国际救援中消毒供应科应急救援储备模块的应用研究

目的 探讨国际救援中消毒供应科应急救援储备模块的应用.方法 根据平时应急卫勤演练及实战任务要求,采用建立医院内消毒供应科应急救援日基数储备数据明细表法,根据实战实际,计算消毒供应携行最大的物资需求.结果 通过建立消毒供应应急救援日基数储备数据,为救援人员物资准备提供了详细的物资目录及携行量,结合战备拉动模拟任务,有效达到在既定时间内快速、准确地完成出库、集装、送达的技术流程,保证了应急救援储备物资效期内质量安全及应急调配.结论 建立消毒供应应急救援储备模块技术,有效提升了消毒供应应急能力,达到应急救援预期效果.     

医疗救援卫生耗材的保障策略

目的:加强医疗救援卫生耗材的应急保障。方法:分析日常医疗耗材的供应基础和要求,明确应急医疗耗材供应的管理要素。结果:应急医疗耗材的供应保障需要更多的经验积累和科学统筹的管理。结论:应该充分重视应急医疗救援的耗材供应,克服管理混乱的弊端,才能保障应急救援工作更快捷、更顺利、更精细。     

自然灾害现场饮用水处理技术的系统评价

系统评价全球近20年来有关灾后饮用水处理方法及效果的文献,为灾后卫生救援中开展饮用水处理和供应提供当前最佳证据.通过文献检索与评价,共纳入22篇文献.本研究主要结论:目前在发达国家和国际灾难救援中,针对应急状态的水处理和供应问题逐渐形成较为规范、成熟的方法;简易的水处理技术在灾难救援中也发挥着重要作用.     

玉树抗震救灾医学救援的组织指挥

通过玉树抗震救灾医学救援实践,从卫勤组织指挥、构建救援体系、协同联合保障、统筹使用力量、应急药材供应等方面,总结研究军队卫勤力量参加自然灾害医学救援的体会和做法,对提高军队卫勤力量在执行高原等特殊环境中非战争军事行动任务能力进行思考。     

移动式医用高压氧供系统的研制

目的：研发一套适用于现场紧急医疗救援的移动式医用高压氧供系统,既可用于单个麻醉机的氧源供应,亦可满足多人同时吸氧。方法综合利用变压吸附（PSA）技术、可编程逻辑控制器（PLC）技术和微型空压机技术,采用Pro/E建模软件进行三维结构设计,并根据YY/T0298-1998要求及相关国家标准进行机械加工。结果研制出一种流量为10 L/min的移动式医用高压氧源供给系统,该系统设计先进、结构合理、制作精良、移动方便,符合便携式的要求,适宜广大农村及偏远地区医疗单位的氧源供应或灾害紧急医疗救援。结论移动式医用高压氧供系统对于野战和院外的紧急医疗救援具有重要的作用。     

一线核应急医学救援队伍建设

目的分析一线核辐射应急医学救援队伍建设存在的问题,研究改进措施。方法根据核辐射应急医学救援队伍建设的实际,结合实地演练经验开展理论分析。结果当前一线核应急救援队伍还普遍存在宏观管理体系松散、专业救治人才缺乏、进修培训不连贯、救治药材更新配套缓慢等薄弱环节。结论通过科学制定应急救援预案、强化应急救援实战演练、优化药材供应储备、完善应急救援信息化支撑等手段,可提高一线核医学应急救援队伍的救治能力。     

我军地震灾害应急医学救援药材保障体制探讨

本文根据地震灾害发生时的特点,提出地震灾害应急医学救援药材保障体制研究的基本原则与要求,阐述药材保障的体制结构,并分析我军和外军灾害救援药材保障体制的运行现状。最后通过对16名卫勤专家进行咨询,并论证得出合理的地震灾害救援药材供应体系分级,以期研究成果为抗震救灾药材保障提供理论支撑。     

抗震救灾医学救援中的卫生物资保障

医学工程保障是有效组织实施抗震救灾医学救援的关键环节之一。本文结合本源参与汶川、芦山抗震救灾医学救援的实践,从医疗物资筹措的方法和渠道、保障临床物资需求、调配和检修设备、消毒供应保障等方面提出了具体做法。     

浅谈军队应急医学救援装备体系构建

近年来, 我国突发公共卫生事件层出不穷, 灾害医学救援形势紧迫, 作为应急医学救援的重要物质基础, 应急医学救援装备的发展已成为维护民众健康的重要基础。进行应急医学救援装备系列化研究, 构建应急医学救援装备体系, 具有重要的现实意义。基于此, 以加强军队应急医学救援力量建设为目标, 分析军队应急医学救援装备体系的建设现状, 并针对建设中的不足提出高效化、信息化、系统化的发展对策, 以期对国内应急医学救援装备体系的构建有一定的启示。     

抗震救灾条件下的医用气体供应

目的:分析解决医用气体不间断供应的难点及对策。方法:针对医用气体不间断供应的难点,制氧机制取氧气后以压氧机灌装氧气瓶为主,供氧时以氧气瓶连接供氧台向各功能舱输送氧气。结果:确保了医用气体方舱发挥最大效能,并合理满足不间断供氧需求。结论:其适用于各野战方舱医院,在今后组织灾害医学救援行动中值得借鉴。     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.