A Tobacco-Free Medical Campus Policy is Associated With Decreased Secondhand Smoke Exposure and Increased Satisfaction Among Military Medical Employees: Results of a Mixed-Methods Evaluation.

INTRODUCTION: Tobacco control is an ongoing concern for the U.S. Army. Although tobacco use is currently prohibited within all military hospitals and clinics, known as military treatment facilities (MTFs), no such facility had implemented a tobacco-free medical campus (TFMC) policy before 2012. This evaluation examined the effects of one Army installation's TFMC policy implementation at its medical facilities. MATERIALS AND METHODS: Online questionnaires were distributed to medical campus employees, including Active Duty Soldiers, civilians, and contractors, before policy implementation (N = 1,210) and 12 months following policy implementation (N = 1,147). Chi-square analyses, independent t tests, and logistic regression models were utilized to examine pretest/post-test changes in employees' secondhand smoke (SHS) exposure; tobacco use, motivation to quit, and cessation; and health outcomes. Twenty-three focus groups, interviews, and informal discussions with 65 employees and patients were conducted 13 months after initial policy implementation to capture both the intended and unintended policy effects. RESULTS: After controlling for demographic characteristics, the study found that employees had more than twice the odds of exposure to SHS in the workplace at baseline than at 12-month follow-up (odds ratio: 2.06, 95% confidence interval: 1.73-2.46, p < 0.001). Employees also reported a lower prevalence of diagnosis with chronic bronchitis (p < 0.05) at follow up compared to baseline. Although the mean number of sick days taken for respiratory illness decreased over time, results were not significant after controlling for demographic factors. No significant differences existed in tobacco-use prevalence or quit rates among tobacco users over time. Employees reported significantly higher levels of satisfaction with a TFMC policy than the original policy (p < 0.001) though this finding was moderated by smoker status such that smokers reported lower levels of satisfaction with the policy over time. Qualitative findings revealed that the most common policy effect was that the policy caused smokers to change the location of where they used tobacco to off campus. Findings further revealed several unintended policy effects, including safety concerns and greater visibility of smokers in front of the MTF. CONCLUSION: The first Army MTF TFMC policy was associated with reported reductions in SHS exposure and improvements in some short-term health outcomes. The policy had no observed association with tobacco-use prevalence, motivation to quit, or cessation at 12-month follow-up. Focus group participants discussed several positive and negative policy effects. These policies should be expanded and studied in more depth across military installations, and policy makers should plan mitigation strategies to reduce unintended effects. This is an important step in military tobacco control, but additional efforts will be necessary to curb tobacco use within this population.

La Sanidad Militar como herramienta de la Diplomacia Médica / Military Health System as a Tool of Medical Diplomacy

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Aspectos médicos y legales de la atención a piratas. La experiencia española en la operación «ATALANTA» / Medical and legal aspects about pirate´s care. Spanish experience in «Atalanta» Operation

La piratería constituye una de las amenazas más antiguas para la seguridad marítima internacional, que persiste hoy en día en países como Somalia. Gracias a la presencia de unidades navales internacionales (como las integradas en la Operación Atalanta), el número de ataques en el Cuerno de África ha decrecido notablemente. Cuando los presuntos piratas son detenidos por efectivos militares tienen que ser atendidos por miembros de Sanidad Militar. El objetivo del presente artículo es analizar los aspectos legales y médicos de la atención a piratas, describir la experiencia española obtenida en la Operación «Atalanta» y revisar la bibliografía publicada sobre el tema

Pirate activity is considered like one of the oldest risk international maritime security, that continues today in countries like Somalia. International naval forces (like ‘Atalanta Operation’) have got a very important decrease in the number of attacks in Horn of Africa. When suspected pirates are detained by military crew, they should be attendance by medical members. The objective of this article is to analyze legal and medical aspects about pirate attention, describe Spanish experience kept in ‘Atalanta Operation' and review bibliography published about the subject

[Improvement of medical equipment setting for the hospital link of the medical service during wartime].

One of the priorities of the military health care is to improve the system of rationing medical equipment for the hospital unit of the medical service of the Armed Forces in wartime. This is determined the fact that the effectiveness of measures to provide military field hospitals with medical supplies depends on the quality of medical care for the wounded and sick, as well as the level of their return to duty. The article presents the characteristics of modern standards medical supplies procurement of military field hospitals included in the new regulatory legal act of the Russian Federation Ministry of Defence--"Standards of supplies medical supplies medical and pharmaceutical organizations (units) of the Russian Federation on the wartime armed forces", approved and put into effect in 2015 by order of the Minister of Defence of the Russian Federation.

Sobre: cumplimiento de la quimioprofilaxis antipalúdica en ASPFOR XXXIII / About: 'Compliance with malaria chemoprophylaxis in ASPFOR XXXIII'

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Condiciones legales y administrativas para la secuenciación del genoma humano en el ámbito militar / Legal and administrative requirements for the sequencing of the human genome in the military context

La Genómica trae nuevas cuestiones jurídicas además de profundizar aquellas que ya se plantearon desde la Genética molecular. La secuenciación completa del genoma humano ha pasado de requerir los esfuerzos económicos de un consorcio internacional a ser asequible por el ciudadano medio. Este cambio revolucionario también afecta a las administraciones exigiendo un replanteamiento del status jurídico de las bases de datos con fines de investigación biomédica y de las de ADN policiales y su posible desarrollo en el ámbito militar. Del mismo modo ocurre con los biobancos asociados a ellas. Las restricciones que los tratados internacionales imponen sobre los fines de la investigación genómica no deben hacer olvidar los amplios cometidos de los Ejércitos en el marco más general de la Defensa Nacional. Se exponen aquí los condicionantes que cumplidos permitirían bases de datos genéticos y biobancos en dicho contexto, bajo el nuevo potencial de la Genómica, y se trata de articular su régimen con el derecho nacional vigente

Genomics leads to new legal issues in addition to deepening those already raised from Molecular Genetics. The whole-genome sequencing of the human genome has evolved from economic efforts requiring an international consortium to be affordable for the average citizen. This revolutionary change also affects the administrations requiring a rethinking of the legal status of the databases for biomedical research and police DNA databases and its possible development in the military field. The same happens with biobanks associated with them. The restrictions imposed by international treaties on genomic research purposes should not obscure the broad roles of hosts in the more general framework of National Defence. The conditions that would allow genetic data-bases and biobanks in this context are discussed here under the new potential of the Genomics, trying to articulate its legal regime with the current national law

[Hi-tech health care: modern status and prospects of development in medical facilities of the Ministry of Defence].

The article is devoted to the current issues of providing hi-tech medical care in hospitals of the Ministry of Defence. Since the beginning of 2013 the executive body of the Russian Ministry of Defense pays special attention to improvement of the quality and accessibility of health care contingent of the Ministry of Defence. Thus, according to decision of the Minister of Defense of the Russian Federation, General of the Army Sergei Shoigu in 2013 more than 1.1 billion rubles (in 2012, targeted funding of high-tech medical care in the Ministry of Defence did not materialize) was allocated for military medical institutions of the Ministry of Defense of the Russian Federation to provide high-tech medical care. As a result, in 7 months in 2013 the volume of medical care has increased by 32% in comparison with the same period in 2012. Currently the main military medical department of the Ministry of Defense is working to resolve the order of delivery and financing hi-tech medical care in the Armed Forces in the following areas: inclusion of military medical institutions of the Ministry of Defence in the list of health organizations, providing high-tech medical care, approved by Order of the Ministry of Health of the Russian Federation, legal regulation of the provision of high-tech medical care in military medical establishments of the Ministry of defense of the Russian Federation within the budget appropriation allocated to the Ministry of Defence.

[Obstetric-gynecologic care for female soldiers: status and prospects].

The article presents the analysis of primary gynecologic pathology in female soldiers for the last years. The basic disease groups are marked out. The information about the very medical help standard in different hospitals is given. This paper presents the perspective directions of development of the delivery of obstetrical and gynecological care for women due to level of military medical establishments of the Russian Federation Ministry of Defense.

[Problems of delivery of health care for children of servicemen and educates of general educational institutions of the Ministry of Defence of the Russian Federation].

On the basis of the legal, instructional-methodological data and evaluation of the organization of medical care for children and adolescents identified the main challenges of pediatric services for the optimization of the Russian Defense Ministry interagency medical personnel accompany the children and adolescents, pre-university students in military educational institutions, at the stage of military reform and optimize the structure of the military medical service. To provide medical assistance to children of servicemen and DVOU pupils in accordance with the standards of health required the integration of interagency efforts of the military-medical institutions and medical institutions of state and municipal health systems.

Brief introduction of the construction of the military medical institution management laws and regulations of the CPLA.

The paper introduces the developing history of the military medical institution management laws and regulations of the Chinese People's Liberation Army, which consists of 9 categories, including general principles, medical division and transfer system, medical quality, personnel resources, department construction, medical equipment, Medicines and preparation, Medical Malpractice handling and hospital infection control. And in this paper, we summarizes the legislation organization into 3 levels, discuss the relationship between the Military Medical Institution Management Law and related laws as well as the national regulations.

[Branch of the 1st Federal Budget Institution "3rd Central Military Clinical Hospital n. a. A. A. Vishnevskii of the Russian Defense Ministry"--60 years].

The history of creation and development of the Central Tuberculosis Hospital of the Ministry of Defense of the USSR--now branch No 1 FBU "3 TsVKG of the Russian Defense Ministry n. a. A.A. Vishnevsky". The contribution into the hospital, not only in organizing of effective treatment, but also into study the state of TB control in the armed forces, the development of methods for differential diagnosis of pulmonary tuberculosis and extrapulmonary forms are presented. The incidence of tuberculosis in the country remains high, so the problem faced by the institution, remain relevant and responsible.

Casualties.

Privation and disease have mainly killed soldiers until very recently. Now that enemy action predominates, faster and better control of bleeding and infection before and during evacuation spares ever more lives today. This essay focuses on psychological war wounds, placing them in the context of military casualties. The surgeon's concepts of 'primary' wounds in war, and of would 'complications' and 'contamination', serve as models for psychological and moral injury in war. 'Psychological injury' is explained and preferred to 'Post-Traumatic Stress Disorder', being less stigmatizing and more faithful to the phenomenon. Primary psychological injury equates to the direct damage done by a bullet; the complications - for example, alcohol abuse - equate to hemorrhage and infection. Two current senses of 'moral injury' equate to wound contamination. As with physical wounds, it is the complications and contamination of mental wounds that most often kill service members or veterans, or blight their lives.

Pediatric neurosurgery during Operation Enduring Freedom.

OBJECT: Operation Enduring Freedom (OEF) is the current US military conflict against terrorist elements in Afghanistan. Deepening US involvement in this conflict and increasing coalition casualties prompted the establishment of continuous neurosurgical assets at Craig Joint Theater Hospital (CJTH) at Bagram Airfield, Afghanistan, in September 2007. As part of the military's medical mission, children with battlefield-related injuries and, on a selective case-by-case basis, non-war-related pathological conditions are treated at CJTH. METHODS: A prospectively maintained record was created in which all rotating neurosurgeons at CJTH recorded their personal procedures. From this record, the authors were able to extract all cases involving patients 18 years of age or younger. Variables recorded included: age, sex, and category of patient (for example, local national, enemy combatant), date, indication and description of the neurosurgical procedure, mechanism of injury, and in-hospital morbidity and mortality data. RESULTS: From September 2007 to October 2009, 296 neurosurgical procedures were performed at CJTH. Fifty-seven (19%) were performed in 43 pediatric patients (16 girls and 27 boys) with an average age of 7.5 years (range 11 days-18 years). Thirty-one of the 57 procedures (54%) were for battlefield-related trauma and 26 for humanitarian reasons (46%). The vast majority of cases were cranial (49/57, 86%) compared with spinal (7/54, 13%), with one peripheral nerve case. Craniotomies or craniectomies for penetrating brain injuries were the most common procedures. There were 5 complications (11.6%) and 4 in-hospital deaths (9.3%). CONCLUSIONS: As in previous military conflicts, children are the unfortunate victims of the current Afghanistan campaign. Extremely limited pediatric neurosurgical service and care is rendered under challenging conditions and Air Force neurosurgeons provide valuable, life-saving pediatric treatment for both war-related injuries and humanitarian needs. As the conflict in Afghanistan continues, military neurosurgeons will continue to care for injured children to the best of their abilities.

Maritime hospital on crest of a wave.

Kent's Medway NHS Foundation Trust has recently signed up to the Chartered Institution of Building Services Engineers' (CIBSE's) 2008 "100 Hours of Carbon Clean Up" campaign, encouraged to participate for the third year running by its environmental team's winning of a top award in 2007. Health Estate Journal editor Jonathan Baillie visited the Trust's sizeable main hospital, Gillingham's Medway Maritime, where two of the team described this year's ambitious energy-saving plans.

San Antonio Military Medical Center integration: a case study in organizational leadership design.

The Defense Base Closure and Realignment Commission law of 2005 established a combined Army-Air Force medical center in San Antonio, Texas. The new facility is named the San Antonio Military Medical Center. This planned integration of two facilities would result in the downsizing of Wilford Hall Medical Center to a clinic and expansion of the nearby Brooke Army Medical Center to encompass all inpatient care. As part of the integration, the emergency services of both hospitals, to include the emergency departments, would merge under single leadership. As part of this case study, the proposed future organizational design is examined. Real and potential barriers to change are also indentified and possible solutions are explored.