厦门市2013－2017年手足口病发病与气象因素影响分析

目的 研究厦门市气象因素对手足口病发病的影响,为手足口病的预警预测和防控提供科学依据。方法 采用R3.4.3软件对2013－2017年厦门市日平均本站气压、日平均相对湿度、日平均气温、日照时数等气象因素资料和日手足口病发病数进行相关分析和分布滞后非线性模型分析。结果 厦门市2013－2017年共报告手足口病36 464例,发病数呈上升趋势（F=40.359,P=0.008）。日平均相对湿度、日平均气温和日照时数与手足口病发病呈正相关（r>0）,日平均本站气压与手足口病发病呈负相关（r<0）。在滞后0～5 d的情况下,日平均本站气压>1 005 hPa时,随着气压的增高,手足口病发病风险逐渐增加;发病风险随着滞后天数的增加而减弱;气压为1 017 hPa滞后0 d时发病风险最高（RR=1.14,95% CI：0.67～1.94）。相对湿度>95%时,随着相对湿度增加,手足口病发病风险逐渐增加,滞后时间分布在0～10 d,以第4、5天最为明显,相对湿度为100%滞后5 d时发病风险最高（RR=1.32,95% CI：1.02～1.71）。>28℃和<8℃时对手足口病发病都是危险因素,但滞后时间不一致,低温时滞后15～20 d相对危险度最高,而高温时滞后时间主要分布在5～15 d,以日平均气温28℃滞后4 d发病风险最高（RR=1.10,95% CI：0.94～1.29）。日照时数较长时（>12 h）滞后0～3 d对手足口病发病呈现危险性,其中日照均数13 h滞后0 d发病风险最大（RR=1.20,95% CI：1.05～1.36）。结论 日平均本站气压、日平均相对湿度、日平均气温、日照时数等气象因素与厦门市手足口病发病相关,且具有一定的滞后性,可以考虑纳入手足口病预警预测体系。     

江西省2017-2022年其他感染性腹泻流行趋势和预测分析

目的 分析江西省2017-2022年其他感染性腹泻流行趋势，探讨自回归移动平均（ARIMA）模型在江西省其他感染性腹泻发病预测中的应用，为开展其他感染性腹泻预测和防控工作提供参考。方法 对江西省2017-2022年其他感染性腹泻病例进行描述性流行病学分析，建立ARIMA模型对2023年其他感染性腹泻发病数进行预测。结果 2017-2022年江西省累计报告其他感染性腹泻为204 842例，年均报告发病率为74.32/10万。全年龄段均有病例报告，发病呈明显的季节性特征，存在冬春季（1-3月）和夏秋季（7-9月）两个发病高峰，且冬春季峰值较高。ARIMA（0，1，2）（2，1，0）₁₂和ARIMA（1，0，0）（2，1，0）₁₂模型的各项参数均有统计学意义（P<0.05），且贝叶斯信息准则值最小分别为13.83和9.12，残差系列均为白噪声（P>0.05）；模型预测值与实际值较为吻合，预测趋势与实际趋势一致，模型预测效果较好。结论 2017-2022年其他感染性腹泻发病仍居江西省法定传染病发病前列，防控形势不可忽视，应在流行季加强对防控重点人群≤3岁儿童和散居儿童家庭的疾病监测和健康宣教工作。ARIMA模型可用于江西省其他感染性腹泻发病的短期预测和趋势分析。     

浙江省气温对其他感染性腹泻的滞后效应及影响因素

目的 研究气温对浙江省不同城市其他感染性腹泻的滞后效应,并探讨其异质性来源,找出脆弱人群。方法 收集2014-2016年浙江省其他感染性腹泻资料及同期气象资料。采用两阶段模型,首先在各个市利用分布滞后非线性模型评价气温对其他感染性腹泻的滞后效应,然后采用多变量Meta分析合并效应值,再通过Meta回归进一步探索其异质性来源。结果 研究期间浙江省共发生其他感染性腹泻301 593例。在全省水平上,其他感染性腹泻发病风险最低时对应的温度为16.7℃,以16.7℃作为参照温度,发病风险最高时对应的温度为6.2℃（RR=2.298,95% CI：1.527~3.459）。以日平均气温的P₅、P₉₅分别代表低温和高温,低温时其他感染性腹泻的发病风险滞后2 d显现,第5天时风险最高（RR=1.057,95% CI：1.030~1.084）,然后持续降低至第23天。高温对应的发病风险当天就会出现（RR=1.081,95% CI：1.045~1.118）,并逐渐减小至第8天。不同地区其他感染性腹泻发病风险差异的异质性来源有城市纬度及人口老龄化率。结论 高温或低温均会增加其他感染性腹泻的发病风险,且存在滞后效应。低温时应加强对高纬度地区人群及老年人群其他感染性腹泻的预防。     

嘉峪关市其他感染性腹泻与气象相关影响因素研究

目的研究其他感染性腹泻发病与气象因素的关联性,分析不同气象因素对其他感染性腹泻的影响及其滞后效应,为调整防控措施提供科学依据。方法利用嘉峪关市2008—2016年其他感染性腹泻发病人数,结合同期气象资料,包括气温、气压、相对湿度、风速等,用广义相加模型结合分布滞后非线性模型探讨不同气象指标对其他感染性腹泻发病的影响。结果嘉峪关市其他感染性腹泻发病时间分布呈明显的季节周期性变化,6—8月出现高峰,其余月份发病例数较少;气象因素在不同滞后日与其他感染性腹泻的关联呈非线性,气温与其他感染性腹泻的风险效应呈正向关联,以日均气温8.50℃为参照,气温为33℃、滞后14d时RR值最高,为7.73(P<0.01)。风速和相对湿度与其他感染性腹泻的风险效应呈负向关联,滞后0d时RR值的95%CI下限均小于1,无统计学意义(P>0.05)。结论气温可能是嘉峪关市其他感染性腹泻暴发的重要原因之一,对其他感染性腹泻在人群中的发生和流行发挥重要作用,通过改善居民生活习惯与易感人群自身体质,可间接影响其他感染性腹泻在人群中的分布。     

应用调整Serfling回归模型估计北京市5岁以下儿童病毒性腹泻相关超额病例数

目的 构建调整Serfling回归模型,估计北京市2011年至2015年5月23日病毒性腹泻相关 <5岁儿童超额腹泻病例数。方法 利用北京市2家儿童专科医院 <5岁儿童急性腹泻周就诊病例数,拟合调整Serfling回归模型,估计其病毒性腹泻相关超额病例数。结果 北京市2011年第8～10周、40～42周,2012年第40～46周,2013年第43～49周,2014年第45周直到2015年第11周为病毒性腹泻流行周。2家儿童专科医院各年度流行周 <5岁儿童病毒性腹泻相关超额就诊病例数分别为911(95%CI:261～1 561)、1 998(95%CI:1 250～2 746)、1 645(95%CI:891～2 397)、2 806(95%CI:1 938～3 674)、1 822(95%CI:614～3 031)例,分别占同期全部 <5岁儿童腹泻就诊病例数的40.38%(95%CI:11.57%～69.19%)、44.21%(95%CI:27.66%～60.77%)、45.08%(95%CI:24.42%～65.69%)、60.87%(95%CI:42.04%～79.70%)和66.62%(95%CI:22.45%～110.82%)。估计北京市2011年至2015年5月23日 <5岁儿童病毒性腹泻相关超额就诊病例数为18 731(95%CI:10 106～27 354)例。结论 冬季是 <5岁儿童病毒性腹泻发病及就诊高峰。调整Serfling回归模型提示:应关注致急性胃肠炎病毒,尤其是诺如病毒的病原学变化。     

细胞色素氧化酶基因CYP1A1多态性与新疆维吾尔族人群冠心病相关性研究

目的 探讨新疆地区维吾尔(维)族人群细胞色素氧化酶基因CYP1A1多态性与冠心病的关联性。方法 使用实时PCR对293例冠心病患者(病例组)和408名健康体检者(对照组)CYP1A1基因单核苷酸多态性(SNPs:rs4886605, rs12441817, rs4646422, rs1048943)进行基因型鉴定。结果 维族人群病例组和对照组rs4886605的基因型及等位基因分布的差异均有统计学意义(均P<0.05)。病例组rs4886605显性模型(CC vs. CT+TT)基因型频率明显低于对照组。调整混杂因素后logistic回归分析表明, 维族人群rs4886605的CC基因型者患冠心病风险明显低于CT+TT基因型者(总体:OR=0.368, 95%CI:0.185～0.530, P=0.018;男性:OR=0.350, 95%CI:0.235～0.568, P=0.015)。病例组和对照组rs12441817的基因型及等位基因分布差异均有统计学意义(均P<0.05)。病例组的rs12441817显性模型(TT vs. CT+CC)基因型频率明显低于对照组。调整混杂因素后logistic回归分析表明, 维族人群rs12441817的TT基因型者患冠心病风险明显低于CT+CC基因型者(总体:OR=0.253, 95%CI:0.231～0.546, P=0.016;男性:OR=0.241, 95%CI:0.132～0.478, P=0.002)。结论 新疆维族人群CYP1A1基因多态性rs4886605、rs12441817的2个位点与发生冠心病相关。rs4886605的CC基因型、rs12441817的TT基因型可能是该人群发生冠心病的保护因素。     

microRNA合成通路基因SNP与头颈鳞癌发病风险的关联研究

目的 探讨microRNA合成通路基因单核苷酸多态性（SNP）与头颈鳞癌发病风险的关联。方法 采用病例对照研究设计,纳入年龄（±5岁）、性别频数匹配的576例头颈鳞癌患者和1 552名健康对照。应用Illumina Infinium BeadChip平台检测microRNA合成通路上DICER1、GEMIN3、PIWIL1的8个潜在功能性SNP位点。通过单因素和多因素logistic回归模型分析不同基因型与头颈鳞癌间的关联。结果 PIWIL1 rs1106042（G>A）的等位基因频率在病例组和对照组中的差异有统计学意义（P=0.011）;在调整年龄、性别、吸烟和饮酒等因素后,携带rs1106042 A等位基因的基因型个体发生头颈鳞癌的风险降低（相加模型：aOR=0.73,95% CI：0.57～0.93, P=0.011）;分层分析显示,rs1106042 A等位基因在年龄≥60岁、女性、非吸烟、非饮酒、口腔癌亚组中具有降低肿瘤发病风险的效应（P<0.05）。结论 PIWIL1基因的潜在功能SNP位点可能与中国人群头颈鳞癌的发病风险相关。     

中国新型冠状病毒肺炎疫情基本再生数评估

目的 目前湖北省的新型冠状病毒肺炎(COVID-19)确诊和疑似病例的数量仍在增加。国内外多个团队对疫情发展进行了模型预测,但结论并不统一。因此,开展本次疫情的预测模型研究、评估COVID-19的基本再生数(basic reproduction number,R₀),对于评估病毒的传播能力以及一系列控制措施的效果具有重要意义。方法 收集从湖北省2020年1月17日到2月8日期间每天报告的确诊病例数等数据,分别采用指数增长方法(exponential growth,EG)、极大似然法(maximum likelihood estimation,ML)、序贯贝叶斯方法(sequential Bayesian method,SB)和时间相关基本再生数(time dependent reproduction numbers,TD)估计R₀值。结果 由观测病例数和4种方法预测的病例数的拟合情况可知,EG方法拟合效果最优。EG方法估计COVID-19湖北省R₀的值为3.49(95%CI:3.42~3.58)。采取封城控制手段期间,EG方法估算R₀值为2.95(95%CI:2.86~3.03)。结论 在传染病流行初期,适合采用EG方法估算R₀。同时需要采取及时有效的控制措施,进一步降低COVID-19的传播速率。     

北京地区2011－2014年致儿童猩红热A组链球菌emm基因型别变化特征分析

目的 了解北京地区致儿童猩红热A组链球菌(GAS)emm基因型别分布,并探讨其型别变化与猩红热病例的关系。方法 收集2011－2014年5－7月北京市36家医院临床诊断为猩红热病例咽拭子GAS分离菌株,采用PCR联合测序方法对分离菌株进行emm分型,选取中国疾病监测信息报告管理系统中北京市猩红热病例报告数据进行分析。结果 共采集咽拭子标本2 161份,分离GAS菌株762株,阳性率为35.3%(762/2 161)。检测到7个emm型别,其中emm12型占69.4%(529/762),emm1型占29.8%(227/762),其他5种emm型别(11、22、75、89、128)占0.8%(6/762)。分析各年份emm型别构成比:2011年emm12型82.2%(295/359),emm1型16.7%(60/359),其他型(11、22、89)1.1%(4/359);2012年emm12型77.3%(123/163),emm1型23.9%(39/163),emm75型0.6%(1/163);2013年emm12型50.7%(38/75),emm1型49.3%(37/75);2014年emm12型44.2%(73/165),emm1型55.2%(91/165),emm128型0.6%(1/165)。不同年份emm型别构成比变化的差异有统计学意义(P<0.001)。2011、2012年emm12为主导菌型,2014年主导型别转换为emm1型。2011－2014年报告猩红热病例分别为6 152、2 908、2 048和3 918例,以2011年报告例数最多,2014年比2013年报告病例数增加91.31%。2011年GAS分离株emm型别存在年龄差异,其中1～5岁组分离的emm12型高于>5岁组(P<0.05)。2011、2013年分离GAS菌株存在地区差异,2011年emm1型分离株为城区高于郊区(P<0.05),2013年emm1型为郊区高于城区(P<0.05)。结论 2011－2014年北京地区GAS菌株优势菌型为emm12和emm1型;不同年份emm12、emm1变换成为主导菌型;emm主导菌型变化与猩红热病例变化趋势有关。     

上海市2014-2021年肠道门诊15岁及以上感染性腹泻病例中致泻性大肠埃希菌流行特征分析

目的 了解上海市肠道门诊≥15岁感染性腹泻病例中致泻性大肠埃希菌（DEC）流行特征,为DEC感染性腹泻防控策略的制定提供科学依据。方法 采用多阶段系统抽样方法,在上海市22家监测点医疗机构的肠道门诊开展腹泻症状监测,收集病例的人口学、临床和流行病学资料,同时采集病例粪便标本,送至医疗机构所在区CDC开展DEC检测及鉴定分型,分析比较2014-2021年不同人群和季节的DEC阳性率。统计学分析采用χ²检验。结果 在15 185例感染性腹泻病例中,DEC的总阳性率为8.05%（1 222/15 185）。其中男性阳性率（8.74%,684/7 824）高于女性（7.31%,538/7 361）,15~29岁组人群阳性率最高（9.14%,335/3 665）,2021年阳性率最高（10.21%,83/813）,以上差异有统计学意义（均P<0.05）。DEC阳性PCR菌型鉴定分离出菌株1 264株中,肠产毒性大肠埃希菌为主（50.24%,635/1 264）,其次是肠黏附性大肠埃希菌（27.93%,353/1 264）和肠致病性大肠埃希菌（21.36%,270/1 264）。DEC存在明显季节性流行特征,夏季阳性率最高（13.92%,774/5 562）（χ²=495.73,P<0.001）。结论DEC是2014-2021年上海市感染性腹泻患者重要病原体之一,引起的感染性腹泻全年均可发生,夏秋季高发,流行型别为肠产毒性大肠埃希菌、肠黏附性大肠埃希菌和肠致病性大肠埃希菌。应针对不同年龄、不同季节和不同型别的DEC感染性腹泻采取特异性的防控措施。     

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.