内脂素在妊娠期糖尿病发病中的作用

目的:探讨内脂素与胰岛素抵抗的关系及其在妊娠期糖尿病(GDM)发病中的作用。方法:采用病例对照的研究方法,通过检测40例GDM孕妇和40例正常孕妇的血清内脂素、空腹血糖(FPG)和空腹胰岛素(FINS)水平,计算HO-MA稳态模型胰岛素抵抗指数(IRI),比较两组胰岛素抵抗程度的差异,并进一步分析内脂素与GDM孕妇胰岛素抵抗之间的关系。结果:GDM组的血清内脂素、FPG、FINS和IRI均明显高于对照组(P<0.01)。相关分析表明:GDM孕妇的血清内脂素水平与IRI呈正相关(γ=0.568,P=0.000)。结论:GDM孕妇的血清内脂素水平较正常孕妇明显增高。内脂素水平与胰岛素抵抗呈正相关,提示其与GDM的发生有关。     

妊娠期糖尿病史二胎孕妇血清胰岛素抵抗及血脂水平分析

目的:分析并比较妊娠期糖尿病(GDM)史二胎孕妇胰岛素抵抗、血脂水平。方法:选取2017年2月—2019年2月于本院首次行75 g口服葡萄糖耐量试验(OGTT)的二胎孕妇,其中有GDM病史72例为观察组,无GDM病史75例为对照组。记录年龄、OGTT孕周、孕前及孕后体质指数(BMI)。检测空腹血糖(FPG)及空腹胰岛素(FINS)、服糖后1hPG、2hPG及1hINS、2hINS水平,计算胰岛素抵抗(IR)指数(HOMA-IR),检测胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)水平。Pearson分析观察组血脂水平与其它临床指标相关性,二元logistic回归分析胰岛素抵抗影响因素。结果:两组年龄、性别、孕周、孕前及孕后BMI无差异(P0.05)。与对照组比较,观察组FPG、1hPG、2hPG、FINS、1hINS、2hINS、HOMA-IR、TCH水平均升高,HDL-C水平均降低(均P0.05),1hPG、1hINS、TG、LDL-C水平无差异(P0.05)。Pearson相关性分析显示,TG与FPG、2hPG、FINS、2hINS、HOMA-IR均呈正相关关系(P0.05),HDL-C与FPG、2hPG、FINS、2hINS、HOMA-IR负相关性(P0.05);TG高水平、HDL-C低水平是HOMA-IR危险因素(P0.05)。结论:GDM病史二胎孕妇血脂代谢及IR出现异常情况高于正常妊娠二胎孕妇,且以TG高表达、HDL-C低表达为主,IR与脂代谢紊乱关系密切。     

血清miR-34a、miR-200a水平与妊娠期糖尿病患者胰岛素抵抗关系

目的:探究血清微小RNA-34a(miR-34a)、微小RNA-200a(miR200a)水平与妊娠期糖尿病(GDM)患者胰岛素抵抗(IR)关系。方法:收集2015年4月—2016年12月本院产前检查孕妇临床资料,根据口服葡萄糖耐量实验(OGTT)结果,选择孕周24～32周时发生妊娠期糖尿病患者90例为GDM组,同期糖耐量正常孕妇60例为NGT组,统计入组时年龄、孕周、体质指数(BMI)等。检测两组血清miR-200a、miR-34a水平、OGTT实验各时间点血糖值、空腹血糖(FPG)、空腹胰岛素(FINS)水平并计算胰岛素抵抗指数(HOMA-IR)。结果:两组年龄、孕周、BMI、糖尿病史等比较无差异(P0.05)。GDM组血清miR-200a、miR-34a水平高于NGT组,OGTT实验后1hPG、2hPG、FPG、FINS和胰岛素抵抗指数(HOMA-IR)水平高于NGT组(均P0.05)。多元回归方程结果显示,miR-34a、miR-200a、1hPG、2hPG与GDM患者HOMA-IR相关(P0.05);Pearson相关性分析结果显示,HOMA-IR与miR-34a、miR-200a均呈正相关。logistic回归分析结果显示,miR-34a、miR-200a、HOMA-IR均是GDM发生的影响因素。结论:血清miR-34a、miR-200a在GDM患者中表达上调,与HOMA-IR呈正相关,血清miR-34a、miR-200a、HOMA-IR均是影响GDM发生的危险因素。     

内脂素在胎盘组织中的表达及其与妊娠期糖尿病并发子痫前期的关系

目的:比较正常孕妇、妊娠期糖尿病(GDM)孕妇、GDM并发子痫前期孕妇胎盘组织中内脂素mRNA及蛋白表达的差异。方法:采用RT-PCR法检测正常孕妇(A组)、GDM孕妇(B组)、GDM并发子痫前期孕妇(C组)胎盘组织中内脂素mRNA水平。采用Western Blot法检测3组胎盘组织中内脂素蛋白表达水平。测定并比较3组孕妇的体重指数(BMI)、空腹胰岛素及空腹血糖水平。结果:空腹胰岛素水平及胰岛素抵抗指数(HOMA-IR)从A组至C组递增,3组间两两比较差异均有统计学意义(P<0.05)。B组和C组胎盘组织中内脂素mRNA及蛋白表达水平均高于A组,差异均有统计学意义(P<0.05)。3组胎盘组织中内脂素mRNA及蛋白表达水平与空腹胰岛素、空腹血糖及HOMA-IR均无相关性(P>0.05)。结论:GDM并发子痫前期孕妇胎盘组织中的内脂素mRNA及蛋白表达水平均显著升高。     

妊娠肥胖、妊娠期糖尿病患者血清脂肪因子水平变化及其影响因素研究

目的:探讨妊娠肥胖和妊娠期糖尿病(GDM)患者血清脂肪因子水平变化及其影响因素。方法:选取单纯肥胖孕妇74例、GDM孕妇62例、健康孕妇84例,测定各孕妇空腹血糖(FPG)、血清总胆固醇(TC)、血清空腹胰岛素(FINS)等生化指标以及脂肪因子水平,比较各组孕妇间指标差异。结果:GDM孕妇TG、FPG、FINS、HOMA-IR、TNF-α和VF水平最高,而HDL-C、LDL-C和APN最低;单纯肥胖孕妇TG、LDL-C、FINS和HOMA-IR水平高于健康孕妇,而HDL-C和FPG水平与健康孕妇比较差异无统计学意义(P>0.05);GDM孕妇和单纯肥胖孕妇RBP-4水平均高于健康孕妇(P<0.05)。血清TNF-α水平与孕前BMI、TG、FPG、FINS和HOMA-IR呈正相关,APN水平与FPG、FINS和HOMA-IR呈负相关,RBP-4水平与BMI、FINS和HOMA-IR呈正相关,VF水平与BMI、FPG、FINS和HOMA-IR呈正相关,新生儿出生体重仅与脐血APN呈正相关(P<0.05)。结论:妊娠肥胖和GDM孕妇TNF-α、RBP-4及VF水平上升,而APN水平下降;TNF-α、APN与胰岛素抵抗密切相关,RBP-4与肥胖密切相关,而VF与FINS密切相关。     

妊娠期糖尿病孕妇血清3-羧基-4-甲基-5-丙基-2-呋喃丙酸水平及临床意义

目的探讨妊娠期糖尿病(GDM)孕妇血清中3-羧基-4-甲基-5-丙基-2-呋喃丙酸(CMPF)的水平变化及临床意义。方法选取2016年2月-2017年4月在河北省人民医院产检的62例GDM孕妇为GDM组,另选取同期在该院产检的51例正常孕妇为正常组。比较两组孕妇体质指数(BMI)、空腹血糖(FPG)、空腹胰岛素(FINS)等临床指标的差异,采用酶联免疫法测定CMPF水平,稳态模型计算胰岛素抵抗指数(HOMA-IR)、胰岛素分泌指数(HOMA-β)、胰岛素早相分泌指数、晚相分泌指数。采用多因素Logistic回归分析方法分析GDM的影响因素,Pearson相关性分析CMPF与临床指标的相关性。结果 GDM组ΔBMI、糖化血红蛋白(HbA1c)、FPG、餐后1 h血糖(1hPG)、餐后2 h血糖(2hPG)、FINS、餐后1 h胰岛素(1hINS)、餐后2 h胰岛素(2hINS)、胰岛素抵抗指数(HOMA-IR)、CMPF水平均显著高于正常组,HOMA-β、早相分泌指数、晚相分泌指数显著低于正常组(P<0. 05)。多因素Logistic回归分析结果显示,ΔBMI、HbA1c、FPG、1hPG、2hPG、HOMA-β、HOMA-IR、早相分泌指数、晚相分泌指数、CMPF是GDM发生的危险因素(P <0. 05)。Pearson相关性分析显示,CMPF与FPG、1hPG、2hPG、HbA1c呈显著正相关关系(P<0. 05),与HOMA-β、早相分泌指数、晚相分泌指数呈显著负相关关系(P<0. 05)。血清CMPF与HOMA-IR无关(P> 0. 05)。结论 GDM患者血清中CMPF水平升高,且血糖升高,胰岛β细胞功能受损,可能为GDM发生的危险因素。     

血糖控制满意的妊娠期糖尿病孕妇血清抵抗素与妊娠结局的关系

目的 探讨血糖控制满意的妊娠期糖尿病（GDM）孕妇血清抵抗素水平、胰岛素抵抗与妊娠结局的关系.方法 选取孕24～ 28周GDM孕妇98例,其中血糖控制满意的72例为血糖控制满意组,血糖控制不满意的26例为血糖控制不满意组.选取同期孕24～28周健康孕妇95例为健康对照组.分别于孕24～28周和孕37 ～ 40周测定三组孕妇空腹血清抵抗素、空腹血糖（FPG）和空腹胰岛素（FINS）.计算稳态模型胰岛素抵抗指数（HOMA-IR）.记录并观察三组孕妇的妊娠结局.结果 血糖控制满意组孕妇的早产、妊娠期高血压疾病、羊水过多、巨大儿、新生儿窒息、新生儿低血糖、剖宫产的发生率明显低于血糖控制不满意组,两组比较差异有统计学意义（P＜0.05）;血糖控制满意组孕妇妊娠期高血压疾病、巨大儿的发生率与健康对照组比较差异有统计学意义（P＜0.05）,而早产、羊水过多、新生儿窒息、新生儿低血糖、剖宫产的发生率与健康对照组比较差异无统计学意义（P＞0.05）.孕24 ～ 28周时,血糖控制满意组抵抗素、FINS、FPG、HOMA-IR明显低于血糖控制不满意组,但明显高于健康对照组,组间比较差异均有统计学意义（P＜0.05）.孕37 ～ 40周时,血糖控制满意组FINS、HOMA-IR仍明显低于健康对照组,组间比较差异均有统计学意义（P＜0.05）;但血糖控制满意组抵抗素、FPG与健康对照组差异无统计学意义（P＞0.05）.结论 随着血糖水平控制,GDM患者抵抗素水平下降,但高胰岛素抵抗仍持续存在.血糖控制满意并不能完全改善GDM患者的妊娠结局.     

妊娠期糖尿病患者血清Vaspin、Chemerin及CRP水平表达及临床意义

目的研究妊娠期糖尿病(GDM)患者内脏脂肪组织源性丝氨酸蛋白酶抑制剂(Vaspin)、脂肪因子趋化素(Chemerin)及C反应蛋白(CRP)水平的表达及临床意义,为临床治疗GDM提供指标监测的靶点。方法选择2015年9月-2017年1月在西安医学院第二附属医院就诊的GDM患者92例为研究对象并记为观察组,另选择同期在本院进行产检的健康孕妇90例为对照组,检测并对比两组孕妇血清Vaspin、Chemerin、CRP水平以及血糖、血脂及胰岛素有关指标,分析患者血清Vaspin、Chemerin及CRP水平与血糖、血脂及胰岛素有关指标的相关性。结果观察组孕妇血清Vaspin、Chemerin及CRP水平均明显高于对照组孕妇,差异有统计学意义(P0.05)。观察组孕妇空腹血糖(FPG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)及甘油三酯(TG)水平均明显高于对照组孕妇,差异有统计学意义(P0.05)。根据Spearman相关性分析显示,患者血清Vaspin与FPG、FINS、HOMA-IR及TG均呈正相关,Chemerin与TG及HOMA-IR呈正相关,CRP与FPG呈正相关,差异均有统计学意义(P0.05)。结论 GDM患者血清Vaspin、Chemerin以及CRP水平均升高,且三者与其机体的糖脂代谢及胰岛素抵抗存在明显联系,临床上可通过监测Vaspin、Chemerin以及CRP水平辅助临床诊治工作的进行。     

Chemerin在妊娠期糖尿病孕妇不同孕周中的表达及意义

目的了解妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇在不同孕周血清Chemerin水平的变化及其临床意义。方法采用酶联免疫吸附法测定171例GDM患者(GDM组)及42例糖耐量正常孕妇(对照组)孕中期及孕晚期的血清Chemerin水平,同时测定受试者空腹血糖(FPG)、空腹胰岛素(FINS)、不同孕期的BMI数值等,计算胰岛素抵抗指数(HOMA-IR)。结果 GDM组在孕中期及孕晚期时的空腹胰岛素、HOMA-IR及Chemerin均明显高于对照组(P0.05)。两组孕妇血清Chemerin在孕中期及孕晚期时与空腹胰岛素及HOMA-IR均呈正相关(P0.05),其中GDM组呈高度正相关,对照组呈中度正相关。而两组孕妇血清Chemerin在孕中晚期时与空腹血糖、服糖后1h血糖、服糖后2h血糖、BMI值均低度相关(|r|0.05)、不相关(|r|0.3)或无统计学意义(P0.05)。GDM组孕妇空腹胰岛素在孕中期和孕晚期对比,检验结果无统计学意义(P0.05),而Chemerin在孕晚期时较孕中期数值升高(P0.01),空腹血糖和HOMA-IR在孕晚期时较孕中期数值降低(P0.01)。正常组孕妇四项数值在孕中期和孕晚期对比检验结果均无统计学意义(P0.05)。结论Chemerin与胰岛素抵抗及GDM发病密切相关,且Chemerin数值不受即时血糖高低的干扰,能反映出GDM孕妇的胰岛素敏感状态,可能对GDM孕妇是否将来易患2型糖尿病起预测指标的作用。     

2型糖尿病患者血清内脂素、脂联素和瘦素水平的变化

目的研究2型糖尿病(T2DM)患者血清中内脂素、脂联素和瘦素水平,为阐明T2DM的发病机制提供基础。方法将220例新诊T2DM患者和214例年龄、性别与体重指数(BMI)相匹配的健康对照组,按BMI≥25kg/m2或25kg/m2分为肥胖亚组和非肥胖亚组,采用酶联免疫吸附法(ELISA)和放射免疫法(RIA)检测其血清内脂素、脂联素和瘦素水平,并同时采用生化和化学发光法检测空腹血糖(FPG)、甘油三酯(TG)、胆固醇(Chol)以及空腹胰岛素(FINS)等。结果1.T2DM组血清内脂素、FPG、FINS、胰岛素抵抗指数(HOMA-IR)、TG、Chol水平均高于健康对照组(P0.05～0.001),而脂联素水平低于健康对照组(P0.001),瘦素在两组人群中差异无统计学意义(P0.05);2.无论是T2DM组还是健康对照组中,其肥胖亚组中的内脂素、瘦素、FINS、HOMA-IR、TG、Chol水平均高于非肥胖亚组(P0.05～0.001),而脂联素低于非肥胖亚组(P0.01～0.001);3.消除BMI因素影响的偏相关分析显示,T2DM患者血清内脂素水平仅与FPG、FINS、HOMA-IR呈正相关(r=0.267～0.443,P0.05～0.01),与脂联素呈负相关(r=-0.312,P0.05)。结论内脂素和脂联素参与了肥胖、胰岛素抵抗以及T2DM发生过程,而瘦素可能仅与肥胖状况有关,未能以独立因子作用直接参与T2DM的发生。     

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.