Job Strain and Tobacco Smoking:An Individual-Participant Data Meta-Analysis of 166 130 Adults in 15 European Studies

BACKGROUND: Tobacco smoking is a major contributor to the public health burden and healthcare costs worldwide, but the determinants of smoking behaviours are poorly understood. We conducted a large individual-participant meta-analysis to examine the extent to which work-related stress, operationalised as job strain, is associated with tobacco smoking in working adults. METHODOLOGY AND PRINCIPAL FINDINGS: We analysed cross-sectional data from 15 European studies comprising 166 130 participants. Longitudinal data from six studies were used. Job strain and smoking were self-reported. Smoking was harmonised into three categories never, ex- and current. We modelled the cross-sectional associations using logistic regression and the results pooled in random effects meta-analyses. Mixed effects logistic regression was used to examine longitudinal associations. Of the 166 130 participants, 17% reported job strain, 42% were never smokers, 33% ex-smokers and 25% current smokers. In the analyses of the cross-sectional data, current smokers had higher odds of job strain than never-smokers (age, sex and socioeconomic position-adjusted odds ratio: 1.11, 95% confidence interval: 1.03, 1.18). Current smokers with job strain smoked, on average, three cigarettes per week more than current smokers without job strain. In the analyses of longitudinal data (1 to 9 years of follow-up), there was no clear evidence for longitudinal associations between job strain and taking up or quitting smoking. CONCLUSIONS: Our findings show that smokers are slightly more likely than non-smokers to report work-related stress. In addition, smokers who reported work stress smoked, on average, slightly more cigarettes than stress-free smokers.

The European Convention on Human Rights after Enlargement

The Council of Europe has dramatically enlarged its membership over the past decade, encompassing the vast majority of the formerly Communist states of Central and Eastern Europe. With this dramatic enlargement, the Council has sought to secure its place in the complex institutional architecture of post-Cold War Europe, building on its traditional strengths in the promotion of democratic governance and human rights. Yet, both inside and outside the organisation, voices have been raised to suggest that the Council has lowered its admission standards in a manner which risks compromising the legitimacy of the European Convention on Human Rights. Against the background of these ongoing controversies, this article assesses the impact of enlargement on the European human rights system. Focusing on the composition of the European Court of Human Rights and the initial pattern of cases from the Central and East European member states, it is demonstrated that the short-term impact of enlargement has been quite limited. Nevertheless, it is clear that the Court will face major new challenges over the coming years. In part, the Court will have to assume the role of an adjudicator of transition. More generally, there will also be mounting pressures for it to (re)cast itself more clearly as a European constitutional court.

Birthweight and the risk of childhood-onset type 1 diabetes: a meta-analysis of observational studies using individual patient data

Aims/hypothesis: We investigated whether children who are heavier at birth have an increased risk of type 1 diabetes. Methods: Relevant studies published before February 2009 were identified from literature searches using MEDLINE, Web of Science and EMBASE. Authors of all studies containing relevant data were contacted and asked to provide individual patient data or conduct pre-specified analyses. Risk estimates of type 1 diabetes by category of birthweight were calculated for each study, before and after adjustment for potential confounders. Meta-analysis techniques were then used to derive combined ORs and investigate heterogeneity between studies. Results: Data were available for 29 predominantly European studies (five cohort, 24 case-control studies), including 12,807 cases of type 1 diabetes. Overall, studies consistently demonstrated that children with birthweight from 3.5 to 4 kg had an increased risk of diabetes of 6% (OR 1.06 [95% CI 1.01-1.11]; p=0.02) and children with birthweight over 4 kg had an increased risk of 10% (OR 1.10 [95% CI 1.04-1.19]; p=0.003), compared with children weighing 3.0 to 3.5 kg at birth. This corresponded to a linear increase in diabetes risk of 3% per 500 g increase in birthweight (OR 1.03 [95% CI 1.00-1.06]; p=0.03). Adjustments for potential confounders such as gestational age, maternal age, birth order, Caesarean section, breastfeeding and maternal diabetes had little effect on these findings. Conclusions/interpretation: Children who are heavier at birth have a significant and consistent, but relatively small increase in risk of type 1 diabetes. © 2010 Springer-Verlag.


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European Union Cross-Border Cooperation and Conflict Amelioration

The relevance of European Union (EU) cross-border cooperation for European border con?ict amelioration may be questioned in the contemporary global climate of threat and insecurity posed by forces of ’dark globalisation’. In any case, empirical evidence exposes the limitations of cross-border cooperation in advancing con?ict amelioration in some border regions. Nevertheless, in an enlarged EU which encompasses Central and East European member states and reaches out to neighbouring states through cross-border cooperation initiatives, the number of real and potential border con?icts with which it is concerned has risen exponentially. Fortunately, there are cases of EU ’borderscapes’ that have adopted a cross-border ’peace-building from below’ approach leading to border con?ict amelioration. Unfortunately, countervailing pressures on EU cross-border cooperation from border security regimes (principally Schengen), the Eurozone crisis, EU budgetary constraints, the conceptualisation of ’Europe as Empire’, and the possible recon?guration of the EU itself compromises this approach. Therefore, the path of European integration may well shift from one of inter-state peace-building and regional crossborder cooperation after the Second World War, to border con?ict and coercion in constituting and reconstituting state borders after the recon?guration of the EU.

Job strain and the risk of severe asthma exacerbations: A meta-analysis of individual-participant data from 100 000 European men and women

Background: Many patients and healthcare professionals believe that work-related psychosocial stress, such as job strain, can make asthma worse, but this is not corroborated by empirical evidence. We investigated the associations between job strain and the incidence of severe asthma exacerbations in working-age European men and women. Methods: We analysed individual-level data, collected between 1985 and 2010, from 102 175 working-age men and women in 11 prospective European studies. Job strain (a combination of high demands and low control at work) was self-reported at baseline. Incident severe asthma exacerbations were ascertained from national hospitalization and death registries. Associations between job strain and asthma exacerbations were modelled using Cox regression and the study-specific findings combined using random-effects meta-analyses. Results: During a median follow-up of 10 years, 1 109 individuals experienced a severe asthma exacerbation (430 with asthma as the primary diagnostic code). In the age- and sex-adjusted analyses, job strain was associated with an increased risk of severe asthma exacerbations defined using the primary diagnostic code (hazard ratio, HR: 1.27, 95% confidence interval, CI: 1.00, 1.61). This association attenuated towards the null after adjustment for potential confounders (HR: 1.22, 95% CI: 0.96, 1.55). No association was observed in the analyses with asthma defined using any diagnostic code (HR: 1.01, 95% CI: 0.86, 1.19). Conclusions: Our findings suggest that job strain is probably not an important risk factor for severe asthma exacerbations leading to hospitalization or death.

European Economic and Social Constitutionalism after the Treaty of Lisbon

European studies frequently regard the economic and social dimensions of EU integration as diametrically opposed, maintaining that this state of affairs is beyond change. This edited collection challenges this perceived wisdom, focusing on the post-Lisbon constitutional landscape. Taking the multi-layered polity that is Europe today as its central organising theme, it examines how the social and the economic might be reconciled under the Union's different forms of governance. The collection has a clear structure, opening with a theoretical appraisal of its theme, before considering three specific policy fields: migration policy and civic integration, company law and corporate social responsibility and the role of third sector providers in public healthcare. It concludes with three case studies in these fields, illustrating how the argument can be practically applied. Insightful and topical, with a unique interdisciplinary perspective, this is an important contribution to European Union law after the Lisbon Treaty

European Union Non-Discrimination Law: Comparative Perspectives on Multidimensional Equality Law

EU equality law is multidimensional in being based on different rationales and concepts. Consequently, the concept of discrimination has become fragmented, with different instruments envisaging different scopes of protection. This raises questions as to the ability of EU law to address the situation of persons excluded on a number of grounds. This edited collection addresses the increasing complexity of European Equality Law from jurisprudential, sociological and political science perspectives. Internationally renowned researchers from Scandinavian, Continental and Central European countries and Britain analyse consequences of multiplying discrimination grounds within EU equality law, considering its multidimensionality and intersectionality. The contributors to the volume theorise the move from formal to substantive equality law and its interrelation to new forms of governance, demonstrating the specific combination of non-discrimination law with welfare state models which reveal the global implications of the European Union. The book will be of interest to academics and policy makers all over the world, in particular to those researching and studying law, political sciences and sociology with an interest in human rights, non discrimination law, contract and employment law or European studies.

Shifting Thresholds, Contested Meanings: Governance, Cross-border Co-operation and the Ulster Unionist Identity

Cross-border (North/South) co-operation between the Republic of Ireland and Northern Ireland was an indelible feature of the form of governance provided by the Belfast Good Friday Agreement (1998). Previous efforts to establish North/South co-operation had all foundered but the establishment and initial operation of the Agreement's cross-border institutions proved to be uncontroversial. However, during its implementation, other areas of the Agreement gave Ulster unionists more pressing cause for concern. These areas of concern included the release of paramilitary prisoners, police reform, the 'decommissioning' of Irish Republican Army (IRA) weaponry, and the unionist perception that the 'Britishness of Northern Ireland' was being actively eroded. These concerns served to emphasise and strengthen political and cultural borders between communities at a regional and local level within Northern Ireland. They also threatened the pro-Agreement unionists' contestation of unionist ideological orthodoxy, a contestation that was undertaken in an attempt to adapt the Ulster unionist identity to the shifting thresholds of the state.

Euroscepticism in the Netherlands: Stirrings of Dissent

Recent years have seen the emergence of a markedly more critical discourse in the Netherlands as regards European integration. Concerns over both the size of the net national contribution to the European Union budget and the implications for the country of EU enlargement have given rise to high-profile public debates. An explicitly articulated discourse of national interest, centred on but not limited to the Liberal VVD, has become a staple of political debate. At the same time, movements with clearly Eurosceptic agendas (the Pim Fortuyn List and the Socialist Party) have enjoyed unparalleled levels of electoral success. Although not of significant electoral salience, 'Europe' has nevertheless emerged as an issue in Dutch politics. The present article examines these stirrings of dissent in an EU member state which had long been regarded as one of the most enthusiastic supporters of further integration.