Grip strength cut-points from the Swiss DO-HEALTH population

BACKGROUND: While grip strength (GS) is commonly assessed using a Dynamometer, the Martin Vigorimeter was proposed as an alternative method especially in older adults. However, its reference values for Swiss older adults are missing. We therefore aimed to derive sex- and age-specific GS cut-points for the dominant and non-dominant hand (DH; NDH) using the Martin Vigorimeter. Additionally, we aimed to identify clinically relevant weakness and assess convergent validity with key markers of physical function and sarcopenia in generally healthy Swiss older adults. METHODS: This cross-sectional analysis includes baseline data from Swiss participants enrolled in DO-HEALTH, a 3-year randomized controlled trial in community-dwelling adults age 70 + . For both DH and NDH, 4 different definitions of weakness to derive GS cut-points by sex and age category (≤ 75 vs. > 75 years) were used: i) GS below the median of the 1st quintile, ii) GS below the upper limit of the 1st quintile, iii) GS below 2-standard deviation (SD) of the sex- and age-specific mean in DO-HEALTH Swiss healthy agers (i.e. individuals without major chronic diseases, disabilities, cognitive impairment or mental health issues) and iv) GS below 2.5-SD of the sex- and age-specific mean in DO-HEALTH Swiss healthy agers. To assess the proposed cut-points' convergent validity, we assessed their association with gait speed, time to complete the 5 Times Sit-To-Stand (5TSTS) test, and present sarcopenia. RESULTS: In total, 976 participants had available GS at the DH (mean age 75.2, 62% women). According to the 4 weakness definitions, GS cut-points at the DH ranged from 29-42 and 25-39 kPa in younger and older women respectively, and from 51-69 and 31-50 kPa in younger and older men respectively. Overall, weakness prevalence ranged from 2.0% to 19.3%. Definitions of weakness using the median and the upper limit of the 1st GS quintile were most consistently associated with markers of physical performance. Weak participants were more likely to have lower gait speed, longer time to complete the 5TSTS, and sarcopenia, compared to participants without weakness. CONCLUSIONS: In generally healthy Swiss older adults, weakness defined by the median or the upper limit of the 1st GS quintile may serve as reference to identify clinically relevant weakness. Additional research is needed in less healthy populations in order to derive representative population-based cut-points

Midwives and protection of pregnant workers in Western Switzerland: Practices, difficulties and contributions.

Switzerland's maternity protection legislation aims to protect the health of pregnant employees and their unborn children by regulating their potential occupational exposure to hazards and strenuous activities. This legislation provides a role for obstetricians, but not for midwives. Identify the practices of Switzerland's French-speaking midwives that favour the implementation of maternity protection legislation and reflect on the profession's role in supporting pregnant employees. 356 midwives answered an online questionnaire. The analysis focuses on the 205 midwives who perform pregnancy consultations in their practice. Data were analysed in two stages using STATA software: 1) simple descriptive and correlational statistics and 2) hierarchical cluster analysis to identify typologies of practices by grouping similar responses. Despite having no officially defined role in Switzerland's maternity protection legislation, its midwives actively participate in protecting pregnant employees , especially those with more knowledge of the legislation, those with more years of experience and those practicing independently. The barriers that midwives face when trying to provide greater support for pregnant employees are linked significantly to their lack of knowledge about the legislation, a lack of recognition for their role in the current legislation and a lack of continuing education about the occupational health risks associated with pregnancy at work. Their profession and specific practices give midwives privileged access to pregnant employees. Midwives' knowledge of the legislation, their awareness of the occupational risks and hazards facing pregnant employees and the conviction that their profession has the potential to make a difference could all be improved. The role of midwives should be-and deserves to be-formally and legally recognised and integrated into Switzerland's maternity protection legislation

Implementation of maternity protection legislation: Gynecologists' perceptions and practices in French-speaking Switzerland.

In several countries, maternity protection legislations (MPL) confer an essential role to gynecologist-obstetricians (OBGYNs) for the protection of pregnant workers and their future children from occupational exposures. This study explores OBGYNs' practices and difficulties in implementing MPL in the French-speaking part of Switzerland. An online survey was sent to 333 OBGYNs. Data analysis included: 1) descriptive and correlational statistics and 2) hierarchical cluster analysis to identify patterns of practices. OBGYNs evoked several problems in MPL implementation: absence of risk analysis in the companies, difficult collaboration with employers, lack of competencies in the field of occupational health. Preventive leave was underused, with sick leave being prescribed instead. Training had a positive effect on OBGYNs' knowledge and implementation of MPL. Hierarchical cluster analysis highlighted three main types of practices: 1) practice in line with legislation; 2) practice on a case-by-case basis; 3) limited practice. OBGYNs with good knowledge of MPL more consistently applied its provisions. The implementation of MPL appears challenging for OBGYNs. Collaboration with occupational physicians and training might help OBGYNs to better take on their role in maternity protection. MPL in itself could be improved

Evaluation of a pilot consultation for maternity protection at work in Switzerland.

Switzerland's Labour Law and its Ordonnance on Maternity Protection aim to protect the health of pregnant employees and their unborn children while enabling them to continue to pursue their professional activities. Some companies encounter difficulties implementing the law's provisions. The Department of Occupational and Environmental Health, part of the Center for Primary Care and Public Health (Unisanté), has provided specialist occupational medicine consultations for pregnant employees since 2015. This study aimed to evaluate how well Swiss' maternity protection legislation is implemented by examining a list of relevant indicators measured during the occupational health consultation. The study also sought to investigate the consultation support provided to the relevant stakeholders and the adjustments made to pregnant employees' working conditions. Descriptive variables and indicators relative to the application of the Swiss maternity protection legislation for 83 pregnant employees were collected during the consultation's pilot phase (between 2015 and 2016). Descriptive statistics and cross-analyses of these indicators were made. Most pregnant employees faced multiple exposures to occupational risks. Preventive risk analyses were rare. Few adjustments to workstations were proposed. We found a tendency for employees to leave their workstations early on in their pregnancies due to sick leave certificate prescriptions. Specialist consultation and collaboration with occupational health physicians to recommend interventions for pregnant employees can provide significant benefits and help some pregnant women to continue at their workstations with appropriate adjustments. A specialised occupational health consultation is a useful instrument for identifying occupational hazards for both the pregnant woman and her unborn child. It is also an opportunity to explain employers' legal responsibilities and obligations to safeguard the health of their pregnant employees and to give specific advice for their company's situation. This consultation also enables employers to maintain their employees' valuable professional competencies in the workplace for as long as possible. Finally, occupational health consultation helps and supports healthcare providers who must, according to the law, make decisions about whether pregnant employees can continue working safely or not

Importance of cultural ecosystem services for cultural identity and wellbeing in the Lower Engadine, Switzerland

Current climate and environmental changes have brought unprecedented rates of change to mountain ecosystems. These changes are impacting the provisioning of ecosystem services. Despite the increase in academic publications on ecosystem services, research on cultural ecosystem services (CES) and their availability in mountain regions has largely been neglected. Here we analyse how important different CES are for inhabitants and visitors in the Lower Engadine region (Switzerland). We use questionnaires and maps to identify the most important CES for individual and collective wellbeing as well as their geographical location in the region. We had 48 participants in this study of which 28 grew up in the Lower Engadine. Our results show that the most important (i.e., ‘Highly important’) CES are: ‘The view of mountains, rivers or glaciers’; the presence of plants typical for the region, for example Fire Lily and Edelweiss (i.e., Lilium bulbiliferum subsp. croceum, Edelweiss-Leontopodium alpinum); ‘Hiking’; ‘Local customs’; ‘Watching large mammals’; and the importance of ‘Terraces for traditional Agriculture activities’. Results from the spatial analysis show that identical geographical locations in the Lower Engadine provide multiple CES and bring health benefits to the users. Digital Archaeolog

Evolution of gynaecologists' practices regarding the implementation of Swiss legislation on maternity protection at work between 2008 and 2017.

In accordance with the International Labour Organization’s Maternity Protection Convention (No. 183) and European Union Directive 92/857CEE (1992), Switzerland’s Labour Law and its Maternity Protection Ordinance (OProMa) aim to protect the health of pregnant employees and their future children while enabling them to pursue their working activities. Gynaecologists-obstetricians have a key role in this legislation, particularly through the prescription of preventive leave for patients who would otherwise face dangerous or arduous tasks in the absence of an adequate risk analysis or suitable protective measures. However, international and national literature suggests that gynaecologists-obstetricians may encounter difficulties in fulfilling their role. This study aimed to: (1) describe the practices and difficulties encountered by gynaecologists-obstetricians in the practical implementation of the OProMa; and (2) compare the evolution of these practices and difficulties between 2008 and 2017. A survey by questionnaire was conducted in 2008 and repeated in 2017. Both surveys focused on gynaecologists-obstetricians working in the French-speaking part of Switzerland (in private practices, hospitals or both). Descriptive and comparative analyses were carried out. 83 gynaecologists-obstetricians responded in 2008 and 93 in 2017: response rates of 47% and 32%, respectively. In 2017, gynaecologists-obstetricians were more likely to ask questions about occupational risks faced by their patients when consulted by working mothers about their pregnancies. The estimated percentage of patients exposed to an occupational risk remained constant (20% in 2008 and 22% in 2017). Communication and collaboration with employers were reported to be difficult in both surveys, even though these are key elements in the implementation of the OProMa. Collaboration with occupational physicians, however, was more frequent in 2017. In 2017, gynaecologists-obstetricians showed a greater awareness of occupational risks and collaborated more frequently with occupational health specialists. However, the application of the OProMa remained limited over the studied time period. Improving training of gynaecologists-obstetricians in this field could be a significant factor in encouraging better implementation of the current legislation. Moreover, gynaecologists-obstetricians need to be given the necessary support to enable their clinical practice to evolve towards a more preventive type of medicine. Collaboration with relevant stakeholders, including occupational physicians, midwives and workers, should be encouraged

Prospective Study of Ageing Trajectories in the European DO-HEALTH Study.

INTRODUCTION Ageing trajectories range from delayed ageing with extended health to accelerated ageing, with an increased risk of frailty. We evaluated the prevalence and prospective change between health states among community-dwelling European older adults. METHODS This prospective study is a secondary analysis of DO-HEALTH, a randomized trial that included adults aged 70 years and older across 5 European countries. Healthy agers (HA) fulfilled the Nurses' Health Study healthy ageing criteria and accelerated agers were non-HA being at least pre-frail according to the Fried frailty criteria. We assessed the proportion of participants changing between health states over 4 assessments and evaluated the odds of changing to a more favourable category. To increase reliability and avoid regression to the mean, we averaged the first 2 years and compared them to the average of the last 2 years. RESULTS Of 2,157 participants, 12.4% were excluded for meeting both healthy ageing and pre-frailty criteria simultaneously. Among the remaining 1,889 participants (mean age 75.1 years, 60.9% female), 23.1% were initially HA, 44.4% were non-HA but not pre-frail, and 32.6% were pre-frail or frail. Subsequently, 65.3% remained in the same health state, 12.0% improved to a healthier state, and 22.8% progressed to a less advantageous state. After adjusting for sex, study centre, treatment, and body mass index, each year of age was associated with 6% lower odds of improving health states. Women had 35% higher odds than men of following a disadvantageous trajectory. CONCLUSION We observed dynamic trajectories of ageing where transitioning to a healthier state became less likely with advancing age and among women

Neue Untersuchungen zu den (prä-)historischen Terrassen von Ramosch

Die gut erhaltene Terrassenlandschaft oberhalb von Ramosch hat eine lange Geschichte, deren ackerbauliche Nutzung im Mittelalter durch historische Quellen belegt ist. Doch bereits die prähistorische Siedlung auf der Mottata beweist, dass sie in eine stark vom Menschen überprägte Landschaft eingebettet war. Um der Frage nach der Entwicklung der Terrassen nachzugehen, engagiert sich seit einigen Jahren ein interdisziplinäres Forschungsprojekt mit dem Ursprung dieser Anlagen.European Prehistor

Prevalence of Physical Frailty: Results from the DO-HEALTH Study

Background: Frailty is a geriatric syndrome associated with multiple negative health outcomes. However, its prevalence varies by population and instrument used. We investigated frailty and pre-frailty prevalence by 5 instruments in community-dwelling older adults enrolled to a randomized-controlled trial in 5 European countries. METHODS: Cross-sectional baseline analysis in 2,144 DO-HEALTH participants recruited from Switzerland, Austria, France, Germany, and Portugal with complete data for frailty. Frailty status was assessed by the Physical Frailty Phenotype [PFP], SOF-Frailty Index [SOF-FI], FRAIL-Scale, SHARE-Frailty Instrument [SHARE-FI], and a modified SHARE-FI, and compared by country, age, and gender. Logistic regression was used to determine relevant factors associated with frailty and pre-frailty. RESULTS: Mean age was 74.9 (±4.4) years, 61.6% were women. Based on the PFP, overall frailty and pre-frailty prevalence was 3.0% and 43.0%. By country, frailty prevalence was highest in Portugal (13.7%) and lowest in Austria (0%), and pre-frailty prevalence was highest in Portugal (57.3%) and lowest in Germany (37.1%). By instrument and overall, frailty and pre-frailty prevalence was highest based on SHARE-FI (7.0% / 43.7%) and lowest based on SOF-FI (1.0% / 25.9%). Frailty associated factors were residing in Coimbra (Portugal) [OR 12.0, CI 5.30-27.21], age above 75 years [OR 2.0, CI 1.17-3.45], and female gender [OR 2.8, CI 1.48-5.44]. The same three factors predicted pre-frailty. CONCLUSIONS: Among relatively healthy adults age 70 and older enroled to DO-HEALTH, prevalence of frailty and pre-frailty differed significantly by instrument, country, gender, and age. Among instruments, the highest prevalence of frailty and pre-frailty was documented by the SHARE-FI and the lowest by the SOF-FI