Swiss Region Research Articles

Ageism and the digital divide in Switzerland during COVID-19: Lessons for the post-pandemic world

The COVID-19 pandemic erupted in early 2020. The Swiss Federal Council implemented a semi-lockdown in March 2020, asking people, particularly older adults, to stay at home to limit the transmission of the disease and to use digital tools to maintain their social relations and activities. This study inquired how older adults confronting precarity experienced these restrictions, how digital tools functioned in this context, and what learning could therefore be imbibed for the post-pandemic era. We conducted semi-structured telephone interviews with adults aged between 66 and 90 years living in a rural and mountainous Swiss region. The obtained data were subsequently thematically analyzed. The results revealed that the respondents experienced ageism during the semi-lockdown and reported limited or non-existent opportunities to use digital tools to maintain online social contact. This predicament increased their sense of loneliness and amplified their feelings of rejection by the outside world. These observations elucidate the need for the enhancement of non-ageist social support for older people, including individuals with limited social and material resources. We advocate the adoption of innovative initiatives in the post-pandemic era to better include precarious older people in our localities and neighborhoods.

Influence of the implementation of strengths-based nursing and healthcare on early childhood nurses’ competencies: a mixed-method study

BackgroundThe scope of practice for nurses caring for families has evolved to meet the challenges presented by societal changes and increasing needs. In 2015, early childhood nurses from a Swiss region decided to implement a new model of care to guide their practice. The aim of this study was to explore the changes to early childhood nurses’ practices following the implementation of the strengths-based nursing and healthcare (SBNH) approach to care.MethodsThis study of early childhood nurses’ (N = 61) practices used a pre-post intervention design and a mixed-method approach. Nurses’ competencies and changes in practice were measured using the Nurse Competence Scale (NCS). The quantitative data were analysed using descriptive statistics, Kruskal Wallis tests and logistic regression. Thematic analysis was used to derive themes from the qualitative data.ResultsAfter the intervention, frequency of competency use increased in all domains of the NCS except the “teaching-coaching” domain; perceived levels of competencies also increased in all areas except “helping role” and “diagnostic functions”. Age and length of employment at the current post hindered improvement in the “teaching-coaching” competency. Interviews revealed themes related to the implementation process: “adaptability”, “implementation process”, “ambivalence” and “engagement to change”. Other themes were related to practice changes: “developing a disciplinary identity”, “path with families” and “strengths”.ConclusionThis study showed that the use of perceived competencies changed over time after the introduction of SBNH into practice. Nurses questioned and adapted their routines based on SBNH. Nurse’s vision of care also changed; they felt that their care was congruent with their values. For families, this approach allowed a change of vision with a resource-centred approach. Implementation of models of care such as the SBNH in the early childhood context is innovative, as little research in the literature addresses the early childhood community home-visiting context is still modest. This research underlines the added value of this approach on early childhood nurses’ competencies.

Biomonitoring of ochratoxin A, 2\u2032R-ochratoxin A and citrinin in human blood serum from Switzerland

Biomonitoring of mycotoxins and their metabolites in biological fluids is increasingly used to assess human exposure. In this study, biomarkers of ochratoxin A (OTA) and citrinin (CIT) exposure were determined in a large number of serum samples from healthy blood donors in Switzerland. In 2019, 700 samples from different regions were obtained. From 240 donors, a second sample (taken 2–9 months later) was available for analysis. Moreover, 355 blood donor samples from 2005 from all regions in Switzerland and 151 additional samples from the southern Swiss region of Ticino from 2005 could be analysed.OTA, 2′R-ochratoxin A (2′R-OTA), ochratoxin alpha (OTα), CIT and dihydrocitrinone (DH-CIT) were analysed using validated targeted methods including precipitation and online SPE clean-up.OTA and 2′R-OTA were frequently detected (OTA in 99%; 2′R-OTA in 51% of the tested samples). The mean concentration in all positive samples was 0.4 ng/mL for OTA and 0.2 ng/mL for 2′R-OTA. OTα was not detected in any sample above the limit of quantification (LOQ). In contrast to OTA, CIT and DH-CIT were only quantifiable in 2% and 0.1% of the samples, respectively. No significant trend was observed between the samples from 2005 and the more recent samples, but OTA concentrations were usually higher in serum samples from the southern Swiss region of Ticino and in males compared to females.Our extensive data fit well within the framework of previously published values for the healthy adult European population.

Economic value of three grassland ecosystem services when managed at the regional and farm scale

Grasslands cover a major share of the world’s agricultural land and their management influences ecosystem services. Spatially targeted policy instruments can increase the provision of ecosystem services by exploiting how they respond to spatial differences in environmental characteristics such as altitude, slope, or soil quality. However, most policy instruments focus on individual farms, where spatial differences are small. Here we assess the economic value of three grassland ecosystem services (i.e., forage provision, carbon sequestration, and habitat maintenance) and its variability in a Swiss region of 791 km2 that consists of 19,000 farmland parcels when managed at the regional and farm scale, respectively. Our spatially explicit bio-economic simulation approach combines biophysical information on grassland ecosystem services and their economic values. We find that in our case study region, spatial targeting on a regional scale management increases the economic value of ecosystem services by 45% compared to targeting at farm scale. We also find that the heterogeneity of economic values coming from prices and willingness to pay estimates is higher than the economic gains from spatial targeting that make use of the spatial difference in environmental characteristics. This implies that heterogeneity in prices and/or societal demand of these three ecosystem services is more important for grassland management than spatial heterogeneity in our case study region. The here applied framework allows for an ex-ante assessment of economic gains from spatial targeting and thus provides basic information for the implementation of incentive mechanisms addressing the nexus of food production and ecosystem service provision in grasslands.

Care and cost trajectories of asylum seekers in a nurse-led, patient centered, care network in Switzerland

BackgroundSwitzerland, with its decentralized health system, has seen the emergence of a variety of care models to meet the complex needs of asylum seekers. A network of public and private providers was designed in the canton Vaud, in which a nurse-led team acts as a first contact point to the health system and provides health checks, preventive care, and health education to this population. In addition, the service plays a case management role for more complex and vulnerable patients. While the network has been examined from a clinical angle, we provide the first descriptive evidence on the care and cost trajectories of asylum seekers in the canton.MethodsWe used routinely collected administrative, patient-level data in a Swiss region responsible for 10% of the asylum seekers in the country. We extracted data on all asylum seekers aged 18 or older who entered the network between 2012 and 2015. The data covered all healthcare costs during the period until they left the network, either because they were granted residence, they left the country, or until 31 December 2018. We estimated random effects regression models for costs and consultations within and outside the network for each month of stay in the network. We investigated language barriers in access to care by stratifying the analysis between patients who spoke one of the official Swiss languages or English and patients who did not speak any of these languages.Principal findingsWe found that both overall health care costs and contacts with the nurse-led team were relatively high during the first year of stay. Asylum seekers then progressively integrated into the regular health system. Individuals who did not speak the language generally had more contacts with the network and fewer contacts outside.ConclusionsIn this exploratory study, we observe a transition from nurse-led specific care with frequent contacts to care in the regular health system. This leads us to generate the hypothesis that a nurse-led, patient-centered care network for asylum seekers can play an important role in providing primary care during the first year after their arrival and can subsequently help them navigate autonomously within the conventional healthcare system.

The ABC of Primary Care for University Students: a 3-Step Structured Approach at Geneva University Hospitals

University and college students present specific health issues with vulnerabilities related to mental health and sexual health, risk-taking behaviors, and delayed access to primary care. A new student outpatient clinic was created in September 2016 at Geneva University Hospitals to respond to the health needs of this population. We present here the clinical management framework developed for a primary care consultation with students. A 3-step approach (ABC) was designed by expert consensus using different sources. A post-consultation satisfaction survey was conducted among students attending the clinic. The approach proposed 3 steps comprising general information, social evaluation, and preventive care. The importance of offering modern means of communication (online appointments, email exchanges with clinicians) was emphasized by experts. The question of cultural identity and connectedness was also addressed, especially for international students or those coming from a different Swiss region. In November 2018, a survey conducted among 128 patients out of 449 consultations showed that 94.5% agreed or totally agreed to recommend the consultation to fellow students, and 89% considered that care providers adequately addressed their specific student-related issues. A specific approach is needed in primary care for university/college students requiring particular competences across several domains. Our findings suggest that our approach is effective to cover the main health challenges faced by students. A comparison of the outcomes of this novel 3-step primary care consultation approach with non-structured approaches should be evaluated in future studies, including clinician’s satisfaction, elements of patient’s participation to governance, and medico-economic aspects.

Prevalence of diabetes mellitus in the greater Bern region (Bern-Mittelland) 2010-2014.

Concerning diabetes mellitus, one of the greatest burdens in public health in the 21st century, epidemiological data in Switzerland are scarce. To address this issue, this study intended to use a little-known but convenient way to quantify the prevalence of diabetes mellitus in the Swiss region of Bern-Mittelland. In a population of approximately 330,000 people, the prevalence for the years 2010–2014 in adult persons was estimated using the capture-recapture method based on data collected routinely at the University Hospital in Bern (Inselspital) using outpatient lists and the registry of persons insured with Helsana Insurance Group. The estimated prevalence of diabetes mellitus was 3.97% (95% confidence interval [CI] 3.41–4.53%) in 2010, with a slight decrease to 3.65% (95% CI 3.24–4.06%) in 2014. An average of 3430 patients with diabetes or 26% of the total number appeared on at least one patient list. The remaining 74% were unknown patients identified by the capture-recapture method. The estimated prevalence of diabetes mellitus was in a range comparable to national and international studies. Thus, administratively collected data in clinics and insurance companies constitute a convenient data source for epidemiological studies. In conjunction with the capture-recapture method an approach with comparatively low effort and costs for the surveillance of chronic disease can be provided.

To log or not to log? Actor preferences and networks in Swiss forest policy

Forests play a fundamental role in climate change mitigation. While there are calls to store carbon by increasing the forest stock, other actors oppose this, arguing that carbon stored in processed timber is more adequate. Applying an adapted version of the policy network analysis (PNA) framework, we uncover both the actors' policy preferences regarding the goal conflict between carbon storage in the forest versus in timber products as well as the actors' perceived importance and information sharing in the forest policy network in a Swiss region (canton Lucerne) via an online stakeholder survey. We find that an increase of carbon storage in the forest does not stand a chance in the Lucerne forest policy network, being rejected by nearly two-thirds of the actors. A majority views increased harvesting for wood products as a superior climate change mitigation measure than harvesting less for carbon storage. We also find that these proponents of wood are more central actors within the policy networks than those in favour of carbon storage in the forest. These findings are relevant for a context where the majority of the forest is privately owned and where interests in timber harvesting might dominate those on carbon storage. The analysis reflects the challenging situation within the timber market, where measures for increased wood harvesting might provide a more acceptable policy option than carbon sequestration for private forest owners.

Effects of management cessation on hoverflies (Diptera: Syrphidae) across Austrian and Swiss mountain meadows

Abstract. Extensively managed grasslands, particularly in mountain regions, are considered to be one of the most diverse agroecosystems worldwide. Their decline due to land use abandonment affects the diversity of both plants and associated pollinators. Extensive grasslands constitute an important habitat type and food resource for hoverflies (syrphids); however, not much is known about the effects of abandonment on this important pollinator group. In the present study, we investigated how abandonment affects species richness and the composition of syrphids in mountainous meadows. We recorded the richness of vascular plants, vegetation cover, flower cover and the surrounding landscape to examine whether and how syrphids are affected by plant and landscape parameters. We investigated the species richness, abundance and species composition of syrphids by sweep netting and by using observation plots in 18 semidry meadows across two Austrian regions and one Swiss region. For each region, we selected three meadows abandoned for more than 20 years and three annually mown non-fertilized meadows. Abandonment or mowing had no significant effect on the total number of syrphid species or individuals or on the number of aphidophagous and non-aphidophagous species and individuals. However, the total number of species and the number of non-aphidophagous species significantly increased with the increasing number of plant species. The surrounding landscape and other plant parameters showed no association with the assessed syrphid parameters. Although syrphids were unaffected by abandonment, higher syrphid species numbers in response to a higher plant richness in annual mown meadows suggest that the management of mountain meadows is beneficial in preserving syrphid richness.

Ticino, jego mieszkańcy i ich tożsamość językowo-kulturowa Ticino, jego mieszkańcy i ich tożsamość językowo-kulturowa


 
 
 The purpose of the article is to discuss and analyze the linguistic and cultural identity of Ticino and its inhabitants . The text presents the Swiss region and its language(s) from a historical and contemporary perspective, as well as two areas of language micro-policy: 1) implemented in the region by representatives of local elites/decision makers 2) present in the daily life of the inhabitants of Ticino: their decisions, views and attitudes towards languages . Discussion of these issues is based on the analysis of ethnographic research conducted in the region and existing documents and literature on the subject . I argue that although multilingualism is present in the region and in its inhabitants’ beliefs and everyday life practices, it does not contradict the fact that Italian is considered to be culturally the most important distinguishing feature of Ticino and the main language of the canton . I conclude that language policy implemented at the regional and local level in recent times has had little impact on the linguistic and cultural identity of the region and its inhabitants .
 
 

Value-driven clustering of industrial additive manufacturing applications

PurposeA prerequisite for the successful adoption of additive manufacturing (AM) technologies in industry is the identification of areas, where such technologies could offer a clear competitive advantage. The purpose of this paper is to investigate the unique value-adding characteristics of AM, define areas of viable application in a firm value chain and discuss common implications of AM adoption for companies and their processes.Design/methodology/approachThe research leverages a multi-case-study approach and considers interviews with AM adopting companies from the Swiss and central European region in the medical and industrial manufacturing industries. The authors rely on a value chain model comprising a new product development process and an order fulfillment process (OFP) to analyze the benefits of AM technologies.FindingsThe research identifies and defines seven clusters within a firm value chain, where the application of AM could create benefits for the adopting company and its customers. The authors suggest that understanding the AM process chain and the design experience are key to explaining the heterogeneous industrial maturity of the presented clusters. The authors further examine the suitability of AM technologies with agile development techniques to pursue incremental product launches in hardware. It is clearly a field requiring the attention of scholars.Originality/valueThis paper presents a value-driven approach for use-case identification and reveals implications of the industrial implementation of AM technologies. The resultant clustering model provides guidance to new AM adopters.

Actors in Water Governance: Barriers and Bridges for Coordination

Multiple actors across different institutional levels play a role in water governance. The coordination of these actors is important for effective water governance. However, the joining together of multiple actors can have several implications, such as a redistribution of power across actors, a change in democratic control and citizen influence as well as shifting accountability structures. These implications can involve different barriers and bridges that might impede or foster coordination. Through qualitative and quantitative methods, we assess the following barriers and bridges for coordination: (1) reputational power in terms of who is perceived as important for coordination in the water sector; (2) democratic legitimacy in terms of actors’ value of local control of water services; and (3) accountability in terms of the regional actors’ capacity to steer in the water sector. This article focuses on three cases in a Swiss region that has experienced water provision challenges due to its highly fragmented water supply structures. We find that reputational power serves as a bridge in our three cases: when the actors responsible for water supply regard potential coordination partners as important, then we observe coordination. In contrast, we do not find conclusive evidence to support the assumption that a fear of losing local control is a barrier for coordination. Instead, our results indicate that accountability, in the form of vertical steering by the regional actors, serves as a bridge for coordination, and that this could help mitigate some of the potentially negative effects of democratic legitimacy perceptions: through convening local actors or providing positive incentives to municipalities to work together, regional actors can foster coordination.

Climate and climate change in the Austrian–Swiss region of the European Alps during the twentieth century according to Feddema

Feddema’s generic climate classification method is applied to study climate and climate change in the Austrian–Swiss region of the European Alps during the course of the twentieth century. A fine-tuned version of it is also tested in addition to the original scheme. Monthly precipitation and air temperature data at a spatial resolution of 10′ × 10′ are taken from the Climatic Research Unit TS 1.2 database to construct 30- and 50-year period averages. It is shown that the alpine climate is sufficiently heterogeneous to make it unnecessary to perform fine-tuning of the original scheme for its characterization on the meso-β scale (20–200 km). It is also demonstrated that data organizational effects are much less intense than the effects caused by the fine-tuning. The area heterogeneity of climate and climate change types is the highest in the vicinity of lakes (Austria: Lake Constance; Switzerland: Lakes Geneva, Neuchâtel, Biel, Zurich, and Constance) and along river valleys (Austria: the Danube, Drava, and Mur; Switzerland: the Aare and Ticino). The dominant climate change process was drying in Austria and warming in Switzerland. Large areas characterized by cold and saturated climate in the Central Eastern Alps did not experience climate change during the twentieth century.

Older Citizens' Opinions on Long-Term Care Options: A Vignette Survey

BackgroundOlder citizens are directly concerned, as potential beneficiaries and informal caregivers, by access to long-term care (LTC) services matching their expectations. The aim of this research was to collect their opinions regarding LTC arrangements for a diversity of disability profiles. Design/Setting/ParticipantsMailed vignette survey in a representative population-based sample of 3133 community-dwelling persons 68 years or older residing in a Swiss region. MeasurementsAll persons received a set of 10 vignettes. For each vignette, they considered 2 social situations successively: a person (1) living with an able-bodied spouse, and (2) living alone or with a spouse unable to help (resulting in 20 vignettes). Subjects selected a care setting (home, sheltered housing, or nursing home) and specified the preferred type of caregivers (spouse, professionals, or both) after community-based care options. Population estimates were based on weighted data accounting for the stratification of the survey sample. ResultsA total of 2985 participants (95.3%) expressed opinions on 55,178 vignettes (mean 18.5 vignettes, SD 4.1) Institutionalization was selected by 0.8% (95% confidence interval 0.3–1.4) of the population for the vignette of lowest disability with able-bodied spouse and 78.8% (76.1–81.6) for the vignette of highest disability and no possible help from a spouse. Continence, cognitive, and behavioral difficulties further influenced the preferences expressed for LTC options. Community-based LTC choices involved professionals mostly as a complement to informal help by the spouse, except for vignettes describing isolated moderate cognitive impairment or difficulties in instrumental activities of daily living. In these cases, most favored help provided by spouses only. ConclusionsThis survey had high acceptance. Responses to variations in the disability and social profile displayed in the vignettes suggested the validity of measurements.

The probability of having advanced medical interventions is associated with age in out-of-hospital life-threatening situations.

BackgroundThe use of out-of-hospital emergency medical services by old and very old individuals is increasing. These patients frequently require complex evaluation and decision-making processes to determine a strategy of care, therapeutic choices or withdrawal of care in life-threatening situations. During out-of-hospital missions, thorough decision-making is difficult because of the limited amount of time and lack of direct access to medical charts or to pre-existing advance directives. In this setting, age may be used as a proxy to determine strategy of care, therapeutic choices or withdrawal of care, particularly in relation to advanced medical interventions. We aimed to determine how an emergency physician’s initiation of out-of-hospital advanced medical interventions varies with the patient’s age.MethodsWe performed a retrospective analysis of the missions conducted by the emergency physicians-staffed emergency medical services in a Swiss region. We used logistic regression analysis to determine whether the probability of receiving an advanced medical intervention was associated with the patient’s age.ResultsAmong 21,922 out-of-hospital emergency adult missions requiring an emergency physician, the probability of receiving an advanced medical intervention decreased with age. It was highest among those aged 18 – 58 years and significantly lower among those aged ≥ 89 years (OR = 0.66; 95 % CI: 0.53 – 0.82). The probability of cardiopulmonary resuscitation attempts progressively decreased with age and was significantly lower for the three oldest age deciles (80 – 83, 84 – 88 and ≥ 89 years).ConclusionThe number of out-of-hospital advanced medical interventions significantly decreased for patients aged ≥ 89 years. It is unknown whether this lower rate of interventions was related only to age or to other medical characteristics of these patients, such as the number or severity of comorbidities. Thus, further studies are needed to confirm whether this observation corresponds to underuse of advanced medical interventions in very old patients.

Nurse-led palliative care services facilitate an interdisciplinary network of care.

Caring for palliative patients at home is complex and challenging. Specialist palliative care exists to provide high quality of care in complex situations. This study aimed to describe the characteristics of a specialist nurse-led palliative care service in an urban Swiss region. A qualitative study design adopting a grounded theory approach was used. Semi-structured interviews were conducted with 41 participants including family caregivers, home care nurses, referring services, treating physicians, specialist nurses and external politicians. In addition, statistical information was included. Specialist nurses played an important role in building and maintaining an interdisciplinary network of care, necessary for the management of complex palliative situations. They performed tasks such as to "include" members and to "negotiate" the network of care with the family and providers. They "tailored" the support to patients and families' needs and as a result "empowered" the network of care. A nurse-led palliative care service facilitated interdisciplinary palliative home care to the benefit of all agents involved.

The cost of hybrid waste water systems: A systematic framework for specifying minimum cost-connection rates

To determine the optimal connection rate (CR) for regional waste water treatment is a challenge that has recently gained the attention of academia and professional circles throughout the world. We contribute to this debate by proposing a framework for a total cost assessment of sanitation infrastructures in a given region for the whole range of possible CRs. The total costs comprise the treatment and transportation costs of centralised and on-site waste water management systems relative to specific CRs. We can then identify optimal CRs that either deliver waste water services at the lowest overall regional cost, or alternatively, CRs that result from households freely choosing whether they want to connect or not. We apply the framework to a Swiss region, derive a typology for regional cost curves and discuss whether and by how much the empirically observed CRs differ from the two optimal ones. Both optimal CRs may be reached by introducing specific regulatory incentive structures.

The association of socio-economic factors with physical fitness and activity behaviours, spinal posture and retinal vessel parameters in first graders in urban Switzerland

ABSTRACTSocio-economic status during childhood has been shown to be a strong predictor of adult health outcome. Therefore, we examined associations of parental educational level, household income and migrant background with physical fitness, spinal flexibility, spinal posture as well as retinal vessel diameters in children of an urban Swiss region. A total of 358 first graders of the Swiss canton Basel-Stadt (age: 7.3, SD: 0.4) were examined. Physical fitness (20 m shuttle run test, 20 m sprint, jumping sidewards and balancing backwards), spinal flexibility and spinal posture (MediMouse®, Idiag, Fehraltdorf, Switzerland) and retinal microcirculation (Static Retinal Vessel Analyzer, Imedos Systems UG, Jena, Germany) were assessed. Parental education, household income, migrant background and activity behaviour were evaluated with a questionnaire. Parental education was associated with child aerobic fitness (P = 0.03) and screen time (P < 0.001). Household income was associated with jumping sidewards (P = 0.009), balancing backwards (P = 0.03) and sports club participation (P = 0.02). Migrant background was associated with BMI (P = 0.001), body fat (P = 0.03), aerobic fitness (P = 0.007), time spent playing outdoors (P < 0.001) and screen time (P < 0.001). For spinal flexibility and retinal vessel diameter, no associations were found (0.06 < P < 0.8). Low parental education, low household income and a migrant background are associated with poor physical fitness, higher BMI and body fat percentage and low-activity behaviour.

Epistemic uncertainty and limitations of theκ0model for near-surface attenuation at hard rock sites

The determination of near-surface attenuation for hard rock sites is an important issue in a wide range of seismological applications, particularly seismic hazard analysis. In this article we choose six hard to very-hard rock sites (Vs30 1030–3000ms–1) and apply a range of analysis methods to measure the observed attenuation at distance based on a simple exponential decay model with whole-path attenuation operator κr. The κr values are subsequently decoupled from path attenuation (Q) so as to obtain estimates of near-surface attenuation (κ0). Five methods are employed to measure κr which can be split into two groups: broad-band methods and high-frequency methods. Each of the applied methods has advantages and disadvantages, which are explored and discussed through the comparison of results from common data sets. In our first step we examine the variability of the individual measured κr values. Some variation between methods is expected due to simplifications of source, path, and site effects. However, we find that significant differences arise between attenuation measured on individual recordings, depending on the method employed or the modelling decisions made during a particular approach. Some of the differences can be explained through site amplification effects: although usually weak at rock sites, amplification may still lead to bias of themeasured κr due to the chosen fitting frequency bandwidth, which often varies between methods. At some sites the observed high-frequency spectral shape was clearly different to the typical κr attenuation model, with curved or bi-linear rather than linear decay at high frequencies. In addition to amplification effects this could be related to frequency-dependent attenuation effects [e.g. Q( f )]: since the κr model is implicitly frequency independent, κr will in this case be dependent on the selected analysis bandwidth. In our second step, using thewhole-path κr data sets from the five approaches, we investigate the robustness of the near-surface attenuation parameter κ0 and the influence of constraints, such as assuming a value for the regional crustal attenuation (Q).We do this by using a variety of fitting methods: least squares, absolute amplitude and regressions with and without fixing Q to an a priori value. We find that the value to which we fix Q strongly influences the near-surface attenuation term κ0. Differences in Q derived from the data at the six sites under investigation could not be reconciled with the average values found previously over the wider Swiss region. This led to starkly different κ0 values, depending on whether we allowed for a data-driven Q, or whether we forced Q to be consistent with existing simulation models or ground motion prediction equations valid for the wider region. Considering all the possible approaches we found that the contribution to epistemic uncertainty for κ0 determination at the six hard-rock sites in Switzerland could be represented by a normal distribution with standard deviation σκ0 = 0.0083 ± 0.0014 s.

Forgoing dental care for economic reasons in Switzerland: a six-year cross-sectional population-based study.

BackgroundWhile oral health is part of general health and well-being, oral health disparities nevertheless persist. Potential mechanisms include socioeconomic factors that may influence access to dental care in the absence of universal dental care insurance coverage. We investigated the evolution, prevalence and determinants (including socioeconomic) of forgoing of dental care for economic reasons in a Swiss region, over the course of six years.MethodsRepeated population-based surveys (2007–2012) of a representative sample of the adult population of the Canton of Geneva, Switzerland. Forgone dental care, socioeconomic and insurance status, marital status, and presence of dependent children were assessed using standardized methods.ResultsA total of 4313 subjects were included, 10.6% (457/4313) of whom reported having forgone dental care for economic reasons in the previous 12 months. The crude percentage varied from 2.4% in the wealthiest group (monthly income ≥13,000CHF, 1CHF ≈ 1$) to 23.5% among participants with the lowest income (<3,000CHF). Since 2007/8, forgoing dental care remained stable overall, but in subjects with a monthly income of <3,000CHF, the adjusted percentage increased from 16.3% in 2007/8 to 20.6% in 2012 (P trend = 0.002). Forgoing dental care for economic reasons was independently associated with lower income, younger age, female gender, current smoking, having dependent children, divorced status and not living with a partner, not having a supplementary health insurance, and receipt of a health insurance premium cost-subsidy.ConclusionsIn a Swiss region without universal dental care insurance coverage, prevalence of forgoing dental care for economic reasons was high and highly dependent on income. Efforts should be made to prevent high-risk populations from forgoing dental care.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6831-14-121) contains supplementary material, which is available to authorized users.