Objective To develop and evaluate the application effect of the improved transvesical intra-abdomincal pressure（IAP） monitoring method based on the disposable closed bladder manometer kit in monitoring IAP and guiding enteral nutrition（EN） in patients with severe acute pancreatitis（SAP）,so as to provide evidence-based medical evidence for its widespread application.Methods Based on the clinical experience, the disposable closed bladder manometer kit（Patent number: ZL202020552480.3） was developed, and based on this kit, the improved transvesical IAP monitoring method（improved method） was developed.A total of 182 patients with SAP who were hospitalized in the Department of Gastroenterology of the Second Affiliated Hospital of Army Military Medical University were studied.A total of 71 patients with urination were monitored by the improved method and the traditional method for consecutive five days, and 25 patients without urination were monitored by the improved method to evaluate the effectiveness of the manometer kit.At the same time, 86 SAP patients requiring EN were divided into the improved method group and the traditional method group（43 cases each） by random number table method（1∶1）.The clinical implementation of EN was guided according to the monitoring results, and the clinical effect after continuous EN 1 week was compared.Results In SAP patients with urination, IAP values measured by the improved method at different time points showed no statistical significance compared with those measured by the traditional method（P＞0.05）,and the improved method could effectively monitor the transvesical IAP in patients without urination.The EN intolerance rate of patients in the improved method group was significantly lower than that in the traditional method group, and the diet compliance rate and body mass index increase of patients in the improved method group were significantly higher than those in the traditional method group, with statistical significance（P＜0.05）.Conclusion The disposable closed bladder manometer kit can effectively monitor the transvesical IAP in SAP patients with and without urine.The improved transvesical IAP pressure monitoring technology based on the kit can effectively guide the dynamic regulation of EN in SAP patients.The kit and the improved monitoring method based on it are worthy of further evaluation and clinical application.

通过国内外对"食育"的定义阐述,提出食育的内容:通过各种饮食观念、营养知识、饮食安全、饮食文化等知识进行教育,一方面获得有关"食"的知识和选择食的能力;另一方面培养出有人与自然、环境和谐相处的意识,,有传统食文化理解力、有良好饮食习惯、能过健康食生活的人.我国食育尚处于起步阶段,在政策制定、理论探索、实践尝试等方面均未形成体系,除借鉴国外食育经验,还需考虑地域、文化、传统、宗教等因素影响,提出符合我国国情,具有中国特色的食育养生的建议与对策,以提升全民健康素养,帮助社区居民树立科学合理的食育健康观.

目的 了解重庆市三甲医院心内科护士对心脏康复的认知情况.方法 采用横断面调查研究,以重庆市11所三级甲等医院心内科护士作为调查对象进行问卷调查,内容包括护士一般资料、护士的专科工作经历;护士对心脏康复相关知识的认知情况和对心脏康复工作开展的意见和建议.结果 2019年2月共234名心内科护士完成问卷,在调查对象中仅有23.93％的护士熟悉心脏康复的内容,参与过心脏康复相关的培训和实践的仅有17.52％.结论 重庆市三甲医院心内科护士对心脏康复认知情况亟待加强,心脏康复的普及是心脏康复推广和实施的前提和重要保证,需要从多层面开展心脏康复相关知识和技能的教育与培训,本文结合调研结果提出"心脏康复护理团队组建模型设想及实施路径"的设想,以期为在相关政策和指南的支持和引导下,组建适宜的心脏康复团队做出有益的尝试.

The paper summed up the key problems of death education in the care of cancer patients.It pointed out that death education plays an important role in helping cancer patients to face life and death,alleviating negative psychological emotions such as fear and anxiety,improving the quality of death,promoting medical staff to understand the needs of cancer patients and relieving the contradictions between doctors and patients.It then further discussed and analyzed factors hindering the development of death education in China,including traditional death culture,family,medical environment and social organization.Based on this,it proposed that China should increase death education propaganda actively,strengthen knowledge training among medical staff,support and encourage social organizations to build a scientific cooperation system which includes doctors,nurses and patients,so as to help more cancer patients find confidence in life and integrate into the society.

Objective:To construct evaluation indicator system of pension services in geriatric department in community health service center under the concept of"integrated care".Methods:Based on previous literatures,policy research and semi-structured interviews, the evaluation index system for elder care services in community health centers under the concept of"integrated care"was preliminarily established.Three rounds of expert interviews were conducted with Delphi method and AHP to determine the index contents and weight.Results:Finally,the evaluation index system of the pension service included the comprehensiveness of the concept of integrat-ed care,the scientific evaluation of the service object,the standardization of the service personnel management,the improvement of the service content and the rationality of the charging standard formulation,and standardization of quality of service control'totally 6 first-level indicators,17 second-level indicators and 55 third-level indicators.In the first-level indicators,standardization of quality of service control had the highest weight(0.208),the rationality of charging standards was the second(0.207),and comprehensiveness of inte-grated care concept was the lowest(0.128).Conclusions:The construction of evaluation index system of pension service can promote the standardized development of pension model of community health service center in China,and also provide some references and guidances for the formulation of the evaluation standard of integrated pension service.

Objective To deeply analyze the life experience of elderly residents living in elderly care departments in Community health service centers in Chongqing,in order to provide reference bases for the establishment and promotion of the new endowment patterns.Methods By using phenomenological research methods,three community health service centers' elderly care departments in Chongqing were purposefully selected,and 18 residents had in-depth interviews and the data were analyzed accordingly with Colaizzi steps,themes were extracted.Results The life experience of elderly residents were presented as 6 themes:security and trust,satisfaction and relief,sympathy and understanding,independence and adaptation,complaints and helpless,fear and anxiety.Conclusion The elderly were satisfied in health care and family comfort,elderly care departments are installed in community health service centers' have good prospects,but managers should pay attention to environmental limitation,social psychological and other important defects.

目的 分析某军医大学2010-2014年新学员健康体检结果,为相关部门开展卫生工作提供科学依据.方法 按照《军队院校招收学员体格检查标准》(后发[2006]6号)对2010-2014年新入学本科学员(共3388名)进行体检,采用EpiData 3.1软件录入学员一般情况及体检结果,并用SPSS 20.0进行数据分析.结果 2010-2014年新学员异常指标总检出率为21.0％(713/3388),且呈逐年上升趋势;共检出异常指标18种,其中异常检出率排序居前五位的分别是龋齿(7.8％)、ALT异常(3.8％)、身高不足(1.9％)、视力低下(1.4％)和HB偏低(1.2％).结论 该军校2010-2014年新学员异常指标总检出率比较高,其中龋齿、ALT异常、身高较低,视力低下、HB偏低多为常见,针对学员异常指标检出情况,有必要实施综合的健康促进措施以维护学员健康.

援外医疗工作是我国外交的重要组成部分.非洲是援外医疗的主要对象.援外医疗实践中,援外医师面临着语言障碍、社会融入、业务开展条件迥异、临床设施落后等问题.在援外医师集训教学中,应针对性的加强日常及专业语言培训;实施跨学科临床业务培训;开展简陋条件下诊治的适应性训练等.进一步提高援外医疗集训教学质量,为开展好援外医疗工作奠定基础.

由于军队工作对死亡教育的特殊要求,第三军医大学开设了为期8周,共计20学时的死亡教育选修课,教学内容涵盖对死亡的认识、死亡界定、相关伦理争议、死亡观、死亡教育活动、寿命评价、丧亲者照护七个方面.根据多年教学效果反馈,提出教学内容模块化重构思路,从普通死亡教育知识和技能、军人死亡观教育及死亡体验与处置能力培训三方面进行教学内容模块化升级.教学方法上建议增加模拟教学、体验式教学等形式.师资培养方面则强调教师死亡照护专业知识培训、吸纳丧葬界职业人士加入教学团队等措施.

目的 分析某军医大学新学员长途徒步行军伤病特征,并探讨其卫生防疫保障措施.方法 系统整理徒步行军医疗就诊档案,采用SPSS 20.0数据录入及分析方法,结合本次卫生防疫保障方案和文献调研,提出具体措施.结果 新训学员就诊人次率高达250.19％(1351/540),常见伤病包括脚泡、上呼吸道感染、胃肠炎、擦伤、软组织伤,占全部诊治人次的77.47％;各伤病的就诊人次存在一定时间特征.结论 新生长途徒步行军伤病谱和特征存在一定特殊性,应根据伤病谱和特征、训练科目和卫生流行病学调查结果进一步强化卫生流行病学侦查、疾病监测和信息分析等措施,从而提早做好施训前防伤病健康教育,科学合理制订卫生防疫保障预案,加强应急医疗事件处突能力,有效防止训练伤病发生.

Objective To explore the mental health and its relationship with mental quality of training logistic soldiers in field.Methods Symptom Checklist 90(SCL-90) and Mental Quality Questionnaire for armymen (MQQA) were employed to evaluate the mental health and mental quality of 230 training logistic soldiers in field,and then an analysis was carried out on the characteristics of the training logistic soldiers on mental health and its relationship with mental quality.Results ①The psychological problem's ratio of training soldiers was 21.3％,and the ratio of the male(22.8％) was significantly higher than that of the female(15.2％) (x2 =8.64,P=0.00).In SCL-90,the scores of somatization (1.46 ± 0.63),hostility (1.49 ± 0.75) and psychotism (1.43 ±0.68) were all higher in training soldiers than the army norm.The factor scores of somatization (1.49 ± 0.66)and psychotism(1.46 ± 0.72) in the male training soldiers were considerably higher than those of the male soldiers norm (P ＜ 0.05),but not in the female(P ＞ 0.05).②There existed a significantly negative correlation between the factor scores of the mental quality and that of SCL-90 (P ＜ 0.05,P ＜ 0.01).③The SCL-90 scores existed clear differences in obsessive-compulsive,interpersonal sensitivity,depression,hostility and paranoid ideation among different mental quality groups (P ＜ 0.05).Conclusion The mental health of training logistic soldiers is poor.The mental health is closely related to the mental quality.Therefore,the mental health education and mental quality training should be strengthened to the training logistic soldiers.

Objective To explore the effects of group psychological training on mental health of military students and field soldiers.Methods A total of 60 students and 48 soldiers received group psychological quality training and studied a textbook Mental Quality Training for armymen for 3 months.Mental Quality Questionnaire for Amymen (MQQA),Symptom CheckList 90 (SCL-90),Self-rating Anxiety Scale (SAS),Self-rating Depression Scale (SDS) and State-Trait Anxiety Inventory(STAI) were employed to evaluate mental health and psychological quality of subject before and after the training.All the data were analyzed by independent-samples t test.Results (1) The difference in MQQA score of field soldiers before and after training was significantly larger than that of military students in loyalty and general score,and lower in willpower((-16.58 ± 7.75) vs.(-1.75 ± 8.68),(-27.74 ± 28.74) vs.(-12.57 ± 30.96),P ＜ 0.05).(2) The SCL-90 difference of field soldiers between before and after training was significantly larger than that of military students in hostility and phobic anxiety((0.26 ±0.47) vs.(0.07 ± 0.24),(0.13 ± 0.40) vs.(0.02 ± 0.13),P ＜ 0.05).(3) The difference in emotion score of field soldiers between before and after training was significantly larger than that of military students in SAS,SDS,SAI,TAI and STAI (P ＜ 0.01).Conclusion The effects of group psychological quality training on field soldier group are better than that of military students,which is helpful to improve mental quality and mental health,as well as to relax anxiety and depression of soldiers.

目的 了解军医大学学生严重亚健康症状及其相关因素,为亚健康干预提供科学依据.方法 用病例对照研究方法,采用标准亚健康诊断调查表和自行设计的亚健康相关因素调查表收集相关信息,对亚健康相关因素进行单因素和多因素logistic回归分析.结果 纳入亚健康组和健康对照组分别为253人和506人,亚健康组检出率排列前3位的临床症状为睡眠质量差(61.7％)、缺乏体育锻炼(56.4％)和注意力难以集中(43.5％)；单因素和多因素logistic回归分析显示,吸烟、饮酒、睡眠不足、偏食是亚健康的重要危险因素,而体育锻炼、兴趣广泛、有安全感是亚健康的保护性因素.结论 军医大学存在一定影响亚健康的相关因素,有必要开展系统的亚健康管理和干预等工作,切实维护军校医学生健康.

按照2007年<烟草控制框架公约>缔约方会议一致通过的关于推行公共与办公场所全面禁烟的指导准则,学校作为公共和办公场所应全面戒烟.但中国控烟协会发布的2011年<全国高等院校无烟环境创建评估暗访报告>数据显示[1],在随机抽取的800所高校中,98%的学校得分不足60分,远未达到教育部和卫生部提出的无烟学校参考标准[2].

自20世纪80年代中期,前苏联学者Berkman提出亚健康的概念以来,处于亚健康状态的人数呈逐年增加趋势,亚健康逐渐受到WHO、各国政府及医学界的高度重视.目前约50%~75%的人群处于亚健康状态,与艾滋病并列为21世纪人类健康的最大敌人[1 - 3].作为未来特殊的社会角色群体的军医大学生的亚健康不仅影响他们的正常学习和生活,还会对社会和其他相关人群产生重要影响.了解他们亚健康的流行病学特征,对于健康维护工作的开展具有重要意义.现将2012年4~6月在我国军医大学在校医学生中的亚健康及其流行病学特征调查结果报告如下.

Objective:To investigate correlation between plasma level of hydrogen sulfide(H2S) and incidence of hypertension in people with high normal blood pressure.Methods:Clinical data of 1 056 subjects with high normal blood pressure undergoing health examination were retrospectively analyzed.Deproteinization method was used to measure plasma H2S concentration.After 24-month follow up,according to develop into hypertension or not,subjects were divided into hypertension group(n=226) and no-hypertension group(n=830).Plasma H2S level was compared between the two groups.Quartile method was used to analyze relation between H2S concentration and incidence rate of hypertension;Logistic regression analysis was used to study whether H2S level was a risk factor for incidence of hypertension.Results:Plasma H2S concentration of hypertension group was significantly lower than that of no-hypertension group [(32.54±3.61) μmol/ L vs.(50.62±3.84) μmol/ L,P<0.01];the lower H2S concentration was(<60.72μmol/ L,<51.84μmol/ L,<42.97μmol/ L,<34.09μmol/ L),the higher incidence rate of hypertension was(13.3%,15.0%,27.8%,35.8%,P<0.01);Logistic regression analysis indicated that plasma H2S concentration was a risk factor of hypertension(OR=2.821,P<0.001).Conclusion:Decrease of plasma concentration of hydrogen sulfide may be a risk factor makeing people with high normal blood pressure develop into hypertension patient.

目的 了解军队某高等院校在校医学生吸烟现状及对吸烟危害健康的认知情况,为有针对性地开展戒烟、控烟工作提供参考.方法 采用按年级分层抽样方法,利用自行设计的调查表,调查某军校778名在校医学生的吸烟现况及其对吸烟危害健康的认知情况.结果 778名被调查者吸烟率为7.7％ (60/778),其中男生吸烟率(8.1％)明显高于女生(4.2％),差异有显著性(P＜0.05)；男生吸烟率有随年级升高而增高的趋势；86.7％ (52/60)的吸烟者在入学前就已经开始吸烟,73.3％(44/60)的吸烟者有过戒烟的念头.心情郁闷、课业压力大、孤独无助及无所事事是导致吸烟的主要因素.结论 军队高等院校在校医学生总体吸烟率较低,充分利用吸烟者戒烟念头及非吸烟者对吸烟的正确认识等开展戒烟控烟工作,有利于扩大和巩固戒烟控烟成果.

目的认真贯彻落实《"十一五"期间全军爱国卫生工作规划》,以文明卫生军营建设为中心,结合军医大学实际,广泛深入开展爱国卫生工作。方法对军医大学开展爱国卫生工作的主要做法进行回顾性总结。结果总结出做好爱国卫生工作的5点做法:(1)不断健全组织和完善制度,有力保证爱国卫生工作落实。(2)加强教育引导和健康促进,有效提高官兵自我保护意识。(3)狠抓硬件建设和综合治理,明显改善营区卫生环境质量。(4)抓好伤病防护和卫生保健,圆满完成教学评价保障任务。(5)坚持监督管理和除害灭病,显著提升官兵文明健康水平。结论深入开展健康教育,狠抓疾病综合防治、饮食卫生监测和营区综合治理等工作的落实,才能使学校爱国卫生呈现良好发展态势。

目的探讨军医大学如何进一步提升医疗保健水平,为军队医疗保健工作做出更大贡献。方法通过近年来干部医疗保健工作实践,对主要做法进行回顾和总结。结果提出了军医大学必须充分利用自身技术和人才优势,科学分析和正确处理存在的矛盾及问题,从而真正提高医疗保健工作的质量水平,达到巩固和提高部队战斗力的目的。结论总结出的做法对相关院校具有积极的借鉴作用。

This paper reviewed the domestic and foreign status of military nurses participating in disaster rescue from the aspects of staffing,capacity building,training and organization.Then it proposed to conduct in-depth theoretical study of nurse roles in disaster rescue,build up and perfect disaster rescue training systems and related strategies,so as to enhance the recognition degree of military nurse's roles in disaster rescue and provide theoretical guidance to ensure the completion of disaster rescue work.