Risk factors for smoking in adolescence: evidence from a cross-sectional survey in Switzerland

BACKGROUND

Cigarette smoking during adolescence is a major public health concern with far-reaching health implications. Adolescents who smoke are at an increased risk of developing long-term health problems and are more likely to continue smoking into adulthood. Therefore, it is vital to identify and understand the risk factors that contribute to adolescent smoking - which in turn facilitate the development of targeted prevention and intervention programs.

METHODS

Data was drawn from a cross-sectional survey conducted between October and December 2021, encompassing adolescents of adolescents aged 14 to 19 residing in Switzerland (n = 2,683). Multiple logistic regression analysis was employed to explore which demographic, household, behavioural and psychographic factors are associated with current smoking status.

RESULTS

The regression results showed higher odds of smoking for female respondents (OR 1.39; p-value 0.007); older adolescents (OR 1.30; p-value < 0.001); those living in the French-speaking part of Switzerland (OR 1.39; p-value 0.021), in suburban areas (OR 1.35; p-value 0.023) and with a smoker in the same household (OR 2.41; p-value < 0.001); adolescents consuming alcohol (OR 4.10; p-value < 0.001), cannabis products (OR 6.72; p-value < 0.001) and hookah (OR 5.07; p-value < 0.001) at least once a month; respondents not engaging in sports (OR 1.90; p-value < 0.001) or music (OR 1.42; p-value 0.031) as top five leisure activities and those experiencing high stress levels at home (OR 1.74; p-value < 0.001). Adolescents with high scores in health awareness (OR 0.33; p-value < 0.001), on the relational self-esteem scale (OR 0.78; p-value 0.054) and on the general well-being scale (OR 0.52; p-value 0.022) were less likely to smoke than their counterparts with lower scores. High risk-seeking was associated with higher odds of smoking (OR 2.15; p-value < 0.001).

CONCLUSIONS

Our results suggest the importance of a comprehensive approach at both individual and institutional levels to reduce smoking rates in adolescents. More specifically, a holistic strategy that encompasses adolescents, families, schools and policymakers ranging from strengthening adolescents' self-esteem, smoking cessation support for parents, to increasing engagement in musical and physical activities, and enhancing health awareness in the school curriculum.

Parents' Perceptions: Environments and the Contextual Strategies of Parents to Support the Participation of Children and Adolescents with Autism Spectrum Disorder-A Descriptive Population-Based Study from Switzerland

Environments have a modifying effect on the participation of children and adolescents with autism spectrum disorder (ASD) in all areas of life. This cross-sectional study investigated parental perspectives on supportive or hindering environments and the daily contextual strategies parents used to enhance their children's participation. Qualitative and quantitative data gathered from 115 parents from German-speaking Switzerland using the participation and environment measure-child and youth (PEM-CY) were analyzed. Results revealed 45 environmental supports and barriers at home, at school, and in the community. Contextual strategies were identified in combination with people, activities, time, objects, and places. Parental perspectives on participation and their contextual strategies should be considered in environmental-based interventions to support the participation of children and adolescents with ASD.

Growth Control of Listeria monocytogenes in Raw Sausage via Bacteriocin-Producing Leuconostoc carnosum DH25

The current study addresses the critical issue of Listeria monocytogenes growth in raw sausage/meat products leading to human infections, most commonly listeriosis, which is known for its high fatality rate. This research focuses on the isolation, identification, and screening of lactic acid bacteria from various meat and fish products in Switzerland. In total, 274 lactic acid bacteria strains were isolated from 30 different products and were screened for their ability to inhibit Listeria monocytogenes growth, with 51 isolates demonstrating anti-Listeria activity at 8 °C, 15 °C, 25 °C, and 37 °C. Further experiments, using a meat model and a raw sausage challenge test, demonstrated that Leuconostoc carnosum DH25 significantly inhibited Listeria monocytogenes growth during the ripening and storage of the tested meat/sausage. This inhibitory effect was found to be attributed to the bacteriocins produced by Leuconostoc carnosum DH25 rather than factors like pH or water activity. The stability of the anti-Listeria substances was examined, revealing their resistance to temperature and pH changes, making Leuconostoc carnosum DH25 a promising protective culture for raw sausages. The genome sequencing of this strain confirms its safety, with no antibiotic resistance genes or virulence factors detected, and reveals the presence of the structural genes for the production of the bacteriocin LeucocinB-Ta11a. This study underscores the potential of LAB strains and their bacteriocins as effective tools for enhancing food safety and preventing Listeria monocytogenes growth in meat products, offering valuable insights into biocontrol strategies in the food industry.

Variations in Ecuadorian Cocoa Fermentation and Drying at Two Locations: Implications for Quality and Sensory

In Ecuador, various processes are applied during cocoa post-harvesting. This study, therefore, explored fermentation parameters across two locations with 2-7 independent runs, focusing on temperature, microbial counts, pH during fermentation and drying, and their impact on cocoa bean quality. Factors including fermentation devices (jute bags, plastic bags, and wooden boxes), pre-drying, turning during fermentation, fermentation duration, and drying temperature were investigated. Fermenting in plastic bags without pre-drying or turning and fermenting in jute bags for only 40 ± 2.0 h yielded low maximal fermentation temperatures Tmax (31.1 ± 0.4 °C and 37.6 ± 1.8 °C), leading to bitter, astringent, woody, and earthy cocoa liquor. Longer fermentation (63 ± 6 h) in wooden boxes with turning (Wt) and in jute bags with pre-drying and turning (Jpt) achieved the highest Tmax of 46.5 ± 2.0 °C, and a more acidic cocoa liquor, particularly in Wt (both locations) and Jpt (location E). Therefore, it is recommended to ferment for a minimum duration from day 1 to 4 (63 ± 6 h), whether using plastic bags (with mandatory pre-drying) or jute bags (with or without pre-drying or turning). Furthermore, this study underscores the risks associated with excessively high drying temperatures (up to 95.2 ± 13.7 °C) and specific dryer types, which can falsify cut-tests and introduce unwanted burnt-roasted off-flavors in the cocoa liquor.

Heat and shear stability of particle stabilised foams for application in gluten-free bread

Bread forms an integral part of the daily diet in many cultures worldwide. At the same time, a significant number of people try to avoid wheat-based products for either health reasons or due to personal preferences. The absence of a protein network in gluten free bread affects its structure, taste, texture and shelf-life. This paper suggests a technological solution to this issue that uses a pre-foamed mass of gluten free raw materials which is mixed with the bread's ingredients, then kneaded and baked to form a high quality gluten free bread. To survive the high shear stresses during kneading and temperature increase during baking, the foam requires exceptional stability. This stability was achieved through particle stabilisation of the bubble interfaces. Both of the tested foams (with and without particles) exhibited thermal stability up to 80 °C. However, resistance to shear stresses was higher in the particle stabilised foams. Of all the tested particles, linseed press cake and banana powder led to the best results. In conclusion, particle stabilised foams seem very well suited to applications in gluten free baked goods. Further application potential is seen for vegan foamed desserts.

What drives health care spending in Switzerland? Findings from a decomposition by disease, health service, sex, and age

BACKGROUND

High and increasing spending dominates the public discussion on healthcare in Switzerland. However, the drivers of the spending increase are poorly understood. This study decomposes health care spending by diseases and other perspectives and estimates the contribution of single cost drivers to overall healthcare spending growth in Switzerland between 2012 and 2017.

METHODS

We decompose total healthcare spending according to National Health Accounts by 48 major diseases, injuries, and other conditions, 20 health services, 21 age groups, and sex of patients. This decomposition is based on micro-data from a multitude of data sources such as the hospital inpatient registry, health and accident insurance claims data, and population surveys. We identify the contribution of four main drivers of spending: population growth, change in population structure (age/sex distribution), changes in disease prevalence, and changes in spending per prevalent patient.

RESULTS

Mental disorders were the most expensive major disease group in both 2012 and 2017, followed by musculoskeletal disorders and neurological disorders. Total health care spending increased by 19.7% between 2012 and 2017. An increase in spending per prevalent patient was the most important spending driver (43.5% of total increase), followed by changes in population size (29.8%), in population structure (14.5%), and in disease prevalence (12.2%).

CONCLUSIONS

A large part of the recent health care spending growth in Switzerland was associated with increases in spending per patient. This may indicate an increase in the treatment intensity. Future research should show if the spending increases were cost-effective.

Health-system drivers influencing the continuum of care linkages for low-birth-weight infants at the different care levels in Ghana

BACKGROUND

Low birth weight (LBW) is associated with short and long-term consequences including neonatal mortality and disability. Effective linkages in the continuum of care (CoC) for newborns at the health facility, community (primary care) and home care levels have a high tendency of minimizing adverse events associated with LBW. But it is unclear how these linkages work and what factors influence the CoC process in Ghana as literature is scarce on the views of health professionals and families of LBW infants regarding the CoC. Therefore, this study elicited the drivers influencing the CoC for LBW infants in Ghana and how linkages in the CoC could be strengthened to optimize quality of care.

METHODS

A constructivist grounded theory study design was used. Data was collected between September 2020 to February 2021. A total of 25 interviews were conducted with 11 family members of LBW infants born in a secondary referral hospital in Ghana, 9 healthcare professionals and 7 healthcare managers. Audio recordings were transcribed verbatim, analyzed using initial and focused coding. Constant comparative techniques, theoretical memos, and diagramming were employed until theoretical saturation was determined.

RESULTS

Emerging from the analysis was a theoretical model describing ten major themes along the care continuum for LBW infants, broadly categorized into health systems and family-systems drivers. In this paper, we focused on the former. Discharge, review, and referral systems were neither well-structured nor properly coordinated. Efficient dissemination and implementation of guidelines and supportive supervision contributed to higher staff motivation while insufficient investments and coordination of care activities limited training opportunities and human resource. A smooth transition between care levels is hampered by procedural, administrative, logistics, infrastructural and socio-economic barriers.

CONCLUSION

A coordinated care process established on effective communication across different care levels, referral planning, staff supervision, decreased staff shuffling, routine in-service training, staff motivation and institutional commitment are necessary to achieve an effective care continuum for LBW infants and their families.

The feasibility, facilitators, and barriers in the initial implementation phase of 'good life with osteoarthritis in Denmark' (GLA:D®) in Switzerland: a cross-sectional survey

BACKGROUND

The guideline-based, conservative, non-pharmacological management of hip and knee osteoarthritis in clinical practice has been insufficient in Switzerland until now. The implementation of "Good Life with Osteoarthritis in Denmark" (GLA:D®), a programme designed to address this evidence-performance gap, was started in 2019 in Switzerland. This study investigated the acceptance and practicality of the GLA:D® Switzerland programme and identified the facilitators and barriers to its implementation, to support the development of tailored implementation strategies.

METHODS

This is a non-experimental observational study. A cross-sectional survey was performed among the physiotherapists (PTs) of the first five GLA:D® Switzerland certification courses, using the Measurement Instrument for Determinants of Innovations (MIDI) to identify the facilitators and barriers. Descriptive statistics were calculated, and qualitative content analysis was used for open-ended questions.

RESULTS

In the online survey, 86 GLA:D® certified PTs participated (response rate: 61%). The majority of 51 PTs (63.7%) worked in private practices. Of the responding PTs 58 (78.4%) were satisfied with the general concept of the GLA:D® Switzerland programme. Practicality was evaluated positively, particularly the second and third individual session (n = 40 PTs, 83.3%), the 40 m Fast-paced Walk Test (43, 89.6%), the 30 s Chair Stand Test (45, 93.8%), and the exercise programme (40, 83.3%). The marketing (12, 15%), the 'data entry' (5, 10.4%), 'register the patient' (7, 14.6%), and the digital patient questionnaire (9, 14.2%) were rated less positively. In total, 12 facilitators and 12 barriers were identified. The barriers were mainly related to adopting user, e.g., perceived personal disadvantages. Barriers were also found in the organisational context, e.g., time available. Facilitators were associated with the GLA:D® Switzerland programme itself, e.g., completeness, relevance for patients, and the adopting user, e.g., self-efficacy, and in the organisational context, e.g., material resources and facilities. Topics related to the socio-political context were raised in the answers to the open-ended questions, e.g., general awareness level of the GLA:D® Switzerland programme and patient recruitment.

CONCLUSION

The acceptance, practicality and facilitators identified from the initial implementation are encouraging. However, the identified barriers and activities rated with low practicality require tailored strategies to support a successful implementation of the GLA:D® Switzerland programme.

A Multi-component Intervention (NEXpro) Reduces Neck Pain-Related Work Productivity Loss: A Randomized Controlled Trial Among Swiss Office Workers

Purpose Neck pain is common among office workers and leads to work productivity loss. This study aimed to investigate the effect of a multi-component intervention on neck pain-related work productivity loss among Swiss office workers. Methods Office workers, aged 18-65 years, and without serious neck-related health problems were recruited from two organisations for our stepped-wedge cluster randomized controlled trial. The 12-week multi-component intervention included neck exercises, health-promotion information, and workplace ergonomics. The primary outcome of neck pain-related work productivity loss was measured using the Work Productivity and Activity Impairment Questionnaire and expressed as percentages of working time. In addition, we reported the weekly monetary value of neck pain-related work productivity loss. Data was analysed on an intention-to-treat basis using a generalized linear mixed-effects model. Results Data from 120 participants were analysed with 517 observations. At baseline, the mean age was 43.7 years (SD 9.8 years), 71.7% of participants were female (N = 86), about 80% (N = 95) reported mild to moderate neck pain, and neck pain-related work productivity loss was 12% of working time (absenteeism: 1.2%, presenteeism: 10.8%). We found an effect of our multi-component intervention on neck pain-related work productivity loss, with a marginal predicted mean reduction of 2.8 percentage points (b = -0.27; 95% CI: -0.54 to -0.001, p = 0.049). Weekly saved costs were Swiss Francs 27.40 per participant. Conclusions: Our study provides evidence for the effectiveness of a multi-component intervention to reduce neck pain-related work productivity loss with implications for employers, employees, and policy makers.Trial Registration ClinicalTrials.gov, NCT04169646. Registered 15 November 2019-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04169646 .

Impact of a diabetes disease management program on guideline-adherent care, hospitalization risk and health care costs: a propensity score matching study using real-world data

OBJECTIVE

To evaluate the impact of a DMP for patients with diabetes mellitus in a Swiss primary care setting.

METHODS

In a prospective observational study, we compared diabetes patients in a DMP (intervention group; N = 538) with diabetes patients receiving usual care (control group; N = 5050) using propensity score matching with entropy balancing. Using a difference-in-difference (DiD) approach, we compared changes in outcomes from baseline (2017) to 1-year (2017/18) and to 2-year follow-up (2017/19). Outcomes included four measures for guideline-adherent diabetes care, hospitalization risk, and health care costs.

RESULTS

We identified a positive impact of the DMP on the share of patients fulfilling all measures for guideline-adherent care [DiD 2017/18: 7.2 percentage-points, p < 0.01; 2017/19: 8.4 percentage-points, p < 0.001]. The hospitalization risk was lower in the intervention group in both years, but only statistically significant in the 1-year follow-up [DiD 2017/18: - 5.7 percentage-points, p < 0.05; 2017/19: - 3.9 percentage points, n.s.]. The increase in health care costs was smaller in the intervention than in the control group [DiD 2017/18: CHF - 852; 2017/19: CHF - 909], but this effect was not statistically significant.

CONCLUSION

The DMP under evaluation seems to exert a positive impact on the quality of diabetes care, reflected in the increase in the measures for guideline-adherent care and in a reduction of the hospitalization risk in the intervention group. It also might reduce health care costs, but only a longer follow-up will show whether the observed effect persists over time.

How do supported employment programs work? Answers from a systematic literature review

Many studies have found that supported employment (SE) has effectively helped people with severe mental illness obtain and maintain competitive employment. However, most SE studies have asked "What works?" rather than discerning what works for whom, in what circumstances, in what respects and how. It is important to understand the outcomes of SE and identify the impact factors (contexts and mechanisms) that can trigger them. Four literature databases were searched for studies that analyzed counseling settings. Overall, 104 publications met the inclusion criteria. The review showed that most of the research on SE programs were one-dimensional, looking at either the effects of SE programs, the client or the professional, or the relationship between clients and professionals. The model reveals that impact factors are interconnected and can have a cumulative impact on the client, professionals, and the environment.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10775-022-09533-3.

Factors related to the change in Swiss inpatient costs by disease: a 6-factor decomposition

There is currently little systematic knowledge about the contribution of different factors to the increase in health care spending in high-income countries such as Switzerland. The aim of this paper is to decompose inpatient care costs in the Swiss canton of Zurich by 100 diseases and 42 age/sex groups and to assess the contribution of six factors to the change in aggregate costs between 2013 and 2017. These six factors are population size, age and sex structure, inpatient treated prevalence, utilization in terms of stays per patient, length of stay per case, and costs per treatment day. Using detailed inpatient cost data at the case level, we find that the most important contributor to the change in disease-specific costs was a rise in costs per treatment day. For most conditions, this effect was partly offset by a reduction in the average length of stay. Changes in population size accounted for one third of the total increase, but population structure had only a small positive association with costs. The most expensive cases accounted for the largest part of the increase in costs, but the magnitude of this effect differed across diseases. A better understanding of the factors related to cost changes at the disease level over time is essential for the design of targeted health policies aiming at an affordable health care system.