychology and psychiatry was 52419 in the world, with the US producing 26318 (first rank) and the UK with 3510 (second rank) and Iran with 310 (18th rank). The top university in Iran in this field is Baqiyatallah University of Medical Sciences with 85 published articles and the largest contribution to the acceptance and publication of articles in the journals was Journal of Military Medicine (Iran) with 56 published articles. The highest citation in this field was for the paper published in the journal of Basic and clinical pharmacology and toxicology in 2006.

Given the history of the imposed war and its impact on the entire Iranian society, as well as the current special conditions of the West Asian region and North Africa, there are great opportunities for research in the field of military psychology and psychiatry. Despite Iran's growing research in this field, Iranian researchers can play a greater role in producing knowledge in this field. The findings of this study show that Baqiyatallah University of Medical Sciences has been a pioneer in the production and dissemination of knowledge in this field. Therefore, it seems that with careful planning, other military universities can be activated in this field and can also take serious steps in applying this knowledge in the next step.

Emergency department (ED) in military hospitals due to its nature is one of the most critical healthcare centers for injured people at urban unrest. The aim of this study was an exploration of dimensions and components of ED preparedness in military hospitals for urban unrest.

This was a qualitative and content analysis study. The study population was the physicians, nurses, emergency managers of military hospitals with at least 15 years of work experience. Sampling was initially targeted with semi-structured interviews and continued with the snowball method until reaching the saturation (10 participants). Interviews were conducted between October 2018 and February 2018. Findings and conceptual model of the research approved by the experts for validation and reliability. Data analysis performed by MAXQDA10 software.

With the implementation of interviews, the 659 code recognized. After deleting the overlaps, 128 codes were obtained. In the next step, the extracted codes were classified into 7 dimensions (themes) and 31 components (sub-themes). The seven dimensions of preparedness included command and control, human resources plan, resource management, communications, protection and security, treatment and increasing capacity, respectively. Finally, the conceptual framework of military hospitals emergency preparedness for urban unrest retrieved and approved by the expert's opinion.

According to the conceptual model of the study, which consisted of 7 main dimensions (themes), the components of emergency preparedness were almost identical in most crises but differed in importance and prioritization. In the emergency preparedness model of military hospitals in urban unrest, there is a significant difference in terms of protection and security which, if weak, will have a significant impact on other aspects of preparedness. Since people's views and opinions aligned with military personnel in natural disasters, there are no significant challenges in terms of protection and security, conversely, in urban unrest, especially if it is accompanied by political issues, due to divergent opinions and other influential factors, there will be irreparable threats to the injured, staff, health centers, and continuing urban unrest.

Nurses are the biggest groups that provide relief and transport services in critical conditions and battlefields. Although many studies are published regarding the role of nurses in war the number of qualitative researches in this field is limited. This study was conducted to identify the role of nurses in the relief and transportation of injured victims on the battlefield.

This qualitative conventional content analysis was done in 2018. Using purposive sampling, 26 nurses with a recent history of participation in military missions were invited to include in the study. Data collection was carried out using in-depth semi-structured interviews. All data is recorded and typed in MAXQDA software, then analyses included 8 steps: transcription the interviews; identifying semantic units; coding; revising codes with text; classifying and developing categories; reviewing categories; identifying themes; and reporting the findings.

In conclusion, 212 codes and 23 subcategories and seven categories were extracted from data analysis. Also three main themes including the "Life savior in relief and transmission", "Management and leadership of relief and transportation" and "Unorganized relief and transportation" were emerged. The main categories were: management skills in relief and transportation, human resources development, savior characteristics and capabilities, knowledge and skills of a savior, unorganized transfer, unorganized saving interventions, and unorganized management.

The findings of this study showed that relief and transportation on the battlefield were fit to the needs of the war. Applying nurses' experiences in this field can create an integrated relevant resource for relief and transportation services and improving combat power.

Research has shown that the type of attentional instructions plays a vital role in performance and learning of various skills, including balance skills and postural control. The purpose of the present study was to investigate the effect of internal and external (close & far) attentional focus on the static and dynamic balance of chemical veterans with movement impairment.

This research is quasi-experimental. The subjects were 30 chemical veterans with movement impairment who were referred to a military hospital in Tehran in 2017 were selected using Krejcie & Morgan sampling method and participated in the study. Test assignments included stork (static balance) and a balance beam test (dynamic balance), which was performed 12 times for both states of balance and 4 states (internal focus, far external attention, close external attention, and control).

The results of variance analysis with repeated measurements (ANOVA) showed that the participants in both circumferences of external (close & far) attentional focus (P=0.001) had a better static and dynamic balance than the internal and control conditions. 

The finding of the present study supports constrained-action hypothesis and explicit processing hypothesis and shows that focusing on the effects of movement in the environment improves the motor's performance of chemical veterans with movement impairment in the static and dynamic balance task.

Increased plasma levels of HCY (homocysteine), CRP (C-reactive protein), TNFα (tumor necrosis factor), cTnI (cardiac troponin I) and cTnT (cardiac troponin T) are known as inflammatory risk factors for cardiomyopathy. So, this study aimed to investigate the effects of 8 weeks combined, interval aerobic and continuous aerobic training on HCY, CRP, TNFα, cTnI, cTnT, lipid profile and performance of military personnel aged 30-45 years old in cold and mountainous climate.

30 Military men aged 30-45 years were randomly assigned into three groups of 10 people, including as combined, interval aerobic and continuous aerobic training groups. Training protocol was implemented for 8-week, three sessions a week and each session takes about 90 minutes on a regular basis by 60% to 80% of 1RM (in complex training group) and  (in aerobic training group) in cold (November/January - with a temperature difference of %5 lower than the average daily temperature) and mountainous climate of Tabriz city. Serum levels of cTnI, cTnT, Lipid Profile (LDL, HDL, and TGC), HCY, CRP, and TNF-α were assessed using ELISA and electrochemiluminescence methods.

8 weeks of combined, interval aerobic and continuous aerobic training protocol, significantly decreased the serum levels of cTnI, cTnT, Lipid Profile (LDL, HDL, TGC), HCY, CRP and TNF-α in Military personnel (P<0.05). Also, ANOVA and bonferroni post-hoc test revealed that the reduction of basic rates of these factors was relatively lower in the combined training group compared to interval aerobic and continuous aerobic training groups (P<0.05).

Implementation of 8 weeks of combined training decreased cardiovascular risk factors and catabolic responses, as these changes improve the performance of military personnel in organizational missions of cold and mountainous climate.

Heat stress is one of the physical hazardous agents in the workplace with many adverse health effects. This study aimed to investigate the relationship between heat stress and workers' blood parameters in a foundry.

This case-control study was conducted in July 2018 on 55 male subjects employed in Saipa Malleable foundry located in Tehran, Iran. The selected individuals included 35 subjects working in the Foundry Hall (exposed group) and 20 subjects working in the CNC workshop (Control group) of a foundry plant. First, demographic information, medical records and occupational data of all subjects were collected using a self-regulated questionnaire. Blood samples (5 ccs) were taken from the subjects during the work to determine the blood components (including WBC, RBC, HCT, HGB, MCH, MCHC, MCV, PLT, RDW, PDW, MPV). Samples were analyzed by Automated Blood Cell Counting. The time-weighted average value of WBGT was determined for studied job tasks in the exposure group and two job tasks in the control group. Sound pressure levels and light intensities were also measured. 

The average WBGT index was 32.97 ° C for the exposed group and 22.5 ° C for the control group. Laboratory findings showed that the number of white blood cells was less in the exposed group. The hemoglobin concentration, hematocrit, mean corpuscular volume (MCV) and platelet count in the exposed group were higher than the control group (P<0.05). No significant relationship was found between the WBGT index and other blood Parameters (P>0.05). The t-test results did not show a significant difference between sound pressure level and light intensity in both exposure and control groups (P>0.05). Spearman's results did not show a significant correlation between sound pressure level and light intensity with blood Parameters, but significant correlation was observed between the average WBGT index and the number of white blood cells, hemoglobin concentration, and hematocrit.

The average number of white blood cells in the exposed group was lower than the control group. Also, the mean concentration of hemoglobin, hematocrit, mean corpuscular volume (MCV) and platelet count was higher than the control group. Exposure to chronic heat stress can increase blood concentrations with increased hematologic factors and increase vascular resistance and reduce oxygen supply to tissues.

Considering the necessity of developing, retaining and promoting employees’ health as the most important organizational capital, this study was conducted to achieve a comprehensive occupational health management model to comprehensively observe the health status of employees in individual, occupational and organizational dimensions.

In terms of aim, the present study is applied while in terms of methodology, it is a qualitative survey – observational and evaluative study. This study is conducted between 2016 through 2018 in 300 workstations within 5 buildings of Police by snowball sampling technique. All data is collected as a field study by using technical devices and forms that finalized by focused group discussions.

Drawing a health management paradigm leads to the establishment of a database on police staff’s health as well as their workplace health and a managerial dashboard to observe organizational health status instantly. By using this model, one can evaluate and monitor police staff health and occupational health instantly.

By developing this professional health model, while jobs related to police are rated, a managerial technique is achieved that a clear, real and complete image of the target community's health status is generated at any moment. Also, strategies related to human health were adjusted according to the health status of the staff.

Understanding the epidemiology of outbreaks of waterborne and foodborne diseases is essential for adopting prevention and control strategies. The purpose of this study was to investigate the reported outbreaks in Iran during 2012-2018.

In this retrospective descriptive study, secondary data extracted from reports of outbreaks of waterborne and foodborne diseases submitted to the Ministry of Health, the Centers for Communicable Disease Control, from 2012 to 2018. Epidemiological trends and aspects of outbreaks were analyzed according to etiologic factors, location of the outbreak, food vehicles, month, year and geographic location.

Between 2012 and 2018, 20615 food and waterborne disease outbreaks were reported, resulting in 158650 illnesses, 19664 hospitalizations, and 288 deaths. The cause of the outbreak of waterborne and foodborne illness has been identified in only 40% of cases based on laboratory results. The most common cause was Escherichia coli (30.6%) followed by Shigella (1.8%). Outbreaks most frequently occurred in personal home (69.1%), ceremony (5.8%), and restaurants (4.4%).

Although reporting of outbreaks of waterborne and foodborne illnesses has improved in recent years, we are still underreported. There is great variability in outbreaks investigation and reporting throughout the country. This study is based only on reports of outbreaks to the Ministry of Health and does not necessarily indicate the correct burden of outbreaks in the country. Strengthening and training of those involved in the reporting system, including for the collection of epidemiological data and samples, is recommended.

Developing Interprofessional education and collaboration is important in systems of medical sciences to deliver better health care. The present study aimed to assess the validation of the Interprofessional Collaborator Assessment Rubric (ICAR) (validity, reliability and confirmatory factor analysis). Also, the interprofessional collaboration of the healthcare team members in emergency departments was evaluated by ICAR.

This descriptive and cross-sectional study conducted in two phases. In the first phase, the face and content validity of ICAR was assessed. The Rubric includes 17 items in six domains including communication skills, collaboration, role and responsibility, teamwork, collaborative patient-centered approach, and conflict management). Also, a confirmatory factor analysis of Rubric was assessed. The reliability of the Rubric was evaluated by internal consistency and reproducibility (test-retest approach). The CFA assessed using Maximum Likelihood by EQS. In the second phase, the interprofessional collaboration of Emergency care team members (including 70 residents, interns, and nurses) were assessed by direct observations. Also, an inter-professional collaboration of healthcare team members was analyzed using descriptive tests (mean and standard deviation) and one-way analysis of variance was used to compare between groups.

The face and content validity of ICAR approved by consensus of 18 faculty members in medical education, nursing education and clinical specialties (CVI>0.70 and CVR>0.49). The reliability of Rubric approved by Cronbach's alpha =0.89 and ICC=0.80. The construct of Rubric confirmed in six domains through GFI=0.9, AGFI=0.9, CFI=0.976, RMSEA=0.06, χ2/df=1.88, χ2=195.78, df=104, P<0.001. The mean score of participants (including interns, emergency medical assistants, and nursing personnel) in the emergency department was 63.35 (17.53). There was a significant difference between the performance of three groups (nurses, interns and assistants) (p-value=0.03).

The results of the present study showed that the scores of inter-professional cooperation of participants in the present study were lower than expected. It is recommended to plan and implement interprofessional training courses to improve inter-professional collaboration between healthcare providers in the study environment. Regarding, the confirmation of ICAR validation, it can be used to assess the interprofessional collaboration of participants.

Combined exposure to noise and temperature can affect the neurophysiological responses of the office staff. The present study was done to investigate the impacts of combined exposure to noise and low air temperature on physiological responses and environmental comfort.

In this experimental study, the studied population included the students who were randomly selected from Hamadan University of Medical Sciences in June 2018. This study was conducted on 24 students who were exposed to ten different conditions set by a combination of low air temperatures of 14, 18, and 22  and noise levels of 55, 65 and 75 dB in a climate chamber. The duration of each session was 55 minutes. Physiological parameters such as blood pressure, heart rate, body temperature, finger skin temperature, galvanic skin response, and respiration rate were measured before and after exposure. Thermal sensation and thermal comfort votes were measured using ISO 10551 standard. Sensitivity to noise was also measured using ISO15666 standard scales for noise annoyance.

Within the range of the studied temperature and noise, the effect size of reducing air temperature on physiological responses was higher than the effect size of increasing noise (P <0.05). By reducing air temperature, noise annoyance reported worse and also the thermal perceptions were affected by increasing noise at cold air temperature (P <0.05). The mean changes of galvanic skin response, respiration rate, heart rate, and noise annoyance when exposed to irrelevant speech have increased as compared with the fan noise and these changes were statistically significant (P <0.05).

The finding of this study showed that the decrease in air temperature compared with the increase of noise led to a more increasing in subjects' physiological responses. Moreover, temperature affected the score of noise annoyance and thermal perceptions were influenced by noise. Also, exposure to irrelevant speech in offices is very effective for employees' comfort.