مجله طب نظامی
سال بیست و پنجم شماره 4 (پیاپی 122، مهر و آبان 1402)

Letter to Editor

Soldiers and veterans with higher psychological vulnerability may be more affected by military and war conditions and show suicidal thoughts and self-harm than others. In this regard, the present study investigated the relationship between mental health and thoughts and behaviors related to suicide among military personnel.

This research was applied in terms of purpose and systematic review in terms of data collection. In the current research, by using specialized keywords search, suicidal thoughts, suicidal behavior, soldier, veteran, post-traumatic stress, mental health, depression, anxiety, stress, self-harm, violence, military, and war in the base. English databases such as Google Scholar, PubMed, ISI, Scopus, and ScienceDirect and also the scientific database of academic jihad (SID), the country's journals database (Magiran), and the database of Iranian medical science articles were searched. After searching for keywords, the statistical population of this study was 764 Persian and English articles published in 2011 (from February) to 2022 (until July). After removing the articles not related to the research objectives, 51 articles were included and fully reviewed according to the PRISMA model.

Investigations have shown the existence of widespread psychological disorders such as post-traumatic stress, depression, anxiety, trauma, fear, stress, social stigma, low sleep quality, lack of social support, moral injury, low resilience, personality disorders, impulsivity, smoking, and alcohol addiction among military personnel had thoughts and behaviors related to suicide. Also, young age, male gender, low education, being single, poor economic status, family history, length of service, and military rank were among the demographic factors influencing the increasing thoughts and behaviors related to suicide among military personnel. According to the studies, having cognitive flexibility, resilience, social support, and spiritual and mental health can significantly reduce the number of thoughts and behaviors related to suicide in military personnel.

Considering that military personnel face various stressful and anxiety-provoking events during their lives, it is necessary to have good mental health. In this context, psychology and counseling centers of military barracks should regularly examine and screen thoughts and behaviors related to suicide to provide appropriate psychological interventions if necessary.

Normal tissue injury is one of the biggest concerns for cancer therapy as also exposure to radiation accidents. Damage to radiosensitive organs such as bone marrow and gastrointestinal system, lung, liver, and kidney is the most important reason for mortality or reduced quality of life caused by long-term side effects of exposure to ionizing radiation. The use of antioxidant compounds and radioprotectors is one of the best options for reducing radiation effects. This study is a narrative review that overviews the capability of antioxidants and natural plant compounds for ameliorating radiation-induced damage. Using natural antioxidants and radioprotectors is one of the best choices for the amelioration of radiation side effects. Although to date, some chemical agents have been studied for this aim, natural antioxidants with low toxicity are more interested in mitigation of radiation accidents after radiological and nuclear accidents. In the current review, natural antioxidants and herbal agents for the amelioration of damages caused by exposure to radiation will be discussed. The need for further research in this area is a significant gap that can be attributed to further applied studies in the future. It seems that natural radiomitigators can play an effective role in treating side effects and reducing mortality after radiation disasters. The need for further research in this area is a significant gap that can be attributed to further applied studies.

Expanding resilience and educating stress adapting abilities in police forces, particularly amid the understudy period, can act as a mental wellbeing protection calculate not as it were amid the understudy period but moreover amid the service period. Subsequently, the reason of this research was to create a multidimensional resilience protocol with a preventive approach and its effectiveness on stress, mental well-being and resilience of officer understudies.

The research in the first stage is descriptive and was conducted using the Delphi method. In the first step of the protocol validity, the content validity index (CVI) of the sessions was used quantitatively based on the experts' opinions. CVI was calculated by evaluating the opinions of 10 experts (one religious expert) in 4 phases for each step. The second step was a quasi-experimental research with a control group, and the investigated population included all the students of one of the officer and police training universities in Tehran in 1401. The resilience training protocol was actualized in the experimental group (15 individuals) in 12 sessions of 90 minutes and at the end of the study in the control group (15 individuals). The research instruments were Connor's resilience questionnaire, Riff's mental well-being, and depression, anxiety, and stress scale (DASS-21). A resilience checklist was also used for screening (cut point 110). Data were analyzed using SPSS v24 software.

The results of the content validity analysis showed that considering that the CVI value of each of the items or steps related to resilience training was not less than 0.70, the training contents are suitable for the title of each training step. Also, the results of multivariate covariance analysis showed that the resilience training protocol significantly increased (P<0.05) psychological well-being (P=0.001 and F=47.8) and resilience (P=0.003 and F=10.7), and significantly reduced stress (P=0.002 and F=11.6) in the tested group.

The multidimensional resilience training protocol, which was developed with a preventive approach, had good content validity, and it is effective in improving psychological well-being and resilience and reducing the stress of officer students, and its' booklet can be used in military medical and educational centers.

Health, according to the World Health Organization, encompasses complete physical, mental, and social well-being, not just the absence of disease and illness. This study aims to monitor and evaluate the scientific publications of military research centers in the health field and their researchers over the past 5 years (2016-2020). Military researchers were first identified using an advanced search strategy for various dimensions of health in the Science Direct database. Then, the complete output of their research articles were extracted from the Scopus database. Pearson's correlation coefficient and the Mann-Kendall trend test were used to analyze the data. R software version 4.2.2 was used for data analysis and VOSviewer software version 1.6.18 was utilized for the visualization of scientometrics approaches. Overall, 3771 and 79069 research articles were identified from military research centers of Iran and the world, respectively, in the field of health during a period of 5 years (2016-2020). Military research centers of China and the United States were the leading countries in terms of scientific publications in the field of health. Iran, the United States, England, and Pakistan experienced significant research growth among the top countries during the period of 2016-2020 (P=0.027). Additionally, the United States recorded near-significant growth in international collaboration (P=0.086) and Iran showed near-significant growth in review researches (P=0.086) during these years. Furthermore, a significant correlation was observed between the total number of articles and the ratio of review articles in Iran over time (P=0.017). The military research centers of Iran and the world and their top researchers shared the priorities of the research topics of 'Medicine and Dentistry' and 'Biochemistry, Genetics, and Molecular Biology'. A shift in research focus towards the keyword 'Covid-19' was observed in Iran and the world in 2020. The main findings of the present study focused on the evaluation and visualization of the scientific publication of military research centers in Iran and worldwide, as well as the associated researchers. There is a need to review science and technology policies in order to strengthen weaknesses and sustain strengths.

Most of the complications after heart surgery are related to immobility. Early mobilization helps prevent these problems from occurring. Despite the awareness of the importance of early mobilization, its implementation rate is still low due to the presence of many obstacles. Appreciative inquiry has been introduced as a key strategy for creating change. This study aimed to investigate the effect of the implementation of an appreciative inquiry strategy on the quality of early mobilization.

This clinical trial research was conducted in Tehran Jamaran Hospital on 98 patients undergoing open heart surgery in 1401. The sampling method was purpose-based based on the inclusion criteria. The quality of early mobilization of the patients was evaluated using a researcher-made checklist, which was validated. The intervention in the test group was carried out in the form of focused group discussions of four people regarding the strategy of appreciative inquiry for the implementation of Early mobilization of patients. The leaders of the open-heart intensive care unit, including the head of the department, his deputy, and the heads of the shifts participated in the discussions. The results were analyzed by statistical software SPSS version 22 using independent t, Mann-Whitney, and chi-square tests and analysis of variance.

The findings showed that the patients of the two test and control groups had no significant differences in terms of demographic characteristics, surgery characteristics, history of smoking and drug use, and underlying diseases. The results of checking the checklist scores using chi-square test showed that with the implementation of the Appreciative inquiry strategy among department leaders, the average score of the checklist for the quality of the implementation of the Early mobilization process went from 8/4 (±1/4) in the control group to 11/6 (±1/4) in the test group (P<0.001).

This study showed that the implementation of the appreciative inquiry strategy is effective in changing the approach of nurses regarding early mobilization and consequently creating a positive change for the implementation of this process. Considering the need to change the approach in different areas of nursing, including early mobilization, it is recommended This strategy can be used in nursing with the aim of creating positive changes.

Working at different levels of the military may cause a person not to follow moral standards properly, so it is necessary to use efficient tools to detect the signs of moral injury. In this regard, the present study was conducted to investigate the psychometric properties of the Persian version of the scale of moral injury symptoms in a military unit. This study was a descriptive evaluation consisting of 402 soldiers of a military unit in Tehran in 2022-2023, who were selected by the available sampling method. Soldiers completed a demographic checklist, moral injury symptom scale (MISS), post-traumatic stress disorder scale (PTSD), and mental health scale (MHC-SF). The psychometric properties of the moral injury symptoms scale were analyzed by confirmatory factor analysis test and Cronbach's alpha coefficient in SPSS version 24 and R software version 4.1 at a significance level of 0.05. The content validity of the questionnaire items was found to be satisfactory in terms of quality. The factor analysis results indicated the existence of a ten-factor structure for the scale of moral injury symptoms. The RMSEA of the model was equal to 0.04 and the SRMR index was equal to 0.07, indicating the model's appropriateness. The calculated values of other indices (GFI, CFI, NFI, NNFI, and IFI) were 0.96, 0.98, 0.95, 0.98, and 0.97 respectively, which indicates the acceptability of the model. Cronbach's alpha coefficient was also 0.96. The findings indicate the construct validity and acceptable validity of the moral injury symptoms scale in the military and the structure of this scale can be used to screen the moral injury symptoms in the military and soldiers.

Health and safety are the greatest blessings. In biological crises, the armed forces are the protectors of people's health. Military personnel defend the country, protect security, independence, and territorial integrity. Complex military missions, the possibility of injury and disability, fear of failure, captivity, and death are the causes of psychosomatic diseases in the military, which affect the family and society. Commanders act as social role models. The spiritual leadership of Mentor commanders is a guarantee of spiritual preparation in combat and effectively reduces the stress of soldiers. This study was conducted with the aim of explaining the role of military commanders as mentor in the spiritual health of society. In a mixed-method research, based on the Creswell et al., model (2003) with a discovery-explanatory approach, qualitative data from non-systematic review and contractual content analysis of different types of spirituality, religious spirituality, spiritual leadership, spiritual mentoring, the theory of personality, spiritual pathology theory of Sound Heart Model with quantitative data from the clinical applications of the model were integrated. The validity of meta-inferences of research was measured in the quantitative data section through internal-external validity and in the qualitative data section with "reliability" or "capability index". Spiritual health means having a sound heart. It is the result of a healthy spiritual personality. Commanders with "healthy spiritual character" behave with wisdom, chastity, courage, generosity, altruism, and kindness. They can cause spiritual training and spiritual preparation of military forces and their families through scaffolding in model-oriented training. Mentor military commanders improve the spiritual health of soldiers and families by creating a secure attachment to God and a positive image of God. Attachment to the Prophet in the position of an interpreter of the holy text of the Quran and a healthy spiritual model and following the Prophet's lifestyle lead to a correct understanding of religion, creating a positive image of God and secure attachment to God (belief in God's presence and sufficiency). Secure attachment to God reduces job stress and pressures of life events. The spiritual leadership of mentor commanders and their "lifestyle" has an effect on improving the spiritual health of society by changing people's attitudes towards life events. Considering the effect of model-oriented education on the formation of a healthy spiritual personality and spiritual training, it is recommended that commanders improve the spirituality of military forces and their families by strengthening the positive image of God and secure attachment to God and try to improve the spiritual health of civilians by changing their attitude towards life events.