[How to improve community engagement in health: Analysis of proposed actions following the implementation of a community engagement assessment tool]. / ¿Cómo mejoramos la participación comunitaria en salud? Análisis de las acciones propuestas tras la aplicación de una herramienta de evaluación.

OBJECTIVE: To analyse the lines of action identified in the health promotion projects participating in the EvaluA GPS research, and their relationship with the scores assigned in EvalGuia, a tool for evaluating evidence-based community participation. DESIGN: Qualitative-quantitative multicentre study. SETTING: Primary care or intersectoral network of primary care and municipalities in five autonomous communities in Spain. PARTICIPANTS: Participants of 10 health promotion projects, selected with convenience sampling, following inclusion criteria (projects with a minimum of community engagement and centred on community health). METHOD: Data were collected through questionnaires (EvalGuía tool) and participatory workshops. Quantitative data were analysed with descriptive statistics, qualitative data were analysed using matrix analysis. RESULTS: After implementing the EvalGuide tool, the lowest scores were assigned in outcome evaluation, knowledge of policies related to community participation, diversity in the core working group, inclusivity policies, financial resources and diffusion of results. The lines of action proposed were heterogeneous and did not always match with those prioritised as lower score. The prioritised lines revolved around project organisation and communication. CONCLUSIONS: The EvalGuide tool can be helpful to design action plans in Health Promotion projects. The implementation of measures in 12 months to increase the diversity of the core working group, to incorporate work-life balance measures or to improve evaluation is difficult. More time is needed to implement such measures.

[Attend, consult, involve: do we need to redefine the concept of community engagement?] / Asistir, consultar, involucrar: ¿es necesario redefinir el concepto de participación comunitaria?

OBJECTIVE: To describe how a sample of people working in community health promotion projects perceive and implement community engagement approaches. METHOD: Mixed qualitative-quantitative study. Data was collected through: semi-structured interviews with 10 people representing the projects, and workshops in which 53 people participated and responded to a questionnaire prepared ad hoc to identify levels of community engagement. Descriptive statistical analysis of the questionnaires and framework analysis of the interviews, observations and workshops recordings. RESULTS: Although the projects are described as highly participatory, community engagement appeared mainly in the form of attending events, with few examples of consultation or community involvement. CONCLUSIONS: This difference may be due to the lack of a culture of participation, both in individuals and institutions, and lack of training in community engagement. It is proposed to change the language from participation-attendance to using expressions such as consulting or involving people.

Evaluating the implementation of community engagement guidelines (EVALUA GPS project): a study protocol.

INTRODUCTION: The EVALUA GPS project aims to evaluate the impact of the implementation of the National Institute for Health Care and Excellence (NICE) guideline 'Community engagement: improving health and well-being and reducing health inequalities' adapted to the Spanish context. METHODS AND ANALYSIS: Phase I: A tool will be designed to evaluate the impact of implementing the recommendations of the adapted NICE guideline. The tool will be developed through a review of the literature on implementation of public health guidelines between 2000 and 2021 and an expert's panel consensus. PHASE II: The developed tool will be implemented in 16 community-based programmes, acting as intervention sites, and 4 controls through a quasi-experimental pre-post study. Phase III: A final online web tool, based on all previously collected information, will be developed to support the implementation of the adapted NICE guidelines recommendations in other contexts and programmes. DATA COLLECTION AND ANALYSIS: Data will be collected through surveys and semistructured interviews. Quantitative and qualitative data will be analysed to identify implementation scenarios, changes in community engagement approaches, and barriers and facilitators to the implementation of the recommendations. All this information will be further synthesised to develop the online tool. ETHICS AND DISSEMINATION: The proposed research has been approved by the Clinical Research Ethics Committee of Aragon. Results will be presented at national and international conferences and published in peer-reviewed open access journals. The interactive online tool (phase III) will include examples of its application from the fieldwork.

Association between informal employment and mortality rate by welfare regime in Latin America and the Caribbean: an ecological study.

OBJECTIVE: We aimed to estimate the association between informal employment and mortality in Latin America and the Caribbean (LAC) by comparing welfare state regimes. DESIGN: Ecological study using time-series cross-sectional analysis of countries. Informality was estimated from household surveys by the Center for Distributive, Labor and Social Studies in collaboration with the World Bank, and the adult mortality rates for 2000-2016 were obtained from the WHO databases. Countries were grouped by welfare state regimes: state productivist, state protectionist and familialist. We calculated the compound annual growth rate for each country and performed linear regression between the informality and the adult mortality rates stratified by sex and welfare state regime. SETTING: Seventeen countries from LAC with available data on informality and adult mortality rates for 2000-2016. PRIMARY OUTCOME MEASURE: The association between informality and mortality by welfare state regime. RESULTS: Between 2000 and 2016, mortality rates decreased an average 1.3% per year and informal employment rates 0.5% per year. We found a significant positive association between informality and mortality rates (women: R2=0.48; men: R2=0.36). The association was stronger among the state regime countries (women: R2=0.58; men: R2=0.77), with no significant association among the familialist countries. CONCLUSION: Informal employment negatively impacts population health, which is modified by welfare state regimes. Addressing informal employment could be an effective way to improve population health in LAC. However, linkage with public health and labour market agendas will be necessary.

Monitoring Self-Perceived Occupational Health Inequities in Central America, 2011 and 2018.

Objectives. To analyze changes in occupational health inequity between 2011 and 2018 among workers in Central America. Methods. Data were collected by face-to-face interviews at the workers' homes for the 2 Central America Working Conditions Surveys (n = 12 024 in 2011 and n = 9030 in 2018). We estimated health inequity gaps by means of absolute and relative population attributable risks and the weighted Keppel index. We stratified all analyses by gender. Results. Between 2011 and 2018, the proportion of workers reporting poor self-perceived health decreased both in women (from 32% to 29%) and men (from 33% to 30%). However, the health inequity gaps remained wide in the 4 stratifiers. Measured by the Keppel index, health inequity gaps between countries increased from 22% to 39% in women and from 20% to 29% in men. Conclusions. While health improved between 2011 and 2018, health inequity gaps remained wide. Wider health inequity gaps were observed between countries than by gender, age, occupation, or education. Public Health Implications. This first benchmark of occupational health inequities in Central America could be useful when developing and evaluating the impact of public policies on work.

Health inequity in workers of Latin America and the Caribbean.

BACKGROUND: Latin America and the Caribbean (LAC) is the world's most inequitable region in terms of wealth distribution. The full scale of social inequalities in health has been hidden by the lack of reliable data. This study aimed to measure and compare health inequalities in the working population within and between 15 countries of LAC. METHODS: A sample of 180,163 workers aged 18 years and older was drawn from the most recent national surveys of working conditions or health in 15 LAC countries. Poor self-perceived health (P-SPH) was used as a health indicator, and age, education level, and occupational category as inequality stratifiers. We calculated four measures: absolute and relative population-attributable risks, the Kuznets and weighted Keppel indexes. RESULTS: P-SPH prevalence ranged from 9% in men from Uruguay to 50% in women from Nicaragua. It was higher in women than in men in most countries. A clear gradient was shown, in which young people in non-manual skilled jobs and high education had the lowest prevalence. Nearly 45% of cases that reported P-SPH among men and 35% among women could be avoided if all the groups received a higher level of education. Also, approximately 42% of P-SPH reported by men and 31% by women could be avoided if they all shared the working and employment conditions of non-manual skilled jobs. CONCLUSIONS: Wide health inequalities were found between occupational and educational groups in LAC. However, country borders appear to be an even more important stratifier in the production of health inequalities. Urgent interventions to improve worker's health are needed in countries where prevalence of poor self-perceived health is high. Strengthening occupational health surveillance system in LAC countries should become a priority, in order to track the interventions to reduce occupational health inequity.

Community engagement to promote health and reduce inequalities in Spain: a narrative systematic review.

OBJECTIVES: Over the past decade, increasing attention has been paid to community engagement in health (CEH) across Europe. This study aimed to identify and review CEH interventions to promote health and reduce inequalities within the Spanish context and the key facilitators for these community processes. METHODS: A systematic search in six databases, followed by a forward citation search, was conducted to identify implementation literature on CEH in Spain. Articles were included when engagement occurred in at least two stages of the interventions and was not limited to information or consultation of stakeholders. RESULTS: A total of 2023 results were identified; 50 articles were reviewed full text. Five articles were finally selected for inclusion. Data were extracted on various factors including details of the interventions, results achieved, stakeholders involved and their relationships. A narrative synthesis was performed to present results and support the discussion. CONCLUSIONS: Three main points are discussed: the role of professionals and citizens in CEH interventions, providing training to enable a reorientation towards a CEH practice and the relevance of contexts as enablers for community engagement processes to thrive.

Conflicto empleo-familia y autopercepción de la salud desde una perspectiva de género / Employment-family conflict and self-perception of health from a gender perspective

Resumen El objetivo de este estudio es analizar las desigualdades de género en la relación del conflicto empleo familia (CEF) con el estado de salud de la población trabajadora de Quito y Guayaquil. Se trata de un estudio transversal de una muestra representativa de la población trabajadora no agrícola, con edad igual o mayor a 18 años y afiliada a la seguridad social, que fue entrevistada entre 2016-2017 en la I Encuesta sobre Condiciones de Seguridad y Salud en el Trabajo de Quito y Guayaquil (n=1729). Se emplearon modelos de regresión de Poisson con varianza robusta, separados por sexo, para calcular las razones de prevalencia ajustadas de seis indicadores de salud. En ambos sexos, el CEF se asoció con mala salud autopercibida, mala salud mental, dolor o molestias de cabeza y de espalda, aunque la magnitud de asociación fue mayor en las mujeres. Además, en las mujeres el CEF se asoció con problemas digestivos (RPa=1,65; IC 95%: 1,17-2,34). En ninguno de los dos sexos se observó asociación entre el CEF y los accidentes de trabajo. Los resultados del presente estudio muestran que el CEF se asocia con malas condiciones de salud en la población trabajadora, particularmente en las mujeres. Las políticas públicas e intervenciones en los centros de trabajo dirigidas a alcanzar un equilibrio entre el empleo y la vida familiar desde una perspectiva de género podrían resultar en una reducción en los daños a la salud y en las desigualdades de género en salud.

Abstract The objective of this study is to analyze gender inequalities in the relationship between employment-family conflict (EFC) and health status in the working population of Quito and Guayaquil. This is a cross-sectional study of non-agricultural employees, aged 18 or older and covered by social security, who were interviewed between 2016-2017 in the First Survey of Safety Conditions and Health at Work of Quito and Guayaquil (n = 1729). Poisson regression models with robust variance separated by sex were used to calculate adjusted prevalence ratios for six health indicators. In both sexes, EFC was associated with poor self-perceived health, poor mental health, and head or back pain or discomfort, although the magnitude of the association was greater in women. Furthermore, EFC was associated with digestive problems only in women (aPR=1.65; 95% CI: 1.17-2.34). In neither sex was there an association between EFC and occupational accidents. The results of this study show that EFC is associated with poor health conditions in the working population, particularly among women. Public policies and workplace interventions aimed at achieving a balance between employment and family life from a gender perspective could help reduce impairments to health and gender inequalities in health.

Joint effect of paid working hours and multiple job holding on work absence due to health problems among basic education teachers in Brazil: the Educatel Study.

The objectives were to assess the joint effect of working hours paid per week and multiple job holding on sickness absence, by sex, among basic education teachers in Brazil. This study is based on a survey carried out over a representative sample of 5,116 active basic education teachers in Brazil between 2015 and 2016 (Educatel Study). We created a dummy variable to assess the joint effect of weekly paid working hours [standard (35-40 hours); part-time (< 35 hours); moderately long (41-50 hours); and very long (> 50 hours)] and multiple job holding (working in several schools - no/yes). Working 35-40 hours in one school was the reference category. We conducted Poisson regression models with robust variance to obtain prevalence ratios (PR) and 95% confidence intervals (95%CI) of the association with self-certified sickness absence and medically certified sickness absence. Models were adjusted for age, type of contract and salary, and stratified by sex. Significant associations with sickness absence were only found among teachers working in more than one school. Associations with self-certified sickness absence were found among women with standard and men with moderately long working hours, and for both women and men working > 50 hours (PR: 1.21, 95%CI: 1.09-1.35; PR: 1.40, 95%CI: 1.18-1.66; respectively). Associations with medically certified sickness absence were found among teachers working > 50 hours, among women (PR: 1.30, 95%CI: 1.03-1.63) and men (PR: 1.41, 95%CI: 1.04-1.92). Teachers working longer hours in several schools could be suffering health problems, deriving in work absence.

Joint effect of paid working hours and multiple job holding on work absence due to health problems among basic education teachers in Brazil: the Educatel Study / Efecto conjunto de las horas de trabajo remunerado y el pluriempleo sobre la ausencia al trabajo por problemas de salud en profesores de educacuión básica en Brasil: el Estudio Educatel / Efeito conjunto das horas de trabalho remunerado e de múltiplos empregos sobre o absenteísmo por motivo de saúde entre professores de ensino básico no Brasil: Estudo Educatel

Abstract: The objectives were to assess the joint effect of working hours paid per week and multiple job holding on sickness absence, by sex, among basic education teachers in Brazil. This study is based on a survey carried out over a representative sample of 5,116 active basic education teachers in Brazil between 2015 and 2016 (Educatel Study). We created a dummy variable to assess the joint effect of weekly paid working hours [standard (35-40 hours); part-time (< 35 hours); moderately long (41-50 hours); and very long (> 50 hours)] and multiple job holding (working in several schools - no/yes). Working 35-40 hours in one school was the reference category. We conducted Poisson regression models with robust variance to obtain prevalence ratios (PR) and 95% confidence intervals (95%CI) of the association with self-certified sickness absence and medically certified sickness absence. Models were adjusted for age, type of contract and salary, and stratified by sex. Significant associations with sickness absence were only found among teachers working in more than one school. Associations with self-certified sickness absence were found among women with standard and men with moderately long working hours, and for both women and men working > 50 hours (PR: 1.21, 95%CI: 1.09-1.35; PR: 1.40, 95%CI: 1.18-1.66; respectively). Associations with medically certified sickness absence were found among teachers working > 50 hours, among women (PR: 1.30, 95%CI: 1.03-1.63) and men (PR: 1.41, 95%CI: 1.04-1.92). Teachers working longer hours in several schools could be suffering health problems, deriving in work absence.

Resumen: El objetivo de este estudio fue evaluar el efecto conjunto de las horas laborales pagadas semanalmente y pluriempleo, en relación con las ausencias por enfermedad, según el por sexo, entre profesores de educación básica en Brasil. Este estudio se llevó a acabo sobre una encuesta de una muestra representativa de 5.116 profesores activos de educación básica en Brasil, entre 2015 y 2016 (Estudio Educatel). Creamos una variable dummy para evaluar el efecto conjunto de las horas laborales pagadas semanalmente [estándar (35-40 horas); a tiempo parcial (< 35 horas); moderadamente largas (41-50 horas); y muy largas (> 50 horas)] y el pluriempleo (trabajando en varias escuelas no/sí). Estar trabajando 35-40h en una escuela fue la categoría de referencia. Se realizaron modelos de regresión de Poisson con varianza robusta para obtener la razón de prevalencia (RP) e intervalos de 95% de confianza (IC95%) de la asociación con las ausencias por enfermedad justificadas personalmente y las ausencias por enfermedad con certificado médico. Los modelos fueron ajustados por edad, tipo de contrato y salario, y estratificados por sexo. Las asociaciones significativas con ausencias por enfermedad se encontraron sólo entre profesores que trabajaban en más de una escuela. Las asociaciones con las ausencias por enfermedad justificadas personalmente se hallaron entre mujeres con horas de trabajo estándar y hombres con horas de trabajo moderadamente largas, y para ambos, mujeres y hombres trabajando > 50 horas (RP: 1,21, IC95%: 1,09-1,35; RP: 1,40, IC95%: 1,18-1,66; respectivamente). Las asociaciones con las ausencias por enfermedad con certificado médico se hallaron entre profesores trabajando > 50 horas, entre mujeres (RP: 1,30, IC95%: 1,03-1,63) y hombres (RP: 1,41, IC95%: 1,04-1,92). Los profesores que trabajan más horas en varias escuelas podrían estar sufriendo problemas de salud, ocasionando ausencias laborales.

Resumo: O estudo teve como objetivos avaliar o efeito conjunto das horas semanais de trabalho remunerado e do fato de ter vários empregos sobre o absenteísmo por motivo de doença entre professores de ensino básico, desagregado por sexo, no Brasil. Este estudo teve como base um inquérito realizado em uma amostra representativa de 5.116 professores de ensino básico em atividade no Brasil entre 2015 e 2016 (Estudo Educatel). Criamos uma variável dummy para avaliar o efeito conjunto das horas semanais de trabalho remunerado [padrão (35-40 horas); tempo parcial (< 35 horas); semana de trabalho moderadamente longa (41-50 horas) e muito longa (> 50 horas)] e múltiplos empregos (trabalho em mais de uma escola - não/sim). A categoria de referência foi o trabalho em uma única escola durante 35-40 horas semanais. Realizamos modelos de regressão de Poisson com variância robusta para obter razões de prevalência (RP) e intervalos de confiança de 95% (IC95%) para a associação com ausência no trabalho por motivo de saúde alegado pelo próprio indivíduo, e com atestado médico. Os modelos foram ajustados para idade, tipo de vínculo de trabalho e salário, e estratificados por sexo. Os resultados só mostraram associações significativas com absenteísmo por motivo de saúde em professores que trabalhavam em mais de uma escola. Foram observadas associações com ausência por motivo de saúde alegado pelo próprio indivíduo em mulheres com semana de trabalho padrão e em homens com semana moderadamente longa, e em mulheres e homens que trabalhavam mais de 50 horas por semana (RP: 1,21, IC95%: 1,09-1,35; RP: 1,40, IC95%: 1,18-1,66; respectivamente). Foram encontradas associações com ausência com atestado médico entre professores que trabalhavam mais de 50 horas por semana, em mulheres (RP: 1,30, IC95%: 1,03-1,63) e homens (RP: 1,41, IC95%: 1,04-1,92). Professores brasileiros que trabalham horas longas em várias escolas podem sofrer problemas de saúde, levando ao absenteísmo.

Propuesta de indicadores para la vigilancia de la salud ocupacional en América Latina y el Caribe

[RESUMEN]. Este artículo propone un conjunto básico y común de indicadores para la vigilancia en salud ocupacional en América Latina y el Caribe e identifica las fuentes de datos disponibles para su medición. Para ello, se llevó a cabo un proceso de consenso de la Red Experta en Encuestas sobre Condiciones de Trabajo, Empleo y Salud (RED ECoTES) en dos etapas. En la primera etapa, se consensuó un primer listado de indicadores, y en la segunda etapa, se identificaron las fuentes de datos y sus características, con el fin de facilitar la comprobación de la factibilidad del cálculo real de cada indicador en 20 países de la Región. La propuesta del conjunto básico de indicadores, y sus definiciones, está conformado por 13 indicadores distribuidos en cuatro dimensiones: condiciones de empleo (tres indicadores), condiciones de trabajo (cuatro indicadores), recursos y actividades preventivas (dos indicadores) y salud (cuatro indicadores). Las principales fuentes disponibles para calcular estos indicadores en la Región fueron las encuestas permanentes de hogares, las encuestas de condiciones de trabajo, empleo y salud, las estadísticas vitales, y los sistemas de notificación de lesiones por accidentes de trabajo. En la Región existen datos para un número relevante de los indicadores propuestos. Sin embargo, un número importante de aquellos orientados a las condiciones de trabajo y actividades preventivas están ausentes en la mayoría de países. La vigilancia efectiva de la salud ocupacional en la Región exige impulsar decididamente las encuestas sobre condiciones de empleo, trabajo y salud en cada uno de los países que la conforman.

[ABSTRACT]. This article proposes a set of common basic indicators for occupational health surveillance in the region of Latin America and the Caribbean and identifies the sources of data that are available for their measurement. To this end, consensus was built among members of the Expert Network on Working, Employment, and Health Conditions Surveys (RED ECoTES) in two stages. In the first stage, a preliminary list of indicators was agreed upon; in the second stage, data sources and their characteristics were identified to help determine the feasibility of measuring the actual value of each indicator in 20 countries of the region. The proposed set of basic indicators, together with their definitions, is composed of 13 indicators in four areas: employment conditions (three indicators), working conditions (four indicators), resources and preventive activities (two indicators), and health (four indicators). The primary sources of data available in the region for calculating these indicators were: permanent household surveys; surveys on conditions of work, employment, and health; vital statistics; and reporting systems for occupational injuries. Data are available in the region for many of the proposed indicators, but a sizable number of those having to do with working conditions and preventive activities are not available in most countries. For effective occupational health surveillance in the region, surveys on conditions of work, employment, and health must be vigorously promoted in each country.

[RESUMO]. Neste artigo é proposto um conjunto básico de indicadores comuns para vigilância em saúde ocupacional na América Latina e Caribe, com a identificação das fontes de dados disponíveis para mensuração destes indicadores. A Rede Latino-Americana de Especialistas em Inquéritos sobre Condições de Trabalho, Emprego e Saúde (REDE ECoTES) conduziu um processo de decisão por consenso em duas etapas. A primeira etapa consistiu da seleção inicial dos indicadores e a segunda etapa compreendeu a identificação das fontes de dados e suas características, com o propósito de facilitar comprovar a viabilidade do cálculo efetivo de cada indicador em 20 países da Região. É proposto um conjunto básico de indicadores e respectivas definições contendo 13 indicadores distribuídos em quatro dimensões: condições de emprego (três indicadores), condições de trabalho (quatro indicadores) e recursos e atividades de prevenção (dois indicadores) e saúde (quatro indicadores). As principais fontes disponíveis na Região para determinar os indicadores são: as pesquisas permanentes de domicílios, as pesquisas sobre as condições de trabalho, emprego e saúde, as estatísticas vitais e os sistemas de notificação de acidentes de trabalho. Existem dados disponíveis para o cálculo de um número relevante dos indicadores propostos. Porém, a maioria dos países não dispõe de dados para calcular um número importante dos indicadores relacionados às condições de trabalho e atividades de prevenção. A vigilância efetiva em saúde ocupacional requer um firme incentivo às pesquisas sobre as condições de emprego, trabalho e saúde em cada país da Região.

Evaluation of the Impact of Ambient Temperatures on Occupational Injuries in Spain.

BACKGROUND: Extreme cold and heat have been linked to an increased risk of occupational injuries. However, the evidence is still limited to a small number of studies of people with relatively few injuries and with a limited geographic extent, and the corresponding economic effect has not been studied in detail. OBJECTIVES: We assessed the relationship between ambient temperatures and occupational injuries in Spain along with its economic effect. METHODS: The daily number of occupational injuries that caused at least one day of leave and the daily maximum temperature were obtained for each Spanish province for the years 1994-2013. We estimated temperature-injuries associations with distributed lag nonlinear models, and then pooled the results using a multivariate meta-regression model. We calculated the number of injuries attributable to cold and heat, the corresponding workdays lost, and the resulting economic effect. RESULTS: The study included 15,992,310 occupational injuries. Overall, 2.72% [95% confidence interval (CI): 2.44-2.97] of all occupational injuries were attributed to nonoptimal ambient temperatures, with moderate heat accounting for the highest fraction. This finding corresponds to an estimated 0.67 million (95% CI: 0.60-0.73) person-days of work lost every year in Spain due to temperature, or an annual average of 42 d per 1,000 workers. The estimated annual economic burden is €370 million, or 0.03% of Spain's GDP (€2,015). CONCLUSIONS: Our findings suggest that extreme ambient temperatures increased the risk of occupational injuries, with substantial estimated health and economic costs. These results call for public health interventions to protect workers in the context of climate change. https://doi.org/10.1289/EHP2590.

Informal employment, unpaid care work, and health status in Spanish-speaking Central American countries: a gender-based approach.

OBJECTIVES: To assess the relationship between paid work, family characteristics and health status in Central American workers; and to examine whether patterns of association differ by gender and informal or formal employment. METHODS: Cross-sectional study of 8680 non-agricultural workers, based on the First Central American Survey of Working Conditions and Health (2011). Main explicative variables were paid working hours, marital status, caring for children, and caring for people with functional diversity or ill. Using Poisson regression models, adjusted prevalence ratios of poor self-perceived and mental health were calculated by sex and social security coverage (proxy of informal employment). RESULTS: A clear pattern of association was observed for women in informal employment who were previously married, had care responsibilities, long working hours, or part-time work for both self-perceived and mental health. No other patterns were found. CONCLUSIONS: Our results show health inequalities related to unpaid care work and paid work that depend on the interaction between gender and informal employment. To reduce these inequalities suitable policies should consider both the labor (increasing social security coverage) and domestic spheres (co-responsibility of care).

Informal employment and health status in Central America.

BACKGROUND: Informal employment is assumed to be an important but seldom studied social determinant of health, affecting a large number of workers around the world. Although informal employment arrangements constitute a permanent, structural pillar of many labor markets in low- and middle-income countries, studies about its relationship with health status are still scarce. In Central America more than 60% of non-agricultural workers have informal employment. Therefore, we aimed to assess differences in self-perceived and mental health status of Central Americans with different patterns of informal and formal employment. METHODS: Employment profiles were created by combining employment relations (employees, self-employed, employers), social security coverage (yes/no) and type of contract--only for employees--(written, oral, none), in a cross-sectional study of 8,823 non-agricultural workers based on the I Central American Survey of Working Conditions and Health of 2011. Using logistic regression models, adjusted odds ratios (aOR) by country, age and occupation, of poor self-perceived and mental health were calculated by sex. Different models were first fitted separately for the three dimensions of employment conditions, then for employment profiles as independent variables. RESULTS: Poor self-perceived health was reported by 34% of women and 27% of men, and 30% of women and 26% of men reported poor mental health. Lack of social security coverage was associated with poor self-perceived health (women, aOR: 1.38, 95% CI: 1.13-1.67; men, aOR: 1.36, 95% CI: 1.13-1.63). Almost all employment profiles with no social security coverage were significantly associated with poor self-perceived and poor mental health in both sexes. CONCLUSIONS: Our results show that informal employment is a significant factor in social health inequalities among Central American workers, which could be diminished by policies aimed at increasing social security coverage.

[Comparison of non-fatal occupational injuries by autonomous communities in Spain (1994-2004)]. / Comparación de las lesiones no mortales por accidente de trabajo por Comunidades Autónomas en España (1994-2004).

OBJECTIVES: Given the differences observed in previous studies with respect to occupational injury rates in Spain's autonomous communities, this study tested the homogeneity hypothesis of occupational injury for specific accident types and economic activity between 1994 and 2004. METHODS: We analyzed non-fatal injuries of a mechanical nature or those due to overexertion taking place in manufacturing or construction companies during the workday and requiring sick leave. The relative risk was adjusted for sex, age and contract type in each autonomous community using standardized injury causes for occupational injury, employing Spanish rates as a reference and stratifying by duration of leave (less than 16 days and more than 15 days). RESULTS: For the different types of accidents analyzed, the adjusted relative risk of occupational injury was heterogeneously distributed across the autonomous communities. Murcia, Navarre, the Balearic Islands and the Basque Country were generally found to be amongst the communities with the most elevated risks, while Castilla-León and Extremadura were those with the lowest risks of occupational injury. CONCLUSIONS: The heterogeneity of occupational injury rates across autonomous communities persisted after selecting a series of specific accident types and adjusting for sex, age and contract type. Therefore, in addition to continued analysis of work conditions to explain this variation, other socioeconomic factors should be taken into account when comparing occupational injury rates among autonomous communities.