High prevalence of forgoing healthcare for economic reasons in Switzerland: a population-based study in a region with universal health insurance coverage.

OBJECTIVE: To investigate the determinants and the 4-year evolution of the forgoing of healthcare for economic reasons in Switzerland. METHOD: Population-based survey (2007-2010) of a representative sample aged 35-74years in the Canton of Geneva, Switzerland. Healthcare forgone, socioeconomic and insurance status, marital status, and presence of dependent children were assessed using standardized methods. RESULTS: A total of 2601 subjects were included in the analyses. Of the subjects, 13.8% (358/2601) reported having forgone healthcare for economic reasons, with the percentage varying from 3.7% in the group with a monthly income ≥13,000CHF (1CHF≈1$) to 30.9% in the group with a monthly income <3000CHF. In subjects with a monthly income <3000CHF, the percentage who had forgone healthcare increased from 22.5% in 2007/8 to 34.7% in 2010 (P trend=0.2). Forgoing healthcare for economic reasons was associated with lower income, female gender, smoking status, lower job position, having dependent children, being divorced and single, paying a higher deductible, and receiving a premium subsidy. CONCLUSION: In a Swiss region with universal health insurance coverage, the reported prevalence of forgoing healthcare for economic reasons was high and greatly dependent on socioeconomic factors. Our data suggested an increasing trend among participants with the lowest income.

La Detecció universal neonatal de la sordesa a Catalunya : situació actual i reptes de futur

Des de principi dels anys 90, els programes per a la detecció universal neonatal de la sordesa -DUNS- s'han anat implementant arreu del món. La seva aportació a la millora de la competència en llenguatge dels infants sords ha estat forca significativa. A l'Estat espanyol, la DUNS esta possibilitant una detecció molt més precç de la sordesa, cosa que accelera l'establiment del diagnostic i del tractament, i augmenta així les probabilitats que la rehabilitació auditiva dels infants sords sigui reeixida. Des de la perspectiva de l'atenció integral de la sordesa infantil, aquests programes tenen com a objectiu la detecció de la patologia dins el primer mes de vida, el diagnòstic als tres mesos i la instauració del tractament al voltant dels sis mesos. Aquests terminis suposen un autèntic repte que exigeix, d'una banda, la creació de centres qualificats i, de l'altra, la reformulació dels protocols d'actuació dels professionals de les distintes disciplines i la seva adaptació a les noves eines disponibles per al diagnòstic, l'adaptació protètica i la rehabilitació auditiva del nadó sord. Si en un article anterior abordava el futur de la intervenció amb infants sords, tot considerant els avenços tècnics ja existens (Valero, 2002); ara em proposo revisar breument l'estat de la qüestió a Catalunya, alhora que es faran una sèrie de reflexions sobre els canvis que la detecció molt primerenca d'infants sords pot reportar tant per als mateixos sords com per als professionals que els hem d'atendre.

The effects of regional educational policies on school failure in Spain

This paper presents a regional analysis of the effects of educational policies implemented in Spain between 1992 and 2003, focusing specifically on school failure rates. We consider the impact of expenditure per pupil, class size, and pupil-teacher ratio on dropout rates at the end of compulsory education and on the proportion of early school-leavers in the 18-24 year age group. Our results indicate that higher levels of educational expenditure per pupil and lower class sizes and pupil-teacher ratios reduce rates of dropout and early school-leaving (although class-size is not always significant). However, the magnitude of the effects of these variables is small at the average level.

Ranking RegionalInnovation Policies: DEA-based Benchmarking in an European Setting

Seudullinen innovaatio on monimutkainen ilmiö, joka usein sijaitsee paikallisten toimijoiden keskinäisen vuorovaikutuksen kentässä. Täten sitä on perinteisesti pidetty vaikeasti mitattavana ilmiönä. Työssä sovellettiin Data Envelopment Analysis menetelmää, joka on osoittautunut aiemmin menestyksekkääksi tapauksissa, joissa mitattavien syötteiden ja tuotteiden väliset suhteet eivät ole olleet ilmeisiä. Työssä luotiin konseptuaalinen malli seudullisen innovaation syötteistä ja tuotteista, jonka perusteella valittiin 12 tilastollisen muuttujan mittaristo. Käyttäen Eurostat:ia datalähteenä, lähdedata kahdeksaan muuttujsta saatiin seudullisella tasolla, sekä mittaristoa täydennettiin yhdellä kansallisella muuttujalla. Arviointi suoritettiin lopulta 45 eurooppalaiselle seudulle. Tutkimuksen painopiste oli arvioida DEA-menetelmän soveltuvuutta innovaatio-järjestelmän mittaamiseen, sillä menetelmää ei ole aiemmin sovellettu vastaavassa tapauksessa. Ensimmäiset tulokset osoittivat ylipäätään liiallisen korkeita tehok-kuuslukuja. Korjaustoimenpiteitä erottelutarkkuuden parantamiseksi esiteltiin ja sovellettiin, jonka jälkeen saatiin realistisempia tuloksia ja ranking-lista arvioitavista seuduista. DEA-menetelmän todettiin olevan tehokas ja kiinnostava työkalu arviointikäytäntöjen ja innovaatiopolitiikan kehittämiseen, sikäli kun datan saatavuusongelmat saadaan ratkaistua sekä itse mallia tarkennettua.

Opportunities for prevention in primary care in a country with universal insurance coverage.

Data from studies in the United States suggest that young people engaging in health-compromising behaviors have lower access to health care. Using data from a Swiss national survey we tested the hypothesis that in a country with universal insurance coverage, adolescents engaging in health-compromising behaviors access primary care to the same extent as those who do not engage in these behaviors.

Careers of Managers, Comparison between ICT and Paper Business Sectors

The purpose of this study is to increase understanding of how the managers build their early career in information and communication technology industry (ICT business sector) and pulp- and paper industry (paper business sector). The focus of the study is to explore the importance differing a business sectors have in influencing managerial careers. Business sectors can affect careers in several ways.Sectors have different history and traditions. Also the age structure of ICT personnel differs from the age structure of personnel in the paper industry. Managers in the ICT and paper sector are technically educated but in different disciplines. Differences exist also in ways of recruiting and developing commitment inpersonnel. The target group of this research, middle management engineering personnel, work in Finnish ICT and paper companies. Research data were gathered in April-December 2002 in South-Karelia by interviewing 30 managers and six directors working in three Finnish ICT companies and in three paper companies. The research issue is approached on two levels: the individual level and the organizational level. The managers related their career stories in focused interviews. Directors, representing the organizations, described the generalities of the business sector and gave background information on company policies, human relationshippractices, as well as career and human resource development. Results of the study contribute to research discussions of career, life-span reasoning, socialization and commitment. Career is conceived as a series of positions including everykind of hierarchical mobility and all kinds of positions in work. A manager's career develops in interaction with the organization and it can be seen as involving a socializing process in an organization as a consequence of experiences andchanges in positions. This research contributes to the understanding of the nature of career in the context of two business sectors. Universal career theories,for the most part, do not perceive the importance of business sector in determining career experience. This study concentrates on describing and understanding early careers in two different business areas, elements committing managers to particular business sectors and the actions of companies in that particular sector. While career research began in the middle of 1950s, the theoretical basis of career research seems to be quite fragmented still. However, a dichotomy is consistently presented between traditional, hierarchical career research and boundaryless career thinking. In this research we examine how these old and new career concepts are evidence in the ICT and paper sectors. Careers are changing from formal, hierarchy-based structures to more fluid arrangements. The new boundaryless career concept captures territory from old career thinking. Mobility between employers, networks, and changing hierarchical structures in organizations, as well as personal and family reasons are theorized to bring changes to careers patterns in the future. However, the pace of this change in careers will vary between the ICT and paper business sectors. Findings of this research indicate that business sector has an effect on how managerial careers develop. The environment where career is developed differs between ICT and paper sectors. Careers begin differently in the two environments and the speed of career progression is distinct. ICT careers are built within the business sector whereas paper careers are made inside one company. Also recruiting and socialization practices differ from one sector to the other.

Els límits a la facultat d’interpretació de les clàusules testamentàries per part del marmessor universal

Aquest comentari analitza la sentència del Tribunal Superior de Justícia de Catalunya de 29 de desembre de 2008, que crea jurisprudència. A la sentència el Tribunal Superior determina el caràcter revisable i revocable, per part dels tribunals de justícia, de la interpretació que realitza el marmessor universal de les clàusules testamentàries.

Surrogate science: The idol of a universal method for scientific inference

The application of statistics to science is not a neutral act. Statistical tools have shaped and were also shaped by its objects. In the social sciences, statistical methods fundamentally changed research practice, making statistical inference its centerpiece. At the same time, textbook writers in the social sciences have transformed rivaling statistical systems into an apparently monolithic method that could be used mechanically. The idol of a universal method for scientific inference has been worshipped since the "inference revolution" of the 1950s. Because no such method has ever been found, surrogates have been created, most notably the quest for significant p values. This form of surrogate science fosters delusions and borderline cheating and has done much harm, creating, for one, a flood of irreproducible results. Proponents of the "Bayesian revolution" should be wary of chasing yet another chimera: an apparently universal inference procedure. A better path would be to promote both an understanding of the various devices in the "statistical toolbox" and informed judgment to select among these.

Ranking Regional Innovation Policies: DEA-based Benchmarking in an European Setting

Seudullinen innovaatio on monimutkainen ilmiö, joka usein sijaitsee paikallisten toimijoiden keskinäisen vuorovaikutuksen kentässä. Täten sitä on perinteisesti pidetty vaikeasti mitattavana ilmiönä. Työssä sovellettiin Data Envelopment Analysis menetelmää, joka on osoittautunut aiemmin menestyksekkääksi tapauksissa, joissa mitattavien syötteiden ja tuotteiden väliset suhteet eivät ole olleet ilmeisiä. Työssä luotiin konseptuaalinen malli seudullisen innovaation syötteistä ja tuotteista, jonka perusteella valittiin 12 tilastollisen muuttujan mittaristo. Käyttäen Eurostat:ia datalähteenä, lähdedata kahdeksaan muuttujsta saatiin seudullisella tasolla, sekä mittaristoa täydennettiin yhdellä kansallisella muuttujalla. Arviointi suoritettiin lopulta 45 eurooppalaiselle seudulle. Tutkimuksen painopiste oli arvioida DEA-menetelmän soveltuvuutta innovaatiojärjestelmän mittaamiseen, sillä menetelmää ei ole aiemmin sovellettu vastaavassa tapauksessa. Ensimmäiset tulokset osoittivat ylipäätään liiallisen korkeita tehokkuuslukuja. Korjaustoimenpiteitä erottelutarkkuuden parantamiseksi esiteltiin ja sovellettiin, jonka jälkeen saatiin realistisempia tuloksia ja ranking-lista arvioitavista seuduista. DEA-menetelmän todettiin olevan tehokas ja kiinnostava työkalu arviointikäytäntöjen ja innovaatiopolitiikan kehittämiseen, sikäli kun datan saatavuusongelmat saadaan ratkaistua sekä itse mallia tarkennettua.

European employment strategy and spanish labour market policies

The paper aim is to analyse the influence of the European Employment Strategy (EES)in the implementation of the Spanish labour market policies. The first part of the paper describes the evolution and content of the EES. In the second one, the definition of activation is also explained. In addition to that, the ways how the EES develops and promotes active labour market policies are examined. The evolution of labour market policies in Spain and the current configuration of both active and passive policies are studied in the next three chapters. In these parts, the paper investigates to which extent the provisions of the EES have been implemented in Spain. The paper shows that: i) activation has been rising in the European countries since the implementation of the EES; ii) this fact has also happened in relative terms (comparing the evolution of active to passive policies); iii) Spain has been one of the countries which has led these processes; iv) the EES seems to have been influencing

A proposal to establish indicators for the evaluation of municipal councils' socio-cultural policies

How can municipal sociocultural policies stimulate and promote community empowerment, civic creativity or social cohesion? What objectives should be proposed at the municipal level to promote processes of sociocultural community development? How can we identify local needs in order to stimulate community development processes? In response to these questions, our paper proposes a creative solution: indicators to evaluate sociocultural policies. The proposal will enable us to obtain information about our own reality and, at the same time, contribute to producing changes and to outlining possible de intervention strategies for local administrations. The proposal describes a system of creative, flexible and rigourous indicators intended for municipal technicians and politicians interested in evaluating their sociocultural actions and strategies. We present the result of a research process whose methods included validation of the indicators by experts and technicians in or related to sociocultural community development, and the application of this system based on a case study of a Spanish municipality. Among the proposed indicators specific consideration is given to the support of local creators and the promotion of civic creativity, as well as the use, the creation and the articulation of sociocultural activities as strategies to contribute to cultural and civic diversity

Frequent users of the emergency department in a universal health coverage system : a randomized controlled trial of a case-management intervention

BACKGROUND: Frequent emergency department users represent a small number of patients but account for a large number of emergency department visits. They should be a focus because they are often vulnerable patients with many risk factors affecting their quality of life (QoL). Case management interventions have resulted in a significant decrease in emergency department visits, but association with QoL has not been assessed. One aim of our study was to examine to what extent an interdisciplinary case management intervention, compared to standard emergency care, improved frequent emergency department users' QoL. METHODS: Data are part of a randomized, controlled trial designed to improve frequent emergency department users' QoL and use of health-care resources at the Lausanne University Hospital, Switzerland. In total, 250 frequent emergency department users (≥5 attendances during the previous 12 months; ≥ 18 years of age) were interviewed between May 2012 and July 2013. Following an assessment focused on social characteristics; social, mental, and somatic determinants of health; risk behaviors; health care use; and QoL, participants were randomly assigned to the control or the intervention group (n=125 in each group). The final sample included 194 participants (20 deaths, 36 dropouts, n=96 in the intervention group, n=99 in the control group). Participants in the intervention group received a case management intervention by an interdisciplinary, mobile team in addition to standard emergency care. The case management intervention involved four nurses and a physician who provided counseling and assistance concerning social determinants of health, substance-use disorders, and access to the health-care system. The participants' QoL was evaluated by a study nurse using the WHOQOL-BREF five times during the study (at baseline, and at 2, 5.5, 9, and 12 months). Four of the six WHOQOL dimensions of QoL were retained here: physical health, psychological health, social relationship, and environment, with scores ranging from 0 (low QoL) to 100 (high QoL). A linear, mixed-effects model with participants as a random effect was run to analyze the change in QoL over time. The effects of time, participants' group, and the interaction between time and group were tested. These effects were controlled for sociodemographic characteristics and health-related variables (i.e., age, gender, education, citizenship, marital status, type of financial resources, proficiency in French, somatic and mental health problems, and behaviors at risk).

Tobacco control policies in hospitals before and after the implementation of a national smoking ban in Catalonia, Spain

Background: Diverse projects and guidelines to assist hospitals towards the attainment of comprehensive smoke-free policies have been developed. In 2006, Spain government passed a new smoking ban that reinforce tobacco control policies and banned completely smoking in hospitals. This study assesses the progression of tobacco control policies in the Catalan Network of Smokefree Hospitals before and after a comprehensive national smoking ban. Methods: We used the Self-Audit Questionnaire of the European Network for Smoke-free Hospitals to score the compliance of 9 policy standards (global score = 102). We used two crosssectional surveys to evaluate tobacco control policies before (2005) and after the implementation of a national smoking ban (2007) in 32 hospitals of Catalonia, Spain. We compared the means of the overall score in 2005 and 2007 according to the type of hospital, the number of beds, the prevalence of tobacco consumption, and the number of years as a smoke-free hospital. Results: The mean of the implementation score of tobacco control policies was 52.4 (95% CI:45.4-59.5) in 2005 and 71.6 (95% CI: 67.0-76.2) in 2007 with an increase of 36.7% (p < 0.01). The hospitals with greater improvement were general hospitals (48% increase; p < 0.01), hospitals with > 300 beds (41.1% increase; p < 0.01), hospitals with employees' tobacco consumption prevalence 35-39% (72.2% increase; p < 0.05) and hospitals that had recently implemented smoke-free policies (74.2% increase; p < 0.01). Conclusion: The national smoking ban appears to increase tobacco control activities in hospitals combined with other non-bylaw initiatives such as the Smoke-free Hospital Network.

Tobacco control policies in hospitals before and after the implementation of a national smoking ban in Catalonia, Spain

Background: Diverse projects and guidelines to assist hospitals towards the attainment of comprehensive smoke-free policies have been developed. In 2006, Spain government passed a new smoking ban that reinforce tobacco control policies and banned completely smoking in hospitals. This study assesses the progression of tobacco control policies in the Catalan Network of Smokefree Hospitals before and after a comprehensive national smoking ban. Methods: We used the Self-Audit Questionnaire of the European Network for Smoke-free Hospitals to score the compliance of 9 policy standards (global score = 102). We used two crosssectional surveys to evaluate tobacco control policies before (2005) and after the implementation of a national smoking ban (2007) in 32 hospitals of Catalonia, Spain. We compared the means of the overall score in 2005 and 2007 according to the type of hospital, the number of beds, the prevalence of tobacco consumption, and the number of years as a smoke-free hospital. Results: The mean of the implementation score of tobacco control policies was 52.4 (95% CI:45.4-59.5) in 2005 and 71.6 (95% CI: 67.0-76.2) in 2007 with an increase of 36.7% (p < 0.01). The hospitals with greater improvement were general hospitals (48% increase; p < 0.01), hospitals with > 300 beds (41.1% increase; p < 0.01), hospitals with employees' tobacco consumption prevalence 35-39% (72.2% increase; p < 0.05) and hospitals that had recently implemented smoke-free policies (74.2% increase; p < 0.01). Conclusion: The national smoking ban appears to increase tobacco control activities in hospitals combined with other non-bylaw initiatives such as the Smoke-free Hospital Network.

Standardisation process of Universal Mobile Telecommunication System in Third Generation Partnership Project

Third Generation Partnership Project (3GPP) on organisaatio, joka määrittelee ja ylläpitää kolmannen sukupolven matkapuhelinverkon standardeja. Organisaatio luotiin monien eri standardointielinten toimesta havaittaessa, ettei maailmanlaajuista kolmannen sukupolven matkapuhelinteknologiaa voitaisi määritellä ilman laajaa yhteistyötä. 3GPP:ssä standardointityö on jakautunut usealle tekniselle määrittelyryhmälle. Jokaisen ryhmän tehtävänä on kehittää määrittelyjä ja raportteja omalla vastuualueellaan. 3GPP:ssä määrittelytyötä tehdään samanaikaisesti teknillisten määrittelyryhmien välillä. Tämä vaatii tiukkoja sääntöjä määrittelyjen luonti-, hyväksyntä- ja ylläpitotehtäviin. Vain siten on mahdollista hallita määrittelyihin tulevia muutoksia ja tarvittavaa kokonaistyömäärää. Tämä diplomityö kuvaa 3GPP:n määrittelemän UMTS-teknologian. Työssä keskitytään tarkemmin 3GPP-organisaation rakenteeseen, määritysten tekemiseen ja työskentelytapoihin. Tämä diplomityö osoittaa millainen organisaatio ja säännöt vaaditaan maailmanlaajuisen matkapuhelinjärjestelmän kehittämiseen.