The influence of patients' immigration background and residence permit status on treatment decisions in health care. Results of a factorial survey among general practitioners in Switzerland.

This study examines the influence of patients' immigration background and residence permit status on physicians' willingness to treat patients in due time. A factorial survey was conducted among 352 general practitioners with a background in internal medicine in a German-speaking region in Switzerland. Participants expressed their self-rating (SR) as well as the expected colleague-rating (CR) to provide immediate treatment to 12 fictive vignette patients. The effects of the vignette variables were analysed using random-effects models. The results show that SR as well as CR was not only influenced by the medical condition or the physicians' time pressure, but also by social factors such as the ethnicity and migration history, the residence permit status, and the economic condition of the patients. Our findings can be useful for the development of adequate, practically relevant teaching and training materials with the ultimate aim to reduce unjustified discrimination or social rationing in health care.

The positioning of sustainability within residential property marketing.

This article investigates the evolution of sustainability positioning in residential property marketing to shed light on the specific role and responsibility of housebuilders and housing investors in urban development. To this end, an analysis is made of housing advertisements published in Basel, Switzerland, over a period of more than 100 years. The paper demonstrates how to draw successfully on advertisements to discern sustainability patterns in housing, using criteria situated along the dimensions building, location and people. Cluster analysis allows five clusters of sustainability positioning to be described­namely, good location, green building, comfort living, pre-sustainability and sustainability. Investor and builder types are differently located in these clusters. Location emerges as an issue which, to a large extent, is advertised independently from other sustainability issues.

Comparison of two strategies to prevent varicella outbreaks in housing facilities for asylum seekers.

BACKGROUND: The proportion of adults with positive varicella serology is lower in populations from tropical countries. Therefore immigrants to countries with a temperate climate are at risk of acquiring varicella infection during adulthood. METHODS: We tested two different strategies to prevent varicella outbreaks in housing facilities for asylum seekers arriving in the Canton of Vaud, Switzerland. The first strategy consisted of a rapid response with isolation of the affected individuals and vaccination of the susceptible contacts. The second strategy consisted of a general vaccination upon arrival of all asylum seekers aged 15-39 years with no history of chickenpox. RESULTS: From May 2008 to January 2009 we applied the rapid response strategy. Eight hundred and fifty-eight asylum seekers arrived in the Canton and an attack rate of 2.8% (seven cases among 248 exposed asylum seekers) was observed. The mean cost was US$ 31.35 per asylum seeker. The general vaccination strategy was applied from February 2009 to May 2010, a period during which 966 asylum seekers were registered. This second strategy completely prevented any outbreak at a mean cost of US$ 83.85 per asylum seeker. CONCLUSIONS: Of the two analyzed interventions to prevent varicella outbreaks in housing facilities for asylum seekers, the general vaccination strategy was more effective, more sustainable, and ethically preferable, although more costly.

Health care-associated measles outbreak in the United States after an importation: challenges and economic impact.

BACKGROUND: On 12 February 2008, an infected Swiss traveler visited hospital A in Tucson, Arizona, and initiated a predominantly health care-associated measles outbreak involving 14 cases. We investigated risk factors that might have contributed to health care-associated transmission and assessed outbreak-associated hospital costs. METHODS: Epidemiologic data were obtained by case interviews and review of medical records. Health care personnel (HCP) immunization records were reviewed to identify non-measles-immune HCP. Outbreak-associated costs were estimated from 2 hospitals. RESULTS: Of 14 patients with confirmed cases, 7 (50%) were aged ≥ 18 years, 4 (29%) were hospitalized, 7 (50%) acquired measles in health care settings, and all (100%) were unvaccinated or had unknown vaccination status. Of the 11 patients (79%) who had accessed health care services while infectious, 1 (9%) was masked and isolated promptly after rash onset. HCP measles immunity data from 2 hospitals confirmed that 1776 (25%) of 7195 HCP lacked evidence of measles immunity. Among these HCPs, 139 (9%) of 1583 tested seronegative for measles immunoglobulin G, including 1 person who acquired measles. The 2 hospitals spent US$799,136 responding to and containing 7 cases in these facilities. CONCLUSIONS: Suspecting measles as a diagnosis, instituting immediate airborne isolation, and ensuring rapidly retrievable measles immunity records for HCPs are paramount in preventing health care-associated spread and in minimizing hospital outbreak-response costs.

Housing shortage and communal politics in European cities around 1900: the cases of Basel 1889 and Belgrade 1906.

In the second half of the nineteenth century, European cities faced a problem well known in postindependence India: the population escalated due to immigration from the rural areas causing rapid and considerable housing shortage. This forced large parts of the poorer classes into miserable living conditions. Lack of space, money and hygiene facilitated the epidemic spread of diseases such as tuberculosis and diarrhoea. The town authorities were called upon to stop speculation and to launch state financed housing projects. However, in reality the situation was very different depending on the place, political aims and financial possibilities arising out of the particular crisis. This article discusses the issue in two continental European cities of around 100,000 inhabitants. The Swiss town of Basel was a hub of trade in Central Europe, while Belgrade was the capital of the Southeastern European kingdom of Serbia.

Cabaret dancers: "Settle down in order to stay mobile?" Bridging theoretical orientations within transnational migration studies.

Adopting a transnational perspective has become essential in understanding the contemporary practices taking place across borders, especially with respect to migrants. In this article, I argue that we can distinguish two theoretical orientations within transnational migration studies: one theorizing the complexity of transnational processes and focusing on established migrants settled in host countries; and the second theorizing transnational practices on the basis of different but continuous forms of mobility. Using the example of cabaret dancers in Switzerland, I show how they develop a very specific form of transnationality, which corresponds at first sight to the second theoretical orientation. Some of them are genuinely "world travelers"­they work in erotic clubs in Switzerland, Japan, or Lebanon, go home regularly to visit their families, or continue their studies. As such, their transnational morphology is highly influenced by gender as well as by the (transnational) nature of the sex industry and the opportunities and legal structure in Switzerland. Nevertheless, to remain in circulation, the dancers need to develop a kind of mobility capital, which involves, paradoxically, becoming "sedentarized" to a certain degree in Switzerland. The article thus advocates a theoretical framework that better captures the experiences of settled as well as of circulatory migrants.

[Disguises, invisibility and disqualification of the guards of children in French-speaking Switzerland]. / Déguisements, invisibilité et disqualification des gardes d'enfants en Suisse Romande aujourd'hui.

Various factors oblige today's parents to entrust their children to a child-care worker (CCW), providing services in the domestic sphere, either at the child's parental house or at the day-care worker's (DCW's) own home. Taking this into account, this paper examines job offers and applications for DCWs published in a regional Swiss newspaper as well as other job offers and applications published on a website called bestnounou.ch. The parents often tend to use a variety of terms, which do not point to the child-caring or rearing activity itself, but rather emphasise sociological characteristics of the CCW (age, gender, civil status), requesting, for example, a "lady", a "grandmother", a "student". Thereby, the parents present the child-care work as: (1) a secondary and temporary activity in relation to another major stable activity (motherhood, apprenticeship, retirement); and (2) an activity that does not require professional skills but inborn aptitudes. Moreover, employers use as synonyms distinctive terms, which refer to various categories of CCW and domestic workers, whose schedules of conditions and salaries are regulated and differ. The parents' inclination to use terms designating the most precarious and underpaid CCW underscores the importance of child-care in the domestic sphere. It leads also to a public image of child-care workers as being a fragmented, unstable, little qualified and economically inconsistent workforce, in contrast to the stable and structural need for their specific services, allowing parents to face their familial and professional responsibilities.

[Forms of custody of children placed in Switzerland: ambiguous policies, resistance, and conflicting objectives (1850-1950).]. / Les formes de garde des enfants placs en Suisse: politiques ambiguës, resistances et objectifs contradictoires (1850-1950) .

In the past, many European countries were faced with the problem of providing care for boarded-out children. And very often the policies implemented up to the middle of the twentieth century were essentially similar and thus similarly inadequate. The problem with boarding out is that it was a measure in response to widely varying situations, not only in respect of the illegitimate as well as the legitimate children concerned, but also with regard to the reasons which led to boarding out. Orphans after the First World War with no relatives who could take them in formed a minority, and in several Swiss cantons the legitimate children outnumbered the illegitimate ones by far. Up to the First World War, the age group concerned was mostly that of children from birth to 14 years. There was considerable ambivalence in the motives leading to the boarding out of children, because they were the result of two conflicting concepts. On the one hand, the parents or the mother of an illegitimate child had to out-place her child/children because the mother had to go out to work, as was often the case with the spread of industrialisation and the frequently inadequate income of the working class. On the other hand, the local Assistance Board was often ready to split up poorer families and to take away their children with the argument that the family environment was considered morally harmful for their upbringing according to the contemporary view. Both parents and the local Assistance Board often chose the cheapest solution for different reasons. In numerous cases the children were placed with farming families quite unable to offer a proper upbringing and children were taken in only because they represented a supplementary source of income and an addition to the workforce. For the local authorities, be they rural or urban, in some cantons even during the interwar period, the auctioning of the children to families living in other parts of Switzerland was a frequent stratagem in order to pay the lowest possible boarding fees, and the level of these fees decreased enormously the older the child was since his/her work capacity increased over time. In most cantons, one of the main problems with boarding out was the totally inadequate supervision of the families to which the children were entrusted, either because of the geographical distance between the local authority and the children, or because of the inadequacy of the supervisory staff, often benevolent females with no clear rules existing for judging the adequacy of the entrusted families, or due to the general lack of interest for the destiny of the children.

Sex and ethnic differences among South Tirolean suicides: a psychological autopsy study.

OBJECTIVE: The aim of the research is to study whether any differences exist in the rates and characteristics of suicide by ethnicity and sex in South Tirol, Italy. METHODS: Psychological autopsy interviews were conducted for suicides who died between March 1997 and July 2006. RESULTS: 332 individuals belonging to the three major South Tirolean ethnic groups (Germans, Italians, Ladins [Ladin is a Rhaeto-Romance language related to the Venetian and Swiss Romansh languages]) died by suicide. Around 23% of the victims had experienced suicidal behaviour among family members, and more than 31% of them had experienced trauma during their childhood. Germans were 1.37 times more at risk to commit suicide than Italians (95% CI: 1.04/1.80; z=2.26, p<.05). 69% of the suicides had attended school for less than 8 years: Germans (OR=4.62; 95% CI: 2.52/8.47; p<.001) and Ladins (OR=11.24; 95% CI: 2.99/42.30; p<.001) were more likely to have lower education than Italians. There were several differences by ethnicity and sex but no sex-by-ethnicity interactions. CONCLUSIONS: The study indicated that suicide, an alarming health and social problem in South Tirol, may require different preventive interventions for men and women and for those of different ethnicities.

[September 11 from the viewpoint of a Swiss trauma fellow in New York]. / Der 11. September aus der Sicht eines Schweizer Trauma Fellows in New York.

This is the report of the events of September 11th seen through the eyes of a Swiss Trauma Fellow. This ill-fated day is described by someone who went down to ground zero with other doctors to help and save lives and came back frustrated because there was so little to be done.

[Cost-benefit analysis of malaria prophylaxis with mefloquine in travelers to Kenya]. / Kosten-Nutzen-Analyse der Malariaprophylaxe bei Keniareisenden mit Mefloquin.

With an increasing movement towards cost saving in the health sector, preventive medicine must also be judged according to its economic viability. The fact that prevention can autofinance itself is suggested by the results of a cost/benefit analysis of chemoprophylaxis of Falciparum malaria with Mefloquin among travellers in Kenya. Out of the whole group of travellers analysed by means of an interview-based test (Malpro-Study), the costs in the case of both Switzerland and the Federal German Republic were lower for those people who had undergone Mefloquin-prophylaxis than for those who had not. In this way the prophylaxis not only compensates the required outlay but also results in an overall benefit in macroeconomic terms. Therefore economically based opposition to the prophylaxis of malaria with Mefloquin for short stays in high-risk countries is not justified.