上海地区海域船舶人员高血压危险因素分析

目的　了解船舶人员高血压发病情况及危险因素 ,以指导防治。方法　对 1997年高血压普查资料行初步整理 ,并着重对高血压危险因素行 logistic回归分析。结果　高血压患病率为 6 .3%。危险因素有年龄、超体重、父系家族史、海上工作年限、职别及行政管理工作。结论　本调查确定的高血压危险因素与全国抽查结果相符 ;父系家族史对男性子代有遗传优势 ;可通过体育锻炼减少高血压发病。     

我国海员适航情况初探(论著)

目的：对我国海员一些生理和神经心理指标进行检测，了解这些指标在航程中的变化，以探究他们适航的快慢程度和稳定性。方法：对同一航次的海员在开航前、开航后第1、3、5、10、20、30天各值班时检测在班海员的心率、呼吸、血压和视觉品质试验。结果：航初第1～5天海员值班时各项心身指标均不稳定，工作效能差。至第10、20天，除舒张压外，其余指标渐稳定，工作效能逐渐提高。及至第30天即将抵终点港时，除心率、舒张压外，各项指标又复不稳定，工作效能亦轻度减退，但仍较航初1～5天为佳。同时，航行中海员昼夜生物节律紊乱。结论：本研究结果表明，短程航行的海员适航情况可分为不适应期、适应的稳定期和适应的不稳定期。为缩短他们的适航过程，预防适应障碍，应加强海员的心身训练。     

应激对海员心理及血清甲状腺素、睾酮和皮质醇含量的影响

目的　研究海员应激对心理、神经、内分泌免疫的影响。方法　海员 85人为海员组 ,同地区码头作业人员 75人为对照组 ,采用症状自评量表 (SCL- 90 )、匹兹堡睡眠质量指数量表 (PSQI)进行测评。同时测定海员组、对照组的血清总甲状腺素 (TT4 )、总三碘甲状腺原酸 (TT3)、睾酮 (Testo)及皮质醇(Cortisol)水平。结果　海员组较明显的心理不良反应为人际敏感、抑郁、躯体化、敌对、偏执等。海员组除抑郁因子分、恐怖因子分与军人常模无明显差异外 ,其余各项因子分、阳性项目数均明显高于军人常模 (分别 P<0 .0 5～ <0 .0 0 1) ;海员组与对照组比较 ,除恐怖因子分外 ,其余各项因子分、阳性项目数均明显高于对照组 (均 P<0 .0 0 1) ;海员组 4 2 .4 %存在睡眠质量问题。与对照组比较 ,海员组 TT3、Testo、Cortisol的水平显著增高 (均 P<0 .0 0 1)。TT4 两组差异不显著 (P>0 .0 5 )。结论　海员面临多种应激源 ,有不同程度的心理不良反应 ,心理应激反应影响神经、内分泌及免疫系统的变化。     

A trial of the pharmacological correction of sleep disorders in sailors during a cruise]

The article makes a comparative estimation of the efficiency between the benzodiazepine pharmacological group (selenium, diazepam) and adaptogens of the plant origin (Extractum Leuzeae carthamoidis fluidum) for correction of sleeping disorders in seamen during cruise. The application of elenium and diazepam have caused the unpleasant subjective sensations, such as psychoemotional retardation, sluggishness, apathism and headaches. After application of Extractum Leuzeae there were no side effects like a drug hang-over; the health status, functional state and job performance of seamen were improved. Having taken Extractum Leuzeae the seamen had the normalization of sleeping in 5-7 days.     

Patient autonomy and relatives' right to know genetic information

One of the most difficult issues doctors face is a conflict between their professional duties. Such a conflict may arise when doctors know that information has implications not only for patients but also for family members but their duty of confidentiality prevents them from disclosing it. A comparative analysis of English and Israeli medical law reveals that the doctors' duty is based on two principles: a liberal perception of patient autonomy and an overriding utilitarian principle of prevention of harm. However, socio-medical research indicates that these principles do not entirely reflect the views of patients and doctors and are too narrow to deal with the complex situations in practice. Thus, it is argued that the doctor's legal duty of confidentiality should be reconsidered and qualified when it concerns the family. It is suggested that if medical law seeks to recognize the various interests family members have in genetic information then we should consider a different approach, founded on a relational interpretation of autonomy and communitarian notions of solidarity and moral responsibility. This approach perceives confidentiality and privacy as embracing the family unit, based on the view that close relatives are not entirely outside the private sphere of the individual but rather are integral to his or her identity. Thus, to the utilitarian mechanism available in medical law this approach adds a social criterion: The effect any decision (to disclose or not to disclose) will have on the familial relationship and on the dynamics of the particular family. This will provide a more flexible and workable alternative for doctors to resolve familial tensions over access to genetic information.     

航海人员单纯收缩期高血压影响因素分析

目的　了解航海人员单纯收缩期高血压 (ISH)的患病率及相关危险因素。方法　对 1997年上海地区海域航海人员资料整理并行 logistic回归分析。结果　 ISH患病率为 2 .5 %。危险因素为体重指数 (BMI)。年龄或工作年限有保护作用。末次测压的 ISH值与父系高血压家族史相关。结论　本组(ISH)高血压机制及危险因素普通高血压病均有所不同 ;即使在 BMI<2 5也增加 ISH危险。     

Medical confidentiality versus disclosure: Ethical and legal dilemmas

A case is described of a fifty year old single man who made disclosures about criminal sexual practices during a psychiatric assessment. In common practice with other professional men, a doctor is under a duty not to disclose, without the consent of his patient, information which he has gained in his professional capacity other than in exceptional circumstances. We discuss the ethical and legal considerations surrounding issues of medical confidentiality and the dilemma that sometimes face clinicians, when they feel obliged, in the public interest, to disclose information they have gained in confidence. Breach of confidences can have deleterious consequences; particularly for the doctor–patient relationship, but failure to disclose in some situations could have serious implications for the well-being of the wider society. Doctors should be aware of the basic principles of confidentiality and the ethical and legal framework around which they are built.     

The quantitative assessment of the level of the emotional stability of an operator specialist]

A methodical approach to appreciation of the emotional stability of specialists-operators was experimentally approved, carrying out standard tests at the simulator of various extreme situations. The authors worked out a quantitative formula for appreciation of emotional stability, making use of the initial data obtained in standard tests carried out by operator in drill, optimum and extreme variants. There is a scale that includes five categories of emotional stability (high, relatively high, middle, relatively low, low). A special methodical approach is recommended to detect emotionally unstable operators (or candidates for these posts), and also for an a priori prognostication of the operators' activities in stress situations.     

The cascade scheme as a methodical platform for analysis of health risks in space flight and partially and fully analog conditions

Space anthropoecology, a subsection of human ecology, studies various aspects of physiological, psychological, social and professional adaptation to the extreme environment of space flight and human life and work in partially- and fully analogous conditions on Earth. Both SF and simulated extreme conditions are known for high human safety standards and a substantial analytic base that secures on-line analysis of torrent of information. Management evaluation and response to germing undesired developments aimed to curb their impact on the functioning of the crew-vehicle-environment system and human health involve the complete wealth of knowledge about risks to human health and performance. Spacecrew safety issues are tackled by experts of many specialties which emphasizes the importance of integral methodical approaches to risk estimation and mitigation, setting up barriers to adverse trends in human physiology and psychology in challenging conditions, and minimization of delayed effects on professional longevity and disorders in behavioral reactions.     

焦虑与海员高血压及相关因素的分析

目的 探讨焦虑对海员高血压患病率的影响及其与高血压相关易患因索的关系。方法 对4048名海员按统一方法进行血压测量与问卷调查，并填写焦虑自评量表（SAS）。结果 （1）随SAS分值的增加，海员的高血压患病率增高（P〈0．001），SAS分值每增加10分，收缩压增加1．8-1．9mmHg，舒张压增加1．1～1．2mmHg。（2）焦虑与吸烟、饮酒、高血压家族史、心率、海龄呈正相关（P〈0．001）。结论 焦虑分值与海员高血压患病率之间存在剂量反应关系，焦虑对海员高血压患病率影响显著。并与高血压多种易患因素相关。     

北方海域航海人员血压调查及影响因素分析

目的 了解北方海域航海人员高血压发病情况及影响因素。方法 对北方海域航海人口（数千名）按统一方法测量血压。结果 （1）高血压总患病率为10．36％。（2）＜35岁者患病率（9．54％）显著高于1991年全国血压抽样调查的同龄男性（5．5％）（P＜0．001）。（3）相关与回归分析表明,对血压有明显并呈正相关的因素为：年龄、体重指数（BMI）、海龄、食盐量、饮酒、心率和高血压家族史（P＜0．01）。结论 北方海域航海人员的高血压患病率偏高,应采取切实可行的方法进行防治。     

Medical approaches to technogenic risks mitigation: instructive experience of space medicine]

Medical approaches to mitigation of technogenic extreme risks are analyzed by the example of space medicine experience in handling of the risks caused to humans by specific and non-specific extreme factors in space flight. Discussion is centered on the amalgamation of closely interconnected fundamental and applied risk researches with the ultimate aim of determining the strategy of risk minimization through optimization of environment, professional activity, and development of effective medical care and prevention instruments. One of the major achievements of the Russian space program was giving evidence of the possibility to control risks in extended orbital missions. As far as the Moon and Mars exploration projects are concerned, views of the U.S. NASA have been formulated in "Bioastronautics Critical Path Roadmap". Excerpts from the document illustrate possible approaches to the current and prospective technogenic extreme risks.     

航海人员洁治术对干槽症的影响及原因分析

目的　探讨干槽症发病的相关因素和预防航海人员干槽症发生的方法。方法　对 4 6 8例需要拔除双侧下颌阻生智齿的航海人员在无拔牙禁忌证的情况下分次进行拔牙手术 (相隔时间 2个月以上 )。第 1次拔牙前不进行特殊术前准备 ,第 2次术前进行全口龈上下洁治术 ,术后 3～ 5 d拔牙。 2次拔牙前均牙菌斑取样检测幽门螺杆菌 (Helicobacter pylori,H.Pylori)。结果　第 1次拔牙后 78颗发生干槽症 ,占 16 .6 7% ;第 2次拔牙后仅 9颗发生干槽症 ,占 1.92 % ,差异非常显著 (P<0 .0 1)。牙菌斑 H.py-lori检测结果 2次拔牙前阳性率分别为 5 4 .2 7% (2 5 4 / 4 6 8)和 14 .74 % (6 9/ 4 6 8) ,差异亦有显著性 (P<0 .0 5 ) ,且所有发生干槽症的手术拔牙前牙菌斑 H.Pylori检测均为阳性。结论　口腔幽门螺杆菌感染可能是航海人员干槽症发病率高的原因 ,术前口腔洁治可以有效预防拔牙术后干槽症的发生。     

北方海域航海人员正常高限血压的发生率及因素分析

目的　了解北方海域航海人员正常高限血压 (HNBP)的发生率及影响因素。方法　对4 0 72名北方海域的航海人员按统一方法进行血压测量与问卷调查。结果　 (1) HNBP发生率为17.88%。 (2 ) HNBP组与除外 HNBP的正常血压组相比 ,饮酒、家族史及体重超重的人数比例明显增高(P<0 .0 5 ) ,HNBP组年龄、海龄、心率、食盐量、A型行为均值与焦虑均值均明显高于正常组 (P<0 .0 5 )。结论　血压在正常高限的北方海域航海人员中存在多种高血压的相关因素 ,对该组人群应注意随访观察 ,加强防护措施。     

吲哚美辛治疗海员中牙龈炎的疗效观察（论著）

目的：观察海员中牙龈炎应用吲哚美辛（消炎痛）治疗的临床疗效，并与灭滴灵治疗作比较，探讨其对牙龈炎优良效用的机理。方法：选口腔科门诊患牙龈炎的海员１８９例，主要以牙龈指数（ＣＩ）为观察指标。实验分吲哚美辛组（６４例）、灭滴灵组（６３例）和对照组（６２例），各组分别治疗１周后进行治疗前后与组间比较。结果：吲哚美辛和灭滴灵组的ＧＩ与治疗前比均非常明显降低（Ｐ＜０．０１），同时此两组与对照组比均有非常显著性差异（Ｐ＜０．０１），而吲哚美辛组与灭滴灵组间无显著性差异。吲哚美辛组中不同年龄和不同类型龈炎的ＧＩ于治疗后均明显降低，而边缘性龈炎的ＧI比肥大性龈炎者降低更明显，但各年龄组间的ＧＩ相比无显著性差异。结论：吲哚美辛对海员龈炎有较好的疗效，对边缘性龈炎的作用优于肥大性龈炎；吲哚美辛用途广、携带使用方便，可作为海员远航的备用药物。     

晕船敏感性与Coriolis加速度耐力及体能的相关性(论著)

目的：测定舰员晕船敏感性与Coriolis加速度耐力及体能的相关性，并探索舰员选拔和抗晕船训练的新方法。方法：在电动转椅上用Coriolis加速度连续累积试验测定118名有近期晕船史舰员的Coriolis加速度耐力。用自行车功量计测定131名舰员的体能，并用上述同样方法测定他们的Coriolis加速度耐力。结果；实验发现晕船敏感性与Coriolis速度耐力之间在统计学上有非常显著的相关性（r=0．993，P＜0．01），而Coriolis加速度耐力与体能之间无显著相关性。结论：Coriolis加速度耐力是晕船敏感性相当灵敏的指标。增强舰员体能并不能降低晕船的敏感性。     

Social contexts of trauma and healing

The social contexts in which the mass trauma of thousands of people occur and in which their recovery should progress have qualities that distinguish it in important ways from individualised trauma in which a person is a victim of a violent attack, rape or a traffic accident. Organised violence, such as wars, oppression by dictatorships and massive terrorist attacks are extreme cases in which hundreds or thousands of people are exposed to trauma in a short period of time. As such, it has multiple consequences that extend beyond the affected individuals and the symptoms they suffer. Although the symptoms may be similar, the social contexts in which individual victimisation and exposure to organised violence happen are very different. The social milieu in which the survivors of individual trauma and survivors of mass trauma are embedded is likewise different, with important consequences for recovery. Understanding the social context of the trauma helps create the right social intervention for healing at social and personal levels.     

结构化面试在护士长选拔中的应用研究

 目的 运用经典测验理论(Classical test theory,CTT)对影响护士长选拔结构化面试信度的主要因素进行初步分析和探讨. 方法以武警总医院护士长选拔结构化面试的考官对52名被试者的评分为研究对象,对题目的难度、区分度、同质性信度和评分者信度进行分析.最后,用上岗1年后的工作实绩作为效标对其进行实证效度的研究.结果 护士长选拔的结构化面试的同质性信度很高,α系数达0.922.面试题目的难度、区分度会影响到面试评分的一致性.护士长职位作为一项操作性比较强的岗位,用结构化面试的方法来考察专业技能效果不好.结论 影响结构化面试评分者信度的主要因素是试题质量、考官素质和测评要素的操作定义.     

海员的深度知觉研究

目的 对海员的深度知觉进行测评，为制定海员选拔标准提供依据。方法 采用深度知觉测试仪对245名海员和87名航海专业学员的深度知觉进行测试。结果 深度知觉对于海员具有很好的鉴别力：不同年龄、工龄、海龄组之间海员深度知觉差异不显著；不同职务、来源和文化程度的海员深度知觉差异不显著；在职海员的深度知觉好于航海专业学员。结论 海员的深度知觉是一稳定的认知能力指标，作为海员的选拔指标是合适的，对于在职海员与学员的评价应有不同要求。     

Aggression and violence towards health care providers – A problem in Turkey?

Health care providers are increasingly concerned about the escalating incidence of verbal and physical abuse to healthcare staff. Factors, such as long wait in hospital areas, which lead to client frustration over an inability to obtain needed services promptly, are influencing these situations. Nonetheless, incidents of this nature can cause immense psychological harm as well as physical damage among medical employees. The current study aimed to ascertain from staff members aggressive experiences in the workplace, and the effects on the individual. The results of this study mirrored those of similar surveys in Turkey. Non-reporting was revealed as a major problem. Respondents believed they were treated less seriously than similar incidents involving private citizens. Accordingly, staff criticized hospital managers, the police, and the courts for their attitude about assaults towards hospital employees. They reported feeling vulnerable to abuse and there was a general desire for training in preventing and protection. These include teaching staff breakaway techniques, increasing the number of trained security officers on duty, issuing personal alarms, and encouraging staff to officially report all incidents.