RESUMO
OBJECTIVE: To identify determinants and outcomes associated with infection in paediatric systemic lupus erythematosus (SLE) patients at admission and during hospitalization in intensive care units (ICUs). PATIENTS AND METHODS: A retrospective cohort study of paediatric SLE patients admitted to two ICUs was conducted. Frequency and risk factors of infection as well as mortality were studied. RESULTS: Seventy-three infection episodes amongst 55 patients were analysed. The median age was 14.4 years (IQR 12.5-16). The median SLEDAI was 16 (IQR 12-20). Twenty-nine episodes were documented at admission; the CRP was higher in these patients (6.58 versus 1.04 mg/dl, p<0.001) than in non-infected patients, even after multivariate adjustment (OR 8.6, 95% CI = 2.1-34.8, p = 0.003). Twenty-five (34.7%) episodes occurred during hospitalization. Lupus activity (OR 1.14, 95% CI = 1.01-1.27, p = 0.029), cyclophosphamide (OR 17.9, 95% CI = 2-156, p = 0.009) and mechanical ventilation (OR 16, 95% CI = 2.1-122, p = 0.008) were associated with infection. Ten episodes (14%) led to death. Admission to the ICU due to infection was strongly associated with mortality (90% versus 31.8%, OR 19.4, 95% CI = 2.3-163, p = 0.006). CONCLUSION: In paediatric lupus patients admitted to the ICU, elevated CRP should alert clinicians to possible infection. During hospitalization, SLE activity and cyclophosphamide were associated with infection. Infection at admission to the ICU was strongly associated with mortality.
Assuntos
Hospitalização/estatística & dados numéricos , Infecções/epidemiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Lúpus Eritematoso Sistêmico/complicações , Adolescente , Estudos de Coortes , Ciclofosfamida/administração & dosagem , Feminino , Humanos , Imunossupressores/administração & dosagem , Infecções/etiologia , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/fisiopatologia , Masculino , Estudos Retrospectivos , Fatores de Risco , Adulto JovemRESUMO
Present working conditions in one of the most active areas of the maquiladora system along the Mexico-U.S. border are reminiscent of nineteenth-century U.S. sweatshops. The organization of production is Tayloristic and authoritarian, with detailed division of labor, repetitive simple tasks, and piecework wages. Modern participative management styles are not apparent in the maquiladora setting. This study consists of two separate but interrelated surveys conducted in 1992, one of community leaders and this one of workers in maquiladora enterprises in the towns of Matamoros and Reynosa, Mexico. The community survey evaluated the economic and psychosocial impact of the maquiladora enterprise and was conducted simultaneously to the workers' survey and in the same Mexican towns where the workers lived and worked. The community leaders acknowledged the employment opportunities that maquiladora factories had brought to the region but believed them to have high environmental and psychosocial costs. For the occupational component, a community-based survey of 267 maquiladora workers was conducted. participants were chosen with more than a year seniority in the industry and living in the two Mexican cities surveyed. They responded to an extensive questionnaire given by trained canvassers. The workers' survey found evidence that maquiladora workers (81% female) report symptoms from musculoskeletal disorders related to working conditions. Acute health effects compatible with chemical exposures were also identified. Prevalence of symptoms was correlated with increasing duration of exposure to ergonomic risk factors and qualitative chemical exposure indexes. Other chronic disease was not apparent. The survey demonstrated inequalities in salary, working hours, and safety training between the two communities. Matamoros workers are substantially better paid and work fewer hours per week than Reynosa workers. Most hazards reported in the worker's survey have been well studied in the general occupational health literature with respect to adverse health effects. Therefore, it is recommended that hazard surveillance studies would be more useful towards the goal of prevention than further etiologic studies. Specific recommendations on policy and remediation interventions are also made.
Assuntos
Doenças Profissionais/epidemiologia , Adulto , Poluentes Ocupacionais do Ar/efeitos adversos , Estudos Transversais , Feminino , Humanos , Indústrias , Masculino , México/epidemiologia , Doenças Profissionais/etiologia , Exposição Ocupacional/efeitos adversos , Serviços de Saúde do Trabalhador , Fatores de Risco , Segurança , Salários e Benefícios , Fatores Socioeconômicos , Inquéritos e Questionários , Estados Unidos , Local de Trabalho/normasRESUMO
Present working conditions in one of the most active areas of the maquiladora system along the Mexico-U.S. border are reminiscent of nineteenth-century U.S. sweatshops. This conclusion was reached after evaluating two separate but interrelated surveys among Mexican nationals living near the Mexico-U.S. border, one of community leaders (Paper I), and one of workers in maquiladora enterprises in the towns of Matamoros and Reynosa, Mexico (Paper II). Paper I evaluates the results of the community leaders' survey. Criteria for selection of the leaders were: level of responsibility in the community; knowledge of the industry in the region, and length of residence in the area (more than 3 years). Representatives from government, maquiladora industry management, labor union leadership, labor union activists, and community improvement activists were interviewed. Structured questionnaires with opportunities for open-ended answers were used by trained Spanish speaking interviewers. The questions covered community demographics, health care structures, governance of the region, knowledge of working conditions, and knowledge of environmental impact on the region and the community. Community leaders were ambivalent on the purported benefits of the development of these types of industries in their communities. A substantial majority (21 of 25) thought that the maquiladoras brought few positive developments, other than creating jobs. Serious concerns about overextending weak social infrastructures and about environmental deterioration were voiced. Immediate (preventive) measures appear necessary to develop community infrastructures and to protect environmental health.