In order to reduce antimicrobial use in pig production, the consequences of insufficient biosecurity and welfare problems need to be known. This study aimed to investigate associations between the number of antimicrobial treatments per fattening pig, and biosecurity, indicators for animal welfare as well as the prevalence of lesions at slaughter. The data used in this study were extracted from the pig health and welfare classification system (Sikava), which gathers data on medicine usage, meat inspection, animal welfare and the condition of farm buildings from over 95% of pig production in Finland. The data were registered during years from 2011 to 2013. Upon antimicrobial prescription, information on the number of fattening pigs treated and the main reason for treatment was recorded. In addition, at least 4 times per year, pig farms registered in Sikava were visited by the farm veterinarian who assessed, among other things, biosecurity and indicators for animal welfare (air quality, condition of facilities, cleanliness, enrichment and stocking density). Finally, data from slaughterhouse inspections were collected (number of carcasses with joint infection, abscesses, lung lesions, pleurisy and liver lesions). For analysis, these datasets were aggregated at the farm level to a quarter of a year. During the studied period, the mean number of antimicrobial treatments per fattening pig per 3 months was equal to 0.09. The main reasons for antimicrobial treatments were musculoskeletal diseases, tail biting and respiratory disorders (42, 33 and 12% of diagnoses, respectively). The meat inspection scoring indicated that as much as 14.7% of all pigs had pleurisy, 5.3% liver lesions and 4.1% abscesses. A standard zero-inflated negative binomial model was used to identify factors associated with the number of antimicrobial treatments per pig. The count of antimicrobial treatments per pig increased with the size of a farm. Regardless of prevalence of lesions, farms with poor drinking equipment, insufficient enrichment and a combination of poor condition of pens and high stocking density were associated with an increased number of antimicrobial treatments for musculoskeletal diseases per pig. Problems with stocking density and enrichment were associated with the number of antimicrobial treatments for tail biting, although these results depended on prevalence of joint infections. Problems with air quality and the combination of poor cleanliness and poor condition of facilities were associated with increased number of antimicrobial treatments due to respiratory diseases. This study suggests that by improving biosecurity and welfare at pig farms, antimicrobial use can be reduced.

Acute compartment syndrome is a limb-threatening condition in which early diagnosis and surgical consultation for fasciotomy are required to preserve functional outcome. The diagnosis is typically considered in patients with traumatic mechanisms of injury such as a direct blow and crush to the compartment, particularly when there is a fracture in the same compartment. We report the case of a patient with acute compartment syndrome of the dorsal forearm that occurred as a result of an atypical noncontact traumatic mechanism. Establishing the diagnosis of compartment syndrome was complicated in this patient, as some of the signs and symptoms of acute compartment syndrome could have been attributed to the presence of a coexisting rupture of the extensor digitorum muscle. This report serves to remind emergency physicians that, although rare, acute compartment syndrome can result from exertional and noncontact traumatic mechanisms.

Objectives:To compare the six-year outcome of a multidisciplinary rehabilitation program with continued care within primary care in terms of health-related quality of life and cost-effectiveness. Furthermore, predictors of total costs to society were examined.

Methods:A prospective, matched, controlled, six-year follow-up was designed. The study included 236 patients (42 men, 194 women) nineteen to sixty-one years of age with prolonged musculoskeletal disorders. The intervention comprised a four-week multidisciplinary rehabilitation and an active one-year follow-up based on a bio-psycho-social approach. The control group received continued care within primary care. The main outcome measures were quality of life measured using the Nottingham Health Profile, motivation identified by an interview and patient-specific total costs to society. Differences in mean costs between groups and cost-effectiveness were evaluated by applying nonparametric bootstrapping techniques.

Results: Total costs per treated patient in the rehabilitation group and the control group were £43,464 (SD=31,093) and £44,123 (SD=33,333), respectively (p=.896). Multidisciplinary rehabilitation improved quality of life somewhat more cost-effectively. Motivation was revealed as a predictor of total costs.

Conclusion: In the long-run, the evaluated multidisciplinary rehabilitation improved the highly motivated patients' quality of life most cost-effectively. The latently motivated patients may require rehabilitation, which is less intensive and with a longer duration, to improve their health in a whole-person perspective. The burden of prolonged musculoskeletal disorders to society was reaffirmed. Motivation could be a predictor of total costs, a factor which has to be taken into account in the examination procedure.

Objectives: To compare the cost-effectiveness of a multidisciplinary rehabilitation program with traditional treatment within primary care in terms of the health-related quality of life (HRQOL) in patients with prolonged musculoskeletal disorders (MSD) on the one hand and the costs to society on the other. Predictors of total costs, such as motivation, socio-economic level, age, pain, and working environment, were investigated.

Methods: A prospective, matched, controlled 2-year follow-up study was designed. The main outcome measures were HRQOL using the Nottingham Health Profile (NHP) and patient-specific total costs due to society. The cost-effectiveness was expressed as a quotient of the total costs to society/NHP global score difference value.

Results: Patients with prolonged MSD generate substantial total costs to society, chiefly in the area of indirect costs. Multidisciplinary rehabilitation improved HRQOL more cost-effectively. Motivation was revealed as a predictor of total costs. The relationship in savings in terms of indirect costs between the highly-motivated and the less-motivated patients was calculated at 4:1.

Conclusions: The large group of patients with prolonged MSD generate substantial total costs, and even small reductions in direct and indirect costs could be of importance to society. The multidisciplinary rehabilitation program applied here was more cost-effective as compared with conventional treatment within primary care when it came to improving the patients' perceived HRQOL. Motivation could be a predictor of total costs, which has to be addressed in the process of identifying the patient as a partner in the rehabilitation process.

Mitochondrial myopathies are rare complex multisystem disorders, which can present several potential anaesthetic problems. A 49-year-old man with mitochondrial myopathy was anaesthetized successfully for cataract extraction using propofol and alfentanil infusions. Vecuronium sensitivity was apparent, with a prolonged duration of action, despite dosage reduction