Health, work and working conditions: a review of the European economic literature

Diversity of flexible working time arrangements and workers' health: An analysis of a workers' panel and linked employer-employee data for France

Flexible working time arrangements (FWTA) have increased over the last decades, favored by labor market deregulation, the decentralization of collective bargaining and the development of new technologies. The negative impact of some non-standard working hours on health (like night work, shift work) is quite well-known but other forms of FWTA have been studied less so far. This article aims to investigate the relationship between FWTA and workers' health. It focuses on employer-oriented FWTA and uses a job demands-control framework to identify different types of working time demands and control. The study uses individual data from the French working conditions survey, including panel data from 2013 to 2019 (64,981 observations) and cross-sectional employer-employee linked data from 2019 (5687 employees from 4672 workplaces). We identify empirically two main dimensions of employer-oriented FWTA, based on 14 working time variables. The first type involves "atypical working hours", such as working weekends, nights, early mornings, evenings, or doing shift work. The second type - "work overflow" - is characterized by long working hours, overtime, taking work home, and having variable working hours. Using a fixed-effects model based on panel data, we show that both types of FWTA have a negative impact on workers' self-rated general health and mental health, as measured by the WHO-5 index. The study also finds that workers who have more control - both individual and collective - to face these demands demonstrate better health. Workers with control over their working hours report better health and are less negatively affected by FWTA. Moreover, workplace-level practices have ambiguous relationships with workers' health. However, those involving social dialogue and workers' participation have more favorable effects: the positive effect of health and safety committees is especially clear. To improve workers' health in the context of increased flexible working time arrangements, public policies should promote the development of control over working time and participation of workers to social dialogue on working time related issues.

Downgraded dreams: Labor market outcomes and mental health in undocumented migration

Undocumented immigrant workers are particularly exposed to mental health risk factors, including occupational downgrading - i.e. the loss in occupational status upon arrival. This study breaks new ground by examining the relationship between occupational downgrading and mental health among this hard-to-reach population, offering the first-ever investigation of its kind. Leveraging a unique dataset collected by a primary care outpatient clinic in Milan, Italy, which combines medical evaluations with detailed occupational information, we construct a direct measure of occupational downgrading, which adds to the literature. We employ logistic regression models to estimate odds ratios (ORs) for mental and behavioral disorders. The study also offers fresh evidence on the socioeconomic and health status of a sizable sample of undocumented migrants. The study sample consists of 1738 individuals that had their first medical examination in 2017-18. Prevalence of mental health conditions is 5.58%. Data also highlight poor labor market integration: one third of individuals in the sample is employed, mostly in elementary occupations; 66.63% of immigrant workers experienced occupational downgrading. Regression results show that undocumented immigrants who undergo occupational downgrading are at considerably higher risk of mental disorders. ORs range from 1.729 (95% CI 1.071-2.793), when the model only includes individual characteristics determined prior to migration, to 2.659 (CI 1.342-5.271), when it accounts for all the available controls. From a policy perspective, our study underscores the need to consider the broader impact of policies, including restrictive entry and integration policies, on migrant health. Additionally, ensuring access to primary care for all immigrants is crucial for early detection and treatment of mental health conditions.

Long-term health conditions and UK labour market outcomes during the COVID-19 pandemic

BACKGROUND

Long-term health conditions can affect labour market outcomes. COVID-19 may have increased labour market inequalities, e.g. due to restricted opportunities for clinically vulnerable people. Evaluating COVID-19's impact could help target support.

AIM

To quantify the effect of several long-term conditions on UK labour market outcomes during the COVID-19 pandemic and compare them to pre-pandemic outcomes.

METHODS

The Understanding Society COVID-19 survey collected responses from around 20,000 UK residents in nine waves from April 2020-September 2021. Participants employed in January/February 2020 with a variety of long-term conditions were matched with people without the condition but with similar baseline characteristics. Models estimated probability of employment, hours worked and earnings. We compared these results with results from a two-year pre-pandemic period. We also modelled probability of furlough and home-working frequency during COVID-19.

RESULTS

Most conditions (asthma, arthritis, emotional/nervous/psychiatric problems, vascular/pulmonary/liver conditions, epilepsy) were associated with reduced employment probability and/or hours worked during COVID-19, but not pre-pandemic. Furlough was more likely for people with pulmonary conditions. People with arthritis and cancer were slower to return to in-person working. Few effects were seen for earnings.

CONCLUSION

COVID-19 had a disproportionate impact on people with long-term conditions' labour market outcomes.

Work accident effect on the use of psychotropic drugs: the case of benzodiazepines

BACKGROUND

A work accident constitutes a shock to health, likely to alter mental states and affect the use of psychotropic drugs. We focus on the use of benzodiazepines, which are a class of drugs commonly used to treat anxiety and insomnia. Prolonged use can lead to dependence. Our objective is to determine the extent to which work accidents lead to benzodiazepine use and overuse (i.e. exceedance of medical guidelines).

METHOD

We use a two-step selection model (the Heckman method) based on data from the French National Health Data System (Système National des Données de Santé, SNDS). Our study sample includes all general plan members who experienced a single work accident in 2016 (and not since 2007). This sample includes 350,000 individuals in the work accident group and more than 1.1 million people randomly drawn from the population without work accidents from 2007 to 2017 (the non-work accident group).

RESULTS

The occurrence of a work accident leads to an increase in benzodiazepine use and overuse the following year. The selection model shows a clear influence of the accident on the use probability (+ 39%), but a very slight impact on the risk of overuse among users (+ 1.7%), once considered the selection effect. The effect on overuse risk is higher for more severe accidents and among women.

CONCLUSION

The increase in the risk of benzodiazepine overuse is due to an increase in the likelihood of using benzodiazepines after a work accident that leads to overuse, rather than an increase in likelihood of overuse among people who use benzodiazepines. Results call for targeting the first-time prescription to limit the risk of overuse after a work accident.

Obesity and labour market outcomes in Italy: a dynamic panel data evidence with correlated random effects

This paper investigates the effects of obesity, socio-economic variables, and individual-specific factors on work productivity across Italian regions. A dynamic panel data with correlated random effects is used to jointly deal with incidental parameters, endogeneity issues, and functional forms of misspecification. Methodologically, a hierarchical semiparametric Bayesian approach is involved in shrinking high dimensional model classes, and then obtaining a subset of potential predictors affecting outcomes. Monte Carlo designs are addressed to construct exact posterior distributions and then perform accurate forecasts. Cross-sectional Heterogeneity is modelled nonparametrically allowing for correlation between heterogeneous parameters and initial conditions as well as individual-specific regressors. Prevention policies and strategies to handle health and labour market prospects are also discussed.

Industry-specific prevalence and gender disparity of common mental health problems in the UK: A national repetitive cross-sectional study

Aims

The aim of the study was to evaluate the prevalence and temporal trend of common mental health problems (CMHPs) in the UK by industrial classification from 2012-2014 to 2016-2018 while evaluating the corresponding gender disparities.

Methods

We used data from the Health Survey for England. CMPH was judged by a 12-item General Health Questionnaire. Industrial classifications were defined using the UK Standard Industrial Classification of Economic Activities. Data were fitted by the logistic models.

Results

In this study, 19,581 participants covering 20 industries were included. In total, 18.8% of participants screened positive for CMHP in 2016-2018, which significantly increased from 16.0% in 2012-2014 [adjusted OR (AOR) = 1.17, 95% CI 1.08-1.27]. In 2016-2018, the prevalence of CMHP ranged from 6.2% in the industry of mining and quarrying to 23.8% in the industry of accommodation and food service activities. From 2012-2014 to 2016-2018, none of the 20 industries studied experienced significant decreases in the above prevalence; conversely, three industries saw significant increases, including wholesale and retail trade, repair of motor vehicles and motorcycles (AOR for trend = 1.32, 95% CI 1.04-1.67), construction (AOR for trend = 1.66, 95% CI 1.23-2.24), and other service activities, which cannot be classified (AOR for trend = 1.94, 95% CI 1.06-3.55). In total, 11 of the 20 industries studied had significant gender disparities against women, with the smallest gap being in the industry of transport and storage (AOR = 1.47, 95% CI 1.09-2.0) and the highest in the industry of arts, entertainment, and recreation (AOR = 6.19, 95% CI 2.94-13.03). From 2012-2014 to 2016-2018, gender disparities were narrowed only in two industries, including human health and social work activities (AOR for trend = 0.45, 95% CI 0.27-0.74), and transport and storage (AOR for trend = 0.5, 95% CI 0.27-0.91).

Conclusion

The prevalence of CMHPs has increased and had a wide variation across industries in the UK. There were disparities against women, and the gender disparities have been keeping almost no improvement from 2012-2014 to 2016-2018.

Explaining health inequalities in Australia: the contribution of income, wealth and employment

BACKGROUND

Studies show widespread widening of socioeconomic and health inequalities. Comprehensive primary health care has a focus on equity and to enact this requires more data on drivers of the increase in inequities. Hence, we examined trends in the distribution of income, wealth, employment and health in Australia.

METHODS

We analysed data from the Public Health Information Development Unit and Australian Bureau of Statistics. Inequalities were assessed using rate ratios and the slope index of inequality.

RESULTS

We found that the social gradient in health, income, wealth and labour force participation has steepened in Australia, and inequalities widened between the quintile living in the most disadvantaged areas and the quintile living in the least disadvantaged areas.

CONCLUSION

Widening income, wealth and employment inequalities have been accompanied by increasing health inequalities, and have reinforced and amplified adverse health effects, leading to increased mortality inequality. Effective comprehensive primary health care needs to be informed by an understanding of structural factors driving economic and health inequities.

Cohort Profile: The Assessing Economic Transitions (ASSET) Study-A Community-Based Mixed-Methods Study of Economic Engagement among Inner-City Residents

The Assessing Economic Transitions (ASSET) study was established to identify relationships between economic engagement, health and well-being in inner-city populations given that research in this area is currently underdeveloped. This paper describes the objectives, design, and characteristics of the ASSET study cohort, an open prospective cohort which aims to provide data on opportunities for addressing economic engagement in an inner-city drug-using population in Vancouver, Canada. Participants complete interviewer-administered surveys quarterly. A subset of participants complete nested semi-structured qualitative interviews semi-annually. Between April 2019 and May 2022, the study enrolled 257 participants ages 19 years or older (median age: 51; 40% Indigenous, 11.6% non-Indigenous people of colour; 39% cis-gender women, 3.9% transgender, genderqueer, or two-spirit) and 41 qualitative participants. At baseline, all participants reported past daily drug use, with 27% currently using opioids daily, and 20% currently using stimulants daily. In the three months prior to baseline, more participants undertook informal income generation (75%) than formal employment (50%). Employed participants largely had casual jobs (42%) or jobs with part-time/varied hours (35%). Nested qualitative studies will focus on how inner-city populations experience economic engagement. The resulting evidence will inform policy and programmatic initiatives to address socioeconomic drivers of health and well-being.

Child and adolescent mental health services in the Western Cape Province of South Africa: the perspectives of service providers

BACKGROUND

Current work in the field point to the need to strengthen child and adolescent mental health services (CAMHS) globally, and especially in low- and middle-income countries (LMICs). Policy development, planning and service provision must be relevant to the needs of stakeholders at grassroots level, and should include their perspectives. This study set out to explore the perspectives and lived experiences of service providers, including their recommendations to strengthen CAMHS in South Africa.

METHODS

Using focus group discussions (FGDs) and semi-structured individual interviews (SSIIs), qualitative data were collected from 46 purposefully selected multidisciplinary health service providers across the Western Cape, one of the nine provinces of South Africa. Audio-recorded data were entered into NVivo 11 (QSR), and thematic analysis was performed by two independent raters.

RESULTS

Results highlighted a significant lack of CAMH resources, poor intersectoral collaboration, limited access to training, absence of consistency and uniformity in service delivery, weak support for staff, and high rates of negative attitudes of staff. External factors contributing to poor CAMHS identified by service providers included poor socioeconomic circumstances, high rates of HIV/AIDS, substance use and stigma. The eight recommendations to strengthen CAMHS included a need to (1) increase CAMH staffing, (2) provide dedicated CAMHS at secondary care and child-friendly infrastructure at primary care, (3) review current service focus on number of patients seen versus quality of care provided to children, (4) formalise intersectoral collaborations, (5) increase learning opportunities for trainees, (6) employ a lead professional for CAMHS in the province, (7) increase support for staff, and (8) acknowledge staff initiatives.

CONCLUSIONS

Findings underlined the need for quality improvement, standardisation and scale-up of mental health services for children and adolescents in South Africa. Whilst we used the Western Cape as a 'case study', we propose that our findings may also be relevant to other LMICs. We recommend that the perspectives of service users, including children and adolescents, be sought to inform service transformation.

Irregular Migrant Workers and Health: A Qualitative Study of Health Status and Access to Healthcare of the Filipino Domestic Workers in Mainland China

In public health research, the health issues of irregular and vulnerable migrant populations remain under-explored. In particular, while mainland China has become a new and popular job-seeking destination for Filipino domestic workers (FDWs), the health status of FDWs and their access to healthcare have been invisible to public and academic concerns. This paper fills this lacuna by conducting a qualitative study that investigates FDWs’ self-reported health status and their healthcare-seeking behaviors. The results show that: (1) respondents do not report significant abusive and exploitative experience because the scarcity of FDWs in China in relation to the high demand enables them a certain degree of agency in labour market; (2) while FDWs do report some health problems, they tend to resort to self-medication and food-healing; (3) the main factors influencing health-seeking behavior include the fear of deportation, language gaps, the lack of knowledge of the local healthcare system and dependence on co-ethnic networks which serves as a double-edged sword; (4) these factors also lead to hesitation in health-seeking choice between public and private hospitals, which sometimes result in delayed treatment. This paper contributes to revealing the health conditions of FDWs in mainland China and calls for more inclusive health policy to enroll foreign domestic workers into the local health system in China.

Follow-up regimes for sick-listed employees: A comparison of nine north-western European countries

The Covid-19 pandemic has revealed the importance of social protection systems, including income security, when health problems arise. The aims of this study are to compare the follow-up regimes for sick-listed employees across nine European countries, and to conduct a qualitative assessment of the differences with respect to burden and responsibility sharing between the social protection system, employers and employees. The tendency highlighted is that countries with shorter employer periods of sick-pay typically have stricter follow-up responsibility for employers because, in practice, they become gatekeepers of the public sickness benefit scheme. In Germany and the UK, employers have few requirements for follow-up compared with the Nordic countries because they bear most of the costs of sickness absence themselves. The same applies in Iceland, where employers carry most of the costs and have no obligation to follow up sick-listed employees. The situation in the Netherlands is paradoxical: employers have strict obligations in the follow-up regime even though they cover all the costs of the sick-leave themselves. During the pandemic, the majority of countries have adjusted their sick-pay system and increased coverage to reduce the risk of spreading Covid-19 because employees are going to work sick or when they should self-quarantine, except for the Netherlands and Belgium, which considered that the current schemes were already sufficient to reduce that risk.

Co-design of a return-to-work intervention after breast cancer treatments: feasibility study protocol (Preprint)

Background

The mortality rate from breast cancer has been declining for many years, and the population size of working-age survivors is steadily increasing. However, the recurrent side effects of cancer and its treatment can result in multiple disabilities and disruptions to day-to-day life, including work disruptions. Despite the existing knowledge of best practices regarding return to work (RTW) for breast cancer survivors, only a few interdisciplinary interventions have been developed to address the individualized needs and multiple challenges of breast cancer survivors, health care professionals, and employer and insurer representatives. Thus, it seems appropriate to develop RTW interventions collaboratively by using a co-design approach with these specific stakeholders.

Objective

This paper presents a protocol for developing and testing an innovative, interdisciplinary pilot intervention based on a co-design approach to better support RTW and job retention after breast cancer treatment.

Methods

First, a participatory research approach will be used to develop the intervention in a co-design workshop with 12 to 20 participants, including people affected by cancer, employer and insurer representatives, and health care professionals. Next, a pilot intervention will be tested in a primary care setting with 6 to 8 women affected by breast cancer. The acceptability and feasibility of the pilot intervention will be pretested through semistructured interviews with participants, health care professionals, and involved patient partners. The transcribed data will undergo an iterative content analysis.

Results

The first phase of the project—the co-design workshop—was completed in June 2021. The pilot test of the intervention will begin in spring 2022. The results from the test will be available in late 2022.

Conclusions

The project will offer novel data regarding the use of the co-design approach for the development of innovative, co-designed interventions. In addition, it will be possible to document the acceptability and feasibility of the pilot intervention with a primary care team. Depending on the results obtained, the intervention could be implemented on a larger scale.

International Registered Report Identifier (IRRID)

DERR1-10.2196/37009

Employment Status and Health Literacy in Denmark: A Population-Based Study

Objectives: Examining whether specific population groups who are not working and those who have an employment have the same health literacy level. Methods: Data were retrieved from a nationally representative cross-sectional study of the Danish population conducted with the health literacy questionnaire (HLS-EU-Q16) in 2016 and 2017. Socio-demographic characteristics were drawn from national registers. Odds ratio for the association between employment status and health literacy was estimated from logistic regression models, adjusted for socio-demographic characteristics. Probability weights were used to adjust for differences in responses. Results: Logistic regression analyses showed that receiving unemployment benefits, social assistance, employment and support allowance, retirement pension and sickness benefit were significantly associated with having inadequate health literacy compared to being employed in any industry. The highest odds ratio for inadequate health literacy was present for receiving unemployment benefit OR = 1.78 (95% CI: 1.23-2.56). Conclusion: Population groups not working and receiving economic public support have higher odds of inadequate health literacy competencies compared to those active in the labor force, considering age and socioeconomic factors. The result contributes to understanding health disparities in connection to occupational situation.

Interaction Between Self-rated Health and Labour Force Participation: A Panel Data Probit Model with Survival Estimates

This study aimed to reveal the relationship between health and labour in Turkey under the intervention of demographic variables. Four waves of the TurkStat Income and Living Conditions Panel Survey (2008–2011) were used. Demographic, education, self-rated health and labour force participation indicators were used to examine different generalised linear model (GLM)-like panel binomial probit model specifications using self-assessed health (SAH) status and self-reported working status (SRWS) as dependent variables. Kaplan–Meier (KM) estimates for the probability of survival in SAH and SRWS were examined using the X2 values of the log-rank and Peto–Peto–Prentice tests for equality of survivor functions by study variables. Study results reveal that the hazard of assessing good health and currently working increases for individuals who are married ( p < 0.001), highly educated ( p < 0.001), do not have any chronic disease ( p < 0.001), do not have any health restrictions ( p < 0.001) and occupy high-qualification jobs ( p < 0.001). KM estimates support the panel model results. The present study reveals that demographic, education, self-rated health and labour force participation are the driving forces in the interaction of health and labour dynamics. Reducing income inequality, increasing the minimum wage and improving working conditions, while promoting gender equality, are essentials of better management of health and labour markets.

Technology-induced job loss risk, disability and all-cause mortality in Norway

Background

Ongoing shifts in economic structure from automation and globalisation can affect employment and mortality, yet these relations are not well described.

Objective

We assess whether long-term employment and health outcomes relate systematically to structural change in the labour market, using the occupational Routine Task Intensity (RTI) score as indicator of exposure is to risks of outsourcing and technology-induced job loss.

Methods

Using a cohort design and administrative data with national population coverage, we categorise all Norwegian employees in 2003 by the RTI score of their occupation and examine how this score correlates with employment and health outcomes measured in 2018 and 2019. The study sample counts 416 003 men and 376 413 women aged 33–52 in 2003.

Results

The occupational RTI score at baseline is robustly associated with long-term employment, disability and mortality outcomes. Raw correlations are reduced after adjustment for potential confounders, but associations remain substantial in models controlling for individual covariates and in sibling comparisons. Working in an occupation with RTI score 1 SD above the mean in 2003 is associated with a raised probability of being deceased in 2019 of 0.24 percentage points (95% CI: 0.18 to 0.30) for men and 0.13 percentage points (95% CI: 0.02 to 0.24) for women, corresponding to raised mortality rates of 6.7% and 5.5%.

Conclusions

Individuals in occupations characterised by high routine intensity are less likely to remain employed in the long term, and have higher rates of disability and mortality.

Does an increase in working hours affect mortality risk? The relationship between working hours and mortality among the older population

BACKGROUND

Population aging, caused by an increase in life expectancy and decrease in fertility rates, has created changes and challenges in various spheres, including the labor market. Though health deteriorates with age, more and more older adults choose to stay in the labor force and work into late life.

OBJECTIVE

Understanding the effects of various work conditions on the health of older workers is crucial for designing policies and interventions to ensure healthy late life and maintain a productive workforce. To contribute to this endeavor, this study investigates the relationship between long working hours (LWH) and mortality among older populations.

METHODS

The study uses the Cox proportional hazards regression model to investigate data from the Health and Retirement Survey (HRS) between the years 1992-2016, a longitudinal nationally representative dataset from the United States.

RESULTS

The results indicate that working 50 hours or more per week is not associated with an increased risk of mortality, for the full sample (1.45 [95% CI: 0.86, 2.45]), for both genders (females 0.51 [95% CI: 0.06, 4.28], males 1.45 [95% CI: 0.81, 2.61]), and for immigrants (female immigrants 0.55 [95% CI: 0.06, 4.75], male immigrants 1.44 [95% CI: 0.79, 2.62]).

CONCLUSIONS

This analysis confirms and extends the findings of earlier studies by taking into consideration the potential impact of many demographic, socioeconomic, work-related and health-related factors.

How the Labor Market Affects the Self-Perceived Health of Older Workers. The Evidence From Central and Eastern European Countries (CEECs)

Background: The paper aims to analyze the impact of key labor market indicators on the self-assessed health of the population of older workers (aged 55-64). Methods: Authors build the econometric models where the dependent variable is the self-perceived health status (for women and men separately). Explanatory variables are selected key indicators of the labor market, covering unemployment, including long-term, inactivity, or under-employment. The average household income is used to control the effect of wealth. Additionally, the models incorporate the variable describing the proximity of retirement. The research sample consists of nine countries of Central and Eastern Europe: Poland, Czech Republic, Slovakia, Hungary, Lithuania, Latvia, Estonia, Bulgaria, and Romania. Results and Conclusions: The study confirms that in the group of elderly workers, the perceived state of health is influenced by long-term unemployment, inactivity, and, in the case of women, time-related underemployment.

Association between early working life patterns, in publicly and privately owned companies, and the course of future sickness absence due to mental disorders: a cohort study in Catalonia (Spain)

OBJECTIVES

To assess the relationship between early working life patterns, at privately and publicly held companies, and the course of sickness absence (SA) due to mental disorders.

METHODS

Cohort study of workers aged 18-28 years, affiliated with the Spanish social security system, living in Catalonia, who had at least one episode of SA due to mental disorders between 2012 and 2014. Individual prior working life trajectories were reconstructed through sequence analysis. Optimal matching analysis was performed to identify early working life patterns by clustering similar individual trajectories. SA trajectories were identified using latent class growth modelling analysis. Finally, the relationship between early working life patterns and subsequent SA trajectories was assessed via multinomial logistic regression models.

RESULTS

Among both men and women, four labour market participation (LMP) patterns were identified: stable permanent employment (reference group), increasing permanent employment, fluctuating employment and delayed employment. Among women, an increasing permanent employment pattern in early working life was related to a decrease of accumulated SA days over time (adjusted OR (aOR) 2.08; 95% CI 1.18 to 3.66). In men, we observed a trend towards a middle stable accumulation of SA days in those with fluctuating employment (aOR 1.25, 95% CI 0.57 to 2.74) or delayed employment (aOR 1.79; 95% CI 0.59 to 5.41). In both men and women, an early working life in big companies was related to a more favourable SA trajectory.

CONCLUSIONS

Early LMP patterns characterised by an increasing stability-decreased number of transitions between temporary contracts and lack of social security coverage towards permanent contracts-were related to a better future SA course due to mental diagnosis.

Understanding sport coaches' turnover intention and well-being: an environmental psychology approach

OBJECTIVE

The purpose of this study was to examine the role of environmental and personal factors in sport coaches' well-being and behavioral intention. To be precise, this study measured how workplace social support, work involvement, and work satisfaction are associated with sport coaches' well-being and turnover intention, adopting the framework of the environmental psychological model.

DESIGN

A total of 519 responses were collected from sport coaches in Singapore. In this study, confirmatory factor analysis and structural equation modeling analysis were conducted using EQS 6.3 software.

RESULTS

Results of structural equation modeling supported all hypothesized relationships, except the paths from work involvement to turnover intention and well-being. Additionally, this study found the indirect effects of workplace social support and work involvement on turnover intention and well-being.

CONCLUSION

This study provided an understanding of external and internal antecedents of sport coaches' future behavior and well-being, ultimately benefiting sport organizations.

Economic evaluation of adjuvant trastuzumab emtansine in patients with HER2-positive early breast cancer and residual invasive disease after neoadjuvant taxane and trastuzumab-based treatment in Canada

Background

In the katherine trial, adjuvant trastuzumab emtansine [T-DM1, Kadcyla (Genentech, South San Francisco, CA, U.S.A.)], compared with trastuzumab, significantly reduced the risk of recurrence or death by 50% (unstratified hazard ratio: 0.50; 95% confidence interval: 0.39 to 0.64; p < 0.0001) in patients with her2-positive early breast cancer (ebc) and residual invasive disease after neoadjuvant systemic treatment. A cost-utility evaluation, with probabilistic analyses, was conducted to examine the incremental cost per quality-adjusted life-year (qaly) gained associated with T-DM1 relative to trastuzumab, given the higher per-cycle cost of T-DM1.

Methods

A Markov model comprising a number of health states was used to examine clinical and economic outcomes over a lifetime horizon from the Canadian public payer perspective. Patients entered the model in the invasive disease-free survival (idfs) state, where they received either T-DM1 or trastuzumab. Transition probabilities between the health states were derived from the katherine trial, Canadian life tables, and published literature from other relevant clinical trials (emilia, cleopatra, and M77001). Resource use, costs, and utilities were derived from katherine, other clinical trials, published literature, provincial fee schedules, and clinical expert opinion. Sensitivity analyses were conducted for key assumptions and model parameters.

Results

Compared with trastuzumab, adjuvant T-DM1 was associated with a cost savings of $8,300 per patient and a 2.16 incremental qaly gain; thus T-DM1 dominated trastuzumab. Scenario analyses yielded similar results, with T-DM1 dominating trastuzumab or producing highly favourable incremental cost-utility ratios of less than $10,000 per qaly.

Conclusions

Adjuvant T-DM1 monotherapy is a cost-effective strategy compared with trastuzumab alone in the treatment of patients with her2-positive ebc and residual invasive disease after neoadjuvant systemic treatment.

Perceived stress and dementia: Results from the Copenhagen city heart study

Objectives: We investigated if perceived stress in midlife increased the risk of dementia. Furthermore, we explored differences between subgroups related to sex, age and employment status when reporting stress.Methods: In this longitudinal study, we used information on perceived stress from 10,814 participants (mean age 56.7 years). Participants were followed through Danish national registers for development of dementia. Participants were considered at risk of dementia from the date they turned 60 years. Perceived stress was assessed as a combination of self-reported intensity and frequency of stress, and categorized into low (score 0-1), medium (score 2-4), and high stress (score 5-6). We used Poisson regression to estimate incidence rate ratios (IRR) and their 95% confidence intervals (CI) and adjusted for sociodemographic factors and psychiatric morbidity at baseline (main model) as well as cardio/cerebrovascular diseases and health behaviors at baseline (additional model).Results: The mean follow-up time was 13.8 years, and 1,519 participants were registered with dementia. Dementia risk was higher in participants reporting medium stress (IRR = 1.11, 95% CI: 0.99-1.24) and high stress (IRR = 1.36, 95% CI: 1.13-1.65). Adjustment for cardio/cerebrovascular diseases and health behaviors did not alter the results. We did not find strong support for differences between subgroups, although the association between stress and dementia was stronger for those who were employed at the time of reporting high stress.Conclusion: Our results provide empirical support for an effect of perceived stress on the risk of dementia in old age.

Later retirement, job strain, and health: Evidence from the new State Pension age in the United Kingdom

This paper examines the impact of raising the State Pension age on women's health. Exploiting a UK pension reform that increased women's State Pension age for up to 6 years since 2010, we show that raising the State Pension age leads to an increase of up to 12 percentage points in the probability of depressive symptoms, alongside an increase in self-reported medically diagnosed depression among women in a lower occupational grade. Our results suggest that these effects are driven by prolonged exposure to high-strain jobs characterised by high demands and low control. Effects are consistent across multiple subcomponents of the General Health Question and Short-Form-12 (SF-12) scores, and robust to alternative empirical specifications, including "placebo" analyses for women who never worked and for men.

The effect of retirement on biomedical and behavioral risk factors for cardiovascular and metabolic disease

Retirement is a major life event potentially associated with changes in relevant risk factors for cardiovascular and metabolic conditions. This study analyzes the effect of retirement on behavioral and biomedical risk factors for chronic disease, together with subjective health parameters using Southern German epidemiological data. We used panel data from the KORA cohort study, consisting of 11,168 observations for individuals 45-80 years old. Outcomes included health behavior (alcohol, smoking, physical activity), biomedical risk factors (body-mass-index (BMI), waist-to-hip ratio (WHR), glycosylated hemoglobin (HbA1c), total cholesterol/HDL quotient, systolic/diastolic blood pressure), and subjective health (SF12 mental and physical scales, self-rated health). We applied a parametric regression discontinuity design based on age thresholds for pension eligibility. Robust results after p-value corrections for multiple testing showed an increase in BMI in early retirees (at the age of 60) [β = 1.11, corrected p-val. < 0.05] and an increase in CHO/HDL in regular retirees (age 65) [β = 0.47, corrected p-val. < 0.05]. Stratified analyses indicate that the increase in BMI might be driven by women and low educated individuals retiring early, despite increasing physical activity. The increase in CHO/HDL might be driven by men retiring regularly, alongside an increase in subjective physical health. Blood pressure also increased, but the effect differs by retirement timing and sex and is not always robust to sensitivity analysis checks. Our study indicates that retirement has an impact on different risk factors for chronic disease, depending on timing, sex and education. Regular male, early female, and low educated retirees should be further investigated as potential high-risk groups for worsening risk factors after retirement. Future research should investigate if and how these results are linked: in fact, especially in the last two groups, the increase in leisure time physical activity might not be enough to compensate for the loss of work-related physical activity, leading thus to an increase in BMI.

Crafting Task and Cognitive Job Boundaries to Enhance Self-Determination, Impact, Meaning and Competence at Work

Job crafting refers to physical and cognitive changes in task or relational work boundaries, enacted by individuals to recreate their work experience in a more motivating and rewarding way, and to realize self-actualization, growth, and meaning at work. This study tests a model of individual, interpersonal, and organizational antecedents and motivational outcomes of situation-directed task and self-directed cognitive job crafting. Employee survey data (N = 1196) from a Chinese telecommunications company permitted confirmatory factor analysis and structural equation modeling. Antecedents were each measured with three-item versions of established scales, a two-dimensional scale on task and cognitive job crafting was newly developed, and a four-dimensional model of psychological empowerment captured motivational effects. Structural modeling confirmed a partial mediating role of job crafting between antecedents and empowerment. Individual growth requires strength and intellectual stimulation from one's leader that is positively related to both tasks and cognitive crafting, while exposure to organizational constraints triggered task crafting only. Confirming differential motivational effects, task crafting predicted control-oriented empowerment dimensions of self-determination and impact, whereas cognitive crafting affected person-oriented dimensions of meaning and competence. Interpreted as a micro-emancipatory form of self-management, job crafting offers some new insights into leadership, coping, work design, work orientations, and motivation. Practical and research implications of this are discussed.

"I Would Love to Just Be Myself": What Autistic Women Want at Work

Background

Autistic individuals experience barriers obtaining and sustaining employment. In the general population, gender also impacts labor market experiences. Understanding the occupational aspirations and expectations of individuals disaggregated by autism diagnosis and gender may assist the development of tailored workplace policies and support strategies.

Methods

We used inductive thematic analysis to understand the employment expectations of 89 participants (34 autistic women, 32 typically developing women, and 23 autistic men) who answered open-ended items in an online survey. Participants were ages 18 to 68 years. We identified themes and compared these by autism diagnosis and gender.

Results

The first major theme emerging from the data was the desire for an opportunity to have a fulfilling career (i.e., fit), with associated minor themes of job-person and person-environment fit. With no associated minor themes, the second and third major themes were desire for stable employment and low hope for finding meaningful work. Differences were apparent by autism diagnosis and not gender.

Conclusions

It is pertinent that autistic women have job-person and person-environment fit to thrive at work. Workplace policies and procedures influencing attitudinal, structural, and procedural change appear warranted to facilitate inclusion of autistic women in the labor market.

Lay summary

Why was this study done?: Autistic people have a lot of difficulties gaining and maintaining suitable work. Yet, no one has asked autistic women what they hope their future in the workforce could look like. Asking this question can highlight problems and possible solutions to help autistic women gain and maintain meaningful employment.What was the purpose of this study?: To help understand the aspirations of autistic women regarding their employment.What did the researchers do?: We asked autistic and nonautistic women, as well as autistic men, in Australia to answer open-ended questions in an online survey about work. One question was "what do you hope for your future in the workforce?" We organized people's responses into categories, or themes, which described different aspects of participants' answers. We then compared written responses of the autistic and nonautistic women, as well as the answers of autistic women and men.What were the results of the study?: Participants' responses can be described with three major themes: (1) an opportunity to have a fulfilling career that matches interests and skills in a suitable environment; (2) wanting stable employment; and (3) having low hope for finding meaningful work. Finding a job that suits interests, skills, and work preferences within a supportive environment was mentioned as vital for sustained participation in the labor market by autistic women. Although these things were also mentioned by nonautistic women, they were much more important for autistic women. Furthermore, autistic women's and men's aspirations are similar, and of equal importance to each of them.What do these findings add to what was already known?: Much is already known about the experiences of autistic men in the workplace. This study addresses and builds on the little research about the occupational aspirations and expectations of autistic women. The results of this study suggest that autistic women want an opportunity to find meaningful and stable work where they "fit in" with the freedom to be themselves. Because some similarities were found between what autistic and nonautistic women (as well as autistic men) need in the workplace, if changes affecting businesses are made to help autistic women, more people would benefit.What are potential weaknesses in the study?: This research is limited by the way information was obtained from participants, and sample characteristics; for example, the autistic women were diagnosed with autism at a younger age than the autistic men. It is a small, qualitative study from a single open-ended survey item. Obtaining participants using social media may mean people in metropolitan areas more likely participated. Furthermore, the sample was from Australia only, looked at people who identified as women or men, and did not address racial or ethnic diversity.How will these findings help autistic adults now or in the future?: Understanding the aspirations of autistic women can suggest interventions that help them succeed in the workforce. The strong desire for job-person-environment fit by autistic women could, for example, suggest encouraging more flexible workplace practices supportive of career development. Or, it could suggest creating a free, or subsidized, support service to help autistic people of all ages find work that matches (or can be molded) to suit their skills, abilities, work preferences, and environmental (e.g., sensory) needs.

The reciprocal relationship between depressive symptoms and employment status

This paper analyzes the reciprocal lagged relationship between depressive symptoms and employment status. We find that severe depressive symptoms contribute to a 25.6% increase in subsequent non-employment rates, a 20.7% increase in non-participation rates and 34.2% increase in unemployment rates, for men. Similar, although weaker, marginal effects are found for women. However, we find no evidence for men and only limited evidence for women that unemployment, non-employment, or non-participation raises the risks of severe depressive symptoms. We observe an impact of labor market status on depressive symptoms only when using point-in-time measures.

Association of employment status and income with self-rated health among waged workers with disabilities in South Korea: population-based panel study

OBJECTIVE

This study aimed to examine the association of employment status and income with self-rated health among waged workers with disabilities in South Korea.

METHODS

This study used the Panel Survey of Employment for the Disabled from 2011 to 2015. A total of 951 waged workers with disabilities were selected as baseline subjects in 2011 and were followed up for 5 years. This study used a generalised linear mixed model after adjusting for covariates.

RESULTS

Among 951 waged workers with disabilities, the results showed that 39.3% of workers with disabilities reported poor self-rated health. Workers with disabilities with a precarious employment status and lower income were 1.22 (95% CI 1.21 to 1.23) and 1.81 (95% CI 1.80 to 1.83) times more likely to have poor self-rated health than those with permanent employment and higher income, respectively. A subgroup analysis found that precarious workers with disabilities in lower income households had higher possibilities of poor self-rated health.

CONCLUSION

This study suggests that precarious employment and lower income of waged workers with disabilities are significantly associated with poor self-rated health compared with those with permanent jobs or higher income.

[Overview of Occupational Surveys in Brazil (2005-2015): a systematic review of the literature]

Occupational Surveys are methods of collecting data from the cross-sectional studies, which are indispensable for the elaboration of public policies oriented to workers' health. The objective of this study was to perform a systematic review on articles that featured results of Occupational Surveys conducted in Brazil from 2005 to 2015. Based on the Prisma recommendation, this review selected articles indexed in Medline, Lilacs and Scielo databases. Analysis of the data consisted of the description of the Occupational Surveys according to: large regions in which the research was carried out; techniques and instruments used; topics covered; sectors of the economy in which health-work relations were investigated; and methodological criteria. Differences in the distribution of Occupational Surveys were observed regionally and by sector. The structure of the investigations, for the most part, was concerned with identifying sickness in workers. A lack of consensus regarding the methods used was revealed, which consequently prejudiced the comparison of results and monitoring of health and working conditions. Efforts are needed to build consensus and foster research in sectors and regions that are as yet scantly explored.

Unemployment and suicide in Italy: evidence of a long-run association mitigated by public unemployment spending

From the mid-1990s on, the suicide rate in Italy declined steadily, then apparently rose again after the onset of the Great Recession, along with a sharp increase in unemployment. The aim of this study is to test the association between the suicide rate and unemployment (i.e., the unemployment rate for males and females in the period 1977-2015, and the long-term unemployment rate in the period 1983-2012) in Italy, by means of cointegration techniques. The analysis was adjusted for public unemployment spending (referring to the period 1980-2012). The study identified a long-run relationship between the suicide rate and long-term unemployment. On the other hand, an association between suicide and unemployment rate emerged, though statistically weaker. A 1% increase in long-term unemployment increases the suicide rate by 0.83%, with a long-term effect lasting up to 18 years. Public unemployment spending (as percentage of the Italian gross domestic product) may mitigate this association: when its annual growth rate is higher than 0.18%, no impact of unemployment on suicide in detectable. A decrease in the suicide rate is expected for higher amounts of social spending, which may be able to compensate for the reduced level of social integration resulting from unemployment, helping the individual to continue to integrate into society. A corollary of this is that austerity in times of economic recession may exacerbate the impact of the economic downturn on mental health. However, a specific "flexicurity" system (intended as a combination of high employment protection, job satisfaction and labour-market policies) may have a positive impact on health.

Multiple exposures to the risk of work absenteeism among Brazilian schoolteachers

The study aimed to identify multiple exposures to the risk of work absenteeism among Brazilian schoolteachers, independently of the reasons reported by teachers (n = 6,510). The data came from a telephone survey on health, working conditions, and absenteeism among schoolteachers in Brazil (Educatel Study, 2015/2016). Exposures were identified and studied by principal components analysis and Poisson regression, with a focus on working conditions and quality of school administration. Three components of risk factors for work absenteeism were identified. Component 1 featured lack of opportunities for new learning experiences, insufficient time for performing tasks, constraints on teachers' autonomy, and little or no social support in the school environment; component 2 was characterized by the perception of heavy demand from tasks and an agitated classroom environment due to students' lack of discipline and intense noise; and component 3 by the experience of verbal or physical violence from students. All three components were specially associaed with stress-related work absenteeism in relation to reported stress at school (aPR = 3.87; 95%CI: 2.93-5.10; p < 0.05/aPR = 3.18; 95%CI: 2.47-4.09; p < 0.05/aPR = 3.31; 95%CI: 2.58-4.25; p < 0.05; respectively) and emotional problems (aPR = 2.28; 95%CI: 1.93-2.70; p < 0.05/aPR = 2.43; 95%CI: 2.05-2.87; p < 0.05/aPR = 2.09; 95%CI: 1.78-2.45; p < 0.05; respectively). The identification of these risk components highlighted the need for systemic changes in Brazilian Basic Education schools.

Gender-specific correlates of perceived life stress: a population-based study, Montreal, Canada, 2012

OBJECTIVES

To identify the gender-specific correlates of perceived life stress in a representative sample of the Montreal population.

METHOD

Data were extracted from the Local Health Survey Program (called "TOPO") collected in 2012. TOPO-2012 provided information on chronic diseases, their determinants and risk factors, as well as lifestyle and health services utilization. Poisson regression was used to identify significant correlates of perceived life stress.

RESULTS

Single-parent females were 21% more likely (RR = 1.21; 95% CI = 1.04-1.42) to report stressful life compared to females living alone. Females born in Canada or established female immigrants were significantly more likely to report stressful life (respectively RR = 1.34; 95% CI = 1.12-1.60 and RR = 1.31; 95% CI = 1.08-1.58) than recent female immigrants. Furthermore, females living in a privileged material neighbourhood reported significantly higher perceived life stress (14% higher) than females living in a deprived neighbourhood. On the other hand, males with higher annual household income were 9% more likely (OR = 1.09; 95% CI = 1.05-1.14) to perceive life stress than males reporting a lower income. Also, overweight males reported higher stress (RR = 1.13; 95% CI = 1.01-1.26) than their normal weighted counterparts. Additionally, males who were diagnosed with a physical health problem were more likely to report stressful life (RR = 1.44; 95% CI = 1.28-1.61) than males who did not report any physical health problem.

CONCLUSION

Identifying correlates of stress at the population level may help researchers characterize people vulnerable to daily stress, provide health agencies the advantage to forecast and prevent its occurrence and diseases associated with it, as well as offer policy advocates a pivotal edge to reduce disparities in population health.

Is there an association between working conditions and health? An analysis of the Sixth European Working Conditions Survey data

This paper analyses the association between working conditions and physical health using data from the Sixth European Working Conditions Survey (EWCS6) released in 2017. The econometric analysis uses two indicators to describe health status: self-assessed health (SAH), which is a subjective indicator of health; and an objective indicator of health (SICK), which is based on the occurrence of any illness or health problem that has lasted or is expected to last for more than 6 months. The theoretical hypotheses concerning the association between working conditions and SAH and the association between working conditions and SICK are tested using a standard ordered probit model and a standard probit model, respectively. The results show that encouraging working conditions, work environment, and job support are associated with both better self-assessed health and better objective health.

A meta-analysis of the association between forgiveness of others and physical health

OBJECTIVE

This meta-analysis tested the relation between forgiveness of others and physical health (PH) with age, gender, race, education level, employment status, sample type, research design, type of PH variables, and publication status as the potential moderators.

DESIGN

Eligible studies had participants with or without physical or mental health problems and had quantitative data on forgiveness of others and PH. The random-effects model was used to aggregate Fisher's z effect sizes, which were converted back to correlation coefficients.

MAIN OUTCOME MEASURES

State forgiveness (forgiving an offense or offender) measures, trait forgiveness (a disposition to forgive) measures and physical health measures were included in the meta-analysis.

RESULTS

A hundred and twenty-eight studies (N = 58,531) were retrieved, in which the mean effect sizes showed a significant positive relationship between forgiveness of others and PH (r = 0.14, p < 0.001, 95% CI [0.11, 0.17]). Further, no moderators showed a significant relation between forgiveness of others and PH.

CONCLUSIONS

The positive relation between forgiveness of others and PH was not affected by potential moderators. Because the results are correlational, more forgiveness interventions may be needed to examine the causal effect of the relation between forgiveness of others and PH.

Trust in the Work Environment and Cardiovascular Disease Risk: Findings from the Gallup-Sharecare Well-Being Index

This study examined associations between trust, an important aspect of workplace social capital, with seven cardiovascular disease (CVD) risk factors (American Heart Association Life’s Simple 7 (LS7)): smoking, obesity, low physical activity, poor diet, diabetes, high cholesterol, and high blood pressure. Data are from the U.S. Gallup-Sharecare Well-Being Index (2010–2012), a nationally representative telephone survey of U.S. workers (n = 412,884). The independent variable was the response to a work environment (WE) question as to whether their supervisor always creates an open and trusting environment. Regression models were adjusted for demographic characteristics with each of the LS7 CVD risk factors as dependent variables. Twenty-one percent of workers reported that their supervisor did not create an open and trusting environment. Trust was associated with increased adjusted odds of having many of the LS7 CVD risk factors. Among those workers whose supervisor created a mistrustful environment, the odds ratios were greatest (>20%) for having four or more of the LS7 CVD risk factors.

Employment predictors of exit from work among workers with disabilities: A survival analysis from the household income labour dynamics in Australia survey

Objectives

Across high-income countries, unemployment rates among workers with disabilities are disproportionately high. The aim of this study was to identify characteristics of employment associated with dropping out of work and assess whether these were different for workers with versus without disabilities.

Methods

Using a longitudinal panel study of working Australians (2001 to 2015), the current study estimated Kaplan–Meier curves and Cox proportional hazard regression models to identify predictors of leaving employment, including psychosocial job quality, employment arrangement, and occupational skill level. Effect modification by disability status of the relationship between employment-related factors and exit from the labour market were assessed by including interaction terms and assessing model fit with a likelihood ratio test. Models were adjusted for a range of socio-demographic and health related factors.

Results

Compared to those without disability, those with disability had a greater risk of leaving employment (HR 1.26, 95% CI 1.18 to 1.35, p<0.001). Other predictors of exit from work included low-skilled occupation (HR 1.18, 95% CI 1.07 to 1.29, p = 0.001), being in a job with low psychosocial job quality (HR 1.11, 95% CI 1.03 to 1.19, p = 0.007), and casual, labour hire or fixed-term contract employment (HR 1.58, 95% CI 1.48 to 1.69, p<0.001). There was no effect modification by disability status.

Conclusions

More research is needed to understand the experiences of workers with disabilities who stay in and leave employment.

The impact of health on wages: evidence for Europe

This paper analyses the effects of health on wages in sixteen European countries using production frontier methodology. It is assumed that workers have a potential income/productivity which basically depends on their human capital, but due to several health problems, situations could exist where workers fail to reach their potential income frontier. The estimation of a true-random-effects model allows us to conclude that the potential hourly wage of workers is significantly influenced by their level of education and their job experience. However, health problems, especially those strongly influencing work activities, contribute towards an individual not attaining the potential income which would otherwise be guaranteed by their human capital endowment. Suffering a strong limitation reduces gross wage per hour by 6.1%. This wage reduction is also observed in the case of a weak limitation, but here the wage difference with respect to workers without any limitation is 2.6%. Additionally, other factors, such as being a woman, the economic cycle or having a temporary contract, appear to distance an individual from their wage frontier.

Belgian temporary workers at end of working life: an intersectional lifecourse analysis

The sector of temporary employment agencies in Belgium has been growing for more than 20 years. If temporary work is seen primarily as a path into the workforce for young people, it also concerns seniors, in increasing proportions. The problematic of end-of-career temporary work was analysed from a dual perspective, considering the embedding of temporalities in advanced modernity and more broadly the ‘lifecourse’ paradigm. A typology was created based on qualitative analysis of 36 semi-structured interviews of temporary workers ⩾45 years old. Results demonstrate how the experiences of temporary workers nearing retirement depend on professional, familial and social paths, and also reveal the presence of different cultural models: What is the importance of work in construction of an identity? What standards and values are applied? How is social time prioritised according to these norms? These analyses incorporate an intersectional framework in which gender and social inequalities structure the lives of workers approaching the end of their careers.

Life expectancy inequalities in the elderly by socioeconomic status: evidence from Italy

BACKGROUND

Life expectancy considerably increased in most developed countries during the twentieth century. However, the increase in longevity is neither uniform nor random across individuals belonging to various socioeconomic groups. From an economic policy perspective, the difference in mortality by socioeconomic conditions challenges the fairness of the social security systems. We focus on the case of Italy and aim at measuring differences in longevity at older ages by individuals belonging to different socioeconomic groups, also in order to assess the effective fairness of the Italian public pension system, which is based on a notional defined contribution (NDC) benefit computation formula, whose rules do not take into account individual heterogeneity in expected longevity.

METHODS

We use a longitudinal dataset that matches survey data on individual features recorded in the Italian module of the EU-SILC, with information on the whole working life and until death collected in the administrative archives managed by the Italian National Social Security Institute. In more detail, we follow until 2009 a sample of 11,281 individuals aged at least 60 in 2005. We use survival analysis and measure the influence of a number of events experienced in the labor market and individual characteristics on mortality. Furthermore, through Kaplan-Meier simulations of hypothetical social groups, adjusted by a Brass relational model, we estimate and compare differences in life expectancy of individuals belonging to different socioeconomic groups.

RESULTS

Our findings confirm that socioeconomic status strongly predicts life expectancy even in old age. All estimated models show that the prevalent type of working activity before retirement is significantly associated with the risk of death, even when controlling for dozens of variables as proxies of individual demographic and socioeconomic characteristics. The risk of death for self-employed individuals is 26% lower than that of employees, and life expectancy at 60 differs by five years between individuals with opposite socioeconomic statuses.

CONCLUSIONS

Our study is the first that links results based on a micro survival analysis on subgroups of the elderly population with results related to the entire Italian population. The extreme differences in mortality risks by socioeconomic status found in our study confirm the existence of large health inequalities and strongly question the fairness of the Italian public pension system.

Harder, better, faster … Yet stronger? Working conditions and self-declaration of chronic diseases

The role played by working conditions in worker health status has been widely acknowledged in the literature in general but has received less attention in economics, due to the inherent statistical biases and lack of data available to determine the role of simultaneous and chronic exposures. This study aims to estimate the causal impact of detrimental working conditions on the self-declaration of chronic diseases in France. Using a rebuilt retrospective lifelong panel and defining indicators for physical and psychosocial strains, I implement a mixed econometric strategy that relies on difference-in-differences and matching methods to take into account for selection biases as well as unobserved heterogeneity. For men and women, I find deleterious effects of both types of working conditions on the declaration of chronic diseases after exposure, with varying patterns of impacts according to the nature and magnitude of the strains. These results provide insights into the debate on legal retirement age postponement and justify not only policies being enacted early in individuals' careers in order to prevent subsequent midcareer health repercussions, but also schemes that are more focused on psychosocial risk factors.

Good jobs, good pay, better health? The effects of job quality on health among older European workers

Using data from the Survey of Health, Ageing and Retirement in Europe, this study presents new evidence on the effects of job quality on the occurrence of severe acute conditions, the level of cardiovascular risk factors, musculoskeletal disorders, mental health, functional disabilities and self-assessed health among workers aged 50+. By combining intrinsic job quality with job insecurity and pay the study maps out multiple potential pathways through which work may affect health and well-being. Levering longitudinal data and external information on early retirement ages allows for accounting of unobserved heterogeneity, selection bias and reverse causality. The empirical findings suggest that inequities in health correlate with inequities in job quality, though a substantial fraction of these associations reflect time-constant unobserved heterogeneity. Still, there is evidence for genuine protective effects of better jobs on musculoskeletal disorders, mental health and general health. The effect could contribute to a substantial number of avoidable disorders among older workers, despite relatively modest effect sizes at the level of individuals. Mental health, in particular, responds to changes in job quality. Selection bias such as the healthy worker effect does not alter the results. But the influence of job quality on health may be transitional among older workers. An in-depth analysis of health dynamics reveals no evidence for persistence.

Company size, work-home interference, and well-being of self-employed entrepreneurs

Background

The impact of working conditions on the health and well-being of workers of large enterprises has been widely described. This influence has not been studied as extensively in very small and medium-sized enterprises mainly due to methodological difficulties. Smaller organisations nevertheless constitute a reality that needs to be better understood.

Methodology

The aim of this article is to better understand the working conditions of entrepreneurs in small and medium-sized enterprises, to describe the impact of these conditions on their health and well-being, and to learn how their work affects their private lives.

This is why a study was conducted in 2015–2016 on a selected sample of entrepreneurs in the Brussels-Capital Region (n = 140). The survey form included questions pertaining to the work environment, motivations underlying the choice of activities, robustness of the business, work-home interference, work-related stress, work satisfaction, self-reported health indicators, and socio-demographic status. The results were compared with those from another survey on workers in small shops conducted between 2012 and 2015 within the same Region (n = 104).

Results

The number of entrepreneurs who participated in the survey added up to 140, with an even distribution between men and women. Two results are highlighted. The first concerns the difficulties faced by entrepreneurs working with a small team (1 to 4 employees): they are more stressed, report having heavy workloads, describe their health more negatively, consume more sedatives, and claim to suffer from loneliness more often than those working with larger teams or alone. Comparatively, in the study on shopkeepers, business owners working alone found themselves in a worse situation regarding their health and well-being.

The second finding involves the difficulties entrepreneurs face when it comes to combining work and family life, and for which gender inequalities were noted. This phenomenon remains insufficiently explored amongst small business owners.

Conclusion

In spite of the difficulties encountered at work, commitment to their chosen profession remains strong amongst entrepreneurs. Our results enable us underscore the aspects of entrepreneurial activity that should be taken into account whilst setting up support mechanisms or promoting entrepreneurship, especially amongst and for women.

Relations causales entre santé et travail

Les économistes s’intéressent aux liens entre santé et travail en examinant en particulier trois relations : l’effet négatif de la santé dégradée sur la position sur le marché du travail, l’influence positive du travail sur la santé mais aussi le rôle délétère de certaines conditions de travail et d’emploi sur l’état de santé. Si la littérature internationale est abondante sur la question, la littérature française est plus récente. En France, les effets d’événements de santé sont plus pénalisants sur la trajectoire professionnelle lorsqu’ils surviennent en seconde partie de carrière invitant à la mise en place d’une prévention précoce en entreprise. Les études soulignent aussi des populations fragiles face aux ruptures de trajectoires professionnelles ou de santé telles que les hommes anxieux.

Association between employment status and self-rated health: Korean working conditions survey

Background

This research was conducted with an aim of determining the association between employment status and self-rated health.

Methods

Using the data from the Third Korean Working Conditions Survey conducted in 2011, We included data from 34,783 respondents, excluding employers, self-employed workers, unpaid family workers, others. Self-rated health was compared according to employment status and a logistic regression analysis was performed.

Results

Among the 34,783 workers, the number of permanent and non-permanent workers was 27,564 (79.2 %) and 7,219 (20.8 %). The risk that the self-rated health of non-permanent workers was poor was 1.20 times higher when both socio-demographic factors, work environment and work hazards were corrected.

Conclusions

In this study, perceived health was found to be worse in the non-permanent workers than permanent workers. Additional research should investigate whether other factors mediate the relationship between employment status and perceived health.