INTRODUCTION To assess the self-perceived mental health of soldiers and officers in the submarine force in the South China Sea, the result of this investigation was compared to the Chinese military male norms, and the factors that influence their mental health was further explored. MATERIALS AND METHODS A total of 580 male submariners agreed to participate. In the final analysis, 511 valid questionnaires were included; 69 incomplete questionnaires were excluded. The Symptom Checklist 90 (SCL-90) was used to measure the self-perceived mental health of the officers and soldiers. RESULTS The scores of four dimensions (somatization, anxiety, phobic anxiety, and paranoid ideation) and the average of the total SCL-90 scores for the submarine force in the South China Sea were significantly higher than the Chinese military norms. Age and length of service were found to be protective factors, with 26- to 30-year-old age group (adjusted odds ratio [AOR] = 0.365, 95% CI = 0.138-0.961) and individuals with 6 to 10 years of service (AOR = 0.357, 95% CI = 0.151-0.842) having lower odds of poor mental health. Education level (bachelor's degree) and workplace (nuclear submarine) were found to be risk factors. CONCLUSIONS This study demonstrates for the first time that soldiers and officers in the submarine force in the South China Sea are exposed to a number of mental health risks and are suffering from serious psychological problems. These findings provide a basis for military departments to effectively address these psychological problems.

文章就军队中心医院卫勤训练中心的建设目的 、现状及存在的问题进行分析,对卫勤训练中心的功能定位、职责任务、运行机制、模块划分及训练保障进行探讨,并针对建设中存在的矛盾问题提出意见建议,指出下一步卫勤训练中心的合理化发展方向.

我国海军发展战略逐步由"近海防御型"向"近海防御与远海护卫型结合"转变,海军重点也逐渐由近海"绿水"向远海"蓝水"转变,战略需求向"远海防卫、近海防御、大洋存在、两极拓展"转变,海军转型工作预计于2025年完成,但目前海军卫勤及医疗保障却依旧停留在"近海"和"绿水"阶段,海军医疗资源仅围绕近海卫勤保障,而聚焦航母编队作战及远航的医疗资源配多少、配在哪儿、怎么配等卫勤重点仍是问题[1].

减员预计的研究是目前国内外卫勤领域研究的重大难题,也是卫勤保障的核心.随着现代战争形式的不断发展,对于如何精确预计减员研究的难度大幅增加.通过国内外研究对比,国内在此方面研究和应用相对不足.为增加国内学者对该领域研究的重视,文章系统检索和分析了相关研究文献,从建模思路、建模方法、模型优缺点等方面对减员预计模型进行综述.

当前,军队基层医院普遍存在技术水平落后和医学人才匮乏等难题,如何顺应改革形势,谋划提升服务保障能力是当前最为现实和紧迫的课题.军队基层医院必须以转型发展为契机,探索人才培养、专科建设和卫勤保障等模式,回归卫勤人员“战斗队”属性,全力创建区域领先的“打仗型”现代化中心医院[1].

新型冠状病毒肺炎(简称新冠肺炎)疫情暴发以来,全国全军积极响应,但病毒传播力极强,感染人数增长迅速.文章主要针对新冠肺炎感染防控难点,结合青藏高原地区实际,分析了军队医院疫情防控面临的主要制约因素,梳理了对策措施和经验,为进一步强化高原军队医院突发公共卫生事件应急处置能力提供依据.

目的 通过分析8所海军医院3年间医疗资源配置公平性的变化趋势,为军队医院医疗资源配置优化提供决策依据.方法 调研8所海军医院3年内收治基本情况资料.采用描述性分析、基于基尼系数及泰尔指数等定量研究方法分析8所海军医院医疗资源配置公平性.结果 8所医院中,B医院基尼系数0.19,垂直公平性最好;H医院0.67,垂直公平性较差.A医院总泰尔系数0.0021,水平公平性最好;C医院总泰尔指数0.0229,水平公平性相对较差.结论 与地方公立医院相比,军队医院资源配置公平性差,改革延迟滞后,应从多个角度优化均衡性,提升军人病床周转率和为兵服务质量.

Objectives: To study injury patterns and medical rescue operations related to tornadoes that occur in rural areas, this study investigated the data pertaining to the 2017 Chifeng tornado (China). Methods: Medical records of 52 tornado-related patients were investigated. Data were collected from 3 local hospitals that received all the tornado victims. Results: A total of 148 injuries were diagnosed. Tornado-related injuries were mainly caused by collapsed houses (51.9%) and direct physical trauma caused by the tornado (38.5%). Most injuries occurred outdoors (63.5%). The head (20.3%) and thorax (14.8%) were most 2 frequent anatomical injury sites. Soft-tissue injuries (43.9%) and contusions and lacerations (37.3%) were the 2 most common injury types. On evaluating the Abbreviated Injury Scale scores, a score of 1 was the most common (66.2%), and a score of 6 was not recorded. Conclusions: A trailing phenomenon in the distribution of time to admission among the victims of a particular tornado in China was observed. The delivery is timely compared with nondisaster situation. There was a statistically significant difference of injury causes between outdoor and indoor patients. Helmets should be used by potential tornado victims. Basement units capable of functioning as shelters should be built in villages.

INTRODUCTION A retrospective review conducted in three hospitals of Guangdong and Hainan, China. To analyze the variation tendency of mean hospitalization costs and length of stay (LOS) in naval hospitals over nine years, paying special attention to the factors affecting hospitalization costs and LOS to provide a reference base for health resource allocation in naval hospitals. MATERIALS AND METHODS A total of 21,375 cases of military patients who were hospitalized and treated in three naval hospitals between January 2008 to December 2016 were extracted from the military health system. There were 16,278 complete and effective cases during those nine years. The situation, trends, and factors influencing hospitalization costs and LOS were analyzed using descriptive statistics, Mann-Whitney U test, Kruskal-Wallis H test, and multiple linear regressions. RESULTS The following factors showed statistically significant differences in hospitalization costs: special care, primary care, year, military rank, critical illness, allergies, and condition (p < 0.0001); and number of hospitalizations, gender, and age (p < 0.01). The following factors showed statistically significant differences in hospital LOS: year, number of hospitalizations, outcomes, military rank, special care, severity of illness, and condition (p < 0.0001); allergy (p < 0.01); and service and gender (p < 0.05). LOS between 2008-2016 showed a decreasing tendency, while hospitalization costs showed an increasing trend. There were 6 factors that affected Abstract (or Structured Summary) both the cost of hospitalization and LOS: special care, year, military rank, condition, allergy, and gender. CONCLUSIONS The results suggest that improving efficiency of military hospital require strengthening hierarchical referrals and controlling hospital LOS. Shortening LOS, optimizing clinical pathways, and reasonably controlling the costs associated with medicines and surgery can help reduce hospitalization costs for military patients. Controlling the growth of hospitalization costs can help avoid the physical and psychological burden of medical over-treatment on patients and may also optimize the allocation of military health resources.

目的 了解某方向潜艇部队官兵在执行任务期间对卫生服务需要及利用情况,为海军卫生机构制定计划、配置资源提供科学依据. 方法 选取2015年7月至2016年7月潜艇部队官兵500例,使用自设问卷调查海上执行任务期间发生的疾病、身体损伤以及疾病解决和再就诊等情况.采用EpiData双人录入数据,使用SPSS21.0进行统计分析. 结果 回收问卷462份,问卷回收率92.4%.潜艇官兵在执行任务期间皮肤类疾病发病率最高,包括湿疹(48.9%)、毛囊炎(32.9%)、足廯(31%);身体损伤发生率最高为晕船(49.4%),舱室内有害气体中毒发生率为28.1%,噪音性耳聋与辐射损伤发生率分别为21.9%和19.9%,发生率最低为中暑(3.0%);官兵认为出海执行任务过程中发生疾病不能解决者占26.4%,执行任务期间患病官兵治疗后因疾病(不含慢性病)出现恶化、未见好转而导致疾病再就诊情况的发生比例为47.6%. 结论 潜艇官兵在执行任务期间发病率高、身体损伤大,潜艇卫生机构不能满足官兵需要.建议将潜艇卫生机构纳入后方医院建设,以提高其医疗水平;研发防辐射保护装备;加强潜艇官兵身心健康教育,做好官兵执行任务中的训练工作.

Objective To understand the health seeking behavior of navy servicemen and its influencing factors. Methods A total of 5500 servicemen from 31 naval units were investigated with questionnaire, and the data were analyzed with constituent ratio,wilcoxon rank-sum test, χ2test and logistic regression. Results The influencing factors of navy servicemen's health seeking behavior include educational background,self-awareness of diseases,psychological stress,distance from medical institutions, satisfaction degree with primary medical institu-tions and conception of health seeking. Conclusion The utilization rate of health services is low and the rate of first visit at primary health institutions is not high among navy servicemen. Strategies are proposed, including en-hancing the rational allocation of health resources,strengthening the construction of primary health institutions,im-proving mental health services in primary health institutions and rationally guiding the conception of health seeking.

海军由近海走向远海,卫勤保障模式发生重大转变.海战伤员情况复杂多变,及时高效的救治通道有助于提升战斗力.后送阶梯应以减少救治层次、促进伤员快速后送为目的,后送装备应以减少后送时间、增加运力为目标.针对国内外军队海上作战医疗后送阶梯及装备现状,提出我军发展方向,提升海战一体化卫勤保障能力.

Objective To describe the demographic characteristics, injury characteristics, treatment and co-morbidity of patients with penetrating injuries,and to analyze the impact of factors of different dimensions on the outcome of patients with penetrating injuries,a retrospective study was conducted in Shanghai to explore the in-jury characteristics of penetrating injuries,the progression patterns of the disease,the treatment of the wounded and the current situation of China's first-aid system. Methods By investigating the Orthopedic Trauma Center and Burn Trauma Center of Shanghai Changhai Hospital, the Acute Trauma Center of Shanghai Changzheng Hospital, and the Emergency Trauma Center of Shanghai Tenth People's Hospital from June 2014 to January 2015, we ob-tained a total sample of 190 patients,including 144 cases of a single injury and 46 cases of multiple injuries. Re-sults The statistically significant influencing factors of the outcome in patients with a single injury include age, pre-hospital duration, fracture and joint injury, and central nervous system damage. The statistically significant influencing factors of the outcome in patients with multiple injuries include gender,pre-hospital duration,uncon-trolled hemorrhagic shock,and disturbance of consciousness. Conclusion The investigation on the epidemiologi-cal characteristics of the penetrating injuries and the prognosis influencing factors could help improve the efficiency and effectiveness of first aid, optimize the allocation of health resources, and reduce the mortality and disability caused by penetrating injuries.

目的 了解执行任务期间舰艇部队官兵的卫生服务需求及卫生救治情况,为相关卫生机构制定计划、配置资源提供科学依据.方法 设计调查问卷并组织舰艇部队官兵填写,调查内容包括官兵基本信息、执行任务期间疾病发生情况、身体损伤情况及卫生救治情况.收集的数据使用EpiData 3.1软件双人录入,采用SPSS 21.0软件进行统计分析.结果 共发放问卷850份,回收有效问卷755份,有效回收率为88.82％.舰艇官兵在执行任务期间疾病发生率高且疾病类型多样,疾病出现频次最高的是急性肠胃炎(49.1％,371/755),其次是中暑(36.4％,275/755).身体损伤中发生率最高的是晕船(65.0％,491/755),其次是噪声性耳聋(20.0％,151/755)及舱室有害气体中毒(19.3％,146/755).有242人次(32.1％)认为在出海过程中患病后不能得到解决.结论 执行任务期间舰艇部队官兵疾病发病率高,身体损伤大,舰艇卫生服务不能很好地满足官兵需求.

Objective To explore the variation tendency and influencing factors of the hospitalization costs and hospital day of soldiers in a navy hospital,so as to provide reference for the health resource allocation of military hospitals.Methods The data of 16 278 military patients who were hospitalized and treated from Jan.2008 to Dec.2016 were extracted from the military health system.The hospitalization costs and status,variation tendency and influencing factors of hospital stay were analyzed by descriptive analysis,Mann-Whitney U test and Kruskal-Wallis H test.Results The average age of admission was (28.33± 13.40) years,and the hospitalization period showed a shortening trend,while the hospitalization costs showed an increasing trend during 2008-2016.The polytomous variables,including services,patient's condition,hospitalized times,hepatitis B surface antigen,hepatitis C antibody,human immunodeficiency virus (HIV) antibody,military appointment,age and outcomes,and the dichotomous variables,including severe condition,critical condition,ICU admission,special-grade nursing care,first-grade nursing care,allergies and operation,were the influencing factors of hospitalization expenses (P＜0.05).The polytomous variables,including services,patient's condition,hospitalized times,HIV antibody,military appointment,age and outcomes,and the dichotomous variables,including gender,severe condition,critical condition,special-grade nursing care,first-grade nursing care and operation,were the influencing factors of hospitalization stay (P＜0.05).Conclusion The decreasing hospitalization day of military patients and increasing hospitalization costs suggest that the medical technology and hospital management efficiency are continuously improving,but facing the pressure of increasing medical costs.From a cost-effective perspective,we should strengthen the graded referral and control hospitalization costs and length of hospital stay.

目的 解决目前我军在各类行动中复杂伤情信息收集不全,资料繁杂不利于信息化处理的问题;弥补救护技术与不同的伤情不能准确相互对应,一线卫生救护人员不能完全遵循统一的标准采取精准高效的战救措施的缺陷;纠正现存的行动后统计伤情不规范现状,并扩展补充伤情统计信息. 方法 查阅国内外最新文献报告,研究主流编码方法及其不足,应用德尔菲法,经过多轮专家咨询,用于演习数据采集,修改后定稿,并设计适用我军的伤病谱结构及编码方法. 结果 建立了涉及9个部分,涵盖伤部、伤类、伤型/疾病、并发症、伤势、AIS/ISS评分、编码、百分比、处置规范的平时、战时、非战争军事行动三维理念伤病谱结构及其编码方法技术体系. 结论 适宜统一的伤病谱结构及其编码方法,有利于伤情信息电子化合成及其后期统计分析,也有利于不同数据间横向纵向比较,统计结果差异小.本研究提高了卫勤资源配置效率,为一线卫生救护人员提供了精准有效救治标准,涵盖平时、战时、非战争军事行动损伤三个维度.

田成义是荒原上一蓬兀自生长的野草,野火催生,万物滋润,疯蛮成长. 田成义不和田家安分守己的家风,自幼痴迷绘画.田成义的父亲是个山区铁路小站上的工人,这样的人家,是养不起“搞艺术”的孩子的.父亲希望儿子能学一门养活自己的手艺.田成义执迷不悟鬼迷心窍就是要画画.家里连画画的纸也没有,田成义就把父亲用过的废旧货运单收集起来,在背面画画.上学后,田成义对画画越发痴迷,父亲怕他荒废学业,用强力禁止他画画.田成义就等家人熟睡后,悄悄溜到灶间,点着煤油灯趴在锅台上画,艺术的魔力攫走了田成义的灵魂.

目的 探讨治疗干预评分系统(therapeutic intervention scoring system-28,TISS-28)在重症监护室(intensive care unit,ICU)护理人力资源配置中的应用效果.方法 2011年4-5月,采用TISS-28对北京市某三级甲等医院神经外科、神经内科、胸血管外科、呼吸科、心脏科等5个ICU进行测评,每个月随机抽取1周(2个月共计14 d)进行测评,共评估患者716例次合计1432个班次的护理工作量.结果 5个ICU工作总量由高到低依次为神经外科、神经内科、胸血管外科、心脏科、呼吸科,分别为(405.14±32.15)、(230.07±13.92)、(213.64±47.15)、(122.14±12.23)、(153.00±35.60)分;平均每班护士工作量由高到低依次为神经外科、呼吸科、胸血管外科、心脏科、神经内科,分别为(62.96±9.22)、(48.86±4.89)、(46.62±9.38)、(44.64±8.81)、(38.35±2.32)分.神经外科ICU护士缺编较为严重.结论 部分ICU护士处于超负荷工作状态;护理管理者应合理有效地配置各ICU护理人力资源,以确保护理工作质量.