北京市顺义区医务人员体质测定结果分析

目的通过对医务人员进行体质测定,了解医务人员的体能情况,以便有针对性地对医务人员进行更全面的健康服务。方法随机抽取北京市顺义区各级医院20-59岁的医务人员273名,其中男135名,女138名。按照《国民体质测定标准》（成年人部分）对医务人员进行体能测试,由专业人员用统一的器材在规定时间内进行测试。结果顺义区医务人员得5分百分比最高的是身高标准体重质量（71．8％）,得0分值最高的是纵跳（5．0％）,3分以上比例最高的是选择反应时（94．5％）,3分以下比例最高的是台阶指数（51．3％）。台阶指数分为2．52。综合评级中各等级人数百分比顺序依次是：优秀率为30．8％,良好率为32．2％,合格率为33．0％,不合格率为4．0％。结论顺义区医务人员大部分体质监测合格,台阶指数分值较低,体质在中年期出现明显的下降。     

Skin disorders and job fitness assessment

BACKGROUND: Assessment of fitness for employment represents the final phase of the risk evaluation and health surveillance carried out during pre-employment and periodical medical examination. Dermatoses are frequent diseases both in the general population and workers, therefore job fitness assessment for workers with skin problems will frequently fall within the occupational health area. The physician must verify whether or not the dermatosis is an occupational disease and must adopt preventive measures to avoid any worsening or relapse of the clinical situation due to occupational factors. OBJECTIVES: This article gives suggestions for correct management of occupational and non-occupational skin diseases in the workplace, with practical examples of job fitness assessment. METHODS: We first examined the role of the occupational physician in the evaluation of occupational risk factors that can induce work-related dermatoses or aggravate other dermatoses. We then discussed the factors that must be considered during assessment of fitness for employment when dermatoses are present. Finally, we examined practical examples of occupational or non-occupational dermatoses that can cause functional limitations, factors that can influence job fitness evaluation, and the possible role of allergological tests. RESULTS AND CONCLUSIONS: Several dermatoses can be aggravated or caused by occupational factors (e.g. atopic dermatitis, allergic contact dermatitis, irritant contact dermatitis, keratinization disorders, lichen planus, physical urticaria). Close cooperation between the dermatologist and the occupational physician is very important in order to make an etiological diagnosis that is necessary for the job fitness assessment. It is difficult to define definitive criteria for the assessment of fitness for employment; in this article only some suggestions are made and they can vary according to the different situations.     

Quality assurance in military medical research and medical radiation accident management

The provision of quality radiation-related medical diagnostic and therapeutic treatments cannot occur without the presence of robust quality assurance and standardization programs. Medical laboratory services are essential in patient treatment and must be able to meet the needs of all patients and the clinical personnel responsible for the medical care of these patients. Clinical personnel involved in patient care must embody the quality assurance process in daily work to ensure program sustainability. In conformance with the German Federal Government's concept for modern departmental research, the international standard ISO 9001, one of the relevant standards of the International Organization for Standardization (ISO), is applied in quality assurance in military medical research. By its holistic approach, this internationally accepted standard provides an excellent basis for establishing a modern quality management system in line with international standards. Furthermore, this standard can serve as a sound basis for the further development of an already established quality management system when additional standards shall apply, as for instance in reference laboratories or medical laboratories. Besides quality assurance, a military medical facility must manage additional risk events in the context of early recognition/detection of health risks of military personnel on deployment in order to be able to take appropriate preventive and protective measures; for instance, with medical radiation accident management. The international standard ISO 31000:2009 can serve as a guideline for establishing risk management. Clear organizational structures and defined work processes are required when individual laboratory units seek accreditation according to specific laboratory standards. Furthermore, international efforts to develop health laboratory standards must be reinforced that support sustainable quality assurance, as in the exchange and comparison of test results within the scope of external quality assurance, but also in the exchange of special diagnosis data among international research networks. In summary, the acknowledged standard for a quality management system to ensure quality assurance is the very generic standard ISO 9001.Health Phys. 103(2):221-225; 2012.     

Occupational medical prophylaxis for the musculoskeletal system: A function-oriented system for physical examination of the locomotor system in occupational medicine (fokus (C) )

Occupational physicians are very often confronted with questions as to the fitness of the postural and locomotor systems, especially the spinal column. Occupational medical assessment and advice can be required by patients with acute symptoms, at routine check-ups, by persons who have problems doing certain jobs, and for expert medical reports as to the fitness of persons with chronic disorders or after operations. Therefore, for occupational medical purposes a physical examination must aim primarily to investigate functions and not structures or radiologic evidence. The physical examination should be structured systematically and according to regions of the body and, together with a specific (pain) anamnesis should provide a basis for the medical assessment.     

Standard setting for progress tests: combining external and internal standards

Objectives  There has been little work on standard setting for progress tests and it is common practice to use normative standards. This study aimed to develop a new approach to standard setting for progress tests administered at the point when students approach graduation.
Methods  In this study we obtained performance data from newly qualified doctors and used this information to set the standard for the last progress test in the final year of undergraduate medical education. This external reference was validated against projections of student performance data based upon normative grading, and other published results. A simple linear growth model was used to set pass scores for progress tests earlier in the final year and this was also validated by published data.
Results  There was good agreement between standards set using the data from newly qualified doctors, the standard expected from extrapolation of the student progression data, and published performance data from another medical school.
Conclusions  We have demonstrated that a combination of data from independent sources can be used to triangulate standard-setting decisions for progress tests. Performance data from successive cohorts of medical students could provide a fruitful source of information for standard setting for progress tests.     

某玉米深加工生产企业职业危害现状调查与评价

目的了解玉米深加工生产企业作业场所职业病危害因素种类、工人接触水平及玉米深加工生产企业存在的职业卫生问题。方法对生产企业职业病危害控制效果评价报告进行分析。采取现场职业卫生学调查,根据国家现行职业卫生标准进行职业病危害因素检测。结果粉尘个体采样测试结果均未超过国家卫生限值的要求,合格率为100%,粉尘定点测试短时间接触浓度合格率为90.91%。所测有毒物质均未超标,所评价毒物作业岗位均合格,以玉米深加工企业较完善的设备维护制度以及所采取的通风防毒措施能满足控制有毒物质危害的效果。结论玉米深加工企业高噪声生产设备较多,加之因工艺要求多为集中布置,造成噪声叠加,工人多为固定岗位作业,接触时间长,对工人健康有一定影响,建议加强个人防护用品的使用。     

Standards on medical fitness examinations for Navy divers

The German Navy employs approximately 480 divers in their primary and secondary role. Before entering diving training, every diver has to pass an intensive physical examination programme at the German Naval Medical Institute (NMI) in Kiel-Kronshagen. Annual follow-ups ensure the currency of the medical findings. Criteria of medical fitness for diving reflect industrial medical standards for hyperbaric workers as well as the general medical guidelines for NATO divers. A diving examination consists of the individual medical history, a physical examination including the neurological status and the assessment of the cardiovascular fitness by ECG and bicycle ergometry. The respiratory system is screened by regular chest x-rays and spirometry or body plethysmography. Blood and urine samples are taken to look for abnormal haematological and metabolic conditions as well as disorders of the genito-urinary system. In order to determine visual fitness, diver's visual acuity, colour vision and stereopsis as well as eye fundi are examined by an eye specialist. Also the ENT examination involves a speciality consultant and consists of audiometry, inspection of the external ear and tympanic membrane and functional tests. To ensure a high standard of dental fitness, screening by a dental officer is part of the annual check-up. Every routine diving medical examination at the NMI includes a pressure test in the hyperbaric chamber. Divers who use nitrox or oxygen-rebreather devices have to pass successfully an oxygen tolerance test under hyperbaric conditions. The annual routine diving medical examination contributes to minimize the risk of accidents in military diving operations.     

Biomedical research on health and performance of military women: accomplishments of the Defense Women's Health Research Program (DWHRP)

In 1994, Congress provided dollar 40 M for biomedical research on issues of importance for military women. This supported 104 intramural and 30 extramural studies and launched an era of research to narrow the knowledge gap on protection and enhancement of health and performance of military women. Projects addressed issues specific to female physiology (e.g., gynecological health in the field, maternal malaria), problems with higher prevalence for women (e.g., marginal iron deficiency, stress fracture), and issues of drug and materiel safety that had only been extrapolated from studies of men (e.g., chemical agent prophylaxis, fatigue countermeasures). Several important assumptions about female physiology and occupational risks were found to be astoundingly wrong. Hormonal changes through the menstrual cycle were less important to acute health risks and performance than predicted, exercise did not increase risk for amenorrhea and consequent bone mineral loss, and women tolerated G-forces and could be as safe as men in the cockpit if their equipment was designed for normal size and strength ranges. Data on personal readiness issues, such as body fat, physical fitness, nutrition, and postpartum return to duty, allowed reconsideration of standards that were gender appropriate and not simply disconnected adjustments to existing male standards. Other discoveries directly benefited men as well as women, including development of medical surveillance databases, identification of task strength demands jeopardizing safety and performance, and greater understanding of the effects of psychosocial stress on health and performance. This surge of research has translated into advances for the welfare of service women and the readiness of the entire force; relevant gender issues are now routine considerations for researchers and equipment developers, and some key remaining research gaps of special importance to military women continue to be investigated.     

2016—2017年度和2017—2018年度民航招飞体检淘汰率变化原因分析

目的 分析招飞标准修改前后两批飞行学生的体检资料(2016—2017年度4 604名学生,2017—2018年度4 483 名学生),探讨招飞标准修改前后体检合格率的变化及对生源质量的影响,为招收飞行学生医学选拔标准提供科学依据。 方法 收集2个年度飞行学生的体检资料,并用χ2检验对初合格率及外科、眼科、内科、耳鼻喉科的淘汰率进行比较。 结果 新标准施行以后,招飞体检初合格率从37.36%提升到40.56%,招飞标准修改前后眼科、外科淘汰率差异有统计学意义(P<0.05)。 结论 新标准的提高有助于提高体检合格率,有助于选拔高素质飞行生源。     

军队医院应急医学救援模块化编组研究

依据应急医学救援工作的特殊性,按照不同应急医学救援任务抽组、组合不同医学救援模块,进行应急医学救援力量的模块化编组是提高军队医院以一种体系、应对多种任务能力的较好方法。本文对军队医院应急医学救援的模块化编组可行性与方法进行探讨。     

武警不同任务部队战士体能水平比较

目的比较武警不同任务部队战士的体能水平和特点,为不同任务部队科学实施体能训练提供依据。方法以执行不同作战任务的某武警总队特战分队(n=76)和机动大队(n=95)男性战士为对象,测量反映体能水平的相关指标,如克托莱指数、肺活量、VO2max、握力、引体向上等,并进行对比分析。结果特战部队战士体质量和克托莱指数显著高于机动部队(P0.01);特战部队肺活量和VO2max显著高于机动部队(P0.05,P0.01);特战部队战士握力、立位体前屈、立定跳远、引体向上、俯卧撑、双杠臂屈伸、仰卧起坐成绩显著高于机动部队战士(P0.05,P0.01);通过体能分级评价,特战部队战士VO2max、立定跳远、俯卧撑的优秀率分别为100%、53.9%、77.6%,机动部队分别为4.2%、6.3%、26.3%,特战部队优秀率显著高于机动部队(P0.01);特战部队引体向上优秀率(9.2%)与机动部队(7.4%)比较,差异没有显著性(P0.05)。结论不同任务部队战士体能水平差别明显,特战部队战士体能水平显著高于机动部队战士,但是体能素质发展不够均衡。机动部队战士各项体能素质有待进一步提高。     

卫生装备模块化难点问题分析

模块化在工业乃至经济领域发挥了巨大的作用,在军队卫生装备方面的应用正在蓬勃发展,我军卫生装备模块化还在探索当中,就模块化过程中需关注的问题：一是模块化目的性要明确;二是模块化要有一定的标准;三是模块的划分与组合要把握一定的度;四是模块组件优化应注意的因素。基于以上四点的思考,对我军的卫生装备模块化进程进行讨论。     

基于“标准预防”的维和二级医院职业防护

目的研究维和二级医院职业防护管理方法。方法建立感染控制管理组织。实施手卫生学防护管理、执业个人防护要求、医疗锐器防护要求、伤员隔离要求、医疗环境与物品管理要求、医疗垃圾和废弃物处置的"标准预防"职业防护管理制度。明确维和职业暴露发生后的处置预案,实施规范的预防职业暴露培训计划。结果任务期43名队员未发生任何职业暴露,实现院内感染"零记录"、医疗队员疟疾"零感染",两次圆满通过联合国核查。结论在感染控制组织领导下,实施"标准预防"管理,对维和医疗队执业暴露感染控制发挥重要的作用,为今后我军海外医疗任务保障提供研究平台。     

The effect of normative social forces on managed care organizations: implications for strategic management

Drawing on institutional theory, this study examines how adherence to a number of "institutional" and "technical" environmental forces can influence the business success of managed care organizations (MCOs). The standards studied include: (1) institutional forces: socially accepted procedures for delivering care (access to quality care, availability of information, and delivery of care in a personal manner); and (2) technical forces: industry standards for cost control and efficient use of financial and medical resources. The most significant finding is that successful MCOs must conform to both institutional and technical forces to be successful. MCOs that conform to either one or the other type of standard were no more successful than those that conformed to neither. These findings have several important implications for MCO strategy. First, to be successful, MCO executives must understand the external environment in which they operate. They must anticipate and respond to shifts in that environment. Second, this understanding of the external environment must place equal emphasis on societal demands (e.g., for accessible care and information) and on technical demands (e.g., for cost-efficient care). These findings may well reflect that once managed care penetration reaches relatively high levels, marketshare can no longer be gained through cost-efficiency alone; rather, enrollee satisfaction based on societal demands becomes a key factor in maintaining and gaining marketshare. Institutional theory provides' some strategies for accomplishing these goals. Cost-containment strategies include implementing policies for cutting costs in areas that do not affect the quality of care, such as using generic drugs and reducing administrative excesses and redundancies. At the same time, MCOs must implement strategies aimed at improving conformity to prevailing societal perceptions of appropriate care, including providing patients more freedom to choose their physicians and encouraging and rewarding care providers for being friendly and personable. An MCO should work to inform the public of the organization's efforts to provide high-quality, low-cost medical care in a friendly, convenient manner.     

Medical fitness for sports, with particular reference to cardiovascular conditions]

Whether a person is medically fit to engage in sports depends not only on his or her present state of health but also on his or her previous medical history, age, personality, and of course, the nature of the particular sport in question. Anyone that feels fit, is physically in good condition, abstains from tobacco, alcohol and other intoxicant stimulants, and passes a thorough medical examination is healthy and fully capable of taking part in any sport whatever. Participation in any form of sport, on the other hand, is absolutely contra-indicated for persons suffering from severe or malignant hypertension, inflammatory or bacterial heart disease, severe angina pectoris - especially with an attendant risk of myocardial infarction - or haemodynamically significant arrhythmias that manifest themselves during, or are aggravated by, physical exertion. Physical activity is generally deleterious in patients with advanced pulmonary disease and chronic cor pulmonale, severe decompensated heart failure or severe renal insufficiency. Severe intercurrent infections also constitute an absolute contra-indication for sport. Between these two extremes of absolute fitness and absolute unfitness there are many intermediate states, e.g. diseases like essential hypertension (WHO Stages I and II), coronary disease and peripheral arterial circulatory disorders, in which patients can derive considerable benefit from properly chosen and carefully graded sporting activity.     

Audit in occupational medicine: an audit of fitness to drive among voluntary drivers in an NHS trust

BACKGROUND: A health surveillance programme, to assess fitness to drive, was initiated for voluntary drivers in an NHS Trust because of reports of increasing frailty and slow reactions among some drivers. After discussion between the occupational health department, voluntary services manager and personnel department it was considered appropriate to apply Driver and Vehicle Licensing Authority (DVLA) Group 2 fitness to drive standards to those voluntary drivers who drove the Trusts minibuses. RESULTS: An audit of the initial health surveillance of 47 drivers is presented. The mean age of the voluntary drivers was 66.4 years. A large number of medical problems with the potential to affect driving were discovered (average of 1.9 medical problems per driver).The outcome was that five voluntary drivers were found unfit to drive the hospital minibus and one voluntary driver was found unfit for car driving. CONCLUSIONS: A fitness assessment form for drivers is presented. This form is primarily for the use of occupational health nurses, to help them to decide when referral to an occupational health physician is indicated.     

运用训练等级考评模式组织医院参谋技能考核比武

运用后勤训练等级考核模式,组织开展参谋技能考核比武,是培养参谋队伍指挥能力素质、打造过硬卫勤指挥机关的有效途径。坚持战斗力保障力标准,以“基本理论、基础体能、基本技能”为主要内容,采取理论辅导、专题授课、集中考核等方式,检验并提高医院首长机关指挥技能。     

Training interventions for general practitioners providing an occupational health service in the British Army

BACKGROUND: General practitioners (GPs) working in the British Army, whether civilian or military, are responsible for providing a first line occupational health (OH) service in addition to their primary health care role. Despite the medical classification system being well established, previous publications have shown considerable inconsistency in the knowledge among GPs. AIM: The aim of this audit cycle was to test effectiveness of training interventions designed for GPs, providing the first line OH service. METHOD: The audit cycle was divided into three stages. The Stages I and III were audits examining the standard of OH records initiated by GPs during a 4-month period (pre- and post-training). The Stage II was a training intervention. Statistical significance was assessed with the chi-square test. RESULTS: The stage one audit showed a statistically significant standard difference between the medical boards initiated by civilian and military GPs. This gap was bridged and the overall standard of the OH records improved significantly after the training. CONCLUSIONS: Appropriate training can enhance a first line OH service provided by GPs. The training must be reinforced at regular intervals. Both OH specialists and GPs can complement each other so as to identify, intervene and prevent work-related ill-health.     

Work capacity evaluation: the final step of health surveillance]

Job fitness evaluation for specific jobs is the conclusive step of workers health surveillance. This should include a physical examination and specific tests for the evaluation of organ functions which are the target for risk factors in the working environment. Occupational physicians must assess job fitness following a specific procedure: cooperation with the employer in the process of risk assessment, creating of a medical surveillance protocol related to the existing risks, implementation of medical surveillance, evaluate of etiological diagnosis of workers' illnesses and express the job fitness assessment. Possible patterns of assessment are: no job limitations, some specific temporary or permanent job limitations, temporary or permanent unfitness. The competence of the occupational physician is crucial when addressing specific problems of the workers, such as indvidual hypersusceptibility, particular tasks, illnesses, pregnancy. The occupational physician's competence is also required after fitness evaluation when transferring the worker to a more suitable job when he is deemed unfit for a job at risk and in selecting adequate personal protective equipment. In addition, the physician must perform other duties according to the existing regulations such as informing workers to obtain their consensus and the assurance of maintaining of professional secrecy as regards personal information. The occupational physician is expected to be independent and impartial towards both employer and employees, which is obtained by up-dating professional skills and by acting with care and honesty.