美军特需药品军民融合管理经验借鉴研究

军队特需药品(简称"军特药")是军队保障作战需要和维护国家安全的重要战略物资,历来受到各国军队高度重视.美军在长期的军特药管理中,取得了许多宝贵的经验与教训.该文通过整合分析美军与FDA的军特药在科研、采购、使用和储备等方面的军民融合管理现状,系统总结其成功经验,发现存在问题,并对我军探索适合自身特色的军特药军民融合管理提出系列建议.     

Making prevention of abuse and neglect through dental awareness green

Family violence encompasses child, spouse, and elder abuse and neglect and is viewed as a serious public health threat in our society. Unfortunately, abuse and neglect are commonplace in our society and are not limited to the civilian sector. The military community mirrors the civilian sector in the prevalence of abuse and neglect. Traditionally, identification and intervention of suspected cases of abuse and neglect was thought to be the role of the medical provider. Reports that up to 94% of family violence injuries have head and neck components, which is the very site that dental providers focus their attention, justifies the need for dental involvement. The U.S. Army Dental Command's Health Promotion and Disease Prevention Program's newest initiative is a family violence awareness program called Prevention of Abuse and Neglect through Dental Awareness (PA.N.D.A.). The program augments the Army Family Advocacy Program and gives dental-specific knowledge to our providers. The goals of this article are to describe the new program of the U.S. Army Dental Command that focuses on providing education and awareness to the dental community regarding family violence and to report the results of a survey that has been administered during the family violence training. More than 71% of individuals attending the P.A.N.D.A. training claimed to have previous training in family violence, whereas only 44% were knowledgeable about military regulations governing abuse and neglect.     

Pneumococcal vaccine to counter emerging infectious disease threat in the military.

Streptococcus pneumoniae causes severe morbidity and mortality worldwide and poses a significant threat to the health and readiness of U.S. military personnel. Although a vaccine to prevent pneumococcal infections has been available for almost 25 years, its use has been limited. Recently, increasing antibiotic resistance among S. pneumoniae strains has emerged, prompting health care professionals to reevaluate the benefit of administering pneumococcal vaccine. The Naval Health Research Center, in collaboration with professionals from numerous civilian and military organizations, has initiated a rigorous double-blind, placebo-controlled trial investigating the operational value of vaccinating young adults as they enlist in the military.     

U.S. military fatalities due to Neisseria meningitidis: case reports and historical perspective

Meningococcal disease has historically been associated with military populations, particularly during periods of mobilization. Although the U.S. military has now been engaged in conflicts for nearly a decade, the incidence of meningococcal disease in the U.S. population as a whole has reached historic lows. Despite vaccination of all service members in basic military training, the risk of meningococcal disease appears to be equal to or greater than that of the civilian population. These 3 case reports of recent fatalities in the U.S. military and their historic contexts illustrate the circumstances under which meningococcus can strike and highlight the need for continued vigilance in military populations.     

The use of deployable military hospitals after hurricanes: lessons from the Hurricane Marilyn response

Deployable military hospitals are frequently requested to supplement surviving local health care capabilities after disasters. Although some authors have advocated their use after mass casualty events such as earthquakes, previous reports have questioned the appropriateness of deploying these hospitals after destructive storms. These hospitals are relatively slow moving, expensive, and may require the diversion of local resources to support. After Hurricane Marilyn in 1995, a military hospital was deployed to the U.S. Virgin Islands. For a variety of reasons, the local health care community declined to use the facility once it was operational. This report is based on interviews with disaster managers and local health officials involved in the Hurricane Marilyn response. Recommendations include improving communications while requesting resources, broadening the range of available health assets to increase flexibility, positioning resources regionally or in the civilian sector, and creating clear indications for full-scale deployable hospitals when they are required.     

Regional methamphetamine use among U.S. Army personnel stationed in the continental United States and Hawaii: a six-year retrospective study (2000-2005)

Substance use disorders constitute a serious and persistent threat to military readiness and to the health and safety of military personnel and their families. Methamphetamine is among the most addictive and damaging of commonly abused drugs; this is of great concern for military health providers in Hawaii due to the unusually high prevalence in the local community. The effect of regional drug use on active duty subpopulations has not been previously studied. This study includes a 6-year retrospective sample of laboratory-confirmed methamphetamine-, cocaine-, and marijuana-positive drug tests among Army soldiers stationed in Hawaii and western and eastern continental U.S. installations. The findings suggest that active duty members are significantly affected by the local drug climate. However, current military drug policies also deter use as evidenced by low absolute drug-positive rates even in regions of high civilian prevalence.     

毒物战的现实威胁

2002年,一份美国空军发起的关于毒物战争的研究报告引起了美国军方和平民灾难应急救援组织的关注。该报告通过对在战争中恶意使用有毒工业化学物质的历史事件的回顾,提出了毒物战（ toxic warfare ）的概念,并讨论了它对美国军事和国土安全的影响。该文综述了毒物战的历史及其对美国军事和国土安全的影响,分析了我国面临的毒物战威胁,并就应对毒物战威胁提出了若干启示。     

Summary of the 2004-2005 influenza season in the U.S. Army Europe

Influenza and other respiratory infections, the most common cause of acute infectious disease in U.S adults, are also the leading cause of outpatient illness and a major cause of infectious disease hospitalization in U.S. military personnel. Although respiratory disease control is improved, epidemics continue to occur, and respiratory disease in military trainees continues to exceed that in U.S. civilian adults. Overall, Department of Defense utilization of the trivalent inactivated vaccine was much lower than anticipated during the 2004-2005 season. The slow start to the 2004-2005 influenza season resulted in a low demand for influenza immunization by the medically high-risk beneficiary population of the Department of Defense. Surveillance for influenza during the 2004-2005 season in U.S. Army Europe reached unprecedented heights, testing and confirming more cases than in any previous year.     

Army trauma research: tapping the potential

Trauma management is the primary mission of military surgeons. Since the Vietnam War, however, military surgeons have relinquished leadership in clinical trauma care to the civilian sector, particularly to urban university surgeons. In this paper we explore whether the Army's contribution to trauma research has also diminished. Using standard bibliometric analysis of publication counts, we have shown that few recent publications related to trauma have originated from U.S. Army Medical Centers, compared with adjacent civilian universities. In 1988, 16 papers originating from the eight Army Medical Centers had key words related to trauma. In contrast, eight universities adjacent to the Army's medical centers published 139 articles on trauma. Problems including lack of clinical exposure to trauma patients, lack of funding, and inadequate emphasis on staff research training have contributed to this decline. We review these factors and describe solutions that could reverse this trend.     

The medical department in military operations other than war. Part I. Planning for deployment.

Many military deployments are "military operations other than war" (MOOTW), a spectrum of assignments less than all-out combat. The corresponding medical support requirement differs from conventional military medical combat support and also from customary civilian medical practice. Hence, medical planners will use different doctrine and planning tools than are used in civilian facilities or on field training exercises when tasked for MOOTW activities. The deployment team must be self-sufficient, plan for very large numbers of affected individuals, and arrange for food, water, shelter, sanitation, power, light, security, transportation, communications, and team health care in advance of arrival. Careful and well-thought-out advance liaison with numerous interested parties is required to ensure mission success. The medical department on these missions may represent the lead element, and other warfare specialists and line and staff officers may support the medical mission by providing security, communications, transportation, and logistics. The medical team may find that it represents the foreign policy "point of the spear" during MOOTW deployments.     

The financial impact of deployments on reserve health care providers

This study retrospectively surveyed the financial impact of deployments on 17 U.S. Army Reserve health care providers. Due to multiple mobilizations, 29 separate deployments were reported. The deployments, mostly between 2001 and 2005, typically lasted 3 months during which 86% reported no civilian income and 76% reported no civilian benefits. Solo practice providers reported the greatest financial losses due to continuing financial responsibility related to their civilian practice despite being deployed. Overall, 2 deployments did not change, 9 increased, and 16 decreased the medical officer's income. Two were not reported. In this small retrospective convenience sample study, solo practice U.S. Army Reserve health care providers were found to be at highest risk of financial losses during military deployments. This being said, no price can be put on the privilege of serving our men and women in uniform.     

The evolution of dependent medical care in the U.S. Army

There is great focus within the military medical community regarding the ever growing cost of medical care overall and dependent care specifically. A great deal of discussion relates to the delivery of care through a growing military-civilian partnership, where an increased amount of health care will be referred to an ever growing network of civilian providers. The U.S. military establishment now stands at an important crossroad leading into the future of dependent care. However, the special concerns, which arise from the responsibility of caring for military dependents, are not a solely recent phenomenon. Ever since the establishment of a permanent standing U.S. Army in the late 1700s, there have been families in need of medical treatment. Although changes occurred continuously, the development and evolution of policies regulating the delivery of medical care to dependants can be divided into three periods. The first is the longest and ranges from the establishment of the Army until the year 1900. The second period spans from 1900 to the post-Korean War year of 1956. The third and final period is from 1956 to 1975. Special changes and advances in each of these periods have served to shape the face of dependent care in today's Army Medical Department.     

Evaluation of the malaria threat at the multipurpose range complex, Yongp'yong, Republic of Korea.

As part of an operational effort to control the transmission of malaria after its reemergence in the Republic of Korea, a number of U.S. military and Korean civilian health workers assessed the situation at a large training site where two cases had been transmitted. The vector mosquitoes (Anopheles sinensis) probably had a limited flight range (< 1 km) in this situation based on low numbers in permanent light traps and biting collections at the billeting area compared with collections from light traps and larval surveys where the mosquito was abundant. The threat of malaria was proven by the presence of infected local Korean residents (13 of 105 sampled). However, only a small proportion of U.S. soldiers (39 of 78 surveyed) at the training site used personal protective measures. Further efforts should include improved techniques for informing and motivating soldiers to use personal protective measures and cooperation with Korean authorities to perform vector control in civilian areas bordering the training area.     

A comparison of median hearing thresholds from U.S. Navy and U.S. Army audiometric data bases

This study examined 1984 monitoring audiometric data from U.S. Navy (military and civilian) employees whose workplace required a mandatory hearing conservation program. Median hearing thresholds were compared in U.S. Navy employees, U.S. Army employees also monitored by a hearing conservation program, and a standard population from the First National Health and Nutrition Survey. Age group and frequency-specific comparisons were included. Results at 4 kHz and 6 kHz demonstrated higher median thresholds in the Navy populations that were significantly higher by clinical and statistical criteria. Possible reasons for the differences are given.     

Surveillance for enteric parasites among U.S. military personnel and civilian staff on Joint Task Force Base-Bravo in Soto Cano, Honduras and the local population in Comayagua and La Paz, Honduras

A study was conducted in Honduras to address whether military personnel assigned to Joint Task Force-Bravo in Soto Cano, Honduras, routinely acquire parasite infections, and the results were compared with those collected from civilian base workers and the general local population in the nearby towns of Comayagua and La Paz. Results from this study report 21 species of enteric parasites among Hondurans living in Comayagua and La Paz, 13 species among local Hondurans working as base civilian personnel, and 3 species among U.S. military servicemen and women. The most prevalent organism found was Blastocystis hominis, infecting 95 people (35.8% of 265 samples). Prevalence rates in this study are similar to documented reports on parasite transmission in Central American countries and other areas of Honduras. Although preventive protocols for U.S. military "force protection" appear to be effective in controlling transmission, continuous surveillance for enteric parasites is warranted because of the high parasite loads in the populations with which military personnel come into contact.     

美军平时医疗保障概况与改革进展

随着近年来美军卫生经费和保障对象健康需求的日益增长,美军平时医疗保障系统不得不采取多项创新性改革措施来控制医疗成本、加强疾病预防和伤员康复,并推行新的初级保健模式,以期在提高医疗保障水平和服务质量的同时有效控制卫生经费。本文主要介绍了美军平时医疗保障体系的概况及最新改革措施与成效。     

Motor vehicle fatalities among men in the U.S. Army from 1980 to 1997

This retrospective cohort study compared trends in motor vehicle occupant fatalities among men in the Army with men in the civilian U.S. population. Motor vehicle fatality rates from 1980 to 1997 indicated both groups showed declines in fatality rates. The overall age-adjusted motor vehicle fatality rate for 17- to 44-year-old males in the Army fell from 40.8 to 20.6 per 100,000, a 49.5% decline. In the U.S. population, the rate dropped from 38.1 to 23.3 per 100,000 for a 38.8% decline. Deaths from motor vehicle crashes fell by almost 50% in the Army during the study period; however, motor vehicle crashes remain the leading cause of death for the Army. U.S. military policies and law enforcement have the potential to make even further gains in reducing motor vehicle crashes and injuries among military personnel.     

Mental health care provision in the U.K. armed forces

Like the United States, the United Kingdom (U.K.) population expresses ongoing interest in the mental health of their nation's armed forces and veterans. Current U.K. military mental health research efforts center on the work of military and civilian academics based at King's College London. These academics work closely with NATO partners, in particular the United States, in planning for future research. Conscious of the cultural dimensions to mental health among military personnel, considerable efforts have been made to strengthen informal support mechanisms including the training of lay Trauma Risk Management (TRiM) practitioners and other welfare services. Formal healthcare support provision comes from primary care providers and Departments of Community Mental Health, which provide local case management and appropriate escalation to in-patient services where required. Although veteran's healthcare is provided by the National Health Service, considerable efforts have been made to ensure their services best meet the needs of veterans and their families.     

Military nursing and diagnosis-related groups: using the past to benefit our future

To contain the escalating cost of health care, a prospective payment system is being introduced into the military. The authors propose a proactive approach to this change in health care financing by evaluating the experiences of nurses to a similar change in the civilian sector. These approaches are presented as nine interrelated lessons: responding optimistically; shifting into a business mode; valuing clinical nursing experts; understanding the implications for documentation; moving to decentralized management; changing outpatient care delivery; considering the effects on job satisfaction; evaluating the relationship between costs and nursing resource consumption; and basing nursing practice in science.     

美军与FDA的特需药品协调政策解析及其对我军的启示

特需药品是军队执行军事行动以及其他国家安全行动中实施医学保障的重要物质基础之一,历来受到各个国家军队的重视.美军在长期的特需药品管理中,取得了许多宝贵的经验.本文通过整合分析美军与美国食品药物管理局(FDA)的特需药品协调政策,总结其取得的经验,发现其中存在的问题,并对我军与中国国家食品药品监督管理局(SFDA)的特需药品协调政策提出建议.