Health and working conditions of pregnant women working inside and outside the home in Mexico City

BACKGROUND: To explore differences related to health and working conditions by comparing socio-demographic parameters, reproductive and prenatal care characteristics and working conditions among pregnant women who are employed outside the home (extra-domestic) while still performing a domestic workload versus those who perform exclusively domestic work in the home (intra-domestic). METHODS: A cross-sectional study was carried out at Family Medicine Unit N 31 of the Mexican Institute of Social Security (IMSS) in Mexico City between April and July 2003. Interviews were conducted with 537 pregnant women engaged in either extra-domestic work plus intra-domestic tasks, or those performing strictly intra-domestic work. Information was obtained regarding their demographic status, prenatal care, reproductive, work characteristics, and health during pregnancy. RESULTS: One hundred ninety-six (36.5%) of the interviewed women had paid jobs outside the home in addition to domestic tasks, while three hundred forty-one (63.5 %) engaged in exclusively intra-domestic occupations. Of the women with paid jobs, 78.6% worked as clerks. Among domestic tasks, we found that the greatest workload was associated with washing of clothes, and our micro-ergonomic analysis revealed that women who worked strictly inside the home had a higher domestic workload versus employed women (69.2 vs. 44.9%). When we analyzed the effect of work on health during pregnancy, we observed that women who worked strictly inside the home were at a higher risk for musculoskeletal and genitourinary symptoms than those employed outside the home. CONCLUSION: These findings suggest that the effect of intra-domestic work should not be ignored when considering women's health during pregnancy, and that greater attention should be paid to women's working conditions during intra and extra-domestic work

Design and rationale of the Post-Intensive Care Syndrome - paediatrics (PICS-p) Longitudinal Cohort Study.

INTRODUCTION: As paediatric intensive care unit (PICU) mortality declines, there is growing recognition of the morbidity experienced by children surviving critical illness and their families. A comprehensive understanding of the adverse physical, cognitive, emotional and social sequelae common to PICU survivors is limited, however, and the trajectory of recovery and risk factors for morbidity remain unknown. METHODS AND ANALYSIS: The Post-Intensive Care Syndrome - paediatrics Longitudinal Cohort Study will evaluate child and family outcomes over 2 years following PICU discharge and identify child and clinical factors associated with impaired outcomes. We will enrol 750 children from 30 US PICUs during their first PICU hospitalisation, including 500 case participants experiencing ≥3 days of intensive care that include critical care therapies (eg, mechanical ventilation, vasoactive infusions) and 250 age-matched, sex-matched and medical complexity-matched control participants experiencing a single night in the PICU with no intensive care therapies. Children, parents and siblings will complete surveys about health-related quality of life, physical function, cognitive status, emotional health and peer and family relationships at multiple time points from baseline recall through 2 years post-PICU discharge. We will compare outcomes and recovery trajectories of case participants to control participants, identify risk factors associated with poor outcomes and determine the emotional and social health consequences of paediatric critical illness on parents and siblings. ETHICS AND DISSEMINATION: This study has received ethical approval from the University of Pennsylvania Institutional Review Board (protocol #843844). Our overall objective is to characterise the ongoing impact of paediatric critical illness to guide development of interventions that optimise outcomes among children surviving critical illness and their families. Findings will be presented at key disciplinary meetings and in peer-reviewed publications at fixed data points. Published manuscripts will be added to our public study website to ensure findings are available to families, clinicians and researchers. TRIALS REGISTRATION NUMBER: NCT04967365

Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2)

OBJECTIVES: We sought to update our 2015 work in the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) guidelines for the diagnosis and management of pediatric acute respiratory distress syndrome (PARDS), considering new evidence and topic areas that were not previously addressed. DESIGN: International consensus conference series involving 52 multidisciplinary international content experts in PARDS and four methodology experts from 15 countries, using consensus conference methodology, and implementation science. SETTING: Not applicable. PATIENTS: Patients with or at risk for PARDS. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Eleven subgroups conducted systematic or scoping reviews addressing 11 topic areas: 1) definition, incidence, and epidemiology; 2) pathobiology, severity, and risk stratification; 3) ventilatory support; 4) pulmonary-specific ancillary treatment; 5) nonpulmonary treatment; 6) monitoring; 7) noninvasive respiratory support; 8) extracorporeal support; 9) morbidity and long-term outcomes; 10) clinical informatics and data science; and 11) resource-limited settings. The search included MEDLINE, EMBASE, and CINAHL Complete (EBSCOhost) and was updated in March 2022. Grading of Recommendations, Assessment, Development, and Evaluation methodology was used to summarize evidence and develop the recommendations, which were discussed and voted on by all PALICC-2 experts. There were 146 recommendations and statements, including: 34 recommendations for clinical practice; 112 consensus-based statements with 18 on PARDS definition, 55 on good practice, seven on policy, and 32 on research. All recommendations and statements had agreement greater than 80%. CONCLUSIONS: PALICC-2 recommendations and consensus-based statements should facilitate the implementation and adherence to the best clinical practice in patients with PARDS. These results will also inform the development of future programs of research that are crucially needed to provide stronger evidence to guide the pediatric critical care teams managing these patients.</p

Advancing Research on Racial–Ethnic Health Disparities: Improving Measurement Equivalence in Studies with Diverse Samples

To conduct meaningful, epidemiologic research on racial–ethnic health disparities, racial–ethnic samples must be rendered equivalent on other social status and contextual variables via statistical controls of those extraneous factors. The racial–ethnic groups must also be equally familiar with and have similar responses to the methods and measures used to collect health data, must have equal opportunity to participate in the research, and must be equally representative of their respective populations. In the absence of such measurement equivalence, studies of racial–ethnic health disparities are confounded by a plethora of unmeasured, uncontrolled correlates of race–ethnicity. Those correlates render the samples, methods, and measures incomparable across racial–ethnic groups, and diminish the ability to attribute health differences discovered to race–ethnicity vs. to its correlates. This paper reviews the non-equivalent yet normative samples, methodologies and measures used in epidemiologic studies of racial–ethnic health disparities, and provides concrete suggestions for improving sample, method, and scalar measurement equivalence

Risk Factors for Health-related Quality of Life Deterioration Following Pediatric Critical Illness

Thesis (Master's)--University of Washington, 2019Background: Many children experience declines in health-related quality of life (HRQL) after critical illness, but it is unknown what components of HRQL are most affected. We aimed to evaluate risk factors for deterioration between baseline and post-discharge HRQL status in the individual components of common HRQL measures among pediatric survivors of critical illness. Methods: We conducted a retrospective cohort study of children ≤18 years admitted to the Seattle Children’s Hospital pediatric and cardiac intensive care units from 12/2011-02/2017 on whom pre-admission baseline, admission, and post-discharge follow-up (median 42.0 days) PedsQL or FS II-R HRQL assessments had been obtained. We determined associations between patient and illness characteristics with failure to recover within 4.5 points of baseline HRQL at follow-up (the minimum clinically significant difference between two scores) using multivariable generalized linear Poisson regression. We determined the individual score components of the PedsQL Infant Scales (age <2), PedsQL Generic Core Scales (age 2-18), and FS II-R (for children with severe developmental or functional disabilities) with the highest prevalence of decline from baseline to follow-up, and assessed factors associated with decline for each question. Results: Failure to recover within 4.5 points of baseline HRQL status occurred in 24.7% of 736 study patients. Factors independently associated with failure to recover were older age (adjusted RR 1.02/year, 95% CI 1.00-1.05), primary admission diagnosis of an oncologic condition (aRR 1.89 relative to respiratory, 95% CI 1.07-3.34) or orthopedic surgery (aRR 1.68, 95% CI 1.04-2.70), and longer duration from discharge to follow-up HRQL assessment (aRR 0.91/week, 95% CI 0.86-0.95). Individual score components most affected for the PedsQL Infant Scales were primarily emotional (crying/fussing, difficulty sleeping, difficulty self-soothing, feeling tired, and feeling afraid). Children 2-18 years assessed with the PedsQL Generic Core Scales most commonly experienced declines in physical functioning (participating in active play/exercise, hurting, lifting something heavy, being unable to do things other children their age can do) and feeling angry. Children for whom the FS II-R was completed most commonly experienced declines in both emotional and physical domains (reacting by crying, not sleeping through the night, irritability, poor energy, and acting moody). Patient demographic characteristics, underlying medical complexity, primary admission diagnosis, and severity of illness were commonly associated with declines in individual score components. Conclusions: One-quarter of children surviving critical care experienced a clinically significant deterioration in HRQL when assessed a median of six weeks post-discharge, and the individual components of HRQL that were most affected varied by patient age and diagnosis. Potential targets for intervention to improve HRQL outcomes for critically ill children include minimizing deconditioning, improving sleep quality, addressing fear, and adequately managing pain