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.     

How do perceptions of local neighborhood relate to adolescents' walking and cycling?

PURPOSE: To examine how perceptions of the local neighborhood relate to adolescents' walking and cycling. DESIGN: Exploratory cross-sectional study. SETTING: Birth cohort from the Nepean Hospital, Sydney, Australia. SUBJECTS: Three hundred forty-seven adolescents (79.1% response rate; 49.6% boys; mean age = 13.0 +/- 0.2 years) and their parents. MEASURES: Self-report and parental-report questionnaires. RESULTS: Multiple linear regressions, adjusted for level of maternal education, revealed that boys who reported having many peers to hang out with locally, cycled for recreation (beta = 0.242, p = .006) or for transport (beta = 0.141, p = .046) more often, and walked for transport for longer (beta = 0.129, p = .024) on weekdays. For girls this variable was related to cycling for recreation on weekends (beta = 0.164, p = .006) and walking to school (beta = 0.118, p = .002). Adolescents who waved/talked to neighbors walked for transport more often (boys, beta = 0.149, p = .037; girls, beta = 0.119, p = .012). Girls who perceived local roads to be safe spent more time walking for transport on weekdays (beta = 0.183, p = .007) and for exercise on weekends (beta = 0.184, p = .034). Parents' perception of heavy traffic was negatively associated with boys' walking for transport (beta = -0.138, p = .037) and many aspects of girls' walking and cycling. CONCLUSION: Social interaction and road safety may be important predictors of adolescents' walking and cycling in their neighborhood. Limitations are the use of self-report and cross-sectional data. Longitudinal studies may clarify these relations.     

How do life style factors relate to general health and overweight?

In this study we examined the associations between on the one hand the life style factors: Sports, Alcohol, Nutrition, Overweight and Smoking (SANOS), the eating styles of dietary restraint, external- and emotional eating and on the other hand overweight, energy at work and perceived general health. Using a web-based life style questionnaire, responses were obtained from 3272 employees (1254 women and 2018 men) in a large banking corporation. These data were subjected to principal component factor analysis. In both sexes, the SANOS life style factors loaded on a factor that stood for good general health and energy at work, and that, in women, additionally comprised high dietary restraint. Overweight, in contrast, loaded in both sexes on a factor that comprised: restrained eating, emotional eating (highest loading) and external eating, and, in the women, additionally general health (negative loading) and energy at work (negative loading). It is concluded that the attempt made in life style programs to elevate general health perception and lower body weight may be more successful for the latter if the program is also targeted at improvement of eating behavior.     

Inpatient reimbursement system in Italy: How do tariffs relate to costs?

In 1995 the Italian National Health Service begun to fund its hospitals on a per case basis, classified according to a DRGs system. Five out of 21 Italian regions developed a regional DRG tariff system, while the majority adopted the system set at national level. The article presents how tariffs are set by the national government and by the Lombardy Region. Production cost (mainly assessed according to a top-down, gross-costing approach) is only one of the variables used for setting tariffs. Microcosting is not used and, apparently, is not deemed as an appropriate methodology. After 10 years since their introduction national and regional tariffs are still not derived from explicit algorithms.     

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.     

How do job characteristics, family situation, domestic work, and lifestyle factors relate to sickness absence? A study based on Sweden Post

OBJECTIVE: We sought to determine how do working life and private life characteristics relate to sickness absence. METHODS: Questionnaire data for 1557 female and 1913 male employees were related to registered sickness absence by multivariate analyses. RESULTS: Apart from health problems, clear associations with sickness absence were observed for complaints attributed to heavy, arduous work, and sickness presenteeism. The use of tranquilizers, occurrence of bullying, and the existence of a high total workload from paid and unpaid work were associated with sickness absence in women. In men, the use of alcohol as sedative, anxiety of reorganization, not holding a supervisor position, adverse life events, and divorce were related with sickness absence. CONCLUSIONS: Our study identified different areas at work and outside work for women and men that could be targets for actions aiming at preventing high sickness absence.     

Is any job better than no job at all? Studying the relations between employment types,unemployment and subjective health in Belgium

Background

This study focuses on the health impact of the labour market position, since recent research indicates that exposure to both unemployment and precarious employment causes serious harm to people’s health and well-being. An overview of general and mental health associations of different labour market positions in Belgium is provided. A distinction is made between employment and unemployment and in addition between different types of jobs among the employed, taking into account the quality of employment. Given the fact that precarious labour market positions tend to coincide with a precarious social environment, the latter is taken into consideration by including the composition and material living conditions of the household and the presence of social support.

Methods

Belgian data from the 1st Generations and Gender Survey are used. A Latent Class Cluster Analysis is performed to construct a typology of labour market positions that includes four different types of waged employment: standard jobs, instrumental jobs, precarious jobs and portfolio jobs, as well as self-employment and unemployment. Then, binary logistic regression analyses are performed in order to relate this typology to health, controlling for household situation and social support. Two health outcomes are included: self-perceived general health (good versus fair/bad) and self-rated mental health (good versus bad, based on 7 items from the Center for Epidemiologic Studies Depression Scale).

Results

Two labour market positions are consistently related to poor general and mental health in Belgium: unemployment and the precarious job type. The rather small gap in general and mental health between both labour market positions emphasises the importance of employment quality for the health and well-being of individuals in waged employment. Controlling for the household level context and social support illustrates that part of the reported health associations can be explained by the precarious social environment of individuals in unfavourable labour market positions.

Conclusions

The results from this study confirm that the labour market position and social environment of individuals are important health determinants in Belgium.

     

How do clinical and psychological variables relate to quality of life in end-stage renal disease? Validating a proximal–distal model

Purpose

The aims of this study were to: (1) validate the proximal–distal (PD) model in predialysis and early dialysis and (2) examine the role of hemoglobin on quality of life (QoL) in these patient groups.

Methods

Cross-sectional observational studies of 475 participants recruited from four major university teaching hospitals were conducted. The multi-sample structural equation modeling with latent composite techniques was employed to test the PD model. Seven factors were measured, including QoL, positive affect, depression, physical functioning, kidney disease symptoms, comorbidity and hemoglobin.

Results

The results showed that both the equality-constrained and equality-unconstrained PD models were supported by fit statistics. The chi square difference test of the two models was non-significant, indicating that the PD model was consistent across groups. The alternative models were rejected by fit statistics, suggesting that hemoglobin does not impact on psychological states but QoL.

Conclusions

This study validates the PD model across the end-stage renal disease (ESRD) patient groups and shows a hierarchical causal relationship between clinical factors, physical functioning, psychological states and QoL, with hemoglobin as an exception. This model provides an empirical framework for integrating and studying a range of clinical factors and health outcomes in ESRD.     

How do obese individuals perceive and respond to the different types of obesity stigma that they encounter in their daily lives? A qualitative study

Obesity stigma exists within many institutions and cultural settings. Most studies suggest that stigmatising experiences have a negative impact on individuals' health and social behaviours and outcomes. However, some studies indicate that obesity stigma can motivate individuals to lose weight. Limited research has examined weight-based stigma from the perspective of obese individuals, including their perceptions of, and responses to, the different types of weight-based stigma they face in their daily lives. This study advances knowledge about weight-based stigma by documenting how obese adults (mostly female) described the different types of obesity stigma that they faced, how they responded to this stigma, and how different types of stigma impact on health and social wellbeing. Semi-structured, qualitative interviews were conducted between April 2008 and March 2009 with a diverse sample of 141 obese Australian adults. Guided by Link and Phelan's (2006) categorisation of different types of discrimination, participants' experiences could be grouped into three distinct types of stigma: 1) Direct (e.g. being abused when using public transport); 2) Environmental (e.g. not being able to fit into seats on planes); and 3) Indirect (e.g. people staring at the contents of their supermarket trolley). Participants described that more subtle forms of stigma had the most impact on their health and social wellbeing. However, it was the interaction between direct, environmental and indirect stigma that created a barrier to participation in health-promoting activities. Participants rarely challenged stigma and often blamed themselves for stigmatising experiences. They also avoided situations where they perceived they would be stigmatised and constantly thought about how they could find a solution to their obesity.     

Physician assistants in occupational medicine: how do they compare to occupational physicians?

BACKGROUND: Physician assistants (PAs) have been present in occupational and environmental medicine (OEM) in the USA since 1971, yet remarkably little is known about their activity. METHODS: An administrative study of PA activities was undertaken and compared with the activities of physicians in the same occupational medicine setting. Patients were not triaged to either provider and all resources of care were recorded for the visit. An episode of care approach was used for the analysis. RESULTS: The characteristics of patients seen by each provider were similar in age, gender ratio and severity of injury. Physicians saw a mean of 2.9 patients/h and PAs 2.5, but PAs worked more hours and saw more patients per year than physicians. The average charge per patient visit and total charge for an episode of care were similar. Differences between PAs and physicians were seen in the areas of 'limited duty' duration given to patients and on average PAs prescribed 15 days and physicians 17 days. PAs referred a patient 19.7% of the time, while physicians referred 17.4%. Most of the referrals were to physical therapy. The salary of a physician, based on an hourly rate, was approximately twice as much as a PA. CONCLUSION: The use of PAs in OEM may represent a cost-effective advantage from an administrative standpoint. Clearly, more research is necessary in determining the role and utilization of PAs in OEM and how they may improve the delivery of physician services.     

How does infant behaviour relate to weight gain and adiposity?

An understanding of how infant eating behaviour relates to later obesity is required if interventions in infancy are to be attempted. The aim of this paper is to review findings from the Gateshead Millennium Study to describe (i) what we have already established about the relationship between infant feeding transitions, infancy weight gain and eating behaviour and (ii) describe new analyses that examine how infant eating behaviour and temperament relate to infancy weight gain and childhood adiposity. The Gateshead Millennium Study recruited 1029 infants at birth and parents completed questionnaires five times in the first year. We have already described how starting solids and ceasing breast-feeding seems to be a response to rapid early weight gain, rather than a cause, and that parents identify and respond to the individual appetite characteristics of their child. A number of questions about eating behaviour at 12 months were used to construct an infancy eating avidity score that was positively associated with height at age 7-8 years, but not with an adiposity index constructed using bioelectrical impedance, waist and skinfolds. Infancy eating avidity score was associated with greater fussiness and lower satiety responsivity on the Child Eating Behaviour Questionnaire at age 6-8 years. Temperament measured at age 6 weeks and 8 months showed no consistent associations with either infancy weight gain or adiposity at 6-8 years. While infancy may seem a logical time to intervene with children at risk of future obesity, the collective findings from this substantial population-based study largely suggest otherwise.     

How do job stress and ergonomic factors impact clinic visits in acute low back pain? A prospective study

OBJECTIVE: We sought to identify whether ergonomic factors, job stress, health behavior, and emotional distress are prospectively related to return visits for acute back pain. METHODS: A total of 368 U.S. Army soldiers completed a baseline survey of health and work factors at their first visit for back pain. Multivariable regression and structural equation modeling were used to describe the relationships among ergonomic exposure, job stress, smoking, and emotional distress and their ability to predict repeat clinic visits. RESULTS: The path analysis indicated that higher levels of ergonomic exposures were directly related to increased job stress (beta = 0.29). Higher levels of job stress were directly related to higher levels of general distress (beta = -35). General distress (beta = -0.70) and smoking (beta = 0.67) were directly linked to clinic visits. CONCLUSIONS: Efforts to directly impact emotional distress or indirectly reduce distress by intervening at the levels of ergonomic risks and psychosocial workplace stress should prove useful in the management of acute low back pain.     

How do Canadian hospitals do it? A comparison of utilization and costs in the United States and Canada

In 1990 Canadian hospitals provided more services at less cost than did acute care facilities in the United States. Canadians spent $2,720 less per discharge for 48 percent longer stays. If U.S. acute care facilities had achieved an average discharge cost comparable to that in Canada, the annual savings among hospitals in the United States would have totalled $84.3 billion. In a comparative study of volumes and costs in medium-size and teaching hospitals, it was found that U.S. hospitals had greater costs for delivering services than Canadian acute care facilities did in almost every department.