Informal employees in the European Union: working conditions, employment precariousness and health.

BACKGROUND: The aim of this study is to estimate the prevalence of informal workers and their working conditions and employment precariousness in the EU-27; and to explore the association of different contract arrangements with health outcomes and how they are influenced by working and employment conditions. METHODS: A sample of 27 245 working-age employees from the fifth European Working Condition Survey of 2010 was analysed. Logistic regression models were fitted to estimate the contribution of different contract arrangement (permanent, temporary and informal) and working and employment precariousness variables on health outcomes (psychosocial well-being and self-rated health). RESULTS: Prevalence of informal employees in the EU-27 is 4.1% among men and 5.1% among women. Although informal employees have the poorest working conditions and employment precariousness, they did not seem to reflect poorer health. Precariousness employment variables have a greater impact than working conditions variables in reducing the association between health outcomes and type of contract arrangement, especially in the case of informal employees. CONCLUSIONS: Informal employment in the EU-27 is characterized by worse working conditions and employment precariousness than the conditions for formal employees. There is no evidence at all that being in informal employment implies better health outcomes compared to permanent employees.

The value of comparative research in major day surgery / El valor de la investigación comparativa en cirugía mayor ambulatoria

Objective: To measure time trends in major day surgery rates according to hospital ownership and other hospital characteristics among the providers of the public healthcare network of Catalonia, Spain. Method: Data from the Statistics of Health Establishments providing Inpatient Care. A generalized linear mixed model with Gaussian response and random intercept and random slopes. Results: The greatest growth in the rate of major day surgery was observed among private for-profit hospitals: 42.9 (SD: 22.5) in 2009 versus 2.7 (SD: 6.7) in 1996. These hospitals exhibited a significant increase in major day surgery compared to public hospitals (coefficient 2; p-value <0.01) Conclusions: The comparative evaluation of hospital performance is a decisive tool to ensure that public resources are used as rationally and efficiently as possible

Objetivo: Medir la evolución temporal de la cirugía mayor ambulatoria entre los proveedores de la red sanitaria pública de Cataluña de acuerdo con la titularidad y otras características de los hospitales. Métodos: Con datos provenientes de la Estadística de Establecimientos Sanitarios con Régimen de Internamiento, se realizó un modelo lineal generalizado mixto con respuesta gaussiana y pendiente e intersección aleatorios. Resultados: Se observó que la mayor variación en la tasa de cirugía mayor ambulatoria era para los hospitales privados con fines de lucro: 42,9 (desviación estándar [DE]: 22,5) en 2009 frente a 2,7 (DE: 6,7) en 1996. Estos hospitales tuvieron un aumento significativo de la cirugía mayor ambulatoria en comparación con los hospitales públicos (coeficiente 2; p <0,01). Conclusiones: La evaluación comparativa del desempeño de los hospitales es una herramienta decisiva para garantizar que los recursos públicos se utilizan de la forma más racional y eficiente posible

The value of comparative research in major day surgery.

OBJECTIVE: To measure time trends in major day surgery rates according to hospital ownership and other hospital characteristics among the providers of the public healthcare network of Catalonia, Spain. METHOD: Data from the Statistics of Health Establishments providing Inpatient Care. A generalized linear mixed model with Gaussian response and random intercept and random slopes. RESULTS: The greatest growth in the rate of major day surgery was observed among private for-profit hospitals: 42.9 (SD: 22.5) in 2009 versus 2.7 (SD: 6.7) in 1996. These hospitals exhibited a significant increase in major day surgery compared to public hospitals (coefficient 2; p-value <0.01) CONCLUSIONS: The comparative evaluation of hospital performance is a decisive tool to ensure that public resources are used as rationally and efficiently as possible.

Informal employment in high-income countries for a health inequalities research: A scoping review.

BACKGROUND: Informal employment (IE) is one of the least studied employment conditions in public health research, mainly due to the difficulty of its conceptualization and its measurement, producing a lack of a unique concept and a common method of measurement. OBJECTIVE: The aim of this review is to identify literature on IE in order to improve its definition and methods of measurement, with special attention given to high-income countries, to be able to study the possible impact on health inequalities within and between countries. METHODS: A scoping review of definitions and methods of measurement of IE was conducted reviewing relevant databases and grey literature and analyzing selected articles. RESULTS: We found a wide spectrum of terms for describing IE as well as definitions and methods of measurement. We provide a definition of IE to be used in health inequalities research in high-income countries. Direct methods such as surveys can capture more information about workers and firms in order to estimate IE. CONCLUSIONS: These results can be used in further investigations about the impacts of this IE on health inequalities. Public health research must improve monitoring and analysis of IE in order to know the impacts of this employment condition on health inequalities.

La precariedad laboral medida de forma multidimensional: distribución social y asociación con la salud en Cataluña / Multidimensional measurement of precarious employment: social distribution and its association with health in Catalonia (Spain)

Objetivo: Mostrar por vez primera la prevalencia de la precariedad laboral medida en forma multidimensional en Cataluña y su asociación con la salud mental y autopercibida. Método: Estudio transversal con datos de la II Encuesta Catalana de Condiciones de Trabajo (2010) con una submuestra de personas asalariadas con contrato. Se calculó la prevalencia de precariedad laboral usando una escala multidimensional, y su asociación con la salud mediante regresiones log-binomiales multivariadas estratificadas por sexo. Resultados: La prevalencia de la precariedad en Cataluña es alta (42,6%). Encontramos mayor precariedad en las mujeres y en los/las trabajadores/as jóvenes, inmigrantes, manuales y con menor educación. Existe un gradiente positivo en la asociación con la mala salud. Conclusiones: La precariedad laboral se asocia con peor salud en la población trabajadora. Deberían incluirse preguntas sobre precariedad e indicadores de salud en las encuestas de condiciones de trabajo para poder realizar una posterior vigilancia y un análisis de las desigualdades en salud (AU)

Objective: To show the prevalence of precarious employment in Catalonia (Spain) for the first time and its association with mental and self-rated health, measured with a multidimensional scale. Method: A cross-sectional study was conducted using data from the II Catalan Working Conditions Survey (2010) with a subsample of employed workers with a contract. The prevalence of precarious employment using a multidimensional scale and its association with health was calculated using multivariate log-binomial regression stratified by gender. Results: The prevalence of precarious employment in Catalonia was high (42.6%). We found higher precariousness in women, youth, immigrants, and manual and less educated workers. There was a positive gradient in the association between precarious employment and poor health. Conclusions: Precarious employment is associated with poor health in the working population. Working conditions surveys should include questions on precarious employment and health indicators, which would allow monitoring and subsequent analyses of health inequalities (AU)

[Multidimensional measurement of precarious employment: social distribution and its association with health in Catalonia (Spain)]. / La precariedad laboral medida de forma multidimensional: distribución social y asociación con la salud en Cataluña.

OBJECTIVE: To show the prevalence of precarious employment in Catalonia (Spain) for the first time and its association with mental and self-rated health, measured with a multidimensional scale. METHOD: A cross-sectional study was conducted using data from the II Catalan Working Conditions Survey (2010) with a subsample of employed workers with a contract. The prevalence of precarious employment using a multidimensional scale and its association with health was calculated using multivariate log-binomial regression stratified by gender. RESULTS: The prevalence of precarious employment in Catalonia was high (42.6%). We found higher precariousness in women, youth, immigrants, and manual and less educated workers. There was a positive gradient in the association between precarious employment and poor health. CONCLUSIONS: Precarious employment is associated with poor health in the working population. Working conditions surveys should include questions on precarious employment and health indicators, which would allow monitoring and subsequent analyses of health inequalities.

Personal de enfermería, condiciones de trabajo y su impacto en la salud / Nurse staffing, working conditions and the impact on health

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Impacto del informe de la Comisión sobre Determinantes Sociales de la Salud cuatro años después / Impact of the Report of the WHO Commission on Social Determinants of Health four years after publication

Tras más de tres años de trabajo, la Comisión de Determinantes Sociales de la Salud de la Organización Mundial de la Salud, presentó a finales de agosto de 2008 su informe final traducido en su versión castellana como "Subsanar las desigualdades en una generación: alcanzar la equidad sanitaria actuando sobre los determinantes sociales de la salud". El informe, muy probablemente uno de los textos de mayor interés en el campo de la salud pública de las últimas décadas, no ha dejado indiferente. Ha recibido notables alabanzas, desaforadas críticas y algunas -las menos hasta el momento- críticas con un carácter más equilibrado y razonable. El objetivo de este texto es apreciar críticamente dicho informe y valorar su impacto cuatro años después de su publicación. Para ello, en primer lugar, se revisa el origen y objetivos de la Comisión resumiendo la visión y difusión del informe; segundo, se valoran las características y contenidos del informe desde distintos puntos de vista ideológicos y políticos: neoliberal y conservador, desde la epidemiología social y desde una visión radical de salud pública; y tercero, se evalua el impacto global del informe cuatro años después de su publicación. El texto concluye con algunas reflexiones finales.

After more than three years of work, the WHO Commission on Social Determinants of Health launched its final Report "Closing the gap in a generation: Health equity through action on the social determinants of health" at the end of August 2008. This report, which is probably one of the most interesting texts in the field of public health in recent decades, has attracted a lot of attention. It has been the object of remarkable praises, of ardent criticism, and to lesser extent, of more balanced and reasonable critiques. The aim of this paper was to critically evaluate the report and to assess its impact four years after its publication. Firstly, the origins and objectives of the Commission was reviewed, outlining the vision and dissemination of the report; secondly, the characteristics and contents of the report were assessed from different ideological and political points of view including neoliberal, conservative, social epidemiology and radical view of public health; and finally, the overall impact of the Report four years after publication was evaluated. The paper concluded with some final reflections.

The welfare state and global health: Latin America, the Arab world and the politics of social class

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Mutational load distribution analysis yields metrics reflecting genetic instability during pancreatic carcinogenesis.

Considering carcinogenesis as a microevolutionary process, best described in the context of metapopulation dynamics, provides the basis for theoretical and empirical studies that indicate it is possible to estimate the relative contribution of genetic instability and selection to the process of tumor formation. We show that mutational load distribution analysis (MLDA) of DNA found in pancreatic fluids yields biometrics that reflect the interplay of instability, selection, accident, and gene function that determines the eventual emergence of a tumor. An in silico simulation of carcinogenesis indicates that MLDA may be a suitable tool for early detection of pancreatic cancer. We also present evidence indicating that, when performed serially in individuals harboring a p16 germ-line mutation bestowing a high risk for pancreatic cancer, MLDA may be an effective tool for the longitudinal assessment of risk and early detection of pancreatic cancer.

Genetic instability and divergence of clonal populations in colon cancer cells in vitro.

The accumulation of multiple chromosomal abnormalities is a characteristic of the majority of colorectal cancers and has been attributed to an underlying chromosomal instability. Genetic instability is considered to have a key role in the generation of genetic and phenotypic heterogeneity in cancer cells. To shed light on the dynamics of chromosomal instability in colon cancer cells, we have analyzed genetic divergence in clonal and subclonal derivates of chromosomally unstable (SW480) and stable (HCT116, LoVo) cell lines. Conventional G-banding karyotyping and arbitrarily primed PCR (AP-PCR) fingerprinting were used to calculate genetic distances among clones and parental cells, and to trace tree-type phylogenies among individual cells and clonal cell populations. SW480 cells showed enhanced karyotypic heterogeneity in clones as compared with parental cells. Moreover, genetic clonal divergence was also increased after two consecutive episodes of single-cell cloning, demonstrating that the homogeneity induced by the bottleneck of cloning is disrupted by genetic instability during clonal expansion and, as a consequence, heterogeneity is restored. These results demonstrate genetic drift in clonal populations originated from isolated cells. The generated cell heterogeneity coupled with selection provides the grounds for the reported feasibility of pre-neoplastic and neoplastic cells to generate new phenotypic variants with increased evolutionary potential.

Validation of RNA arbitrarily primed PCR probes hybridized to glass cDNA microarrays: application to the analysis of limited samples.

BACKGROUND: The applicability of microarray-based transcriptome massive analysis is often limited by the need for large amounts of high-quality RNA. RNA arbitrarily primed PCR (RAP-PCR) is an unbiased fingerprinting PCR technique that reduces both the amount of initial material needed and the complexity of the transcriptome. The aim of this study was to evaluate the feasibility of using hybridization of RAP-PCR products as transcriptome representations to analyze differential gene expression in a microarray platform. METHODS: RAP-PCR products obtained from samples with limited availability of biological material, such as experimental metastases, were hybridized to conventional cDNA microarrays. We performed replicates of self-self hybridizations of RAP-PCR products and mathematical modeling to assess reproducibility and sources of variation. RESULTS: Gene/slide interaction (47.3%) and the PCR reaction (33.8%) accounted for the majority of the variability. From these observations, we designed a protocol using two pools of three independent RAP-PCR reactions coming from two independent reverse transcription reactions hybridized in duplicate and evaluated them in the analyses of paired xenograft-metastases samples. Using this approach, we found that HER2 and MMP7 may be down-regulated during distal dissemination of colorectal tumors. CONCLUSION: RAP-PCR glass array hybridization can be used for transcriptome analysis of small samples.

Orthotopic implantation of human hepatocellular carcinoma in mice: analysis of tumor progression and establishment of the BCLC-9 cell line.

PURPOSE: To allow the longitudinal investigation of molecular events associated with the progression of human hepatocellular carcinoma (HCC), we sought to develop a murine model by orthotopic implantation of tumor fragments obtained from patients diagnosed at early stage. EXPERIMENTAL DESIGN: Tumor pieces (2 x 2 mm) were implanted on the liver surface of nu/nu mice. After xenograft growing, subsequent passages were performed to achieve long-term implant viability. Isolation of tumoral hepatocytes was done to establish new cell lines. HCC characteristics, proliferation rate, apoptotic index (terminal deoxynucleotidyl transferase-mediated nick end labeling), and expression of cell-cycle regulators (cyclins E and A, p21(Cip1), p27(Kip1), p16(INK4a), pRb, and p53) were assessed by Western Blot and immunohistochemistry, to correlate them with tumor progression. RESULTS: Five (50%) of the 10 primary HCCs resulted in small slow-growing liver implants. Three of them are viable after 48 months, whereas the remaining two survived for 15 and 13 months. Xenografts throughout passages exhibited a more aggressive phenotype with a poorer degree of differentiation, intense proliferation, moderate apoptosis, cell-cycle deregulation, p53 alterations, microvascular invasion, and dissemination. In one single passage, we observed critical growth delay, which was associated with significant p27(kip1) overexpression. We established the anchor-free growing BCLC-9 cell line from one xenograft. This has gains of chromosomes 7, 5p, 6q, and 9q, is hepatitis B virus-DNA positive, does not secrete alpha-fetoprotein, and has TP53 missense mutations in codons 192 and 242. CONCLUSIONS: The orthotopic implantation of early HCC fragments in nude mice provides a useful model to investigate the mechanisms of human HCC evolution and to establish new cell lines.

Common genetic evolutionary pathways in familial adenomatous polyposis tumors.

Cancer cells progress through the accumulation of genetic alterations. Familial adenomatous polyposis (FAP) tumors provide an excellent model to unravel the molecular steps underlying malignant transformation. Global genomic damage was assessed in 56 adenomas and 3 carcinomas from six FAP patients and compared with that of sporadic adenomas and carcinomas. Evolutive trees were traced after application of maximum likelihood clustering and split decomposition methods to the analysis of comprehensive genetic profiles generated by diverse molecular approaches: arbitrarily primed PCR, comparative genomic hybridization, and flow cytometry. Overall, genomic damage as assessed by arbitrarily primed PCR was lower in familial adenomas than in sporadic adenomas and carcinomas. Comparative genomic hybridization data also show a low number of alterations in the majority of FAP adenomas. Tumors of the same patient were likely to share specific genetic alterations and may be grouped into one or two clusters. Putative common pathways were also identified, which included tumors of up to three different patients. According to our data, FAP tumors accumulate specific genetic alterations and in a preferred order that is characteristic of each individual. Moreover, the particular genetic background and environmental conditions of a FAP patient restrain the molecular evolution portrait of synchronous tumors.