Risk factors for depressed mood amongst a community dwelling older age population in England: cross-sectional survey data from the PRO-AGE study.

BACKGROUND The Quality and Outcomes Framework in the United Kingdom (UK) National Health Service previously highlighted case finding of depression amongst patients with diabetes or coronary heart disease. However, depression in older people remains under-recognized. Comprehensive data for analyses of the association of depression in older age with other health and functional measures, and demographic factors from community populations within England, are lacking. METHODS Secondary analyses of cross-sectional baseline survey data from the England arm of a randomised controlled trial of health risk appraisal for older people in Europe; PRO-AGE study. Data from 1085 community-dwelling non-disabled people aged 65 years or more from three group practices in suburban London contributed to this study. Depressed mood was ascertained from the 5-item Mental Health Inventory Screening test. Exploratory multivariable logistic regression was used to identify the strongest associations of depressed mood with a previous diagnosis of a specified physical/mental health condition, health and functional measures, and demographic factors. RESULTS Depressed mood occurred in 14% (155/1085) of participants. A previous diagnoses of depression (OR 3.39; P < 0.001) and poor vision as determined from a Visual Function Questionnaire (OR 2.37; P = 0.001) were amongst the strongest factors associated with depressed mood that were independent of functional impairment, other co-morbidities, and demographic factors. A subgroup analyses on those without a previous diagnosis of depression also indicated that within this group, poor vision (OR 2.51; P = 0.002) was amongst the strongest independent factors associated with depressed mood. CONCLUSIONS Previous case-finding strategies in primary care focussed on heart disease and diabetes but health-related conditions other than coronary heart disease and diabetes are also associated with an increased risk for depression. Complex issues of multi-morbidity occur within aging populations. 'Risk' factors that appeared stronger than those, such as, diabetes and coronary heart disease that until recently prompted for screening in the UK due to the QOF, were identified, and independent of other morbidities associated with depressed mood. From the health and functional factors investigated, amongst the strongest factors associated with depressed mood was poor vision. Consideration to case finding for depressed mood among older people with visual impairment might be justified.

A follow-up on Acute Pain Services in Germany compared to international survey data.

BACKGROUND After the introduction of instruments for benchmarking, certification and a national guideline for acute pain management, the aim of this study was to describe the current structure, processes and quality of German acute pain services (APS). METHODS All directors of German departments of anaesthesiology were invited to complete a postal questionnaire on structures und processes of acute pain management. The survey asked for staff, techniques and quality criteria, which enabled a comparison to previous data from 1999 and surveys from other countries. RESULTS Four hundred and eight (46%) questionnaires were returned. APS have increased considerably and are now available in 81% of the hospitals, mainly anaesthesia based. However, only 45% fulfilled the minimum quality criteria, such as the assignment of personnel, the organization of patient care during nights and weekends, written protocols for postoperative pain management, regular assessments and documenting pain scores. Staff resources varied considerably, but increased compared to 1999. Two daily rounds were performed in 71%, either by physicians and nurses (42%), by physicians only (25%) or by supervised nurses (31%). Most personnel assigned to the APS shared this work along with other duties. Only 53% of the hospitals had an integrated rotation for training their specialty trainees. CONCLUSIONS The availability of APS in Germany and other countries has increased over the last decade; however, the quality of nearly half of the APS is questionable. Against the disillusioning background of recently reported unfavourable pain-related patient outcomes, the structures, organization and quality of APS should be revisited.

Sample sizes of studies on diagnostic accuracy: literature survey

OBJECTIVES: To determine sample sizes in studies on diagnostic accuracy and the proportion of studies that report calculations of sample size. DESIGN: Literature survey. DATA SOURCES: All issues of eight leading journals published in 2002. METHODS: Sample sizes, number of subgroup analyses, and how often studies reported calculations of sample size were extracted. RESULTS: 43 of 8999 articles were non-screening studies on diagnostic accuracy. The median sample size was 118 (interquartile range 71-350) and the median prevalence of the target condition was 43% (27-61%). The median number of patients with the target condition--needed to calculate a test's sensitivity--was 49 (28-91). The median number of patients without the target condition--needed to determine a test's specificity--was 76 (27-209). Two of the 43 studies (5%) reported a priori calculations of sample size. Twenty articles (47%) reported results for patient subgroups. The number of subgroups ranged from two to 19 (median four). No studies reported that sample size was calculated on the basis of preplanned analyses of subgroups. CONCLUSION: Few studies on diagnostic accuracy report considerations of sample size. The number of participants in most studies on diagnostic accuracy is probably too small to analyse variability of measures of accuracy across patient subgroups.

[Neuromonitoring and neuroprotection in cardiac anaesthesia. Nationwide survey conducted by the Cardiac Anaesthesia Working Group of the German Society of Anaesthesiology and Intensive Care Medicine]

OBJECTIVE: The primary objective of this nationwide survey carried out in department of cardiac anesthesia in Germany was to identify current practice with regard to neuromonitoring und neuroprotection. METHODOLOGY: The data are based on a questionnaire sent out to all departments of cardiac anesthesia in Germany between October 2007 und January 2008. The anonymized questionnaire contained 26 questions about the practice of preoperative evaluation of cerebral vessels, intra-operative use of neuromonitoring, the nature und application of cerebral protective measures, perfusion management during cardiopulmonary bypass, postoperative evaluation of neurological status, and training in the field of cerebral monitoring. RESULTS: Of the 80 mailed questionnaires 55% were returned and 90% of department evaluated cerebral vessels preoperatively with duplex ultrasound. The methods used for intra-operative neuromonitoring are electroencephalography (EEG, 60%) for type A dissections (38.1%), for elective surgery on the thoracic and thoraco-abdominal aorta (34.1% and 31.6%, respectively) and in carotid surgery (43.2%) near infrared spectroscopy (40%), evoked potentials (30%) and transcranial Doppler sonography (17.5%), with some centers using combined methods. In most departments the central nervous system is not subjected to monitoring during bypass surgery, heart valve surgery, or minimally invasive surgery. Cerebral protective measures used comprise patient cooling on cardio-pulmonary bypass (CPB 100%), extracorporeal cooling of the head (65%) and the administration of corticosteroids (58%), barbiturates (50%) and antiepileptic drugs (10%). Neuroprotective anesthesia consists of administering inhalation anesthetics (32.5%; sevoflurane 76.5%) and intravenous anesthesia (20%; propofol and barbiturates each accounting for 46.2%). Of the departments 72.5% cool patients as a standard procedure for surgery involving cardiovascular arrest and 37.5% during all surgery using CPB. In 84.6% of department CPB flow equals calculated cardiac output (CO) under normothermia, while the desired mean arterial pressure (MAP) varies between 60 and 70 mmHg (43.9%) and between 50 and 60 mmHg (41.5%), respectively. At body temperatures less than 18 degrees C CPB flow is reduced below the calculated CO (70%) while 27% of departments use normothermic flow rates. The preferred MAP under hypothermia is between 50 and 60 mmHg (59%). The results of intra-operative neuromonitoring are documented on the anesthesia record (77%). In 42.5% of the departments postoperative neurological function is estimated by the anesthesiologist. Continuing education sessions pertaining to neuromonitoring are organized on a regular basis in 32.5% of the departments and in 37.5% individual physicians are responsible for their own neuromonitoring education. CONCLUSION: The present survey data indicate that neuromonitoring and neuroprotective therapy during CPB is not standardized in cardiac anesthesiology departments in Germany. The systemic use of available methods to implement multimodal neuromonitoring would be desirable.

Who Is Afraid of School Choice?

This study uses survey data to investigate attitudes among Swiss voters to different models offering more freedom of choice in the educational system. There is a clear opposition to the use of taxpayer money to fund private schools, while free choice between public schools seems to appeal to a majority. The opinions appear to be based on a rational calculation of personal utility. For both types of choice, approval rates are lower for middle to high-income groups and individuals with a teaching qualification. Furthermore, residents of small to medium-sized towns are opposed to more school choice. On the support side, approval rates for private school choice are higher among parents of school-age children and residents in urban areas. The results also indicate differences between the country's language regions, attributable to intercultural differences in what people consider the role of the state.

Hidden school dropout among immigrant students: a cross-sectional study

Actual school dropout among immigrant youth has been addressed in a number of studies, but research on hidden school dropout among immigrant students is rare. Thus, the objective of this paper is to analyze hidden school dropout among primary school students with an immigrant background. The analyses were performed using survey data of 1186 immigrant students in Swiss primary schools. Our results show that immigrant students’ academic achievement, their attitudes towards school-related values, and the quality of their relationships with classmates and teachers were significant predictors of their disengagement during classes. Moreover, our findings strongly suggest that those predictors that are important for actual school dropout are crucial for hidden school dropout as well. We conclude that low-achieving immigrant youth who do not value school and who have poor relationships with teachers and peers are especially at risk of hidden and, eventually, of actual school dropout.

Individual socialization or politocultural context? The cultural roots of volunteering in Switzerland

Volunteering rates in Switzerland vary substantially across language regions. In this article, we investigate the cultural roots of this variation by presenting and empirically testing two different conceptualizations of how linguistic culture is related to individual volunteering. Whereas the first perspective perceives the individual as belonging to a particular language community and its norms and values as crucial for individual volunteering, the other sees the linguistic culture mainly as an important context in which an individual lives and which therefore influences individual volunteering. Empirically, we base our analysis on new survey data from 60 Swiss communes and apply a Bayesian multi-level analysis in order to disentangle the linguistic group from contextual effects. Our analysis supports the view that cultural patterns of civic self-organization can indeed explain regional volunteering behaviour in Switzerland. Whereas the propensity to volunteer is generally highest in German-speaking Switzerland, our findings reveal that it is the group of French speakers that exhibits the highest propensity to volunteer when controlling for language region.

Why participate in an online social network: an empirical analysis

Despite their enormous success the motivation behind user participation in Online Social Networks is still little understood. This study explores a variety of possible incentives and provides an empirical evaluation of their subjective relevance. The analysis is based on survey data from 129 test subjects. Using Structural Equation Modeling, we identified that the satisfaction of the needs for belongingness and the esteem needs through self-presentation together with peer pressure are the main drivers of participation. The analysis of a sub-sample of active users pointed out the satisfaction of the cognitive needs as an additional participation determinant. Based on these findings, recommendations for online social network providers are made.

Gender Stereotypes and Gendered Vocational Aspirations among Secondary School Students

Research Topic/Aim: Horizontal gender inequalities appear to be rather stable, with girls more often choosing ‘female' service professions, and boys choosing career paths related to science, technology, engineering or mathematics, since measures to bring more women into typical ‘male' jobs and more men into typical ‘female' jobs did not turn out to be sustainable. This paper focuses on gender stereotypes, namely non-egalitarian patriarchal gender-role orientations and gender associations of the school subjects German and mathematics. Dealing with and abolishing such gender stereotypes may be key strategy to reach sustainability regarding more equal vocational choices. Thus, gender stereotypes will be theorised and empirically analysed as a major predictor of gender-typical vocational perspectives considering interest in these school subjects as a mediating factor. Furthermore, we focus on structural patriarchy as a root of gender-role orientations, and teacher gender regarding its impact on gendered images of subjects. Theoretical and methodology framework: Our analyses of gender segregation in vocational aspirations and vocational choice center on Gottfredson's (2002; Gottfredson and Becker, 1981) Theory of Circumscription, Compromise and Self-Creation. One of the main assumptions of this theory is that people associate jobs with particular sexes and those jobs that do not fit particular gender roles are not considered. Empirical analyses are based on survey data of eighth-graders in the Swiss canton of Bern (N = 672). Structural Equation Models (SEM) for male and female students are estimated. Conclusions/Findings: Results reveal different patterns for boys and girls; for boys, gender-typical (male) vocational perspective could be explained via gender role orientations, interest in mathematics and gender associations of the school subjects, for girls, the factors under consideration could be empirically linked to ‘atypical vocational perspective'. Relevance to Nordic educational research: The study focuses on gender relations in society and how they are reproduced. Gender segregation in vocational choice and at the labour market is a universal issue - affecting both egalitarian and non-egalitarian gender regimes in similar ways. Although in general Northern countries appear to be more equal regarding gender inequality, gender segregation is rather persistent (Jarman, Blackburn and Brooks, 2012) and therefore remains a relevant topic.

Drivers of collaboration to mitigate climate change: An illustration of Swiss climate policy over 15 years

Climate change mitigation policy is driven by scientific knowledge and involves actors from the international, national and local decision-making levels. This multi-level and cross-sectoral context requires collaborative management when designing mitigation solutions over time and space. But collaboration in general policymaking settings, and particularly in the complex domain of climate mitigation, is not an easy task. This paper addresses the question of what drives collaboration among collective actors involved in climate mitigation policy. We wish to investigate whether common beliefs or power structures influence collaboration among actors. We adopt a longitudinal approach to grasp differences between the early and more advanced stages of mitigation policy design. We use survey data to investigate actors’ collaboration, beliefs and power, and apply a Stochastic Actor-oriented Model for network dynamics to three subsequent networks in Swiss climate policy between 1995 and 2012. Results show that common beliefs among actors, as well as formal power structures, have a higher impact on collaboration relations than perceived power structures. Furthermore, those effects hold true for decision-making about initial mitigation strategies, but less so for the implementation of those measures.

Mind the gap: Do proportional electoral systems foster a more equal representation of women and men, poor and rich?

Female gender and low income are two markers for groups that have been historically disadvantaged within most societies. The study explores two research questions related to their political representation: (1) ‘Are parties biased towards the ideological preferences of male and rich citizens?’; and (2) ‘Does the proportionality of the electoral system moderate the degree of under-representation of women and poor citizens in the party system?’ A multilevel analysis of survey data from 24 parliamentary democracies indicates that there is some bias against those with low income and, at a much smaller rate, women. This has systemic consequences for the quality of representation, as the preferences of the complementary groups differ. The proportionality of the electoral system influences the degree of under-representation: specifically, larger district magnitudes help in closing the considerable gap between rich and poor.

More Money, Fewer Problems? Cross-Level Effects of Economic Deprivation on Political Representation

While equal political representation of all citizens is a fundamental democratic goal, it is hampered empirically in a multitude of ways. This study examines how the societal level of economic inequality affects the representation of relatively poor citizens by parties and governments. Using CSES survey data for citizens’ policy preferences and expert placements of political parties, empirical evidence is found that in economically more unequal societies, the party system represents the preferences of relatively poor citizens worse than in more equal societies. This moderating effect of economic equality is also found for policy congruence between citizens and governments, albeit slightly less clear-cut.

Vulnerability and Growth. Developmental dynamics and differential effects of the loss of an intimate partner in the second half of life. IP 12: Study outline and first results

This working report gives an overview of the Individual Project 12 “Vulnerability and growth. Developmental dynamics and differential effects of the loss of an intimate partner in the second half of life” of the Swiss National Centre of Competence in Research LIVES led by Pasqualina Perrig-Chiello, University of Bern. This longitudinal and interdisciplinary project aims at examining vulnerability and personal growth after a critical life event, namely the break-up of a long-term intimate relationship in the second half of life, be it due to divorce or due to bereavement. In this report we present details about the rationale, the main research questions, the hypotheses and the methods of the study. Special attention is given to the methodological approach. The authors give a first sample description and report on the validity of the data by comparing the sample with Swiss Labour Force Survey and Swiss Health Survey data.