When is a job not a job?Complementing previous literature on welfare reform and the character of jobs in the lowwage labour market, we illustrate the lack of regularity and security that mark the jobs held by many low-income mothers. To do so, we present a typology of mothers' work patterns and illustrate their experiences through case examples. Our qualitative analysis of longitudinal pathways-to-work in three cities involved an examination of the experiences of 99 diverse, low-income working mothers with a young child. The work patterns that emerged from this analysis include: continuous duration of a single job; multiple job spells; underemployment; and churning in and out of employment. Findings indicate that a complicated 'coming together' of well-paying stable jobs, consistent aid from public systems and stable family networks are necessary for mothers to take even the first steps into stable employment.Para complementar la literature previa sobre reformes de asistencia social y el cara´cter de trabajo en el mercado laboral de sueldo bajo, ilustramos la falta de regularidad y seguridad que tipifican los puestos de trabajo de muchas madres de bajos ingresos. A este fin, presentamos una tipología de pautas laborales para estas madres e ilustramos sus experiencias dando casos de ejemplo. Nuestra ana´lisis cualitativo de caminos al trabajo longitudinales en tres ciudades supuso un examen de las experiencias de 99 diversas madres de bajos ingresos y con un hijo pequeño. Las pautas laborales que salen de este análisis incluyen: duración contínua de un solo trabajo; multiples temporadas de trabajo; subempleo; y giro contínuo de empleo a desempleo. Los resultados indican que es necesaria una reunio´n complicada de pautas de trabajos estables y bien remunerados, ayuda constante de sistemas públicos y redes familiares estables para que las madres puedan tomar hasta los primeros pasos hacia empleo estable.
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We would like to report a patient who, while receiving tetra-cosactide (synthetic ACTH), developed a blood picture consistent with overwhelming infection. However, the clinical presentation was masked. Because of the high incidence of side effects reported with tetracosactide, 1 we recommend that the natural form be used preferentially over the synthetic.A 3-year-old Saudi female was diagnosed as having infantile spasms. She was severely mentally retarded, and computerized tomographic (CT) scan of the brain showed evidence of generalized brain atrophy and a cystic space consistent with porencephaly. Her flexor spasms were not controlled by conventional anticonvulsants and she was admitted for trial therapy with ACTH.A tapering ACTH dosage regimen was planned for the patient, starting at 120IU daily and gradually reducing it to a final daily dose of 20 IU over a period of 20 days. Since natural ACTH was not available, tetracosactide (Organon, synthetic form) was used in equivalent dosages (1 mg = 100 IU ACTH). The patient's white blood count (WBC) and differential were within normal limits.On the seventh day of therapy, after a total dose of 3.5 mg, the child developed a low-grade fever of 38°C and she appeared less active. Clinically, it was difficult to assess a change in her baseline of activity since it was always low. Crepitations were evidenced upon auscultation and chest X-ray. Tetraco-sactide was discontinued. Blood cultures and complete blood count (CBC) were drawn. The WBC was 21,000/mm3, with a differential showing 10% polymorphs, 5% lymphocyes and 63% band forms. The chest X-ray revealed "abnormal hazy shadows, suggestive of an early inflammatory lesion." Intravenous gentamicin and cloxacillin were instituted. The child had no further episodes of fever and blood cultures were reported as negative. After three days of intravenous antibiotics a repeat CBC showed WBC 25,200/mm3, with 71% polymorphs, 22% lymphocytes and 3% band forms. Clinically, she appeared well and more alert.Synthetic ACTH (tetracosactrin) is frequently used instead of the natural form for the treatment of infantile spasms. The literature indicates that it is associated with a much higher incidence of side effects and more fatal outcomes than the natural ACTH, 2,3 the most common complication being infection. A case of marked leukocytosis without evidence of infection after tetracosactrin has been previously reported. The use of tetracosactide for treatment of infantile spasms is not recommended.2 We agree and feel that its use is potentially dangerous because, as demonstrated by our patient, severe infection can be effectively masked while rendering interpretation of monitoring parameters ambiguous. We feel that the natural form of ACTH should be used preferentially, when available.
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