Alcohol-selling outlets and mortality in Switzerland--the Swiss National Cohort

AIM To examine the association of alcohol-related mortality and other causes of death with neighbourhood density of alcohol-selling outlets for on-site consumption. DESIGN, SETTING AND PARTICIPANTS Longitudinal study of the adult Swiss population (n = 4 376 873) based on census records linked to mortality data from 2001 to 2008. MEASUREMENTS Sex-specific hazard ratios (HR) for death and 95% confidence intervals (95%CI) were calculated using Cox models adjusting for age, educational level, occupational attainment, marital status and other potential confounders. The density of alcohol-selling outlets within 1000 m of the residence was calculated using geocodes of outlets and residences. FINDINGS Compared with >17 outlets within 1000 m the HR for alcohol-related mortality in men was 0.95 (95%CI: 0.89-1.02) for 8-17 outlets, 0.84 (95%CI: 0.77-0.90) for 3-7 outlets, 0.76 (95%CI: 0.68-0.83) for 1-2 outlets and 0.60 (95%CI: 0.51-0.72) for 0 outlets. The gradient in women was somewhat steeper, with a HR comparing 0 with >17 outlets of 0.39 (95%CI: 0.26-0.60). Mortality from mental and behavioural causes and lung cancer were also associated with density of alcohol-selling outlets: HRs comparing 0 outlets with >17 outlets were 0.64 (95%CI: 0.52-0.79) and 0.79 (95%CI: 0.72-0.88), respectively, in men and 0.46 (95%CI: 0.27-0.78) and 0.63 (95%CI: 0.52-0.77), respectively, in women. There were weak associations in the same direction with all-cause mortality in men but not in women. CONCLUSIONS In Switzerland, alcohol-related mortality is associated with the density of outlets around the place of residence. Community-level interventions to reduce alcohol outlet density may usefully complement existing interventions.

Avoidable hospitalizations in Switzerland: a small area analysis on regional variation, density of physicians, hospital supply and rurality.

BACKGROUND Avoidable hospitalizations (AH) are hospital admissions for diseases and conditions that could have been prevented by appropriate ambulatory care. We examine regional variation of AH in Switzerland and the factors that determine AH. METHODS We used hospital service areas, and data from 2008-2010 hospital discharges in Switzerland to examine regional variation in AH. Age and sex standardized AH were the outcome variable, and year of admission, primary care physician density, medical specialist density, rurality, hospital bed density and type of hospital reimbursement system were explanatory variables in our multilevel poisson regression. RESULTS Regional differences in AH were as high as 12-fold. Poisson regression showed significant increase of all AH over time. There was a significantly lower rate of all AH in areas with more primary care physicians. Rates increased in areas with more specialists. Rates of all AH also increased where the proportion of residences in rural communities increased. Regional hospital capacity and type of hospital reimbursement did not have significant associations. Inconsistent patterns of significant determinants were found for disease specific analyses. CONCLUSION The identification of regions with high and low AH rates is a starting point for future studies on unwarranted medical procedures, and may help to reduce their incidence. AH have complex multifactorial origins and this study demonstrates that rurality and physician density are relevant determinants. The results are helpful to improve the performance of the outpatient sector with emphasis on local context. Rural and urban differences in health care delivery remain a cause of concern in Switzerland.

Constructing, Creating and Contesting Cityscapes. A Socio-Anthropological Approach to Urban Transformation in Southern Xinjiang, People’s Republic of China

This manuscript is based on a PhD thesis submitted at the Institute of Social Anthropology at the University of Bern in 2014. The dissertation was part of the research project „Xinjiang Uyghur Autonomous Region and Chinese Territoriality. The Development of Infrastructure and Han Migration into the Region“ under the supervision of Prof. Dr. Heinzpeter Znoj and financed by the Swiss National Science Foundation SNSF. Madlen Kobi analyzes the architectural and socio-political transformation of public places and spaces in rapidly urbanizing southern Xinjiang, P.R. China, and in doing so pays particular attention to the cities of Aksu and Kaxgar. As the Xinjiang Uyghur Autonomous Region lies in between China and Central Asia, it is especially characterized by differing political, cultural, and religious influences, and, furthermore, due to its being a multiethnic region, by multiple identities. One might expect cultural and social identities in this area to be negotiated by referring to history, religion, or food. However, they also become visible by the construction and reconstruction, if not demolition, of public places, architectural landmarks, and private residences. Based on ethnographic fieldwork performed in 2011 and 2012, the study explores everyday life in a continuously transforming urban environment shaped by the interaction of the interests of government institutions, investment companies, the middle class, and migrant workers, among many other actors. Here, urban planning, modernization, and renewal form a highly sensitive lens through which the author inspects the tense dynamics of ethnic, religious, and class-based affiliations. She respects varieties and complexities while thoroughly grounding unfolding transformation processes in everyday lived experiences. The study provides vivid insights into how urban places and spaces in this western border region of China are constructed, created, and eventually contested.