The Future Configuration of NHS Occupational Health Services

http://www.nhsplus.nhs.uk/providers/images/library/files/The_Future_Configuration_of_NHS_Occupational_Health_Services_Final_September_2010_+_appendices.pdf


The Future Configuration of NHS Occupational Health Services

This report was commissioned by NHS Plus from
Helen Kirk MA BSc(Hons) BA RGN RM SCPHN(OH)
September 2010


Introduction
The 452 statutory NHS organisations in England are currently served by 175 NHS Occupational
Health services. A range of reviews and reports over the past 10 years have pointed to wide
variations in the quality of service delivery. Recent developments in terms of the Boorman Review and introduction of national Accreditation standards for occupational health providers have prompted renewed thinking about the configuration of NHS Occupational Health services. The purpose of this paper is to draw upon the available evidence and identify options for the future configuration of services. NHS Plus commissioned this work in summer 2010 to contribute to the debate about service configuration. It is based upon a range of evidence, although worldwide published literature on the configuration of occupational health services is disappointingly limited

Across the wire

http://www.centreformentalhealth.org.uk/pdfs/Across_the_wire.pdf

Across the wire: Veterans, mental health and vulnerability
Matt Fossey

The mental health of veterans of the armed forces and its link to offending has been a subject of considerable concern in recent years. This paper reviews the available evidence and suggests ways of tackling the issues that emerge. Various social and psychological factors affect the lives of veterans. These may have been caused by events before people entered military service, during service or soon after discharge. They could be a result of previous family, education or social experiences or be a combination of all. Some of these elements have been discussed at length in the media, and have stimulated widespread debate, most of which has focused on the risk of post-traumatic stress disorder (PTSD) among veterans of recent or current active service in Iraq and Afghanistan. Most people who serve in Her Majesty’s Forces do not suffer with mental health difficulties evenafter serving in highly challenging environments. The majority of those who return from highthreat locations say that they have had a rounded and fulfilling experience (Greenberg,2010). The armed forces aim to equip service personnel with training, respect, sense of purpose and belonging as well as life skills for successful transition back to civilian life. However, no system is able to eliminate all risk. There is a vast, and growing, academic interest
in the health and well-being of service personnel and veterans. Particularly notable is the work
of the King’s Centre for Military Health Research (KCMHR, 2010a; KCMHR, 2010b).
This paper explores what we know from published literature about the mental health of people who have served in the armed forces, about the links between mental health and alcohol use in service personnel, and about veterans in the criminal justice system.

Army Physical Readiness Training

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA531081&Location=U2&doc=GetTRDoc.pdf

Army Physical Readiness Training

TC 3-22.20

The Army assesses, plans, prepares and executes training and leader development through training based on tasks,
conditions and standards. Knowing the task, assessing the level of proficiency against the standard and developing a
sustained or improved training plan is the essence of all Army training.
Army training overall prepares Soldiers, leaders and units to fight in the full spectrum of operations. Combat
readiness is the Army’s primary focus as it transitions to a more agile, versatile, lethal and survivable force.
Physical Readiness Training (PRT) prepares Soldiers and units for the physical challenges of fulfilling this mission
in the face of a wide range of threats, in complex operational environments and with emerging technologies.
 Part I, Philosophy, covers approach, system and leadership.
 Part II, Strategy, covers types of programs, planning considerations and special conditioning
programs.
 Part III, Activities, covers execution of training, preparation and recovery, strength and mobility and
endurance and mobility.
 Appendix A is the Army Physical Fitness Test.
 Appendix B discusses climbing bars.
 Appendix C discusses posture and body mechanics.
 Appendix D discusses environmental considerations.
 Appendix E discusses obstacle negotiation.
This manual—
 Provides Soldiers and leaders with the doctrine of Army Physical Readiness Training.
 Reflects lessons learned in battles past and present, time-tested theories and principles and emerging
trends in physical culture.
 Helps ensure the continuity of our nation’s strength and security.
 Prepares Soldiers physically for full spectrum operations.
 Explains training requirements and objectives.
 Provides instructions, required resources and reasons why physical fitness is a directed mandatory
training requirement as specified in AR 350-1, Army Training and Leader Development.
 Allows leaders to adapt PRT to unit missions and individual capabilities.
 Guides leaders in the progressive conditioning of Soldier strength, endurance and mobility.
 Provides a variety of PRT activities that enhance military skills needed for effective combat and duty performance

Demographic, Physical, and Mental Health Factors Associated with Deployment of U.S. Army Soldiers to the Persian Gulf

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA530640&Location=U2&doc=GetTRDoc.pdf


Demographic, Physical, and Mental Health Factors Associated
With Deployment of U.S. Army Soldiers to the Persian Gulf

Nicole S. Bell, ScD, MPH*; LTC Paul J. Amoroso, MC USAf; Jeffrey O. Williams, BS*;
Michelle M. Yore, MSPHf, LTC Charles C. Engel, Jr., MC USAf; Laura Senier, BA*;
Annette C. DeMattos, BS*; David H. Wegman, MD§

MILITARY MEDICINE, 175,4:227, 2010


A total of 675,626 active duty Army soldiers who were known to be at risk for deployment to the Persian Gulf were followed from 1980 through the Persian Gulf War. Hospitalization histories for the entire cohort and Health Risk Appraisal surveys for a subset of 374 soldiers were used to evaluate prewar distress, health, and behaviors. Deployers were less likely to have had any prewar hospitalizations or hospitalization for a condition commonly reported among Gulf War veterans or to report experiences of" depression/suicidal ideation. Deployers reported greater satisfaction with life and relationships but displayed greater tendencies toward risk taking, such as drunk driving, speeding, arid failure to wear safety belts. Deployed veterans were more likely to receive hazardous duty pay and to be hospitalized for an injury than nondeployed Gulf War-era veterans. If distress is a predictor of postwar morbidity, it is likely attributable to experiences occurring during or after the war and not related to prewar exposures or health status. Postwar excess injury risk may be explained in part by a propensity for greater risk taking, which was evident before and persisted throughout the war.

Air Break During Preoxygenation and Risk of Altitude Decompression Sickness

http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA530698&Location=U2&doc=GetTRDoc.pdf


Air Break During Preoxygenation and Risk of Altitude Decompression Sickness


P ILMANIS AA, W EBB JT, B ALLDIN UI, C ONKIN J, F ISCHER JR. Air break
during preoxygenation and risk of altitude decompression sickness.
Aviat Space Environ Med 2010; 81: 944 – 50 .
Introduction: To reduce the risk of decompression sickness (DCS),
current USAF U-2 operations require a 1-h preoxygenation (PreOx). An
interruption of oxygen breathing with air breathing currently requires
signifi cant extension of the PreOx time. The purpose of this study was to
evaluate the relationship between air breaks during PreOx and subsequent
DCS and venous gas emboli (VGE) incidence, and to determine
safe air break limits for operational activities. Methods: Volunteers
performed 30 min of PreOx, followed by either a 10-min, 20-min, or
60-min air break, then completed another 30 min of PreOx, and began
a 4-h altitude chamber exposure to 9144 m (30,000 ft). Subjects were
monitored for VGE using echocardiography. Altitude exposure was
terminated if DCS symptoms developed. Control data (uninterrupted
60-min PreOx) to compare against air break data were taken from the
AFRL DCS database. Results: At 1 h of altitude exposure, DCS rates were
signifi cantly higher in all three break in prebreathe (BiP) profiles compared
to control (40%, 45%, and 47% vs. 24%). At 2 h, the 20-min and
60-min BiP DCS rates remained higher than control (70% and 69% vs.
52%), but no differences were found at 4 h. No differences in VGE rates
were found between the BiP profiles and control. Discussion: Increased
DCS risk in the BiP profi les is likely due to tissue renitrogenation during
air breaks not totally compensated for by the remaining PreOx following
the air breaks. Air breaks of 10 min or more occurring in the middle of
1 h of PreOx may signifi cantly increase DCS risk during the first 2 h
of exposure to 9144 m when compared to uninterrupted PreOx
exposures.