Suicide by jumping and accessibility of bridges: results from a national survey in Switzerland

Rates of suicide by jumping show large regional differences. Barriers on bridges may prevent suicides but also may lead to a substitution of jumping site or method. The aim of our study was to compare suicide data from regions with and without suicide bridges and to estimate the effects on method and site substitution if bridges were to be secured. In a national survey, suicide data for the years 1990 to 2003 were collected. Regions with high rates of bridge suicides were identified and compared with regions with low rates, and the analysis revealed that only about one third of the individuals would be expected to jump from buildings or other structures if no bridge was available. The results suggest no method substitution for women. For men, a trend of a substituting jumping by overdosing in regions without suicide bridges was found. We conclude that restricted access to suicide bridges will not automatically lead suicidal individuals to choose another jumping site or suicide method. The results support the notion that securing bridges may save lives.

Impact of unlinked deaths and coding changes on mortality trends in the Swiss National Cohort

BACKGROUND Results of epidemiological studies linking census with mortality records may be affected by unlinked deaths and changes in cause of death classification. We examined these issues in the Swiss National Cohort (SNC). METHODS The SNC is a longitudinal study of the entire Swiss population, based on the 1990 (6.8 million persons) and 2000 (7.3 million persons) censuses. Among 1,053,393 deaths recorded 1991-2007 5.4% could not be linked using stringent probabilistic linkage. We included the unlinked deaths using pragmatic linkages and compared mortality rates for selected causes with official mortality rates. We also examined the impact of the 1995 change in cause of death coding from version 8 (with some additional rules) to version 10 of the International Classification of Diseases (ICD), using Poisson regression models with restricted cubic splines. Finally, we compared results from Cox models including and excluding unlinked deaths of the association of education, marital status, and nationality with selected causes of death. RESULTS SNC mortality rates underestimated all cause mortality by 9.6% (range 2.4%-17.9%) in the 85+ population. Underestimation was less pronounced in years nearer the censuses and in the 75-84 age group. After including 99.7% of unlinked deaths, annual all cause SNC mortality rates were reflecting official rates (relative difference between -1.4% and +1.8%). In the 85+ population the rates for prostate and breast cancer dropped, by 16% and 21% respectively, between 1994 and 1995 coincident with the change in cause of death coding policy. For suicide in males almost no change was observed. Hazard ratios were only negligibly affected by including the unlinked deaths. A sudden decrease in breast (21% less, 95% confidence interval: 12%-28%) and prostate (16% less, 95% confidence interval: 7%-23%) cancer mortality rates in the 85+ population coincided with the 1995 change in cause of death coding policy. CONCLUSIONS Unlinked deaths bias analyses of absolute mortality rates downwards but have little effect on relative mortality. To describe time trends of cause-specific mortality in the SNC, accounting for the unlinked deaths and for the possible effect of change in death certificate coding was necessary.

Occupational exposure to magnetic fields and electric shocks and risk of ALS: The Swiss National Cohort

Amyotrophic lateral sclerosis (ALS) has been associated with exposures in so-called 'electrical occupations'. It is unclear if this possible link may be explained by exposure to extremely low-frequency magnetic fields (ELF-MF) or by electrical shocks. We evaluated ALS mortality in 2000-2008 and exposure to ELF-MF and electrical shocks in the Swiss National Cohort, using job exposure matrices for occupations at censuses 1990 and 2000. We compared 2.2 million workers with high or medium vs. low exposure to ELF-MF and electrical shocks using Cox proportional hazard models. Results showed that mortality from ALS was higher in people who had medium or high ELF-MF exposure in both censuses (HR 1.55 (95% CI 1.11-2.15)), but closer to unity for electrical shocks (HR 1.17 (95% CI 0.83-1.65)). When both exposures were included in the same model, the HR for ELF-MF changed little (HR 1.56), but the HR for electric shocks was attenuated to 0.97. In conclusion, there was an association between exposure to ELF-MF and mortality from ALS among workers with a higher likelihood of long-term exposure.

Avian area vasculosa and CAM as rapid in vivo pro-angiogenic and antiangiogenic models.

Angiogenesis, the development of new blood vessels from preexisting ones, is driven by coordinated signaling pathways governed by specific molecules, hemodynamic forces, and endothelial and periendothelial cells. The processes involve adhesion, migration, and survival machinery within the target endothelial and periendothelial cells. Factors that interfere with any of these processes may therefore influence angiogenesis either positively (pro-angiogenesis) or negatively (antiangiogenesis). The avian area vasculosa (AV) and the avian chorioallantoic membrane (CAM) are two useful tools for studying both angiogenesis and antiangiogenesis since they are amenable to both intravascular and topical administration of target, agents, are relatively rapid assays, and can be adapted very easily to study angiogenesis-dependent processes, such as tumor growth. Both models provide a physiological setting that permits investigation of pro-angiogenic and antiangiogenic agent interactions in vivo.

Rhyming the National Spirit: Taras Shevchenko and Ilia Chavchavadze

The paper is a comparative inquiry into the roles of Ilia Chavchavadze (1837-1907) and Taras Shevchenko (1818-1861) as national poets and anti-colonial (anti-Tsarist) intellectuals within the context of their respective national traditions (Georgia and Ukraine). During the period of their activity (19th and the beginning of 20th century) both Ukraine and Georgia were under Tsarist imperial rule, albeit the two poets lived in different periods of Russian empire history. Through their major works, each called on their communities to ‘awaken’ and ‘revolt’ against oppression, rejected social apathy caused by Tsarist subjugation and raised awareness about the historical past of their nations. The non-acceptance of present and belief in an independent future was one of the dominant themes in the poetry and prose of both. Their contemporary importance is illustrated in political discourse both after Orange Revolution in Ukraine (2004), and Rose Revolution in Georgia (2003) where both poets are referred “as founding fathers of national ideology”, the history textbooks alluding to them as “symbols of anti-colonial resistance”. To this day, however, there has been surprisingly little academic writing in the West endeavoring to compare the works and activities of the two poets and their impact on national mobilization in Tsarist Ukraine and Georgia, even though their countries are often mentioned in a same breath by commentators on contemporary culture and politics. The paper attempts to fill this gap and tries to understand the relationship between literature and social mobilization in 19th century Russian Empire. By reflecting on Taras Shevchenko’s and Ilia Chavchavadze’s poetry, prose and social activism, I will try to explain how in different periods of Russian imperial history, the two poets helped to develop a modern form of political belonging among their compatriots and stimulated an anti-colonial mobilization with different political outcomes. To theorize on the role of poets and novelists in anti-colonial national movement, I will reflect on the writings of Benedict Anderson (1991), John Hutchinson (1994; 1999), Rory Finnin (2005; 2011) and problematize Miroslav Hroch’s (1996) three phase model of the development of national movements. Overall, the paper would aim to show the importance of, what John Hutchinson called, ‘cultural nationalists’ in understanding contemporary nationalist discourse in Georgian and Ukrainian societies.

The new final Clinical Skills examination in human medicine in Switzerland: Essential steps of exam development, implementation and evaluation, and central insights from the perspective of the national Working Group

Objective: Since 2011, the new national final examination in human medicine has been implemented in Switzerland, with a structured clinical-practical part in the OSCE format. From the perspective of the national Working Group, the current article describes the essential steps in the development, implementation and evaluation of the Federal Licensing Examination Clinical Skills (FLE CS) as well as the applied quality assurance measures. Finally, central insights gained from the last years are presented. Methods: Based on the principles of action research, the FLE CS is in a constant state of further development. On the foundation of systematically documented experiences from previous years, in the Working Group, unresolved questions are discussed and resulting solution approaches are substantiated (planning), implemented in the examination (implementation) and subsequently evaluated (reflection). The presented results are the product of this iterative procedure. Results: The FLE CS is created by experts from all faculties and subject areas in a multistage process. The examination is administered in German and French on a decentralised basis and consists of twelve interdisciplinary stations per candidate. As important quality assurance measures, the national Review Board (content validation) and the meetings of the standardised patient trainers (standardisation) have proven worthwhile. The statistical analyses show good measurement reliability and support the construct validity of the examination. Among the central insights of the past years, it has been established that the consistent implementation of the principles of action research contributes to the successful further development of the examination. Conclusion: The centrally coordinated, collaborative-iterative process, incorporating experts from all faculties, makes a fundamental contribution to the quality of the FLE CS. The processes and insights presented here can be useful for others planning a similar undertaking. Keywords: national final examination, licensing examination, summative assessment, OSCE, action research

Parks of the future: Protected areas in Europe challenging regional and global change

Climate change, declines in biodiversity, increasing consumption of resources, urbanisation, urban sprawl and demographic change continue to challenge theregions of Europe. In response to these processes of regional and global change, there has been an unmistakeable boom in parks in Europe since the 1990s. Morethan a fifth of the continent is now protected using designations such as regionalnature parks, national parks, UNESCO Biosphere Reserves and World Heritagesites. The responsibilities of these areas are usually diverse and, in addition tonature protection and the conservation of cultural landscapes, increasingly involvethe promotion of sustainable development. In the 22 chapters of this volume, 28 authors from all over Europe analyse and comment on experiences of tackling the challenges of regional and global changein parks. They illustrate discussions with selected case studies and deal with keyissues of current protected area policy: How do parks address the pending challengesand what successes have they had thus far? What pioneering approaches are there in spatial planning and regional development? Which forms of park managementand governance are most promising? This informative and well-illustratedbook also considers which tasks will be assumed by parks in the future and whatroles parks may play in the debate concerning transformations required to promotesustainability in Europe.

National competence center for wildlife diseases in Switzerland: Mandate, development and current strategies.

The need for wildlife health surveillance has become increasingly recognized. However, comprehensive programs which cover a wide spectrum of species, pathogens and geographic areas are still lacking in most European countries and practical examples of systems in place remain scarce. This article provides an overview of the organization of wildlife health surveillance in Switzerland, with a focus on the development, current strategies and the activities of the national program carried out by the Centre for Fish and Wildlife Health (FIWI), University of Bern. This documentation may stimulate on-going discussions on the design and development of national wildlife health surveillance programs in other countries. Investigations into wildlife health in Switzerland date back to the 1950s. The FIWI acts as a national competence center for wildlife diseases on mandate of the Swiss federal authorities. The mandate includes four main activities: disease diagnostics, research, consulting and teaching. In line with this, the FIWI has made continuous efforts to strengthen a national network of field partners and implemented strategies to facilitate long-term and metastudies.

Report from the National Institute of Allergy and Infectious Diseases workshop on drug allergy

Allergic reactions to drugs are a serious public health concern. In 2013, the Division of Allergy, Immunology, and Transplantation of the National Institute of Allergy and Infectious Diseases sponsored a workshop on drug allergy. International experts in the field of drug allergy with backgrounds in allergy, immunology, infectious diseases, dermatology, clinical pharmacology, and pharmacogenomics discussed the current state of drug allergy research. These experts were joined by representatives from several National Institutes of Health institutes and the US Food and Drug Administration. The participants identified important advances that make new research directions feasible and made suggestions for research priorities and for development of infrastructure to advance our knowledge of the mechanisms, diagnosis, management, and prevention of drug allergy. The workshop summary and recommendations are presented herein.