Stunting disparities and its associated factors among preschool children of employed and unemployed mothers in Gondar City: a comparative community-based cross-sectional study

Introduction

A stunted child refers to a child who is too short for his/her age, which is the most common cause of morbidity and mortality in children under five in developing countries. Stunting in preschool children is caused by a multitude of socioeconomic and child-related factors, including the employment status of women. This study aimed to compare the prevalence and factors associated with stunting of preschool children among employed and unemployed mothers in Gondar city, Northwest Ethiopia, in 2021.

Methods

From 30 February to 30 March 2021, a community-based comparative cross-sectional study was conducted among 770 preschool children of employed and unemployed mothers in Gondar city. A structured questionnaire-based interview with anthropometric measurements was used to collect data. A multi-stage sampling technique was used. Data were entered into EPI Info version 7.22 and transferred to Stata version 14 for further analysis. To identify factors associated with stunting, a binary logistic regression analysis was used. The presence of an association was declared based on a p-value of <0.05 and confidence intervals.

Results

A total of 770 preschool children participated in the study. The overall prevalence of stunting among preschool children was 39.7% (95% CI: 36.3-43.2). The prevalence was higher among preschool children of employed mothers (42.6%) (95% CI: 37.6-47.5) than among unemployed mothers (36.7%) (95% CI: 32.0-41.7). Maternal age [AOR = 2.8, 95% CI: 1.26-6.34] and wealth status [AOR = 0.32, 95% CI: 0.18-0.57] were significantly associated with stunting among unemployed mothers, while family size [AOR = 7.19, 95% CI: 2.95-17.5], number of children under the age of five [AOR = 1.92, 95% CI: 1.12-3.29], and having a home servant [AOR = 0.126, 95% CI: 0.06-0.26] were associated with stunting of preschool children among employed mothers.

Conclusion

Stunting is more common in preschool children of employed mothers than in those of unemployed mothers. As a result, interventions such as raising awareness among employed mothers to devote time and care to their children, as well as concerned bodies assisting women with preschool or under-five children, is required. The nutrition intervention should focus on encouraging dietary diversity to combat the existing nutrition-associated stunting in children. Similarly, further research on the difference between employed and unemployed mothers' child stunting status as well as an investigation of extra variables such as the number of hours worked by an employed mother is also recommended to upcoming researchers.

Suicide Trends in Jordan in Correlation With the COVID-19 Pandemic: A Forensic Medicine Perspective

Background This study aimed to examine the suicide trends among Jordanians who died by suicide before and during the coronavirus disease 2019 (COVID-19) pandemic and assess their correlation with demographic data, including gender, age, marital status, and the method used for suicide, from a forensic medicine perspective. Methodology This was a retrospective, observational, autopsy-based study. Of the 731 medicolegal autopsies performed at the Al-Hussein New Hospital at Al Salt City between 2017 and 2022, 41 confirmed cases of suicide were identified. Results The study indicated that 75% of the subjects committed suicide during the COVID-19 pandemic period, of whom 13% were children. The average age of those who died by suicide was 32.1 (SD = 12.2) years. Overall, 58.5% were single, 61.0% unemployed, and 53.7% had a mental illness. Males were four times more likely to commit suicide than females. Hanging represented 60.61% of all male suicides, followed by firearms (27.27%); however, females used poisoning. Around 60% and 25% of the study subjects were in the age group of 21-40 years and 41 and more, respectively. The study also identified a statistically significant association between gender, age, and the time of suicide (during COVID-19). The findings of this study could not confirm any association between suicide and mental illness, marital status, and employment status. Conclusions The suicide rate in Jordan increased during the COVID-19 pandemic, and it is alarming that most of those who committed suicide were at a young age and in their productive years.

Modifiable determinants of central obesity among the rural black population in the DIMAMO HDSS, Limpopo, South Africa

Background

Central obesity is a leading risk factor for cardiometabolic diseases, in which body fat accumulates to a particular extent, and may negatively impact on health. The prevalence of abdominal obesity has increased over the last 10 years and currently surpasses that of overall obesity. There is a scarcity of data on the determinants of central obesity, especially among populations residing in rural Africa. The aim of the present study was thus to determine sociodemographic and lifestyle factors that are associated with central obesity.

Methods

This was a cross-sectional, retrospective study. The present study used secondary data from the AWI-Gen phase 1 study. The study comprised 791 participants, of which 242 were men and 549 were women aged 40 years and above. The participants were selected by convenient sampling. Data were analyzed using the Statistical Package for Social Sciences version 27. A comparison of proportions was performed using the chi-square test, while a comparison of means was performed using an unpaired Student t-test. The association between sociodemographic and lifestyle factors with central obesity was analyzed using bivariate correlation, partial correlation, and binary regression analysis, and the statistical significance was set at a p-value of <0.05.

Results

The proportion of central obesity in the total population was 59.9%, and significantly more women were centrally obese (79.6 vs. 15.3%, p = <0.001) as compared to men. Married status correlated positively and significantly with central obesity in both bivariate and partial correlations. Moreover, binary logistic regression further confirmed the positive association between married status and central obesity. Single status correlated negatively and significantly with central obesity. The correlation remained unchanged even after controlling for age and gender. Binary logistic regression showed that unemployment correlated significantly with central obesity. The proportion of smokers was also significantly higher in participants without central obesity than in those with central obesity (87.2 vs. 34.0%, p = <0.001). Smoking correlated negatively and significantly with central obesity in bivariate and partial correlations. In addition, binary logistic regression further confirmed the negative association between smoking and central obesity.

Conclusion

The present study shows that in this population, central obesity is determined by gender, unemployment, and marital status.

Effectiveness of Mental Health Apps for Distress During COVID-19 in US Unemployed and Essential Workers: Remote Pragmatic Randomized Clinical Trial

BACKGROUND

During the COVID-19 pandemic, the general public was concerned about the mental health impacts of unemployment due to COVID-19 and the stress essential workers experienced during this time. Several reports indicated that people in distress were turning to digital technology, but there was little evidence about the impact of these tools on mitigating distress.

OBJECTIVE

This study seeks to determine the acceptability, feasibility, usability, and effectiveness of mobile mental health apps for decreasing mental health symptoms in essential workers and unemployed individuals with suicide risk.

METHODS

We recruited participants who indicated that they were unemployed because of COVID-19 or were COVID-19-designated essential workers. Participants were randomized to 1 of 4 free commercial mobile apps for managing distress that were (1) highly rated by PsyberGuide and (2) met the criteria for intervention features these participants indicated were desirable in a previous survey. Participants used the apps for 4 weeks and completed baseline and 4-week self-assessments of depression, anxiety emotional regulation, and suicide risk.

RESULTS

We found no differences between the apps in any outcome but did find significant changes in depression and anxiety over time (Patient Health Questionnaire [PHQ]-9: estimate=-1.5, SE 0.2, 95% CI -1.1 to -1.8, P<.001; Generalized Anxiety Disorder Scale [GAD]-7: estimate=-1.3, SE 0.2, 95% CI -1.0 to -1.6, P<.001). We found no significant changes in suicidal behavior (Suicide Behaviors Questionnaire-Revised [SBQ-R]) or emotional regulation (Difficulties in Emotion Regulation Scale - Short Form [DERS-SF]) for the 4 weeks. We did find a significant dose-response pattern for changes in depression and anxiety. Using the app at least once a week resulted in greater improvements in treatment conditions over time on depression (estimate=-0.6, SE 0.2, 95% CI 1.0-0.2, P=.003) and anxiety (estimate=0.1, SE 0.2, 95% CI 0.4-0.6, P=.78). There was no association between app frequency and changes in suicidal behavior (SBQ-R) or emotional regulation (DERS-SF). We further found a significant difference between the conditions with regard to app usability, with the control app being the most usable (mean_{Beautiful Mood} 72.9, SD 16.7; mean_{COVID Coach} 71.2, SD 15.4; mean_Calm 66.8, SD 17.3; mean_{7 Cups} 65.2, SD 17.7). We found no significant differences for app acceptability or appropriateness.

CONCLUSIONS

Few studies have evaluated prospectively the utility and usability of commercial apps for mood. This study found that free, self-guided commercial mobile mental health apps are seen as usable, but no one app is superior to the other. Although we found that regular use is indicated for effects on depression and anxiety to occur in those who are more symptomatic, regression to the mean cannot be ruled out.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04536935; https://tinyurl.com/mr36zx3s.

Socioeconomic disparities in rates of facial fracture surgeries for women and men at a regional tertiary care centre in Australia

BACKGROUND

Assault is the most common mechanism of injury in patients presenting with facial trauma in Australia. For women, there is a propensity for maxillofacial injuries to stem from intimate partner violence (IPV). Those with a low socioeconomic status have higher rates of IPV. This study examines variations in the proportion of surgical procedures that are due to facial trauma for Australian women and men by employment status and residential socioeconomic status.

METHODS

A single centre retrospective study was conducted (2008-2018). The proportion of operative patients presenting with facial fractures was examined. Multivariable logistic regression adjusting for year and age, was performed for women and men.

RESULTS

Facial fractures comprised 1.51% (1602) of all surgeries, patients had a mean age of 32, and 81.3% were male. Unemployed patients were more likely to require surgery for a facial fracture (OR 2.36 (2.09-2.68), P <0.001), and there were no significant variations by index of economic resources (IER). Unemployed males had higher rates of facial fractures (OR 2.09 (1.82-2.39), P <0.001). Unemployed and disadvantaged IER females had higher rates of facial fractures (OR 5.02 (3.73-6.75), P <0.001 and OR 2.31(1.63-3.29), P <0.001).

CONCLUSIONS

This study found disparities in rates of surgery for facial fractures; unemployment increased the rates for men and women, whereas disadvantaged IER increased rates for women. Studies have demonstrated higher rates of IPV for unemployed and low socioeconomic status women. Further research ascertaining the aetiology of these disparities is important both for primary prevention initiatives and to enable treating clinicians to better understand and address the role of IPV and alcohol consumption in these injuries.

Health Literacy Needs Among Unemployed Persons: Collating Evidence Through Triangulation of Interview and Scoping Review Data

Background

Unemployed persons are at high risk for low health literacy. Most studies addressing health literacy of unemployed persons focus on risk factors for low health literacy or correlates of health literacy, but studies on needs of unemployed persons regarding health literacy are scarce. We aimed to obtain better understanding of health literacy needs of unemployed adults by triangulating the results from a scoping review on health literacy needs in unemployed adults and additional in-depth qualitative interviews.

Methods

Scoping review: We searched six databases up to January 2021 as well as gray literature for relevant studies following PRISMA-ScR guidelines. Titles, abstracts, and full texts were screened independently by two researchers. Qualitative study: Ten participants of a job-reintegration program in Germany were interviewed following a guideline covering topics including health issues of interest to the participants, their sources of health-related information and the barriers/facilitators they experience when accessing health services.

Results

Scoping review: After screening 2,966 titles and abstracts, 36 full texts were considered, and five articles fulfilled the inclusion criteria. Four focused on mental health literacy and outcomes, while the fifth assessed information-seeking practices. One additional report on health literacy was identified via the gray literature search. Awareness of one's condition was identified as a facilitator for mental health help-seeking, while fear of harmful effects of medication prevented help-seeking. Qualitative study: Participants were interested in and were generally well-informed about health topics such as nutrition and physical activity. The main challenge perceived was translating the knowledge into practice in daily life. GPs and the social services providers played an important role as a source of health information and advice. Regarding mental health, similar barriers, facilitators and needs were identified through triangulation of findings of the scoping review with those of the interviews.

Conclusions

There is need to address health literacy needs of long-term unemployed persons that go beyond mental health literacy. Public health interventions should not only aim at improving health literacy scores, but also focus on how to help participants translate health literacy into practice. Population groups of interest should also be involved in all processes of designing interventions.

Disparities in surgical outcomes for low socioeconomic status patients in Australia

Background

There are disparities in surgical outcomes for patients of low socioeconomic status globally, including in countries with universal healthcare systems. There is limited data on the impact of low socioeconomic status on surgical outcomes in Australia. This study examines surgical outcomes by both self‐reported unemployment and neighbourhood level socioeconomic status in Australia.

Methods

A retrospective administrative data review was conducted at a tertiary care centre over a 10‐year period (2008–2018) including all adult surgical patients. Multivariable logistic regression adjusting for year, age, sex and Charlson Comorbidity Index was performed.

Results

106 197 patients underwent a surgical procedure in the decade examined. The overall adverse event rates were mortality (1.13%), total postoperative complications (10.9%), failure to rescue (0.75%) and return to theatre (4.31%). Following multivariable testing, unemployed and low socioeconomic patients had a higher risk of postoperative mortality (OR 2.06 (1.50–2.82), OR 1.37 (1.15–1.64)), all complications (OR 1.43 (1.31–1.56), OR 1.21 (1.14–1.28)), failure to rescue (OR 2.03 (1.39–2.95), OR 1.38 (1.11–1.72)) and return to theatre (OR 1.42 (1.27–1.59), OR 1.24 (1.14–1.36)) (P < 0.005 for all).

Conclusions

Despite universal healthcare, there are disparities in surgical adverse events for patients of low socioeconomic status in Australia. Disparities in surgical outcomes can stem from three facets: a patient's access to healthcare (the severity of disease at the time of presentation), variation in perioperative care delivery, and social determinants of health. Further work is required to pinpoint why these disparities are present and to evaluate the impact of strategies that aim to reduce disparities.

Mental Health and the Perceived Usability of Digital Mental Health Tools Among Essential Workers and People Unemployed Due to COVID-19: Cross-sectional Survey Study

BACKGROUND

COVID-19 has created serious mental health consequences for essential workers or people who have become unemployed as a result of the pandemic. Digital mental health tools have the potential to address this problem in a timely and efficient manner.

OBJECTIVE

The purpose of this study was to document the extent of digital mental health tool (DMHT) use by essential workers and those unemployed due to COVID-19, including asking participants to rate the usability and user burden of the DMHT they used most to cope. We also explored which aspects and features of DMHTs were seen as necessary for managing stress during a pandemic by having participants design their own ideal DMHT.

METHODS

A total of 2000 people were recruited from an online research community (Prolific) to complete a one-time survey about mental health symptoms, DMHT use, and preferred digital mental health features.

RESULTS

The final sample included 1987 US residents that identified as either an essential worker or someone who was unemployed due to COVID-19. Almost three-quarters of the sample (1479/1987, 74.8%) reported clinically significant emotional distress. Only 14.2% (277/1957) of the sample used a DMHT to cope with stress associated with COVID-19. Of those who used DMHTs to cope with COVID-19, meditation apps were the most common (119/261, 45.6%). Usability was broadly in the acceptable range, although participants unemployed due to COVID-19 were less likely to report user burden with DMHTs than essential workers (t198.1=-3.89, P<.001). Individuals with emotional distress reported higher financial burden for their DMHT than nondistressed individuals (t69.0=-3.21, P=.01). When the sample was provided the option to build their own DMHT, the most desired features were a combination of mindfulness/meditation (1271/1987, 64.0%), information or education (1254/1987, 63.1%), distraction tools (1170/1987, 58.9%), symptom tracking for mood and sleep (1160/1987, 58.4%), link to mental health resources (1140/1987, 57.4%), and positive psychology (1131/1986, 56.9%). Subgroups by employment, distress, and previous DMHT use status had varied preferences. Of those who did not use a DMHT to cope with COVID-19, most indicated that they did not consider looking for such a tool to help with coping (1179/1710, 68.9%).

CONCLUSIONS

Despite the potential need for DMHTs, this study found that the use of such tools remains similar to prepandemic levels. This study also found that regardless of the level of distress or even past experience using an app to cope with COVID-19, it is possible to develop a COVID-19 coping app that would appeal to a majority of essential workers and unemployed persons.

Exploring 'Return to Productivity' Among People Living with Burn Injury: a Burn Model System National Database Report

INTRODUCTION

Burn survivors experience barriers to returning to work. For those who do return to work, little is known regarding whether they achieve pre-injury productivity (i.e., equivalent or gain in income compared to pre-injury income). Identifying patients at risk of not achieving pre-injury productivity is important for targeting services that support this population.

METHODS

We extracted occupational and income data through 24 months post-injury from the multi-center, longitudinal Burn Model System National Database. Annual income was reported in six groups: <$25k, $25k-50k, $50k-99k, $100k-149k, $150k-199k, $>199k. Participants were classified by change in income at each follow up (i.e., gain, loss, equivalent). Explanatory variables included demographics, injury characteristics, insurance payer, employment status, and job type. Multi-level, multi-variable logistic regression was used to model return to productivity.

RESULTS

453 participants provided complete income data at discharge and follow up. Of the 302 participants employed pre-injury, 180 (60%) returned to work within 24 months post-injury. Less than half (138) returned to productivity (46% of participants employed pre-injury; 77% of those who returned to work). Characteristics associated with return to productivity included older age (median 46.9 vs 45.9 years, OR 1.03, p=0.006), Hispanic ethnicity (24% vs 11%, OR 1.80, p=0.041), burn size >20% TBSA (33.7% vs 33.0%, OR 2.09, p=0.045), and post-injury employment (54% vs 26%, OR 3.41, p<0.001).

CONCLUSION

More than half of employed people living with burn injury experienced loss in productivity within 24 months post-injury. Even if they return to work, people living with burn injuries face challenges returning to productivity and may benefit from vocational rehabilitation and/or financial assistance.

Effectiveness of a low-dose mindfulness-based intervention for alleviating distress in young unemployed adults

While the effectiveness of mindfulness-based interventions (MBIs) with respect to distress has been widely researched, unemployed individuals, who often suffer from high levels of distress, have largely been neglected in MBI research. The present study aimed to investigate the effects of a low-dose MBI on distress in a sample of young unemployed adults. The sample included 239 young unemployed adults enrolled for a 6-week long employability-related training camp. Participants were allocated into an intervention group that received weekly 1-hour mindfulness training over 4 weeks, and a control group. Dispositional mindfulness, distress and well-being were assessed in the entire sample prior to the start and upon completion of the mindfulness training. A mixed model ANCOVA showed that distress was inversely and significantly predicted by baseline levels of mindfulness and well-being. After accounting for the baseline levels of mindfulness and well-being, a significant effect of the mindfulness intervention was evident. This result shows that a low-dose MBI can decrease distress in a sample of young unemployed adults and its effectiveness is positively associated with initial levels of dispositional mindfulness and well-being.

Development of a valid psychological scale for youth police selection among young unemployed and excluded persons: The Nemesis scale

BACKGROUND

Youth, unemployment and poverty confirm a set of situations that are often inseparable. An example of this is the case of young people from the Andean coca areas.

OBJECTIVE

To develop and validate a psychological test that can be used as a predictor of adequate police performance for use in police force recruitment.

METHODS

The study comprised a sample of 713 young people, who were selected to join a pre-police training program designed to allow them to subsequently join the Peruvian police force. A new 200-item instrument, called Nemesis, was created. Derogatis' SCL-90 test was administered to determine the validity of the new instrument. The suitability of the items for the future questionnaire was determined through factor analysis, which reduced the questionnaire to 14 items. Logistic regression was used to determine whether the items on the scale could predict possible admittance into the police training academy.

RESULTS

A statistical regression analysis showed that the global percentage of correct predictions exceeded chance by almost 15%. Based on this analysis, the scale was determined to be valid.

CONCLUSIONS

The proposed objective of verifying the psychometric properties of the Nemesis scale was fulfilled, as the scale has adequate reliability and validity.

Incidence and Length of Sickness Absence among Hierarchical Occupational Classes and Non-Wage-Earners: A Register Study of 1.6 Million Finns

Socioeconomic differences in sickness absence are well known, but previous studies have tended to focus on wage earners only. This study examined incidence and length of sickness absence comparing the employee groups of upper and lower non-manual employees and manual workers, but also entrepreneurs, the unemployed and other non-wage-earners. The study utilized register data on a nationally representative 70% sample of Finns aged 25–62 at the end of year 2012 (N = 1,615,352). Sickness absence spells compensated by sickness allowance and initiated during 2013 were retrieved from the register of the Social Insurance Institution of Finland (SIIF) and followed until the end of each episode and linked to socio-demographic covariates collected from the registers of the SIIF and of Statistics Finland. Zero-inflated negative binomial regression was used in multivariate models. After adjusting for age, marital status, region and income, there were clear differences in the occurrence and length of sickness absence across socioeconomic groups. Compared to upper non-manual employees, lower non-manual employees and especially manual workers had higher cumulative annual incidence of sickness absence among both men and women, but the entrepreneurs, the unemployed and other non-wage-earners had a clearly higher expected number of sickness absence days. Results varied by diagnostic group. The results highlight the importance of different types of preventive measures for reducing the occurrence of sickness absence and for preventing prolongations of sickness absence spells in different socioeconomic groups.

The Influence of Unemployment and Disability Status on Clinical Outcomes in Patients Receiving Surgery for Low Back-Related Disorders: An Observational Study

Introduction

Employment status plays an essential role as a social determinant of health.

Unemployed are more likely to have a longer length of hospital stay and a nearly twofold greater rate of 30 day readmission than those who were well employed at the time of back surgery. This study aimed to investigate whether employment status influenced post-surgery outcomes and if so, the differences were clinically meaningful among groups.

Methods

This retrospective observational study used data from the Quality Outcomes Database Lumbar Registry. Data refinement was used to isolate individuals 18 to 64 who received primary spine surgeries and had a designation of employed, unemployed, or disabled. Outcomes included 12 and 24 month back and leg pain, disability, patient satisfaction, and quality of life. Differences in descriptive variables, comorbidities, and outcomes measures (at 12 and 24 months) were analyzed using chi-square and linear mixed-effects modeling. When differences were present among groups, we evaluated whether they were clinically significant or not.

Results

Differences (between employed, unemployed, and disabled) among baseline characteristics and comorbidities were present in nearly every category (p<0.01). In all cases, those who were disabled represented the least healthy, followed by unemployed, and then employed. Clinically meaningful differences for all outcomes were present at 12 and 24 months (p<0.01). In post hoc analyses, differences between each group at nearly all periods were found.

Conclusions

The findings support that the health-related characteristics are markedly different among employment status groups. Group designation strongly differentiated outcomes. These findings suggest that disability and unemployment should be considered when determining prognosis of the individual.

The Implementation and Evaluation of the South African Adaptation of the JOBS Program

No validated intervention that specifically addresses the psychosocial needs of unemployed people exists in the South African context. This study intends to evaluate an evidence-based job-search program, called the JOBS intervention, that is aimed at the self-efficacy, amotivation, and self-esteem related to participants searching for jobs. A quasi-experimental research design was used. Convenient samples were taken of unemployed individuals from two low-income communities (N = 130; experimental group = 69; control group = 61). The Qhubekela Phambili program, which is based on the JOBS program, was adapted for the South African context and was implemented over six 4-h sessions. Data collection took place pre- and post-intervention. One-way repeated measures multivariate analysis of variance was used to analyze the data. Those who had undergone the intervention showed statistically significantly higher levels of job-search self-efficacy and self-esteem. This study makes a novel contribution to the literature on the JOBS program, particularly regarding developing countries. This study showed that in a context characterized by poverty and a lack of support for the unemployed, the program also delivered promising results. It confirms previous findings that the JOBS program is suitable in a variety of labor market and economic conditions.

Explaining Job Search Behavior in Unemployed Youngsters Beyond Perceived Employability: The Role of Psychological Capital

Job search seems to be a daunting task for youngsters in the Spanish labor market, unfortunately so given that it is the best predictor of getting a job even during economic crisis. Accordingly, it is vitally important to find resources that promote youngsters’ job search. The present study examines the effect of psychological capital on job search through perceived employability in a sample of Spanish unemployed youngsters. We analyzed data of 568 Spanish unemployed youngsters aged 16–29 years using structural equation modeling. Results showed that unemployed youngsters who possess high levels of psychological capital also perceive more control over job search which is directly connected with their job search intention. Surprisingly, analyses also showed that perceived employability is not an antecedent of job search. Instead, psychological capital seems to be a more beneficial resource for keeping unemployed youngsters engaged in job search in an adverse economic context.

Unemployment and mental health in the German population: the role of subjective social status

Purpose

Subjective social status (SSS) reflects individuals’ perceived position in a social hierarchy. Low SSS is associated with several mental health impairments. The aim of this cross-sectional study was to examine if unemployed individuals report lower SSS in Germany (national SSS) and lower SSS in their social community (local SSS) than employed individuals. Moreover, the relationship between unemployment, SSS, and mental health was examined.

Patients and methods

113 unemployed and 1117 employed individuals from a representative German panel provided information on their national and local SSS, their monthly income and their mental health. SSS was assessed with the German version of the MacArthur Scales. Mental health was measured using the mental component scale (MCS) of the SF-12.

Results

Unemployed individuals reported significantly lower national SSS, local SSS and mental health compared to employed participants. Mediational analyses suggest that the negative effect of employment status on mental health was explained via a reduction of national SSS. Local SSS did not mediate the association of employment status and mental health.

Conclusion

Unemployment is associated with lower SSS and reduced mental health. The perceived position relative to others in the country (ie, national SSS) mediates the association between employment status and mental health.

Restructuring of a Textile Manufacturing Company and Workers' Health

Organizational restructuring is associated with greater mortality and morbidity of the workers affected by it. We examined the quality of workers' health at a textile manufacturing company after restructuring, comparing three groups of workers: workers who remained (survivors), workers who lost their jobs and later found new jobs (the reemployed), and unemployed workers. A total of 1046 workers participated in a telephonic survey. The data were processed using SPSS and the R package version 1.2 of prLogistic. The differences between groups were calculated using the chi-square test and adjusted prevalence ratios. The comparison between the three groups shows significantly poorer mental health of the unemployed, who more often than survivors and the reemployed reported depression, as well as significant differences in elevated blood pressure, cholesterol level, and cardiac disorders. The reemployed, who were nonetheless in better health compared to the unemployed, reported poor mental health or depression more often in comparison to survivors. Higher morbidity of the unemployed and reemployed could be influenced by numerous factors associated with restructuring.

Work disabilities and unmet needs for health care and rehabilitation among jobseekers: a community-level investigation using multidimensional work ability assessments

OBJECTIVE

Comprehensive understanding of the prevalence and quality of work disabilities and unmet needs for health care and rehabilitation to support return to work (RTW) among jobseekers.

DESIGN

Community-level, cross-sectional analysis with multidimensional clinical work ability assessments.

SETTING

Paltamo, Finland.

PARTICIPANTS

Unemployed citizens either participating in the Full-Employment Project or long-term unemployed (n = 230, 81%).

MAIN OUTCOME MEASURES

Based on data from theme interviews, patient records, supervisors' observations of work performance and clinical examinations, a physician concluded the individual's work ability, categorised into four groups: good work ability, good work ability expected after RTW support, able to transitional work only or unable to work. These groups were cross tabulated with primary diagnoses, types of plans to support RTW, as well as categories of social functioning and motivation, for which sensitivity and specificity scores in detecting work disability were calculated.

RESULTS

Only about half of the jobseekers had good work ability, 27% were found unable to work in the open labour market and 15% even eligible for a disability pension. For 20%, care or rehabilitation was seen necessary to enable RTW. Poor supervisor- and self-rated performance at work or poor social functioning appeared as sensitive measures in detecting work disability.

CONCLUSIONS

Work disabilities and unmet needs for health care and rehabilitation are highly prevalent among jobseekers, as depicted using a multidimensional work ability assessment procedure inspired by the International Classification of Functioning (ICF). Further development of work ability assessment practices is clearly needed. KEY POINTS Although the association of unemployment with poor health is well known, evidence on the work ability of the unemployed remains scarce. Work disabilities are common among the unemployed. Multidimensional work ability assessment among the unemployed reveals unmet needs for care and rehabilitation to support return to work. Context sensitivity may add to the accuracy of the doctor's conclusions on work ability.

The relationship between changes in employment status and mortality risk based on the Korea Labor and Income Panel Study (2003-2008)

The aim of this study was to analyze the relationship between the mortality rate and changes in employment status. This study used mortality data from the Korean Labor and Income Panel Study. To analyze the relationship between the mortality rate and changes in employment status, the population was classified into employed, unemployed, or economically inactive. Demographic and socioeconomic variables such as gender, age, educational level, annual household income, marital status, and self-rated health status were controlled. In this study, the generalized estimating equations were used to analyze the relationship between the morality rate and the changes in employment status. The mortality rate was higher (odds ratio = 4.31) among the population that experienced a change in economic status from employed to unemployed than those who maintained employment. The mortality rate for the population who became unemployed or economically inactive was higher (odds ratio = 5.05) in cases of death by disease.

How does unemployment affect self-assessed health? A systematic review focusing on subgroup effects

BACKGROUND

Almost all studies on the effect on health from unemployment have concluded that unemployment is bad for your health. However, only a few review articles have dealt with this relation in recent years, and none of them have focused on the analysis of subgroups such as age, gender, and marital status. The objective of our article is to review how unemployment relates to self-assessed health with a focus on its effect on subgroups.

METHODS

A search was performed in Web of Science to find articles that measured the effect on health from unemployment. The selection of articles was limited to those written in English, consisting of original data, and published in 2003 or later. Our definition of health was restricted to self-assessed health. Mortality- and morbidity-related measurements were therefore not included in our analysis. For the 41 articles included, information about health measurements, employment status definitions, other factors included in the statistical analysis, study design (including study population), and statistical method were collected with the aim of analysing the results on both the population and factor level.

RESULTS

Most of the studies in our review showed a negative effect on health from unemployment on a population basis. Results at the factor levels were most common for gender (25 articles), age (11 articles), geographic location (8 articles), and education level (5 articles). The analysis showed that there was a health effect for gender, age, education level, household income, and geographic location. However, this effect differed between studies and no clear pattern on who benefits or suffers more among these groups could be determined. The result instead seemed to depend on the study context. The only clear patterns of association found were for socioeconomic status (manual workers suffer more), reason for unemployment (being unemployed due to health reasons is worse), and social network (a strong network is beneficial).

CONCLUSIONS

Unemployment affects groups of individuals differently. We believe that a greater effort should be spent on specific groups of individuals, such as men or women, instead of the population as a whole when analysing the effect of unemployment on health.

[Public health issues of the Roma and non-Roma unemployed in the Ózd microregion of Hungary]

INTRODUCTION

In their previous studies authors of the present work showed that public health situation and socioeconomic position of unemployed Roma persons in the Ozd microregion were well below the average of the whole Hungarian population.

AIM

To continue these previous studies, the authors wanted to determine whether the greater proportion of the unemployed Roma persons in the Ózd microregion compared to the country average could contribute to the worse public health situation and the poor hygienic situation of the living environment of unemployed persons hardly or not suitable for learning.

METHOD

Data from 400 unemployed Roma (96 males, 97 females) and caucasian non-Roma subjects (114 males, 93 females) obtained in 2012 and 2013 using self-completed and interview questionnaires were analysed. In addition, occupational medical examination methods were applied and the results were analysed.

RESULTS

It was found that all studied parameters (public health and epidemiological safety, in-door living environmental hygiene, conditions for learning) indicated significantly disadvantaged situation of the Roma compared to the non-Roma unemployed persons. There was a clear relationship between these examined parameters and other factors adversely influencing the quality of life of Roma persons (unemployment, deep poverty, lower level of education, shorter life span). Finally, the results showed that the quality of life conditions of the lowest 1/10, 1/5 of the non-Roma unemployed persons were comparable to those found in the average of Roma unemployed persons.

CONCLUSIONS

The authors conclude that i) the greater proportion of unemployed Roma persons in the Ozd microregion contributes to the worse public health, epidemiological safety and the worse living conditions of unemployed persons in this regions of the country; ii) It would be essential to provide Roma persons with conditions appropriate for learning, which could enable them to get qualification necessary for employment.

The mediating role of self-efficacy in the relationship between Big five personality and depressive symptoms among Chinese unemployed population: a cross-sectional study

BACKGROUND

Besides the rapid growth of economy, unemployment becomes a severe socio-economic problem in China. The huge population base in China makes the unemployed population a tremendously huge number. However, health status of unemployed population was ignored and few studies were conducted to describe the depressive symptoms of unemployed individuals in China. This study aims to examine the relationship between Big five personality and depressive symptoms and the mediating role of self-efficacy in this relationship.

METHODS

This cross-sectional study was performed during the period of July to September 2011. Questionnaires consisting of the Center for Epidemiologic Studies Depression Scale (CES-D), the Big Five Inventory (BFI) and the General Self-efficacy Scale (GSE), as well as demographic factors, were used to collect information of unemployed population. A total of 1,832 individuals (effective response rate: 73.28%) became our subjects. Hierarchical linear regression analyses were performed to explore the mediating role of self-efficacy.

RESULTS

The prevalence of depressive symptoms was 67.7% among Chinese unemployed individuals. After adjusting for demographic characteristics, extraversion, agreeableness and conscientiousness were all negatively associated with depressive symptoms whereas neuroticism was positively associated with depressive symptoms. The proportion of mediating effect of self-efficacy in the relationship between extraversion/agreeableness/conscientiousness/neuroticism and depressive symptoms was 25.42%, 10.91%, 32.21% and 36.44%, respectively. Self-efficacy is a mediator in the relationship between extraversion/agreeableness/conscientiousness/neuroticism and depressive symptoms.

CONCLUSION

Self-efficacy partially mediated the relationship between Big five personality and depressive symptoms among Chinese unemployed individuals. Interventions that focus on both individuals' personality and self-efficacy may be most successful to reduce depressive symptoms of unemployed individuals.

Primary health care services in activation and employment

Introduction

The evaluation research was conducted to establish the role of primary health care in the process of rehabilitation, activation and employment of the long-term unemployed citizens. Empirical data was gathered from 17 municipal projects. Projects aimed to develop health care services for the unemployed and to improve co-operation between health care services and local activation and employment services.

Theory

The theory of transitional labour markets was used as a framework for the evaluation [1]. The aim of activation is to encourage people to make transitions towards the labour markets or other desired activity (education, pension etc.). Health care services were constructed as one possible factor enabling transitions from unemployment. Inter-agency co-operation between state and municipal actors is crucial in activation processes.

Methods

The research was conducted from the perspective of process evaluation. Data consists of surveys, interviews and case-studies. Data from the surveys was analyzed with SPSS using descriptive statistics. Content analysis was used for the qualitative data.

Results and conclusions

Many of the long-term unemployed clients needed health care services and counselling besides social and employment services. Transitions to rehabilitation or pension become possible only after a medical assessment of persons' working ability has been made. During the evaluation period transitions to work, rehabilitation or pension were very rare among the clients. Co-operation between primary health care and activation services improved during the projects. The public health nurses in the projects worked as case-managers. The level of integration of health care services and activation services varied in the municipalities. The role of primary health care is important in recognizing health factors that can hinder employment and in initiating rehabilitation processes.