Heat illness in the services.

In spite of considerable progress in prevention, heat illness remains a significant occupational risk in the Services. A retrospective analysis of cases reported through the Defence Analytical Services Agency for the years 1981-91 shows higher numbers in the second part of this period, though this may be due to reporting differences. Overall, there was an average of 135 servicemen and women admitted to hospital each year for heat-related conditions though only 15.5 of them required sick leave for more than a week. Annual incidence was higher in the Army (73 per 100,000) than in the RN (14) and the RAF (5). Tri-service incidence was 42 per 100,000 for males and 11 for females. There were 11 deaths, all in the Army, but only 5 servicemen were discharged because of heat illness. Although the largest number of cases was reported from Great Britain, the incidence of cases in troops in Hong Kong and Cyprus was greater. In all locations, cases occurred in the coldest part of the year, but were commoner in the warmer months. Heat exhaustion (73.6%) seems more frequent than heat stroke (13%), but there are problems with definition and reporting. Current preventive measures are outlined and suggestions are made for more accurate monitoring of heat illness in the future. In the light of recent literature, recommendations are made for the grading and management of servicemen following heat illness.

Heat-exercise hyperpyrexia.

A fatal case of "heat stroke" occurring on exercise in temperate conditions is described. Possible mechanisms for increased susceptibility are discussed and attention is drawn to a possible overlap with the malignant hyperpyrexia (MH) syndrome. The second day of strenuous exercise may be a time of special risk. More frequent consideration of dantrolene treatment in heat injury is suggested and the term "heat-exercise hyperpyrexia" is proposed to replace "heat stroke" and "exertional hyperpyrexia".

Asthma in the army: a retrospective study and review of the natural history of asthma and its implications for recruitment.

In an attempt to define the problem of asthma in the British Army and to relate it to recruiting policy, records were obtained for all discharges from the Army and all admissions to hospital for 48 hours or more with a principle diagnosis of asthma over four years. There were approximately 50 medical discharges from asthma per year, representing about 1 in 3400 of the held strength of the Army and 6.3% of the discharges from all medical causes. The average number of non-effective days before discharge was about 20 and those discharged were generally young (57% aged 20 years or less), of short service (47% less than 2 years service) and of low rank (86% privates, apprentices or juniors). Three hundred and fifty two individuals were admitted to hospital on 415 occasions in 4 years, of whom 82 were eventually discharged from the service for medical reasons. Average non-effective days for this group was 11. There was only one death. Of 108 discharged soldiers who were eventually shown to have a history of asthma in childhood (HAC), this was identified at recruit examination in only 43%. Before enlistment, only 20% were referred for consultant opinion and only 6% had exercise testing. 28% were probably current asthmatics on entry. From available records, age of remission of childhood asthma was most commonly 10-14 years (64%). Relapse was commonest at age 17-21 years (76%) with 25% of relapses occurring at 18 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Primary health care in hospitals

Patan Hospital in Patan, Nepal provides a large volume of primary health care activities within its walls as well as supporting such work outside