区域一体化部队卫生服务模式探索

区域一体化部队卫生服务模式是在部队卫勤建设转型发展关键节点提出的改革思路,符合部队卫生＂六种能力＂建设的现实需求,它的改革试点,为部队卫勤改革深入推进提供实践平台。     

军队医院与部队卫生机构一体化卫勤保障的做法与成效

建立区域一体化卫勤保障模式是军队卫勤保障的一个重要发展方向。结合承担全军区域一体化卫勤保障模式改革试点经验和近年来完成多样化非战争军事行动卫勤保障实践,就如何提高战时和应急情况下的卫勤保障效能和效率,探索军队医院与部队卫生机构模块化混合编组、实战化联演联训、一体化联合保障的卫勤保障新模式,为军队卫勤保障模式改革提供借鉴。     

区域一体化卫勤保障实践与思考

本文对区域一体化卫勤保障模式改革试点工作的基本任务、一体化卫勤保障的做法与成效进行系统归纳,提出对区域一体化卫勤保障模式的认识与体会,并对区域一体化卫勤保障模式的推广提出建议。     

加强部队救治能力建设的实践与思考

随着未来战争形态发展变化,卫勤保障力生成模式发生深刻转变,部队卫生机构在平战时卫勤保障中的地位和作用日益凸显.大力加强部队卫生机构建设,着力提高部队救治能力,已成为卫勤核心保障能力建设的重要课题.通过结合沈阳军区部队救治力量建设试点工作实践,从卫勤指挥链条、专业队伍建设、力量编组模式、卫生装备改革和训练方式转型5个方面提出了部队救治能力建设的思考与建议.     

部队卫生服务现状与一体化卫勤保障模式认知调查

目的：对部队卫勤体制和官兵卫生服务需求情况调研,改善部队官兵就医现状,优化部队卫勤体制。方法对不同地区的各类部队人员和医务人员发放卫勤体制问卷,对调研结果进行描述性统计分析。结果进一步明确部队和医院的隶属关系、端正医院的服务方向、提升部队卫生人员素质、改善医疗设备、将医院纳入部队管理体制、强化部队医院对部队的服务意识是切实改善现状、保障官兵卫生服务需求的有效措施。一体化卫勤保障模式具有较高的认可度和可行性。结论部队官兵对部队卫生服务的总体评价较好,但联勤医院服务保障体系需完善,医疗技术水平、就医顺畅程度、全方位医疗服务、一体化卫勤保障等方面有待提升。     

医院与部队区域一体化护理培训模式研究

建立医院与部队一体化护理培训模式是加强基层部队卫生机构护理队伍建设和提高区域部队护理整体质量水平的重要途径。本文对构建医院与部队区域一体化护理培训模式的必要性进行了论述,并对区域一体化卫勤保障的运行与管理、困难与问题进行了系统全面阐述,并提出了建议,为全军推行区域一体化护理培训模式提供了经验。     

区域一体化卫勤保障模式的SWOT分析

区域一体化卫勤保障是军队卫勤保障改革的有益探索。文章应用SWOT方法综合分析区域一体化卫勤保障模式的优势、劣势、面临的机遇和威胁,提出实施区域一体化卫勤保障的策略,指出要健全组织机构、强化统筹协调,聚焦保障需求、创新服务模式,完善信息平台、提升服务质量,加强制度建设、争取政策支持。     

基于多级模糊综合评判的中心医院基层军医培训效果评价

目的：综合评价区域一体化卫勤保障试点中心医院实施的基层部队军医培训工作效果。方法依托区域一体化基层部队军医培训体系设计调查问卷,通过调查区域一体化卫勤保障改革试点培训工作参训人员获得相关指标,并利用模糊综合评判原理,获得综合评价结果。结果区域一体化中心医院基层军医培训工作总体评价结果为“良好”,四个二级指标“反应层”、“学习层”、“行为层”、“结果层”评价结果也均为“良好”,但各组得分存在差异。结论基层部队军医对区域一体化卫勤保障试点中心医院军医培训工作有较好的认同感,培训措施与政策取得一定成效。但各项工作仍有改进的空间,必须持续加大改革建设的力度。     

区域一体化军队医疗卫生技术帮带效果评估

本文对区域一体化卫勤保障模式改革试点中开展技术帮带的实践与效果进行了系统论述。主要做法,一是充分调研,明确帮带目标;二是实行主责学科负责制;三是实行双向代职;四是建立部队卫生人员培训中心;五是开展远程医学服务。并对主要成效进行阐述。     

新时期军事斗争卫勤准备的任务与要求

文章从新军事变革要求卫勤全面转型、军事斗争要求卫勤加快保障能力建设、军队现代化建设要求深化军队卫生工作改革、反恐及应付突发公共卫生事件成为军队卫勤基本任务、保障打赢信息化战争需要卫勤信息化、战斗力发展要求建立新军人健康观和医疗观等六个方面全面分析了新时期军队卫勤发展环境背景；同时，从联勤医院的保障对象和保障方式，战时医院基本任务，在反恐和突发公共卫生事件中军队医院的任务，在卫勤保障一体化中军队医院的任务，创新发展强健医学、急救医学、创伤医学、“三防”临床医学成为军队医院的重要任务等五个方面阐述了军队医院任务的拓展；并且，提出了新时期军事斗争准备对医院的基本要求，即：加快培养联勤医护人员，提高战伤救治效率，组织装备模块化，加快医院与部队预防-医疗-保健“一体化”进程，加快医院信息化建设，以及加强康复治疗、军事作业医学和核化损伤救治研究。     

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.     

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.     

Empathic processes: perception by medical students of patients'' anxiety and depression

Perceptions by medical students of patients' affective states were investigated, and the effect of the students' own emotions on such perceptions. One hundred and one fourth-year medical students rated the levels of anxiety and depression of three women patients presented on videotape, rated their own levels of anxiety and depression and completed a questionnaire on aspects of the rating process. Students had widely different and often inappropriate perceptions of patients' levels of anxiety and depression. Students who consistently overrated anxiety or depression in patients, compared to those who consistently underrated, were themselves significantly more anxious or depressed. These data suggest a need in medical education for systematic teaching of empathic skills and for recognition of potential bias in clinical decision-making arising from the clinician's own emotional state.     

The reported incidence of work-related ill-health in Scotland (2002-2003)

BACKGROUND: Although incidence data for work-related ill-health in the UK are available, more detailed information for smaller geographical areas has hitherto been unpublished. AIMS: To estimate the incidence of work-related ill-health reported by clinical specialists in Scotland, 2002-2003. METHODS: THOR (The Health and Occupation Reporting network) is a UK wide reporting scheme for work-related ill-health. In 2002-2003, 241 out of 2162 physicians in THOR were based in Scotland. We have summarized the reported cases and calculated incidence rates for categories of ill-health by age, gender and industry. The UK Labour Force Survey (2002) was used to provide denominator data, with comparisons made between rates for Scotland and the rest of the UK. RESULTS: In 2002-2003, 4043 estimated cases were reported from Scotland. Mental ill-health was most frequently reported (41%); followed by musculoskeletal disorders (31%), skin disorders (16%), respiratory disease (10%), hearing disorders (2%) and infection (1%). The reported average annual incidence rate per 100,000 employees for all work-related ill-health in Scotland was 86.0. The highest reported rate for mental ill-health was found for employees in public administration and defence (76.7 per 100,000), and health and social work (72.3 per 100,000). The construction industry had the highest reported rate of musculoskeletal disorders (41.6 per 100,000), while hairdressers appeared at most risk of developing occupational contact dermatitis (rate=86.4 per 100,000). CONCLUSIONS: Despite its limitations, THOR has indicated types of work-related ill-health and related industries for targeted disease prevention in Scotland.     

Function of the protein RPE65 in the visual cycle

A protein called RPE65 performs a key role in the trans-cis isomerization of retinol in the retinal pigment epithelium of the eye. The palmitoylation of RPE65 serves to switch off the visual cycle in darkness and to switch it on in the light.     

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.     

Acute symptoms following work with pesticides

BACKGROUND: Serious accidental poisoning by pesticides is rare in the UK, but more minor pesticide-related illness may be under-reported. Anecdotally, use of sheep dip has been linked with flu-like symptoms. AIM: To explore the frequency, nature and determinants of acute symptoms following work with pesticides. METHODS: A postal survey of men in three rural areas of England and Wales provided data on occupational use of five categories of pesticide, occurrence of 12 specified symptoms within 48 h of using pesticides and tendency to somatize. Risk factors for pesticide-related symptoms were assessed by modified Cox regression. RESULTS: Of 10 765 responders (response rate = 31%), 4108 had at some time used pesticides occupationally, including 935 (23%) who reported symptoms following such work on at least one occasion. In two areas, acute symptoms were most frequent following use of sheep dip (29 and 32% of users), but in the third area the rate was significantly lower (13% of users). The relative frequency of symptoms was similar for all five categories of pesticide, and flu-like symptoms did not cluster unusually among users of sheep dip. Risk of pesticide-related symptoms increased with somatizing tendency (prevalence ratio for highest versus lowest category 2.4, 95% confidence interval 2.0-3.0) and was higher in men who had used pesticides most often or handled concentrate. CONCLUSION: Acute symptoms are common following work with pesticides, but in many cases the illness may arise through psychological rather than toxic mechanisms.