21世纪高级医学人才素质教育及实施的基本途径

（1）目的 探讨21世纪高级医学人才的素质教育及实施的途径。（2）方法 根据21世纪医学和社会发展的需要,分析了21世纪高级医学人才的素质及实施素质教育的基本途径。（3）结果 21世纪高级医学人才要掌握高新技术,拥有广博的知识和坚实的医学基础,具有创新精神和开拓能力,对具体工作具有较强的适应性。转变教育思想,调整新的医学教育课程结构和优化课程内容体系,建立一支适应素质教育需要的师资队伍,创建校园精神文明和营造素质教育氛围是实施素质教育的基本途径。（4）结论 21世纪需要高素质医学人才,转变教育思想和观念,优化课程体系和教学内容、构建新的人才培养模式是实施素质教育的基本途径。     

Healthcare Workers’ (HCWs) attitudes towards mandatory influenza vaccination: A systematic review and meta-analysis

Influenza is a disease responsible for thousands of deaths every year. Although healthcare workers (HCWs) represent a way of contagion for patients, vaccination coverage among them is low. Mandatory vaccination has been proposed, but controversies remain. This systematic review and meta-analysis aimed to assess the acceptance of mandatory vaccination by HCWs, and to investigate associated characteristics. MEDLINE, Scopus, Embase, PsycInfo, CINAHL and Web of Science were used to search for studies assessing the topic. PRISMA statements were followed. Of the 13,457 univocal records found, 52 studies were included in the systematic review and 40 in the meta-analysis. The pooled proportion of HCWs accepting the policy was of 61% (95% CI: 53%- 68%) but with great heterogeneity between continents (from 54% in Europe to 69% in Asia) and in different professionals (from 40% in nurses to 80% in students). Vaccinated HCWs agreed more frequently with mandatory vaccination than non-vaccinated ones. More studies that consider mandatory vaccination acceptance as the main outcome are needed, but the results of this study confirm that in some settings the majority of HCWs favour mandatory vaccination. This, combined with effects that a flu epidemic could have if overlapped to pandemics with similar symptoms, requires renewed considerations on mandatory vaccination.     

“You Have to Die Not to Come to Work”: A Mixed Methods Study of Attitudes and Behaviors regarding Presenteeism,Absenteeism and Influenza Vaccination among Healthcare Personnel with Respiratory Illness in Israel, 2016–2019

IntroductionHealthcare personnel (HCP) have an increased risk of exposure to influenza and other respiratory pathogens. Increased presenteeism, decreased absenteeism, and low uptake of the influenza vaccine can contribute to the spread of influenza among HCP in healthcare settings. We used a mixed methods approach to investigate attitudes and behaviors of HCP in Israel towards influenza vaccination, presenteeism, and absenteeism.MethodsThe study took place over three influenza seasons (2016–2017, 2017–2018, 2018–2019) at the largest hospital in southern Israel. We administered a Knowledge, Attitudes and Practices (KAP) questionnaire and conducted semi-structured interviews with HCP who had been recently ill with respiratory symptoms. The KAP questionnaire included closed-ended questions about attitudes and behaviors regarding influenza, working while sick, and influenza vaccination. The interviews investigated HCP’s perceptions of influenza infection and attitudes about absenteeism, presenteeism, and the influenza vaccine.ResultsWe conducted 74 semi-structured interviews over three influenza seasons. Four HCP were interviewed twice, in separate seasons for different illness episodes. The 70 individuals interviewed included 16 physicians, 45 nurses or technicians, and 9 administrative staff. The median age was 42.5 years (range: 25–60), and most (79%) were female. Half (50%) got vaccinated against influenza before their illness episode. In interviews, most HCP said they come to work while sick (presenteeism) due to a strong personal work ethic and an institutional culture that discourages taking sick leave (absenteeism). HCP expressed skepticism about the effectiveness of the influenza vaccine as well as concern that the influenza vaccine causes severe illness.DiscussionOver three influenza seasons in Israel, HCP cited a number of reasons for working while sick, and doubted the usefulness of influenza vaccine. Addressing reasons for presenteeism and vaccine hesitancy among HCP is crucial to protect HCP and patients from influenza virus infection and other viral respiratory illnesses, such as COVID-19.     

History of pandemic H1N1-containing influenza vaccination and risk for spontaneous abortion and birth defects

BackgroundOne recent study suggested an association between receipt of pandemic H1N1 (pH1N1)-containing vaccines in consecutive influenza seasons and spontaneous abortion, but corroborating scientific evidence is limited. In the present study, we leveraged a population of vaccine-compliant pregnant military women to examine history of pH1N1-containing influenza vaccination and adverse pregnancy outcomes. Because seasonal influenza vaccination is compulsory for military service, safety concerns regarding repeat vaccination are particularly relevant in this population.MethodsPregnancies and live births from Department of Defense Birth and Infant Health Research program data were linked with military personnel immunization records to identify women vaccinated with a pH1N1-containing vaccine in pregnancy prior to 21 6/7 weeks’ gestation, October 2009–April 2015. Cox and modified Poisson regression models estimated associations between vaccination with pH1N1- versus non–pH1N1-containing influenza vaccine in the season prior to the index pregnancy, and spontaneous abortion and birth defects, respectively. Cox models were calculated for two periods of follow-up: through (1) 21 6/7 weeks’ gestation and (2) 28 days postvaccination.ResultsOf 26,264 pregnancies, 21,736 (82.8%) were among women who received a dose of pH1N1-containing vaccine in the prior influenza season and 4,528 (17.2%) were among women who received non–pH1N1-containing vaccine in the prior influenza season. Among 23,121 infants, 19,365 (83.8%) and 3,756 (16.2%) had mothers exposed and unexposed to pH1N1-containing vaccine in the prior influenza season, respectively. The adjusted hazard ratio (aHR) for spontaneous abortion approximated 1.0 across the complete follow-up period (95% confidence interval [CI]: 0.89–1.13) and was slightly elevated when censored at 28 days postvaccination, though the CI was imprecise (aHR: 1.19; 95% CI: 0.97–1.46). No associations with birth defects were observed.ConclusionThis work lends additional safety evidence and support for vaccination against pH1N1 in pregnancy, regardless of the vaccine received in the prior influenza season.     

人工智能在军事医学中的应用现状及展望

介绍了人工智能(artificial intelligence,AI)在伤员搜救和管理、伤员救治、军事医学培训、医疗数据管理等军事医学领域中的应用现状,分析了AI在军事医学应用中存在的问题,指出了向强AI系统迈进、突出环境自适应性,紧跟AI技术发展、系统高度综合集成,大力发展数据库技术、确保产品应用价值是未来AI在军事医学中的发展方向。     

部队急性病毒性肝炎发病前瞻性研究

目的　查明部队人群急性病毒性肝炎真实年发病率 .方法　前瞻性研究 ,观察抽样部队 1a内病毒性肝炎发生情况 .结果　共观察 16 0 36 0人 ,发生病毒性肝炎 310人 ,年发病率为 193.3/ 10万 ,甲肝年发病率 10 0 .4/ 10万 ,乙肝年发病率为 5 7.4/ 10万 .干部病毒性肝炎年发病率 (30 9.6 / 10万 )远高于战士 (173.6 / 10万 ,P<0 .0 1) ,干部乙肝年发病率(12 4.7/ 10万 )也高于战士 (4 6 .0 / 10万 ,P<0 .0 1) ,新兵甲肝年发病率 (130 .6 / 10万 )高于老兵 (81.0 / 10万 ,P<0 .0 1) .结论　部队人群病毒性肝炎年发病率仍很高 .在部队中 ,乙肝预防的重点是干部 ,甲肝预防的重点是新兵 .我们建议应加强部队病毒性肝炎预防策略的研究 ,降低其发病率     

新兵接种甲肝和乙肝疫苗3年效果

目的：观察新兵接种甲肝疫苗与乙肝疫苗3a效果。方法：随机对照试验。观察3a接种甲肝、乙肝疫苗保护效果。结果：接种甲肝疫苗组2201人,无1人发生甲型肝炎;对照组2611人,发病4人;甲肝疫苗接种3a的保护率为100％。接种乙肝疫苗组2611人,发生乙型肝炎1人;对照组2628人,发生乙型肝炎5人;乙肝疫苗接种3a的保护率为80％。结论：部队新兵接种甲型与乙型肝炎疫苗,可使部队战士甲、乙型肝炎发病率减少80％。     

关于实行高校教师聘任制的思考

人才是社会财富之源,是生产力中最活跃的因素。计划经济管理模式严重束缚了高校人才的积极性和创造性。本文就高校在社会主义市场经济条件下,探索教师聘任的实现形式,建立与社会主义市场经济相适应,符合高校自身发展规律的教师聘任制。运用市场机制,面向社会,以公开、平等、竞争、择优的原则,打破论资排辈,营造有利子优秀人才脱颖而出的用人环境,激发广大教师奋发进取的精神。改革现行社会保障制度,配套建立适合高校特点的社会保障体系,是深化学校用人制度改革的重要保证。     

部队甲型病毒性肝炎疫苗的接种策略

目的 探讨部队甲肝疫苗接种的最佳策略。方法 应用决策树模型和成本效用分析方法。结果 部队官兵接种甲肝疫苗,先筛选后接种方案优于直接接种方案;采用先筛选后接种方案接种干部每增加一个DALY将产生168.23元的正效益,而新兵则需2792.30元的净投入。经灵敏度分析,该决策结果稳定,不随引入决策模型的各参数的变化而变化。结论 在当前条件下,部队接种甲肝疫苗宜首选先筛选后接种方案,优先接种干部人群。