Revisiting the effects of organized mammography programs on inequalities in breast screening uptake : a multilevel analysis of nationwide data from 1997 to 2017

This study revisits the effects of mammography screening programs on inequalities in breast screening uptake in Switzerland. The progressive introduction of regional mammography programs by 12 out of the 26 Swiss cantons (regions) since 1999 offers an opportunity to perform an ecological quasi-experimental study. We examine absolute income and marital status inequalities in mammography uptake, and whether the cantons' implementation of mammography programs moderate these inequalities, as previous research has devoted little attention to this. We use five waves of the Swiss Health Interview Survey covering the 1997–2017 period and comprising data on 14,267 women aged 50–70. Both up-to-date and ever-screening outcomes are analyzed with multilevel models which assess the mammography programs' within-canton effect. Findings show that higher income women and married women (compared to unmarried women) had significantly higher mammography uptake probabilities. Mammography programs did not moderate absolute income differences in up-to-date screening; however, they were associated with smaller absolute income differences in ever-screening uptake. Mammography programs related to higher screening uptake for married women, more than for unmarried women. In conclusion, we showed absolute income inequalities in mammography uptake which were not revealed by previous studies using relative inequality measures. Mammography programs may have contributed to reducing income inequalities in ever-screening, yet this was not observed for up-to-date screening. This study has implication for preventive health interventions—e.g., cancer screening promotion should pay attention to women's marital status since screening programs may widen the screening gap between married and unmarried women

Larch needle breakdown in contrasting streams of an alpine glacial floodplain

Larch (Larex decidua Mill.) is an early successional tree species of glacial sediments and valley side-slopes at treeline in the Swiss Alps. In such areas, the needles from this deciduous conifer are a dominant source of particulate organic matter to springs and streams of glacial floodplains. We examined the breakdown of larch needles in 5 stream types of a glacial floodplain in the Swiss Alps in relation to macroinvertebrates, aquatic fungi, and litter nutrient concentrations. The 5 streams ranged from a physically harsh pro-glacial (kryal) stream that lacked significant input of terrestrially derived particulate organic matter to a stable side-slope springbrook that flowed through a mixed larch/pine forest with alder also present in the riparian zone. We hypothesized that needle breakdown (as a surrogate of ecosystem function) would be significantly faster in the springbrook than in the other streams, reflecting differences in macroinvertebrate and fungal assemblages present among streams. Although needle breakdown was generally slow, especially relative to alder leaves, parameters of litter breakdown were indeed higher in the springbrook than in the other streams. Concentrations of nutrients (N and P) found in decomposing needles were 2 to 4 x higher in the springbrook than in the other streams. Ergosterol levels (a measure of fungal biomass) in needles were 4 x greater in the springbrook than for needles in the kryal and main channel sites. Last, abundances of macroinvertebrates colonizing needle packs, shredders in particular, were higher in the springbrook and a side-channel site than in the other stream types. The results emphasize the importance of trophic linkages in the successional development and function of lotic ecosystems