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IntroductionBack pain is an abundant problem in normal pregnancy and sick leave for that reason accounts for the majority of all social insurance expenses from work absenteeism during pregnancy in several countries [8,10,22]. The type of disability behind that absenteeism has not been identified, with the diagnosis most often used being "back pain" [22]. Earlier publications have reported that 70% of all pregnant women have some kind of back pain [2,9,11,14,15] and that 20% of all women are on sick leave for that reason for an average of 7 weeks during pregnancy [8,10,13,22].The incidence of women with some kind of residual back pain 6 years post partum was 20% in one study [18], while serious residual pain has been estimated to affect 7% percent of all pregnant women 18 months post partum [13].Back pain in pregnancy is not one single pain type, but should be separated into at least lumbar back pain and posterior pelvic pain, and treated accordingly [1,5,6,7,9,14,15,17]. This would reduce sick leave during pregnancy [10,15], and may even have a long-term effect [18].Abstract This study is a prospective, consecutive, 3-year cohort study of women with back pain in an index pregnancy. The aim was to describe the physical status and disability among women with back pain 3 years after delivery. Pain was identified as lumbar back pain, posterior pelvic pain or combined lumbar as well as posterior pelvic pain. Previous studies have established that all three types of pain can be reduced by structured physiotherapy during pregnancy, and the beneficial effect may last for several years. Though it is known that some women have residual pain for a long time, the relative incidence of the three pain types and their degree of disability associated with each have never been reported. Neither has any study presented findings of a physical examination of women 3 years post partum with a focus on the type of pain. All women who were registered as having experienced back pain during an index pregnancy were interviewed by mail 3 years post partum. Women who had residual back pain filled in an additional questionnaire and were physically examined. Out of 799 pregnant women, 231 had some type of back pain during the index pregnancy, and 41 women had pain 3 years later. Women with combined lumbar and posterior pelvic pain were significantly more disabled (P<0.05) and had significantly lower endurance in the lumbar back and hip abduction muscles (P<0.01). Some 5% of all pregnant women, or 20% of all women with back pain during pregnancy, had pain 3 years later. The key problem may be poor muscle function in the back and pelvis.

No recent systematic review has examined definitions of precarious employment in the literature. This review showed how precarious employment was defined across 63 studies from different continents and research disciplines. Three dimensions of precarious employment emerged: employment insecurity, income inadequacy, and lack of rights and protection.

Objectives To evaluate the long term effects of perioperative blockade on mortality and cardiac morbidity in patients with diabetes undergoing major non-cardiac surgery. Design Randomised placebo controlled and blinded multicentre trial. Analyses were by intention to treat. Setting University anaesthesia and surgical centres and one coordinating centre. Participants 921 patients aged > 39 scheduled for major non-cardiac surgery. Interventions 100 mg metoprolol controlled and extended release or placebo administered from the day before surgery to a maximum of eight perioperative days. Main outcome measures The composite primary outcome measure was time to all cause mortality, acute myocardial infarction, unstable angina, or congestive heart failure. Secondary outcome measures were time to all cause mortality, cardiac mortality, and non-fatal cardiac morbidity. Results Mean duration of intervention was 4.6 days in the metoprolol group and 4.9 days in the placebo group. Metoprolol significantly reduced the mean heart rate by 11% (95% confidence interval 9% to 13%) and mean blood pressure by 3% (1% to 5%). The primary outcome occurred in 99 of 462 patients in the metoprolol group (21%) and 93 of 459 patients in the placebo group (20%) (hazard ratio 1.06, 0.80 to 1.41) during a median follow-up of 18 months (range 6-30). All cause mortality was 16% (74/462) in the metoprolol group and 16% (72/459) in the placebo group (1.03, 0.74 to 1.42). The difference in risk for the proportion of patients with serious adverse events was 2.4% ( − 0.8% to 5.6%). Conclusions Perioperative metoprolol did not significantly affect mortality and cardiac morbidity in these patients with diabetes. Confidence intervals, however, were wide, and the issue needs reassessment. Trial registration Current Controlled Trials ISRCTN58485613.