Place of death and health care utilization for people in the last 6 months of life in Switzerland: a retrospective analysis using administrative data

BACKGROUND: There is a growing interest in examining the current state of care and identifying opportunities for improving care and reducing costs at the end of life. The aim of this study is to examine patterns of health care use at the end of life and place of death and to describe the basic characteristics of the decedents in the last six months of their life. METHODS: The empirical analysis is based on data from 58,732 Swiss residents who died between 2007 and 2011. All decedents had mandatory health insurance with Helsana Group, the largest health insurer in Switzerland. Descriptive statistical techniques were used to provide a general profile of the study population and determinants of the outcome for place of death were analyzed with an econometric approach. RESULTS: There were substantial and significant differences in health care utilization in the last six months of life between places of death. The mean numbers of consultations with a general practitioner or a specialist physician as well as the number of different medications and the number of hospital days was consistently highest for the decedents who died in a hospital. We found death occurred in Switzerland most frequently in hospitals (38.4% of all cases) followed by nursing homes (35.1%) and dying at home (26.6%). The econometric analysis indicated that the place of death is significantly associated with age, sex, region and multiple chronic conditions. CONCLUSIONS: The importance of nursing homes and patients' own homes as place of death will continue to grow in the future. Knowing the determinants of place of death and patterns of health care utilization of decedents can help decision makers on the allocation of these needed health care services in Switzerland

Effect of suboptimal environment and host age on helminth community of black grouse (Tetrao tetrix)

Helminths have often been considered responsible in driving partially wildlife population density fluctuations, therefore more information have to be achieved when target hosts are endangered or threatened species, such as black grouse (Tetrao tetrix). During eight years (2003-2010), we collected and analyzed 431 intestinal contents of hunted black grouse from Central Alps (VB), recording age, body weights, biometric measures and the culling site to investigate (1) their helminth community structure, (2) how much infection varies in relation to age class and to prealpine and alpine origin area and (3) if parasites may act as population destabilizing factors. The helminth community is composed by two nematodes Ascaridia compar and Aonchotheca caudinflata: A. compar is the predominant species and a significant higher intensity of both helminths is recorded in juveniles. A. caudinflata has a negative effect on weights of all the population subjects (p<0.001), independently of age and origin area; prealpine population, characterized by significantly lower weights than those of the alpine ones (p<0.05), is found more infected by both helminths, with also a negative impact (p<0.001) of A. compar recorded on prealpine adults’ weights. The negative effect noticed for A. caudinflata emphasizes its pathogenicity and shows that this infection can be considered a further stressor for the studied population. Moreover A. compar affects essentially adults in prealpine area and this fact, together with the major infection of the entire prealpine population, supports the hypothesis that habitat characteristics play a role in the infectious process