What is the impact of job precariousness on depression? Risk assessment and attributable fraction in Spain

OBJECTIVES

The prevalence of depression related to precarious employment (PE) has become a significant public health concern, given the declining trend of the standard employment relationship. Research has focused on the mental health detrimental effects of employment conditions, whereas there is scarce evidence concerning the burden of depression that could be prevented by targeting precariousness. This paper estimates the impact of PE on the risk of depression and the attributable fraction within the active and working salaried population in Spain.

STUDY DESIGN

Observational cross-sectional on data drawn from the Spanish portion of European Health Survey 2020.

METHODS

After applying selection criteria and descriptives, binary logistic regression models stratified by sex are used to examine the associations between a 9-categories combination of employment precariousness and occupational social class, and depressive symptoms.

RESULTS

There is a higher risk of depression among individuals in PE and among those who are unemployed, with a notable gradient based on occupational social class for women. Adjusting by sex, age and foreign-born origin, we estimate that approximately 15.0% (95% confidence interval [CI]: 1.0%-26.2%) of depression cases among the working population and 33.3% (95% CI: 23.2%-43.2) among the active population can be attributed to PE.

CONCLUSIONS

These findings highlight the public health impact of PE on mental health, provide evidence to estimate the economic burden linked to employment-related mental health, and underscore the need for policy changes and interventions at the level of labour markets and workplaces to mitigate the detrimental effects of PE.

What should we know about precarious employment and health in 2025? Framing the agenda for the next decade of research

The generalization of flexible labour markets, the declining influence of unions and the degradation of social protection has led to the emergence of new forms of employment at the expense of the Standard Employment Relationship, as well as a considerable amount of research across social and scientific disciplines. Years ago we suggested the urgent need to disentangle the consequences of new types of employment for the health and well-being of workers, contending that the study of precarious employment and health is in its infancy. Today, research challenges include clearer, more precise definitions of the original concepts, a more detailed understanding of the pathways and mechanisms through which precarious employment harms worker health, stronger information systems for monitoring the problem and a complex systems approach to employment conditions and health research. All of these must be guided by the theoretical and policy debates linking precarious employment and health, and be geared towards developing better tools for the design, implementation and evaluation of policies intended to minimize precariousness in the labour market and its effects on public health and health inequalities. Our aim in this paper is to outline an agenda for the next decade of research on precarious employment and health, establishing a compelling programme that expands our understanding of complex causes and links.

A qualitative study about immigrant workers' perceptions of their working conditions in Spain

BACKGROUND

Spain has recently become an inward migration country. Little is known about the occupational health of immigrant workers. This study aimed to explore the perceptions that immigrant workers in Spain had of their working conditions.

METHODS

Qualitative, exploratory, descriptive study. Criterion sampling. Data collected between September 2006 and May 2007 through semi-structured focus groups and individual interviews, with a topic guide. One hundred and fifty-eight immigrant workers (90 men/68 women) from Colombia (n = 21), Morocco (n = 39), sub-Saharan Africa (n = 29), Romania (n = 44) and Ecuador (n = 25), who were authorised (documented) or unauthorised (undocumented) residents in five medium to large cities in Spain.

RESULTS

Participants described poor working conditions, low pay and health hazards. Perception of hazards appeared to be related to gender and job sector. Informants were highly segregated into jobs by sex, however, so this issue will need further exploration. Undocumented workers described poorer conditions than documented workers, which they attributed to their documentation status. Documented participants also felt vulnerable because of their immigrant status. Informants believed that deficient language skills, non-transferability of their education and training and, most of all, their immigrant status and economic need left them with little choice but to work under poor conditions.

CONCLUSIONS

The occupational health needs of immigrant workers must be addressed at the job level, while improving the enforcement of existing health and safety regulations. The roles that documentation status and economic need played in these informants' work experiences should be considered and how these may influence health outcomes.

Area deprivation and mortality in the provincial capital cities of Andalusia and Catalonia (Spain)

OBJECTIVE

To study the linkage between material deprivation and mortality from all causes, for men and women separately, in the capital cities of the provinces in Andalusia and Catalonia (Spain).

METHODS

A small-area ecological study was devised using the census section as the unit for analysis. 188,983 Deaths occurring in the capital cities of the Andalusian provinces and 109,478 deaths recorded in the Catalan capital cities were examined. Principal components factorial analysis was used to devise a material deprivation index comprising the percentage of manual labourers, unemployment and illiteracy. A hierarchical Bayesian model was used to study the relationship between mortality and area deprivation.

MAIN RESULTS

In most cities, results show an increased male mortality risk in the most deprived areas in relation to the least depressed. In Andalusia, the relative risks between the highest and lowest deprivation decile ranged from 1.24 (Malaga) to 1.40 (Granada), with 95% credibility intervals showing a significant excess risk. In Catalonia, relative risks ranged between 1.08 (Girona) and 1.50 (Tarragona). No evidence was found for an excess of female mortality in most deprived areas in either of the autonomous communities.

CONCLUSIONS

Within cities, gender-related differences were revealed when deprivation was correlated geographically with mortality rates. These differences were found from an ecological perspective. Further research is needed in order to validate these results from an individual approach. The idea to be analysed is to identify those factors that explain these differences at an individual level.

Trends in socioeconomic mortality inequalities in a southern European urban setting at the turn of the 21st century

OBJECTIVE

To analyse trends in mortality inequalities by educational level for main causes of death among men and women in Barcelona, Spain, at the turn of the 21st century (1992-2003).

METHODS

The population of reference was all Barcelona residents older than 19 years. All deaths between 1992-2003 were included. Educational level was obtained through record linkage between the mortality register and the municipal census of Barcelona city. Variables studied were age, sex, educational level, period of death (four periods of 3 years) and cause of death. Age-standardised mortality rates for each educational level, sex and period were calculated. Poisson regression models were fitted to obtain relative index of inequality (RII) for educational level, adjusted for age for the time-periods.

RESULTS

RII for all causes of death was constant (around 1.5), but rate differences were higher in 1995-7 (715.6 per 100,000 in men and 352.8 in women) than in other periods and tended to decrease in men over the periods. Analysis of inequality trends by specific causes of death shows a stable trend for the majority of causes, with higher mortality among those with less education for all causes of death except lung cancer and breast cancer among women having RII below 1.

CONCLUSIONS

Relative inequalities in total mortality by sex in Barcelona did not change during the 12 years studied, whereas absolute inequalities tended to decrease in men. Our study fills an important gap in southern Europe and Spanish literature on trends during this period.

Applying an Equity Lens to Tobacco-Control Policies and Their Uptake in Six Western-European Countries

We identified policies that may be effective in reducing smoking among socioeconomically disadvantaged groups, and examined trends in their level of application between 1985 and 2000 in six western-European countries (Sweden, Finland, the United Kingdom, the Netherlands, Germany, and Spain). We located studies from literature searches in major databases, and acquired policy data from international data banks and questionnaires distributed to tobacco policy organisations/researchers. Advertising bans, smoking bans in workplaces, removing barriers to smoking cessation therapies, and increasing the cost of cigarettes have the potential to reduce socioeconomic inequalities in smoking. Between 1985 and 2000, tobacco control policies in most countries have become more targeted to decrease the smoking behaviour of low-socioeconomic groups. Despite this, many national tobacco-control strategies in western-European countries still fall short of a comprehensive policy approach to addressing smoking inequalities.

Associations between temporary employment and occupational injury: what are the mechanisms?

OBJECTIVE

To determine whether observed higher risks of occupational injury among temporary workers are due to exposure to hazardous working conditions and/or to lack of job experience level.

METHODS

Data systematically recorded for 2000 and 2001 by the Spanish Ministry of Labour and Social Affairs on fatal and non-fatal traumatic occupational injuries were examined by type of employment and type of accident, while adjusting for gender, age, occupation, and length of employment in the company. In the study period there were 1500 fatal and 1 806 532 non-fatal traumatic occupational injuries that occurred at the workplace. Incidence rates and rate ratios (RR) were estimated using Poisson regression models.

RESULTS

Temporary workers showed a rate ratio of 2.94 for non-fatal occupational injuries (95% CI 2.40 to 3.61) and 2.54 for fatal occupational injuries (95% CI 1.88 to 3.42). When these associations were adjusted by gender, age, occupation, and especially length of employment, they loose statistic significance: 1.05 (95% CI 0.97 to 1.12) for non-fatal and 1.07 (95% CI 0.91 to 1.26) for fatal.

CONCLUSIONS

Lower job experience and knowledge of workplace hazards, measured by length of employment, is a possible mechanism to explain the consistent association between temporary workers and occupational injury. The role of working conditions associated with temporary jobs should be assessed more specifically.

Trends in smoking behaviour between 1985 and 2000 in nine European countries by education

OBJECTIVE

To examine whether trends in smoking behaviour in Western Europe between 1985 and 2000 differed by education group.

DESIGN

Data of smoking behaviour and education level were obtained from national cross sectional surveys conducted between 1985 and 2000 (a period characterised by intense tobacco control policies) and analysed for countries combined and each country separately. Annual trends in smoking prevalence and the quantity of cigarettes consumed by smokers were summarised for each education level. Education inequalities in smoking were examined at four time points.

SETTING

Data were obtained from nine European countries: Norway, Sweden, Denmark, Finland, the United Kingdom, the Netherlands, Germany, Italy, and Spain.

PARTICIPANTS

451 386 non-institutionalised men and women 25-79 years old.

MAIN OUTCOME MEASURES

Smoking status, daily quantity of cigarettes consumed by smokers.

RESULTS

Combined country analyses showed greater declines in smoking and tobacco consumption among tertiary educated men and women compared with their less educated counterparts. In country specific analyses, elementary educated British men and women, and elementary educated Italian men showed greater declines in smoking than their more educated counterparts. Among Swedish, Finnish, Danish, German, Italian, and Spanish women, greater declines were seen among more educated groups.

CONCLUSIONS

Widening education inequalities in smoking related diseases may be seen in several European countries in the future. More insight into effective strategies specifically targeting the smoking behaviour of low educated groups may be gained from examining the tobacco control policies of the UK and Italy over this period.

Distribution of sickness absence in the European Union countries

AIMS

To determine the sickness absence frequency in European Union (EU) countries.

METHODS

Sickness absence was measured by questionnaire using the Third European Survey on Working Conditions. Employees were considered to have sickness absence if they reported to be absent at least one day in the past 12 months because of an accident at work, work related problems, or by other health problems.

RESULTS

Sickness absence percentages were lower in Southern European countries compared with Central and Northern European countries, and, in general, slightly higher in men than in women.

CONCLUSION

This is the first description of sickness absence in each of the 15 EU countries. Examination of the sickness absence patterning between EU countries could indicate countries where important lessons to reduce sickness absence are to be learned and diffused across the EU.

The geography of the highest mortality areas in Spain: a striking cluster in the southwestern region of the country

AIMS

To determine the areas of Spain with the most increased mortality risk.

METHODS

Age adjusted relative risk of death by gender was estimated in each of 2218 small areas of the country using a non-parametric empirical Bayes method. To determine areas with "significantly increased risk" a Poisson based score test was used.

RESULTS

Mapping of the highest risk areas showed a striking geographical clustering in the southwestern region of the country. This region, comprising 8% of the Spanish population, accounts for about one third (2884 deaths) of the total excess mortality.

Análisis de los mecanismos de producción de las lesiones leves por accidentes de trabajo en la construcción en España

OBJECTIVES

The construction industry produces the highest number of occupational injuries in Spain (25.6%). Of these, 98.5% were minor injuries with 5 million workdays lost in 2000. This occurred even after the recent introduction of numerous health and occupational safety regulations. The objective of the present study was to identify the specific mechanisms of minor occupational injuries in the construction sector.

METHODS

In 2000, there were 235,853 minor occupational injuries in the construction industry. From these, injuries in general construction and civil engineering were selected (n = 155,044). These injuries affected both the total number of workers in the sector as well as bricklayers and unskilled construction workers. Insurance and financial activities (n = 2,019) were selected as a reference economic sector. Minor occupational injuries due to nontraumatic processes (heart attack, etc.) were taken as a control group (n = 167), assuming that the risk of nontraumatic processes was independent of economic activities. Odds ratios (OR) were adjusted by age, sex, years of work experience, type of employment and company size through nonconditional logistic regression models.

RESULTS

The mechanisms with the highest risk of minor occupational lesions in construction workers as a group compared with employees in the financial sector were projection of fragments (OR = 33.0; 95% CI, 15.3-70.8) and being struck by objects (OR = 18.2; CI 95%, 9.7-34.1). These were also the most specific mechanisms of injury in the subgroup of bricklayers and unskilled construction workers.

CONCLUSIONS

Activities aimed at preventing minor occupational injuries in the construction sector should be orientated towards these mechanisms, especially projection of fragments despite the low frequency of this mechanism compared with that of other mechanisms. Case-control design is a useful alternative approach for research into occupational injuries.

[Description of psychosocial risk factors in four companies]

OBJECTIVE

To describe the distribution of work-related psychosocial risk factor scores in four companies according to the personal and occupational characteristics of the workers.

METHODS

Cross-sectional study of a sample of 890 workers in four companies who participated in this study voluntarily. The overall response rate was 34.5%. A self-administrated questionnaire was used to measure the presence of demand, control and social support according to the workers' perceptions. Statistical analyses were performed using median and dispersion measures of psychosocial risk factors for each company separately, as well as description of their distribution according to personal and occupational variables.

RESULTS

The median score for social support was almost always equal to 5 for all four companies. However, there was greater variability in psychological demand (between 13 and 16), and for control (between 20 and 26). Comparison of the scores for social and occupational variables revealed similar values for social support but not for control and demand, which showed greater variation according to sex (men), age group (less than 40 years) and occupation (clerks).

CONCLUSIONS

Although the low response rate could limit the validity of our results, this is the first study to value the distribution of work-related psychosocial risk factor scores in four companies in Spain. Variability among companies for different groups of workers was found. This study could be useful for future studies exploring the feasibility of defining reference values for use in preventive measures.

Structural role of conserved Asn179 in the short-chain dehydrogenase/reductase scaffold

Short-chain dehydrogenases/reductases (SDR) constitute a large family of enzymes found in all forms of life. Despite a low level of sequence identity, the three-dimensional structures determined display a nearly superimposable alpha/beta folding pattern. We identified a conserved asparagine residue located within strand betaF and analyzed its role in the short-chain dehydrogenase/reductase architecture. Mutagenetic replacement of Asn179 by Ala in bacterial 3beta/17beta-hydroxysteroid dehydrogenase yields a folded, but enzymatically inactive enzyme, which is significantly more resistant to denaturation by guanidinium hydrochloride. Crystallographic analysis of the wild-type enzyme at 1.2-A resolution reveals a hydrogen bonding network, including a buried and well-ordered water molecule connecting strands betaE to betaF, a common feature found in 16 of 21 known three-dimensional structures of the family. Based on these results, we hypothesize that in mammalian 11beta-hydroxysteroid dehydrogenase the essential Asn-linked glycosylation site, which corresponds to the conserved segment, displays similar structural features and has a central role to maintain the SDR scaffold.

Gender inequalities in health among workers: the relation with family demands

OBJECTIVES

To analyse whether there are gender inequalities in health among male and female workers who are married or cohabiting and to assess whether there are gender differences in the relation between family demands and health. Additionally, for both objectives it will be examined whether these gender patterns are similar for manual and non-manual workers.

DESIGN AND SETTING

The data have been taken from the 1994 Catalonian Health Survey (CHS), a cross sectional survey based on a representative sample of the non-institutionalised population of Catalonia, a region in the north east of Spain that has about 6 million inhabitants. The dependent variables were four ill health indicators (self perceived health status, limiting longstanding illness, having at least one chronic condition and mental health) and two health related behaviours closely related to having time for oneself (no leisure time physical activity and sleeping six hours or less a day). Family demands were measured with three variables: household size, living with children under 15 years and living with adults older than 65 years. The analysis was separated for gender and social class (manual and non-manual workers) and additionally adjusted for age. Gender differences for all dependent and independent variables were first tested at the bivariate level using the chi(2) test for categorical variables and the t test for age. Secondly, multivariate logistic regression models were fitted.

PARTICIPANTS

Persons who were employed, married or cohabiting, aged 25 to 64 years (2148 men and 1185 women).

RESULTS

A female excess for all the ill health indicators was found, while there were no gender differences in the health related behaviours analysed. Family demands had a greater impact on health and health related behaviours of female manual workers. In this group household size was positively related to four dependent variables. The adjusted odds ratios (ORs) to living in family units of more than four persons versus living only with the spouse were 2.74 (95%CI=1.22, 6.17) for poor self perceived health status, 3.16 (95%CI=0.98, 10.15) for limiting long standing illness, 3.28 (95%CI=1.45, 7.44) for having at least one chronic condition, and 2.60 (95%CI=1.12, 6.00) for sleeping six hours or less a day. Among female manual workers living with children under 15 years was positively associated with no leisure time physical activity (adjusted OR=2.37; 95% CI=1.43, 3.92) and with sleeping six hours or less a day (adjusted OR=1.91; 95% CI=1.13, 3.32). Living with adults older than 65 years had an unexpected negative relation with poor self perceived health status (adjusted OR=0.33; 95%CI=0.16, 0.66), and with chronic conditions (adjusted OR=0.45; 95%CI=0.24, 0.87) in female manual workers. Among male manual workers living with children under 15 years was positively associated with longstanding limiting illness (adjusted OR=2.44; 95%CI=1.36, 4.38).

CONCLUSION

When gender differences in health are analysed, both the paid and the non-paid work should be considered as well as the interaction between these two dimensions, gender and social class. In Catalonia, as probably in Spain and in other countries, private changes such as sharing domestic responsibilities, as well as active public policies for facilitating family care are needed in order to reduce gender health inequalities attributable to the unequal distribution of family demands.

[Emotional disorders in the working population: an emerging problem in occupational health?]

BACKGROUND

To know the prevalence of emotional disorders in a working population.

SUBJECTS AND METHOD

Workers in four companies: construction (A), automobile components (B), electrical and electronic systems (C) and management services (D). The design of the study was cross-sectional with the GHQ-28 questionnaire.

RESULTS

The prevalence fluctuated between 8,4% (A) and 24,0% (D). Sex, age, educational level and occupation showed significance differences in some companies.

CONCLUSIONS

The results suggest an important prevalence of emotional disorders that likely increase as there will be more firms of services.

Material deprivation and leading causes of death by gender: evidence from a nationwide small area study

STUDY OBJECTIVE

To investigate the association between material deprivation and 10 leading causes of death by gender.

DESIGN

Small area cross sectional ecological study using two dimensions of material deprivation (Index 1 and Index 2) drawn from 1991 census and cause specific mortality data aggregated for 1987-1995.

SETTING

2218 small areas in Spain.

MAIN RESULTS

Strong detrimental associations of two deprivation indices were found with top six leading causes of death for men and top seven leading causes of death for women, except breast cancer. For men, the highest percentages of excess mortality (between 40% and 60%) were found for smoking and alcohol related causes of death such as lung cancer, chronic obstructive pulmonary diseases, and cirrhosis while for women the highest percentages of excess mortality (between 40% and 60%) were found for diet related causes such as diabetes and ischaemic heart disease.

CONCLUSIONS

Health inequality is a widespread phenomenon in the majority of the top leading causes of deaths of the nation. Increasing levels of deprivation indices are associated with mortality risk differently by both cause and gender. Results suggest that deprivation effects mainly captured by Index 2 may manifest largely as unfavourable health behaviours leading to gender specific sets of causes of deaths. Findings of this study are consistent with the idea that material deprivation determines health inequality through both an increase of general susceptibility to ill health, leading to excess mortality in a wide range of causes, and a set of specific factors, resulting in an increased risk of death from a specific set of causes in each gender.

Social class inequalities in the use of and access to health services in Catalonia, Spain: what is the influence of supplemental private health insurance?

OBJECTIVE

To analyse social class inequalities in the access to and utilization of health services in Catalonia (Spain), and the influence of having private health insurance supplementing the National Health System (NHS) coverage.

DESIGN

1994 Catalan Health Interview Survey, a cross-sectional survey conducted in 1994.

SETTING

Catalonia (Spain).

STUDY PARTICIPANTS

The participants were a representative sample of people aged over 14 years from the non-institutionalized population of Catalonia (n = 12,245).

MAIN OUTCOME MEASURES

Health services utilization, perceived health, having only NHS or NHS plus a private health insurance, and social class.

RESULTS

Although one-quarter of the population of Catalonia had a supplemental private health insurance, percentages were very different according to social class, ranging from almost 50% for classes I and II to 16% for classes IV and V in both sexes. No inequalities by social class were observed for the utilization of non-preventive health care services (consultation with a health professional in the last 2 weeks and hospitalization in the last year) among persons with poor self-perceived health status, i.e. those in most need. However, social inequalities still remain in the use of health services provided only partially by the NHS, and when characteristics of last consultation are taken into account. Subjects who paid for a private service waited an average of 18.8 minutes less than those attending the NHS. Within the NHS, social classes IV and V waited longer (35.5 minutes) than social classes I and II (28.4 minutes).

CONCLUSION

The NHS in Catalonia, Spain, has reduced inequalities in the use of health services. Social inequalities remain in the use of those health services provided only partially by the NHS.

[Housework, gender and health in the working population]

OBJECTIVE

To analyse the relation between domestic workload and self-perceived health status among workers and to examine whether there are gender inequalities.

METHODS

The selected population were the 215 men and 106 women younger than 65 years interviewed in the Terrassa Health Survey, 1998 who had a paid work and were married or cohabiting. Adjusted odds ratios (aOR) by domestic workload, age and occupational social class with their 95% confidence intervals (CI) were calculated.

RESULTS

Whereas among men domestic workload was not associated with health status, among women poor self-perceived health status was positively related to household size (aOR = 3.65; 95% IC = 1.06-12.54) and to lack of a person for doing domestic tasks (aOR = 4.43; 95% CI = 1.05-18.62).

CONCLUSION

Both household characteristics and having a support for facing domestic tasks play an important role in gender health inequalities.

Genesis of Drosophila ADH: the shaping of the enzymatic activity from a SDR ancestor

Drosophila alcohol dehydrogenase (ADH) is an NAD(H)-dependent oxidoreductase that catalyzes the oxidation of alcohols and aldehydes. Structurally and biochemically distinct from all the reported ADHs (typically, the mammalian medium-chain dehydrogenase/reductase-ethanol-metabolizing enzyme), it stands as the only small-alcohol transforming system that has originated from a short-chain dehydrogenase/reductase (SDR) ancestor. The crystal structures of the apo, binary (E.NAD(+)) and three ternary (E.NAD(+).acetone, E.NAD(+).3-pentanone and E.NAD(+).cyclohexanone) forms of Drosophila lebanonensis ADH have allowed us to infer the structural and kinetic features accounting for the generation of the ADH activity within the SDR lineage.

An empirical evaluation of various priors in the empirical Bayes estimation of small area disease risks

Empirical and fully Bayes estimation of small area disease risks places a prior distribution on area-specific risks. Several forms of priors have been used for this purpose including gamma, log-normal and non-parametric priors. Spatial correlation among area-specific risks can be incorporated in log-normal priors using Gaussian Markov random fields or other models of spatial dependence. However, the criterion for choosing one prior over others has been mostly logical reasoning. In this paper, we evaluate empirically the various priors used in the empirical Bayes estimation of small area disease risks. We utilize a Spanish mortality data set of a 12-year period to give the underlying true risks, and estimate the true risks using only a 3-year portion of the data set. Empirical Bayes estimates are shown to have substantially smaller mean squared errors than Poisson likelihood-based estimates. However, relative performances of various priors differ across a variety of mortality outcomes considered. In general, the non-parametric prior provides good estimates for lower-risk areas, while spatial priors provide good estimates for higher-risk areas. Ad hoc composite estimates averaging the estimates from the non-parametric prior and those from a spatial log-normal prior appear to perform well overall. This suggests that an empirical Bayes prior that strikes a balance between these two priors, if one can construct such a prior, may prove to be useful for the estimation of small area disease risks.

How do types of employment relate to health indicators? Findings from the second European survey on working conditions

STUDY OBJECTIVE

To investigate the associations of various types of employment with six self reported health indicators, taking into account the part played by demographic variables, individual working conditions and four ecological indicators at the country level.

DESIGN

Cross sectional survey (structured interview) of a sample of the active population of 15 European countries aged 15 years or over. Main independent variables were nine types of employment categorised as follows: small employers, full and part time permanent employees, full and part time fixed term employees, full and part time sole traders and full and part time temporary contracts. Main outcome measures were three self reported health related outcomes (job satisfaction, health related absenteeism, and stress) and three self reported health problems (overall fatigue, backache, and muscular pains). Logistic regression and multilevel models were used in the analyses.

SETTING

15 countries of the European Union.

PARTICIPANTS

15 146 employed persons aged 15 or over.

MAIN RESULTS

Precarious employment was consistently and positively associated with job dissatisfaction but negatively associated with absenteeism and stress (as compared with full time permanent workers). Fatigue, backache and muscular pains also tended to be positively associated with precarious employment, particularly with full time precarious employment. Small employers reported high percentages of stress and fatigue, but absenteeism was relatively low. Sole traders generally reported high percentages of all outcomes, except for absenteeism, which was low. For each type of employment (except temporary contracts), full time workers tended to report worse health outcomes than part time workers. Patterns were generally consistent across countries. Associations persisted after adjustment for individual level working conditions and were not modified by country level variables.

CONCLUSIONS

This study is the first to examine the relations between various types of employment and six health related indicators for all 15 member states of the European Union. Suggestive patterns worthy of further exploration have been found. Standardised definitions of types of underemployment and health related outcomes, more potent epidemiological designs and the inclusion of socioeconomic information (for example, social security systems, incapacity benefit schemes) at the regional level are proposed for inclusion in further research.

Structure-function relationships in Drosophila melanogaster alcohol dehydrogenase allozymes ADH(S), ADH(F) and ADH(UF), and distantly related forms

Drosophila melanogaster alcohol dehydrogenase (ADH), a paradigm for gene-enzyme molecular evolution and natural selection studies, presents three main alleloforms (ADHS, ADHF and ADHUF) differing by one or two substitutions that render different biochemical properties to the allelozymes. A three-dimensional molecular model of the three allozymes was built by homology modeling using as a template the available crystal structure of the orthologous D. lebanonensis ADH, which shares a sequence identity of 82.2%. Comparison between D. lebanonensis and D. melanogaster structures showed that there is almost no amino-acid change near the substrate or coenzyme binding sites and that the hydrophobic active site cavity is strictly conserved. Nevertheless, substitutions are not distributed at random in nonconstricted positions, or located in external loops, but they appear clustered mainly in secondary structure elements. From comparisons between D. melanogaster allozymes and with D. simulans, a very closely related species, a model based on changes in the electrostatic potential distribution is presented to explain their differential behavior. The depth of knowledge on Drosophila ADH genetics and kinetics, together with the recently obtained structural information, could provide a better understanding of the mechanisms underlying molecular evolution and population genetics.

[Social self-positioning as indicator of socioeconomic status]

OBJECTIVE

Self-perceived class results from directly questioning subjects about his or her social class. The aim of this investigation was to analyse self-perceived class in relation to other indicator variables of socioeconomic level.

METHODS

Data from the 1994 Catalan Health Interview Survey, a cross-sectional survey of a representative sample of the non-institutionalised population of Catalonia was used. We conducted a discriminant analysis to compute the degree of right classification when different socioeconomic variables potentially related to self-perceived class were considered. All subjects who directly answered the questionnaire were included (N = 12,245). With the aim of obtaining the discriminant functions in a group of subjects and to validate it in another one, the subjects were divided into two random samples, containing approximately 75% and 25% of subjects (analysis sample, n = 9,248; and validation sample, n = 2,997).

RESULTS

The final function for men and women included level of education, social class (based in occupation) and equivalent income. This function correctly classified 40.9% of the subjects in the analysis sample and 39.2% in the validation sample. Two other functions were selected for men and women separately. In men, the function included level of education, professional category, and family income (39.2% of classification in analysis sample and 37.2% in validation sample). In women, the function (level of education, working status, and equivalent income) correctly classified 40.3% of women in analysis sample whereas the percentage was 38.9% in validation sample. The percentages of right classification were higher for the highest and lowest classes.

CONCLUSION

These results show the utility of a simple variable to self-position within the social scale. Self-perceived class is related to education, income, and working determinants.

[Types of employment and health: analysis of the Second European Survey on Working Conditions]

OBJECTIVES

To investigate the relationships among types of employment and several health self-perceived outcomes in a sample of active workers from the 15 state members of the European Union.

METHODS

Cross-sectional study with data drawn from the Second European Survey on Working Conditions (n = 15,146 individuals). The predictive variable was the types of employment aggregated in: permanent workers, sole traders, small employers (less than 10 employees) and temporary workers (full-and part-time). Unconditional logistic regression models were adjusted by age, gender and several indications of working conditions. Permanent workers was used as the baseline category.

RESULTS

Employees with permanent (69,3%) and temporary (12,5%) contracts notified the highest level of a job absenteeism while temporary employees reported the highest level of job dissatisfaction. On the other hand, sole traders (12,2%) and small employees (6.1%) notified the most frequent level of overall fatigue, backache and muscular pains. Having permanent workers as baseline category, temporary employees was associated with high dissatisfaction (OR = 1.68), and and overall fatigue (OR = 1.16), but with lower frequency of stress (OR = 0.74) and job absenteeism (OR = 0.87). Small employers showed a low frequency of absenteeism (OR = 0.68), but a high stress (OR = 1.77) and overall fatigue (OR = 1.27). Finally, sole traders reported more frequently overall fatigue (OR = 1.40), and stress (OR = 1.33), but less job absenteeism (OR = 0.58).

CONCLUSIONS

These findings suggest that types of employment may have an independent effect on several health self-perceive outcomes. Further research is necessary to overcome various shortcoming of this study, and to assess the role either job security or level of income and social protection.

Infant and perinatal mortality in Spain 1981-1991: interprovincial variations in Autonomous Communities with extreme economic levels

The aims of the present study were to describe and compare infant, neonatal, postneonatal and perinatal mortality in aggregates of Spanish Autonomous Communities (AC) with higher and lower income, as well as to describe and compare their respective inequalities among the provinces constituting AC with similar (high or low) and with extreme economic levels, over the period from 1981 to 1991. The coefficient of variation (weighted by the number of births) has been used as the measure of interprovincial inequalities in mortality within each aggregate of AC and time trends in the average mortality rates and in their coefficients of variation have been analyzed using simple linear regression. The results of the study confirmed that the four mortality rates were all higher in the aggregate of AC of lower income than in that of higher income, and have fallen in both in a similar manner. Thus the perinatal mortality rates for the lower and higher income aggregates of AC respectively were 17.3 and 12.5 per 1000 births in 1981, and 8.3 and 6.8 in 1991. The inequality in postneonatal mortality was dominant in the group of AC with a lower economic level whereas geographical inequalities in perinatal mortality predominated in the higher income group. The predominance of interprovincial inequalities in perinatal mortality when all the AC (with extreme economic levels) were considered suggest that economic factors are closely related to perinatal mortality.