Cantonal Level Research Articles

Assessment of the banking sector's exposure to hydrometeorological events in Costa Rica

This study examines, for the first time, the exposure of the credit portfolio of the banking system in Costa Rica to hydrometeorological events, specifically excess rainfall events, with a focus on firm credit at the canton level. We propose a credit risk indicator to identify cantons with credit portfolios that are more affected by rainfall events. Moreover, we introduce a novel approach with respect to firm level data to assign a single productive location to firms with two or more establishments. We find that cantons with the highest number of excess rainfall events represent a small share of the average credit balance of the country. Furthermore, we observe that the top three cantons with the highest credit risk score are driven by economic activities that are not expected to be notably vulnerable to extreme rainfall.

The institution of popular veto: experience of selected foreign countries

This article examines the legislation of foreign countries regarding mechanisms of direct democracy, particularly the institution of popular veto. A historical analysis of the development of this instrument in European law has been conducted. The methodological basis of the publication consists of scientific methods based on the requirements of objective and comprehensive analysis of socio-political and legal phenomena, which include direct democracy in foreign countries. The research methodology is founded on general theoretical principles and approaches to determining the initial parameters of the formation and development of popular veto as a form of direct democracy. To achieve scientific objectivity in the results, the author used a full range of general scientific and special research methods widely applied in the modern science of constitutional law. It has been established that although modern forms of direct democracy emerged relatively recently, the concept of popular veto has roots in ancient civilizations as a means of limiting the abuse of power. Initially, the right of veto was exercised not directly by citizens, but by authorized persons on behalf of the people, who could reject laws that contradicted fundamental norms. It is argued that although popular veto was first enshrined in French constitutional law, Switzerland is considered its birthplace, where this institution received genuine development and was first implemented in practice in 1831. The evolution of popular veto is closely linked to the development of Swiss statehood; however, the immediate impetus for its implementation was granting citizens direct voting rights and the right to participate in referendums. Initially, popular veto was applied at the level of individual cantons, and in 1874 it was enshrined in the Swiss Constitution at the national level. According to the constitutional procedure, a specified number of voters can officially express disagreement with an adopted law within a set period, after which it must be submitted to a nationwide referendum for approval or repeal.

The effects of mobile primary health teams: Evidence from the Médico del Barrio strategy in Ecuador

Starting in 2017, Ecuador gradually expanded its primary healthcare access program nationwide using mobile traveling healthcare teams through the Estrategia Médico del Barrio (EMB) [or Neighborhood Doctor Strategy]. EMB teams, composed of a primary care physician, a nurse, and a community health worker, made home visits in marginalized areas. We estimate the impact of the EMB on health and utilization outcomes using nationally representative household surveys for 2006 (N = 55,666), 2012–13 (N = 92,500) and 2018–19 (N = 168,747). The treatment variable at the extensive margin is any exposure to EMB at the canton level. At the intensive margin, we use exposure in terms of weeks covered by EMB and the number and composition of EMB personnel per 1000 population. We identify outcomes of treated vs. non- or partially-treated cantons based on the random combination of the timing of the start of the program’s implementation and the timing of the survey interview, which varied across cantons. We use difference-in-difference (DD) and difference-in-difference-in-difference (DDD) frameworks, the latter for cantons with high indigenous concentration. We find significant effects on the reported health problem and preventive care, but mixed results in terms of curative healthcare. The DDD specification shows that EMB improved health problem diagnoses and preventive healthcare utilization, including in highly indigenous cantons, yet it seemed to have mixed results in terms of curative care use in Ecuador. Various alternative specifications and robustness tests do not qualitatively alter the main findings.

The Swiss Debt Brake Is Democratic, Strict, Transparent, and Binding. A Model to Follow?

Abstract The Swiss debt brake at the federal level was accepted in 2001 by a direct democratic referendum, where it received an overwhelming approval rate of almost 85 percent “yes” votes. The fiscal rule mandates that budgeted expenditures cannot exceed cyclically adjusted expected revenues, targeting gross debt while prohibiting new structural debt. Violations due to ordinary or extraordinary expenditures are transparently recorded in separate accounts, which must be balanced within three and six years, respectively. The federal rule is complemented by decentralized debt brakes at the cantonal level. Compared to a synthetic Switzerland without the federal debt brake, the fiscal rule did not decrease public investments, with the notable exception of military expenditure. Additionally, the accuracy of budget forecasts has improved, evidenced by reduced discrepancies between projected and actual revenues and expenditures.

Education systems as life course policies? The example of subnational educational regimes and young adults’ family transitions

Abstract This study investigates the role of subnational educational opportunities for three typical transitions in young adulthood: 1) leaving the parental home, 2) starting to cohabit and 3) becoming a parent. Educational opportunities shape young adults’ life courses as they facilitate the accumulation of human capital, labour market entry and financial independence. Education systems and opportunities are part of transition regimes shaped by the specific cultural, economic and policy characteristics of a (subnational) context, and are thus likely to affect moving out and family formation. Drawing on the example of Switzerland with its large cantonal variation in educational opportunities, we use longitudinal data from the TREE panel study to follow a cohort of young adults born in the mid-1980s from ages 16 to 29. Event history models show that larger shares of young people in vocational education at a cantonal level are associated with earlier moving out and parenthood, but later partnership formation. The influence of vocational opportunities is moderated by the presence of a university in the canton.

ОСОБЛИВОСТІ ОЦІНКИ НЕРУХОМОСТІ: ЗАКОРДОННИЙ ДОСВІД

The purpose of the article is to study the features of real estate valuation abroad. The article analyzes the experience of real estate valuation in foreign countries. It was found that the Center of Lithuanian Registers operates in Lithuania, which includes the register of immovable property and cadastre, the register of legal entities, the register of addresses and registers of residents. In Georgia, all registers are united in the National Public Register Agency. In Sweden, a general assessment is carried out every six years with the purpose of adjustments if necessary, a simplified general assessment is carried out three years after the general assessment, a special assessment is carried out annually to assess newly built properties. In Slovenia, an infrastructure has been created for more efficient management of land resources and mass valuation of real estate, and a register of sales prices is in place to ensure the collection of information about deals on the real estate market. In Poland, mass assessment is a set of procedures for determining the cadastral value of property for tax purposes. In Switzerland, the cadastral accounting of real estate is carried out at the international and cantonal levels. In France, residential buildings are taxed separately from industrial and commercial objects. The annual rental value is used to estimate the value of commercial buildings. In Australia, Denmark, Sweden and Indonesia, the method of determining the estimated value is based on the comparison of sales prices, in Switzerland, Canada and the Netherlands – on the capitalization of income from the permanent use of real estate. Ukrainian legislation on real estate valuation is analyzed. Its features during the war period are highlighted. It is indicated that access to the State Register of Property Rights to immovable property has been restored, and separate norms and rules have been established regarding registration actions. It has been found that in Ukraine such methodical approaches to assessment as income (profitable), expenditure (property), comparative (market) have been established. Further research should be aimed at revealing the role of economic analysis in the land management system after the end of martial law.

From Research to Policy: Unveiling Dementia Prevention Efforts in Switzerland

ABSTRACT Recent research has challenged the notion that dementia is an inevitable outcome of age-related cognitive decline, highlighting the possibility of preventing or delaying onset by addressing specific risk factors. This paradigm shift suggests that prevention through lifestyle modifications and early interventions is possible, potentially averting millions of cases worldwide. This study explores the translation of scientific evidence on dementia prevention into public health policy in Switzerland. Combining the analysis of official policy documents and qualitative interviews with stakeholders, the study explores potential barriers and challenges to implementing preventive intervenions or programs, as well as opportunities for improvement. Results indicate a significant gap in incorporating emerging scientific evidence on dementia prevention into health policies and disseminating information to the public in Switzerland. This study underscores the need for a collaborative and coordinated approach to address these barriers and effectively translate scientific findings into preventive policies and campaigns. These insights can inform policy and targeted programs in Switzerland both at the federal and the cantonal level, eventually serving as a model for other countries seeking to translate evidence-based dementia prevention strategies into public health policies. By bridging the gap between research and policy, significant progress can be made in preventing or delaying the onset of dementia, providing significant benefits to individuals, families, and society.

Potentially avoidable hospitalizations and socioeconomic status in Switzerland: A small area-level analysis

The Swiss healthcare system is well known for the quality of its healthcare and population health but also for its high cost, particularly regarding out-of-pocket expenses. We conduct the first national study on the association between socioeconomic status and access to community-based ambulatory care (CBAC). We analyze administrative and hospital discharge data at the small area level over a four-year time period (2014 – 2017). We develop a socioeconomic deprivation indicator and rely on a well-accepted indicator of potentially avoidable hospitalizations as a measure of access to CBAC. We estimate socioeconomic gradients at the national and cantonal levels with mixed effects models pooled over four years. We compare gradient estimates among specifications without control variables and those that include control variables for area geography and physician availability. We find that the most deprived area is associated with an excess of 2.80 potentially avoidable hospitalizations per 1,000 population (3.01 with control variables) compared to the least deprived area. We also find significant gradient variation across cantons with a difference of 5.40 (5.54 with control variables) between the smallest and largest canton gradients. Addressing broader social determinants of health, financial barriers to access, and strengthening CBAC services in targeted areas would likely reduce the observed gap.

FEATURES OF THE DEVELOPMENT OF EDUCATION IN SWITZERLAND

The article provides an analysis of the current problems of education in Switzerland. Based on the development of normative materials (national and cantonal levels), scientific research by foreign scientists (U. Bekolli, X. Bueler, U. Fredriksson, B. Getto, A. Gretler, T. Holzer, M. Keim, K. Maag-Merki, J. Zulliger) and generalization of the educational activities of practicing teachers (N. Boruvka, К. Кirr, R. Stuber) the Swiss education system is characterized, the latest trends and contradictions in its development are highlighted.In the course of the general historical and pedagogical discourse, it was emphasized that Switzerland has fundamental pedagogical traditions, which are reflected in the works of J. Pestalozzi (1746-1827), A. Ferrier (1841-1919), J.-Zh. Rousseau (1712-1778), E. Clavius (1837-1906). It has been established that modern education in Switzerland is decentralized and lies within the responsibility of cantons (administrative units), so certain features may exist in different regions of the country. However, the general principles of organizing the education system of the Swiss cantons are similar. Each canton establishes its own educational calendar, curriculum and didactic criteria.The basic structure of Swiss education includes the following levels: preschool education, primary education, secondary education (lower secondary education and upper secondary education), vocational education, higher education. One of the features of the education system in Switzerland is multilingualism. Four languages are officially recognized in the country: German, French, Italian and Romansh. Depending on the region, the language of instruction may differ. Foreign languages are highly valued in the Swiss education system. Most children and young people learn English and at least a second national language. It is also worth noting that the education system in Switzerland is quite flexible, there are different paths and programs that meet the needs of pupils and students with different educational goals and interests.It was found that the problems of education in Switzerland are studied by many scientists who specialize in the field of education, psychology and sociology. Among the most urgent problems of Swiss pedagogy, it is appropriate to single out the following aspects: digitalization of education and the impact of this process on the transformation of educational interaction between teacher and student, teacher and student (pedagogical creativity and cooperation in conditions of digitalization); organization of didactic communication in a multicultural and multilingual educational environment (approximately 25% of the population of Switzerland is made up of foreigners); professional development of teachers (lack of support for innovation, inflated expectations of society, instability of employment, etc.); application of labor education and productive work in the educational process; improvement of ties between educational institutions and basic enterprises, etc.

Decisions of the Council of Ministers of Bosnia And Herzegovina as Sub-Laws in Comparison With Regulations of Governments

This paper researches the decisions of the Council of Ministers of Bosnia and Herzegovina as general sub-laws and compares them with regulations of governments on other levels of government in Bosnia and Herzegovina. The comparison of the decisions of the Council of Ministers is carried out with the regulations of the Government of the Federation and the Government of Sarajevo Canton, with the intention to determine that decisions of the Council of Ministers have in essence the same scope and subject of regulating as the aforementioned government regulations, placing emphasis on the constitutional distribution of competencies between state, entities and cantons. The original research has determined that the Council of Ministers carries out the majority of legislative activities with their decisions, but rulebooks and instructions also appear as sub-laws, which isn’t the case on federal and cantonal levels, where rulebooks and instructions are exclusively adopted by administrative bodies, although administrative bodies on the level of Bosnia and Herzegovina also adopt these types of legislation. It has been determined that most decisions, rulebooks and instructions of the Council of Ministers, as well as regulations of governments are adopted for the purpose of executing the law, therefore as classical sub-laws, although different examples also appear. Finally, an amendment to the law is proposed in the sense that the Council of Ministers adopts regulations as sub-laws, with the cessation of adoption of rulebooks and instructions, which would be more appropriate from the aspect of our administrative law and bring about more order and would systematise this area.

Social workers’ intention to hold elected political office: a quantitative study based on the theory of planned behavior

ABSTRACT Social work is closely intertwined with formal and informal policy processes and social workers, in line with the global definition of social work as well as national codes of ethics, are called upon to act as policy actors at various levels. One possible way to do this is to hold elected political office. This quantitative cross-sectional study examines the intention of 92 Swiss social workers to hold elected political office at the local, cantonal, or national level and uses the Theory of Planned Behavior (TPB) to identify factors associated with their intention. The findings show that social workers’ intention is strongly associated with the core factors of the TPB – attitudes, subjective norm, and perceived behavioural control. Based on the study’s findings, this article outlines avenues for further research and suggests possible strategies to enhance the policy role of social workers, specifically addressing social work education, professional associations of social work, and social welfare organisations.

Doctors forthe people? The problematic distribution ofrural service doctors inEcuador.

Primary health care is at the core of health systems that aim to ensure equitable health outcomes. With an estimated 36% of rural population, Ecuador has a service year programme (created in 1970) for recently graduated doctors to provide primary care services in rural and remote communities. However, little has been done to monitor or evaluate the programme since its inception. The aim of this study was to assess Ecuador's rural medical service implementation with a focus on equitable distribution of doctors across the country. For this purpose, we analysed the distribution of all doctors, including rural service doctors, in health-care facilities across rural and remote areas of Ecuador in the public sector at the canton level for 2015 and 2019, by level of care (primary, secondary and tertiary). We used publicly available data from the Ministry of Public Health, the Ecuadorian Institute of Social Security and the Peasant Social Security. Our analyses show that two of every three rural service doctors are concentrated at the secondary level, while almost one in five rural service doctors, at the tertiary level. Moreover, cantons concentrating most rural service doctors were in the country's major urban centres (Quito, Guayaquil, Cuenca). To our knowledge, this is the first quantitative assessment of the mandatory rural service year in Ecuador in its five-decade existence. We provide evidence of gaps and inequities impacting rural communities and present decision makers with a methodology for placement, monitoring and support of the rural service doctors programme, provided that legal and programmatic reforms come into place. Changing the programme's approach would be more likely to fulfill the intended goals of rural service and contribute to strengthening primary health care.

Spatial-Temporal Determinants of Income Inequality in the Cantons of Ecuador between 2010 and 2019: a Spatial Panel Econometric Analysis

Inequality is a problem that remains latent throughout generations, despite the growth of countries and the mechanisms that were implemented to mitigate it. Understanding the structure of spillovers from a spatial point of view would allow for the management of current resources, with the aim of improving the distribution among individuals at the cantonal level for Ecuador. In this context, this study aims to estimate the effect of the determinants of income inequality at the cantonal level, through the use of spatial models during the period 2010–2019, for 213 cantons in Ecuador. The Kuznets inverted-U theory is applied, which allows us to understand the changes that economic growth produces on income inequality levels. The approach indicates that the current average rate of growth of production per capita has made inequality levels decrease. In addition, human capital has the opposite effect to that expected, increasing inequality levels as a result of a concentration of this resource in certain cantons. On the other hand, the entrepreneurial structure of micro and small enterprises allows to mitigate the inequality levels between cantons. In this sense, among the policy objectives is to prioritize a more homogeneous growth of the cantons of Ecuador, likewise, generate policies that allow reducing the concentration of human capital in certain regions, as well as financial development. On the other hand, it is important to strengthen the prevalence of Micro, small and medium-sized enterprises in the long term, with the aim of improving family income levels and reducing inequality.

The effect of the healthcare system's structure on COVID‐19 dynamics in Ecuador

AbstractTo manage the COVID‐19 pandemic, governments established certain stringency measures, such as lockdowns and traffic light systems. However, the response to the pandemic depended on the regions' preexisting capacities and underlying conditions. This study aims to determine the relationship between the COVID‐19 pandemic dynamics and the underlying regional healthcare system's structure in Ecuador, using three dependent variables—the number of COVID‐19 cases, the COVID‐19 prevalence rate at the cantonal level, and the daily deaths resulting from COVID‐19 at the provincial level—for three phases: isolation, social distancing, and contingency. Using daily COVID‐19 data and cantonal (provincial) level variables, a negative binomial model and a tobit model were estimated to analyze the determinants of the number of COVID‐19 cases and the prevalence rate, respectively. The results show a positive relationship between primary and secondary health centers and the number of infected people, implying that it is possible to make more diagnoses when the health infrastructure is more developed. As for COVID‐19 deaths, primary health centers are associated with a low number of daily deaths whereas secondary health centers are associated with a higher number of daily deaths, implying the transfer of severe COVID‐19 cases to cantons with secondary health centers. More affluent cantons had more COVID‐19 cases and deaths. Stringency measures, such as the traffic light system, were effective in managing the pandemic. The geographical proximity between cantons and the nature of economic activities (essential versus non‐essential) also impacted the spread of the virus.

Climate change vulnerability hotspots in Costa Rica: constructing a sub-national index

For policies and programs aiming at reducing climate risk, it is important to obtain vulnerability information at the sub-national level to identify hotspots. For the case of Costa Rica, no sub-national climate vulnerability index exists to date. To fill this gap, we constructed a climate vulnerability index at the canton level. We ground our work in the conceptual framework that vulnerability is a function of exposure, sensitivity, and adaptive capacity. Making extensive use of geographic information systems and publicly available data, we constructed 13 spatial layers to reflect the multi-dimensionality of vulnerability. Layers reflect for example, changes in climatic extremes, flood risk, vegetation cover, access to infrastructure (road density) and health services (distance to hospitals), as well as various socioeconomic (wealth level, employment rates, remittances, literacy rate) and demographic (infant mortality) characteristics. Following normalization, we constructed an inverse variance weighted index of canton-level climate vulnerability. We confirmed the validity of our climate vulnerability index through correlation with disaster damage data. We find the strongest climate vulnerability not only in the rural, agricultural producing border cantons (Los Chiles, Matina, Talamanca, Buenos Aires), but also for a few central urban cantons (Tibas, San Jose). Projects and interventions in these hot spot cantons may reduce sensitivity through strengthening hydrological infrastructure and economic development, while adaptive capacity may be improved through addressing barriers of remittance transfer, and via public health programs.

Widespread Clean Cooking Fuel Scale-Up and under-5 Lower Respiratory Infection Mortality: An Ecological Analysis in Ecuador, 1990-2019.

Nationwide household transitions to the use of clean-burning cooking fuels are a promising pathway to reducing under-5 lower respiratory infection (LRI) mortality, the leading cause of child mortality globally, but such transitions are rare and evidence supporting an association between increased clean fuel use and improved health is limited. This study aimed to investigate the association between increased primary clean cooking fuel use and under-5 LRI mortality in Ecuador between 1990 and 2019. We documented cooking fuel use and cause-coded child mortalities at the canton (county) level in Ecuador from 1990 to 2019 (in four periods, 1988-1992, 1999-2003, 2008-2012, and 2015-2019). We characterized the association between clean fuel use and the rate of under-5 LRI mortalities at the canton level using quasi-Poisson generalized linear and generalized additive models, accounting for potential confounding variables that characterize wealth, urbanization, and child health care and vaccination rates, as well as canton and period fixed effects. We estimated averted under-5 LRI mortalities accrued over 30 y by predicting a counterfactual count of canton-period under-5 LRI mortalities were clean fuel use to not have increased and comparing with predicted canton-period under-5 LRI mortalities from our model and observed data. From 1990 to 2019, the proportion of households primarily using a clean cooking fuel increased from 59% to 95%, and under-5 LRI mortality fell from 28 to 7 per 100,000 under-5 population. Canton-level clean fuel use was negatively associated with under-5 LRI mortalities in linear and nonlinear models. The nonlinear association suggested a threshold at approximately 60% clean fuel use, above which there was a negative association. Increases in clean fuel use between 1990 and 2019 were associated with an estimated 7,300 averted under-5 LRI mortalities (95% confidence interval: 2,600, 12,100), accounting for nearly 20% of the declines in under-5 LRI mortality observed in Ecuador over the study period. Our findings suggest that the widespread household transition from using biomass to clean-burning fuels for cooking reduced under-5 LRI mortalities in Ecuador over the last 30 y. https://doi.org/10.1289/EHP11016.

Vier Thesen zur effektiven Umsetzung der Innenentwicklung in der Schweiz

: Densification is considered a desirable planning solution to prevent urban sprawl and reduce land consumption. The implementation of this goal is acknowledged to come with a range of benefits such as biodiversity preservation, improved energy efficiency, and optimising infrastructure costs. While the need for densification is largely undisputed in the planning debate, the question remains, however, of how to achieve this policy objective. Planning practice is struggling with the implementation of densification objectives because the process implies that stakeholders must deal with the existing built environment, small-scale ownership structures, mosaic of ways, etc. In this paper, we discuss four theses that help explain these implementation difficulties. We take the Swiss spatial planning policy system as a case study example due to its traditionally high priority of densification implementation in Swiss cantons and municipalities. Our four theses suggest different intervention approaches at the federal, cantonal, and local levels to steer and implement densification goals effectively. As well as a clear definition of what ‘densification’ means (and what not), greater financial and personnel support is regarded as being key for municipal planning administrations to effectively resist increasingly professional and legally powerful landowners. English title: Four theses on the effective implementation of densification goals in Switzerland

Besonderheiten des schweizerischen Parlamentarismus, des Parteien- und Wahlsystems

The parliamentary culture in the three levels of government in Switzerland (federal, can- tonal, and municipal) differs in various ways from the parliamentary customs and practices in other European countries, particularly in Germany and Austria . The strong tradition of popular rights in Switzerland shapes the work and impact of the parliaments at all three levels . Popular rights form the core of direct democracy . They allow for proposing revisions to constitutional and legislative provisions (popular initiative) or voting on parliamentary decisions retrospectively (referendum) . They thus expand the indirect democracy that is limited to the election of individuals . In addition to a brief overview of the history and orientation of political parties, the procedures for the election of parliaments at the federal and cantonal levels are examined . Other peculiarities include the mostly annual rotation of the presidencies of the Swiss parliaments and the principle of part-time participation in the parliaments .

7.L. Workshop: New roles and innovative skill-mix in nursing across Europe: trends and lessons for implementation

Abstract Many countries in Europe are changing the roles and skill-mix of their nursing workforce. A sufficient and well-skilled nursing workforce has shown to be key for population health, most recently demonstrated during the Covid-19 pandemic. An increasing number of countries have introduced Master-level education for nurses to work in advanced practice nursing (APN) roles. These changes in the educational systems have implications on patients, clinical practice, teams and health systems. Moreover, many countries are re-orienting their health services from hospital to primary health care and prevention, driving new roles for nurses. The relevance of high-quality education and upskilling has been exemplified during the Covid-19 pandemic, where nurses had to quickly adapt to new treatment and caregiving situations in challenging work environments. Objectives of the workshop. This workshop will provide an overview of research and policy developments in Europe, drawing on recent research. First, an overview of innovative skill-mix changes in nursing will be presented and evidence on health outcomes, based on a study from the European Observatory on Health Systems and Policies. Second, research from Germany in five innovator hospitals will be presented, a country which is still at an early stage with integrating nurses in advanced roles. The panel discussion will address innovations in APN research, practice and policy lessons in Europe and with in-depth insights from four countries (Netherlands, Finland, Switzerland, Germany). In the Netherlands, the policy instrument “experimental law” has led to full practice authority for Nurse Practitioners, its impact on practice as well as barriers and enablers will be addressed. In Finland, the focus will be on recent evidence on the expanded role of nurse prescribers, the policy process and early evidence on impacts for nurses and patients. In Switzerland, the lack of regulation and reimbursement schemes restrict advanced practice, whereas drivers comprise changes in population needs, education (master and doctoral level) and reduced workforce availability. Developments at the national and cantonal level and the evaluation of innovative care models with APNs will be presented using case examples and recent research (e.g. university hospitals, primary care). The panelists will discuss implications for research, policy and nursing management, also taking into account the Covid-19 pandemic and other unexpected “health shocks” which have shown to impact considerably on nurses’ roles in practice. Lessons will be shared on strategies for a well-qualified and -resourced nursing workforce integrated in systems. The format is ‘regular workshop’ with two presentations and a panel discussion with experts from four countries. Key messages • Multiple innovative nursing skill-mix model exist, with promising outcomes for individuals and population groups if nurses are well trained and equipped. • Implementation of APN roles requires enabling policy contexts, sufficient funding, clinical leadership, teams that are open to innovations, and strong nurses that take on APN roles.

Influence of cantonal health policy frameworks & activities on the influenza vaccination rate in patients with non-communicable diseases in Switzerland

Background and objectiveSeasonal influenza may cause serious illness, especially in high-risk populations such as older adults and individuals suffering from non-communicable diseases (NCD) and may be prevented by a vaccination. However, an assessment of the impact of the Swiss legal frameworks and number of health activities on influenza vaccination coverage of the population at the cantonal level is lacking. MethodsTwo participating healthcare insurers sent out 25,000 semi-structured questionnaires to their subscribers aged 60–85 in five Swiss cantons selected according to the number of health activities and legal framework regarding influenza vaccination and linguistic region. Influenza vaccination coverage of the participants was evaluated and stratified by disease status, age, canton, and linguistic region. Results were compared by cantonal activities, legal framework, and linguistic region. Results7,617 valid questionnaires were evaluated from the cantons Aargau, Jura, St. Gallen, Schwyz, and Vaud. 47.9 % stated to have an NCD, with the most frequent being muscle/ skeletal disease (36.7%). Before 2018, 48.6% were vaccinated against influenza, and 35.9% in 2019, with the highest in canton Vaud. In all cantons and in both survey periods, NCD patients and those aged 73–85 had a higher vaccination coverage than participants without NCD, and aged 60–72. There was no difference in the odds of getting an influenza shot based on legal framework. Although a comparison of the number of activities between the German-speaking cantons did not reveal any significant differences, the odds of the participants living in a French-speaking canton getting an influenza vaccination was more likely than those living in a German-speaking canton. ConclusionThere was no association between the investigated cantonal frameworks and number of health activities and influenza vaccination coverage in NCD patients in the selected cantons. However, age, disease status and linguistic region appear to have an influence on vaccination uptake.