新形势下军队医院卫生技术人员的稳定与思考

目的 分析在新形势下军队医院卫生技术人员的稳定性及影响因素。方法 对某省5家军队医院现役卫生技术人员进行问卷调查,采用卡方检验进行统计学分析。结果 有21.4％的现役卫生技术人员有转业倾向,其中医疗岗位占93.5%。与地方比福利待遇偏低、职称晋升困难、改非现役文职人员的不确定性显著影响人员的稳定性。结论 通过组织谈心和政策约束,稳定医疗岗位人才。对于选择提前退休或自主择业人员,积极创造条件返聘,通过各种途径稳定卫生技术人员,确保军队医院稳步转型。     

Overweight and obesity in military personnel: sociodemographic predictors

In the United States, nationally representative civilian studies have shown that BMI is associated with select sociodemographic characteristics. Active-duty military personnel are not included in these surveys and the persistence of these associations in military personnel is unknown. Data from the worldwide, representative 2002 and 2005 Department of Defense (DoD) Surveys of Health-Related Behaviors Among Active Duty Military Personnel were used to assess the prevalence of overweight and obesity and, the association of BMI with sociodemographic characteristics. The final response bases included 12,756 (2002) and 16,146 (2005) personnel. Results indicated that the combined prevalence of overweight and obesity in military personnel increased to an all-time high in 2005 (60.5%) with higher prevalence of obesity in 2005 compared to 2002 (12.9% vs. 8.7, respectively, P ≤ 0.01). Holding other variables constant, regression analysis indicated that women were significantly less likely than men to be overweight or obese in both survey years (P ≤ 0.0001), which is contrary to civilian data. Similar to civilian data, the prevalence of obesity was significantly associated with increased age, black or Hispanic/Latino race/ethnicity, and being married (P ≤ 0.01). US military personnel are not immune to the US obesity epidemic. Demographic characteristics associated with being overweight should be considered when developing military-sponsored weight management programs.     

Global comparison of warring groups in 2002-2007: fatalities from targeting civilians vs. fighting battles

Background

Warring groups that compete to dominate a civilian population confront contending behavioral options: target civilians or battle the enemy. We aimed to describe degrees to which combatant groups concentrated lethal behavior into intentionally targeting civilians as opposed to engaging in battle with opponents in contemporary armed conflict.

Methodology/Principal Findings

We identified all 226 formally organized state and non-state groups (i.e. actors) that engaged in lethal armed conflict during 2002–2007: 43 state and 183 non-state. We summed civilians killed by an actor''s intentional targeting with civilians and combatants killed in battles in which the actor was involved for total fatalities associated with each actor, indicating overall scale of armed conflict. We used a Civilian Targeting Index (CTI), defined as the proportion of total fatalities caused by intentional targeting of civilians, to measure the concentration of lethal behavior into civilian targeting. We report actor-specific findings and four significant trends: 1.) 61% of all 226 actors (95% CI 55% to 67%) refrained from targeting civilians. 2.) Logistic regression showed actors were more likely to have targeted civilians if conflict duration was three or more years rather than one year. 3.) In the 88 actors that targeted civilians, multiple regressions showed an inverse correlation between CTI values and the total number of fatalities. Conflict duration of three or more years was associated with lower CTI values than conflict duration of one year. 4.) When conflict scale and duration were accounted for, state and non-state actors did not differ. We describe civilian targeting by actors in prolonged conflict. We discuss comparable patterns found in nature and interdisciplinary research.

Conclusions/Significance

Most warring groups in 2002–2007 did not target civilians. Warring groups that targeted civilians in small-scale, brief conflict concentrated more lethal behavior into targeting civilians, and less into battles, than groups in larger-scale, longer conflict.     

Viral Hepatitis: Problems of Incidence and Control in Military Personnel

(A) Hepatitis B virus (HBV) is now the major cause of infectious viral hepatitis in U.S. military personnel and probably also in the civilian population over 15 years of age. (B) The incidence of icteric, viral hepatitis is much higher in U.S. military personnel than in comparable age groups in the civilian population. The 17-to 20-year-old enlisted men show the highest rates. (C) In parts of the world (e.g., U.S.A., Germany) where most of the inapparent infection is caused by the adw subtype of HBV, most of the acute clinical disease is caused by the ayw subtype. In the U.S.A. and Germany, 95% or more of HB_s Ag isolates from U.S. military personnel with acute hepatitis is ayw. (D) It may be many years before one can expect to have sufficient data for a decision as to the possible availability of an effective HBV vaccine. Accordingly, a decision is urgently needed regarding either the immediate use of the best practically available hepatitis immune gamma globulin, that can be prepared by modern techniques, for the prevention of hepatitis in U.S. military personnel or postponement of such use until an adequate and properly controlled trial can be carried out in active duty military personnel in an area of high incidence.     

Current status of vivax malaria among civilians in Korea

A result of national malaria surveillance in Korean civilians was described. Since a case of indigenous vivax malaria was detected in 1993, a total of 2,198 cases was confirmed by blood smear up to 1997. Of them, 1,548 cases were soldiers serving in the demilitarized zone (DMZ), while 650 cases were civilians. Number of civilian cases was 3 in 1994, 19 in 1995, 71 in 1996, and 557 in 1997. Of them, 239 were ex-soldiers who discharged after military service in the prevalent areas such as Paju, Yonchon, Kimpo, Kangwha, Tongduchon in Kyonggi-do and Chorwon in Kangwon-do while 308 patients were civilian residents in the prevalent areas. Seventy-two patients, living nationwide, had a history of visiting the prevalent areas during transmission season. Only 32 civilian patients denied any relation with the prevalent areas. As a whole, a half of the civilian cases was diagnosed when living in non-prevalent areas. Male patients in their twenties was the highest in number. Annual parasite index is steadily elevated in residents living in the prevalent areas. Monthly incidence showed an unimodal distribution, forming a peak in August. Ex-soldiers exhibited a delayed incubation ranging from 153 to 452 days (279 ± 41 days). The time required for diagnosis was shortened from 23.6 days in 1995 to 13.7 days in 1997. Although the current epidemic of vivax malaria started as a border malaria, it seems highly probable that vivax malaria is established in the local areas and responsible for at least a part of transmission.     

Comparing Conservation Priorities for Useful Plants Among Botanists and Tibetan Doctors

Perspectives of diverse constituencies need to be incorporated when developing conservation strategies. In Menri (Medicine Mountains) of the Eastern Himalayas, Tibetan doctors and professional botanists were interviewed about conservation of useful plants. We compare these two perspectives and find they differ significantly in conservation priorities (Wilcoxon Signed Ranks P < 0.05), both in how they prioritized, as well as the priorities themselves. Tibetan doctors first consider which plants are most important to their medical practice and, then secondarily, the conservation status of these plants. Additionally, perceptions of threatened medicinal plants differ among Tibetan doctors who received medical training in Lhasa, who were local trained, and who were self-taught. In contrast, professional botanists came to a consensus among themselves by first considering the conservation status of plants and then considering use. We conclude that, in order to effect community based conservation, opinions from both Tibetan doctors and professional botanists should be considered in establishing conservation priorities and sustainable conservation programs. Furthermore, we set our own research agenda based on combined perspectives.     

Minds “At Attention”: Mindfulness Training Curbs Attentional Lapses in Military Cohorts

We investigated the impact of mindfulness training (MT) on attentional performance lapses associated with task-unrelated thought (i.e., mind wandering). Periods of persistent and intensive demands may compromise attention and increase off-task thinking. Here, we investigated if MT may mitigate these deleterious effects and promote cognitive resilience in military cohorts enduring a high-demand interval of predeployment training. To better understand which aspects of MT programs are most beneficial, three military cohorts were examined. Two of the three groups were provided MT. One group received an 8-hour, 8-week variant of Mindfulness-based Mind Fitness Training (MMFT) emphasizing engagement in training exercises (training-focused MT, n = 40), a second group received a didactic-focused variant emphasizing content regarding stress and resilience (didactic-focused MT, n = 40), and the third group served as a no-training control (NTC, n = 24). Sustained Attention to Response Task (SART) performance was indexed in all military groups and a no-training civilian group (CIV, n = 45) before (T1) and after (T2) the MT course period. Attentional performance (measured by A’, a sensitivity index) was lower in NTC vs. CIV at T2, suggesting that performance suffers after enduring a high-demand predeployment interval relative to a similar time period of civilian life. Yet, there were significantly fewer performance lapses in the military cohorts receiving MT relative to NTC, with training-focused MT outperforming didactic-focused MT at T2. From T1 to T2, A’ degraded in NTC and didactic-focused MT but remained stable in training-focused MT and CIV. In sum, while protracted periods of high-demand military training may increase attentional performance lapses, practice-focused MT programs akin to training-focused MT may bolster attentional performance more than didactic-focused programs. As such, training-focused MT programs should be further examined in cohorts experiencing protracted high-demand intervals.     

Diagnoses and factors associated with medical evacuation and return to duty among nonmilitary personnel participating in military operations in Iraq and Afghanistan

Background

Nonmilitary personnel play an increasingly critical role in modern wars. Stark differences exist between the demographic characteristics, training and missions of military and nonmilitary members. We examined the differences in types of injury and rates of returning to duty among nonmilitary and military personnel participating in military operations in Iraq and Afghanistan.

Methods

We collected data for nonmilitary personnel medically evacuated from military operations in Iraq and Afghanistan between 2004 and 2007. We compared injury categories and return-to-duty rates in this group with previously published data for military personnel and identified factors associated with return to duty.

Results

Of the 2155 medically evacuated nonmilitary personnel, 74.7% did not return to duty. War-related injuries in this group accounted for 25.6% of the evacuations, the most common causes being combat-related injuries (55.4%) and musculoskeletal/spinal injuries (22.9%). Among individuals with non–war-related injuries, musculoskeletal injuries accounted for 17.8% of evacuations. Diagnoses associated with the highest return-to-duty rates in the group of nonmilitary personnel were psychiatric diagnoses (15.6%) among those with war-related injuries and noncardiac chest or abdominal pain (44.0%) among those with non–war-related injuries. Compared with military personnel, nonmilitary personnel with war-related injuries were less likely to return to duty (4.4% v. 5.9%, p = 0.001) but more likely to return to duty after non–war-related injuries (32.5% v. 30.7%, p = 0.001).

Interpretation

Compared with military personnel, nonmilitary personnel were more likely to be evacuated with non–war-related injuries but more likely to return to duty after such injuries. For evacuations because of war-related injuries, this trend was reversed.In modern warfare, injuries sustained in combat have never been the leading source of attrition among soldiers. In World War I, World War II and the Korean War, respiratory and infectious diseases were the top reasons for hospital admissions among service members. By the Vietnam Conflict, non-battle injuries had supplanted respiratory illness as the leading cause of hospital admissions and have remained the leading cause ever since.^1,2The principal causes for medical evacuation of military personnel from US operations in Iraq and Afghanistan were recently described in a large four-year epidemiologic study.³ In descending order, the leading reasons were musculoskeletal conditions, combat-related injuries, neurologic symptoms and psychiatric disorders; the last category surpassed combat-related injuries as the number two reason in the latter half of both engagements. However, nonmilitary personnel were not included in that study. Over the past three years, nonmilitary members, including US Department of Defense civilians, private contractors and diplomats, have comprised about 50% of personnel serving in Iraq and about two-thirds of those serving in Afghanistan.^4,5Several reasons may explain why the types of injury and the return-to-duty rates differ between military and nonmilitary personnel. First, the motivations for overseas deployment might differ between the groups. Whereas some civilian personnel (e.g., diplomats) may be assigned to positions in Iraq and Afghanistan, virtually all private contractors volunteer for their jobs. In contrast, most military members have little choice in their deployment. Second, military and nonmilitary members assigned to war zones have different occupational specialties, living conditions and regulations to which they must adhere. Especially for junior military personnel, jobs tend to be more dangerous, living environments more austere and regulations more stringent. Finally, unlike military personnel, who are paid regardless of deployment status, most contractors’ pay is contingent upon continued employment in theatres of operation. In addition, nonmilitary personnel are generally compensated with higher salaries than service members in comparable occupational specialties.In civilian cohorts, many of these factors have been shown to influence return-to-work rates in a variety of contexts. Studies of the effect of financial compensation on work status after injury have generally shown a direct correlation between return-to-work rates and higher income levels.^6,7 Similar associations have also been found between return-to-work rates and job satisfaction and coping mechanisms, factors that may be influenced by work conditions and perceived control over one’s environment.^8–10The objectives of our study were threefold: to ascertain whether the reasons for medical evacuation from military operations differed between military and nonmilitary personnel; to determine whether return-to-duty rates differed between the two groups; and to identify factors that influence return-to-duty rates among nonmilitary members.     

Historical review and surveillance of Japanese encephalitis, Republic of Korea, 2002–2004

Japanese encephalitis virus (JEV), transmitted by culicine mosquitoes, is endemic throughout much of South‐East Asia, extending to the Korean Peninsula. The zoonotic cycle is from large water birds to culicine mosquitoes, with swine as an amplifying host and man as an incidental host. Culex tritaeniorhynchus, the primary JEV vector in the Republic of Korea, populations peak in late August through to early September when most cases of Japanese encephalitis (JE) are reported. Cx. tritaeniorhynchus were observed near the Demilitarized Zone in each of the years that mosquitoes were assayed for JEV. Each year that vector mosquitoes were assayed for JEV, minimum field infection rates (number of JEV positive mosquites/1000 Cx. tritaeniorhynchus assayed) ranged from 0.31 to 3.27. The epidemiology of JE has been recorded in Korea for more than half a century, from 1949 to 2005. During a major epidemic in 1949, there were 5616 cases and 2729 deaths reported, with levels persisting near epidemic levels of 1000 cases annually thereafter until 1969. Following the introduction and government mandated mass immunization in 1971, JE decreased dramatically. Since 1984, 0–6 cases of JE have been reported each year. However, continued evidence of mosquitoes positive for JEV indicates that JE continues to be a civilian and military health threat to immunocompromised persons in Korea, as well as non‐immune US soldiers, civilians and their family members.     

Botanists and their childhood memories: an underutilized expert source in ethnobotanical research

Botanists are an overlooked group of informants in ethnobotanical studies. The aim of this study was to assess their potential as sources of original ethnobotanical information. Wild food plants remembered by Polish botanists from their childhood were freelisted by 71 botanists. The results were compared with several ethnobotanical studies: three from the 21^st century and one from the mid‐20^th century. The botanists listed 123 species (mean of 9.3 species per individual). Although the average number of personal freelists was slightly lower for botanists than for local key informants in two of the other studies (11 and 13, respectively), the total list of species was longer than in any other Polish ethnobotanical study. Two of the ethnobotanical studies supplied richer material on past famine plants, whereas the botanists mentioned many alien plants and plants from urban habitats not mentioned in the ethnographical study. It can be concluded that botanists are possibly the best source of information for studies of contemporary or new uses of plants, but are inadequate for uses that are dying out. © 2012 The Linnean Society of London, Botanical Journal of the Linnean Society, 2012, 168 , 334–343.     

军队医院聘用人员管理中的法律风险与防范对策

聘用人员是军队医院发展中不可缺少的支持力量,也为军队医院人力资源管理工作带来了一定的法律风险。从招聘录用、纪律管理、人事管理3个环节着手,分析了军队医院聘用人员管理中容易产生的法律风险,并提出了防范的具体措施。     

Mortality experience of US veterans following service as international peacekeepers in Bosnia/Kosovo theater, 1996–2002

BackgroundBeginning in 1996 US military personnel served as peacekeeping forces in Bosnia/Kosovo. No studies have assessed the long-term post-deployment health of this US cohort. Based on the health concerns raised in studies of military personnel from other countries, this study focused on mortality due to Leukemia, respiratory disease, respiratory cancer, and heart disease.MethodsThis study compared the post-war cause-specific mortality of 53,320 veterans who deployed to Bosnia/Kosovo between 1996–2002 to that of 117,267 veterans who also served in the military between 1996–2002, but were not deployed to Bosnia/Kosovo. Expressed as standardized mortality ratios (SMR)s the cause-specific mortality for both deployed and non-deployed were compared separately to that of the US general population. Cause-specific mortality risks among Bosnia/Kosovo veterans relative to that of non-deployed veterans were assessed using Hazard Ratios (HR)s generated by Cox proportional-hazards models.ResultsThe overall mortality of both deployed and non-deployed veterans was almost half that of the US population, SMR = 0.59, 95%, C.I., 0.55–0.62 and SMR = 0.66, 95%, C.I., 0.64–0.68, respectively. Neither group of veterans had any excess of disease related mortality compared to that of the US population. Compared to non-deployed, deployed veterans did not experience any increased risks for any of the diseases of a priori interest.ConclusionIt does not appear that US military deployed to Bosnia/Kosovo have any increased risks of disease related mortality. However, this study would not have been able to detect increased risk of cancers with latency periods that exceeded the 18 years of follow-up available in this study.     

Wildlife trade products available to U.S. military personnel serving abroad

Military personnel and affiliates have significant buying power that can influence demand for wildlife products. Purchase and transport of certain wildlife products violates United States laws, military regulations, and national country laws where the items were purchased. We surveyed military bazaars (n = 4) in Kabul, Afghanistan from June 2007 to March 2009 to observe which species were available to soldiers. In June 2008, we conducted a pilot survey of U.S. Army personnel (n = 371) stationed at Fort Drum, New York, USA, who had been deployed or stationed overseas including in Afghanistan and Iraq. Soldiers reported skins of wild felids and gray wolf Canis lupus as most commonly observed wildlife products available for sale in Afghanistan. Forty percent of respondents said they had either purchased or seen other members of the military purchase or use wildlife products. The U.S. military was willing to assist in curtailing supply and demand for wildlife products in order to protect soldiers from unknowingly breaking the law and to conserve wildlife in the countries where they serve. Regular, focused training of military personnel should be considered an important step to reducing trade in wildlife products by addressing both demand and market supply.     

部队医院文职人员管理的探索与研究

随着部队医疗机构人事编制的调整,军队医院及疗养院为缓解人员严重短缺的问题,通过公开考核面向社会招聘具有专业资格的非现役文职人员。文职人员作为军队疗养院的聘用制人员已成为医护工作的主要力量。因此,完善文职人员的管理工作是提高医院医疗质量的重点。本文通过分析文职人员聘用、教育、生活福利待遇及公务事业、社会保险等文职人员管理制度,探讨各项管理制度的特点及作用,提出适合我院推行的文职人员管理制度,即充分利用社会人才资源,建立健全文职人员管理评价体系,提高文职人员献身部队、服务军队的积极性和创造性。     

Alimentary infections during war conditions: Mostar and Tomislavgrad, Bosnia and Herzegovina, 1992-1995

The aim of this study was to assess the outcome of sanitary and epidemiologic measures undertaken in relation to alimentary infections in the military corps of the Croatian Defense Council (Hrvatsko vje?e obrane) and civilian population in Mostar and Tomislavgrad regions during the 1992-1995 War in Bosnia and Herzegovina. A total of 25 (4.8%) of soldiers and 7 (7.1%) of non-military personnel were not being granted medical clearance to be employed in the food provision services. We recorded a total of 68 alimentary infections cases in military personnel (with an incidence of 536.2 per 100,000 persons), and 436 in civilian population (573.9 per 100,000 person), without significant difference between them (p=0.647). We did not record any alimentary infection outbreak in the military personnel, while two smaller epidemics of the abdominal typhus were recorded among civilian populations, but without lethal outcomes. The results of this study suggest that even the most basic adherence to the principle of standard sanitary and epidemiologic preventive measures may substantially reduce the probability of alimentary infections outbreaks, even in the highly disruptive, warfare environment.     

军队疗养院非现役文职人员工作满意度及职业需求调查

目的:非现役文职作为军队疗养院的聘用制人员已成为医护工作的主要力量。本文通过调查军队疗养院非现役文职人员的工作满意度,分析其对自身职业的潜在需求,为提高医疗服务质量提出可行对策。方法:采用问卷调查的方式对我院聘用的100名非现役文职人员调查该群体工作满意度及对自身职业的潜在需求。结果:非现役文职人员对管理制度、工作环境、团队合作及人际关系等方面表示满意,其中最满意的是工作环境;而对工作压力、工资福利、奖惩制度、职称晋升及个人发展等方面表示不满,其中最不满意的是工资福利。非现役文职人员对优化人事编制、提高福利待遇及减轻工作负荷的需求度较高,而对职业情感、临床带教及军事知识的需求度较低。结论:军队疗养院的管理人员应完善管理机制,充分了解非现役护理队伍对职业的潜在需求,积极的为其创造良好的晋升政策和发展平台,建立绩效考核制度以提高该群体的工作满意度,进而提升军队疗养院护理服务的质量。     

Dissemination of the Look AHEAD Intensive Lifestyle Intervention in the United States Military: A Randomized Controlled Trial

Objective

The purpose of this study, “Fit Blue,” was to compare a translation of the Look AHEAD (Action for Heath in Diabetes) intensive lifestyle intervention with a self‐paced version of the same intervention among active duty military personnel.

Methods

Active duty military personnel (N = 248; 49% male, 34% racial minority) with overweight or obesity were randomized to 12‐month distance‐based (i.e., phone and email) parallel programs, counselor‐initiated (CI) condition or self‐paced (SP) condition, from 2014 to 2016. Trained lay interventionists were retired military personnel or had extensive familiarity with the military.

Results

The CI condition had greater weight loss at 4 months (CI: mean ± SD = ?3.2 ± 3.4 kg; SP: ?0.6 ± 2.9 kg; P < 0.0001) and at 12 months (CI: mean ± SD = ?1.9 ± 4.1 kg; SP: ?0.1 ± 3.8 kg; P < 0.001). Participants in the CI condition also had a greater percent weight loss at both 4 months (CI: 3.5% ± 3.8, SP: 0.6% ± 3.1; P < 0.0001) and 12 months (CI: 2.1% ± 4.7, SP: 0.0% ± 4.0; P < 0.001). In addition, a greater proportion of CI participants lost 5% or more at 4 months (CI: 29.8%, SP: 10.5%; P < 0.001) and at 12 months (CI: 29.5%, SP: 15.6%; P < 0.05).

Conclusions

The CI behavioral weight loss intervention translated from Look AHEAD was well received and is a promising approach for managing weight in an active duty military population.

     

THE NEW MILITARY MEDICAL ETHICS: LEGACIES OF THE GULF WARS AND THE WAR ON TERROR

United States military medical ethics evolved during its involvement in two recent wars, Gulf War I (1990–1991) and the War on Terror (2001–). Norms of conduct for military clinicians with regard to the treatment of prisoners of war and the administration of non‐therapeutic bioactive agents to soldiers were set aside because of the sense of being in a ‘new kind of war’. Concurrently, the use of radioactive metal in weaponry and the ability to measure the health consequences of trade embargos on vulnerable civilians occasioned new concerns about the health effects of war on soldiers, their offspring, and civilians living on battlefields. Civilian medical societies and medical ethicists fitfully engaged the evolving nature of the medical ethics issues and policy changes during these wars. Medical codes of professionalism have not been substantively updated and procedures for accountability for new kinds of abuses of medical ethics are not established. Looking to the future, medicine and medical ethics have not articulated a vision for an ongoing military‐civilian dialogue to ensure that standards of medical ethics do not evolve simply in accord with military exigency.     

Massacre over civilians during the war in Croatia

The 1991-1995 War for independence of Croatia was a cruel armed conflict, provoked by the conquering aspirations of the "Yugoslav Federal Army" under Serbian command and Serbian terrorists. It took place on the territory of the Republic of Croatia and gave rise to a mass destruction of civilian and sacral buildings and civilian massacres. Here we present three representative cases as an example of the massacre over civilians that happened in the vicinity of Vrhovine, in northwestern Croatia. Seven civilians were taken from their homes in the village of Dabar, exposed to unprecedented, savage torture and cruel execution. Forensic medicine experts revealed that victims were beaten with blunt objects, probably the butt end of rifles or high boots, stabbed with sharp objects as they were dying, and finally killed by gunshots. Their dead bodies were mutilated by cutting auricles and exposed to post-mortem humiliation. Events at Vrhovine have all the characteristics of crimes against humanity and inapprehensible breaches of the Geneva Convention at the very end of 20th century.