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BACKGROUND: Precarious employment is a major social determinant of health and health inequalities with effects beyond the health of workers. OBJECTIVE: To investigate the association between precarious employment and sickness absence in 4 Nordic countries, Denmark, Finland, Norway, and Sweden. METHODS: Logistic regression analyses were conducted separately for each country on data from 4186 respondents aged 15-65 years in Denmark, Finland, Norway, and Sweden derived from the 2010 European Working Conditions Survey. Sickness absence was based on self-reports and defined as absence of seven or more day per year. Precarious employment was operationalized as a multidimensional construct of indicators. Analyses were also conducted separately for men and women. RESULTS: The prevalence of sickness absence was lowest in Sweden (18%), and highest in Finland (28%). 3 precarious employment indicators were positively associated with sickness absence; the pattern being largely similar in the total sample. In the sex-disaggregated sample, 5 precarious employment indicators increased the likelihood of sickness absence; the pattern was heterogeneous, with women generally having significantly higher odds of sickness absence than men. "Low household income" and "sickness presenteeism" were strong predictors of sickness absence among both sexes in most of the 4 studied countries. Sickness absence varied between the Nordic countries in the sex-disaggregated analyses. CONCLUSION: Precarious employment indicators predicted sickness absence in the Nordic countries. Findings emphasize the need to prioritize informed and monitored collective bargaining for all workers, increase working time flexibility, and improving work conditions.

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BACKGROUND: Little attention has been given to the relationship between work-life balance and sickness absence. OBJECTIVE: To investigate the association between poor work-life balance and sickness absence in 4 Nordic welfare states. METHODS: Multivariable logistic regression analysis was performed on pooled cross-sectional data of workers aged 15-65 years from Denmark, Finland, Sweden, and Norway (n=4186) obtained from the 2010 European Working Conditions Survey (EWCS). Poor work-life balance was defined based on the fit between working hours and family or social commitments outside work. Self-reported sickness absence was measured as absence for ≥7 days from work for health reasons. RESULTS: Poor work-life balance was associated with elevated odds (OR 1.38, 95% CI 1.06 to 1.80) of self-reported sickness absence and more health problems in the 4 Nordic countries, even after adjusting for several important confounding factors. Work-related characteristics, ie, no determination over schedule (OR 1.26, 95% CI 1.04 to 1.53), and job insecurity (OR 1.56, 95% CI 1.21 to 2.02) increased the likelihood of sickness absence, and household characteristics, ie, cohabitation status (OR 0.75, 95% CI 0.58 to 0.96) reduced this likelihood. The associations were non-significant when performed separately for women and men. CONCLUSION: Sickness absence is predicted by poor work-life balance. Findings suggest the need for implementation of measures that prevent employee difficulties in combining work and family life.

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Necrotizing fasciitis (NF) is a rare and often fatal soft-tissue infection involving the superficial fascial layers of the extremities, abdomen or perineum. Progression to septic shock can occur very rapidly with its associated high morbidity and mortality. NF is usually caused by beta haemolytic streptococci; less often a poly-microbial isolate is the cause. It typically occurs in patients with some degree of immune dysfunction. We present a case of severe pneumococcal necrotizing fasciitis in an obese patient with Type 2 diabetes. There was no history of trauma or evidence of diabetes-related complications. The initial presentation was with features of septic arthritis of the left knee, which subsequently progressed to NF. Differentiation from cellulitis is often difficult in the early stages. Invasive pneumococcal infections are extremely rare, with only a few reported in the literature. Moreover, our case highlights the need to consider other differential diagnoses (and to look out for complications) in patients with diabetes, especially if there is little clinical response to the initial treatment.

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We report a case of splenic flexure volvulus in a patient who had previously been operated upon for a sigmoid volvulus. The clinical features and management of splenic flexure volvulus are discussed.

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The authors describe the design and development of a breath-actuated multidose dry-powder inhaler and summarize the in vitro and in vivo data demonstrating its robustness and performance in the laboratory and during clinical use. Drugs for the treatment of asthma--including budesonide, beclomethasone dipropionate and salbutamol--when formulated with lactose powder as a carrier and dispensed via this device, have exhibited clinical efficacy and safety profiles comparable with standard pressurized metered-dose inhalers and dry-powder formulations.

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The aim of this study was to measure the effects of heparin therapy in patients undergoing vascular surgery, and to monitor the effectiveness of continuous intravenous heparin therapy in ward-based patients. In addition, we compared results from a new portable device with those from the standard laboratory assay. A prospective comparison of the two methods in patients undergoing peripheral vascular surgery, and in ward-based patients who were receiving intravenous heparin infusions was undertaken. Fifty patients who were undergoing vascular surgery and receiving a bolus dose of intravenous heparin, and 22 patients receiving a continuous heparin infusion, were recruited. Blood samples were taken 10 and 40 min following bolus heparin administration or after > 12 h of a continuous heparin infusion. Plasma activated partial thromboplastin times (APTTp) measured by the haematology laboratory were compared with whole blood (APTT(B)) ascertained with the CoaguChek Plus Device (Boehringer Mannheim UK Diagnostics and Biochemicals Limited) at each time point. The results from the two methods were compared using the method of Bland and Altman (Lancet, 1986, 307-310). We found a good level of agreement between the two methods (at induction, mean bias was -0.050, limits of agreement -0.46 - 0.36; heparin infusions, mean bias was -0.283, limits of agreement -1.64 - 1.07). In addition we discovered that many of our patients appeared to be excessively anticoagulated during surgery (10 min following heparin bolus 47/50 patients had an APTT(B) > 150 s, 45/50 had an APTTp > 250 s; at 40 min 45/50 had an APTT(B) > 150 s, 39/50 had an APTTp > 250 s). In conclusion, whole blood APTT measurement allows rapid and accurate assessment of the effects of heparin therapy when compared with laboratory APTT measurement and may prevent both excessive and suboptimal anticoagulation.

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The aim of this double-blind, randomised study was to assess the effects of the addition of 0.5 mg of vecuronium bromide to a standard local anaesthetic mixture used for peribulbar anaesthesia. We studied 60 patients undergoing regional anaesthesia for intra-ocular surgery and were primarily interested in the quality of globe and lid akinesia. All received a mixture of 5 ml 2% lignocaine with 1:200,000 adrenaline, 5 ml 0.75% bupivacaine and 150 IU hyaluronidase with either 0.9% saline 0.25 ml (group A, n = 30) or vecuronium bromide 0.25 ml (0.5 mg) (group B, n = 30). Eye movements assessed at both 5 and 10 min were significantly reduced in the vecuronium group (group B) (p < 0.05). We conclude that the addition of vecuronium at a dose of 0.5 mg to the standard local anaesthetic mixture improves the quality of globe and lid akinesia.

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We have shown previously that a plasma fentanyl concentration of 1.67 ng ml-1 reduced the MAC of isoflurane by 50%. By comparing equal degrees of MAC reduction by sufentanil, we may determine the potency ratio of these opioids. Seventy-six patients were allocated randomly to receive predetermined infusions of sufentanil, and end-tidal concentrations of isoflurane in oxygen. Blood samples were obtained 10 min after the start of the infusion, and just before and after skin incision. Any purposeful movement by the patient was recorded. The MAC reduction of isoflurane produced by sufentanil was obtained using a logistic regression model. A sufentanil plasma concentration of 0.145 ng ml-1 (95% confidence limits 0.04, 0.26 ng ml-1) resulted in a 50% reduction in the MAC of isoflurane. At a plasma concentration greater than 0.5 ng ml-1, sufentanil exhibited a ceiling effect.

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A randomised, double-blind comparison of the efficacy, duration of action and side effects of two analgesic regimens following elective epidural Caesarean section is described. Patients received epidural diamorphine 3 mg or intramuscular morphine 10 mg in the immediate postoperative period. Time to next analgesia was longer after epidural diamorphine (11.0 hours) compared to intramuscular morphine (6.5 hours) (p less than 0.05). In addition, a greater number of patients in the diamorphine group had a pain score less than 2.5 cm at 5 hours (p less than 0.05). However, more patients in the diamorphine group required catheterisation and suffered emetic sequelae, whereas more patients in the morphine group were sedated at 8 hours. Ten patients in each group had continuous pulse oximetry performed overnight after administration of the trial medications. Neither group demonstrated evidence of hypoxia.

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The alveolar form of hydatid disease, caused by the larval stage of the cestode Echinococcus multilocularis, is virtually confined geographically to the northern hemisphere. It produces clinically malignant multivesicular infiltrating lesions most often in the liver, and is quite different from the usual cystic variety caused by E. granulosus. We present a case report of a patient with alveolar hydatid disease, whose treatment with mebendazole was brief due to side effects of alopecia and granulocytopenia; and review the features of this disease which, with increasing international migration, may be encountered more frequently in Australia.

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Five volunteers, whose ages ranged between 37 and 64 years, took part in a crossover study to determine the pharmacokinetics and bioavailability of mebendazole in man following intravenous and oral administration of a tracer dose of [3H]-mebendazole. Following intravenous administration, the average distribution half-life, elimination half-life and rate of clearance were 0.20 h, 1.12 h, and 1.063 min respectively. After oral administration of the solution, the average elimination half-life was 0.93 h, the apparent rate of clearance was 0.846 l/min, the average time to peak plasma concentration was 0.42 h, and the bioavailability of mebendazole was 22%. Comparison of metabolite area under the plasma concentration vs time data from each route of administration indicates that absorption of mebendazole from the gastrointestinal tract at this dose level is almost complete. The low bioavailability observed following oral administration at this dose level is postulated to be due to high first pass elimination. Approximately half of the administered dose of radioactivity following intravenous and oral administration was detected in the urine, and the major unconjugated metabolite of mebendazole was found to be 2-amino-5(6) [alpha-hydroxybenzyl]benzimidazole (IV), not 2-amino-5(6)benzoylbenzimidazole (II), as previously reported.

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Mebendazole levels were assayed by high performance liquid chromatographic assay in plasma, host tissues, and hydatid material taken from four patients who underwent surgery for hydatid disease. The drug was absorbed and had penetrated both into the host and into the parasite material. The levels of the drug in viable hydatid cysts were much lower than those in dead cysts. The possibility of exclusion or detoxification of the drug by viable hydatid cysts is raised.

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Information regarding the epidemiology and pathology of Echinococcus granulosus in Australasia is not well presented in standard surgical textbooks. This review presents the basic science of E. granulosus in Australasia, emphasizing those areas which are not well known, are misunderstood, or are of particular relevance to current surgical practice.

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This paper reports a case of clostridial myonecrosis (gas gangrene) which occurred in a vegetable gardener receiving immunosuppression therapy with prednisolone and azathioprine for renal allograft preservation. The infection developed after the excision of crusted squamous-cell carcinomata from the dorsum of the hand, the circulation of which was compromised by the presence of a radial artery/cephalic vein arteriovenous fistula. Amputation, followed by treatment with hyperbaric oxygen, was successful.

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The plasma concentrations of mebendazole and its metabolites have been monitored in twelve patients after receiving a 10 mg/kg dose for cystic hydatid disease. The mebendazole plasma concentration-time profiles differed considerably between patients; elimination half-lives ranged from 2.8-9.0 h, time to peak plasma concentration after dosing ranged from 1.5-7.25 h and peak plasma concentrations ranged from 17.5 to 500 ng/ml. The mean peak plasma concentration of mebendazole after an initial dose (69.5 ng/ml) was lower than found in patients during chronic therapy (137.4 ng/ml). The plasma AUCTS for the major metabolites of mebendazole (methyl 5-(alpha-hydroxybenzyl)-2-benzimidazole carbamate and 2-amino-5 benzoylbenzimidazole) were about five times the plasma AUCT found for mebendazole in patients on chronic therapy. It is suggested that the slower clearance of these polar metabolites relative to mebendazole results from enterohepatic recycling. Since mebendazole is also highly plasma protein bound, caution should be observed in administering mebendazole to patients with liver disease. Concentrations of mebendazole found in the tissue and cyst material collected from two patients during surgery ranged from 59.5 to 206.6 ng/g wet weight.

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