Role of the independent duty corpsman on the USNS Comfort (T-AH 20): the Operation Desert Shield/Desert Storm experience.

Independent duty corpsmen (IDCs) have a significant role in providing health care on the USNS Comfort (T-AH 20). The IDCs are responsible for staffing sick call, emergency response teams, and resuscitation/stabilization teams. IDCs are trained in advanced patient care and in medical administrative and logistical duties. During peacetime, their function often focuses on primary care to the decrement of skills necessary to perform in medical emergencies. The Operation Desert Shield/Desert Storm mobilization has emphasized the need for Navy medicine to continue its support of IDC training so that they are kept in a state of preparedness to competently deliver the full spectrum of care that is expected of them.     

海警某基层单位医疗保障现状与需求调研

 目的 了解海警某基层单位医疗保障的现状与需求,为海警医疗建设提供科学参考依据。方法 2018-10至2019-04,便利抽样法选取3个海警基层单位行政管理人员作为调查对象,采用自制的《海警医疗保障状况与需求信息采集表》对其进行问卷调查。利用构成比和选择率进行相关统计分析。结果 本次调查共3个单位270名人员,男250名,女20名,年龄23~49岁,工龄1~32年,学历专科25.6%,本科72.6%,硕士1.9%,职务分布范围广。95.2%的人员认为拥有医疗应急预案和卫生信息化建设装备,但是大多数属于不完善状态。19.0%的人员认为拥有舰艇-岛礁-岸基三级救治平台, 78.7%的人员认为应该加强医疗体系建设,95.2%的人员认为执行任务时舰船需要配备卫生救援人员;对于医疗信息化建设的需求和医学远程会诊和急救指导的需求几乎达到100%。结论 海警某基层单位医疗保障现状不理想,分任务分类别准备预案,加强医疗信息化建设,加强梯队和救治平台建设都是下一步需要加强的方向。     

Health indicators in children from Meulaboh, Indonesia, following the tsunami of December 26, 2004

The French Army medical service carried out an epidemiological survey to estimate health indicators in children living in Meulaboh, Indonesia, in the weeks following the tsunami of December 26, 2004, within a sample from refugee camps, schools, and quarters of the town. Thirty-four percent of the children in camps, 21.9% in schools, and 49.5% from quarters presented psychological trauma. Malnutrition affected 20.5% in camps and 34.4% in the town between 6 and 59 months, 11.3% in camps, and 7.6% in schools between 6 and 15 years. The children had suffered various symptoms since the tsunami; access to care was possible for 53.9% in the camps, 23.8% from schools, and 39.3% from the town. Those results have been subsequently used by the local health authorities to improve child health care. The method used for this survey could be applied for future disaster scenarios.     

The socioeconomic aspects of information technology for health care with emphasis on radiology

RATIONALE AND OBJECTIVES: Information technology is the key to cost effective and error free medical care in the United States and the only problem is that there is not enough of it yet. During the past 15 years, billions of dollars have been spent on information technology for health care with very little benefit but significant adverse effects on patients, physicians, and nurses. The truth about health care information technology (HIT) probably lies somewhere between these extreme statements, representing technophile and skeptical views, respectively. MATERIALS AND METHODS: There is no doubt that computer and communication hardware has reached a state of sophistication and availability in which any and all necessary information can be generated, stored, and distributed to health care workers in support of their patient care tasks. The barriers to rapid and widespread development and diffusion of cost effective and practically useful HIT are exclusively related to human factors. RESULTS: This article explores some of the organizational, cultural, cognitive, and economic forces that interact to influence success of HIT initiatives in health care organizations. A key point to be recognized is that the intrinsically handcrafted nature of health care work combined with high degrees of complexity and contingency make it impossible to "computerize" with the same ease and completeness of other industries. The major thrust of the argument is that designers of information systems and health care informatics managers must meet needs of patients and care providers. The software they create and implement should promote, support, and enhance the existing processes of health care rather than seeking to dictate how direct care providers should do their work. CONCLUSIONS: Instead of looking for "buy in" from physicians and nurses, the informatics community must return the authority over functional specification of patient care information systems to them--where it belonged in the first place. This same lesson about computer technology and organizational politics is also being learned in the business community, where executives are reclaiming responsibility for mission critical informatics decisions.     

Medical education and health care in Iraqi Kurdistan in the last four decades

Medical education and health care in Iraqi Kurdistan were oppressed by the regime of Saddam Hussein for four decades. There have been efforts to revive them by Kurdish and non-Kurdish professionals in and outside Kurdistan with the assistance of various governmental and non-governmental organisations. However, the health care and medical education systems in Iraqi Kurdistan require ongoing international support. Recent global awareness of the war on terror and attempts to rebuild the health care system should not concentrate only on the immediate effects of the war, but they should also focus on the wide-ranging implications of the previous dictatorship regime.     

Medical education and health care in Iraqi Kurdistan in the last four decades

Abstract

Medical education and health care in Iraqi Kurdistan were oppressed by the regime of Saddam Hussein for four decades. There have been efforts to revive them by Kurdish and non-Kurdish professionals in and outside Kurdistan with the assistance of various governmental and non-governmental organisations. However, the health care and medical education systems in Iraqi Kurdistan require ongoing international support. Recent global awareness of the war on terror and attempts to rebuild the health care system should not concentrate only on the immediate effects of the war, but they should also focus on the wide-ranging implications of the previous dictatorship regime.     

东莞市后街镇中心小学学生视力3年调查

目的　为了了解东莞市厚街镇中心小学学生的视力情况。方法　采用标准对数视力表 (GB 1 1 5 33- 89) ,连续 3年(2 0 0 0 - 2 0 0 2年 )分别对该校全体学生进行检测。结果　 2 0 0 2年和 2 0 0 1年的近视率要显著高于 2 0 0 0年 (χ20 0 -0 1 =5 8.6 4 ,χ20 0 -0 2=5 2 .39,均P <0 .0 1 ) ,且各年度高年级的近视率显著高于低年级 ,并有随年级增高的趋势 ;(χ2 分别为 1 2 5 .90、1 91 .2 7、4 5 .35 ,P均 <0 .0 1 ) ,一年级近视率也有随年度增高的趋势 (χ2 =2 4 .2 6 ,P <0 .0 1 ) ,并急剧增长。结论　该校学生的近视率有逐年增高的趋势应采取相应措施加以控制     

How primary care services can incorporate refugee health care

Two principles should underpin the provision of primary health care to refugees: (a) that refugees should have the same access to quality primary care services as the local population, and (b) any specialist service should have the goal of full integration of the refugee into normal general practice. The various ways in which medical care can be provided to refugees and the knowledge, skills and attitudes important to such provision are described. One way in which such a service was provided in east Kent is reported. The term 'refugee' encompasses newly arrived refugees who are awaiting a decision from the Home Office, as well as those who have been given permission to stay, either as recognized Refugees under the provisions of the 1951 United Nations Convention, or with Exceptional or Indefinite Leave to Remain.     

Primary care enrollment levels in staff- and group-model health maintenance organizations: a standard to compare military enrollment with civilian organizations

A literature review was conducted to determine civilian staff- and group-model health maintenance organization (HMO) primary care provider staffing. Civilian staff- and group-model HMOs enroll an average of 1,473 members per primary care physician. When physician extenders are considered, the average enrollment is 1,156 members per primary care provider. Despite the similarities between the staff- and group-model HMO and military medicine, military medical care is significantly different and may decrease the capability for enrollment as a result of mission support, occupational medicine, and other military-unique factors. Comparisons between military and civilian enrollment should be tempered with these considerations.     

The female athlete triad

The Female Athlete Triad poses serious health risks, both short and long term, to the overall well-being of affected individuals. Sustained low energy availability can impair health, causing many medical complications within the skeletal, endocrine, cardiovascular, reproductive, and central nervous systems. With the surge of females participating in athletics within the past 10 to 15 years, it is both conceivable and likely that the prevalence of this syndrome will continue to grow. Therefore, it is imperative that appropriate screening and diagnostic measures are enacted by a multidisciplinary team of health care providers, counselors, teachers, and dieticians in order to provide the proper care to affected athletes. Initial awareness should take place within the educational confines of elementary and high schools. Screening for female athletes exhibiting risk factors for the triad should also take place at the time of sports physicals. If one component of the triad is identified, the clinician should take the time to effectively workup the other 2. Treatment for each component of the triad includes both pharmacological and nonpharmacological measures, with emphasis placed upon increased energy availability and overall improved nutritional health. Using this all-encompassing type of approach, sports medicine practitioners should feel empowered to continue to promote the lifelong well-being of female athletes in the years to come.     

Epidemiology of injuries and illnesses during the United States Air Force Academy 2002 Basic Cadet Training program: documenting the need for prevention

The rapid physical and emotional conditioning that occurs during Basic Cadet Training (BCT) creates ample opportunity for injuries and illnesses. The goal of this analysis will be to document the magnitude of injury and illness problems during BCT at the Air Force Academy and to identify potential risk factors for targeted prevention efforts. Data used in this study were collected on the basic cadet population from various sources during BCT 2002. Data analysis for this retrospective observational study included cumulative incidences, chi2 analysis, and logistic regression. Risk factors for injuries included being of the female gender, being an intercollegiate athlete, being overweight, and having an obese body mass index (BMI). Female gender, military preparatory school attendance, and obese BMI were risk factors for illnesses. Future BCT medical surveillance should focus on females, recruited athletes, and those with high BMIs. Prevention efforts should focus on reducing ankle sprains and respiratory infections to limit the amount of lost training time.     

Racial variations in Department of Veterans Affairs ambulatory care use and unmet health care needs

Our objective was to describe racial/ethnic variations in Department of Veterans Affairs (VA) ambulatory care use and its association with the presence of unmet health care needs. Using the 1992 National Survey of Veterans, we examined race/ethnicity and unmet health care need for ambulatory care users of VA and non-VA facilities. Black and Hispanic veterans were more likely to report any VA use. In unadjusted analyses, American Indian/Eskimo, Hispanic, and black veterans were 4.4, 2.5, and 1.9 times more likely, respectively, than white veterans to report an inability to get needed care. Adjusting for VA ambulatory care use diminished the disparity in inability to get needed care between American Indian/Eskimo or Hispanic veterans and white veterans and eliminated the disparity between black and white veterans. Our findings support the VA's role as a medical safety net provider and suggest that VA ambulatory care use is effective in mitigating health-related racial disparities for some veterans. Additional facilitators for reducing unmet need should be explored.     

试论登岛作战卫勤保障需求与卫生装备研究

本文探讨了登岛作战卫勤保障需求和卫生装备研究的有关问题，研究提出了：登岛作战卫勤保障将呈现需求多元化、阶梯扁平化和聚焦卫勤能力等新特点；不同作战阶段、不同作战样式引发不同的伤员救治需求，航渡、抢滩登岛和扩大登陆场作战伤员救治需求是重中之重；应优先研制海上、岛上及“三防”作战卫勤保障专用卫生装备，完善配套单兵自救互救及师救护所医技保障装备，解决岛上伤员战略、战役后送和卫生装备战略投送问题，形成5种卫勤保障能力，即：海上系列救治装备保障能力、生防系列救治装备保障能力、单兵非医救治自我保障能力、师救护所医技自我保障能力和卫生装备信息化保障能力；加强登岛作战的卫勤理论研究，加强卫生装备科研的组织领导工作，顶层设计、整合力量、集中财力，采用新的组织体制和运行机制，形成科技攻关合力、科技攻关助推力和科技攻关制度约束力。     

Wilderness medicine: strategies for provision of medical support for adventure racing

In adventure racing, or multisporting, athletes perform multiple disciplines over a course in rugged, often remote, wilderness terrain. Disciplines may include, but are not limited to, hiking, trail running, mountain biking, caving, technical climbing, fixed-line mountaineering, flat- and white-water boating, and orienteering. While sprint races may be as short as 6 hours, expedition-length adventure races last a minimum of 36 hours up to 10 days or more and may cover hundreds of kilometres. Over the past decade, adventure racing has grown in popularity throughout the world with increasing numbers of events and participants each year. The provision of on-site medical care during these events is essential to ensure the health and safety of the athletes and thus the success of the sport. At present, there are no formal guidelines and a relatively small amount of literature to assist in the development of medical support plans for these events. This article provides an introduction to the provision of medical support for adventure races. Since a wide variety of illness and injury occur during these events, the medical support plan should provide for proper personnel, equipment and supplies to provide care for a wide range of illness and injury. Foot-related problems are the most common reasons for athletes to require medical attention during these events. This article also highlights some of the controversies involved in the provision of medical support for these events. Suggested penalties for acceptance of medical care during the event and strategies for removal of an athlete from the event for medical reasons are offered. In addition, some of the challenges involved in the provision of medical support, including communication, logistics and liability are discussed. This information should prove useful for medical directors of future, similar events. Because of their extreme nature, expedition-length adventure races represent a new and unique area of wilderness and event medicine.     

Prevention of violence in prison – The role of health care professionals

The World Health Organization (WHO) classifies violence prevention as a public health priority. In custodial settings, where violence is problematic, administrators and custodial officials are usually tasked with the duty of addressing this complicated issue-leaving health care professionals largely out of a discussion and problem-solving process that should ideally be multidisciplinary in approach.Health care professionals who care for prisoners are in a unique position to help identify and prevent violence, given their knowledge about health and violence, and because of the impartial position they must sustain in the prison environment in upholding professional ethics. Thus, health care professionals working in prisons should be charged with leading violence prevention efforts in custodial settings.In addition to screening for violence and detecting violent events upon prison admission, health care professionals in prison must work towards uniform in-house procedures for longitudinal and systemized medical recording/documentation of violence. These efforts will benefit the future planning, implementation, and evaluation of focused strategies for violence prevention in prisoner populations.     

Medical action for global security (MEDACT): Founding statement

Two principles should underpin the provision of primary health care to refugees: (a) that refugees should have the same access to quality primary care services as the local population, and (b) any specialist service should have the goal of full integration of the refugee into normal general practice. The various ways in which medical care can be provided to refugees and the knowledge, skills and attitudes important to such provision are described. One way in which such a service was provided in east Kent is reported. The term ‘refugee’ encompasses newly arrived refugees who are awaiting a decision from the Home Office, as well as those who have been given permission to stay, either as recognized Refugees under the provisions of the 1951 United Nations Convention, or with Exceptional or Indefinite Leave to Remain.     

Evaluations over the medical emergency responding to chemical terrorist attack

The use of chemical warfare agents intentionally has become a great concern in the arena of the cold war. On the other hand, there has always been a threat on civilian population due to their mass destruction effects, including psychological damage and a great deal of discussion how to respond to it in terms of medical management. It is very important to provide the best lifesaving medical care and triage in a chemical-contaminated area. Mass casualties exposed to chemical agents require immediate medical intervention to save their lives and should be classified in accordance to medical care priorities and available medical sources, including antidotes and sophisticated health facilities. Establishing the decontamination area for chemical casualties where it is located at the suitable place with respect to the wind direction is necessary. To overcome the mass destruction effects of chemical warfare agents following the terrorist attack, we must have the emergency medical response plan involving experienced triage officers and medical care providers to be able to perform medical management in the chemical-contaminated area and health facilities.     

Reflections on the development of health care and patients' rights in Croatia

Nowadays, in the world of markets and market economy, not only health care but medicine and medical practice in general, are looked upon more and more through the eyes of profit-making and financial interests. At the same time, there is an increasing number of initiatives intended to emphasise that human medicine should be at the service of society and that this fact should have priority over any market and financial interests of individuals even in "the market oriented world". The experience of the Croatian non-governmental organization to which the authors belong and which deals with patients' rights and helps in the development of partnership relations between patients and other subjects in the health care system, can be of a wider interest. This short review is the result of eight years' experience of the Croatian Association for Patients' Rights (CAPR), and its possible effects on the health care system in the future from the authors' points of view.     

Health care reforms in Poland

This paper examines the shape of the recently reformed health care system in Poland. Until December 31,1998 everyone had access to free health care and the medical institutions were financed by the State. Since January 1, 1999, under the provisions of the Universal Health Insurance Act, hospitals became independent from the State budget and gained more financial resources for their activities. 17 regional health insurance funds contract for medical services with hospitals and individual practices. Most services provided to the insured are paid by the funds that receive premiums, but some are still financed from the State budget. The revised legislation on Medical Care Establishments intended to create a better management of health care institutions and administrative control over the quality of care. The system has been severely criticised: it is too bureaucratic, there are too many insurance funds, patients have experienced problems with access to health care, particularly to special treatment or to treatment available outside the area of the health insurance fund to which the patient belongs. The new Minister for Health suggested that the 17 funds should be replaced by 5 "health funds" that would finance health care and be closely connected to the local government answerable for their activities. This paper will deal with the scope of health care packages, the conditions of provision of health services, obligations of health care providers, patient rights, and the quality of health care.