武警部队医院健康教育现状分析及对策

目的　了解武警部队医院健康教育的现状 ,发现不足 ,并提出问题的解决方法。方法　对全国 51所武装警察医院负责健康教育的专职行政人员进行无记名问卷调查 ,部分项目进行现场观察。结果　 2 9 4 %的医院健康教育工作开展较为规范 ;35 3%医院配备有专职健康教育人员 ;2 1 6 %的医院有健康教育网络或类似组织机构 ;2 1 6 %的医院门诊大厅中有大屏幕播放卫生科普知识 ,52 9%的医院设立了健康教育咨询台 ,74 5%的医院住院部科室内有宣传栏或黑板报 ;6 5 2 %的医院没有对医务人员进行健康教育专业培训 ;2 1 6 %的医院将健康教育列入各科室业务考评范围。结论　武警部队医院健康教育工作发展不平衡 ,大多数医院尚未开展此项工作或不规范 ,有待于在组织、制度、实施、管理、评价等方面进一步完善     

武警部队防生化医学应急装备的研制

为完善武警部队处置生化恐怖事件时的医学应急装备,研制一套具有生化侦检、生化洗消、生化救治和生化防护功能的应急救援装备,突出装备的机动性和实用性,以提升武警部队在处置生化恐怖事件时的卫勤保障能力.     

武警部队指挥类院校健康教育教学现状调查分析

目的 了解中国人民武装警察指挥类院校的健康教育教学现状。方法 对全国30所武警部队指挥类院校主管健康教育的1名人员进行问卷调查。结果 问卷回收率为90．0％，有效率为88．9％。8．3％的被调查不知道中国人民解放军三总部颁发的“军队健康教育方案”和“部队健康教育提纲”，45．8％听说过但不熟悉其内容，20．9％不清楚“提纲”中有无有关健康教育的内容。79．2％的院校有健康教育课，仅12．5％院校的健康教育课达31课时。89．5％的院校将健康教育列入教学计划。31．6％无专门的健康教育教材。仅10．5％的院校有专职健康教育教师。健康教育的教学形式中课堂教学占84．2％。26．3％的院校实行开卷考试，21．1％的院校完全不考试。结论 大部分武警指挥类院校开设健康教育课程，但他们的健康教育教学未完全符合三总部件的要求。     

A survey of the provision of educational supervision in occupational medicine in the Armed Forces

OBJECTIVE: The aim of this study was to assess whether balanced educational supervision was being provided for occupational medicine (OM) specialist registrars (SpRs) in the Armed Forces and to consider the effectiveness of current supervision. METHODS: Anonymized postal questionnaires, using Likert five-point response scales, were sent to Service OM SpRs and their educational supervisors (Ed Sup) to assess the degree of understanding of the purpose, effectiveness and organization of the educational supervision being provided. RESULTS: Completed questionnaires were returned from 35 (92%) specialists and 14 (61%) SpRs. Less than a third of the specialists were involved as Ed Sup and only three (11%) had undergone any formal medical education training. There was an agreement about the purpose and effectiveness of educational supervision between both the groups, though there appeared to be a bias towards providing supportive functions with patient management and educational components scoring less highly. CONCLUSIONS: A high response rate enabled an accurate assessment of OM supervision practices in the Armed Forces to be made. There was agreement over the relative effectiveness, importance and coverage of educational supervision, though this was being provided by a relatively small group of OM specialists, few of whom had undertaken any formal medical education training. The supervision provided also appeared to be biased towards providing supportive functions rather than patient management and educational components of training, which may result in an unbalanced training for the SpRs. Having assessed the relatively close-knit service OM community, there would be value in seeing whether similar patterns prevail in the wider OM community.     

Accidental injuries in agriculture in the UK

The rate of occupational accidents in British agriculture is higher than in most other industries. The most common fatal accidents are those involving vehicles and machinery, falls from a height and electrocution. A substantial proportion of reported non-fatal injuries in agricultural employees is attributable to manual handling, but among self-employed farmers the contribution is much smaller. Few data are available on longer-term determinants of risk, but accidental deaths are most frequent in July, August and September. The main approaches to preventing agricultural accidents are through engineering improvements, and education and training of the workforce. The introduction of roll-over protection structures for tractors has been an important development in recent decades. Other engineering controls include guards for power take off shafts, guard rails to prevent falls, better handling facilities for animals and closed transfer systems for pesticides. Training on safety is available from several sources, but its effectiveness in reducing accidents is uncertain.     

The reliability of personal alcohol consumption estimates in a working population

Health and safety problems related to alcohol consumption represent a major concern in many businesses and consequently pre-employment questionnaires and workplace health promotion packages frequently contain questions seeking basic estimates of alcohol consumption. Although individuals with very heavy drinking patterns often attract much attention, on a population basis most morbidity is likely to arise from drinkers consuming above the recommended limits but not sufficient to result in gross occupational or social effects. This study reviews the research on the reliability of questionnaire techniques used to quantify alcohol consumption and compares the most valid retrospective interview based estimate of consumption, the time line follow-back (TLFB), with a prospective daily diary (DD) method in a working population. The DD method was acceptable and produced significantly higher estimates of consumption and for 'normal' subjects gave consistent estimates of +/- 10 units/week over several weeks. Appropriate questionnaire design is discussed and the use of a DD method in health promotion activities recommended.     

Comparison of sensorineural symptoms between UK orthopaedic surgeons and gynaecologists

BACKGROUND: We have previously described significant differences in self-reported neurological symptoms of orthopaedic surgeons when compared to a group of gynaecologists. We suggested that this may be secondary to occupational sources of hand-transmitted vibration. The original study was intentionally brief and failed to address potential confounders. AIMS: To compare the prevalence of sensorineural symptoms between UK orthopaedic surgeons and gynaecologists and adjust for potential confounding factors. METHODS: Postal questionnaires were sent to 2040 members of the British Orthopaedic Association and 1797 members of the Royal College of Gynaecologists requesting information about demographics and self-reported neurological symptoms. Demographics of the orthopaedic surgeons and gynaecologists were compared using chi-squared tests and independent t-tests. Multiple logistic regressions were carried out to compare the prevalence of symptoms while adjusting for potential confounding factors. RESULTS: Differences in the demographic profile of the orthopaedic surgeons and gynaecologists were identified: orthopaedic surgeons were predominantly male, were more junior in grade, were younger, used double gloving more often, had larger glove size, were more likely to be ambidextrous, to use vibrating tools outside of work and to consume greater amounts of alcohol. Orthopaedic surgeons reported a higher prevalence of tingling and numbness of fingers while at work and at other times. These differences were significant even after adjusting for potential confounding factors. CONCLUSION: Observed differences could be related to exposure to hand-transmitted vibration at work. Further assessment of risk to orthopaedic surgeons from hand-held power tools used in the course of their work is recommended.     

Heat Illness in the Army in Cyprus

Heat illness in the British Armed Forces is a significant occupationalrisk. This paper analyzes reports of heat casualties occurringin Episkopi, Cyprus from January 1990 through December 1994.A total of 96 casualties were reported from 48 separate incidents.On seven occasions, three or more casualties occurred concurrently(maximum 19). There were 20 incidents causing 32 casualtiesfrom Cyprus-based units and 28 incidents causing 64 casualtiesfrom units visiting Cyprus. There was a clear seasonal variationof reports with the maximum number of reports occurring fromMay to August. The majority of reported casualties occurredwhen the Wet Bulb Globe Temperature was between 26°C and29°C. Cyprus-based units had most casualties occurring asa consequence of forced marching whereas most casualties fromvisiting units occurred during military field exercise training.Visiting Territorial Army units had the highest incidence ofheat casualties for visiting units. The majority of heat casualtieswere mild; there were only ten severe cases. It was not possibleto identity any particular risk factors applicable to individualsexcept incomplete acclimatization. The study showed that thecurrent guidelines used by the British Armed Forces do not preventall heat casualties. It is not possible to estimate how manycasualties are prevented by the guidelines. All incidents involvinga serious casualty or multiple casualties should be investigatedto determine whether the guidelines should be further amended.     

武警干部自感压力状况及影响因素分析

目的了解武警干部人群心理压力的程度、来源及应对方式。方法采用整群随机抽样的方法,抽取武警某部2253名军官作为调查对象,用中国武警军官压力问卷进行调查。结果自感心理压力一般水平的军官最多,占45．6％。很大的只占7．4％。压力应对方式以积极主动自我调节和主动寻求社会支持为主。logistic回归分析了影响军官压力的主要因素,其中高文化程度、高睡眠质量是保护因素,高工作负荷、人际关系差、消极应对方式是危险因素。结论掌握武警干部压力的状况为制定军人心理健康教育与健康促进策略提供了科学依据。     

Fatal work-related accidents in UK merchant shipping from 1919 to 2005

BACKGROUND: Historically, merchant seafaring was the most hazardous occupation in Britain. However, fatal accident rates have fallen sharply in the last 30 years. AIMS: To establish the causes of all fatal accidents and their trends among seafarers who were employed in UK merchant shipping from 1919 to 2005 and to compare with those in the general workforce and in other industries. METHODS: A historical study, based on examinations of death inquiry files from 1976 to 2005 and official mortality returns from 1919 to 1975, with a total population of 11.90 million seafarer-years at risk. RESULTS: From 1919 to 2005, there were 17,386 deaths from accidents in UK shipping, 6,074 from shipping disasters and 11,312 from personal accidents. Over time, there were large reductions in mortality rates for all the main types of fatal accident, except accidents on deck. Major causes of mortality from shipping disasters were vessels foundering in typhoons, storms and severe gales, explosions in cargo holds and collisions in poor visibility. Fatal accident rates were higher among British seafarers than among Lascars. The relative risk of an accident in UK shipping-compared with the general British workforce-was similar in 2001 to that in 1961. CONCLUSIONS: There have been major improvements in health and safety that have led to substantial reductions in fatal accident rates in UK merchant shipping throughout most of the last 90 years. This mirrors comparable improvements in the fatal accident rate among the general workforce of Great Britain.     

Personality characteristics,psychological symptoms and anxiety levels of drivers in charge of urban transportation in Istanbul

The purpose of the study was to examine whether poor working conditions influenced drivers' psychological health, and to identify drivers' personality characteristics. The subjects were 208 bus drivers working in the European sector in Istanbul. Their personality characteristics, psychological symptoms and anxiety levels were investigated using the Eysenck Personality Questionnaire (EPQ), the Symptom Check List (SCL90-R) and Spielberger's State and Trait Anxiety Inventory (STAI). The average age of drivers was 38.65 +/- 4.69 years, and the mean working period was 7.44 +/- 4.00 years. According to the EPQ, 55 drivers had average standard extroversion scores, 25 had average neuroticism scores and none of the drivers had high scores for psychoticism and lying. The STAI 'state' score of the group was 41.94 +/- 8.93 and the 'trait' score was 47.00 +/- 7.02. The mean SCL90-R of the group was 1.09 +/- 0.57. All subtest scores of SCL90-R were higher for those who suffered from back pain, were dissatisfied with their jobs or undertook long-distance driving. Subtests on somatization, anxiety, anger/hostility, paranoid ideation and general symptom index for SCL90-R and STAI trait scores were higher when comparing employees who had worked for >10 years with those working 相似文献   

Prevalence of musculoskeletal symptoms among aluminium workers

The aim of this study was to determine the prevalence of musculoskeletal symptoms (MSS) in workers in the aluminium industry, and to test the relationship with work by using the duration of employment as a measure of exposure. A total of 5654 workers (92%) answered a questionnaire. Operators, who were more exposed to physically demanding work, showed a greater incidence of MSS than did office workers. Among operators, the duration of employment was significantly correlated with MSS in nine out of ten areas of the body, when adjusted by multiple regression analyses for age, gender, height, weight, smoking and physical activity. Among office workers this relationship was weaker and was significant only for neck and lower back areas. The higher prevalence of MSS among operators and the association between their duration of employment and MSS suggests that a higher risk of MSS is related to the working environment.     

Work-related life events, psychological well-being and cardiovascular risk factors in male Swedish automotive workers

AIMS: To analyse the relationship between life events, social support, psychological well-being and cardiovascular risk factors in blue- and white-collar Swedish automotive workers. METHODS: Baseline questionnaire regarding life events, social support, depressed mood and mental strain and smoking habits. Follow-up questionnaire after 5 years included the Psychological General Well-being Inventory to assess various health variables. At baseline and follow-up, anthropometric data were obtained. Blood pressure, blood glucose and serum lipids were measured and smoking habits were surveyed. RESULTS: The blue-collar workers showed a profile indicating increased cardiovascular risk with a higher proportion of smokers, a higher waist to hip ratio and higher triglycerides. They also reported themselves to have worse general health and less emotional self-control, but were less anxious than the white-collar workers. Negative life events, especially those related to work seemed to affect the well-being of the blue-collar workers more adversely than the white-collar workers. Being nervous and depressed at baseline increased the risk of poor psychological well-being at the follow-up. Social support within this 5-year perspective was a factor which predicted psychological well-being in both worker categories. Increase in cholesterol/high-density lipoprotein-cholesterol (HDL-C) ratio was the only cardiovascular risk factor associated with the strain of life events but not with work-related events. CONCLUSION: Over a 5-year period, men who experienced negative, strongly stressful and work-related life events displayed poorer psychological well-being at follow-up regardless of worker category. Social support was protective.     

The feasibility of conducting occupational epidemiology in the UK

A postal survey was carried out of 1,000 UK companies to collect information about employee biographical and work history records. The overall response rate was 46%. All companies collected surname, forenames, address, date of birth and National Insurance number--information needed for cross-sectional studies. Other biographical details such as maiden name and National Health Service number were collected less often, which could increase the cost and difficulty of tracing ex-employees. Seventy per cent reported destroying their records within 10 years of an employee leaving, rising to 82% for companies with fewer than 100 employees. The destruction of employee records creates problems for historical cohort studies and case-control studies, and may hamper ex-employees trying to claim benefit for occupational-related illness. If the scope of future occupational epidemiology is to be improved, guidelines for the collection and retention of the data required must be developed and industry encouraged to participate.     

Low prevalence of clinical latex allergy in UK health care workers: a cross-sectional study.

The prevalence of natural rubber latex allergy amongst health care workers has been reported to vary between 1 and 40%. This is because different diagnostic criteria have been used on heterogeneous groups of subjects. We have undertaken a cross-sectional study of all 5600 employees in two National Health Service trusts served by one department of occupational health and one department of clinical immunology. The period prevalence (1999-2000) for Type I clinical latex allergy in the clinical health care workers was found to be 17/3500 (0.5%). Difficulties in diagnosis and factors which may have contributed to this low prevalence rate are discussed. No cases were forced to leave health care work as a consequence of their allergy.     

军队医疗保障制度改革现状及发展趋势

军队医疗保障制度是指在一定的历史条件下形成的军队人员医疗待遇、医疗服务保障基本方式、医疗经费运行机制等方面的制度体系。其核心是费用制度。中国人民解放军医疗保障制度,在提高医疗经费标准、加强医疗费用管理、建立医疗特殊项目补助经费等改革的基础上,2004年5月我军实施了新的医疗保障制度,其主要内容是:①分类保障;②合理医疗;③统定管理;④持卡就医。⑤远离军队医疗机构人员门(急)诊实行社会化保障。目前,制度运行基本顺畅,正在寻求从以下几个方面进行深化改革:更多地依托地方医疗机构为军队服务,完善军人退役医疗保险制度,加强军人大病费用管理,规范基层部队医疗服务管理。     

A systematic review of prevalence and risk factors associated with playing-related musculoskeletal disorders in pianists

BACKGROUND: Playing-related musculoskeletal disorders (PRMDs) are a recognized problem amongst instrumental musicians. Although pianists are prominent in data regarding prevalence of PRMDs, there is poor understanding of piano-specific risk factors associated with PRMDs. AIM: To synthesize published literature on the prevalence of and risk factors associated with PRMDs in pianists. METHODS: Thirty-eight databases were searched. Eligible studies were those investigating prevalence of or risk factors associated with PRMDs in pianists, using an appropriate methodology according to a hierarchy of evidence. Information regarding study population, operational definition of PRMD, risk factors investigated, statistical tests used and outcomes was extracted and narratively synthesized for all eligible papers above an arbitrarily chosen quality score. RESULTS: The literature search identified 482 citations. Fifty-two papers were ranked in a hierarchy of evidence; 12 were eligible for evaluation using a quality assessment tool. Common methodological limitations included sampling/measurement biases, inadequate reporting of reliability/validity of outcome measures, lack of operational definition of PRMD and no statistical significance testing. Prevalence rates for PRMDs in pianists varied widely (26-93%). Four authors demonstrated statistically significant risk factors; however, no authors combined a clear operational definition of PRMD with statistically established risk factors. There was no consensus between authors regarding risk factors. CONCLUSIONS: Current evidence does not provide sufficient information regarding prevalence of and risk factors associated with PRMDs in pianists. Future studies should provide an operational definition of PRMD, use valid, reliable measurement tools, utilize a prospective cohort study design and perform appropriate statistical tests.     

Medical downgrading, self-perception of health, and psychological symptoms in the British Armed Forces

Objective

To investigate the contribution of psychological symptoms to limited employability for medical reasons in the British Armed Forces.

Methods

A sample of 4500 military personnel was randomly selected to receive either a full or an abridged questionnaire. The questionnaires asked whether the participant was medically downgraded and if yes, the reason for it. The full questionnaire included the General Health Questionnaire‐12 (GHQ‐12), the post‐traumatic stress disorder (PTSD) checklist, 15 symptoms to assess somatisation, and selected items of the quality of life SF‐36 questionnaire. The abridged questionnaire included the GHQ‐4, a 14 item PTSD checklist, five symptoms, and the item on self‐perception of health from the SF‐36. Subjects above a threshold score for GHQ, PTSD, and symptoms were considered to have psychological symptoms.

Results

12.4% of the participants were medically downgraded. The majority (70.4%) had social or work limitations. Medically downgraded personnel had higher odds ratios in comparison to non‐downgraded personnel for psychological distress 1.84 (95% CI 1.43 to 2.37), PTSD 3.06 (95% CI 1.82 to 5.15), and number of symptoms 2.37 (95% CI 2.37 1.62 to 3.47). GHQ, PTSD, and symptoms scores were mainly, but not exclusively, related to chronic physical injury.

Conclusions

Psychological symptoms are common among medically downgraded personnel. Although the mechanisms involved are unclear, tackling issues of psychological symptoms among these subjects could contribute to faster restitution to full employability in the Armed Forces.     

The estimated workforce served by occupational physicians in the UK

During the past decade, an occupational disease surveillance scheme has been created in the UK, based on systematic reporting of newly diagnosed cases by six groups of clinical consultants and by specialist occupational physicians. Labour Force Survey statistics have proved a reasonably satisfactory denominator for the former, but not for the occupational physicians, who provide services for only a selected subsection of the employed population. To remedy this deficiency, approximately 700 occupational physicians who were recorded as having been a reporter at some time were invited to provide their best estimate of the number of employees for whom they were responsible. After various exclusions--mainly physicians who were not, or were no longer, responsible for any defined workforce, and others who had not reported for at least 3 years--the number of active participants for whom data, by industry, occupation and sex, were obtained or estimated was 503. The resulting total number of employees served was estimated at 3.2 million, comprising 12% of the general working population. The proportion with access to an occupational physician varied enormously, from 43% in the health and social services to 1% in agriculture, forestry and fishing, and 6% in the rest of industry. Numbers estimated for each industrial sector were fairly reliable, but by occupation less so, especially in the health and social services.