Improving multilevel analyses: the integrated epidemiologic design.

Multilevel analysis has been widely used to allow the simultaneous examination of the effects of individual- and group-level variables on individual health outcomes. In spite of its utility, multilevel design can have some drawbacks in the estimation of risk factor effects when the within-group variation of variables of interest is small relative to between-group variation. An extreme case of this is a group-level risk factor, which by definition has no within-group variation.

Barrio Adentro and the reduction of health inequalities in Venezuela: an appraisal of the first years.

This article presents an update on the characteristics and performance of Venezuela's Bolivarian health care system, Barrio Adentro (Inside the Neighborhood). During its first five years of existence, Barrio Adentro has improved access and utilization of health services by reaching approximately 17 million impoverished and middle-class citizens all over Venezuela. This was achieved in approximately two years and provides an example of an immense "South-South" cooperation and participatory democracy in health care.

Examining associations between job characteristics and health: linking data from the Occupational Information Network (O*NET) to two U.S. national health surveys.

Objective: To determine whether the Occupational Information Network (O*NET) database can be used to identify job dimensions to serve as proxy measures for psychosocial factors and select environmental factors, and to determine whether these factors could be linked to national health surveys to examine associations with health risk behaviors and outcomes.

Methods: Job characteristics were obtained from O*NET 98. Health outcomes were obtained from two national surveys.

A multi-group cross-lagged analyses of work stressors and health using Canadian National sample.

This article examines the reciprocal relationships between work variables and health outcomes and if these relationships differ by social class (measured by occupational grouping). We used longitudinal data from the 1994/95--2002/03 Canadian National Population Health Survey (NPHS). Karasek's work stress variables were measured in the 1994/95 (cycle 1, time 1), 2000/01 (cycle 4, time 2) and 2002/03 (cycle 5, time 3) surveys.

Addressing social determinants of health inequities: what can the state and civil society do?

In this Health Policy article, we selected and reviewed evidence synthesised by nine knowledge networks established by WHO to support the Commission on the Social Determinants of Health. We have indicated the part that national governments and civil society can play in reducing health inequity. Government action can take three forms: (1) as provider or guarantor of human rights and essential services; (2) as facilitator of policy frameworks that provide the basis for equitable health improvement; and (3) as gatherer and monitor of data about their populations in ways that generate health information about mortality and morbidity and data about health equity.

Gender, precarious work, and chronic diseases in South Korea.

Objective: In view of the growing number of nonstandard workers in South Korea, this study examined whether nonstandard workers reported poorer health compared to standard workers and assessed whether there were gender differences in the association between employment status and chronic health outcomes.

Method: Data were taken from a representative-weighted sample of 1,563 men and 1,045 women aged 20-64, from the 2001 National Health and Nutrition Examination Survey. Nonstandard employment included part-time work, temporary work, and day labor.

Measuring job characteristics and mental health among Latino farmworkers: results from cognitive testing.

Background: Few research instruments used in occupational stress research have been evaluated for acceptability and validity among immigrant Latino farmworkers.

Methods: Cognitive testing was completed with 40 migrant and seasonal farmworkers (21 women, 19 men) through two focus groups and 16 one-on-one interviews conducted in Texas and Florida. Participants responded to the K-6, a short form instrument designed to measure psychological distress, selected items from the Job Content Questionnaire (JCQ) and standard health items.

Occupational segregation as a determinant of US worker health.

Background: Racial segregation provides a potential mechanism to link occupations with adverse health outcomes.

Methods: An African-American segregation index (I(AA)) was calculated for US worker groups from the nationally representative pooled 1986-1994 National Health Interview Survey (n = 451,897). Ranking and logistic regression analyses were utilized to document associations between I(AA) and poor worker health.

Socioeconomic inequalities in mortality in Barcelona: a study based on census tracts (MEDEA Project).

The aim of this study is to describe inequalities in socioeconomic indicators and in mortality by sex in the census tracts of Barcelona city during the period 1996-2003. The results show that there is excess mortality in coastal and northern areas. This distribution is similar to that of socioeconomic deprivation and therefore there is an association between mortality and socioeconomic indicators, not only for total mortality but also for the specific causes of death studied.

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.

Inequalities in health by social class dimensions in European countries of different political traditions.

Objective: To compare inequalities in self-perceived health in the population older than 50 years, in 2004, using Wright's social class dimensions, in nine European countries grouped in three political traditions (Social democracy, Christian democracy and Late democracies).

Methods: Cross-sectional design, including data of the Survey of Health, Ageing and Retirement in Europe (Sweden, Denmark, Austria, France, Germany, The Netherlands, Spain, Italy and Greece). The population aged from 50 to 74 years was included.

Ethnic, racial, and gender variations in health among farm operators in the United States.

Purpose: The purpose of this study was to collect baseline prevalence data on the health problems faced by minority, white, and female farm operators.

Methods: An occupational health survey of farm operators was conducted by the U.S.

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.

Abuse and violence during home care work as predictor of worker depression.

Objectives: Home care workers provide care without the normal protections afforded in the hospital. This study describes the prevalence of abuse and violence experienced by home care workers and its relationship to workers' depression.

Methods: A two-wave telephone survey (N=1,643) was conducted to assess the prevalence of abuse and prevalence/incidence of workers' depression.

Precarious employment and health: developing a research agenda.

New types of work arrangements can be as dangerous as traditional unemployment for workers' health

Challenging the neoliberal trend: the Venezuelan health care reform alternative.

Throughout the 1990s, all Latin American countries but Cuba implemented to varying degrees health care sector reforms underpinned by a neoliberal paradigm that redefined health care as less of a social right and more of a market commodity. These health care sector reforms were couched in the broader structural adjustment of Latin American welfare states prescribed consistently by international financial institutions since the mid-1980s. However, since 2003, Venezuela has been developing an alternative to this neoliberal trend through its health care reform program called Misión Barrio Adentro (Inside the Neighbourhood).

Venezuela's Barrio Adentro: an alternative to neoliberalism in health care.

Throughout the 1990s, all Latin American countries but Cuba implemented health care sector reforms based on a neoliberal paradigm that redefined health care less as a social right and more as a market commodity. These reforms were couched in the broader structural adjustment of Latin American welfare states as prescribed by international financial institutions since the mid-1980s. However, since 2003, Venezuela has been developing an alternative to this neoliberal trend through its health care reform program, Misión Barrio Adentro (Inside the Neighborhood).

Is precarious employment more damaging to women's health than men's?

Current global economic trends in both developed and developing countries, including unregulated labor markets, trade competition and technological change, have greatly expanded a complex labor market situation characterised by many employees working under temporary work status, job insecurity, low social protection and low income level. Although the health of women is disproportionately affected by workplace flexibility, this has been largely ignored. The main purpose of this paper is to draw attention to this relevant but neglected topic.