Is breast cancer risk the same for all progestogens?

The population-based case–control study CECILE investigated the impact of various menopausal hormone therapy (MHT) products on breast cancer (BC) risk in 1,555 postmenopausal women [1]. The case group (n = 739) included incident cases of in situ (!) or invasive BC in postmenopausal women. The control group (n = 816) included women from the general population within predefined quotas by age and socio-economic status (SES). While quotas by age were applied to obtain similar distributions by age among controls and among cases, quotas by SES in control women were applied to reflect the distribution by SES of women in the general population in the study area. Data of participants were obtained by a structured questionnaire during in-person interviews, and from pathology reports if applicable, respectively. Women were divided into current and past MHT user. MHTs were classified in estrogen-only therapy (ET), estrogen combined with progestin therapy (EPT) and tibolone. EPT was subdivided in three subtypes according to the progestogen constituent: natural micronized progesterone, progesterone derivatives, and testosterone derivatives. In comparison to never MHT users, any current or past MHT use (ET, EPT, tibolone) was not associated with an increased BC risk. However, in subanalysis BC risk was significantly increased for current use of EPT for 4 or more years (n = 73 cases and n = 56 controls, adjusted OR 1.55; 95 % CI 1.02–2.36). Within the group of current EPT users for 4 or more years, 14 cases had used estrogens combined with micronized progesterone (n = 17 controls), and 55 a combination with a synthetic progestogen (n = 34 controls), respectively. Compared to never MHT use, current use of EPT containing a synthetic progestogen for 4 or more years was associated with a significantly increased BC risk (adjusted OR 2.07; 95 % CI 1.26–3.39), but EPT containing micronized progesterone was not (adjusted OR 0.79; 95 % CI 0.37–1.71). 73 % of current MHT users started treatment within the first year of onset of menopause. Early EPT (n = 52 cases and n = 38 controls, adjusted OR 1.65; 95 % CI 1.02–2.69), but not early ET, starters had a significantly higher BC risk compared to never MHT users. In contrast, MHT initiation beyond 1 year after menopause was not associated with an increased BC risk. The authors concluded that: (1) ET and EPT containing natural progesterone did not increase BC risk whereas, (2) BC risk was increased in users of tibolone or EPT containing a synthetic progestogen, respectively, and that (3) MHT use early after onset of menopause was associated with an increased BC risk as compared to women who delay MHT beyond 1 or more years.

Gender-fair language use in online job advertisements - relations to job status and gender equality

Purpose Gender fair language use in job advertisements has been shown to impact the outcome of personnel selections. It is thus important to assess, to what extent gender fair language is used in job advertisements and with which factors it is associated, e.g., language, culture, status, and gender typicality of profession. Design/Methodology In the present research we investigated gender fair language use in job advertisements published online in four European countries with different socio-economic rankings of gender equality (World Economic Forum, 2011), namely Austria (rank 34), Czech Republic (75), Poland (42), and Switzerland (10). From four lines of business with different percentages of female employees – steels/metals, science, restaurants/food services, and health care –we randomly selected 100 job advertisements, summing up to 1600 job advertisements in total. Results A first analysis of the Swiss data indicates that the phrasing of job advertisements is closely related to a profession’s gender typicality (e.g., merely masculine forms are used in steels and metals, gender-fair forms in healthcare). Feminine forms however are almost never used. Cross-cultural comparisons will be presented. Limitations We analyzed job advertisements of four specific lines of business in four European countries. To what extend results can be generalized remains an open question. Research/Practical Implications The present data provide a sound basis for future studies on gender fair language use in job advertisements. Furthermore it sheds a light on how companies comply with national guidelines of gender equality. Originality/Value This is the first time that gender fair language use in job advertisements is investigated (a) across different countries and languages and (b) considering status and gender typicality of professions.

Reducing vulnerability to climate change in the Swiss Alps: a study of adaptive planning

The Swiss Alps will experience pronounced effects of climate change due to the combination of their latitudinal positioning, altitude and unique ecosystems, placing socio-economic stresses on alpine communities, many of which rely on seasonal tourism. Studies into tourism adaptation within the Swiss Alps have so far focused on the technical adaptation options of alpine stakeholders, rather than perceptions of adaptation to climate change at the operational and community level. This article investigates attitudes to adaptation in two alpine regions within Switzerland's well-established decentralized political framework, through semi-structured qualitative interviews. Stakeholders focused almost entirely on maintaining the status quo of winter tourism, through technical or marketing measures, with mixed attitudes towards climatic impacts. A matrix based on the relative internal strengths and weaknesses, external opportunities and threats of adaptation measures (a SWOT framework) was used to assess the measures and suggest how stakeholders could capitalize on the new opportunities thrown up by climate change to create a competitive advantage. A comprehensive and collaborative planning approach is vital to enable policy makers and stakeholders to maximize opportunities, minimize the adverse effects of climate change on the local economy, and develop inclusive adaptation measures that benefit the entire region in order to create more sustainable social, economic and environmental structures.

High life in the sky? Mortality by floor of residence in Switzerland

Living in high-rise buildings could influence the health of residents. Previous studies focused on structural features of high-rise buildings or characteristics of their neighbourhoods, ignoring differences within buildings in socio-economic position or health outcomes. We examined mortality by floor of residence in the Swiss National Cohort, a longitudinal study based on the linkage of December 2000 census with mortality and emigration records 2001-2008. Analyses were based on 1.5 million people living in buildings with four or more floors and 142,390 deaths recorded during 11.4 million person-years of follow-up. Cox models were adjusted for age, sex, civil status, nationality, language, religion, education, professional status, type of household and crowding. The rent per m² increased with higher floors and the number of persons per room decreased. Mortality rates decreased with increasing floors: hazard ratios comparing the ground floor with the eighth floor and above were 1.22 [95% confidence interval (CI) 1.15-1.28] for all causes, 1.40 (95% CI 1.11-1.77) for respiratory diseases, 1.35 (95% CI 1.22-1.49) for cardiovascular diseases and 1.22 (95% CI 0.99-1.50) for lung cancer, but 0.41 (95% CI 0.17-0.98) for suicide by jumping from a high place. There was no association with suicide by any means (hazard ratio 0.81; 95% CI 0.57-1.15). We conclude that in Switzerland all-cause and cause-specific mortality varies across floors of residence among people living in high-rise buildings. Gradients in mortality suggest that floor of residence captures residual socioeconomic stratification and is likely to be mediated by behavioural (e.g. physical activity), and environmental exposures, and access to a method of suicide.

Suicide assisted by right-to-die associations: a population based cohort study

Background: In Switzerland, assisted suicide is legal but there is concern that vulnerable or disadvantaged groups are more likely to die in this way than other people. We examined socio-economic factors associated with assisted suicide. Methods: We linked the suicides assisted by right-to-die associations during 2003–08 to a census-based longitudinal study of the Swiss population. We used Cox and logistic regression models to examine associations with gender, age, marital status, education, religion, type of household, urbanization, neighbourhood socio-economic position and other variables. Separate analyses were done for younger (25 to 64 years) and older (65 to 94 years) people. Results: Analyses were based on 5 004 403 Swiss residents and 1301 assisted suicides (439 in the younger and 862 in the older group). In 1093 (84.0%) assisted suicides, an underlying cause was recorded; cancer was the most common cause (508, 46.5%). In both age groups, assisted suicide was more likely in women than in men, those living alone compared with those living with others and in those with no religious affiliation compared with Protestants or Catholics. The rate was also higher in more educated people, in urban compared with rural areas and in neighbourhoods of higher socio-economic position. In older people, assisted suicide was more likely in the divorced compared with the married; in younger people, having children was associated with a lower rate. Conclusions: Assisted suicide in Switzerland was associated with female gender and situations that may indicate greater vulnerability such as living alone or being divorced, but also with higher education and higher socio-economic position.

Toxoplasma gondii Infection in Kyrgyzstan: Seroprevalence, Risk Factor Analysis, and Estimate of Congenital and AIDS-Related Toxoplasmosis

Background HIV-prevalence, as well as incidence of zoonotic parasitic diseases like cystic echinococcosis, has increased in the Kyrgyz Republic due to fundamental socio-economic changes after the breakdown of the Soviet Union. The possible impact on morbidity and mortality caused by Toxoplasma gondii infection in congenital toxoplasmosis or as an opportunistic infection in the emerging AIDS pandemic has not been reported from Kyrgyzstan. Methodology/Principal Findings We screened 1,061 rural and 899 urban people to determine the seroprevalence of T. gondii infection in 2 representative but epidemiologically distinct populations in Kyrgyzstan. The rural population was from a typical agricultural district where sheep husbandry is a major occupation. The urban population was selected in collaboration with several diagnostic laboratories in Bishkek, the largest city in Kyrgyzstan. We designed a questionnaire that was used on all rural subjects so a risk-factor analysis could be undertaken. The samples from the urban population were anonymous and only data with regard to age and gender was available. Estimates of putative cases of congenital and AIDS-related toxoplasmosis in the whole country were made from the results of the serology. Specific antibodies (IgG) against Triton X-100 extracted antigens of T. gondii tachyzoites from in vitro cultures were determined by ELISA. Overall seroprevalence of infection with T. gondii in people living in rural vs. urban areas was 6.2% (95%CI: 4.8–7.8) (adjusted seroprevalence based on census figures 5.1%, 95% CI 3.9–6.5), and 19.0% (95%CI: 16.5–21.7) (adjusted 16.4%, 95% CI 14.1–19.3), respectively, without significant gender-specific differences. The seroprevalence increased with age. Independently low social status increased the risk of Toxoplasma seropositivity while increasing numbers of sheep owned decreased the risk of seropositivity. Water supply, consumption of unpasteurized milk products or undercooked meat, as well as cat ownership, had no significant influence on the risk for seropositivity. Conclusions We present a first seroprevalence analysis for human T. gondii infection in the Kyrgyz Republic. Based on these data we estimate that 173 (95% CI 136–216) Kyrgyz children will be born annually to mothers who seroconverted to toxoplasmosis during pregnancy. In addition, between 350 and 1,000 HIV-infected persons are currently estimated to be seropositive for toxoplasmosis. Taken together, this suggests a substantial impact of congenital and AIDS-related symptomatic toxoplasmosis on morbidity and mortality in Kyrgyzstan.

Gender and language in online job advertisements - a cross-cultural study

The aim of this project is to investigate the use of gender-fair language from a cross-linguistic perspective. Specifically, we are interested in whether the use of gender-fair language correlates with socio-economic rankings of gender equality and with structural features of a language. We decided to analyze online job advertisements, as they reflect common language use and can easily be compared across languages. Moreover, formulations in job advertisements have been shown to impact personnel selection via the way target groups are addressed and referred to. In the present study we examined to what extent job advertisements are formulated in a gender-fair way and how this correlates with factors such as language, culture as well as status and gender-typicality of the job advertised. The data consisted of job advertisements published online in four European countries which occupy different positions in socio-economic rankings of gender equality (World Economic Forum, 2011): Switzerland (10), Austria (rank 34), Poland (42), and Czech Republic (75). We randomly selected 100 job advertisements from four lines of business characterized by different proportions of female employees – steels/metals, science, restaurants/food services, and health care. The advertisements were analyzed with regard to the linguistic form of the job title and the remaining text; we also noted indicators of job status, reference to gender-typical traits, pictures of women/men and other information which might be relevant to the use of gender-fair language (e.g., equal opportunity policies). A first analysis of the data indicates that the phrasing of job titles is closely related to the gender-typicality of a profession. While mainly gender-fair forms are used in healthcare, masculine forms are used more often in the domain of steels and metals. Feminine forms only, however, are almost never used. Cultural differences as well as correlations with associated variables will be discussed.

How the Euro divides the union: the effect of economic adjustment on support for democracy in Europe

As often pointed out in the literature on the European debt crisis, the policy programme of austerity and internal devaluation imposed on countries in the Eurozone's periphery exhibits a lack of democratic legitimacy. This article analyses the consequences these developments have for democratic support at both the European and national levels. We show that through the policies of economic adjustment, a majority of citizens in crisis countries has become ‘detached’ from their democratic political system. By cutting loose the Eurozone's periphery from the rest of Europe in terms of democratic legitimacy, the Euro has divided the union, instead of uniting it as foreseen by its architects. Our results are based on aggregated Eurobarometer surveys conducted in 28 European Union (EU) member states between 2002 and 2014. We employ quantitative time-series cross-sectional regression analyses. Moreover, we estimate the causal effect of economic adjustment in a comparative case study of four cases using the synthetic control method.