Sexual harassment and assault experienced by reservists during military service: prevalence and health correlates

The current investigation identified the gender-specific prevalence of sexual harassment and assault experienced during U.S. military service and the negative mental and physical health correlates of these experiences in a sample of former reservists. We surveyed a stratified random sample of 3,946 former reservists about their experiences during military service and their current health, including depression, posttraumatic stress disorder, somatic symptoms, and medical conditions. Prevalence estimates and confidence intervals of sexual harassment and assault were calculated. A series of logistic regressions identified associations with health symptoms and conditions. Both men and women had a substantial prevalence of military sexual harassment and assault. As expected, higher proportions of female reservists reported sexual harassment (60.0% vs 27.2% for males) and sexual assault (13.1% vs 1.6% for males). For both men and women, these experiences were associated with deleterious mental and physical health conditions, with sexual assault demonstrating stronger associations than other types of sexual harassment in most cases. This investigation is the first to document high instances of these experiences among reservists. These data provide further evidence that experiences of sexual harassment and assault during military service have significant implications for the healthcare needs of military veterans.     

Understanding the impact of war zone experiences: a primer for civilian nurses

As the United States continues to fight the war on terror in Iraq and Afghanistan, the number of personnel deployed to war zones and transitioning back to the home front increases. After nine years of intensive experience, military nurses have learned much about the needs of wounded warriors in critical care settings and in acute phases of recovery. Several articles have been published about the lessons learned and skill sets needed by military nurses in critical care settings. The unique nature of the volunteer military, along with the deployment of reservists and contractors to war zones, has created a sub-population of individuals who have transitioned or are transitioning back into their civilian world. Nurses involved in primary care and emergency nursing can learn much from the experiences of those nurses who have worked with traumatic brain injuries (TBI), posttraumatic stress disorders (PTSD), alcohol abuse and substance abuse as ineffective coping mechanisms and risks of suicide. The purpose of this article is to share some of the lessons learned by military and veterans administration healthcare workers with civilian nurses.     

Using military friendships to optimize postdeployment reintegration for male Operation Iraqi Freedom/Operation Enduring Freedom veterans

Social relationships are important to health out comes. The postdeployment family reintegration literature focuses on the role of the civilian family in facilitating the transition from Active Duty military deployment to civilian society. The focus on the civilian family relationship may miss other important personal connections in veterans' lives. One such connection is the relationship many veterans have with former military unit members who served with them when deployed. Drawing on interviews with male Operation Iraqi Freedom/Operation Enduring Freedom veterans conducted from 2008 to 2009, we argue that the members of a military unit, especially during armed conflict, should be considered a resource to help the "family" reintegration process rather than impede it. This research has implications for current reintegration policy and how best to assist veterans transitioning into civilian society.     

How do I get an emergency civilian walking blood bank running?

The shift toward using a transfusion strategy in a ratio to mimic whole blood (WB) functionality has revitalized WB as a viable option to replace severe blood loss in civilian health care. A military‐civilian collaboration has contributed to the reintroduction of WB at Haukeland University Hospital in Bergen, Norway. WB has logistical and hemostatic advantages in both the pre‐ and in‐hospital settings where the goal is a perfectly timed balanced transfusion strategy. In this paper, we describe an event leading to activation of our emergency WB collection strategy for the first time. We evaluate the feasibility of our civilian walking blood bank (WBB) to cover the need of a massive amount of blood in an emergency situation. The challenges are discussed in relation to the different stages of the event with the recommendations for improvement in practice. We conclude that the use of pre‐screened donors as a WBB in a civilian setting is feasible. The WBB can provide platelet containing blood components for balanced blood resuscitation in a clinically relevant time frame.     

The transition from student to qualified nurse: a military perspective

This article explores some of the issues surrounding my transition from student nurse to qualified Royal Air Force staff nurse. It supports much of the research showing that the transition to staff nurse is stressful, with the time for preceptorship and supernumerary status varying. The education and support received during this period is still largely dependent on staff availability and this remains an area of concern. For military nurses the transition period is extra challenging, as there are military as well as nursing demands. This includes working predominantly in a civilian environment, while being aware that we may be deployed overseas with the military. However, the ability to adapt and adjust to changing circumstances is what essentially makes military nurses unique and distinctive. Provided that support is in place and appropriate clinical experience is obtained, we can fulfil our primary military roles.     

北京市军队医院首批非现役文职护士的工作、生活状况调查

目的了解军队医院首批非现役文职护士工作和生活状况,对非现役文职护士的管理给予针对性分析并为实现非现役文职人员的规范化管理提出建议。方法采用问卷调查法对北京市驻地5所三级甲等军队医院临床一线328名首批非现役文职护士的基本资料和工作、生活状况进行调查分析。结果军队医院首批非现役文职护士能胜任本职工作,自我发展需求高,能积极面对困难、有效应对压力。结论首批任用的非现役文职护士的前期培养任务基本完成,目前的人员队伍较稳定;但管理者仍需进一步完善对非现役文职护士的管理,注重专业素质和综合能力的培养,科学建设非现役文职护理队伍。     

Lessons from the tip of the spear: medical advancements from Iraq and Afghanistan

The conflicts in Iraq and Afghanistan have seen the advancement of combat medicine. The nature of the conflicts, with troops located in remote areas and faced with explosive ordinance designed to focus massive injuries on dismounted personnel, have forced military medical personnel to adapt accordingly. There has been a rekindling of interest in the use of tourniquets to stop exsanguination from extremity wounds, as well as in the transfusion of fresh whole blood from walking blood banks. These previously discarded techniques, born on battlefields long ago, have been refined and perfected and have led to an unprecedented survival for our wounded warriors. New developments in the field of applied hemostatic agents, damage control surgical techniques, and the implementation of an efficient evacuation system have also contributed to these results. The field of combat medicine has taken several concepts initially designed in civilian settings, such as temporary abdominal packing and vascular shunting, and adapted them to the military setting to provide state of the art trauma management to our troops in combat. In turn, developments in the resuscitation of the trauma patient, using increased blood and plasma products and less crystalloid, have been pioneered in conflict and transitioned to the civilian sector. Advancements made during the wars in Iraq and Afghanistan, as well as those still being developed, will shape the care of the injured patient, in both civilian and military settings, for the foreseeable future.     

军队医院文职人员管理现状的调查

目的了解军队医院文职人员管理中存在的主要问题,给予针对性分析并提出建议,实现对文职人员的规范化管理。方法采用自设问卷,对北京市驻地5所三级甲等军队医院的22名文职人员管理工作者进行调查,统计并分析军队医院文职人员使用与管理中存在的主要问题。结果军队医院文职人员管理结构合理,管理框架基本形成,培训呈现多样化,各项保障基本到位,但文职人员的归属感不强。结论军队医院文职人员的管理构架基本形成,但是仍需从构建管理体系、强化管理者素质、文职人员的有效培养和科学使用方面加以改进。     

Informed Consent and Ethical Issues in Military Medical Research

Informed consent in military research shares many of the same fundamental principles and regulations that govern civilian biomedical research. In fact, much of modern research ethics is grounded in events that occurred in the context of war or government‐sponsored research. Despite these similarities and common origins, research in the military has additional requirements designed to preserve service members' informed consent rights. The special nature of the superior–subordinate relationship in the military necessitates careful protections to avoid perceptions of coercion or undue influence on a military subject. Additionally, current legal and regulatory requirements for advanced informed consent significantly restrict the flexibility of the military to conduct research using waiver of consent. This has implications on the ability of the nation to develop effective medical treatments for the global war on terrorism. Nevertheless, work is under way to realign defense research policy with the norms of civilian biomedical practice. Future directions include the adoption of waivers for military emergency research, and the cautious introduction of human subject studies on the battlefield. This paper discusses historical background, regulatory differences, and concerns and challenges of some of these regulatory differences for research personnel that apply to informed consent and waiver of said informed consent for emergency research conducted by the U.S. military.     

Polish Orthopaedics in the Polish Army in the years 1918-1945

On the occasion of 75th anniversary of PTOiTr , the authors would like to present the history of military orthopaedics, which is inseparably connected with the tradition and history of Polish orthopaedics from the beginning to the present. This article is the first presentation of this kind in history. Using the few written sources which are available , including memoirs and reports sent in by different traumatic-orthopaedic units, the authors present individual orthopaedists including professors : J. Wierzejewski, W. Dega, A. Gruca, M. Garlicki, D. Tylman, B. Wróblewski, S. Malawski, T. Soko?owski and others, who devoted their careers wholly or partially to military service and military orthopaedics , as well as the patients - wounded or ill soldiers and institutions of military orthopaedics. In spite of the fact that we are only a part of a broader environment (representing about 8-10% of all orthopaedists) , we have always tried to make our mark, through our work and input, not only on the development of orthopaedic care of soldiers and civilians but also, to the best of our ability, on the development of orthopaedic knowledge and education and training of medical staff for military service and civilian medicine.     

部队新聘非现役文职人员军事训练伤发生情况的调查

目的了解部队新聘非现役文职人员军事训练伤的发生情况,为今后科学施训和完善文职人员培训管理提供理论依据。方法 2014年9-12月,采用自行设计的非现役文职人员军事训练伤情况调查问卷对222名部队新聘非现役文职人员进行调查。结果 222名新聘非现役文职人员训练伤的发生率为46.4%,高于既往部队新兵训练伤的发生率。结论部队新聘非现役文职人员军事训练伤发生率较高,影响了参训人员的身心健康和训练效果,需进一步加强其军事训练的健康教育工作。     

军队疗养院非现役文职护士心理健康与个性特征的相关性

目的分析某军队疗养院非现役文职护士心理健康状况及其与个性特征的相关性。方法选取某军队疗养院85名非现役文职护士,采用症状自评量表和卡特尔16项人格因素问卷进行心理测量,并将其得分与地方医院护士和军人护士进行比较。结果疗养院非现役文职护士的症状自评量表各因子分均低于地方医院护士和军人护士(P<0.01或P<0.05);疗养区护士的部分症状自评量表因子得分高于治疗区护士(P<0.01)。结论管理者应重视非现役文职护士的适应性训练,综合运用症状自评量表与卡特尔16项人格因素问卷选拔非现役文职护士。     

军队医院文职护士灾难救援能力的现状

目的了解某军队医院文职护士的灾难救援能力现状,为文职护士灾难救援能力培训提供科学依据。方法采用自行设计的军队文职护士灾难救援能力现状调查表,通过方便抽样对某军队2所三甲医院35名文职护士进行调查。结果军队文职护士执行灾难救援任务意愿较强,在灾难护理知识掌握上,对灾难护理概念、五大急救技术(即心肺复苏、止血、包扎、固定和转运)掌握较好,但是对三防医学救援知识、野外生存技能和伤情评估相关知识掌握欠佳。结论军队医院文职护士的灾难救护能力亟需全面提高,在平时战备训练中尤其应加强军事医学知识和野外生存能力的训练,以适应各种灾难救援的需要。     

军队医院文职人员培训与考核状况的调查分析

目的了解军队医院文职人员接受部队培养与考核的状况,给予针对性分析并提出建议,为制定和完善更有利于军队引进和培养优秀人才的相关政策提供依据。方法采用整群抽样法对5个省市6所军队医院350名各类专业文职人员进行调查,统计并分析其接受培训与考核的状况。结果文职人员岗前培训时间不等,以全脱产封闭式军事化训练为主;继续教育主要以参加院内培训项目为主;医院对文职人员的评价倾向于对业务技能与工作业绩的指标评价;考核结果主要运用于续聘或解聘的参考。结论军队医院文职人员的培训和考核体系基本形成,但需规范岗前培训和入职后的继续教育内容,强化考核对人才培养的激励作用并建立人才培养的长效机制。     

海上训练官兵SCL-90的测评分析

目的探讨海上训练官兵的整体心理健康状况,为做好海上训练官兵的心理卫生工作提供依据。方法应用症状自评量表（SCL-90）分别对1012名海上训练的官兵及980名未参加海上训练的官兵进行测试和分析。结果海上训练官兵SCL-90量表的测评总分、总分均值、阳性项目数、阳性项目均分及阴性项目数均明显高于未参加海上训练的官兵和常模,差异有统计学意义（P〈0．01）;未参加海上训练的官兵总分、总分均值、阳性项目数、阳性项目均分及阴性项目数与常模比较,差异无统计学意义（P〉0．05）。同时,海上训练官兵各因子得分均高于未参加海上训练的官兵及常模,差异有统计学意义（P〈0．01）;而未参加海上训练的官兵各因子得分与常模比较,无统计学意义（P〉0．05）。结论医院应开展海上训练官兵心理影响的研究,加强海上训练官兵的心理健康教育,增强官兵的心理防护能力和应急反应能力,不断提高部队的战斗力。     

Uniformed Medical Students and Residents in Emergency Medicine

“Uniformed medical students and residents” refers to medical school enrollees and physicians in training who are obligated to serve in the military after graduation or training completion. This is in exchange for 2 forms of financial support that are provided by the military for individuals interested in pursuing a career in medicine. These programs are offered namely through the Uniformed Services University of Health Sciences (USUHS) and the Health Professions Scholarship Program (HPSP). Uniformed medical school graduates can choose to serve with the military upon graduation or to pursue residency training. Residency can be completed at in-service programs at military treatment facilities, at out-service programs, at civilian residency training programs, or via deferment programs for residency training at civilian programs. Once their residency training is completed, military physicians should then complete their service obligation. As such, both USUHS and HPSP students should attend a basic officer training to ensure their preparedness for military service. In this article, we elaborate more on the mission, requirements, application, and benefits of both USUHS and HPSP. Moreover, we expand on the officer preparedness training, postgraduate education in the military, unique opportunities of military medicine, and life after completion of military obligation.     

军队医院文职护士继续教育学习需求的调查与分析

目的 了解军队医院文职护理人员对继续教育学习需求的现状,为科学开展继续教育提供依据.方法 按单纯随机整群抽样方法抽取10所军队综合性医院在职文职护士2 000名,采用"军队医院护理人员继续教育调查问卷"对其进调查.结果 回收有效问卷1 912份.93.7%～95.2%的文职护士有进一步提高军人素养和军事护理学知识与技能的需求,不同工作年限、不同层次护理人员对继续教育的内容、形式的需求不同.结论 文职护士对继续教育需求大,亟需通过分层次、科学合理的继续教育全面提升综合素质,以更好地满足岗位任职和现代卫勤保障的需求.     

Community-integrated brain injury rehabilitation: Treatment models and challenges for civilian, military, and veteran populations

Traumatic brain injury (TBI) is a major health problem in civilian, military, and veteran populations. Individuals experiencing moderate to severe TBI require a continuum of care involving acute hospitalization and postacute rehabilitation, including community reintegration and, one would hope, a return home to function as a productive member of the community. In the military, the goal is to help individuals with TBI return to active duty or make an optimal return to civilian life if the extent of their injuries necessitates a "medical board" discharge. Whether civilian, military, or veteran with TBI, individuals who move beyond the need to live in a facility must be reintegrated back into the community. This article discusses four treatment models for community reintegration, reviews treatment standardization and outcome issues, and describes a manualized rehabilitation pilot program designed to provide community reintegration and return to duty/work for civilians, veterans, and military personnel with TBI.     

军队医院非现役护理文职人员执业感受的质性研究

目的了解军队医院从事临床护理工作文职人员的执业感受,为完善文职人员管理提供理论依据。方法采用质性研究中的现象学研究方法,对9名军队医院护理文职人员进行非结构访谈,并用现象学分析法对获得的资料进行分析和整理,提炼出主题。结果文职人员执业感受的4个主题：自身地位重新确立、适当压力成为良性刺激、现实与期望存在差距、对职业前景感到迷茫。结论军队医院文职人员的职业感受以消极为主,应合理使用与管理文职人员,重视其地位转变后的身份确立、压力缓解、保障落实、职业规划,以稳定护理队伍,促进军队医院护理水平的整体提高。