Precarious employment and mental health in the Belgian service voucher system: the role of working conditions and perceived financial strain.

INTRODUCTION: Jobs in domestic cleaning are often conceived as 'precarious employment' (PE)-i.e. a multidimensional concept referring to accumulated adverse characteristics of employment due to workers' weak bargaining position. Against this background, the Belgian service voucher system (SVS) was implemented aimed at creating formal and stable, subsidized domestic services jobs. PURPOSE: The current study assesses the relationship between PE and mental health (WHO5) in the Belgian SVS, accounting for the potential mediating role of working conditions and perceived financial strain at the household level. METHODS: We analysed a cross-sectional sample of 1,115 Belgian SVS domestic cleaners, collected in 2019 through an online survey. A mediation model was estimated. RESULTS: The crude effect of PE on adverse mental health was strong (ß 0.545-S.E. 0.063). However, 50% of the association between PE and mental well-being was mediated by work task characteristics (quantitative demands, physical demands, task variation and autonomy) and 25% by household-level perceived financial strain. The remaining direct effect of PE on adverse mental well-being is ß 0.066 (S.E. 0.032-25% of the total effect). CONCLUSION: These findings are the first based on the Belgian Employment Precariousness Scale (EPRES-BE) and are consistent with earlier-made-but seldom simultaneously tested-assumptions on the mechanisms relating PE to adverse mental health-i.e. involving direct associations and indirect associations via adverse working conditions and material deprivation. Based on the results, we recommend more democratic and higher-quality management practices in the SVS, in addition to higher wages and working time reduction.

Employment trajectories and mental health-related disability in Belgium.

OBJECTIVES: An individual's quality of employment over time has been highlighted as a potential determinant of mental health. With mental ill-health greatly contributing to work incapacities and disabilities in Belgium, the present study aims to explore whether mental health, as indicated by registered mental health-related disability, is structured along the lines of employment quality, whereby employment quality is assessed over time as part of individuals' labour market trajectories. METHODS: Using administrative data from the Belgian Crossroads Bank for Social Security over 16 quarters between 2006 and 2009, transitions between waged jobs of varying quality (based on dimensions of income, working time, employment stability and multiple jobholding), self-employment, and unemployment are considered among individuals in the labour force aged 30-40 at baseline (n = 41,065 women and 45,667 men). With Multichannel Sequence Analysis and clustering, we constructed ideal types of employment trajectories. Fitting Cox regressions, we then evaluated individuals' hazard of experiencing a disability from a mental disorder between 2010 and 2016. RESULTS: Our analysis highlights various gender-specific trajectories. Among both genders, individuals exposed to near-constant unemployment over the initial 4 years showed the highest hazard of subsequent mental health-related disability compared to a group characterised by stable full-time employment, single jobholding, and above-median income. Trajectories involving a higher probability of subsidised and non-standard employment and (potential) spells of unemployment and lower relative income were also strong predictors of cause-specific disabilities. Health selection and confounding might, however, be contributing factors. CONCLUSIONS: Our study shows a gradient of mental disorders resulting in a disability along trajectory types. Our findings highlight the predictive power of labour market trajectories and their employment quality for subsequent mental disorder-related disability. Future research should examine the mechanisms, including selection effects in this association.

Precarious employment and mental health across European welfare states: a gender perspective.

OBJECTIVE: The aim of this article was to examine the relationship between precarious employment (PE), welfare states (WS) and mental health in Europe from a gender perspective. METHODS: Data were derived from the European Working Conditions Survey 2015. PE was measured through the Employment Precariousness Scale for Europe (EPRES-E), validated for comparative research in 22 European countries, and categorized into quartiles. Countries were classified into Continental, Anglo-Saxon, Scandinavian, Southern and Central-Eastern WS. Mental health was assessed through the WHO-5 Well-Being Index and dichotomized into poor and good mental health. In a sample of 22,555 formal employees, we performed gender-stratified multi-level logistic regression models. RESULTS: Results showed greater prevalences of PE and poor mental health among women. However, the association between them was stronger among men. Cross-country differences were observed in multi-level regressions, but the interaction effect of WS was only significant among women. More precisely, Central-Eastern WS enhanced the likelihood of poor mental health among women in high precarious employment situations (quartiles 3 and 4). CONCLUSIONS: These findings suggest the interaction between contextual and individual factors in the production of mental health inequalities, both within and across countries. They also call for the incorporation of gender-sensitive welfare policies if equitable and healthy labor markets are to be achieved in Europe.

Health-improving interventions for obtaining employment in unemployed job seekers.

BACKGROUND: Unemployment is associated with decreased health which may be a reason or a consequence of becoming unemployed. Decreased health can inhibit re-employment. OBJECTIVES: To assess the effectiveness of health-improving interventions for obtaining employment in unemployed job seekers. SEARCH METHODS: We searched (3 May 2018, updated 13 August 2019) the Cochrane Central Register of Controlled Trials, MEDLINE, Scopus, PsycINFO, CINAHL, SocINDEX, OSH Update, ClinicalTrials.gov, the WHO trials portal, and also reference lists of included studies and selected reviews. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of the effectiveness of health-improving interventions for obtaining employment in unemployed job seekers. The primary outcome was re-employment reported as the number or percentage of participants who obtained employment. Our secondary outcomes were health and work ability. DATA COLLECTION AND ANALYSIS: Two authors independently screened studies, extracted outcome data, and assessed risk of bias. We pooled study results with random-effect models and reported risk ratios (RRs) with 95% confidence intervals (CIs) and assessed the overall quality of the evidence for each comparison using the GRADE approach. MAIN RESULTS: We included 15 randomised controlled trials (16 interventions) with a total of 6397 unemployed participants. Eight studies evaluated therapeutic interventions such as cognitive behavioural therapy, physical exercise, and health-related advice and counselling and, in seven studies, interventions were combined using therapeutic methods and job-search training. Therapeutic interventions Therapeutic interventions compared to no intervention may increase employment at an average of 11 months follow-up but the evidence is very uncertain (RR = 1.41, 95% CI 1.07 to 1.87, n = 1142, 8 studies with 9 interventions, I² = 52%, very low-quality evidence). There is probably no difference in the effects of therapeutic interventions compared to no intervention on mental health (SMD 0.12, 95% CI -0.06 to 0.29, n = 530, 2 studies, low-quality evidence) and on general health (SMD 0.19, 95% CI -0.04 to 0.41, n = 318, 1 study, moderate-quality evidence). Combined interventions Combined interventions probably increase employment slightly compared to no intervention at an average of 10 months follow-up (RR 1.12, 95% CI 1.06 to 1.20, n = 4101, 6 studies, I² = 7%). There were no studies that measured work-ability, adverse events, or cost-effectiveness. AUTHORS' CONCLUSIONS: Interventions combining therapeutic methods and job-search training probably have a small beneficial effect in increasing employment. Therapeutic interventions may have an effect on re-employment, but we are very uncertain. Therapeutic interventions may not improve health in unemployed job seekers. Large high-quality RCTs targeting short-term or long-term unemployed people are needed to increase the quality of the evidence. A cost-effectiveness assessment is needed of the small beneficial effects.

Perceptions and decision-making with regard to pregnancy among HIV positive women in rural Maputo Province, Mozambique - a qualitative study.

BACKGROUND: In preventing the transfer of HIV to their children, the Ministry of Health in Mozambique recommends all couples follow medical advice prior to a pregnancy. However, little is known about how such women experience pregnancy, nor the values they adhere to when making childbearing decisions. This qualitative study explores perceptions and decision-making processes regarding pregnancy among HIV positive women in rural Maputo Province. METHODS: In-depth interviews and five focus group discussions with fifty-nine women who had recently become mothers were carried out. In addition, six semi-structured interviews were held with maternity and child health nurses. The ethnographic methods employed here were guided by Bourdieu's practice theory. RESULTS: The study indicated that women often perceived pregnancy as a test of fertility and identity. It was not only viewed as a rite of passage from childhood to womanhood, but also as a duty for married women to have children. Most women did not follow recommended medical advice prior to gestation. This was primarily due to perceptions that decision-making about pregnancy was regarded as a private issue not requiring consultation with a healthcare provider. Additionally, stigmatisation of women living with HIV, lack of knowledge about the need to consult a healthcare provider prior to pregnancy, and unintended pregnancy due to inadequate use of contraceptive were crucial factors. CONCLUSION: Women's experiences and decisions regarding pregnancy are more influenced by social and cultural norms than medical advice. Therefore, education concerning sexual and reproductive health in relation to HIV/AIDS and childbearing is recommended. In particular, we recommend maternal and child healthcare nurses need to be sensitive to women's perceptions and the cultural context of maternity when providing information about sexual and reproductive health.

Underemployment, overemployment and deterioration of mental health: the role of job rewards.

OBJECTIVES: Working more (overemployment) or less (underemployment) than preferred has been associated with poor mental health in cross-sectional studies, but longitudinal evidence is scarce. We investigate whether under- and overemployment is associated with 2-year changes of mental health and whether associations vary by job rewards (i.e. high earnings, job security, promotion prospects and occupational prestige). METHODS: We used two waves of the German Socio-Economic Panel (GSOEP), with information on mental health collected in 2006 and 2008. Workers in paid employment (3266 men and 3139 women) who did not change jobs between 2006 and 2008, aged 20-60 years were selected. Under- and overemployment was assessed using the discrepancy between the actual and preferred working hours. Mental health was assessed using the Mental Component Summary (MCS) score, a subscale from the Short Form 12 Health Survey. Questions on rewards at work were added and divided into tertiles. Conditional change models were estimated to predict change in MCS. RESULTS: Findings indicate that overemployment and low reward at work (for men and women) were linked to a reduction in mental health. Underemployment was not related to a reduction in mental health. Albeit associations between under-/overemployment and mental health slightly differed across levels of reward, interactions did not reach statistical significance. CONCLUSIONS: Our findings demonstrate that overemployment was related to negative mental health change, and that this relationship held true both for people with high and with low reward at work.

New perspectives on occupational health and safety in immigrant populations: studying the intersection between immigrant background and gender.

OBJECTIVES: Few studies investigating health inequalities pay attention to the intersection between several social determinants of health. The purpose of this article is to examine the relation between perceptions of work-related health and safety risk (WHSR) and (1) immigrant background and (2) gender in the EU-15. The effects are controlled for educational attainment, the quality of work (QOW) and occupation. DESIGN: Pooled data from the European Social Survey 2004 and 2010 are used in this study. The sample is restricted to respondents of working age (16-65 years) (N = 17,468). The immigrants are divided into two groups according to their country of origin: (semi-)periphery and core countries. Both groups of immigrants are compared to natives. Additionally, the research population is stratified by gender. Descriptive statistics and logistic regression analyses are used. RESULTS: Core immigrants (both men and women) do not differ from natives in terms of QOW. (Semi-)periphery immigrants (both men and women) are employed in jobs with lower QOW. While no differences in WHSR are found among men, female immigrants (both (semi-)periphery and core) have significantly more WHSR compared to native women. Although WHSR is generally lower in women, (semi-)periphery women have a similar prevalence of WHSR as men. CONCLUSION: (Semi-)periphery immigrants are employed in lower quality jobs, while core immigrants do not differ from natives in that regard. Female immigrant workers--especially those from (semi-)periphery countries--have higher WHSR compared to native women. Our findings highlight the importance of an intersectional approach in the study of work-related health inequalities.

Mortality in adult immigrants in the 2000s in Belgium: a test of the 'healthy-migrant' and the 'migration-as-rapid-health-transition' hypotheses.

OBJECTIVE: Firstly, to map out and compare all-cause and cause-specific mortality patterns by migrant background in Belgium; and secondly, to probe into explanations for the observed patterns, more specifically into the healthy-migrant, acculturation and the migration-as-rapid-health-transition theories. METHODS: Data comprise individually linked Belgian census-mortality follow-up data for the period 2001-2011. All official inhabitants aged 25-54 at time of the census were included. To delve into the different explanations, differences in all-cause and chronic- and infectious-disease mortality were estimated using Poisson regression models, adjusted for age, socioeconomic position and urbanicity. RESULTS: First-generation immigrants have lower all-cause and chronic-disease mortality than the host population. This mortality advantage wears off with length of stay and is more marked among non-Western than Western first-generation immigrants. For example, Western and non-Western male immigrants residing 10 years or more in Belgium have a mortality rate ratio for cardiovascular disease of 0.72 (95% CI 0.66-0.78) and 0.59 (95% CI 0.53-0.66), respectively (vs host population). The pattern of infectious-disease mortality in migrants is slightly different, with rather high mortality rates in first-generation sub-Saharan Africans and rather low rates in all other immigrant groups. As for second-generation immigrants, the picture is gloomier, with a mortality disadvantage that disappears after control for socioeconomic position. CONCLUSION: Findings are largely consistent with the healthy-migrant, acculturation and the migration-as-rapid-health-transition theories. The convergence of the mortality profile of second-generation immigrants towards that of the host population with similar socioeconomic position indicates the need for policies simultaneously addressing different areas of deprivation.

Labour market trajectories and early retirement due to permanent disability: a study based on 14 972 new cases in Spain.

BACKGROUND: To analyse the impact of labour market trajectory indicators on early retirement, measured by age at onset of permanent disability (PD). METHODS: Four labour market trajectory indicators were reconstructed in 14 972 new cases of PD recognized between 2004 and 2010: (1) number of employment contracts, (2) number of unemployment periods, (3) number of periods without social security affiliation and (4) percentage of time spent in inactivity. The outcome was measured as the age at onset of PD. Median differences and 95% confidence intervals (95%CI) were compared using a median regression. Analyses were stratified by sex and adjusted for occupational category and total time elapsed between the beginning of working life and the age at onset of PD: separately for each labour market indicator, and adjusted for each other. RESULTS: In men, the age at the onset of PD for workers with 15 or more employment contracts decreased by 4.8 years; and for workers with five or more periods without affiliation it decreased by 4.6 years. In women, the corresponding decreases were 5.8 years for 15 or more contracts and 7.2 years for five or more unaffiliated periods. The results for four indicators slightly changed when they were mutually adjusted. CONCLUSIONS: Poor employment conditions, such as having a high number of periods without affiliation, a high number of contracts (in men) and a higher percentage of inactive time (in women) are associated with early retirement due to PD.

Contemporary employment arrangements and mental well-being in men and women across Europe: a cross-sectional study.

INTRODUCTION: There is the tendency in occupational health research of approximating the 'changed world of work' with a sole focus on the intrinsic characteristics of the work task, encompassing the job content and working conditions. This is insufficient to explain the mental health risks associated with contemporary paid work as not only the nature of work tasks have changed but also the terms and conditions of employment. The main aim of the present study is to investigate whether a set of indicators referring to quality of the employment arrangement is associated with the well-being of people in salaried employment. Associations between the quality of contemporary employment arrangements and mental well-being in salaried workers are investigated through a multidimensional set of indicators for employment quality (contract type; income; irregular and/or unsocial working hours; employment status; training; participation; and representation). The second and third aim are to investigate whether the relation between employment quality and mental well-being is different for employed men and women and across different welfare regimes. METHODS: Cross-sectional data of salaried workers aged 15-65 from 21 EU-member states (n =11,940) were obtained from the 2010 European Social Survey. Linear regression analyses were performed. RESULTS: For both men and women, and irrespective of welfare regime, several sub-dimensions of low employment quality are significantly related with poor mental well-being. Most of the significant relations persist after controlling for intrinsic job characteristics. An insufficient household income and irregular and/or unsocial working hours are the strongest predictors of poor mental well-being. A differential vulnerability of employed men and women to the sub-dimensions of employment quality is found in Traditional family and Southern European welfare regimes. CONCLUSIONS: There are significant relations between indicators of low employment quality and poor mental well-being, also when intrinsic characteristics of the work task are controlled. Gender differences are least pronounced in Earner-carer countries.

Structural and intermediary determinants of social inequalities in the mental well-being of European workers: a relational approach.

BACKGROUND: The objective of this study is to examine social inequalities in employee mental well-being, using relational social class indicators. Relational social class indicators are based on theoretical insights about the mechanisms generating social (health) inequalities. Additionally, it is examined whether the psychosocial work environment and employment quality act as intermediary determinants of social class inequalities in mental well-being, simultaneously testing the mediation (differential exposure) and moderation (differential vulnerability) hypotheses. METHODS: Data from the European Social Survey Round 2 (2004/5) and Round 5 (2010) were analysed. Mental well-being was assessed by the WHO Well-being Index. The measure for social class was inspired by E.O. Wright's class scheme. Three-level linear multilevel modelling was used to account for clustering of employees within research years and countries. RESULTS: We found social class inequalities in mental well-being in the European working population for both men and women. Compared to unskilled workers, managers reported the best mental well-being, while supervisors held an intermediary position. As regards the mediation hypothesis, an unfavourable psychosocial work environment and low-quality employment conditions mediated the relation between social class and poor mental well-being in both men and women. However, low quality of employment relations only mediated the "social class-mental well-being" association in the male sample. As regards the moderation hypothesis, modification effects were seen for the psychosocial work environment and employment conditions in both men and women. CONCLUSION: Relational indicators of social class are related to mental well-being in European employees. Relational accounts of social class are complementary to stratification indicators in social epidemiology. From a policy perspective, better employee mental well-being and less social class inequality could be achieved through initiatives addressing the unequal social relations generated by structural positions in the labour process.

Measuring employment precariousness in gig jobs: A pilot study among food couriers in Brussels1.

BACKGROUND: Within the extensive literature on precarious working conditions in the gig economy, remarkably little attention has been paid to how we can formally assess precarity. The few existing measurement instruments that seek to capture precarity in the gig economy assess the characteristics of platforms as job providers, but do not consider the situation of individual gig workers. Moreover, these approaches do not account for the different employment statuses of gig workers. OBJECTIVE: This research's objective was to adapt, test and validate the Employment Precariousness Scale (EPRES) to the context of food couriers in Belgium. METHODS: Fieldwork observations were combined with primary survey-data (N = 123). The scale was validated by testing reliability and external validity. RESULTS: Although the small sample size requires caution, the EPRES-gw (i.e., our adaptation for 'gig work') indicated sound reliability through sufficiently high internal consistency. The scale also showed good external validity through a significant positive correlation with poor well-being. CONCLUSION: The scale's characteristics in empirical analyses compare to previous research using the EPRES among employees. The EPRES-gw is therefore a promising instrument for studying employment precariousness in gig jobs.

Does employment status matter for job quality? A cross-national perspective.

BACKGROUND: Dual labour market theory raises questions about the relationship between non-standard employment and job quality. While scattered empirical evidence exists, there is a paucity of systematic evidence on the relationship between workers' employment status and job quality. OBJECTIVE: The authors investigated the relation between workers' employment status (e.g., open-ended, long- and short-term fixed contracts, economically dependent and independent solo self-employment, and self-employment with employees) and important dimensions of job quality (JQ) (e.g., employment prospects, physical work environment, skills and discretion, and working times quality). Cross-national variation in that relation and causes of that variation (e.g., country-level unemployment rate and labour market efficiency) were also investigated. METHODS: Hierarchical regression modelling was applied using a sample of 34,094 workers from the European Working Conditions Survey 2015. RESULTS: The study highlighted a negative association between fixed-term contracts and JQ. For self-employed workers (except economically dependent self-employed workers) a generally positive association was observed. In this study, also positive associations were found between labour market efficiency at the country-level and some JQ indicators. National unemployment rates were negatively associated to most JQ indicators. CONCLUSION: Non-standard employment contracts exhibited poorer job quality than open-ended contracts. Stronger labour market organization centred around indicators of both flexibility and equity related to more beneficial job quality for all employment statuses, thereby promoting more labour market inclusivity.

Design and development of a digital intervention for workplace stress and mental health (EMPOWER).

Purpose: We describe the design and development of the European Platform to Promote health and wellbeing in the workplace (EMPOWER) digital intervention that provides an integrative user programme meeting the needs of employees and employers in addressing work stress. Results: A user-centred design process was followed from January 2020 until November 2021. A tailored algorithm was developed to provide support at the individual employee level and the company level. Each element of the digital intervention was developed in English and then translated in Spanish, English, Polish and Finnish. The digital intervention consists of a website and a mobile application (app) that provides algorithm-based personalised content after assessing a user's somatic and psychological symptoms, work functioning, and psychosocial risk factors for work stress. It has a public section and an employer portal that provides recommendations to reduce psychosocial risks in their company based upon clustered input from employees. Usability testing was conducted and showed high ease of use and completion of tasks by participants. Conclusion: The EMPOWER digital intervention is a tailored multimodal intervention addressing wellbeing, work stress, mental and physical health problems, and work productivity. This will be used in a planned RCT in four countries to evaluate its effectiveness.

The Public's Perceptions of Air Pollution. What's in a Name?

Air pollution is a major global health threat. There is growing evidence for a negative effect of air pollution on health and well-being. Relationships between air pollution and health are mediated by health risk perceptions and play a crucial role in public response to it. Air pollution in the public's mind is often different from air pollution defined by the scientific community. Therefore, in order to develop successful prevention and alleviation strategies, an understanding of public risk perceptions is key. The central question of this paper is: 'How does "the public" (in Brussels) perceive air pollution?' This research is an attempt to enrich the limited body of qualitative research in the field, approaching the topic of perception from 4 different, complementary angles: definition, association, categorisation and problematisation. About 51 interviews were conducted in the Brussels-Capital Region. Consistent with earlier research, this research illustrates that perceptions of air pollution are diverse, subjective, context-dependent and often deviate from conceptualisations and definitions in the scientific community. Respondents underestimate the potential harm and problematisation depends on comparative strategies and perceived avoidability. The novel aspect of this paper is the identification of 5 mental schemes by which specific elements are categorised as being air pollution: (1) the source of the element, (2) its health impact, (3) its climate impact, (4) its functionality and (5) sensory perceptions. The insights gained from this research contribute to the field of environmental epidemiology through a better understanding of how 'the public' perceives air pollution and in what way this may deviate from how it is perceived by experts. We hope to raise the awareness among experts and policy makers that air pollution perceptions are far from universal and consensual but on the contrary individual and contested.

Identifying cleaning products associated with short-term work-related respiratory symptoms: A workforce-based study in domestic cleaners.

Domestic cleaners have an increased risk of asthma-like and other respiratory symptoms and conditions. Uncertainty exists about which products are most hazardous. We aimed to investigate, among professional domestic cleaners, the associations of ocular/respiratory outcomes with using specific types of products at work and with the ability to choose their own products. Among domestic cleaners employed by "service vouchers" companies in Belgium, we administered an online questionnaire on ocular/respiratory symptoms (frequency and time relation to workdays), frequency of use of 40 types of products, and ability to choose one's own products. Work-relatedness was defined as symptoms improving/disappearing on days off-work. We studied associations between frequency of product-use with work-related outcomes (eye irritation, rhinitis symptoms, sore throat, laryngeal symptoms, asthma symptoms, cough) and with chronic bronchitis, using multivariable logistic and elastic net regression. Adjusted odds ratios (OR) with 95%-confidence intervals were obtained per time a product was used per week. Among 1,586 domestic cleaners (99% women), the number of times sprays were used (median 13/week) was significantly associated with all outcomes (ORs between 1.012 and 1.024 per time sprays were used per week). Bleach/disinfectant-containing liquid products were associated with all outcomes, except for laryngeal symptoms (ORs 1.086 to 1.150); ammonia with work-related upper airway symptoms and chronic bronchitis. Cleaners able to choose their own products had fewer work-related eye symptoms (OR 0.728;0.556-0.954), rhinitis (OR 0.735;0.571-0.946) and cough (OR 0.671;0.520-0.865). Using elastic net regression, work-related rhinitis was most strongly associated with mould removal spray (OR 1.108;1.006-1.248), carpet/seat/curtain spray (OR 1.099;1.001-1.304) and ammonia (OR 1.081;1.002-1.372); work-related asthma with carpet/seat/curtain spray (OR 1.103;1.017-1.322), mould removal spray (OR 1.029;0.995-1.199) and drain cleaner (OR 1.023;0.979-1.302). In a large group of domestic cleaners, we documented that cleaning products have a range of adverse respiratory effects. Empowering cleaners to choose their products may reduce the burden of symptoms.

Non-Standard Employment and Unemployment during the COVID-19 Crisis: Economic and Health Findings from a Six-Country Survey Study.

The COVID-19 crisis is a global event that has created and amplified social inequalities, including an already existing and steadily increasing problem of employment and income insecurity and erosion of workplace rights, affecting workers globally. The aim of this exploratory study was to review employment-related determinants of health and health protection during the pandemic, or more specifically, to examine several links between non-standard employment, unemployment, economic, health, and safety outcomes during the COVID-19 pandemic in Sweden, Belgium, Spain, Canada, the United States, and Chile, based on an online survey conducted from November 2020 to June 2021. The study focused on both non-standard workers and unemployed workers and examined worker outcomes in the context of current type and duration of employment arrangements, as well as employment transitions triggered by the COVID-19 crisis. The results suggest that COVID-19-related changes in non-standard worker employment arrangements, or unemployment, are related to changes in work hours, income, and benefits, as well as the self-reported prevalence of suffering from severe to extreme anxiety or depression. The results also suggest a link between worker type, duration of employment arrangements, or unemployment, and the ability to cover regular expenses during the pandemic. Additionally, the findings indicate that the type and duration of employment arrangements are related to the provision of personal protective equipment or other COVID-19 protection measures. This study provides additional evidence that workers in non-standard employment and the unemployed have experienced numerous and complex adverse effects of the pandemic and require additional protection through tailored pandemic responses and recovery strategies.

Study protocol of EMPOWER: A cluster randomized trial of a multimodal eHealth intervention for promoting mental health in the workplace following a stepped wedge trial design.

Objective: This article describes the EMPOWER study, a controlled trial aiming to determine the effectiveness and cost-effectiveness of an eHealth intervention to prevent common health problems and reduce presenteeism and absenteeism in the workplace. Intervention: The EMPOWER intervention spans universal, secondary and tertiary prevention and consists of an eHealth platform delivered via a website and a smartphone app designed to guide employees throughout different modules according to their specific profiles. Design: A stepped-wedge cluster randomized trial will be implemented in four countries (Finland, Poland, Spain and UK) with employees from small and medium enterprises (SMEs) and public agencies. Companies will be randomly allocated in one of three groups with different times at which the intervention is implemented. The intervention will last 7 weeks. Employees will answer several questionnaires at baseline, pre- and post-intervention and follow-up. Outcome measures: The main outcome is presenteeism. Secondary outcomes include depression, anxiety, insomnia, stress levels, wellbeing and absenteeism. Analyses will be conducted at the individual level using the intention-to-treat approach and mixed models. Additional analyses will evaluate the intervention effects according to gender, country or type of company. Cost-effectiveness and cost-utility analyses [based on the use of quality-adjusted life-years (QALYS)] will consider a societal, employers' and employees' perspective.

Employment precariousness in Spain: prevalence, social distribution, and population-attributable risk percent of poor mental health.

As a consequence of labor market flexibilization, nonstandard employment has expanded and standard employment has declined. In many cases, these transformations are best described as an evolution toward precarious employment, which is considered a major determinant of health and health inequalities. Using the Employment Precariousness Scale (EPRES), this study aims to determine the prevalence of precarious employment in the waged and salaried workforce in Spain, to describe its distribution across social groups defined by occupational class, gender, age, and immigrant status, and to estimate the proportion of cases of poor mental health potentially attributable to employment precariousness. Data are from the Psychosocial Work Environment Survey conducted in 2004-5 on a representative sample of the Spanish workforce. Findings indicate a high prevalence of employment precariousness, affecting nearly 6.5 million workers, with almost 900,000 of them exposed to high precariousness. These estimates are higher than the proportion of fixed-term employment reported in regular statistical sources but may today be an underestimation, given the current economic crisis. Additionally, a significant proportion of cases of poor mental health are potentially attributable to employment precariousness. Both the proportion of cases of poor mental health attributable to and the prevalence of employment precariousness were highly unequally distributed across the study sample, indicating that this may be a significant contributor to social inequalities in mental health.

Congenitally deaf children's care trajectories in the context of universal neonatal hearing screening: a qualitative study of the parental experiences.

The objective of this study is to examine the early care trajectories of congenitally deaf children from a parental perspective, starting with universal neonatal hearing screenings. The analysis using a three-dimensional care trajectory concept is aimed at developing a basic typology of postscreening care trajectories. Children with severe/profound hearing loss, registered in the Flanders' (Belgium) universal neonatal hearing screening program, born between 1999 and 2001. Thematic content analysis of qualitative data collected retrospectively from participant's parents. Two basic types of care trajectories emerged; based on differences in care-use in the phase of further diagnosis and related parental experiences. Subtypes resulted from events related to cochlear implantation. Five trajectory phases were identified: screening, further diagnosis, care and technology, cochlear implantation, and reduction of care and were characterized by specific parental experiences such as confusion, disbelief, disappointment, and uncertainty. Those experiences relate to care professionals' acts and communication and the child's functional evolution. Early care interventions could benefit from coordinated transition between phases, parent support throughout the care trajectory, and a broad approach to deafness in professionals' communication.