https://militarymedj.bmsu.ac.ir/ Journal of Military Medicine en daily 1 Wed, 16 Sep 2026 00:00:00 +0330 Wed, 16 Sep 2026 00:00:00 +0330 https://militarymedj.bmsu.ac.ir/article_1001399.html Conflict occurrence is an inherent component of intensive care unit operations. This environment involves high uncertainty along with severe therapeutic risks while relying on a distributed decision-making system. The fact that persistent conflict stems from structural roots rather than mere resource deficiency is frequently overlooked. Evidence indicates the persistence of this phenomenon even in adequately resourced departments. The CONFLICUS study evaluated 323 units across 24 countries and found that 71.6% of the staff reported at least one conflict during the week preceding the assessment. Current understanding of this phenomenon suffers from conceptual fragmentation. Variables such as moral distress and psychological safety alongside ethical climate assessments have measured isolated dimensions of a singular reality under disparate labels. This trend has generated a disconnected perception of the underlying nature of the issue.Overcoming this conceptual fragmentation requires redefining conflict through task-related, procedural, as well as relational dimensions . Task conflict focuses on the substance of clinical decision-making regarding prognosis and treatment proportionality. Process conflict relates to identifying the decision-makers alongside the mechanisms of reaching a conclusion. Relational conflict emerges following the impairment of mutual trust or respect. The central argument posits that conflict escalates from task and procedural dimensions into the relational sphere. At this stage, conflict transforms into a resistant and destructive phenomenon because the involved parties interpret subsequent interactions exclusively through a lens of distrust. Threats to professional identity along with damage to moral integrity represent the most severe manifestation of this conflict, which escalates rapidly and leads to the accumulation of negative ethical consequences. https://militarymedj.bmsu.ac.ir/article_1001400.html Modern warfare has fundamentally altered the epidemiology and characteristics of combat-related injuries, with blast-induced traumatic brain injury (bTBI) emerging as the hallmark neurological injury of contemporary conflicts. Unlike conventional traumatic brain injury, blast exposure produces complex biomechanical forces that induce diffuse microstructural damage, blood–brain barrier disruption, neurovascular dysfunction, and persistent neuroinflammatory responses, often in the absence of abnormalities on conventional neuroimaging. This narrative review summarizes current evidence regarding the pathophysiological mechanisms, clinical manifestations, neuroimaging findings, and long-term neurological consequences of blast-related neurotrauma. Current evidence indicates that blast-related mild traumatic brain injury (mTBI) is associated with diffuse axonal injury, chronic activation of microglia, oxidative stress, mitochondrial dysfunction, and persistent alterations in white matter integrity detectable by advanced imaging techniques such as diffusion tensor imaging. These biological processes contribute to prolonged cognitive impairment, post-traumatic headache, sleep disturbance, chronic pain, epilepsy, and an increased risk of later neurodegenerative and cerebrovascular disorders. Although post-traumatic stress disorder (PTSD) frequently coexists with blast-related mTBI and complicates clinical assessment, increasing evidence suggests that both conditions share overlapping but distinct neurobiological mechanisms. Other war-related neurological disorders, including Gulf War Illness and stress-associated neurological conditions, are discussed as complementary components within the broader spectrum of military neurotrauma. Overall, modern war-related neurotrauma represents a complex multisystem neurological disorder rather than an isolated mechanical brain injury. Early recognition, multimodal assessment, advanced neuroimaging, and long-term multidisciplinary rehabilitation are essential to improve neurological recovery and functional outcomes in affected military personnel and civilians. https://militarymedj.bmsu.ac.ir/article_1001401.html Chemical, biological, radiological, and nuclear (CBRN) agents represent a distinct category of threats that have the potential to cause mass casualties, social disruption, and profound public health crises. The unique and diverse nature of these agents requires a specialized and multidisciplinary approach to medical defense. Within this framework, pharmaceutical sciences play a pivotal role, going beyond treatment to address the entire cycle of countering CBRN threats. This includes the rational design of medical countermeasures, understanding the mechanisms involved in the pathophysiology of injury or infection, and developing effective approaches for decontamination, prevention, and treatment after exposure. This article provides a comprehensive analysis of CBRN agents from a pharmaceutical sciences perspective. Each threat category is first introduced separately, and important representative agents within each category are outlined. The main body of this article is devoted to the pharmacological approaches used to combat these threats, including a detailed review of common medical countermeasures such as antidotes and chelating agents, as well as more advanced tools such as monoclonal antibodies. In addition, important challenges that could limit the effectiveness of pharmacological approaches. https://militarymedj.bmsu.ac.ir/article_1001402.html Since the beginning of the 21st century, the world has experienced numerous outbreaks of emerging and reemerging viral infections. In addition to threatening public health, these outbreaks have had profound economic, social, military, and security consequences and have challenged countries' stability and national security. This narrative review article aims to examine the threats posed by emerging and reemerging viruses to the main pillars of national security. By reviewing relevant documents and sources, this study first assesses the characteristics that transform emerging and reemerging viruses into security crises. Then, using case studies from recent viral epidemics, it infers and explains the impact of these threats on the four key pillars of national security (military, economic, social, and political). Studies show that characteristics such as high transmission rates, significant mortality, unpreparedness of health systems, and widespread fear have the potential to transform a viral epidemic into a security crisis. Case studies illustrate the devastating effects of these crises on reducing military preparedness, creating economic stagnation, widening social divisions, and undermining the rule of law. The difficulty of distinguishing between a natural outbreak and a bioterrorist attack also highlights the need to strengthen oversight and response mechanisms. In today's interconnected world, health security and national security are inextricably linked. Key actions suggested include adopting a "One Health" approach, investing in new detection and monitoring technologies, improving governance for effective and transparent responses, and strengthening international cooperation. Ignoring this connection and lacking comprehensive planning could lead to more serious security crises in the future. https://militarymedj.bmsu.ac.ir/article_1001403.html Background and Aim: Pediatric triage in the prehospital emergency setting requires a high level of cognitive and operational competence from emergency medical technicians (EMTs) because of the unique physiological and psychological characteristics of children. The use of innovative educational tools may enhance EMTs' preparedness and competence in disaster situations. This study aimed to design and evaluate a JumpSTART-based educational application for pediatric disaster triage and to assess its effect on the knowledge of prehospital emergency technicians.Methods: This quasi-experimental, one-group pretest–posttest study was conducted in 2025 among 19 prehospital emergency technicians in Meybod, Iran, using a census sampling method. Data were collected using a researcher-developed questionnaire assessing knowledge of pediatric triage. Face and content validity were confirmed by a panel of emergency medicine specialists and experienced emergency medical technicians, and the questionnaire demonstrated good internal consistency (Cronbach's α = 0.89). Following the pretest, participants received a 100-minute training session using the JumpSTART educational application, which incorporated interactive content and simulation-based learning. A posttest was administered one week after the intervention. Data were analyzed using descriptive statistics, paired t-test, Spearman's correlation, and one-way ANOVA in SPSS version 25.Results: The mean pediatric triage knowledge score increased from 42.68 before the intervention to 89.21 (out of 100) after the intervention. The improvement in knowledge following use of the educational application was statistically significant (P < 0.001). No significant associations were found between knowledge gain and demographic variables, including age group, years of work experience, or educational level (P > 0.05).Conclusion: The findings indicate that the JumpSTART-based educational application significantly improved participants' theoretical knowledge of pediatric triage. However, given the one-group study design and the small sample size, these findings should be interpreted as evidence of improved knowledge rather than enhanced clinical performance or real-world decision-making. Further randomized controlled studies with larger sample sizes and appropriate control groups are needed to determine the effectiveness of this educational tool in improving clinical performance during pediatric disaster triage. https://militarymedj.bmsu.ac.ir/article_1001404.html Background and Aim: Moral sensitivity and safe care are vital components of nurses’ professional practice. Moral sensitivity is the ability to recognize ethical situations and make appropriate decisions, while safe care focuses on maintaining patient health and reducing medical errors. Enhanced clinical reasoning skills and moral sensitivity play an important role in clinical decision-making, ultimately improving care quality and safety. Therefore, this study aimed to determine the relationship between moral sensitivity and safe care among nurses working in a psychiatric hospital.Methods: This cross-sectional-correlational study investigated 150 psychiatric nurses at Shahid Beheshti Hospital in Kerman in 2024. Participants were selected using a census method based on predefined inclusion criteria. Data were collected using a demographic characteristics questionnaire, the Modified Moral Sensitivity Questionnaire (MMSQ), and Surveys on Patient Safety. The data were then analyzed using SPSS software.Results: The mean moral sensitivity score was at a moderate level (60.36 ± 19.58), while the mean safe care score was favorable (284.89 ± 48.36). A significant direct correlation was found between safe care and moral sensitivity (r=0.64, P<0.001). Furthermore, safe care demonstrated a significant direct relationship with all dimensions of moral sensitivity, except for professional knowledge.Conclusion: The study results can help nurse managers and policymakers to effectively manage human resource and to improve moral sensitivity and safe care among Iranian nurses. https://militarymedj.bmsu.ac.ir/article_1001405.html Background and Aim: Enhancing functional capacity is one of the essential requirements for military personnel. Alongside this, monitoring physical health and inflammatory biomarkers plays a crucial role in sustaining military service. This study aimed to investigate the effects of eight weeks of high-intensity functional training (HIFT) and high-intensity multicomponent training (HIMT) on inflammatory indices in cadets at Imam Ali Military University.Methods: In this quasi-experimental study, 42 male cadets aged 20–24 years voluntarily participated and were randomly assigned to three equal groups: HIFT, HIMT, and control (n=14 each). The intervention groups completed their respective training protocols for eight weeks. Blood samples were collected at baseline and 48 hours after the last training session in a fasting state. Data normality was assessed using the Shapiro-Wilk test, and statistical analysis was performed using one-way ANOVA followed by Tukey's post hoc test.Results: No significant changes were observed in NLR across the groups (P>0.05). In the PLR index, Tukey’s post hoc analysis revealed significant differences between the HIFT and control groups (P=0.025) and between HIFT and HIMT (P=0.004), whereas no difference was found between HIMT and control (P=0.762). For the SII index, a significant difference was found among the groups in the post-test (P=0.001). Pairwise comparisons indicated significant differences between HIFT and HIMT (P=0.002) as well as between HIMT and control (P=0.001), but not between HIFT and control (P=0.432).Conclusion: The findings suggest that both HIFT and HIMT can modulate inflammatory immune responses and contribute to improved immune function in military cadets. These results highlight the importance of incorporating modern high-intensity training modalities into military fitness programs. https://militarymedj.bmsu.ac.ir/article_1001406.html Background and Aim: Obesity and psychological distress are major threats to the physical fitness and operational performance of military personnel, particularly in naval forces with prolonged missions and sedentary conditions. This study aimed to investigate the prevalence of general and abdominal obesity and its association with levels of depression, anxiety, and stress among personnel of naval floating units in the northern and southern regions of Iran.Methods: This cross-sectional descriptive-analytical study was conducted on 190 military personnel (101 from the northern unit, 89 from the southern unit). Demographic data, Body Mass Index (BMI), waist circumference (with a cutoff point of ≥99.5 cm for abdominal obesity), and psychological distress (using the validated DASS-42 questionnaire) were collected. Cronbach's alpha coefficients for the depression, anxiety, and stress subscales were 0.89, 0.86, and 0.88, respectively. Data were analyzed using SPSS version 26, employing chi-square tests, mean comparison tests, and logistic regression.Results: The mean BMI was 26.68 (±3.46), falling within the overweight range. Overall, 46.8% of participants were overweight, 18.5% were obese, and 34.7% had normal weight. Additionally, 57.4% of participants had abdominal obesity. The mean scores for depression, anxiety, and stress were 11.33, 6.88, and 12.69, respectively; 48.4% were in the abnormal depression range, 33.7% in the abnormal anxiety range, and 36.3% in the abnormal stress range. In the logistic regression model, depression was associated with increased odds of abdominal obesity (OR = 1.07, 95% CI: 1.01–1.13, P = 0.021), while stress showed a reducing effect (OR = 0.92, 95% CI: 0.86–0.98, P = 0.010), and anxiety was not statistically significant. BMI was significantly higher in the northern unit compared to the southern unit (27.21 vs. 26.08, P = 0.024), but depression and stress scores were significantly higher in the southern unit (P < 0.05). Moreover, abdominal obesity was more prevalent among higher ranks (48.6% vs. 11%, P = 0.001).Conclusion: This study, as the first comprehensive simultaneous assessment of physical and mental health among Iranian naval personnel, demonstrated that the prevalence of general and abdominal obesity in this population is high and accompanied by significant psychological distress. Depression, as an independent risk factor, was associated with an increased likelihood of abdominal obesity. Regional and rank differences also underscore the necessity of developing integrated physical-psychological screening protocols and implementing targeted interventions, particularly in high-stress southern units and among higher-ranking officers, to maintain operational readiness and enhance personnel well-being.