Mortality by education in German speaking Switzerland, 1990-1997: results from the Swiss National Cohort

Background The aim of this paper is to show for the first time mortality differentials by level of education for Swiss men and women. This work is of interest to public health efforts in Switzerland as well as for co-operative international research into the determinants of socioeconomic differentials in health and mortality. Methods This study is based on a longitudinal data set from the Swiss National Cohort, currently incorporating a probabilistic record linkage of the 1990 Swiss census, and all subsequent deaths until the end of 1997. The study population covers all Swiss nationals aged ≥25 years living in German speaking Switzerland, with 19.7 million person-years and 296 929 deaths observed. Educational gradients were analysed using standardized mortality ratios, multiple logistic regression, and the Relative Index of Inequality (RII). Results There were sizeable gradients in mortality by education for all age groups and both sexes. The mortality odds ratio decreased by 7.2% (95% CI: 7.0-7.5%) per additional year of education for men, and by 6.0% (95% CI: 5.6-6.3%) for women. In men, we found a steady decrease of the gradient from 13.1% (95% CI: 11.9-14.4%) in the age group 25-39 to 4.5% (95% CI: 4.0-5.0%) in the age group ≥75 years. For women in the age groups under 65 the gradients were smaller; over the age of 40 there was no decrease with increasing age. These results were fairly insensitive to variations in the parameters of record linkage. Conclusions Despite a comparatively low overall mortality, Swiss men in the 1990s show larger relative gradients in mortality by education than men in other European countries in the 1980s, with the possible exception of younger men in Italy. In Switzerland there is a sizeable potential for further increasing overall life expectancy by reducing the mortality of those with a lower educational level. The results presented contribute to a reliable assessment of socioeconomic mortality differentials in Europ

A simple approach to fairer hospital benchmarking using patient experience data

Objective To determine the factors contributing most to variability in patient experience in order to present approaches for fairer benchmarking of hospitals and for quality improvement. Design Secondary analysis of data from a widely used survey on patient experience. Setting Inpatients from all 24 acute hospitals in the Canton of Bern in Switzerland. Data collection followed the standardized and validated Picker Institute methodology for a period of 13 weeks in the fall/winter of 2005. Participants Inpatients age 18 years and older (n = 14 089), discharged within the sampling period. Main outcome measures ‘Patient experience', measured by the total Picker Problem Score (PPS) and by six domain scores (care, communication, respect, cooperation, organization, discharge management). Results In regression analysis, the patient factors self-reported health, age and education explained the highest proportion of variability in the PPS (4.8, 2.2 and 0.7%, respectively). Multiple linear adjustment for factors associated with patients removed between 29 and 33% of variability between hospital categories. The domain score means varied from under 5% for ‘respect towards the patient' to 34% for ‘discharge management'. Ranking of hospitals by domain scores differed from the ranking based on the total PPS. Conclusions Statistical adjustment for patient mix and additional stratification for some hospital factors make benchmarking using patient survey data fairer and more transparent. Use of our approach for presenting quality data may make interpretation easier for the different target groups and may enhance the relevance of such information for decision-makin

Risk of Infectious Complications in Patients Taking Glucocorticosteroids

The association between corticosteroid therapy and subsequent infections was calculated by pooling data from 71 controlled clinical trials. The overall rate of infectious complications was 12.7% in the 2,111 patients randomly allocated to systemic corticosteroids and 8.0% in the 2,087 controls (relative risk [RR], 1.6; 95% confidence interval [CI], 1.3-1.9; P 1; P = .03) diseases. The rate was not increased in patients given a daily dose of <10 mg or a cumulative dose of <700 mg of prednisone. With increasing doses the rate of occurrence of infectious complications increased in patients given corticosteroids as well as in patients given placebo, a finding suggesting that not only the corticosteroid but also the underlying disease state account for the steroid-associated infectious complications observed in clinical practic

The Prognostic Significance of Protein-energy Malnutrition in Geriatric Patients

Although it has been shown that protein-energy malnutrition is a predictor of adverse outcome in geriatric patients, it is unclear whether this is due to underlying disease or disability, or whether malnutrition is an independent outcome predictor. To clarify the predictive role of malnutrition, we analysed the 4.5-year mortality and living location follow-ups of 219 geriatric patients admitted to a geriatric assessment unit. Prevalence of anthropometric and serological malnutrition indicators were between 13.7% and 39.8% at hospital admission. In bivariate models, prealbumin, subnormal arm muscle area, and subnormal body weight were predictors of mortality and survival at home. On the other hand, albumin, transferrin, and triceps skin-fold thickness did not predict these outcomes. In multivariate models the hazard ratio (HR) of 4.5-year mortality remained significant with an HR of 1.8 (95% CI 1.3−2.6) for subnormal arm muscle area, and 1.6 (95% CI 1.3−2.6) for subnormal body weight. Prealbumin was the strongest serological outcome predictor (multivariate mortality HR 1.9, 95% CI, 1.3−2.8). In these models, subnormal cognitive function, impaired physical function, and creatinine clearance < 30 ml/min were also associated with increased mortality. Malnutrition did not predict hospital discharge location, but among patients discharged home, those with initial malnutrition had a decreased length of survival at home. Our findings indicate that certain protein-energy malnutrition indicators are independent risk factors predicting decreased length of overall survival and survival at home in geriatric patients. Physicians should screen actively for this often unrecognized problem and initiate appropriate treatment strategie

Evidence-based design recommendations for prevalence studies on multimorbidity: improving comparability of estimates

Background: In aging populations, multimorbidity causes a disease burden of growing importance and cost. However, estimates of the prevalence of multimorbidity (prevMM) vary widely across studies, impeding valid comparisons and interpretation of differences. With this study we pursued two research objectives: (1) to identify a set of study design and demographic factors related to prevMM, and (2) based on (1), to formulate design recommendations for future studies with improved comparability of prevalence estimates. Methods: Study data were obtained through systematic review of the literature. UsingPubMed/MEDLINE, Embase, CINAHL, Web of Science, BIOSIS, and Google Scholar, we looked for articles with the terms “multimorbidity,” “comorbidity,” “polymorbidity,” and variations of these published in English or German in the years 1990 to 2011. We selected quantitative studies of the prevalence of multimorbidity (two or more chronic medical conditions) with a minimum sample size of 50 and a study population with a majority of Caucasians. Our database consisted of prevalence estimates in 108 age groups taken from 45 studies. To assess the effects of study design variables, we used meta regression models. Results: In 58% of the studies, there was only one age group, i.e., no stratification by age. The number of persons per age group ranged from 136 to 5.6 million. Our analyses identified the following variables as highly significant: “mean age,” “number of age groups”, and “data reporting quality” (all p < 0.0001). “Setting,” “disease classification,” and “number of diseases in the classification” were significant (0.01 < p ≤ 0.03), and “data collection period” and “data source” were non-significant. A separate analysis showed that prevMM was significantly higher in women than men (sign test, p = 0.0015). Conclusions: Comparable prevalence estimates are urgently needed for realistic description of the magnitude of the problem of multimorbidity. Based on the results of our analyses of variables affecting prevMM, we make some design recommendations. Our suggestions were guided by a pragmatic approach and aimed at facilitating the implementation of a uniform methodology. This should aid progress towards a more uniform operationalization of multimorbidity. Keywords: Age, Gender, Study design variables, Multiple chronic conditions, Systematic revie

Motivation and personality factors of Generation Z high school students aspiring to study human medicine

Background: A new generation of medical students, Generation Z (Gen Z), is becoming the predominant population in medical schools and will join the workforce in a few years’ time. Medicine has undergone serious changes in high-income countries recently. Therefore, it is unclear how attractive the medical profession still is for high school students of Gen Z. The aim of this study was to investigate what motivation leads Gen Z students in their choice to study human medicine, and how they see their professional future. Our study was guided by motivation theory and the influence of personality traits and other personal factors on students’ choice of university major. Methods: In a cross-sectional online survey, we included third- and fourth-year high school students in Northern Switzerland. We examined the importance of criteria when choosing a university major: personality traits, career motivation, life goals, and other considerations influencing the choice of human medicine versus other fields of study. Results Of 1790 high school students, 456 (25.5%) participated in the survey (72.6% women, mean age 18.4 years); 32.7% of the respondents aspired to major in medicine at university. For all respondents, the foremost criterion for selecting a field of study was ‘interest in the field,’ followed by ‘income’ and ‘job security.’ High school students aiming to study human medicine attached high importance to ‘meaningful work’ as a criterion; supported by 36.2% of those students answering that helping and healing people was a core motivation to them. They also scored high on altruism (p < 0.001 against all groups compared) and intrinsic motivation (p < 0.001) and were highly performance- (p < 0.001) and career-minded (p < 0.001). In contrast, all the other groups except the law/economics group had higher scores on extraprofessional concerns. Conclusions: Swiss Gen Z students aspiring to study human medicine show high intrinsic motivation, altruism, and willingness to perform, sharing many values with previous generations. Adequate work-life balance and job security are important issues for Gen Z. Regarding the current working conditions, the ongoing shortage of physicians, and recent findings on physicians’ well-being, the potential for improvement and optimization is high

Emotional and physical demands on caregivers in home care to the elderly in Switzerland and their relationship to nursing home admission

Background: Planning the home care of growing numbers of old, dependent people must include the caregivers' burden. Methods: A convenience sample of 129 caregivers of elderly patients with multiple diagnoses was interviewed about the caregiving context, burden, caregivers' tolerance of patients' troublesome behaviours and physical symptoms, mutuality and feelings of closeness between caregiver and patient. Continued maintenance of home care was assessed by a follow-up telephone call. Results: Caregivers were mainly spouses (67%) and female (73%), and the mean duration of care was 5.5 years. In five activities of daily living (ADL) 50-69% of the patients needed full help. Caregivers reported predominantly negative effects of caregiving on their physical and mental health, rest and sleep, leisure time and social life, problems with patients' symptoms and behaviours and little or no conversing (51%) or exchanging feelings with patients (71%). Predictive models: Contributors to variance were for burden (35%), impact of care on caregivers' mental health, social relations and leisure time, patients' gender, accumulation of patients' symptoms and behaviours; for caregivers' tolerance toward patients' symptoms and behaviours (17%) caregivers' physical health, patients' level of confusion, feelings of mutuality; for mutuality (22%) and for closeness (19%) caregivers' mental health, patients' accumulation of symptoms and behaviours. Within 23 months 19% of the patients had been institutionalized. Factors giving a higher likelihood of institutionalization were: being male, caregiver was not a partner, and less closeness between caregiver and patient. Conclusion: Caregiving of older persons has bio-psychosocial ramifications for caregivers. Closeness between caregiver and patient seems to be a key factor in determination of the long-term outcom

F tests with random sample sizes. Theory and applications

This work was partially supported by CMA/FCT/UNL, under the project PEst-OE/MAT/UI0297/2011.Given a fixed time span for collecting observations in a study comparing, for example, the pathologies of patients entering a hospital sequentially, it is advisable to consider the sample sizes of the ANOVA levels as random variables. Using this approach, more powerful tests are developed, leading to lower critical values. The approach is used to obtain the minimum duration of data collection to ensure a pre-fixed power for the F test.authorsversionpublishe