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。     

Meningococcal Disease in California: Epidemiology and Management

Between 1969 and 1975 in California, 1,953 cases of meningococcal disease were reported. For cases reported in 1973, 1974 and 1975, detailed information about chemoprophylaxis of cases and contacts was obtained in addition to demographic and laboratory data. A review of data for the seven years showed a reduction in the case rate from 2.6 to 0.6 per 100,000 population, but this drop was due primarily to a very substantial decline in the military rate from 35.7 to 1.8 per 100,000 population. No reduction was apparent in the case fatality rate. Five groups of associated meningococcal disease cases were identified for a total of nine secondary or coprimary cases among 862 household contacts. Associated cases occurred in 10.4 per 1,000 household contacts—a rate several hundred times greater than that for the general population.The study findings indicate that many physicians are unaware of the following: (1) nonhousehold contacts are at little or no risk of contracting meningococcal disease; (2) prophylaxis should be offered only to household or intimate contacts immediately upon identification of an index case without waiting for test results for meningococcal carriage; (3) valid medical and epidemiologic indications exist for administering prophylaxis to household contacts who are culture negative as well as those who are culture positive; (4) the current drug of choice for prophylaxis is rifampin, but since no drug is completely effective, close medical observation remains the most important factor in the management of household or intimate contacts to meningococcal disease.     

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.     

Hospital admissions for skin and soft tissue infections in a population with endemic scabies: A prospective study in Fiji, 2018–2019

Scabies is an important predisposing factor for impetigo but its role in more serious skin and soft tissue infections (SSTIs) is not well understood. Information is limited on incidence of SSTIs in the presence of endemic scabies. We conducted a prospective study of hospital admissions for SSTIs in the Northern Division of Fiji (population: 131,914). Prospective surveillance for admissions with impetigo, abscess, cellulitis, wound infection, pyomyositis, necrotizing fasciitis, infected scabies, and crusted scabies was conducted at the Division’s referral hospital between 2018 to 2019. Information was collected on demographic characteristics, clinical features, microbiology, treatment and outcomes. Over the study period, 788 SSTI admissions were recorded corresponding to a population incidence 647 per 100,000 person-years (95%CI 571–660). Incidence was highest at the extremes of age with peak incidence in children aged <5 years (908 per 100,000) and those aged ≥65 years (1127 per 100,000). Incidence was 1.7 times higher among the Indigenous Fijian population (753 per 100,000) compared to other ethnicities (442 per 100,000). Overall case fatality rate was 3.3%, and 10.8% for those aged ≥65 years. Scabies was diagnosed concurrently in 7.6% of all patients and in 24.6% of admitted children <5 years. There is a very high burden of hospital admissions for SSTIs in Fiji compared to high-income settings especially among the youngest, oldest and indigenous population which is concordant with scabies and impetigo distribution in this population. Our findings highlight the need for strategies to reduce the burden of SSTIs in Fiji and similar settings.     

Tuberculosis Mortality and Living Conditions in Bern,Switzerland, 1856-1950

Background

Tuberculosis (TB) is a poverty-related disease that is associated with poor living conditions. We studied TB mortality and living conditions in Bern between 1856 and 1950.

Methods

We analysed cause-specific mortality based on mortality registers certified by autopsies, and public health reports 1856 to 1950 from the city council of Bern.

Results

TB mortality was higher in the Black Quarter (550 per 100,000) and in the city centre (327 per 100,000), compared to the outskirts (209 per 100,000 in 1911–1915). TB mortality correlated positively with the number of persons per room (r = 0.69, p = 0.026), the percentage of rooms without sunlight (r = 0.72, p = 0.020), and negatively with the number of windows per apartment (r = -0.79, p = 0.007). TB mortality decreased 10-fold from 330 per 100,000 in 1856 to 33 per 100,000 in 1950, as housing conditions improved, indoor crowding decreased, and open-air schools, sanatoria, systematic tuberculin skin testing of school children and chest radiography screening were introduced.

Conclusions

Improved living conditions and public health measures may have contributed to the massive decline of the TB epidemic in the city of Bern even before effective antibiotic treatment became finally available in the 1950s.     

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。     

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.     

Five year cancer incidence in Calabar,Nigeria (2009–2013)

Cancer incidence rates are presented for the Calabar Cancer Registry, a population-based cancer registry (PBCR) covering the population of two Local Government Areas (LGAs) of Calabar the capital of Cross-River State, Nigeria. (375,196 inhabitants in 2006). During the period 2009–2013, a total of 719 new cases were registered comprising 320 men (an age standardised incidence rate (ASR) of 78.8 per 100,000) and 399 women (ASR of 86.9 per 100,000).Breast and cervical cancers account for 60.4% of all cancers in women, with breast cancer (ASR 35 per 100,000) almost twice as common as cervix cancer (ASR 21 per 100,000) and occurring in rather younger women. Prostate cancer was the most common cancer in men (ASR 50.8 per 100,000).Hodgkin’s lymphoma was common in both sexes, and there were moderate numbers of HIV-related cancers recorded (Kaposi sarcoma, non Hodgkin lymphoma, and squamous cell carcinomas of conjunctiva).     

Spread of salmonellosis in Moscow and the ways of its prophylaxis

The article deals with the results of the epidemiological analysis of the spread of salmonellosis in Moscow. During the last 15 years the proportion of Salmonella enteritidis was about 80% and more. After salmonellosis morbidity decreased to 19.9 per 100,000 of the population (the minimum level) in 1985 its sharp rise was noted. Morbidity rate increased from 31.7 in 1987 to 55.1 per 100,000 in 1988, then to 93.9 per 100,000 of the population in 1989 (the maximum level). In the subsequent years up to 1996 a decrease in morbidity rate was observed, but in 1997-2002 morbidity rate stabilized within 29.8-35.7 per 100,000 of the population without a perceptible tendency towards decrease. The sharp increase of the etiological role of S. enteritidis which led to a wide spread of Salmonella infections was caused by the "chicken-egg" factor of their transmission. High morbidity rate among children and adults, registered all the year round, is the consequence of the constant epidemic activity of this factor.     

Epidemiologic situation of brucellosis in the regions of the Republic of Dagestan affected by the flood of 2002

The Republic of Daghestan is at present one of the most unsafe territories in the Russian Federation with respect to brucellosis morbidity among humans. The figures of human morbidity in brucellosis grew from 3.4 per 100,000 of the population in 1999 to 10.5 per 100,000 of the population in 2002, thus exceeding the figures for the whole of Russia 15- to 20-fold. The analysis of human morbidity in the Kizlyar region (where the interregional regrouping of the cattle was made) after the natural calamity, as well a in other regions where live-stock was evacuated, indicated that by the end of 2002 an essential deterioration of the epidemiological situation took place in these regions. In view of grave epizootological situation and the absence of epidemiological safety in brucellosis in the Republic of Daghestan the sanitary, epidemiological and veterinary services should, together with other priority tasks in their work aimed at the liquidation of the emergency situation, pay greater attention to measures for the prevention of the spread of brucellosis.     

Birth defects prevalence among infants of Persian Gulf War veterans born in Hawaii, 1989-1993

BACKGROUND: Gulf War veterans (GWVs) have expressed concern about possible teratogenic exposures. However, epidemiologic studies on birth defects prevalence among their progeny have been limited to military hospitals, anomalies diagnosed among newborns, or self-reported data. To measure the prevalence of selected birth defects among infants of GWVs and nondeployed veterans (NDVs) in Hawaii, using birth defects surveillance records. METHODS: Personal identifiers of 684,645 GWVs and 1,587,102 NDVs and their families were matched against birth certificate records of 99,545 live births reported to the State of Hawaii Department of Health between 1989 and 1993 to identify births to military personnel. These births were matched with records from the Hawaii Birth Defects Program. RESULTS: A total of 17,182 military infants (3,717 GWV infants and 13,465 NDV infants) were identified. Of these, 367 infants (2.14/100 live births) were identified with one or more of 48 major birth defects diagnoses. The prevalence of the 48 birth defects were similar for GWV and NDV infants during the prewar and postwar periods, and among GWV infants who were conceived before and after the Gulf war. CONCLUSIONS: The results must be interpreted with caution because of the small number of affected infants in each birth defects category. This study demonstrated the feasibility of measuring birth defects prevalence among military infants through multiple data linkage. Further, it included live births to parents who had separated from the military, births in civilian hospitals, and birth defects diagnosed through the first year of life.     

部队疗养院非现役文职护理人员的现状分析

目的:分析部队疗养院非现役文职护理人员的现状并给出相应对策。方法:采用不记名问卷形式对92名非现役文职护理人员进行调查。结果:部分非现役文职护理人员在业务能力、军事素质、身心健康等方面存在不足。结论:应采取有效措施提升非现役文职护理人员的综合素质,提高护理质量。     

部队疗养院非现役文职护理人员的现状分析

目的：分析部队疗养院非现役文职护理人员的现状并给出相应对策。方法：采用不记名问卷形式对92名非现役文职护理人员进行调查。结果：部分非现役文职护理人员在业务能力、军事素质、身心健康等方面存在不足。结论：应采取有效措施提升非现役文职护理人员的综合素质,提高护理质量。     

Toward a Social Theory of Sexual Risk Behavior Among Men in the Armed Services: Understanding the Military Occupational Habitus

Worldwide, military personnel have been recognized as a population at elevated risk for sexually transmitted infections (STIs) and HIV; however, it is not well understood how the military occupation itself is implicated in the production of sexual risk behavior. Using qualitative and quantitative data collected from the Belize Defense Force (BDF), we employed a grounded theoretical framework and the Bourdieusian concept of the field and habitus to clarify how the military occupation is implicated in structuring aspects of sexual risk behaviors among personnel. We focus results on in-depth qualitative interviews conducted with 15 male-identified BDF personnel. We identify and describe how two field elements, namely operational tempo and ongoing exposure to occupational hazards, are occupationally specific field elements implicated in the production of sexual risk behavior through the mediating matrix of the military class habitus. Our findings demonstrate a conceptual clarity regarding the institutional field and habitus through which military personnel make sense of and act on the risk of bodily harm with regard to their own sexual behaviors. We conclude by outlining our theoretical concept so that it can be directly applied in public health efforts in order to leverage military occupational field elements for the purpose of HIV and STI prevention.     

Gastrointestinal helminths and protozoa from two raccoon populations in Kansas

A survey in Kansas compared the prevalence of gastrointestinal helminths and protozoa in 2 raccoon (Procyon lotor) populations; a population in a typical rural setting and a relatively undisturbed population on a military reservation. Gastrointestinal tracts of 128 raccoons were examined. Freeze storage of alimentary tracts prevented collection of data on trematode prevalence. Helminth infections other than trematodes included 1 acanthocephalan, 2 cestodes, and 3 nematodes. Helminths were found in all raccoons from the population on the military installation and 96% of those from the rural population. Prevalence of helminths was generally greater in raccoons from the population living in the rural setting. Eimeria spp. and Sarcocystis sp. were also found, whereas Giardia spp. and Cryptosporidium parvum were not.     

Mortality from and Incidence of Pesticide Poisoning in South Korea: Findings from National Death and Health Utilization Data between 2006 and 2010

Pesticide poisoning has been recognized as an important public health issue around the world. The objectives of this study were to report nationally representative figures on mortality from and the incidence of pesticide poisoning in South Korea and to describe their epidemiologic characteristics. We calculated the age-standardized rates of mortality from and the incidence of pesticide poisoning in South Korea by gender and region from 2006 through 2010 using registered death data obtained from Statistics Korea and national healthcare utilization data obtained from the National Health Insurance Review and Assessment Service of South Korea. During the study period of 2006 through 2010, a total of 16,161 deaths and 45,291 patients related to pesticide poisoning were identified, marking respective mortality and incidence rates of 5.35 and 15.37 per 100,000 population. Intentional self-poisoning was identified as the major cause of death due to pesticides (85.9%) and accounted for 20.8% of all recorded suicides. The rates of mortality due to and incidence of pesticide poisoning were higher in rural than in urban areas, and this rural-urban discrepancy was more pronounced for mortality than for incidence. Both the rate of mortality due to pesticide poisoning and its incidence rate increased with age and were higher among men than women. This study provides the magnitude and epidemiologic characteristics for mortality from and the incidence of pesticide poisoning at the national level, and strongly suggests the need for further efforts to prevent pesticide self-poisonings, especially in rural areas in South Korea.     

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。     

Distribution of surgical hydatidosis in Tunisia, results of 2001-2005 study and trends between 1977 and 2005

We have performed an exhaustive retrospective study in all surgical wards (54 services in 35 hospitals) which usually carry out surgical treatment of hydatic cysts in the country, covering the period between January 2001 and December 2005, in order to determine the annual surgical incidence of human cystic hydatidosis in Tunisia. A total of 6249 surgical interventions were recorded during the period 2001-2005. The highest proportion was recorded in the hospitals of Tunis District (42.9%). The service of thoracic surgery from Ariana hospital occupies the first rank (95%). The yearly incidence rate varies between 11 and 13.6 per 100,000. Calculated over the 5 years period, the incidence rate is 63.2 per 100,000 inhabitants, which means an average yearly incidence rate of 12.6 per 100,000 [12.28-12.99]. Governorates of the North West and the Western Central regions of the country are the most endemic area with an average annual incidence rates varying between 19.2 and 33.9 per 100,000, which is at least once and half higher than the national level. After 30 years (1977-2005), the average annual incidence rate slightly dropped, from 15 to 12.6 per 100,000, proving that such zoonosis remains a problem of public health in Tunisia. In order, to control in more or less short term this heavy burden disease and public health expenditure, the only efficient way is the prevention of the diseases with a mass treatment campaign of dogs, principal host of the parasite.     

Heterogeneous distribution of human cystic echinococcosis after a long-term control program in Neuquén, Patagonia Argentina

The present study is the first comprehensive analysis of human cystic echinococcosis (CE) epidemiological data carried out in the province of Neuquén, Patagonia Argentina, after 34 years of uninterrupted control program. A retrospective study of all the official records of confirmed human CE cases between 1995 and 2004 was carried out. A total of 1107 cases were reported. The overall mean annual incidence (MAI) was 24.4 per 100,000 inhabitants for the total population and 9.7/100,000 in the 0-14 year group. Distribution of cases by age and sex as well as frequency of cyst locations was analysed. Children accounted for 13.3% of total cases, indicating active transmission of the disease. Territorial distribution of cases was highly heterogeneous: MAI per 100,000 ranged from 7.9 in the Metropolitan Sanitary Area to 78.4 in the western rural areas. Higher values were recorded in small communities as Pilo Lil (800/100,000). MAI showed a significant decrease from 1995 to 1999 (43.9-18.8) but remains stable from 2000 to 2004 (15.9-15.5). These results suggest that standard control measures, despite long-term implementation, are not able to produce a sustained improvement of the epidemiological status of the disease. Further studies about local transmission cycles, definite and intermediate hosts present, Echinococcus granulosus strains or cultural behaviours in small communities are required in order to adequate the control actions in Neuquén.