What should we know about precarious employment and health in 2025? Framing the agenda for the next decade of research.

The generalization of flexible labour markets, the declining influence of unions and the degradation of social protection has led to the emergence of new forms of employment at the expense of the Standard Employment Relationship, as well as a considerable amount of research across social and scientific disciplines. Years ago we suggested the urgent need to disentangle the consequences of new types of employment for the health and well-being of workers, contending that the study of precarious employment and health is in its infancy. Today, research challenges include clearer, more precise definitions of the original concepts, a more detailed understanding of the pathways and mechanisms through which precarious employment harms worker health, stronger information systems for monitoring the problem and a complex systems approach to employment conditions and health research. All of these must be guided by the theoretical and policy debates linking precarious employment and health, and be geared towards developing better tools for the design, implementation and evaluation of policies intended to minimize precariousness in the labour market and its effects on public health and health inequalities. Our aim in this paper is to outline an agenda for the next decade of research on precarious employment and health, establishing a compelling programme that expands our understanding of complex causes and links.

Opiniones de los delegados de prevención sobre su interacción con los trabajadores en un contexto de relaciones desiguales de poder: un estudio cualitativo exploratorio en Barcelona / Safety Representatives’ Views on Their Interaction With Workers in a Context of Unequal Power Relations: An Exploratory Qualitative Study in Barcelona (Spain)

La interacción entre los trabajadores y los delegados de prevención, un factor que determina la efectividad de estos representantes, es un tema poco explorado en la investigación en salud laboral. Se realizó un estudio cualitativo, exploratorio y descriptivo-interpretativo a través de entrevistas semi-estructuradas con delegados de prevención de Barcelona (España) con el objetivo de analizar su perspectiva sobre su interacción con los trabajadores y sus determinantes. Los resultados indicaron que la interacción de los delegados de prevención con los trabajadores se limita principalmente a los procesos de información y para identificar riesgos laborales. Factores destacados que determinan esta interacción se relacionan con la forma en que los delegados de prevención entienden y llevan a cabo su función, el sector y tamaño de la empresa y el miedo de los trabajadores al despido, exacerbada por los cambios en el mercado laboral y la crisis económica actual. En conclusión, la interacción de los delegados de prevención con los trabajadores está influenciada por una frecuente visión técnico-legal del papel de los delegados de prevención y por las relaciones desiguales de poder entre trabajadores y la dirección. Una pobre interacción con los trabajadores puede llevar a una disminución de la efectividad de estos representantes en materia de prevención (AU)

The interaction between workers and safety representatives (SRs), a factor that determines SRs’ effectiveness, is an unexplored issue within occupational health research. We undertook a qualitative exploratory interpretative descriptive study by means of semi-structured interviews with SRs from Barcelona (Spain) to analyze the SRs’ perspective on the interaction with workers and its determinants. Findings indicated that SRs’ interaction with workers is mainly limited to information processes and to identifying occupational hazards. Prominent factors determining this interaction are associated with the way SRs understand and carry out their role, the firm sector and size, and workers’ fear of dismissal, exacerbated by changes in the labour market and the current economic crisis .In conclusion, interaction with workers is influenced by a more prevalent technical-legal view of the SRs’ role and by unequal power relations between workers and management. Poor interaction with workers might lead to decreasing SRs’ effectiveness (AU)

Precarious employment: understanding an emerging social determinant of health.

Employment precariousness is a social determinant that affects the health of workers, families, and communities. Its recent popularity has been spearheaded by three main developments: the surge in "flexible employment" and its associated erosion of workers' employment and working conditions since the mid-1970s; the growing interest in social determinants of health, including employment conditions; and the availability of new data and information systems. This article identifies the historical, economic, and political factors that link precarious employment to health and health equity; reviews concepts, models, instruments, and findings on precarious employment and health inequalities; summarizes the strengths and weaknesses of this literature; and highlights substantive and methodological challenges that need to be addressed. We identify two crucial future aims: to provide a compelling research program that expands our understanding of employment precariousness and to develop and evaluate policy programs that effectively put an end to its health-related impacts.

Evaluación de los criterios de imputabilidad de dermatosis profesional definidos por Mathias / Assessment of the Mathias Criteria for Establishing Occupational Causation of Contact Dermatitis

Las dermatosis representan un 30% de las enfermedades profesionales. De ellas, el 90% corresponden a eczema de contacto repercutiendo ostensiblemente en la economía y la calidad de vida del paciente. En 1989 Toby Mathias propuso 7 criterios para la evaluación del vínculo entre el eczema de contacto y una profesión dada. Objetivo: Evaluar la utilidad de los criterios de imputabilidad de enfermedad profesional definidos por Mathias en pacientes afectos de dermatosis cutánea. Métodos: Estudio descriptivo de 103 pacientes afectos de dermatosis cutáneas consecutivamente visitados desde enero a marzo del año 2009 en la Unidad de Inmunología y Alergia cutánea del Servicio de Dermatología del Parc de Salut Mar de Barcelona, correlacionando los criterios de imputabilidad laboral de la patología cutánea mediante valoración del especialista y mediante entrevista personalizada, incluyendo los criterios de Mathias por facultativo independiente. Valoración estadística descriptiva e inferencial. Resultados: Trece pacientes mostraban implicación laboral, según la aplicación de los criterios de Mathias, y 12 pacientes mostraban relevancia laboral según criterio del especialista en Dermatología. La sensibilidad de los criterios de Mathias fue de un 100%, la especificidad fue de un 98,90%, el valor predictivo positivo de un 92,31% y el valor predictivo negativo de un 100%, con una prevalencia del 11,65%. Conclusiones: Los criterios de Mathias muestran una elevada validez y rendimiento, siendo útiles para el diagnóstico de eczema de contacto de origen laboral. Pensamos que su aplicación contribuiría en la precisión diagnóstica y pronóstica de las dermatitis de contacto profesionales (AU)

Dermatoses account for up to 30% of occupational diseases. Of these, 90% correspond to contact dermatitis, a disease associated with a marked economic burden and considerably impaired quality of life. In 1989, Toby Mathias proposed 7 criteria to assess the relationship between contact dermatitis and occupation. Objective: To assess the Mathias criteria for establishing occupational causation of contact dermatitis in patients with dermatoses. Materials and methods: This was a descriptive study of 103 patients with dermatoses, attended consecutively between January and March of 2009 in the immunology and skin allergy department of the Parc de Salut Mar, Barcelona, Spain. The diagnosis of an occupational cause of the skin complaint by a specialist after interviewing the patient was correlated with diagnosis according to the Mathias criteria, applied by an independent specialist. Descriptive and inferential statistics were calculated. Results: An occupational cause was identified in 13 patients according to the Matthias criteria and in 12 according to the judgment of the dermatologist. The sensitivity for the Mathias criteria was 100% and the specificity was 98.90%, with a positive predictive value of 92.31% and a negative predictive value of 100%. The prevalence of occupational contact dermatitis was 11.65%. Conclusions: The Mathias criteria show a high validity and diagnostic yield, making them useful for establishing occupational causation of contact dermatitis. We believe that application of these criteria would help improve diagnostic and prognostic accuracy in occupational contact dermatitis (AU)

[Assessment of the Mathias criteria for establishing occupational causation of contact dermatitis]. / Evaluación de los criterios de imputabilidad de dermatosis profesional definidos por Mathias.

BACKGROUND: Dermatoses account for up to 30% of occupational diseases. Of these, 90% correspond to contact dermatitis, a disease associated with a marked economic burden and considerably impaired quality of life. In 1989, Toby Mathias proposed 7 criteria to assess the relationship between contact dermatitis and occupation. OBJECTIVE: To assess the Mathias criteria for establishing occupational causation of contact dermatitis in patients with dermatoses. MATERIALS AND METHODS: This was a descriptive study of 103 patients with dermatoses, attended consecutively between January and March of 2009 in the immunology and skin allergy department of the Parc de Salut Mar, Barcelona, Spain. The diagnosis of an occupational cause of the skin complaint by a specialist after interviewing the patient was correlated with diagnosis according to the Mathias criteria, applied by an independent specialist. Descriptive and inferential statistics were calculated. RESULTS: An occupational cause was identified in 13 patients according to the Matthias criteria and in 12 according to the judgment of the dermatologist. The sensitivity for the Mathias criteria was 100% and the specificity was 98.90%, with a positive predictive value of 92.31% and a negative predictive value of 100%. The prevalence of occupational contact dermatitis was 11.65%. CONCLUSIONS: The Mathias criteria show a high validity and diagnostic yield, making them useful for establishing occupational causation of contact dermatitis. We believe that application of these criteria would help improve diagnostic and prognostic accuracy in occupational contact dermatitis.

The enolase of Borrelia burgdorferi is a plasminogen receptor released in outer membrane vesicles.

The agent of Lyme disease, Borrelia burgdorferi, has a number of outer membrane proteins that are differentially regulated during its life cycle. In addition to their physiological functions in the organism, these proteins also likely serve different functions in invasiveness and immune evasion. In borreliae, as well as in other bacteria, a number of membrane proteins have been implicated in binding plasminogen. The activation and transformation of plasminogen into its proteolytically active form, plasmin, enhances the ability of the bacteria to disseminate in the host. Outer membrane vesicles of B. burgdorferi contain enolase, a glycolytic-cycle enzyme that catalyzes 2-phosphoglycerate to form phosphoenolpyruvate, which is also a known plasminogen receptor in Gram-positive bacteria. The enolase was cloned, expressed, purified, and used to generate rabbit antienolase serum. The enolase binds plasminogen in a lysine-dependent manner but not through ionic interactions. Although it is present in the outer membrane, microscopy and proteinase K treatment showed that enolase does not appear to be exposed on the surface. However, enolase in the outer membrane vesicles is accessible to proteolytic degradation by proteinase K. Samples from experimentally and tick-infected mice and rabbits as well as from Lyme disease patients exhibit recognition of enolase in serologic assays. Thus, this immunogenic plasminogen receptor released in outer membrane vesicles could be responsible for external proteolysis in the pericellular environment and have roles in nutrition and in enhancing dissemination.

Phylogenetic analysis of a virulent Borrelia species isolated from patients with relapsing fever.

Multilocus sequence analysis (MLSA) was used to clarify the taxonomic status of a virulent Borrelia organism previously isolated from patients with relapsing fever and from ticks in Spain that is designated the Spanish relapsing fever (SRF) Borrelia. This species has been used extensively in experimental infection models because of its continued virulence. Seven genes were amplified to analyze the phylogenetic relationships among several Spanish isolates of SRF Borrelia and other relapsing fever Borrelia species. The genes targeted in this study included rrs and flaB, which have commonly been used in phylogenetic studies; the rrf-rrl intergenic spacer (IGS), which is highly discriminatory; and four additional genes, p66, groEL, glpQ, and recC, which are located on the chromosome and which have therefore evolved in a clonal way. The species included in this study were Borrelia duttonii, B. recurrentis, B. crocidurae, and B. hispanica as Old World Borrelia species and B. turicatae and B. hermsii as New World Borrelia species. The results obtained by MLSA of the SRF Borrelia on the basis of 1% of the genomic sequence data analyzed confirmed that the SRF Borrelia isolates are B. hispanica. However, the prototype isolates of B. hispanica used in this study have an uncertain history and display unique phenotypic characteristics that are not shared with the SRF Borrelia. Therefore, we propose to use strain SP1, isolated from a relapsing fever patient in 1994 in southern Spain, as the type strain for B. hispanica.

A qualitative study about immigrant workers' perceptions of their working conditions in Spain.

BACKGROUND: Spain has recently become an inward migration country. Little is known about the occupational health of immigrant workers. This study aimed to explore the perceptions that immigrant workers in Spain had of their working conditions. METHODS: Qualitative, exploratory, descriptive study. Criterion sampling. Data collected between September 2006 and May 2007 through semi-structured focus groups and individual interviews, with a topic guide. One hundred and fifty-eight immigrant workers (90 men/68 women) from Colombia (n = 21), Morocco (n = 39), sub-Saharan Africa (n = 29), Romania (n = 44) and Ecuador (n = 25), who were authorised (documented) or unauthorised (undocumented) residents in five medium to large cities in Spain. RESULTS: Participants described poor working conditions, low pay and health hazards. Perception of hazards appeared to be related to gender and job sector. Informants were highly segregated into jobs by sex, however, so this issue will need further exploration. Undocumented workers described poorer conditions than documented workers, which they attributed to their documentation status. Documented participants also felt vulnerable because of their immigrant status. Informants believed that deficient language skills, non-transferability of their education and training and, most of all, their immigrant status and economic need left them with little choice but to work under poor conditions. CONCLUSIONS: The occupational health needs of immigrant workers must be addressed at the job level, while improving the enforcement of existing health and safety regulations. The roles that documentation status and economic need played in these informants' work experiences should be considered and how these may influence health outcomes.

Medium- and short-chain dehydrogenase/reductase gene and protein families : Structure-function relationships in short-chain alcohol dehydrogenases.

The structure-function relationships of alcohol dehydrogenases from the large family of short-chain dehydrogenase/reductase (SDR) enzymes are described. It seems that while mammals evolved with a medium-chain alcohol dehydrogenase family (MDR), fruit flies utilized an ancestral SDR enzyme. They have modified its function into an efficient alcohol dehydrogenase to aid them in colonizing the emerging ecological niches that appeared around 65 million years ago. To the scientific community, Drosophila has now served as a model organism for quite some time, and Drosophila alcohol dehydrogenase is one of the best-studied members of the SDR family. The availability of a number of high-resolution structures, accurate and thorough kinetic work, and careful theoretical calculations have enabled an understanding of the structure-function relationships of this metal-free alcohol dehydrogenase. In addition, these studies have given rise to various hypotheses about the mechanism of action of this enzyme and contribute to the detailed knowledge of the large superfamily of SDR enzymes.

Immigration and self-reported health status by social class and gender: the importance of material deprivation, work organisation and household labour.

OBJECTIVE: Spain and Catalonia have experienced several immigration waves over the last century. The goal of this study was to examine the role of social class and its mediating pathways (ie, work organisation, material deprivation at home and household labour) in the association between migration status and health, as well as whether these associations were modified by social class or gender. SETTING: Barcelona city, Spain. DESIGN AND PARTICIPANTS: The study used the Barcelona Health Interview Survey, a cross-sectional survey of 10,000 residents of the city's non-institutionalised population in 2000. The present study was conducted on the working population, aged 16-64 years (2342 men and 1872 women). The dependent variable was self-reported health status. The main independent variable was migration status. Other variables were: social class (measured using Erik Olin Wright's indicators); age; psychosocial and physical working conditions; job insecurity; type of labour contract; number of hours worked per week; material deprivation at home and household labour. Two hierarchical logistic regression models were built by adding different independent variables. RESULTS: Among men, foreigners presented the poorest health status (fully adjusted odds ratios (OR) 2.16; 95% CI 1.14 to 4.10), whereas among women the poorest health status corresponded to those born in other regions of Spain. There was an interaction between migration and social class among women, with women owners, managers, supervisors or professionals born in other regions of Spain reporting a worse health status than the remaining groups (fully adjusted OR 3.60; 95% CI 1.83 to 7.07). CONCLUSION: This study has shown that the pattern of perceived health status among immigrant populations varies according to gender and social class. These results have to be taken into account when developing policies addressed at the immigrant population.

Trends in socioeconomic mortality inequalities in a southern European urban setting at the turn of the 21st century.

OBJECTIVE: To analyse trends in mortality inequalities by educational level for main causes of death among men and women in Barcelona, Spain, at the turn of the 21st century (1992-2003). METHODS: The population of reference was all Barcelona residents older than 19 years. All deaths between 1992-2003 were included. Educational level was obtained through record linkage between the mortality register and the municipal census of Barcelona city. Variables studied were age, sex, educational level, period of death (four periods of 3 years) and cause of death. Age-standardised mortality rates for each educational level, sex and period were calculated. Poisson regression models were fitted to obtain relative index of inequality (RII) for educational level, adjusted for age for the time-periods. RESULTS: RII for all causes of death was constant (around 1.5), but rate differences were higher in 1995-7 (715.6 per 100,000 in men and 352.8 in women) than in other periods and tended to decrease in men over the periods. Analysis of inequality trends by specific causes of death shows a stable trend for the majority of causes, with higher mortality among those with less education for all causes of death except lung cancer and breast cancer among women having RII below 1. CONCLUSIONS: Relative inequalities in total mortality by sex in Barcelona did not change during the 12 years studied, whereas absolute inequalities tended to decrease in men. Our study fills an important gap in southern Europe and Spanish literature on trends during this period.

Area deprivation and mortality in the provincial capital cities of Andalusia and Catalonia (Spain).

OBJECTIVE: To study the linkage between material deprivation and mortality from all causes, for men and women separately, in the capital cities of the provinces in Andalusia and Catalonia (Spain). METHODS: A small-area ecological study was devised using the census section as the unit for analysis. 188,983 Deaths occurring in the capital cities of the Andalusian provinces and 109,478 deaths recorded in the Catalan capital cities were examined. Principal components factorial analysis was used to devise a material deprivation index comprising the percentage of manual labourers, unemployment and illiteracy. A hierarchical Bayesian model was used to study the relationship between mortality and area deprivation. MAIN RESULTS: In most cities, results show an increased male mortality risk in the most deprived areas in relation to the least depressed. In Andalusia, the relative risks between the highest and lowest deprivation decile ranged from 1.24 (Malaga) to 1.40 (Granada), with 95% credibility intervals showing a significant excess risk. In Catalonia, relative risks ranged between 1.08 (Girona) and 1.50 (Tarragona). No evidence was found for an excess of female mortality in most deprived areas in either of the autonomous communities. CONCLUSIONS: Within cities, gender-related differences were revealed when deprivation was correlated geographically with mortality rates. These differences were found from an ecological perspective. Further research is needed in order to validate these results from an individual approach. The idea to be analysed is to identify those factors that explain these differences at an individual level.

The important and diverse roles of antibodies in the host response to Borrelia infections.

Antibodies are of critical importance in the host response to tick-borne Borrelia species that cause relapsing fever and Lyme disease. Recent studies on the role of various B cell subsets in the host response to Borrelia, complement-independent, bactericidal antibodies, and diagnostics led to this review that focuses on the array of functions that antibodies to Borrelia can perform.

Applying an equity lens to tobacco-control policies and their uptake in six Western-European countries.

We identified policies that may be effective in reducing smoking among socioeconomically disadvantaged groups, and examined trends in their level of application between 1985 and 2000 in six western-European countries (Sweden, Finland, the United Kingdom, the Netherlands, Germany, and Spain). We located studies from literature searches in major databases, and acquired policy data from international data banks and questionnaires distributed to tobacco policy organisations/researchers. Advertising bans, smoking bans in workplaces, removing barriers to smoking cessation therapies, and increasing the cost of cigarettes have the potential to reduce socioeconomic inequalities in smoking. Between 1985 and 2000, tobacco control policies in most countries have become more targeted to decrease the smoking behaviour of low-socioeconomic groups. Despite this, many national tobacco-control strategies in western-European countries still fall short of a comprehensive policy approach to addressing smoking inequalities.

La precariedad laboral y la salud de los inmigrantes en España: ¿qué sabemos y qué deberíamos saber? / Precarious employment and immigrant health in Spain: what do we know what should we know?

La inmigración en España es un tema de actualidad, no sólo por el aumento de personas que llegan a nuestro país, sino también por el gran número de desafíos de tipo legislativo, político, cultural, social, laboral y de salud que se plantean. Existennumerosas publicaciones científicas que analizan la situación de la población inmigrante; sin embargo, en la mayoría, los aspectos relacionados con la salud y, los potenciales efectos sobre la salud que puede tener un medio laboral con elevadonivel de precariedad, son aún temas poco estudiados. El objetivo de este trabajo es presentar lo que hasta el momento se conoce sobre la precariedad laboral y sus posibles efectos sobre la salud de los inmigrantes, así como plantear lo que aún desconocemos y deberíamos saber sobre estos temas. Por su actualidad y frente al desconocimiento existente, consideramos que la inmigración debería ser un tema prioritario y de debate en salud laboral

The issue of immigration in Spain is a current topic, not only because of the increasing number of people coming into the country but also given the legislative, political, cultural, social and health challenges this entails. Numerous scientific publications analyse the situation of the immigrant population. However, health-related issues and the potential effects a precarious labour environment may have on them require further study. This paper reviews what has been explored to date about precarious employment and its possible effects on the health of immigrants. It also intends to cast light on what is unknown on the subject and is still to be addressed. Due to its current importance and the current lack of knowledge on the subject, we believe that immigration should be a key issue of debate in occupational health