Politicians in the Media: Determinants of Legislators' Presence and Prominence in Swiss Newspapers

In times of increasing "mediatization" of politics, when voters and their elected representatives primarily communicate through the media, the question of who gets into the news and why becomes of the utmost importance. This article examines the determinants of Swiss legislators' presence and prominence in the print media by focusing on three competing approaches drawn from communication studies. The first approach regards the media as a "mirror" of political reality and argues that the media focus on the most active deputies in parliament. Second, news values theory predicts that "authoritative" politicians in leadership positions get the most media coverage. Third, theories of "news bias" hold that the media privilege legislators who are in line with their own editorial interests. Overall, the statistical analyses show an important leadership effect and provide strong support for the second explanation. While deputies in official functions get the most extensive news coverage, media access can also be won by parliamentary activity. The least support is shown for the news bias theory, although some newspapers try to localize parliamentary news coverage by focusing on deputies from their own media market.

Disseminated M. avium complex infection in the Swiss HIV Cohort Study: declining incidence, improved prognosis and discontinuation of maintenance therapy.

Introduction of potent antiretroviral combination therapy (ART) has reduced overall morbidity and mortality amongst HIV-infected adults. Some prophylactic regimes against opportunistic infections can be discontinued in patients under successful ART. (1) The influence of the availability of ART on incidence and mortality of disseminated M. avium Complex infection (MAC). (2) The safety of discontinuation of maintenance therapy against MAC in patients on ART. The Swiss HIV-Cohort Study, a prospective multicentre study of HIV-infected adults. Patients with a nadir CD4 count below 50 cells/mm3 were considered at risk for MAC and contributed to total follow-up time for calculating the incidence. Survival analysis was performed by using Kaplan Meier and Cox proportional hazards methods. Safety of discontinuation of maintenance therapy was evaluated by review of the medical notes. 398 patients were diagnosed with MAC from 1990 to 1999. 350 had a previous CD4 count below 50 cells/mm3. A total of 3208 patients had a nadir CD4 count of less than 50 cells/mm3 during the study period and contributed to a total follow-up of 6004 person-years. The incidence over the whole study period was 5.8 events per 100 person-years. In the time period of available ART the incidence of MAC was significantly reduced (1.4 versus 8.8 events per 100 person-years, p < 0.001). Being diagnosed after 1995 was the most powerful predictor of better survival (adjusted hazard ratio for death: 0.27; p < 0.001). None of 24 patients discontinuing maintenance therapy while on ART experienced recurrence of MAC during a total follow-up of 56.6 person-years (upper 95% confidence limit 5.3 per 100 person-years). Introducing ART has markedly reduced the risk of MAC for HIV-infected individuals with a history of very low CD4 counts. Survival after diagnosis of MAC has improved after ART became available. In patients responding to ART, discontinuation of maintenance therapy against M. avium may be safe.

Les thromboses veineuses mésentériques : facteurs associés à une évolution chronique et prévalence et importance clinique dans la Swiss Inflammatory Bowel Disease Cohort

Ce projet de thèse consiste en deux travaux sur le thème commun des thromboses veineuses mésentériques. Dans le premier travail, préliminaire au deuxième, nous avons décrit les signes d'évolution chronique des thromboses veineuses mésentériques. Les signes aigus sont bien connus et bien décrits (défaut de remplissage intra-luminal) contrairement aux signes chroniques dont la description manquait dans la littérature. Nous avons de plus cherché quels étaient les facteurs prédicateurs pour une évolution chronique. Pour se faire, nous avons sélectionné un collectif de patients avec un diagnostic de thromboses veineuses mésentériques aiguës et avons revu tous les scanners abdominaux en phase veineuse de ces patients à la recherche des signes d'évolution des thromboses. Cette étude a permis de mettre en évidence que les signes d'évolution chronique des thromboses veineuses mésentériques sont la sténose ou l'obstruction complète de la veine thrombosée et le développement d'un réseau de collatérales permettant de contourner la veine thrombosée. D'autre part, nous avons mis en évidence que la plupart des cas de thrombose veineuse mésentérique présente une évolution chronique, indépendamment de si le patient a reçu un traitement anticoagulant. Les thromboses étendues, situées dans des veines de petit calibre, auquel s'associe une infiltration de la graisse mésentérique au moment du diagnostic sont des facteurs favorisants pour une évolution chronique. La seconde étude a été réalisée grâce et avec la collaboration de la « Swiss Inflammatory Bowel Disease Cohort study » (SIBDCS). Les patients atteints de maladie inflammatoire chronique de l'intestin (MICI) présentent un risque augmenté de complications thromboemboliques, principalement de thrombose veineuse périphérique et d'embolie pulmonaire mais également de thrombose veineuse mésentérique. La littérature à ce sujet est pauvre et la prévalence de cette complication n'est pas connue dans cette population. Les buts de cette étude étaient donc d'évaluer la prévalence des thromboses veineuses mésentériques chez les patients atteints de MICI et de corréler leur survenue avec l'évolution clinique des patients. Parmi les patients inclus dans la SIBDCS, suivis au CHUV, nous avons revu tous les scanners abdominaux réalisés en phase veineuse à la recherche de signes (aigus ou chroniques) de thrombose veineuse mésentérique. Nous avons ainsi créé deux groupes de patients : les patients avec ou sans thrombose veineuse mésentérique. Ces deux collectifs ont ensuite été corrélés à la présence de signes radiologiques d'activité de la maladie inflammatoire de l'intestin et à la survenue aux complications liées à la MICI. Ainsi, nous avons mis en évidence que les thromboses veineuses mésentériques sont fréquentes chez les patients atteints de MICI, soit près de 30% chez les patients atteints de maladie de Crohn et 20% chez les patients atteints de RCUH. D'autre part, dans le groupe de patients atteints de maladie de Crohn, nous avons trouvé une association entre la survenue de thrombose veineuse mésentérique et une évolution de la maladie de Crohn plus sévère (plus de signes d'activité radiologique) et plus compliquée (plus de sténose et de nécessité de recours à la chirurgie). Ces deux articles ont été publiés dans l'American Journal of Roentgenology au mois de juillet 2014 dans la rubrique Gastrointestinal imaging.

Health care supply, payment system and medical practice : evidence from obstetric practice

ABSTRACTA significant share of deliveries are performed by Cesarian section (C-section) in Europe and in many developed and developing countries. The aims of this thesis are to highlight the non medical, especially economic and financial, incentives that explain the use of C-section, as well as the medical consequences of C-section on women's health, in regard with other factors of ob¬stetrical care quality such as hospital concentration. Those diagnoses enable us to exhibit ways of improvement of obstetrical care quality in France. Our analysis focus on two countries, France and Switzerland. In the first part of the thesis, we show the influence of two non medical factors on the C-section use, namely the hospital payment system on the one hand and the obstetricians behaviour, especially their demand for leisure, on the other hand. With French data on the year 2003, we show firstly that the fee-for-service payment system of private for profit hospitals induces a higher probability of using C-section. Obstetricians play also a preeminent role in the decision to use a C-section, as the probability of a C-section rises with the number of obstetricians. We then focus on a French reform introduced in 2004, to investigate the impact of Prospective Payment System on obstetric practise. We show that the rise of C-section rate between 2003 and 2006 is mainly caused by changes in hospitals and patients features. Obstetricians practises do not vary a lot for patients with the same risk code. In the mean time however, the number of women coded with a high risk rises. This can be caused by improvements in the quality of coding, obstetricians chosing codes that match better the real health state of their patients. Yet, it can also show that obstetricians change their coding practises to justify the use of certain practises, such as C-section, with no regard to the health state of patients. Financial factors are not the only non medical fac¬tors that can influence the resort to C-section. Using Shelton Brown ΠΙ identification strategy, we focus on the potential impact of obstetricians leisure preference on the use of C-section. We use the distributions of days and hours of delivering and the types of C-section - planned or emergency C-sections - to show that the obstetricians demand for leisure has a significant impact on the resort to C-section, but only in emergency situations. The second part of the thesis deals with some ways to improve obstetric care quality. We use on the one hand swiss and french data to study the impact of C-section on the patients' probability of having an obstetric complication and on the other hand the influence of hospital concentration on the quality of obstetric care. We find the same results as former medical studies about the risks entailed by C-section on obstetric complications.These results prove women ought to be better informed of the medical consequences of C-section and that the slowing of C-section use should be a priority of public health policy. We finally focus on another way to improve obstetric care quality, that is hospital lmarket concentration. We investigate the impact of hospital concentration by integrating the Herfindahl-Hirschman index in our model, on health care quality, measured by the HCUP indicator. We find that hospital concentration has a negative impact on obstetric care quality, which undermines today's policy of hospital closings in France.JEL classification: 112; 118Keywords: Hospital; C-section; Payment System; Counterfactual Estimation; Quality of Care.RÉSUMÉUne part importante des accouchements sont réalisés par césarienne en Europe et dans de nom¬breux pays développés ou en développement. Les objectifs de cette thèse sont de mettre en évidence les déterminants non médicaux, notamment économiques et financiers, expliquant le développe¬ment de cette pratique, ainsi que ses conséquences sur la santé des femmes après Γ accouchement, en lien avec d'autres facteurs comme la concentration locale des structures hospitalières. Les résul¬tats exposés dans cette thèse éclairent les perspectives et voies d'amélioration de la qualité des soins en obstétriques.Notre analyse se concentre sur deux pays : la France et la Suisse. Dans la première partie de la thèse, nous mettons en évidence l'influence de deux déterminants non médicaux sur l'emploi de la césarienne : le système de paiement des hôpitaux d'une part, et le comportement des médecins obstétriciens d'autre part. En étudiant des données françaises de 2003, nous montrons d'abord que le financement à l'acte des établissements privés engendre une hausse de la proba¬bilité de pratiquer une césarienne. Le rôle de l'obstrétricien paraît également déterminant dans la décision d'opérer une césarienne, la probabilité d'employer cette technique augmentant avec le nombre d'obstétriciens. Nous nous intéressons ensuite à l'impact de la mise en place en 2004 du système de paiement prospectif sur l'évolution des pratiques obstétricales entre 2003 et 2006 en France. La hausse du taux de recours à la césarienne entre 2004 et 2006 peut ainsi être principa¬lement imputée aux évolutions des caractéristiques des hôpitaux et des patients, les pratiques des obstétriciens, pour un même codage de la situation du patient, variant peu. Dans le même temps cependant, les pratiques de codage des patients parles obstétriciens évoluent fortement, les femmes étant de plus en plus nombreuses à porter des codes correspondant à des situations à risques. Cette évolution peut indiquer que la qualité du codage en 2006 s'est améliorée par rapport à 2004, le codage correspondant de plus en plus à la situation réelle des patientes. H peut aussi indiquer que les pratiques de codage évoluent pour justifier un recours accru à la césarienne, sans lien avec l'état réel des patientes. Les facteurs financiers ne sont pas les seuls facteurs non médicaux à pouvoir expliquer le recours à la césarienne : nous nous intéressons, en suivant la stratégie d'identifica¬tion de Shelton Brown m, à l'impact potentiel de la demande de loisir des médecins obstétriciens sur la pratique de la césarienne. En utilisant la distribution des jours et heures d'accouchement, et en distinguant les césariennes planifiées de celles effectuées en urgence, nous constatons que la demande de loisir des obstétriciens influence significativement le recours à la césarienne, mais uni¬quement pour les interventions d'urgence. La deuxième partie de la thèse est consacrée à l'étude de la qualité des soins en obstétriques. Nous utilisons des données suisses et françaises pour analyser d'une part l'impact de la césarienne sur la survenue de complications obstétricales et d'autre part l'impact de la concentration des soins sur la qualité des soins en obstétrique. Nons confirmons les résultats antérieurs de la littérature médicale sur la dangerosité de la césarienne comme facteur de complications obstétricales. Ces conclusions montrent que les femmes ont besoin d'être informées des conséquences de la césarienne sur leur santé et que le ralentissement de l'augmentation de la pratique de la césarienne devrait être un objectif de la politique publique de santé. Nous nous in¬téressons à un autre facteur d'amélioration des soins en obstrétique, l'organisation des hôpitaux et particulièrement leur concentration. Nous estimons ainsi l'effet de la concentration sur la qualité des soins obstétriques en intégrant l'indice de Herfindahl-Hirschman dans notre modèle, la qualité des soins étant mesurée à l'aide de l'indicateur HCUP. Nous constatons que la concentration des naissances a un impact négatif sur la qualité des soins en obstétrique, résultat qui va dans le sens contraire des politiques de fermeture d'hôpitaux menées actuellement en France. JEL classification : 112 ; 118Mots-clés : Hôpital ; Césarienne ; Système de paiement ; Contrefactuels ; Qualité des soins, sur la qualité des soins en obstétrique.

Sex, politics and social change in the eighteenth and the nineteenth centuries: Evidence from the Swiss Alps

The 18th century "sexual revolution" can not simply be explained as a consequence of economic or institutional factors - industrialization, agricultural revolution, secularization or legal hindrances to marriages: the example of western Valais (Switzerland) shows that we have to deal with a complex configuration of factors The micro-historical approach reveals that in the 18th and 19th century sexuality - and above all illicit sexuality - was a highly subversive force which was considerably linked to political innovation and probably more generally to historical change. Non-marital sexuality was clearly tied to political dissent ant to innovative ways of behaviour, both among the social elites and the common people. This behaviour patterns influenced crucial evolutions in the social, cultural and economic history of the region.

Immunoelectron microscopical identification of the uncoupling protein in brown adipose tissue mitochondria.

The distribution of the uncoupling protein (UCP) in brown adipocyte mitochondria of the hibernant Muscardinus avellanarius was obtained by ultrastructural immunocytochemistry. In both cryosections and sections of Lowicryl-embedded material UCP was localized in the mitochondrial cristae of brown adipocytes, but not in liver mitochondria. It should now be possible to easily identify the morphology of cells committed to BAT differentiation in the tissue as well as in cell culture.

Prevalence, awareness, treatment and control of hypertension in a Swiss general population: the CoLaus Study

Objective: To assess the prevalence levels of awareness, treatment and control of hypertension and associated factors in Switzerland. Methods: Population-based cross-sectional study of 6,182 subjects (52.5% women) aged 35-75 years living in Lausanne, Switzerland. Hypertension was defined as blood pressure ≥140/90 mm Hg or current antihypertensive medication. Results: The overall prevalence of hypertension was 36% (95% CI: 35-38%). Among hypertensive participants, 63% were aware of having hypertension. Among aware hypertensives, 78% were treated, and among treated hypertensives 48% were controlled (BP <140/90 mmHg). In multivariate analysis, prevalence of hypertension was associated with older age, male gender, low educational level, high alcohol intake, awareness of diabetes, awareness of dyslipidaemia, obesity and parental history of myocardial infarction (MI). Awareness of hypertension was associated with older age, female gender, awareness of diabetes, awareness of dyslipidaemia, obesity and parental history of MI. Control was associated with younger age, higher educational level and no alcohol intake. Alone or in combination, sartans were the most often prescribed antihypertensive medication category (41%), followed by diuretics, beta-blockers, ACE inhibitors and calcium channel blockers. Only 31% of treated hypertensives were taking ≥2 antihypertensive medications. Conclusion: Although more than half of the participants with hypertension were aware of being hypertensive and more than three quarters of them received a pharmacological treatment, less than half of those treated were adequately controlled. Treated hypertensive subjects should be followed up more closely.

Cultural competency of health-care providers in a Swiss University Hospital: self-assessed cross-cultural skillfulness in a cross-sectional study.

BACKGROUND: As the diversity of the European population evolves, measuring providers' skillfulness in cross-cultural care and understanding what contextual factors may influence this is increasingly necessary. Given limited information about differences in cultural competency by provider role, we compared cross-cultural skillfulness between physicians and nurses working at a Swiss university hospital. METHODS: A survey on cross-cultural care was mailed in November 2010 to front-line providers in Lausanne, Switzerland. This questionnaire included some questions from the previously validated Cross-Cultural Care Survey. We compared physicians' and nurses' mean composite scores and proportion of "3-good/4-very good" responses, for nine perceived skillfulness items (4-point Likert-scale) using the validated tool. We used linear regression to examine how provider role (physician vs. nurse) was associated with composite skillfulness scores, adjusting for demographics (gender, non-French dominant language), workplace (time at institution, work-unit "sensitized" to cultural-care), reported cultural-competence training, and cross-cultural care problem-awareness. RESULTS: Of 885 questionnaires, 368 (41.2%) returned the survey: 124 (33.6%) physicians and 244 (66.4%) nurses, reflecting institutional distribution of providers. Physicians had better mean composite scores for perceived skillfulness than nurses (2.7 vs. 2.5, p < 0.005), and significantly higher proportion of "good/very good" responses for 4/9 items. After adjusting for explanatory variables, physicians remained more likely to have higher skillfulness (β = 0.13, p = 0.05). Among all, higher skillfulness was associated with perception/awareness of problems in the following areas: inadequate cross-cultural training (β = 0.14, p = 0.01) and lack of practical experience caring for diverse populations (β = 0.11, p = 0.04). In stratified analyses among physicians alone, having French as a dominant language (β = -0.34, p < 0.005) was negatively correlated with skillfulness. CONCLUSIONS: Overall, there is much room for cultural competency improvement among providers. These results support the need for cross-cultural skills training with an inter-professional focus on nurses, education that attunes provider awareness to the local issues in cross-cultural care, and increased diversity efforts in the work force, particularly among physicians.

Rockfall hazard and risk assessments along roads at a regional scale: Example in Swiss Alps

Unlike fragmental rockfall runout assessments, there are only few robust methods to quantify rock-mass-failure susceptibilities at regional scale. A detailed slope angle analysis of recent Digital Elevation Models (DEM) can be used to detect potential rockfall source areas, thanks to the Slope Angle Distribution procedure. However, this method does not provide any information on block-release frequencies inside identified areas. The present paper adds to the Slope Angle Distribution of cliffs unit its normalized cumulative distribution function. This improvement is assimilated to a quantitative weighting of slope angles, introducing rock-mass-failure susceptibilities inside rockfall source areas previously detected. Then rockfall runout assessment is performed using the GIS- and process-based software Flow-R, providing relative frequencies for runout. Thus, taking into consideration both susceptibility results, this approach can be used to establish, after calibration, hazard and risk maps at regional scale. As an example, a risk analysis of vehicle traffic exposed to rockfalls is performed along the main roads of the Swiss alpine valley of Bagnes.

MMP-9 as predictive factor for response and progression free survival in breast cancer patients treated with bevacizumab and pegylated liposomal doxorubicin. A multicenter, single-arm phase II trial (SAKK24/06). On behalf of the Swiss Group for Clinical Cancer Research (SAKK).

The benefit of bevacizumab (Bv) has been shown in different tumors including colorectal cancer, renal cancer, pulmonary non-small cell cancer and also breast cancer. However to date, there is no established test evaluating the angiogenic status of a patient and monitoring the effects of anti-angiogenic treatments. Tumor angiogenesis is the result of a balance between multiple pro- and anti¬angiogenic molecules. There is very little published clinical data exploring the impact of the anti-angiogenic therapy on the different angiogenesis-related molecules and the potential role of these molecules as prognostic or predictive factors.

Prevalence of and associated factors for adult attention deficit hyperactivity disorder in young Swiss men.

OBJECTIVE: The present study aimed to measure the prevalence of adult attention deficit hyperactivity disorder (ADHD) in a large, representative sample of young Swiss men and to assess factors associated with this disorder. METHODS: Our sample consisted of 5656 Swiss men (mean age 20 years) who participated in the Cohort Study on Substance Use Risk Factors (C-SURF). ADHD was assessed with the World Health Organization (WHO) adult ADHD Self Report Screener (ASRS). Logistic regression analyses were conducted to assess the association between ADHD and several socio-demographic, clinical and familial factors. RESULTS: The prevalence of ADHD was 4.0%, being higher in older and French-speaking conscripts. A higher prevalence also was identified among men whose mothers had completed primary or high school/university and those with a family history of alcohol or psychiatric problems. Additionally, adults with ADHD demonstrated impairment in their professional life, as well as considerable mental health impairment. CONCLUSION: Our results demonstrate that ADHD is common among young Swiss men. The impairments in function and mental health we observed highlight the need for further support and interventions to reduce burden in affected individuals. Interventions that incorporate the whole family also seem crucial.