Azithromycin and cefixime combination versus azithromycin alone for the out-patient treatment of clinically suspected or confirmed uncomplicated typhoid fever in South Asia: a randomised controlled trial protocol.

Background: Typhoid and paratyphoid fever (enteric fever) is a common cause of non-specific febrile infection in adults and children presenting to health care facilities in low resource settings such as the South Asia.  A 7-day course of a single oral antimicrobial such as ciprofloxacin, cefixime or azithromycin is commonly used for its treatment. Increasing antimicrobial resistance threatens the effectiveness of these treatment choices. We hypothesize that combined treatment with azithromycin (active mainly intracellularly) and cefixime (active mainly extracellularly) will be a better option for the treatment of typhoid fever in South Asia. Methods: This is a phase IV, international multi-centre, multi-country, comparative participant-and observer-blind, 1:1 randomised clinical trial. Patients with suspected uncomplicated typhoid fever will be randomised to one of the two interventions: Arm A: azithromycin 20mg/kg/day oral dose once daily (maximum 1gm/day) and cefixime 20mg/kg/day oral dose in two divided doses (maximum 400mg bd) for 7 days, Arm B: azithromycin 20mg/kg/day oral dose once daily (max 1gm/day) for 7 days AND cefixime-matched placebo for 7 days. We will recruit 1500 patients across sites in Bangladesh, India, Nepal and Pakistan. We will assess whether treatment outcomes are better with the combination after one week of treatment and at one- and three-months follow-up. Discussion: Combined treatment may limit the emergence of resistance if one of the components is active against resistant sub-populations not covered by the other antimicrobial's activity. If the combined treatment is better than the single antimicrobial treatment, this will be an important result for patients across South Asia and other typhoid endemic areas. Clinicaltrials.gov registration: NCT04349826 (16/04/2020).

Mental health of a police force: estimating prevalence of work-related depression in Australia without a direct national measure.

The risk of work-related depression in Australia was estimated based on a survey of 631 police officers. Psychological wellbeing and psychological distress items were mapped onto a measure of depression to identify optimal cutoff points. Based on a sample of police officers, Australian workers, in general, are at risk of depression when general psychological wellbeing is considerably compromised. Large-scale estimation of work-related depression in the broader population of employed persons in Australia is reasonable. The relatively high prevalence of depression among police officers emphasizes the need to examine prevalence rates of depression among Australian employees.

Promoting employee wellbeing: the relevance of work characteristics and organizational justice.

Research focusing on the relationship between organizational justice and health suggests that perceptions of fairness can make significant contributions to employee wellbeing. However, studies examining the justice-health relationship are only just emerging and there are several areas where further research is required, in particular, the uniqueness of the contributions made by justice and the extent to which the health effects can be explained by linear, non-linear and/or interaction models. The primary aim of the current study was to determine the main, curvilinear and interaction effects of work characteristics and organizational justice perceptions on employee wellbeing (as measured by psychological health and job satisfaction). Work characteristics were measured using the demand-control-support (DCS) model (Karasek and Theorell, 1990) and Colquitt's (2001) four justice dimensions (distributive, procedural, interpersonal and informational) assessed organizational justice (Colquitt, 2001). Hierarchical regression analyses found that in relation to psychological health, perceptions of justice added little to the explanatory power of the DCS model. In contrast, organizational justice did account for unique variance in job satisfaction, the second measure of employee wellbeing. The results supported linear relationships between the psychosocial working conditions and the outcome measures. A significant two-way interaction effect (control x support at work) was found for the psychological health outcome and the procedural justice by distributive justice interaction was significant for the job satisfaction outcome. Notably, the findings indicate that in addition to traditional job stressors, health promotion strategies should also address organizational justice.