经阴道髂尾肌筋膜固定术联合传统术式治疗盆腔脏器脱垂的疗效分析

目的探讨经阴道髂尾肌筋膜固定术联合经阴道全子宫切除术＋阴道前、后壁修补术治疗盆腔脏器脱垂(POP)的应用价值。 方法选取2014年1月至2015年12月,广东省河源市龙川县人民医院与广东省佛山市南海区第六人民医院收治的98例POP患者为研究对象。根据POP患者接受的手术治疗方式,将其分为观察组(n＝48,接受经髂尾肌筋膜固定术联合经阴道全子宫切除术＋阴道前、后壁修补术治疗)与对照组(n＝50,仅接受经阴道全子宫切除术＋阴道前、后壁修补术治疗)。统计学比较2组患者的一般临床资料、手术时间、术中出血量、术后胃肠功能恢复时间、住院时间、治疗费用、治疗有效率、不良反应率,以及复诊时感染率、手术创面愈合不良发生率及复发率。 结果①2组患者年龄、人体质量指数、产次、绝经时间及POP量化分期法(POP-Q)分度、合并症构成比等一般临床资料分别比较,差异均无统计学意义(P>0.05)。②2组患者手术时间及术中出血量比较,差异均无统计学意义(P>0.05)。观察组患者术后胃肠功能恢复时间为(8.5±2.7)h,较对照组的(10.6±3.2)h短,并且差异有统计学意义(t＝3.504,P＝0.035)。③观察组患者住院时间为(8.4±1.2)d,较对照组的(10.5±1.7)d短,差异有统计学意义(t＝7.038,P<0.001)。观察组治疗费用为(6 084.7±844.9)元,较对照组的(6 515.6±1 018.4)元低,并且差异亦有统计学意义(t＝2.275,P＝0.047)。④观察组治疗有效率为97.9%(47/48),住院期间不良反应率为4.2%(2/48),对照组分别为90.0%(45/50)与8.0%(4/50),二者分别比较,差异均无统计学意义(P>0.05)。复诊时,2组患者感染率、手术创面愈合不良发生率及复发率分别比较,差异均无统计学意义(P>0.05)。 结论经阴道髂尾筋膜固定术联合传统术式治疗POP,疗效及安全性较为可靠,并且治疗费用较低。     

TVH联合阴道前后壁修补术治疗盆腔脏器脱垂效果评价

目的观察阴式全子宫切除术(the total vaginal hysterectomy,TVH)联合阴道前后壁修补术治疗盆腔脏器脱垂(pelvic organ prolapse,POP)的临床效果。方法选择2013年1月—2015年12月就诊的POP患者72例,随机分为对照组与观察组各36例。对照组给予AH加阴道前后壁修补术,观察组给予TVH联合阴道前后壁修补术。统计两组手术时间、术后排气时间、失血量、术后进食时间及住院时间;分别于术后1、3个月及1年比较两组疗效;统计两组术后1、3个月及1年复发率。计量资料比较采用t检验,计数资料比较采用χ~2检验,P0.05为差异有统计学意义。结果两组手术时间比较差异无统计学意义(P0.05),观察组术后排气时间、失血量、术后进食时间及住院时间[(2.31±0.41)d、(122.47±8.59)、(2.57±0.40)ml、(5.46±1.12)d]低于对照组[(3.75±0.35)d、(171.34±10.21)、(3.94±0.63)ml、(9.14±1.50)d],比较差异有统计学意义(均P0.05)。对照组术后1个月、3个月及1年总有效率分别为61.11%(22/36)、63.89%(23/36)、47.22%(17/36);观察组分别为88.89%(32/36)、94.44%(34/36)、77.78%(28/36)。术后1个月、3个月及1年观察组总有效率均高于对照组(均P0.05)。两组术后1年内复发情况比较差异有统计学意义(χ~2=5.791,P0.05)。结论 TVH联合阴道前后壁修补术治疗POP具有较好的临床疗效,快速、有效、复发率低及安全性好。     

腹腔镜下子宫腹直肌前鞘悬吊固定术治疗盆腔脏器脱垂的临床疗效

目的探讨腹腔镜下子宫腹直肌前鞘悬吊固定术治疗盆腔脏器脱垂(POP)的临床疗效。 方法选择2014年10月1日至2017年1月31日于广东省河源市和平县人民医院及暨南大学附属第一医院因POP就诊的21例患者为研究对象,并纳入研究组,所有患者均接受腹腔镜下子宫腹直肌前鞘悬吊固定术。选择同期于上述2家医院就诊并接受阴式全子宫切除术＋阴道前、后壁修补术的17例POP患者纳入对照组。采用盆腔脏器脱垂定量分度法(POP-Q)对2组患者POP程度进行评估,并对2组患者术前及研究组患者术后第4天进行POP-Q评分系统中Aa、Ba、Ap、Bp及C点共计5个指示点进行测量。采用成组t检验,对2组患者手术时间、术中出血量及住院时间进行比较。采用配对t检验,对研究组患者术前与术后POP-Q评分系统5个指示点测定结果比较。采用Wilcoxon秩和检验,对2组患者子宫脱垂、阴道前壁脱垂和阴道后壁脱垂POP-Q分度构成比进行比较。采用Fisher确切概率法,对2组患者术后总客观复发率进行比较。本研究遵循的程序符合广东省河源市和平县人民医院及暨南大学附属第一医院人体试验委员会制定的伦理学标准,得到该委员会批准,并与所有受试者签署临床研究知情同意书。 结果①2组患者的年龄、产次、绝经年限及人体质量指数(BMI)等一般情况比较,差异均无统计学意义(P>0.05)。②2组患者的子宫脱垂、阴道前壁脱垂及阴道后壁脱垂的POP-Q分度构成比比较,差异均无统计学意义(P>0.05)。③研究组患者的手术时间为(76.7±15.6)min,显著短于对照组的(123.8±17.9)min;研究组患者的术中出血量为(37.9±6.4)mL,显著低于对照组的(138.8±28.9)mL;研究组患者的住院时间为(6.3±2.8)d,显著短于对照组的(9.4±3.8)d,2组上述指标分别比较,差异均有统计学意义(t＝－8.654, P<0.001; t＝－14.150, P<0.001; t＝－2.452, P＝0.023)。④研究组术前与术后第4天POP-Q评分系统测定结果显示,Aa点分别位于(－0.5±1.3)cm与(－2.3±0.5)cm处,Ba点分别位于(2.1±1.6)cm与(－1.9±0.4)cm处,Ap点分别位于(－1.1±1.3)cm与(－2.8±0.3)cm处,Bp点分别位于(0.3±1.8)cm与(－2.6±0.4)cm处,C点分别位于(3.6±1.7)cm与(－7.7±0.6)cm处,上述测定结果分别比较,差异均有统计学意义(t＝12.408、14.791、6.355、8.820、28.302, P<0.001)。⑤研究组和对照组患者的总客观复发率分别为33.3%(7/21)和23.5%(4/17),2组比较,差异无统计学意义(P＝0.167)。 结论腹腔镜下子宫腹直肌前鞘悬吊固定术治疗POP安全有效,并且在手术时间、术中出血量及术后住院时间较阴式全子宫切除术＋阴道前、后壁修补术具有明显优势,但是腹腔镜下子宫腹直肌前鞘悬吊固定术的远期疗效仍有待多中心、随机对照研究进一步证实。     

经阴道行阴道旁修补术联合阴道后壁桥式修补术在女性盆腔器官脱垂治疗中的应用

目的 探讨经阴道途径行阴道旁修补(VPVR)术联合阴道后壁桥式修补术在治疗女性盆腔器官脱垂中的有效性和安全性.方法 对65例不同程度阴道前壁和/或后壁膨出伴子宫脱垂的患者采用VPVR术联合阴道后壁桥式修补术.术后定期随访,对手术效果进行主观及客观评价,并采用PFDI-20短表进行生活质量调查.结果 65例患者均行阴式全子宫切除术及阴道前壁修补术,其中33例行VPVR术,32例行VPVR术联合中央修补术;40例同时行阴道后壁桥式修补术.手术时间(110.00±20.12)min,失血量(119.52±45.33)ml.25例伴有张力性尿失禁的患者术后症状明显改善,除4例术后阴道前壁愈合不良外余无其他手术并发症发生.术后随访6～29个月,主观治愈率92.31%(60/65),客观治愈率100.00%(65/65).65例患者中58例(89.23%)接受生活质量调查,与术前相比,生活质量明显改善(P<0.01).结论 VPVR术联合阴道后壁桥式修补术治疗不同程度阴道前壁和/或后壁膨出伴子宫脱垂安全有效,远期疗效尚待进一步观察.     

阴道前后壁修补术联合阴道骶棘韧带固定术治疗子宫脱垂的效果分析

目的 分析阴道前后壁修补术联合阴道骶棘韧带固定术(SSLF)治疗子宫脱垂的临床效果。方法 选取2016年7月—2019年7月云南省第一人民医院收治的子宫脱垂患者85例为研究对象，根据手术方案不同分成A组(41例，采取经阴道全子宫切除+阴道前后壁修补术治疗)和B组(44例，采取经阴道全子宫切除+阴道前后壁修补术+SSLF治疗)。对比两组患者手术相关指标、POP-Q分度情况、盆底功能障碍性疾病症状简表-20(PFDI-20)评分、盆腔脏器脱垂/尿失禁性生活质量问卷-12(PISQ-12)评分及术后1年复发情况。结果 B组患者手术时间[(116.43±23.56)min]长于A组[(100.08±19.47)min],术中出血量[(104.24±22.73)ml]高于A组[(95.13±15.27)ml],差异均有统计学意义(t=3.473、2.153,均P<0.05)。两组患者术后排气时间[B组(26.03±5.78)d、A组(24.19±5.14)d]、住院时间[B组(7.48±2.34)d、A组(7.03±2.05)d]比较，差异均无统计意义(t=1.547、0.940,均P&g...     

两种修补术式对剖宫产术后子宫切口憩室患者月经恢复情况、再次宫内妊娠率及术后复发率的影响

目的探讨宫腹腔镜联合修补术式与经阴道修补术式对剖宫产术后子宫切口憩室(PCSD)患者月经恢复情况、再次宫内妊娠率的影响。方法研究对象选取我院2012年2月—2014年7月收治的PCSD患者共120例,其中行宫腹腔镜联合修补术式68例设为宫腹腔镜联合修补术组,行经阴道修补术式共52例设为经阴道修补术组,比较两组患者围手术期临床指标,月经恢复效果,治疗前后子宫憩室宽度和深度,再次宫内妊娠率及复发率等。结果经阴道修补术组患者手术时间(60.2±8.6)min显著短于宫腹腔镜联合修补术组(74.3±13.1)min;宫腹腔镜联合修补术组患者术中出血量(83.6±14.2)ml、术后阴道流血时间(7.9±0.6)d及住院时间(5.2±1.9)d均显著优于经阴道修补术组[分别为(118.3±23.6)ml、(9.7±0.6)d、(8.5±2.4)d];两组患者术后肛门排气时间比较差异无统计学意义;两组患者月经恢复效果比较差异无统计学意义;两组患者治疗后子宫憩室宽度和深度组间比较差异无统计学意义;同时两组患者再次宫内妊娠率和复发率比较差异无统计学意义。结论宫腹腔镜联合修补术式与经阴道修补术式对PCSD临床疗效接近,但宫腹腔镜联合修补术式可有效降低术中创伤程度,缩短术后阴道流血时间和住院时间,而与经阴道修补术式则具有术中操作简便,用时较短等优势。     

腹腔镜下子宫/阴道骶骨固定术治疗中盆腔脱垂的临床疗效分析

目的探讨腹腔镜下子宫/阴道骶骨固定术治疗中盆腔脱垂的临床疗效及安全性。方法选取2010年1月-2015年6月该院收治的72例Ⅲ~Ⅳ度中盆腔脱垂(子宫脱垂或阴道穹窿脱垂)患者,分别行腹腔镜下子宫/阴道骶骨固定术,对于同时合并阴道前后壁脱垂的患者分别行阴道前后壁修补术,对于合并压力性尿失禁的患者同时行经闭孔无张力尿道中段悬吊术(TVT-O)。手术前后分别依据POP-Q评分、盆底功能障碍性疾病症状问卷-20(PFDI-20)、盆底疾病生活质量影响问卷短表-7(PFIQ-7)、盆腔器官脱垂/尿失禁性生活质量问卷-12(PISQ-12)评估手术疗效。结果 72例患者均成功施行腹腔镜下子宫/阴道骶骨固定术,术中过程顺利,手术时间(136±43)min,出血量(86±47)ml,住院时间(5.0±1.8)d。术后2~3 d拔除尿管,1例发生尿潴留,促排尿治疗后好转,其余均可恢复自主排尿。肛门排气均正常。术后随访1~12个月,Aa、Ba、C、D、Ap、Bp各点差异均有统计学意义(P0.05)。术后2例出现阴道前壁脱垂复发,无阴道后壁及子宫或阴道顶端脱垂复发病例;手术前后PFDI-20、PFIQ-7、PISQ-12评分差异均有统计学意义(P0.001)。结论腹腔镜下子宫/阴道骶骨固定术治疗中盆腔脱垂安全、有效;手术显著改善患者日常生活及性生活质量,但对同时合并阴道前后壁脱垂效果可能相对较差。     

改良盆底重建术与阴道壁桥式修补术在治疗女性盆腔脏器脱垂中的应用

目的探讨改良盆底重建术和阴道壁桥式修补术治疗盆腔脏器脱垂(POP)的临床效果。方法选择2009年1月至2010年12月在本院妇科行手术治疗的50例POP患者为研究对象。按照不同手术方式将其随机分为研究组(n=25,接受改良盆底重建术)和对照组(n=25,接受阴道壁桥式修补术),两组患者均根据自身情况决定保留或不保留子宫。评价两种术式的治疗效果(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象本人的知情同意,并与之签署临床研究知情同意书)。两组患者年龄、体重指数(BMI)及盆腔脏器脱垂定量(POP-Q)等比较,差异无统计学意义(P>0.05)。结果①两组手术平均时间比较,差异无统计学意义(P>0.05);②研究组术中平均出血量略多于对照组,但差异无统计学意义(P>0.05);③研究组平均住院时间明显短于对照组,两组比较,差异有统计学意义(P<0.01);④术后对照组阴道长度较术前明显缩短,组内比较,差异有统计学意义(P<0.05);研究组术后阴道长度则较术前无明显变化,组内比较,差异无统计学意义(P>0.05)。两组术后阴道长度比较,差异有统计学意义(P<0.05);⑤研究组随访(6～30个月)未发现复发患者,对照组中2例复发;⑥研究组患者行改良盆底重建术后对性生活影响较小,与对照组比较,差异有统计学意义(P<0.001)。结论改良盆底重建术是治疗POP的有效术式,手术简单、安全且微创。     

改良式全盆底悬吊术在女性盆腔器官脱垂中的临床应用

目的 探讨女性盆腔器官脱垂(POP)应用聚丙烯网片在保留子宫的同时进行盆底重建的可行性和有效性.方法 以2008年11月至2010年5月期间手术治疗的120例女性盆腔器官脱垂患者为研究对象,分为研究组55例行保留子宫的改良式全盆底悬吊术(UCG 组)和对照组65例行传统的阴式子宫全切加阴道前后壁修补术(HG组).比较两组围手术期情况、术前术后POP-Q评分及治愈率.结果 两组平均手术时间(120.3±36.5min vs 135.7±34.2min,t=0.12,P=0.62)及术中出血量(78.9±20.9mL vs 82.1±22.0ml,t=1.39,P=0.71)无统计学意义;UCG组平均术后住院日比HG组短(5.0±0.3d VS 7.1±0.6d,t=3.92,P＜0.01).随访1年后的治愈率,两组间差异有统计学意义(92.7% vs 77.5%,χ2=5.97,P=0.02).结论 与HG组比较,UCG治疗重度POP可保留子宫,手术简单、安全、微创,患者术后恢复快.UCG是治疗重度POP的有效术式.     

新式阴道前壁补片修补术治疗压力性尿失禁女性患者的疗效分析

目的探讨阴道前壁黏膜下双侧耻骨后间隙造穴植入生物补片修补术(简称为新式阴道前壁补片修补术),对压力性尿失禁(SUI)女性患者的近、远期手术疗效。方法选择2009年1月至2014年12月,在济南军区总医院诊断为SUI,并行新式阴道前壁补片修补术治疗的316例女性患者为研究对象,并对其随访≥12个月。本术式中使用本研究设计并获中国实用新式专利的"YGP-Ⅱ型阴道前壁穴道分离补片放置复合钳"。采用《国际尿失禁咨询委员会尿失禁问卷简表》(ICIQ-SF)进行疗效主观评价,采用尿垫试验进行疗效客观评价。分析患者手术情况及术后并发症等临床资料,统计学分析该术式近、远期疗效。本手术及研究遵循的程序,得到济南军区总医院医学伦理委员会批准,并取得患者知情同意。结果 (1)本研究中度SUI患者为264例,重度SUI患者为52例;平均手术时间为(15.7±4.2)min,术中平均出血量为(69.1±26.9)mL,术后平均住院时间为(1.9±1.7)d。(2)术后并发症包括排尿不尽、发热、小便困难、尿路感染及补片外露等,术后无严重并发症发生。(3)中度或重度SUI女性患者,术前ICIQ-SF评分均较术后12个月高,并且差异均有统计学意义(t=12.569,14.028;P0.001);术后随访12个月患者的SUI治愈率(91.8%)与随访≥24个月的治愈率(94.2%)比较,差异无统计学意义(χ2=1.020,P=0.211)。结论本新式阴道前壁补片修补术,治疗中、重度SUI女性患者有效,远期疗效可靠,并且更微创化,是否适于临床推广应用,尚需多中心、大样本随机对照试验进一步研究、证实。     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.     

Stress in the Norwegian police service

BACKGROUND: High levels of stress have been attributed to the conditions of police work, but there is little empirical evidence for this. AIMS: To develop a new instrument to measure job stress in the police; to assess the most severe and frequent police stressors; to compare levels of stress according to the demographic and organizational factors; and to study stress in relation to personality traits, work locus of control and coping strategies. METHODS: A comprehensive nationwide questionnaire survey of 3272 Norwegian police at all hierarchical levels, including the Norwegian Police Stress Survey (NPSS), the Job Stress Survey, the Basic Character Inventory, the Work Locus of Control Scale, and the Coping Strategies Scale. RESULTS: Work injuries were appraised as the most stressful but least frequent stressor and job pressure was reported the least severe but most frequent stressor. Females experienced job stressors less frequently, but appraised them as more severe than men did. Older police officers reported more job pressure severity and fewer work injuries. The police in districts where peer support was planned but not implemented, and who worked in districts with more than 50,000 inhabitants, perceived the lack of support more severely than others. The correlations between stress and personality traits, work locus of control, and coping were moderate. CONCLUSIONS: The NPSS captures police-specific stressors that are not adequately measured by global stress instruments. The study of stress in police work should preferably involve a nationwide use of police-specific stress instruments.