我国2015－2016年哨点监测手足口病病原学和并发症分析

目的 分析2015－2016年我国手足口病哨点监测系统的手足口病特征,探讨建立手足口病哨点监测的可行性、优势及不足。方法 数据来源于11个国家级哨点监测点2015年11月至2016年10月手足口病监测数据,描述手足口病的病原特征、代表性和重症病例并发症情况,采用多因素logistic回归分析手足口病哨点监测样本阳性率的相关影响因素。采用SPSS 20.0软件进行统计学分析。结果 共有4 783例手足口病病例样本,其中轻症病例3 390例,重症病例1 390例,死亡3例。肠道病毒（EV）阳性率为81.43%（3 895/4 783）,轻症病例优势血清型为其他EV（52.68%,1 482/2 813）,重症病例优势血清型为EV71（65.31%,706/1 081）。哨点监测显示的优势血清型与同时期现有监测血清型基本一致。其他EV所致病例中低年龄组儿童所占比例高于EV71和柯萨奇病毒A组16型（Cox A16）（χ²=130.17,P<0.001）。多因素logistic回归结果显示,样本阳性率高与男性、高发月份病例、儿童医院病例、样本为粪便、及时采样有关。不同类型样本阳性率均呈现随发病-采样间隔时间的延长而下降的趋势（粪便趋势χ²=14.47,P<0.001;咽拭子趋势χ²=31.99,P<0.001;肛拭子趋势χ²=24.26,P<0.001）。无菌性脑膜炎、非脑干脑炎、脑干脑炎为重症病例最常见的3种并发症,EV71和其他EV所致重症病例并发症差异无统计学意义。结论 哨点监测发现性别、发病月份、接诊医院类别、标本类型、采样及时性是影响手足口病样本阳性率的5个独立影响因素。哨点监测可以收集这些影响因素以提升监测质量。设立手足口病国家级哨点监测在我国是可行的。     

北京市入托体检健康儿童肠道病毒71型和柯萨奇病毒A组16型感染状况及就诊行为调查

目的 了解北京市入托儿童肠道病毒71型(EV71)和柯萨奇病毒A组16型(Cox A16)感染状况及其相关的就诊率,为估算手足口病疾病负担参考。方法 2013年8月20－31日对北京市东城区、朝阳区和怀柔区进行入托体检的健康儿童开展血清学调查,采用ELISA方法检测血清中EV71和Cox A16的IgG和IgM抗体。结果 共调查813名儿童,平均年龄为(3.5±1.0)岁。Cox A16 IgG阳性率为61.9%,IgM阳性率为4.4%;EV71 IgG阳性率为9.3%,IgM阳性率为1.1%;各种抗体阳性率在不同性别中的分布差异无统计学意义(P>0.05),在不同年龄组中的分布差异有统计学意义(P<0.05)。Cox A16抗体阳性者中7.8%有皮疹,EV71抗体阳性者中10.7%有皮疹。Cox A16或EV71抗体阳性者中,仅7.1%在父母陪伴下到医院就诊,而有皮疹的抗体阳性病例中,80.5%去医院就诊。结论 北京市健康入托儿童中,既往感染Cox A16的比例较大,EV71抗体阳性率明显低于Cox A16,提示托幼儿童对EV71普遍易感,应是手足口病防控重点人群。     

手足口病重症病例临床分期与结局分析

目的 了解手足口病重症病例临床分期与结局的特征及关联性,为建立临床重症病例评估方法提供依据。方法 根据地理位置、经济状况和疫情高发水平选择河南、山东、浙江、四川和云南省,随机抽取法定传染病报告中手足口病重症病例,收集病例人口学、临床资料和实验室检测结果等,按统一标准进行临床分期,分析各期病例构成、临床结局及其关联性。结果 共调查手足口病重症病例657例。实验室诊断病例357例,其中肠道病毒71型阳性病例326例,占91.3%（326/357）。临床分期：2期（神经系统受累期）病例542例、3期（心肺功能衰竭前期）病例99例、4期（心肺功能衰竭期）病例16例,分别占重症病例数的82.5%（95%CI：79.4%~85.3%）、15.1%（95%CI：12.4%~18.0%）、2.4%（95%CI：1.4%~3.9%）。11例有后遗症,占重症病例数的1.7%（95%CI：0.9%~3.0%）;8例死亡,病死率为1.2%（95%CI：0.6%~2.3%）。临床2、3和4期在各年龄组、5个省份、后遗症病例数、死亡例数的构成比差异均有统计学意义（分别为 χ²=22.632,P=0.012;χ²=41.481,P=0.000;χ²=12.960,P=0.001;χ²=16.850,P=0.001）。结论 手足口病重症病例临床分期与后遗症、死亡结局有关联性。临床分期可用于手足口病重症病例严重程度的评价。     

手足口病重症病例分析:基于全国手足口病监测试点数据

目的 了解手足口病重症病例的患病情况、病原构成以及危险因素。方法 对2015年11月1日至2016年11月30日全国手足口病监测试点网络直报系统报告的1 489例手足口病重症及死亡病例进行研究,对基本信息、就诊及治疗情况、临床严重程度及病原构成进行描述性分析并通过多项logistic逐步回归分析重症病例治疗结果的危险因素。结果 1 489例重症病例中有7例死亡病例。960例（72.9%）年龄<3岁,937例（62.9%）为男性,病例大部分居住于农村（63.9%）。494例（33.2%）患者首次就诊时选择村级和乡镇级机构。重症病例的发病-就诊、发病-诊断为手足口病和发病-重症诊断的时间间隔分别为0（0～1） d、1（0～2） d和2（1～4） d。并发症有无菌性脑膜炎（51.9%,773例）、非脑干脑炎（25.3%,377例）、脑干脑炎（17.5%,260例）、脑脊髓炎（0.4%,6例）、急性弛缓性麻痹（0.1%,1例）、肺水肿/肺出血（0.3%,4例）和心肺功能衰竭（4.6%,68例）。1 217例纳入病原分析的重症及死亡病例的病原构成依次为肠道病毒（EV）71（52.8%,642例）、其他肠道病毒（21.5%,261例）、柯萨奇病毒（Cox） A16（3.0%,36例）、EV71和Cox A16合并感染（0.1%,1例）。并发症（Z=3.15,P=0.002）和发病-重症诊断的时间（Z=3.95,P<0.001）为治疗结果的危险因素。结论 手足口病重症病例以农村男童为主,并发症以无菌性脑膜炎、非脑干脑炎和脑干脑炎为主。EV71是重症及死亡病例的重要病原构成。确诊的及时性以及并发症类型对于治疗结果具有重要影响。     

湖南省安化县2013-2016年手足口病住院负担估计

目的 估计2013年10月至2016年9月湖南省安化县各血清型及分年龄组的手足口病住院负担。方法 收集6家病毒学监测医院的儿童手足口病住院记录及23家乡镇卫生院的手足口病新农合报销记录,估计安化县分年龄组的手足口病住院负担。结合病毒学监测结果,估计各血清型肠道病毒（EV）相关的手足口病住院负担。结果 共纳入手足口病住院病例3 541例,其中实验室确诊病例数为3 146例。仅有1例为手足口病重症,其余均无并发症。临床诊断和实验室确诊手足口病平均住院率分别为723/10万（95% CI：699/10万~747/10万）和642/10万（95% CI：620/10万~665/10万）。柯萨奇病毒（Cox）A组16型（Cox A16）（208/10万）和6型（Cox A6）（202/10万）相关的手足口病住院率高于EV71（130/10万）、Cox A10（38/10万）和其他EV（64/10万）,差异有统计学意义（P<0.001）。手足口病住院率在1岁组最高（3 845/10万）,之后随年龄增长住院率逐渐降低。与EV71和Cox A16相比,Cox A6相关的手足口病住院率表现出低年龄特点（P<0.001）。结论 湖南省安化县轻症手足口病住院负担严重,尤其在低年龄组儿童中,且主要由EV71、Cox A16、Cox A6和Cox A10导致。     

高危型HPV E6/E7 mRNA与宫颈癌相关性分析

目的 探讨高危型HPV E6/E7 mRNA检出率与宫颈癌的相关性,为临床防治宫颈癌提供依据。方法 选择2015年收治的100例宫颈癌患者为A组,同期100例健康体检者为B组,采用荧光定量PCR检测入组患者高危型HPV E6/E7 mRNA和病理学检查,比较两组患者HPV E6/E7感染率和荧光定量PCR检查效率,分析HPV E6/E7感染与宫颈鳞状上皮病变的相关性。结果 A组阳性76例,阳性率为76.0%;B组阳性13例,阳性率为13.0%;A组阳性率高于B组,差异有统计学意义（χ²=24.522,P<0.001）。两组阳性预测值和阴性预测值比较,差异无统计学意义（P>0.05）。宫颈癌患者HPV E6/E7 mRNA阳性率（76.0%）高于高度宫颈鳞状上皮病变者（26.1%）、低度宫颈鳞状上皮病变者（17.6%）和非典型鳞状上皮细胞者（6.7%）,差异有统计学意义（χ²=7.615,P=0.001; χ²=9.114,P=0.001; χ²=18.241,P<0.001）。结论 宫颈癌患者HPV E6/E7mRNA检出率高,且随宫颈鳞状上皮病变加重,其HPV E6/E7 mRNA阳性率越高。     

2016 - 2018年西安市手足口病的病原变化

目的 了解西安市2016 - 2018手足口病的病原构成和变化趋势,为下一步的防控提供科学依据。方法 通过“中国疾病预防控制信息系统”收集手足口病病例的信息,用RT - PCR检测肠道病毒,鉴别出EV71、Cox A16、Cox A6和Cox A10,用Excel和SPSS 18.0软件进行统计学分析。结果 2016 - 2018年共收集到2 797例HFMD标本,其中2 484例肠道病毒阳性,EV71、Cox A16和其他肠道病毒的构成比分别为28.34%、21.30%和50.36%。643株非EV71和非Cox A16的其他肠道病毒中,Cox A6和Cox A10的构成比分别为63.45%和9.64%。≤5岁患者占到所有患者的94.85%,男女性别比为1.42∶1。2017年HFMD的优势毒株是EV71,2016和2018年的优势病原是其他肠道病毒。轻症HFMD病例的优势血清型是其他肠道病毒,构成比为51.32%（1 183/2 305）,重症病例的优势血清型是EV71,构成比为58.66%（105/179）。结论 HFMD肠道病毒发生变化,2016 - 2018年西安市HFMD的优势病原是其他肠道病毒,Cox A6的流行强度增加,应加强对其他肠道病毒的监测。     

湖北省2009－2015年手足口病流行病学和病原学分析

目的 描述2009－2015年湖北省手足口病的分年龄组、轻症和重症死亡病例的流行病学和病原学特征,为制定手足口病防控策略提供依据。方法 利用2009－2015年传染病报告信息管理系统中报告的湖北省手足口病例个案信息和湖北省各级CDC病原学监测的信息;通过对病例年龄、病例类型、临床诊断病例和实验室确诊及不同血清型分层分析。结果 2009－2015年湖北省累计报告手足口病495 783例,年均发病率为1 231.0/100万。手足口病高发的年龄段为0.5～5岁,重症和死亡病例发生风险的高发年龄段为6～11月龄。轻症病例2009－2015年的优势病原每年依次是EV71、Cox A16、Cox A16、Cox A16、EV71、Cox A16和其他肠道病毒。发病高峰出现于每年的4－6月和11－12月,偶数年比奇数年发病峰值高。结论 2009－2015年湖北省手足口病重点干预人群是0.5～5岁婴幼儿,尤其是发生重症死亡风险高的6～11月龄婴儿。加强对重点人群的监测,有效防控手足口病,减少重症和死亡。     

妊娠期妇女甲状腺功能减退对妊娠结局和胎儿影响的分析

目的 分析妊娠期妇女甲状腺功能减退(甲减)对妊娠结局和胎儿的影响。方法 选择2013年1月至2015年10月在上海市第八人民医院行产前检查并分娩的4286例孕妇为研究对象,入组患者均在孕10周时行甲状腺功能检查,分为甲减、亚临床甲状腺功能减退(亚甲减)和健康3组,分析甲减发生状况及其对妊娠结局和胎儿的影响。结果 共检出甲减209例,发生率为4.9%(209/4286),其中临床甲减85例,亚甲减124例。健康组早产发生率(1.0%)明显低于甲减组(10.6%)和亚甲减组(6.5%),差异有统计学意义(χ²=38.884,P<0.001;χ²=17.722,P<0.001);健康组贫血发生率(3.8%)明显低于甲减组(18.8%)和亚甲减组(9.7%),差异有统计学意义(χ²=30.949,P<0.001;χ²=23.275,P<0.001);健康组低体重发生率(1.1%)明显低于甲减组(14.1%)和亚甲减组(4.8%),差异有统计学意义(χ²=50.593,P<0.001;χ²=15.637,P<0.001);健康组胎儿窘迫发生率(1.9%)明显低于甲减组(10.6%)和亚甲减组(5.6%),差异有统计学意义(χ²=19.257,P<0.001;χ²=12.357,P<0.001);健康组胎儿Apgar评分(9.69±0.32)明显高于甲减组(9.25±0.45)和亚甲减组(9.28±0.44),差异有统计学意义(t=8.823,P<0.001;t=15.175,P<0.001)。结论 妊娠期妇女甲减可对妊娠结局和胎儿构成不利影响,临床应加强妊娠期妇女相关检查,早发现早治疗。     

苏州市2011-2017年5岁以下儿童流感门诊病例临床特征及疾病负担

目的 了解2011-2017年苏州大学附属儿童医院<5岁儿童流感样病例（ILI）临床特征及疾病负担。方法 2011年3月至2017年2月于苏州市儿童医院监测因流感样疾病就诊的<5岁门诊病例,通过问卷调查和电话随访收集人口学信息、临床信息、疾病史及与医疗有关的直接和间接费用,比较ILI及不同流感亚型确诊病例的临床特征和社会经济负担。结果 共纳入6 310例,其中791例（12.9%）流感病毒检测阳性,其中A/H1N1阳性88例（11.1%）,A/H3N2阳性288例（36.4%）,B型415例（52.5%）。流感阳性儿童发生咳嗽、流涕、喘息、呕吐、抽搐的比例皆高;A/H1N1、A/H3N2、B型感染导致临床特征的主要差异为咳嗽（χ²=9.227,P=0.010）、喘息（χ²=7.273,P=0.026）和呕吐（χ²=8.163,P=0.017）。流感病毒阴性者治疗平均费用688.4（95%CI：630.1~746.7）元,流感病毒阳性者为768.0（95%CI：686.8~849.3）元。A/H1N1阳性者治疗总费用明显高于A/H3N2阳性和B型阳性者（χ²=7.237,P=0.028）。结论 儿童感染流感病毒更易发生咳嗽、流涕、喘息、呕吐、抽搐等临床症状,并造成严重的疾病负担,其中A/H1N1亚型感染造成的疾病负担高于其他2种亚型。     

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.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

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.