Acceptability of adverse childhood experiences questions for health surveillance in U.S. Armed Forces

BACKGROUND: Research has documented a consistent and strong association between adverse childhood experiences (ACE) and negative health outcomes in adulthood. The Department of Defense is expanding health surveillance of military members and considering the inclusion of ACE questions. OBJECTIVE: To explore the perceptions and attitudes of service members and spouses regarding the use of ACE questions in routine health surveillance. METHOD: Forty-one active duty service members and spouses were interviewed at two Army troop medical centers. Semistructured qualitative interviews were used to examine their views regarding the use of ACE questions in military health surveillance. RESULTS: Participants believe there is value in health surveillance; however, they are cautious about providing ACE or other information that may be perceived negatively, without confidentiality reassurances. CONCLUSION: Successful employment of ACE questions in active duty military health surveillance will depend on the ability of military health officials to ensure confidentiality and to communicate the relevance of ACE to health status.     

Dynamics of returning the injured and ill to military and work responsibilities in wartime]

Returning of the injured and diseased to military and working duties in war have been trained and tested in the final training of members of the School of Reserve Medical Officers of the Military Medical Academy in the period 1985-1989. The time of returning of the injured and diseased members of the armed forces depends directly on the organization of the military medical and public health service, and especially of the preparedness of health personnel, well equipped military medical units and health institutions and the consistent application of the unique military doctrine.     

Evaluation of the provision and needs of the medical service of the Russian Federation for hospital beds

Taking into account the average statistical data of the last years the need of treated contingents for hospital beds constitutes 9.7%. Increase in accessibility of hospital treatment for the military pensioners and members of families as well as improvement of management of military hospital affairs will increase the index up to 9.9%. With transfer of military medical service to national standards and development of hospital-substitutive technologies the need for hospital beds will constitute 8.4%. The results obtained show that if all contingents attended to RF AF medical service would have the opportunity to treat only in the military medical institutions the reforming of military health should be aimed at maintenance and more effective use of hospital bed fund.     

透视美军"部队健康全面保护"构想

“部队健康全面保护”构想是美军军事医学的纲领性文件，是系列的健康保护规划，是美军“2010年联合构想”的卫生勤务子构想。其核心思想是强健促进、伤病预防、战救勤务并重，全面保持、恢复和提高军人健康。该构想对美军军事医学产生了重要影响，对我军也有重要启示。     

The conception of physician staff training and regular policy of Russian Federation Armed Forces Medical Service

The Conception proposed by the authors is an ideology of development of medical service regular support that determines the main contents of regular policy. The problems discussed in the article are the following: the primary directions and main principles of regular policy in RF Armed Forces medical service; bringing the medical service up to strength; the state and main directions for improving the system of military medical education; the postgraduate and additional professional education of military medical cadres; the improvement of work with medical service managerial staff; as well as the development of system for managing the medical service regular resources in the RF Armed Forces. The main directions to develop the system for managing the regular resources are the following: the improvement of information support, the use of modern automated control systems; the introduction of new analytical, educational and informative technologies in practice; the further modernization, improvement of quality and effectiveness of military medical educational system; the improvement of organizational-and-staff structure in military health service institutions; the improvement of regular staff activities--the development of regular management; the improvement of medical staff certification in the Armed Forces; the improvement of medical service Headquarters' activities and development of modern functional model for managing the military medical cadres. The Conception proposed is directed to the further development o regular potential--the main resource of military health service.     

Career History Archival Medical and Personnel System

The Career History Archival Medical and Personnel System is a database that provides information on cancer, chronic diseases, occupational and preventive medicine, epidemiological research, and the use of health care in the Navy and Marine Corps. It was created at the Naval Health Research Center for enlisted Navy personnel, and it is being expanded to encompass all military personnel. Its objective is to provide a comprehensive, chronologically ordered database of career and medical events in all active duty military service members and to track career and disease events in order from the date of entry to service to the date service ended. Events include the dates of beginning and ending of each specific military occupation, all assignments to a military units or ships, all hospitalized diseases, and other events. The database contains detailed epidemiological data on more than six million members of the military services. It is the largest known epidemiological database in the United States.     

海军某部官兵医疗服务利用的多因素分析

目的了解影响某海军部队官兵门诊与住院服务利用的主要因素，积极推进海军部队卫生服务建设。方法采用分层整群随机抽样，共调查某海军部队官兵3700名，有效问卷3566份，有效率96．38％，利用Logistic回归模型进行分析。结果该部队官兵的两周患病就诊率是52．96％，门诊供药情况是影响门诊服务利用的最主要因素；年住院率为7．68％，文化程度、自感病轻、自我治疗等因素是影响住院服务利用的主要因素。结论该部队官兵医疗服务需要量大，但利用有待提高。建议开展有针对性的健康教育，使部队官兵增强自我保健意识。卫生管理机构应加大对基层重点保障部位的投入，更好满足基层官兵的医疗服务需要。     

The results and aims of Russian Federation Armed Forces medical service activities

In the past year the main efforts were concentrated on bringing the medical service staff and structure into line with the Armed Forces fighting staff and the problems being solved. The medical forces and means of permanent battle readiness have gotten the further development. The system providing the medical equipment and property was subjected to radical reorganization. The normative-and-law basis of military health service was improved and the licensing of military medical institutions' activities including those stationed outside the Russian Federation was conducted. The significant result of 2006 was the approval of a Conception of military medical service regular policy, the main principles of which are the openness, the scientific substantiation of quantitative and qualitative characteristics of medical staff and the rise of military medical service prestige. In 2007 the main aims of medical service are connected with the problems of battle and mobilization readiness, organizational construction, treatment-and-prophylactic support, troop sanitary-and-epidemiological safety, regular work and military medical education.     

Survey of repellent use by service members arriving in Kuwait for Operation Iraqi Freedom 2

The 8th Medical Brigade, deployed to Kuwait in January 2004 in support of Operation Iraqi Freedom provided theater-wide health service support and medical command and control. An historic "surge" of troops and equipment occurred during our deployment as 140,000 service members (SMs) redeployed out of theater and 110,000 arrived to take their place. The brigade's preventive medicine personnel conducted a questionnaire-based survey at military camps in northwestern Kuwait in mid-March to determine whether SMs had been provided with supplies and information to protect them against endemic vector-borne diseases. Of 1,200 questionnaires distributed, 870 (73%) were returned. In addition to military affiliation information, the survey contained specific questions related to the provision of n-diethyl-m-toluamide repellents, permethrin and treated uniforms, and medical threat briefings. On average, less than one-half of the SMs received these resources before their arrival in Kuwait. Significant differences of resource provision existed among service branches, components, and mobilization or deployment stations.     

Determination of the reasons for unfitness for military service in Turkey

This study aims to evaluate the frequencies and diagnosis types of cases in which young adult males were classified as unfit for military service before or during military service. This cross-sectional study was conducted between November 1998 and October 1999 by investigating the military medical board records of 21,985 "unfit" cases. Unfit for military service decisions were based on any of 436 different diagnoses. Twenty-three diagnosis types, each with a frequency of greater than 1.0%, collectively accounted for the majority of cases (59.2%). Initial medical examinations before service detected 64.0% of cases, whereas the remaining 36.0% were detected during service. Initial medical examinations can be a remarkable data source to determine the health profile of a young adult male population. High rates of failure in initial medical examinations call for improvements to initial medical examination procedures, which should eventually lead to cost savings for the military.     

Gaps in expectations among clients of secondary medical services in the military system compared with the civilian system as a satisfaction index

The Israel Defense Forces Medical Corps operates a health network for Israel Defense Forces soldiers. Secondary medicine is included in the services to which soldiers are entitled. It is provided to military personnel through two parallel systems: within the Medical Corps specialists' clinics and through the auspices of a number of civilian hospital outpatient clinics. The military medical system, like the civilian medical system, is designed to serve its clientele. One of the indices for ascertainment of satisfaction with medical services is compatibility of client expectations with the service actually received. In this study, we present a gap index that demonstrates that there is gap in satisfaction among soldiers receiving secondary medical services from the military network compared with soldiers who receive secondary medical services from the civilian network. We designed a questionnaire administered to 1,532 soldiers and used 1,359 (89% response rate) for our analysis. The military system provides soldiers with services fully in synch with military regulations. Consequently, in most cases, there is a gap between soldiers' expectations from military medical service and the service they receive in practice-a phenomena that impairs soldier satisfaction. On the other hand, soldiers receiving medical services and treatment from the public civilian system receive, for the most part, service and treatment that meets or even exceeds their expectations because the system operates according to other regulations.     

Organization of surgical measure in military hospitals

The reform of military health service intends a clear organization of medical attendance, and, first of all, surgical one, particularly in military hospitals with different patient capacity. Seeing it leaders of surgery units in medical service got the task to elaborate the standards of realization of surgical attendance for military hospitals with different patient capacity during peaceful time, correctly execute all orders on preparation of military surgeons, enroot new high-quality and expensive types of maintenance into practice. Optimization and standardization of processes of surgical maintenance in Defense Establishment of Russian Federation, of tasks in the sphere of staff politics and of teaching process, modernization of technical equipment of medical service and enrooting new high-quality methods in practice allows augment the effectiveness of surgical attendance in military hospitals with different patient capacity.     

2011年度美军卫生勤务进展概述

本文分析了2011年度美军卫勤发展的重要动态,概述了美军卫勤发展的总体态势,总结归纳了美军卫勤转型中的主要成就和经验.主要内容包括:卫勤组织管理、战时医疗保障、平时医疗保障、医学教育训练和军事医学科研.     

Delphi technique: theory and suggestions on usage in health care and military medicine

The authors pursued research of adaptability of Delphi technique for solution of organizing problems of health care and military medicine in modem conditions. The essence of the research lies in the fact that with the help of serial consecutive actions--questioning and interviews of the most authoritarian specialists--intellectual elite of health care and military medicine (former leaders of GVMU MO RF (State Military-Medical Department of Moscow Region of Russian Federation) and their deputy directors, also famous specialists in the field of organization of health care and military medicine), and with the help of "brainstorms" to achieve the maximal agreement under the elaboration of strategy, ways and perspectives of the development of medical service of MO RF and also search of concrete solutions of actual military-medical problems.     

军队人员门诊用药方案的综合评价与分析

目的 探讨符合卫生需求和医疗保障的军队人员门诊用药的可行方案。方案 运用德尔菲法建立评价指标体系,分析影响军队人员门诊用药方案的因素,运用品种简化法分析方案的可行性。结果 第三种方案,即总部制定军队人员门诊用药的基本原则和要求为较优方案。结论 在现阶段,总后勤部卫生部应制定军队人员门诊用药的基本原则、要求和监督管理措施,各级医疗单位结合各自的卫生保障任务,制定相应的军队人员门诊用药目录和保障措施。     

Stability operations and the implications for military health services support

This paper examines the implications of the new military campaign type--Stability Operations--on military health service support. The paper uses the format of the medical estimate process and shows how the health service support planning factors of Mission Analysis; Ground; Enemy forces; Friendly forces; Time and Space; Security; Casualty Estimate; Medical Command, Control, Communication, Computers and Information (C4I); Medical Capabilities; Medical Force Protection; Medical Logistics; and Medical CBRN are affected by this change. The paper also identifies two new roles for military medical services, assistance to security sector reform and assistance to reconstruction and development. These two new roles will be discussed more fully in later papers.     

Shaping the medical environment in Kosovo through engagement

Operation Joint Guardian in Kosovo represents one type of military operation that the United States and other nations could be engaged in during the next 25 years. These military operations also carry unique challenges to a senior medical officer (or medical task force commander). In Kosovo, the senior medical officer had to help shape the medical environment as the military coalition sought to restore a safe and secure environment. This article discusses medical engagement strategies specific to Kosovo, where helping to shape the medical environment demanded that the senior medical officer engage with other coalition nations, United Nations (U.N.) agencies, and selected Kosovar health care providers. Successful implementation of the U.N. health care strategy is one of the key elements of U.N. success and the military coalition's exit from Kosovo. The goal of this report is to form a template for medical engagement strategies that a future senior medical officer may use in other similar military operations.     

Assessment of changes in mental health conditions among sailors and marines during postdeployment phase

Previous research regarding the mental health ramifications of military deployments focused on the U.S. Army population. As part of its deployment health surveillance mission, Navy and Marine Corps Public Health Center conducted a study of the Department of Navy population to identify reported mental health effects associated with Operation Iraqi Freedom, describe mental health care utilization by returning service members previously deployed in support of Operation Iraqi Freedom, and examine the relationships between self-identified risks and provider referral practices. Despite a considerable number of self-reported mental health concerns, referral for mental health consultations and health care utilization were rare. The psychological well-being of service members is essential to the military's optimum functionality and operational readiness; therefore, continued research in this area has significant bearing on future force health protection efforts. Additionally, this study highlights the need for further research on deployment-related mental health concerns.