Strategies used by women workers to reconcile family responsibilities with atypical work schedules in the service sector.

OBJECTIVE: Workers' attempts to accommodate family needs may be considered illegitimate in the paid work sphere. Their attempts at work-family balancing (WFB) in that sphere can remain invisible, even when those attempts require considerable energy. Since identification of WFB strategies can potentially lead to suggestions to improve management practices, we report an attempt to find them in the work sphere. PARTICIPANTS: 14 care aides in a Québec residence for seniors and 2~schedule managers were recruited. METHODS: Qualitative ergonomic analysis was employed. 24 hours observation; interviews of nursing and human resources staff; qualitative ergonomic analysis by two researchers; feedback collected from meetings with management and union. Strategies for schedule choice were compared between care aides with heavier vs. lighter family responsibilities. RESULTS: For workers with heavier family responsibilities, choice of work schedules was almost entirely conditioned by family considerations, leaving little leeway to manage workers' own health protection. CONCLUSIONS: Family constraints affected activity at work, and strategies for handling family constraints could potentially be affected by changes in work organization. Managers should encourage full discussion of work-family balancing strategies if they wish to adapt their working conditions to the workers, and ergonomists should include this balancing as a facet of work activity, despite possible negative consequences.

Clinical implications from studies of HLA antigens in idiopathic nephrotic syndrome in children.

HLA class I and II antigen frequencies were determined in two large cohorts of children with idiopathic nephrotic syndrome (NS) from Southwest France (n = 199) and Southwest Germany (n = 152) and compared with unrelated healthy individuals from the same geographical areas. Strength of HLA association was expressed by the relative risk (RR) estimated by Odd's ratio. We examined 105 steroid-resistant and 242 steroid-sensitive NS patients who were subdivided in non-relapsers, infrequent relapsers and frequent relapsers or steroid-dependent patients. In steroid-sensitive patients significant associations were found with HLA-DR7 (RR 5.1 in French, 3.2 in Germans), -DQ2 (RR 4.7/2.3) and with the phenotypic combination HLA-DR3/DR7 (RR 5.6/7.7). Significant negative associations were encountered with HLA-DR2, -DR6 and -DQ1. The associations were stronger in frequent relapsers/steroid-dependent patients than in infrequent relapsers and were not significant in non-relapsers. In steroid-resistant patients the only significant association found was with the combined occurrence of HLA-DR3/DR7. We propose that in childhood NS tissue typing for selected HLA class II antigens is helpful in prediciting the clinical course.

[Prenatal diagnosis of a case of Fryns' syndrome]. / Un cas de diagnostic prénatal du syndrome de Fryns.

Fryns' syndrome was reported for the first time in 1979 in children who died neonatally of prematurity and respiratory distress. This lethal, autosomal recessive syndrome is characterized by a diaphragmatic defect, pulmonary hypoplasia, a "coarse" face and distal limb abnormalities. This report presents a prenatal ultrasonographic diagnosis at 20 weeks' gestation of a case of Fryns' syndrome and defines the frequency of each of its abnormalities from the 38 cases listed in the literature.

[Vesicovaginal fistula. Still a daily reality in Africa. Apropos of 89 cases]. / Les fistules vésico-vaginales. Encore une réalité quotidienne en Afrique. A propos de 89 cas.

Vesico-vaginal fistulae (VVF) are still a daily occurrence in Africa. Obstetrical causes are the most frequent. This severe disability requires that everything be implemented to obtain a leak-free closure of the pathological opening. The authors report their experience with 89 cured cases of VVF. Except for 2 cases cured with an abdominal approach, the Moir technique gave good results in 78 cases, for midline, moderate size, fistulae. In 3 instances, closure of the vagina alone was satisfactory. There were 10 recurrences, cured 9 times at the second operation and once at the third. 3 recurrences came from other institutions and were cured after 4 and 5 successive procedures. In 6 instances, for fistulae close to 5 cm or larger and located in areas difficult to reach, the authors have developed a technique of vaginal closure alone using a turned-over, undetermined vaginal flap creating a leak-free diverticulum. No recurrences have been observed with this technique.

[Benign tumors of the ovary in young girls. Apropos of 3 cases in Africa]. / Les tumeurs bénignes de l'ovaire chez la fillette. A propos de trois cas en Afrique.

From three cases of benign ovarian tumors in young African girls, the authors study the diagnostic means, among which ultrasonography is currently predominant. They finally discuss therapeutic means, with surgery permitting a histological diagnosis. Follicular cysts require a more nuanced approach; because of possible regression, one may consider repeated taps during laparoscopy, as surgery is not indicated just in the case of complications.

[Volvulus of the pelvic colon. Apropos of 59 cases in the western Africa savannah area]. / Les volvulus du côlon pelvien. A propos de 59 cas en zone de savane Africaine de l'ouest.

The authors describe their experience after treatment of 59 cases of volvulus of the pelvic colon. This disorder is frequent in West Africa and affects the protein deficient malnourished population. A definite predominance of volvulus occurred during the dry season between December and April, perhaps related to a diet richer in cellulose or deficient in water. There was a delay in presentation at the Hospital Center; necrosis of the twisted loop, the age of the patient and multiple associated conditions all contributed to the severity of this condition. Treatment had three aims: removal of the obstruction, reestablishment of continuity and avoidance of recurrence. Indications were dictated by the patient's general condition and the vascular status of the loop of bowel. It is reasonable to attempt reduction via intubation if the loop of bowel appears viable. Success enables a colectomy to be performed after a preparation, while failure necessitates surgical correction of ideally colectomy in a one stage procedure. On the other hand, a gangrenous loop necessitates colectomy without untwisting, with closure of the distal end using the Hartmann technique and with reestablishment of continuity 3 weeks later.