مجله طب نظامی
سال بیست و سوم شماره 1 (پیاپی 98، فروردین 1400)

Identifying strategic issues enables the organization to select appropriate strategies and guide the organization in line with its objectives by identifying specific competencies, discovering competitive opportunities, determining weaknesses, reducing barriers and threats. In this regard, prioritizing strategies is important due to financial and time constraints. Therefore, the present study aimed to Identify and prioritizes the strategies of a trauma hospital by Analytical Hierarchy Process.

This descriptive study was carried out at trauma hospital in Yazd in 2018 with the aim of identifying the internal (weakness and strength) and external (opportunities and threats) factors and prioritizing each factor by AHP. The research population consisted of all senior and middle managers of the hospital who were selected purposefully. Information gathering was done by interviews and focused group discussion as well as the researcher-made questionnaire. The data were analyzed by AHP method and Expert Choice 11 software.

In the phase of identifying, 101 weaknesses, 23 strengths, 35 opportunities and 14 threats were identified. The highest priority in each area was related to the experienced and committed staff (0.289), weak monitoring system to monitor physicians (0.235), hospital geographical location factors in terms of centrality in the city (0.283) and negative attitudes of people regarding high death rates (0.310), respectively.

According to the results, it is recommended to use the capacities of the University of Medical Sciences to monitor medicines and to set up smart systems in order to increase the supervision of medical staff. Hold joint committees with military organizations to take advantage of the mediachr('39')s capacity to change peoplechr('39')s views and facilitate traffic on the streets around the hospital is necessary.

Due to the increasing number of Armed Forces Retirement and an increase in the number of cases of sleep disorder by age, sleep disorder is a common problem in the Armed Forces Retirement. For Armed Forces Retirement, the disease and its treatment can have long-term negative effects on their Relaxation Deepening and sleep Quality. The purpose of this study was to evaluate the effect of Rhythmic Neural, Musculoskeletal Exercises on the Relaxation Deepening and sleep Quality in the Armed Forces Retirement.

The present study had a semi-experimental design and used pre-tests and post-tests. A total of 60 Armed Forces Retirement (60-70 years), were randomly assigned into two groups of 30 (experimental group: 30 men; control group: 30 men). During 12 sessions, Patients were treated 3 times weekly with Rhythmic Neural, Musculoskeletal Exercises. Heart rate, blood pressure, hands grip strength, flexibility, Berg balance scale, quality of sleep were measured before and after the exercise program.

The results of covariance test showed that some of physiological factors such as heart rate, blood pressure, balance scales and flexibility and the quality of sleep subscales Improved after Practice sessions in Armed Forces Retirement. But Hands grip strength were not significantly improved in experimental compared with control group (P-value <0.05).

The findings indicated that application of rhythmic neural, musculoskeletal exercises can improve some of physiological factors and quality of sleep in the Armed Forces Retirement.

Knee osteoarthritis is a common degenerative disease that disables affected people. The purpose of this study was to evaluate the clinical outcome of local quadriceps vibration in military personnel with moderate knee osteoarthritis.

In this randomized clinical trial, 76 military personnel with moderate knee osteoarthritis were studied through simple random sampling in two intervention groups (routine physiotherapy group with local quadriceps vibration) and control group (routine physiotherapy). The tools used were: demographic and clinical information questionnaire, standard WOMAC and SF36 questionnaires, and goniometer. The variables studied were: pain severity, severity of knee disability, knee flexion range of motion, and patient quality of life score. These variables were measured before and after the intervention in both groups. The results were analyzed by K-S Test, Paired T-Test, and T-Test.

 Baseline demographic results such as gender (P = 0.112), age (P = 0.290), and BMI (P = 0.870) showed no statistically significant difference between the two groups (the two groups were similar). The mean of pain severity (P = 0.001), knee disability severity (P = 0.003), knee flexion range of motion (P = 0.011), and quality of life (P = 0.017) scores before and after intervention in both groups showed a significant difference (recovery process). The change percentage in variables was higher and significant in the intervention group than the control group (P = 0.004).

Routine physiotherapy plus local quadriceps vibration (compared to routine physiotherapy) can reduce pain severity, reduce knee disability, improve knee flexion range, and improve quality of life in people with moderate knee osteoarthritis.

Today, in universities and research institutes, the lack of attention to commercialization makes it impossible or difficult to enter the markets for technology and research products. therefore, this study aims to design a commercialization model for research achievements of a military research institute.

This descriptive-analytic study was done in a cross-sectional study in 2019. The research population consists of senior, middle and operational managers, faculty, experts and researchers in a military research institute. The sampling was done by census method and number of 130 people. The data gathering tool is a researcher-made questionnaire whose validity and reliability have been confirmed. The composite reliability for each of the four domains (individual, intra-organizational, external organizational and communication) was higher than 0.7, indicating appropriate homogeneity or internal consistency. To collect and analyze quantitative data, a structural equation model based on partial least squares approach was performed with Smart-PLS3 software.

The pattern of factors influencing the commercialization of academic research achievements was divided into four groups of 60 factors: individual intra-organizational, external organizational and communication. According to the research findings in the final model of the research, the correlation was significant for all dimensions and the communication factors had the lowest correlation (0.880) and intra-organizational (0.971) the highest correlation. To ensure the quality of the measurement model, positive values of the cv-com index represent the appropriate quality of the measurement model.

Governments and other effective institutions with formulas and facilitating and accelerating policies should move universities towards a model of knowledge-based commercialization by adopting smart measures. On the other hand, universities are pursuing strategies such as holding joint conferences and meetings with industry to increase the relevance and awareness of the partieschr('39') needs and capabilities in the path of commercialization.

Work-related musculoskeletal disorders (WRMSDS) are a multifactorial phenomenon and are the most common type of occupational injuries and the main cause of disability in the workplace. The purpose of this study was to Investigating the relationship between mental workload, occupational stress and demographic factors with the prevalence of musculoskeletal disorders and its disabilities in flight security employees.

This cross-sectional study was carried out in 2019 among 316 employees of Iran flight security. Demographic data were collected by a demographic questionnaire. To study the prevalence of musculoskeletal disorders, occupational stress, mental workload and disability, the Cornell Questionnaire, Job Content Questionnaire (JCQ), NASA TLX and Pain Disability Questionnaires (PDQ) were used, respectively. Data were analyzed using independent sample t-test, chi-square and multiple logistic regression in SPSS software version 25.

Results showed that 31.65% of the personnel had no musculoskeletal disorders and 68.35% had musculoskeletal disorders in at least one of their organs. There was a significant correlation between the parameters of increased age, higher work experience, high body mass index, gender and educational level and prevalence of musculoskeletal disorders. Moreover, some components related to occupational stress and mental workload had significant association with mentioned disorders (P-value <0.05).

The results of the present study revealed that the prevalence of musculoskeletal disorders and their disabilities were high in the flight security team and parameters of occupational stress and mental workload are among the most important risk factors for the prevalence of the musculoskeletal disorders and related disabilities. Therefore, corrective measures through controlling individual and psychosocial risk factors are necessary to reduce the prevalence of these disorders.

Proper nutrition is one of the most important pillars of health that plays an important role in the physical and mental fitness of military forces. Nutritional deficiencies endanger the performance, efficiency and health of staff and can lead to malnutrition and weight loss. Therefore, studying the status of dietary intake and the level of staff satisfaction from nutritional status will be effective in improving the quality of nutritional services. The aim of this study was to evaluate the dietary menu and staff satisfaction with it in selected military areas of the country in comparison to military dietary reference intake.

In this descriptive cross-sectional study, 684 military personnel from different military districts of the country were studied in 2013. Quality and quantity of served food, satisfaction from menu and sanitary status of the dining room were evaluated using a researcher-made questionnaire. Also, normal and operational menus were compared with target and standard values in order to check the menus and dietary intake of staff.

After evaluating the diet using Nutritionist IV software, it was found that the dietary intake of carbohydrate and protein and some micronutrients exceed the standard of military intake but in the case of most of micronutrients, vitamin A, D, B5, biotin, folic acid, B12, and zinc were found to be deficient in all seasons. In the case of the operational ration there was a lack of calcium, potassium and phosphorus intake in addition to the lack of some vitamins. The assessment of quality and quantity of served food, satisfaction from menu and sanitary status of the dining room showed that the lowest satisfaction is related to the operational category and the highest amount is related to the headquarters. Also, a comparison of satisfaction using the one-way ANOVA test showed that the highest satisfaction rate from the menu was in provincial employees and the lowest was in operational staff (P <0.05).

The present study showed that the highest level of employee’s nutritional status satisfaction was observed in the headquarters and the lowest level was observed in the operational category. Therefore, the use of supplements or the inclusion of some food groups in the diet that meet the needs of the body and attention to the satisfaction of forces (which is an effective factor in the dietary intake and nutrition status) is important.

Intensive resistance trainings cause the production of many free radicals and pre-inflammatory cytokines in athletes and military personnel. These factors may cause many complications for the athlete. In recent years, the use of anti-inflammatory compounds made of herbal extracts has been considered to reduce these inflammatory factors. The purpose of this study was to evaluate the effect of green tea extract on inflammatory cytokines caused by endurance trainings in athletes.

This study was conducted on 36 male athlete. Their individual characteristics including height, weight, body mass index were measured. Subjects (N=36) were randomly divided into three groups. The first group did their exercises without any supplement or medication. The green tea extract and the placebo were used along with the TRX training in group two and three respectively. Serum levels of IL-6 and TNF-α inflammatory factors were evaluated by ELISA method in all groups.

Serum levels of TNF-α and IL-6 in the group with green tea extract supplement along with the training was reduced in comparison with the placebo and training group. This decrease was not statistically significant in terms of TNF-α, but it was significant for IL-6 factor.

The results of the present study indicate that the use of green tea extract along with intense resistance training in athletes can reduce the production of some cytokines and thus reduce inflammatory injuries among them.

The medical equipment supply chain management is one of the main challenges for hospitals and medical centers. Meanwhile, military hospitals need more serious attention because of their critical position. The purpose of this study is to identify and prioritize the factors affecting the management of medical equipment supply chain in a military hospital in Tehran and finally evaluating the performance of the hospital in this regard.

At first, by examining previous researches and interviewing with some of staff and hospital managers, the influential factors in the management of the medical equipment supply chain were identified. in this regard, The MAXQDA 2020 software was used for this purpose. Then, effective methods were weighed using Fuzzy Analytic Hierarchy Process (AHP). Finally, the current performance of the hospital was assessed using a questionnaire.

Based on the findings, the factors affecting the supply chain of medical equipment supply were divided into 5 general categories. These 5 categories which found their weights obtained from fuzzy AHP, respectively: Resources and stakeholders, internal operations management, sustainability, integrity and information management. Also, the results of the performance evaluation showed that the current condition of the hospital is 43%, which is actually less than the acceptable level.

The importance of medical equipment supply chain management is not only due to its important role in the quality of treatment but also because of its major contribution to the hospitalchr('39')s operating budget. It should be noted that the factors affecting this issue are directly and indirectly related to each other. Finally, identifying weaknesses and proper planning to improve them can amend the condition of the hospital and ultimately enhance patient satisfaction.

Achieving public health coverage is a prerequisite for the sustainable development of countries, and this is highly dependent on patient financing in the form of health insurance. Therefore, improving the efficiency of health insurance through the consolidation of insurance funds is very important. The aim of this study was to structuring the barriers to the integration of health insurance in Iran using the Dematel approach.

The Mixed study was done in three stages qualitative, Delphi technique and systematic analysis of barriers to health insurance integration in Iran on experts and specialists in health insurance (12 samples in the interview and 68 samples in the quantitative phase). The data collection tool in the "Qualitative Stage" was the interview guide, in the "Delphi Stage" was a questionnaire in the Likert, and in the "Systematic Analysis Stage" was a pairwise comparison questionnaire. Qualitative phase analysis was performed by conceptual framework method, Delphi stage using SPSS software and simple sample type test and weighting of factors using FUZZY DEMATEL technique and MATLAB software.

Out of 36 identified barriers to health insurance integration in Iran, 28 barriers have been accepted in the Delphi phase. Among the factors accepted in the Delphi phase, the highest average was related to "political behavior and resistance to accepting the integration of insurance" and the lowest average was related to "family physician and referral system". The results of systematic relation analysis showed that "obstructing the structure of the health system" with coordinates (1.30 and 1.30) as the most effective barrier and "preventing cultural-economic infrastructure" with coordinates (1.11 and -1.11) were identified as the most effected barrier.

According to the results regarding the impact of financing and structural barriers, it is suggested that while performing accurate statistical and financial data calculations, the share of each insured group to accumulate funds be determined. Health and insurance policymakers need to anticipate sustainable financing. Also, to lay the foundation for the basic infrastructure of this system, in accordance with the conditions of the Ministry of Health and Social Insurance.

Thrombotic thrombocytopenic purpura is a rare and life-threatening disease with a relatively high prevalence of 5% in pregnancy that causes thrombocytopenia. Due to the high prevalence and mortality of fetal and maternal mortality, which resolves rapidly with the onset of plasmapheresis, the diagnosis of this disease is clinically important. The aim of this study was to successfully manage thrombotic thrombocytopenic purpura syndrome (TTP) with plasmapheresis in pregnant women.

Case Report: 

The patient was a 29-year-old woman who was admitted at 21 weeks’ gestation and second pregnancy with fever, muscle aches, increased liver enzymes, headache, decreased consciousness and hallucinations. Due to the low pH and high lactic acid dehydrogenase and neurological symptoms and fever, TTP was diagnosed for the patient and started with 15 units of freshly frozen plasma daily plasma milling until normalization of lactic acid dehydrogenase and platelets. He was discharged in good general condition.

TTP should be considered in the differential diagnosis of missed pregnancies in the second trimester of pregnancy and pregnancies with thrombotic microangiopathy and reduced ADAMTS13 activity should be considered. Although TTP is a deadly disease without treatment, most patients recover with plasmapheresis, so it is recommended to start plasmapheresis as soon as there is clinical doubt based on the patientchr('39')s tests and symptoms.