戈壁野营驻训我部开展卫生防病的实践体会

新形势下,做好部队野营训练的卫勤保障工作,深入研究训练伤及其相关疾病的防治,是新时期军事斗争准备卫勤保障的重要内容,也是时代赋予医务人员的崇高责任。随着信息化进程的不断加快,部队完成军事斗争准备各项任务日趋繁重。对广大官兵的身心健康提出了更高标准,发挥健康教育优势,促进官兵健康,必须与时俱进,不断创新。我部采取多种方式、提高官兵自我防护及保健能力,从而促进部队整体全面建设稳步发展。     

Live to Work or Love to Work: Work Craving and Work Engagement

Objective

According to the theory of work craving, a workaholic has a craving for self-worth compensatory incentives and an expectation of relief from negative affect experienced through neurotic perfectionism and an obsessive-compulsive style of working. Research has shown that workaholism and work engagement should be considered as two distinct work styles with different health consequences. However, the mechanisms underlying the adoption of these work styles have been neglected. The present study proposes that work craving and work engagement are differentially associated with self-regulatory competencies and health. In particular, we expected that the working styles mediate the relationships between emotional self-regulation and health. Methods: In the cross-sectional study, 469 teachers from German schools completed online administered questionnaires. By means of structural equation modeling, we tested two indirect paths: a) from self-relaxation deficits via work craving to poor health and b) from self-motivation competencies via work engagement to good health.

Results

As expected, we found evidence that a) the negative relationship of self-relaxation deficits on health was partially mediated by work craving and b) the positive relationship of self-motivation competencies on health was partially mediated by work engagement.

Conclusions

The present study emphasizes the importance of self-regulation competencies for healthy or unhealthy work styles. Whereas work craving was associated with a low ability to down-regulate negative emotions and poor health, work engagement was associated with a high ability to up-regulate positive emotions and good health.     

戈壁野营驻训我部开展卫生防病的实践体会

新形势下,做好部队野营训练的卫勤保障工作,深入研究训练伤及其相关疾病的防治,是新时期军事斗争准备卫勤保障的重要内容,也是时代赋予医务人员的崇高责任。随着信息化进程的不断加快,部队完成军事斗争准备各项任务日趋繁重。对广大官兵的身心健康提出了更高标准,发挥健康教育优势,促进官兵健康,必须与时俱进,不断创新。我部采取多种方式、提高官兵自我防护及保健能力,从而促进部队整体全面建设稳步发展。     

“They See Us As Machines:” The Experience of Recent Immigrant Women in the Low Wage Informal Labor Sector

This study explores the organization of work and occupational health risk as elicited from recently immigrated women (n = 8) who have been in the US for less than three years and employed in informal work sectors such as cleaning and factory work in the greater Boston area in Massachusetts. Additional interviews (n = 8) with Community Key Informants with knowledge of this sector and representatives of temporary employment agencies in the area provides further context to the interviews conducted with recent immigrant women. These results were also compared with our immigrant occupational health survey, a large project that spawned this study. Responses from the study participants suggest health outcomes consistent with being a day-laborer scholarship, new immigrant women are especially at higher risk within these low wage informal work sectors. A difference in health experiences based on ethnicity and occupation was also observed. Low skilled temporary jobs are fashioned around meeting the job performance expectations of the employer; the worker’s needs are hardly addressed, resulting in low work standards, little worker protection and poor health outcomes. The rising prevalence of non-standard employment or informal labor sector requires that policies or labor market legislation be revised to meet the needs presented by these marginalized workers.     

Implications of flexible work systems for work studies

The relationship between changing work systems and work study methods is discussed by focusing on a recent trend toward more flexible work systems in different countries. These systems are commonly characterized by (a) uncoupling of working hours from business hours, (b) combining different atypical work forms and (c) individualized work patterns. Increased flexibility in working patterns is demanded because business hours may be covered by different workers and because special arrangements become necessary for unpopular shifts or linking separate jobs. Changes in work systems seem more successful when they are associated with (a) multiskilled work, (b) independent task implementation, (c) networked communication, (d) balanced or adjusted workload, and (e) accommodation of workers' preferences. Special attention is drawn to safety and health concerns and work-life effects. Many intervention studies done for work improvement are paying attention to multifaceted work aspects, locally available options, and participation by people. All these elements are important because prepackaged solutions do not exist. The following three views seem especially useful for action-oriented work studies: 1) Look at multiple aspects of the work, including work content and atypical work forms; 2) Know worker preferences and available options; and 3) Take into account work elements that may not be well defined, but important from local points of view. It is envisioned that these studies can provide support for a well-informed participatory process of work system changes in each local context.     

Armonización de bases de datos para el estudio de la fragilidad en personas mayores: Estudio INTAFRADE

ObjectivesThe main objective of the present work is to evaluate the feasibility of harmonising the available information from different independent databases, in order to build an integrated database to study frailty.Material and methodsThis work is based on the European project, Integral Approach to the Transition between Frailty and Dependence on older adults: Patterns of occurrence, identification tools and model of care (INTAFRADE), developed by 4 groups, 3 in Spain and one in France. Each partner provided their databases related to the study of frailty. As a previous step to the creation of an integrated database the characteristics and variables included in each study were mapped, specifying whether their harmonisation was possible or not.ResultsA total of 30 different variables that corresponded to 8 dimensions were identified: Sociodemographic and social characteristics, health status, lifestyle habits, anthropometric measures, other physical measurements, use of health services, and adverse health results. Of them all, 28 (93%) variables were harmonisable, although only 20% were present in all databases, with 47% in 3 of them. In relation to the frailty instruments, all of them were lacking at least 50% of the items. The harmonisation process will allow us to jointly analyse information available on 2,361 people.ConclusionsThe European INTAFRADE study will allow a deeper understanding of the frailty process in older people by harmonising information from heterogeneous databases.     

Welcome to the Swamp: Addressing Community Capacity in Ecohealth Research and Intervention

The standpoint from which this article is written is that of development practitioners who work fairly continuously with community transformation processes, and with their peers in many disciplines who are trying to stimulate and support such processes. Drawing on three case examples, the authors put forward four lessons for an ecosystems approach to health development work. First, health and natural resource management professionals, and the technical solutions they create, cannot, by themselves, solve many of the problems communities face. To be effective, solutions have to address a complex set of variables that may be largely invisible to professionals from outside the communities. Creating a map of the human and natural systems within which a particular human health issue arises is often an important first step. Second, another reason why professionals cannot solve complex health challenges on their own is that, in the end, many of the solutions must be implemented by community people from the inside out. Therefore the “map” needs to include human dynamics and community capacity. Third, identifying and assessing the specific capacities that a community needs to address particular health determinants is therefore an important part of health development work. It is critical that community capacity assessment is not undertaken in the abstract, but rather in a way that links capacity assessment with real, ongoing work and through a participatory process that builds understanding and commitment within the community, and identifies clear pathways for future action. Finally, outside professionals working with a community contribute to its capacity to address critical health challenges, not only because of the technical knowledge and skills they bring, but also through the characteristics and attitudes they exhibit. It is therefore important that professionals build their own capacity to role model effective community practice.     

Assessment of the Efficiency of a Metal Phytoextraction Process with Biological Indicators of Soil Health

The ultimate goal of any soil remediation process should be not only to remove the contaminant(s) from the polluted site but to restore soil health as well. In consequence, reliable indicators of soil health are needed if we are to properly evaluate the efficiency of a soil remediation process. The aim of the current work was to determine the effect of metal phytoextraction, through the utilization of the Zn hyperaccumulator T. caerulescens, on biological parameters of soil health, on the assumption that biological indicators of soil health might be valid monitoring tools to assess the efficiency of a metal phytoextraction process. To this end, a short-term microcosm phytoextraction study was carried out, with two heavy metal polluted soils collected from an abandoned mine, to determine the effect of metal phytoextraction on soil biological parameters. Higher values of biomass C, basal respiration, substrate induced respiration, and β-glucosidase activity were observed in the presence of T. caerulescens plants, as compared to unplanted pots. Our data confirm the great capacity of T. caerulescens to phytoextract Zn from polluted soils and, interestingly, suggest that metal phytoextraction has indeed a beneficial effect on soil biological activity. It was concluded that the revegetation of these metal polluted soils with T. caerulescens could help activate their biochemical and microbial functionality.     

吸烟、自由基与健康

吸烟有害健康,其中,吸烟过程中产生的大量自由基是损害健康的重要因素。研究吸烟产生的自由基及其损害健康的机理,以及减少乃至祛除吸烟危害、保护人类健康的策略,具有重要的社会意义。从学术角度来看,吸烟产生多种自由基,也是研究自由基的一个好模型。本文综述了吸烟、自由基与健康关系方面的研究进展,特别总结了我们实验室20多年在这方面的研究工作,供读者和同行参考。     

Ecosystem Approach to Human Health in Two Villages of the North Jordan Valley: Scoping the Problems

North Jordan Valley (NJV) is a narrow rift valley that extends from lake Tiberius in the north to the Dead Sea in the south. It follows the River Jordan and contains the most fertile lands in Jordan. With a population around 140,000, primarily working in agriculture, NJV is Jordan’s premier agricultural production area. NJV is an ecosystem that is stressed both naturally and by human activities. Limited precipitation and very hot summer seasons are stresses that are inherent parts of the ecosystem itself. However, human activities like agriculture, poor sanitation, and tourism produce health risks to the people through the pollution and degradation of natural resources. The area also faces several socioeconomic problems such as poverty, large family size, and unemployment. In NJV, women typically work at home as housewives taking care of large families and are engaged in agricultural activities through which they are exposed, along with men and children, to high temperature and high concentration of pesticides. This article presents the findings of a Participatory Rapid Appraisal (PRA) study that focused on assessing local communities’ perception and awareness of the linkages between disruption of the ecosystem and prevailing public health problems. From an academic point of view, one of the key challenges of implementing ecosystem approaches to human health is the incorporation of various stakeholders as full partners throughout the research process rather than as contributors to a research designed from the sole perspective and interests of the academic research team. This study was conceptualized as a preliminary study to guide and inform the design of a larger research study on health and environment linkages in the NJV. The process was considered key for ensuring that research questions would reflect and build upon the priorities of multiple stakeholders, including community members, and would involve them in the design of the research. In addition to the successful involvement of local communities and other stakeholders in the identification of primary health problems and community priorities in the study area, the research played a key role in introducing various stakeholders to the basics of the Ecosystem Approaches to Human Health (Ecohealth) concept. The study took place in two small villages in NJV (Tal Al-Arbaeen and Tal Al-Menteh). The first village is located upstream of the junction point where King Abdullah Canal’s fresh water mixes with marginal quality water of King Talal Reservoir (KTR) while the second one is situated downstream. Results of this study showed that local communities are generally aware of the linkages between the health of the ecosystem and human health and well-being. According to the results of the study, key stressors to the environment (socioeconomic and institutional) include the use/abuse of agrochemicals and household insecticides, spread of flies (associated to organic agriculture), mismanagement of organic fertilizers, lack of sanitation services, unsanitary household conditions, and a serious problem of stray dogs and rodents. Problems associated with poverty and large family size were also commonly mentioned. Diarrhea, respiratory diseases, and infectious and parasitic diseases were believed to be the most common health problems in both villages. Local communities showed great interest and concern for the various health problems to which they are confronted and expressed eagerness to contribute to potential mitigation/intervention measures.     

Anchoring Vignettes in the Health and Retirement Study: How Do Medical Professionals and Disability Recipients Characterize the Severity of Work Limitations?

PurposeRecent studies report systematic differences in how individuals categorize the severity of identical health and work limitation vignettes. We investigate how health professionals and disability recipients characterize the severity of work limitations and whether their reporting patterns are robust to demographic, education, and health characteristics. We use the results to illustrate the potential impact of reporting heterogeneity on the distribution of work disability estimated from self-reported categorical health and disability data.MethodNationally representative data on anchoring disability vignettes from the 2004 Health and Retirement Study (HRS) are used to investigate how respondents with an occupation background in health and Social Security disability beneficiaries categorize work limitation vignettes. Using pain, cardiovascular health, and depression vignettes, we estimate generalized ordered probit models (N = 2,660 individuals or 39,681 person-vignette observations) that allow the severity thresholds to vary by respondent characteristics.ResultsWe find that health professionals (excluding nurses) and disability recipients tend to classify identical work limitations as more severe compared to non-health professional non-disabled respondents. For disability recipients, the differences are most pronounced and particularly visible in the tails of the work limitations distribution. For health professionals, we observe smaller differences, affecting primarily the classification of mildly and moderately severe work limitations. The patterns for health professionals (excluding nurses) are robust to demographics, education, and health conditions. The greater likelihood of viewing the vignette person as more severely work limited observed among disability recipients is mostly explained by the fact that these respondents also tend to be in poorer health which itself predicts a more inclusive scale.ConclusionsKnowledge of reporting scales from health professionals and disabled individuals can benefit researchers in a broad range of applications in health and disability research. They may be useful as reference scales to evaluate disability survey data. Such knowledge may be beneficial when studying disability programs. Given the increasing availability of anchoring vignette data in surveys, this is a promising area for future evaluation research.     

ETHICS BEYOND BORDERS: HOW HEALTH PROFESSIONALS EXPERIENCE ETHICS IN HUMANITARIAN ASSISTANCE AND DEVELOPMENT WORK

Health professionals are involved in humanitarian assistance and development work in many regions of the world. They participate in primary health care, immunization campaigns, clinic- and hospital-based care, rehabilitation and feeding programs. In the course of this work, clinicians are frequently exposed to complex ethical issues. This paper examines how health workers experience ethics in the course of humanitarian assistance and development work. A qualitative study was conducted to consider this question. Five core themes emerged from the data, including: tension between respecting local customs and imposing values; obstacles to providing adequate care; differing understandings of health and illness; questions of identity for health workers; and issues of trust and distrust. Recommendations are made for organizational strategies that could help aid agencies support and equip their staff as they respond to ethical issues.     

An Approach to Integrating Occupational Safety and Health into Life Cycle Assessment: Development and Application of Work Environment Characterization Factors

Integrating occupational safety and health (OSH) into life cycle assessment (LCA) may provide decision makers with insights and opportunities to prevent burden shifting of human health impacts between the nonwork environment and the work environment. We propose an integration approach that uses industry‐level work environment characterization factors (WE‐CFs) to convert industry activity into damage to human health attributable to the work environment, assessed as disability‐adjusted life years (DALYs). WE‐CFs are ratios of work‐related fatal and nonfatal injuries and illnesses occurring in the U.S. worker population to the amount of physical output from U.S. industries; they represent workplace hazards and exposures and are compatible with the life cycle inventory (LCI) structure common to process‐based LCA. A proof of concept demonstrates application of the WE‐CFs in an LCA of municipal solid waste landfill and incineration systems. Results from the proof of concept indicate that estimates of DALYs attributable to the work environment are comparable in magnitude to DALYs attributable to environmental emissions. Construction and infrastructure‐related work processes contributed the most to the work environment DALYs. A sensitivity analysis revealed that uncertainty in the physical output from industries had the most effect on the WE‐CFs. The results encourage implementation of WE‐CFs in future LCA studies, additional refinement of LCI processes to accurately capture industry outputs, and inclusion of infrastructure‐related processes in LCAs that evaluate OSH impacts.     

Intersecting Cultures in Deaf Mental Health: An Ethnographic Study of NHS Professionals Diagnosing Autism in D/deaf Children

Autism assessments for children who are deaf are particularly complex for a number of reasons, including overlapping cultural and clinical factors. We capture this in an ethnographic study of National Health Service child and adolescent mental health services in the United Kingdom, drawing on theoretical perspectives from transcultural psychiatry, which help to understand these services as a cultural system. Our objective was to analyse how mental health services interact with Deaf culture, as a source of cultural-linguistic identity. We ground the study in the practices and perceptions of 16 professionals, who have conducted autism assessments for deaf children aged 0–18. We adopt a framework of intersectionality to capture the multiple, mutually enforcing factors involved in this diagnostic process. We observed that professionals working in specialist Deaf services, or with experience working with the Deaf community, had intersectional understandings of assessments: the ways in which cultural, linguistic, sensory, and social factors work together to produce diagnoses. Working with a diagnostic system that focuses heavily on ‘norms’ based on populations from a hearing culture was a key source of frustration for professionals. We conclude that recognising the intersectionality of mental health and Deaf culture helps professionals provide sensitive diagnoses that acknowledge the multiplicity of D/deaf experiences.     

Educational Inequalities in Exit from Paid Employment among Dutch Workers: The Influence of Health,Lifestyle and Work

Background

Individuals with lower socioeconomic status are at increased risk of involuntary exit from paid employment. To give sound advice for primary prevention in the workforce, insight is needed into the role of mediating factors between socioeconomic status and labour force participation. Therefore, it is aimed to investigate the influence of health status, lifestyle-related factors and work characteristics on educational differences in exit from paid employment.

Methods

14,708 Dutch employees participated in a ten-year follow-up study during 1999–2008. At baseline, education, self-perceived health, lifestyle (smoking, alcohol, sports, BMI) and psychosocial (demands, control, rewards) and physical work characteristics were measured by questionnaire. Employment status was ascertained monthly based on tax records. The relation between education, health, lifestyle, work-characteristics and exit from paid employment through disability benefits, unemployment, early retirement and economic inactivity was investigated by competing risks regression analyses. The mediating effects of these factors on educational differences in exit from paid employment were tested using a stepwise approach.

Results

Lower educated workers were more likely to exit paid employment through disability benefits (SHR:1.84), unemployment (SHR:1.74), and economic inactivity (SHR:1.53) but not due to early retirement (SHR:0.92). Poor or moderate health, an unhealthy lifestyle, and unfavourable work characteristics were associated with disability benefits and unemployment, and an unhealthy lifestyle with economic inactivity. Educational differences in disability benefits were explained for 40% by health, 31% by lifestyle, and 12% by work characteristics. For economic inactivity and unemployment, up to 14% and 21% of the educational differences could be explained, particularly by lifestyle-related factors.

Conclusions

There are educational differences in exit from paid employment, which are partly mediated by health, lifestyle and work characteristics, particularly for disability benefits. Health promotion and improving working conditions seem important measures to maintain a productive workforce, particularly among workers with a low education.     

Development and preliminary validation of an index for indicating the risks of the design of working hours to health and wellbeing

BASS 4, a computer program for the design and evaluation of workings hours, is an example of an ergonomics-based software tool that can be used by safety practitioners at the shop floor with regard to legal, ergonomic, and economic criteria. Based on experiences with this computer program, a less sophisticated Working-Hours-Risk Index for assessing the quality of work schedules (including flexible work hours) to indicate risks to health and wellbeing has been developed to provide a quick and easy applicable tool for legally required risk assessments. The results of a validation study show that this risk index seems to be a promising indicator for predicting risks of health complaints and wellbeing. The purpose of the Risk Index is to simplify the evaluation process at the shop floor and provide some more general information about the quality of a work schedule that can be used for triggering preventive interventions. Such a risk index complies with practitioners' expectations and requests for easy, useful, and valid instruments.     

Fidelity of implementation: development and testing of a measure

Background

There is a considerable evidence base for 'collaborative care' as a method to improve quality of care for depression, but an acknowledged gap between efficacy and implementation. This study utilises the Normalisation Process Model (NPM) to inform the process of implementation of collaborative care in both a future full-scale trial, and the wider health economy.

Methods

Application of the NPM to qualitative data collected in both focus groups and one-to-one interviews before and after an exploratory randomised controlled trial of a collaborative model of care for depression.

Results

Findings are presented as they relate to the four factors of the NPM (interactional workability, relational integration, skill-set workability, and contextual integration) and a number of necessary tasks are identified. Using the model, it was possible to observe that predictions about necessary work to implement collaborative care that could be made from analysis of the pre-trial data relating to the four different factors of the NPM were indeed borne out in the post-trial data. However, additional insights were gained from the post-trial interview participants who, unlike those interviewed before the trial, had direct experience of a novel intervention. The professional freedom enjoyed by more senior mental health workers may work both for and against normalisation of collaborative care as those who wish to adopt new ways of working have the freedom to change their practice but are not obliged to do so.

Conclusions

The NPM provides a useful structure for both guiding and analysing the process by which an intervention is optimized for testing in a larger scale trial or for subsequent full-scale implementation.     

An ergonomic study on teenage girls working in the manual brick manufacturing units in the unorganized sectors in West Bengal, India

There are laws which protect and prevent the teenage girls from working. But still in the developing countries like India, Bangladesh, etc. teenage girls coming from low socio-economic background work, to add to the family income. There is dearth of data regarding the ergonomic studies of the teenage girls working in the manual brick manufacturing units of the unorganized sectors in India. Therefore, a field study was conducted in about four brick manufacturing units of West Bengal, India. Their job in these fields was to carry 8-10 unbaked and sun-dried bricks (49.11 +/- 2.13 Kg) from the brick field to the kiln-top and again carry the baked bricks back from the kiln to some other corner of the brick field, under the hot sun. Thus, this study aimed at evaluating their work load and their consequent work-related health effects. Results show that 86 % of them suffered from work-related pain in different body parts and there was an increase in their physiological and psychological parameters after work. It is concluded that the frequent use of awkward postures while at work (OWAS) and performing heavy to moderate types of tasks in the field are deteriorating their health conditions.     

Concept, measurement and use of acculturation in health and disease risk studies

Acculturation, a concept with its root in social science and cultural anthropology, is a process intimately related to health behavior and health status of minority populations in a multicultural society. This paper provides a brief review of the subject of acculturation as it relates to health research, showing that this concept has a potential to identify risk factors that underlie increased prevalence of chronic diseases, particularly in immigrant populations. A proper understanding of this is helpful in designing intervention programs to reduce the burden of such diseases and to increase the quality of life in such populations. The concept is defined with an outline of its history showing its evolution over time. Criteria for measuring acculturation are described to illustrate the need of accommodating its multidimensional features. Drawing examples from health research in US Hispanics, the role of acculturation on health behavior is discussed to document that the discordant findings are at least partially due to either use of incomplete dimensions of the concept, or not accounting for the dynamic aspect of its process. Finally, with illustration of a finding from a study among overweight Mexican American women of South Texas, a model of acculturation study is proposed that may be used in other immigrant populations undergoing the acculturation process.