| BackgroundsChina has the world largest highland territory and a large number of native andimmigrant highlanders. The highland territory also is the flash point of border conflicts,race extremism, separatism, and terrorism. To defense and develop the world largesthighland territory, a great many of people are working and living in the area, and there alsoare a great many of new comers enter the area every year. The population that entering thehighland is mainly make up of young male Chinese Han population. The populationincludes soldiers, workers, merchants, and civil servants, among which soldiers take up alarge part of them.After military population entering highland area, many servicemen will developaltitude disease due to the effectiveness of hypobaric hypoxia. During the early period ofnewly entering high altitude, military population will affect by acute altitude disease.Although the symptoms would subside after a period of acclimation, the symptoms cansignificantly reduce operation capability of the servicemen in the early time of entering.Even if living in highland for a long period, many of the servicemen who were deployed forlong-term highland service cannot fully get acclimation and develop chronic altitudedisease. The early symptoms of the chronic altitude disease are not serious. However, it istreatment-resistance and would deteriorate gradually as time goes on, which disintegratehealth of the highland servicemen and decay combat effectiveness of the highland troops.Unfortunately, there are not enough awareness been paid for the harmful effectiveness ofchronic altitude disease in the highland servicemen population.Altitude diseases are not only a series of complicated medical problems, but also aseries of complicated public health and military logistics' problems for highland troops. Thediseases not only cause suffering and misery for oneself and his family, but also cause losing of the troops' combat effectiveness and heavy logistics burden of the army. Hence, itis imperative for the authorities to take effective health service measures to prevent andcontrol both acute and chronic altitude disease. The purposes should be decreasingincidence, alleviating symptoms, reducing harm, improving health status, enhancingcombat effectiveness. To accomplish these purposes of control and heal altitude diseases,population level health related determents should be taken into account. Evaluation ofpopulation level determents of altitude diseases is helpful for countermeasure making foreffective controlling of the diseases in highland troops on the view of macroscopic.However, there is little work on this study field presently.Study purposesThe purposes of this study, firstly, are to investigate the contemporary distributionstatus of acute and chronic altitude disease among different time, different area, anddifferent military populations, including disease indicators and disability indicators.Secondly, to discuss the relationship between altitude diseases and population leveldeterments that include military factor, environmental factor, social factor, hygiene factor,behavior factor, and demographic characteristic factor. Thirdly, to find out and quantify therisk and protect factors of altitude diseases and build up disease model for describing theepidemic tendency of the diseases. Fourthly, to bring forward suggestions of the highlandtroops' health service for altitude diseases according to the factors. Moreover, through thisstudy, to discover new research direction, build up new research mode, find out new studyclues, and lay the groundwork and pave the way for future studies of military highlandhealth service.Study contentsThis study is composed by three parts. The first part is the study of population levelhealth determents of acute altitude disease in highland troops. The second part is the studyof population level health determents of chronic altitude disease in highland troops. Thethird part is countermeasure study of health service for altitude diseases. The first two partsare parallel study, while the third part gives out the countermeasures that based on thefindings of the first two parts.The first part of this study includes two stages. The first stage is preliminary analysesby using the medical records that already possessed or easy to obtain. The second stage is further analyses based on the first stage by using the advanced medical records thatcollected from highland units. Aims of the second stage are to verify the findings of the firststage, to find out other potential population level determents of acute altitude disease, andto build up acute altitude disease model of highland troops.The second part of this study is composed by two parallel study sections. One of thesections is epidemiological ecological study of chronic altitude disease among permanenthighland units, which is to discuss the relationship between prevalence of chronic altitudedisease and population level determents of highland military unit. The other section is studyon the highland troops' burden of chronic altitude disease, which is to discuss the highlandtroops' health lost caused by chronic altitude disease and its related population level factors.The third part of this study is to discuss the highland troops' health servicecountermeasures for acute and chronic altitude disease separately. The health servicecountermeasures for acute altitude disease are focus on the health service preparationsbefore highland entering operation and health supports during the highland enteringoperation. The health service countermeasures for chronic altitude disease are focus on thehealth service for prevention and heal the disease and servicemen health improvement inpermanent highland units.Study methodologyThe first part of this study based on retrospective strategy. We collected highlandtroops' recent year medical records during highland entering operations and extracted studyfactors. By statistic analyses we obtained the incidence rates, significant determents, andbuilt up disease model. The second part of this study based on across sectional strategy. Werandomly selected a sample of representative highland military units for chronic altitudedisease field investigation. During the investigation we carried out chronic altitude diseasediagnosis, symptom questionnaire, hygienic survey, and unit base information inquiry in thesample units. The third part of this study discussed health service countermeasures bymethodology of reasonable induction and logical deduction.In specific study, we used field investigation and questionnaire to obtain the status oftarget population; used case-control research to analyze the population level determents ofacute altitude disease; used cyanmethemoglobin technique to diagnose chronic altitudedisease; used epidemiological ecological investigation to find and analyze population level determents of chronic altitude disease; used Delphi processed person-treat-off strategy todeduce the disease weights of chronic altitude disease; used disability adjusted life year tocalculate the disease burden of highland troops; used correlation analysis to preliminarilyselect the population level determents of altitude disease, used regression analysis toconclude the population level determents of altitude diseases and to build up mathematicaldisease model.Main findingsBy the population level determents' analyses of highland troops, the acute altitudedisease determents were obtained, including: race (Tibetan vs. Han, OR=0.03-0.08), bornprovince (east vs. northwest, OR=1.32-1.39), season (cold vs. warm, OR=1.25-1.28),deployment type (emergency by land vs. normal by land, OR=2.08-2.11; normal by air vs.normal by land, OR=2.00-2.20; emergency by air vs. normal by land, OR=2.40-3.34),prophylaxis (prophylaxis vs. none, OR=0.75-0.76). When draw up highland enteringoperation plan, lower start point (600-800m vs.1300-1500m, OR=1.32-1.44) and higherdestination (4100-4300m vs.2900-3100m, OR=3.94-4.12;3600-3700m vs.2900-3100m, OR=2.71-2.74) also should be seriously take into account. Prediction value of themultiple regression model built in the study is acceptable (the area under receivercharacteristic curve is0.703), which could be used as reference for health service planmaking before troops entering highland.According to this investigation, the prevalence rate of chronic altitude disease amongthe highland troops is from1.25to36.58%(14.65±8.15%). Series community level factorswere verified as significant determents of chronic altitude disease, including pharmacyinvestment (OR=0.897,P=0.022), oxygen generation system (available vs. unavailable,OR=0.827, P=0.020), occupation (construction vs. logistics, OR=1.240, P=0.029), andsocial development level (urban vs. rural, OR=1.228, P=0.019). The study also indicatedthat the disease burden caused by chronic altitude disease is serious among highland troops,although it changes dramatically in different servicemen population. In differentservicemen population, the individual disability adjusted life years lost was form0.13to0.33, while the disability adjusted life years lost by one thousand people was form3.60to52.78. The population who lived in a higher area, got older, serviced for longer years inhighland, had smoking behavior, and engaged in construction occupation, are more likely to develop chronic altitude disease and also more likely to get heavier disease burden.When making health service plan before troops entering highland, the health serviceauthority should take the population level determents of acute altitude disease into account,and use the risk predicting model to export risk value of the disease, so that it could providequantitive reference for scientific military planning before operation of entering highland.For highland permanent military units, the health service should focus on increasing theinvestment of pharmacy and oxygen generation system, giving more attention to the healthcare and health protection of the population of construction occupation, enhancingservicemen's awareness of giving up smoking and self protection, and establishingscientific and reasonable rotation and compensation mechanism according to one's livingaltitude, highland service year, and occupation.Policy recommendationThe characteristics of health service are different between acute and chronic altitudedisease, thereby they should be carried out focus on their factors.The health service for acute altitude disease should focus on entering highlandoperation. Its purpose should be to enhance the operation capability and promote highlandacclimation during early time of entering. Its key point should be to advance prediction ofacute altitude disease and correctly make health service plan based on the prediction.The health service for chronic altitude disease should focus on the long-term highlandservice military population. Its purpose should be to reduce and alleviate harmful effectscaused by chronic altitude disease, promote the population health, maintain the highlandtroops' combat effectiveness. Its key point should be to reduce the disease burden ofhighland troops caused by chronic altitude disease and establish long-term health servicemechanism.Fundamental reason of both acute and chronic altitude disease is hypobaric hypoxiacaused by high altitude, while the occurring developing of the diseases are significantlyaffected by medical facilitate and health behavior. Acute altitude disease mainly relatedwith some characteristics of highland military operation, e.g. deployment type and season;while chronic altitude disease mainly related with highland service year, living condition,occupation. In the implementation of highland troops' health service for altitude disease,the population level determents of altitude disease should be taken into account, so that medical resources could be distributed scientifically, support plan could be made reasonably,and health intervention could be executed effectively. |
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