Epidemiology

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The clustering of xerophthalmia within households and villages was estimated among preschool age children using data from studies conducted in Malawi, Zambia, Indonesia and Nepal over the past decade. Pairwise odds ratios (OR) were used to measure the magnitude of clustering. This OR measures the risk of xerophthalmia for a preschool child given that another randomly chosen preschool child from the same household (or same village but different household) had xerophthalmia, relative to the risk if that randomly chosen preschool child did not have xerophthalmia. Village pairwise OR ranged from 1.2 in Malawi to 2.2 in Nepal. Household pairwise OR ranged from 4.4 in Malawi to 9.7 in Indonesia, indicating that xerophthalmia clustering was much greater within households than villages. The magnitude of this clustering was as large, or larger than, infectious outcomes such as diarrhoea, fever and cough. Although xerophthalmia was associated with a weekly history of infectious morbidity, the clustering of diarrhoea, fever and cough explained very little of the xerophthalmia clustering observed in each of these studies, Hence, other household factors such as food availability and dietary practices should be examined for their role in the clustering of xerophthalmia within certain households.

To examine whether high job strain (a combination of high job demands and low job control) is a risk factor for disability pension. Ten municipalities and 21 hospitals in Finland. A prospective cohort study of 20 386 female and 4 764 male Finnish public sector employees aged 19-50 using data from two surveys (baseline in 2000-2 and follow-up in 2005) and employers' registers. In addition to self-reported job strain, we computed work unit-aggregated job strain for each participant (the average of scores of all workers of participant's work unit except the participant him/herself). 93 employees (0.4%) retired because of disability during the follow-up. In multilevel logistic regression analysis adjusted for demographic characteristics and health risk behaviour, odds for disability pension was 2.60 (95% CI 1.26 to 5.34) times higher for employees with high self-assessed job strain than for those with low self-assessed job strain at baseline. The corresponding OR for passive job versus low job strain was 2.82 (95% CI 1.34 to 5.96). Analysis of work unit-aggregated scores replicated the association for high job strain, OR 2.25 (95% CI 1.17 to 4.35), but not that for passive job. The association between work unit job strain and disability pension remained significant after further adjustment for prevalent diseases, psychological distress and perceived health status. Job strain is associated with risk of subsequent disability pension. If causal, this association suggests that organisational interventions to reduce job strain may also reduce early exit from work.

To examine health, job satisfaction, and behavioural risks as antecedents of selection from fixed term to permanent employment. Prospective cohort study of change in employment contract during a two year period. Self reported health, recorded sickness absence, job satisfaction, behavioural risks, demographics, and occupational characteristics were assessed at baseline. Hospital staff in two Finnish hospital districts. A cohort of 526 hospital employees (54 men, 472 women) aged 20 to 58 years with a fixed term job contract at baseline. During the follow up period, 137 became permanently employed. Men, employees in higher positions, full time workers, and those with five to eight years in the employ of the hospital were more likely to become permanently employed. After adjusting for these factors, obtaining a permanent job contract was predicted by self rated good health (odds ratio (OR) 3.90; 95% confidence intervals (CI) 1.34 to 11.36), non-caseness of psychological distress (OR 1.80; 95% CI 1.01 to 3.20), high job satisfaction (OR 1.86; CI 1.17 to 2.94), and non-sedentary life style (OR 2.64; CI 1.29 to 5.41), compared with the rest of the cohort. Investigation of fixed term employees yields new information about selective mechanisms in employment mobility. Good health seems to promote the chances for a fixed term employee to reach a better labour market status. These results correspond to earlier research on selective mechanisms in other forms of employment mobility and provide a partial explanation for the socioeconomic gradient of health.

The role of early personality in socioeconomic inequalities in health is not well understood. We investigated the extent to which type A components in adolescence and early adulthood contributed to the inverse association between education and behavioural cardiovascular disease risk factors in adulthood. Prospective cohort study with a population-based random sample of 477 men and 648 women, aged 12-21 years at baseline. Baseline data included information on pathogenic and protective components of type A behaviours (impatience, aggression, hard-driving, and engagement-involvement) and parental education. The 9-year follow-up data included information on the participant's educational level and health behaviours (smoking, alcohol consumption, physical inactivity, butter use). After adjustment for parental education, high levels of impatience and low levels of hard-driving in adolescence and early adulthood predicted low educational level in adulthood (Ps < 0.01 for men, Ps < 0.001 for women). Adulthood education was inversely associated with smoking in women and men (odds ratios [OR] = 8.5 and 7.9, 95% CI: 3.4-18.4 and 3.1-23.9, respectively), and with physical inactivity in women (OR = 5.4, 95% CI: 2.6-11.4). In men, components of type A behaviour explained 28.5% of the inverse association between education and smoking, even after controlling for parental education. In women, the corresponding proportions were 20.5% and 17.7% for smoking and physical inactivity, respectively. The inverse associations of adulthood education with smoking in men and women and physical inactivity in women may be partly rooted in personality-related factors present earlier in life. Our evidence suggests that personality should be studied as a potential contributor to socioeconomic differences in health behaviours.