Bedürfnisse der pflegenden Angehörigen während der Transition ihres Familienmitgliedes in ein Alters- und Pflegeheim: Literaturübersicht

Viele Angehörige pflegen und betreuen ihre Familienmitglieder zu Hause. Mit steigender Pflegebedürftigkeit wird es für die pflegenden Angehörigen zunehmend schwieriger diesen Dienst zu übernehmen. Das Alters- und Pflegeheim ist oftmals die beste Möglichkeit, um eine adäquate Pflege für die ältere Person zu schaffen. Für alle Betroffenen bedeutet der Heimeintritt einen grossen Wechsel im alltäglichen Leben und verlangt Anpassung. Oftmals werden die pflegenden Angehörigen während diesem Prozess zu wenig berücksichtigt

The last stages of star formation in the dwarf spheroidal galaxy Sextans

This thesis is anchored in the research of better understanding of the chemical evolution of galaxies. Many dwarf spheroidal galaxies (dSph) are orbiting the Milky Way displaying various star formation histories. The formation of these dwarf galaxies and the drivers of their evolution are still not well understood. We studied in detail one of them, Sextans, a low mass dSph composed of an old population. 90% of Sextans stars were formed 11-14 Gyr ago (Lee et al. 2009). Battaglia et al. (2011) show the presence of a radial metallicity gradient in Sextans considering observation based on intermediate resolution spectroscopy until the tidal radius. For a projected radius R 0.8 deg all stars are metal-poor [Fe/H] < -2.2 dex. Due to its distance and its low surface brightness high resolution spectra are required to obtain accurate abundances. Up to recently only 14 Sextans stars have been observed in high resolution spectroscopy (Shetrone et al. 2001; Aoki et al. 2009; Tafelmeyer et al. 2010; Honda et al. 2011) but in majority they were focused only on extremely metal-poor stars. In order to understand the chemical evolution of Sextans we needed to study a statistically significant sample of stars covering a larger metallicity range. This has been done in this work based on the largest high resolution spectroscopic sample of 87 red giant branch stars ever obtained in such low mass dwarf spheroidal galaxies. Our sample of stars located in the center of Sextans displays a large metallicity distribution ranging from -1.0 dex to -3.5 dex. We derived abundances of 10 elements : 3 alpha-elements (Mg, Ca and Ti), 5 iron-peak elements (Sc, Cr,Mn, Co and Ni) and 2 neutron-capture elements (Ba and Eu). Combining the results we had the first picture of the chemical evolution of Sextans. From [alpha/Fe] distribution reflecting the ratio between supernovae [SNe II/SNe Ia], we found that the domination of SNeIa in chemical evolution occurred around [Fe/H] = -2.0 dex. A lower knee than for Fornax and Sculptor suggests that star formation was less efficient in Sextans in agreement with their respective estimated mass. The absence of intrinsic scatter in [alpha/Fe] showed that in the center of Sextans the interstellar medium has been homogeneously enriched through star formation. Some hypothesis like tidal interactions with the Milky Way could explain this abundance homogeneity in the center of the galaxy and the metallicity gradient toward the outskirts. Abundances in iron-peak elements and neutron-capture elements give new observational constraints for a better understanding of the various nucleosynthesis sources of these elements

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

BACKGROUND: While 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. METHODS: Repeated 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. RESULTS: A 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 ≥ 13,000 CHF, 1 CHF ≈ 1$) to 23.5% among participants with the lowest income (&lt;3,000 CHF). Since 2007/8, forgoing dental care remained stable overall, but in subjects with a monthly income of &lt;3,000 CHF, 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. CONCLUSIONS: In 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

A comparison of the spatial dependence of body mass index among adults and children in a Swiss general population.

BACKGROUND: Body mass index (BMI) may cluster in space among adults and be spatially dependent. Whether BMI clusters among children and how age-specific BMI clusters are related remains unknown. We aimed to identify and compare the spatial dependence of BMI in adults and children in a Swiss general population, taking into account the area's income level. METHODS: Geo-referenced data from the Bus Santé study (adults, n=6663) and Geneva School Health Service (children, n=3601) were used. We implemented global (Moran's I) and local (local indicators of spatial association (LISA)) indices of spatial autocorrelation to investigate the spatial dependence of BMI in adults (35-74 years) and children (6-7 years). Weight and height were measured using standardized procedures. Five spatial autocorrelation classes (LISA clusters) were defined including the high-high BMI class (high BMI participant's BMI value correlated with high BMI-neighbors' mean BMI values). The spatial distributions of clusters were compared between adults and children with and without adjustment for area's income level. RESULTS: In both adults and children, BMI was clearly not distributed at random across the State of Geneva. Both adults' and children's BMIs were associated with the mean BMI of their neighborhood. We found that the clusters of higher BMI in adults and children are located in close, yet different, areas of the state. Significant clusters of high versus low BMIs were clearly identified in both adults and children. Area's income level was associated with children's BMI clusters. CONCLUSIONS: BMI clusters show a specific spatial dependence in adults and children from the general population. Using a fine-scale spatial analytic approach, we identified life course-specific clusters that could guide tailored interventions

Independent association between socioeconomic indicators and macro- and micro-nutrient intake in Switzerland.

Socioeconomic differences in diet are rarely assessed with more than one indicator. We aimed to assess differences in macro- and micro-nutrient intake in both sexes according to education, income, and occupation. We used data from validated food frequency questionnaire measured dietary intake in 5087 participants (2157 women) from yearly adult population-based cross-sectional surveys conducted from 2005 to 2012 in the canton of Geneva, Switzerland. We used two ANOVA models: age-adjusted and multivariable adjusted simultaneously for all three socioeconomic indicators. Low-education men consumed more calcium but less vitamin D than high-education men; low-income men consumed less total and animal protein (80.9±0.9 vs 84.0±0.6 g/d; 55.6±1.0 vs 59.5±0.7 g/d) and more total carbohydrates and sugars (246±2 vs 235±2 g/d; 108±2 vs 103±1 g/d) than high-income men. Occupation and diet showed no association. Low-education women consumed less vegetable protein (20.7±0.2 vs 21.6±0.2 g/d), fibre (15.7±0.3 vs 16.8±0.2 g/d), and carotene (4222±158 vs 4870±128 μg/d) than high-education women; low-income women consumed more total carbohydrates (206±2 vs 197±1 g/d) and less monounsaturated fat (27.7±0.4 vs 29.3±0.3 g/d) than high-income women. Finally, low-occupation women consumed more total energy (1792±27 vs 1714±15 kcal/d) and total carbohydrates (206±2 vs 200±1 g/d), but less saturated fat (23.0±0.3 vs 24.4±0.2 g/d), calcium (935±17 vs 997±10 mg/d) and vitamin D (2.5±0.1 vs 2.9±0.1 μg/d), than high-occupation women. In Switzerland, the influence of socioeconomic factors on nutrient intake differs by sex; income and education, but not occupation, drive differences among men; among women, all three indicators seem to play a role. Interventions to reduce inequalities should consider the influence of education, income, and occupation in diet to be most effective

Trends and determinants of time in bed in Geneva, Switzerland

STUDY OBJECTIVES: There is limited information regarding sleep duration and determinants in Switzerland. We aimed to assess the trends and determinants of time in bed as a proxy for sleep duration in the Swiss canton of Geneva. METHODS: Data from repeated, independent cross-sectional representative samples of adults (≥ 18 years) of the Geneva population were collected between 2005 and 2011. Self-reported time in bed, education, monthly income, and nationality were assessed by questionnaire. RESULTS: Data from 3,853 participants (50% women, 51.7 ± 10.9 years) were analyzed. No significant trend was observed between 2005 and 2011 regarding time in bed or the prevalence of short (≤ 6 h/day) and long (&gt; 9 h/day) time in bed. Elderly participants reported a longer time in bed (year-adjusted mean ± standard error: 7.67 ± 0.02, 7.82 ± 0.03, and 8.41 ± 0.04 h/day for 35-50, 50-65, and 65+ years, respectively, p &lt; 0.001), while shorter time in bed was reported by non-Swiss participants (7.77 ± 0.03 vs. 7.92 ± 0.03 h/day for Swiss nationals, p &lt; 0.001), participants with higher education (7.92 ± 0.02 for non-university vs. 7.74 ± 0.03 h/day for university, p &lt; 0.001) or higher income (8.10 ± 0.04, 7.84 ± 0.03, and 7.70 ± 0.03 h/day for &lt; 5,000 SFr; 5,000-9,500 SFr, and &gt; 9,500 SFr, respectively, p &lt; 0.001). Multivariable-adjusted polytomous logistic regression showed short and long time in bed to be positively associated with obesity and negatively associated with income. CONCLUSION: In a Swiss adult population, sleep duration as assessed by time in bed did not change significantly between 2005 and 2011. Both clinical and socioeconomic factors influence time in bed