Bricknell M C
Army Medical Directorate, Keogh Barracks, Aldershot, Hants.
J R Army Med Corps. 1999 Jun;145(2):80-3. doi: 10.1136/jramc-145-02-07.
This paper examines the requirement for health surveillance systems for military forces. Military health surveillance is the routine systematic collection, analysis, interpretation, and reporting of standardised, population based data for the purpose of characterising and countering threats to the military population's health, well-being and performance. The components of a health surveillance system should enable concurrent or retrospective analysis of health effects in military personnel using a cohort study design. Military hazards include trauma, infection, toxic effects, radiation, psychological stress and ergonomic stress. Variations in distribution of the hazard, distribution of the population, fragility of the cohort, and the variation in the duration and magnitude of exposure complicate definition of the exposed cohort. The measurement of biological effect is complicated by limits in knowledge about the relationship between exposure to the hazard and effect. A biological model that explains detection, causality, pathological process and health effect should support this knowledge. Lastly the definition of health effect needs to consider the difference between clinical activity rates and true measures of health outcome. The UK has a number of health surveillance systems including sentinel reporting, a population-based primary care reporting system and measures of medical discharge and death. The US Army is developing IT-based surveillance systems to link hazard, personnel and medical databases. The paper suggests a conceptual model for such a system in the UK military.
本文探讨了军队健康监测系统的要求。军事健康监测是为了描述和应对对军人健康、福祉及表现的威胁，对基于人群的标准化数据进行常规系统收集、分析、解读及报告。健康监测系统的组成部分应能使用队列研究设计对军事人员的健康影响进行同步或回顾性分析。军事危害包括创伤、感染、毒性作用、辐射、心理压力和工效学压力。危害分布、人群分布、队列脆弱性以及暴露持续时间和程度的变化使暴露队列的定义变得复杂。由于对危害暴露与影响之间关系的认识有限，生物效应的测量也很复杂。一个解释检测、因果关系、病理过程和健康影响的生物学模型应支持这一认识。最后，健康影响的定义需要考虑临床活动率与健康结果真实测量之间的差异。英国有一些健康监测系统，包括哨点报告、基于人群的初级保健报告系统以及医疗出院和死亡措施。美国陆军正在开发基于信息技术的监测系统，以连接危害、人员和医疗数据库。本文提出了一个适用于英国军队此类系统的概念模型。
