Cardiovascular disease in Switzerland - health care, mortality and geographical pattern

SUMMARY Switzerland is facing an aging population and a growing amount of patients with chronic diseases. It is crucial to display health care processes and pathways, to identify inequalities and obstacles, and to point out possibilities for improvements of the Swiss health care system (e.g. increase efficiency). The introductory part of the thesis presents a brief description of the Swiss health care system, health services research and regional variation as well as an introduction of CVD and its epidemiological key figures, aetiology and treatments. This is followed by the description of the utilized methods and data, and the objectives of this thesis. The subsequent sections present the four articles included in this thesis. The first article focuses on a small area analysis on regional variation of avoidable hospitalisations in Switzerland including density of primary care physicians and specialists, rurality and hospital supply factors as explanatory variables in the analysis. Lower rates of avoidable hospitalisations were found in areas with very high supply of primary care physicians, increased avoidable hospitalisation rates in areas with more specialists and in areas with higher proportion of rural residents. The second article aims to examine whether emergency patients with acute ST-segment elevation myocardial infarction were adequately treated, i.e. according to the treatment guidelines, in Switzerland. Results show that older and female patients were less likely to receive revascularization which suggests that the treatment guidelines may not be uniformly applied in Switzerland. Similar to the first article, also in the third article a small area analysis was performed but this time investigating regional variation in costs at the end of life. Strongest associations of cost was found with cause of death, age and language region of the decedents. The strong spatial variation of costs could only partly be explained by the included covariates. Article four aims to examine the relationship of distance to different hospital types and mortality from AMI or stroke. We found that AMI mortality in the Swiss population 30 and older and stroke mortality in those 65 and above increased with distance to central and university hospitals, while adjusting for sociodemographic and economic characteristics of the population. The presentation of the four articles is followed by a discussion, which summarizes the main findings and the strengths and limitations of the presented articles. The thesis concludes with a discussion about the challenges for policy, practice and future research.

Paleontological and sedimentological investigations of a sediment profile from northeast Greenland

The Kap Mackenzie area on the outer coast of northeast Greenland was glaciated during the last glacial stage, and pre-Holocene shell material was brought to the area. Dating of marine shells indicates that deglaciation occurred in the earliest Holocene, before 10 800 cal. a BP. The marine limit is around 53 m a.s.l. In the wake of the deglaciation, a glaciomarine fauna characterized the area, but after c. one millennium a more species-rich marine fauna took over. This fauna included Mytilus edulis and Mysella sovaliki, which do not live in the region at present; the latter is new to the Holocene fauna of northeast Greenland. The oldest M. edulis sample is dated to c. 9500 cal. a BP, which is the earliest date for the species from the region and indicates that the Holocene thermal maximum began earlier in the region than previously documented. This is supported by driftwood dated to c. 9650 cal. a BP, which is the earliest driftwood date so far from northeastern Greenland and implies that the coastal area was at least partly free of sea ice in summer. As indicated by former studies, the Storegga tsunami hit the Kap Mackenzie area at c. 8100 cal. a BP. Loon Lake, at 18 m a.s.l., was isolated from the sea at c. 6200 cal. a BP, which is distinctly later than expected from existing relative sea-level curves for the region.

Homogeneous Spatial Units (HSU) - a Pan-European geographical basis for environmental and socio-economic modelling

The spatial data set delineates areas with similar environmental properties regarding soil, terrain morphology, climate and affiliation to the same administrative unit (NUTS3 or comparable units in size) at a minimum pixel size of 1km2. The scope of developing this data set is to provide a link between spatial environmental information (e.g. soil properties) and statistical data (e.g. crop distribution) available at administrative level. Impact assessment of agricultural management on emissions of pollutants or radiative active gases, or analysis regarding the influence of agricultural management on the supply of ecosystem services, require the proper spatial coincidence of the driving factors. The HSU data set provides e.g. the link between the agro-economic model CAPRI and biophysical assessment of environmental impacts (updating previously spatial units, Leip et al. 2008), for the analysis of policy scenarios. Recently, a statistical model to disaggregate crop information available from regional statistics to the HSU has been developed (Lamboni et al. 2016). The HSU data set consists of the spatial layers provided in vector and raster format as well as attribute tables with information on the properties of the HSU. All input data for the delineation the HSU is publicly available. For some parameters the attribute tables provide the link between the HSU data set and e.g. the soil map(s) rather than the data itself. The HSU data set is closely linked the USCIE data set.

Wild life of the world : a descriptive survey of the geographical distribution of animals /

Mode of access: Internet.

The Modern world dictionary of the English language ... to which is added a compendium of historical, biographical, geographical, scientific, religious, and sociological names, and a complete summary of human achievement in the nineteenth & twentieth centuries ...

Editors-in-chief: Robert Hunter and Charles Morris.

The geographical distribution of animals. With a study of the relations of living and extinct faunas as elucidating the past changes of the earth's surface.

Mode of access: Internet.

NEOGENYTON, OR, INDICATION OF SIXTY-SIX NEW GENERA OF PLANTS OF NORTH AMERICA

Mode of access: Internet.