Hospital use of young children in Switzerland: a nation-wide study based on a complete survey over 4 years

Background Young children are known to be the most frequent hospital users compared to older children and young adults. Therefore, they are an important population from economic and policy perspectives of health care delivery. In Switzerland complete hospitalization discharge records for children [<5 years] of four consecutive years [2002–2005] were evaluated in order to analyze variation in patterns of hospital use. Methods Stationary and outpatient hospitalization rates on aggregated ZIP code level were calculated based on census data provided by the Swiss federal statistical office (BfS). Thirty-seven hospital service areas for children [HSAP] were created with the method of "small area analysis", reflecting user-based health markets. Descriptive statistics and general linear models were applied to analyze the data. Results The mean stationary hospitalization rate over four years was 66.1 discharges per 1000 children. Hospitalizations for respiratory problem are most dominant in young children (25.9%) and highest hospitalization rates are associated with geographical factors of urban areas and specific language regions. Statistical models yielded significant effect estimates for these factors and a significant association between ambulatory/outpatient and stationary hospitalization rates. Conclusion The utilization-based approach, using HSAP as spatial representation of user-based health markets, is a valid instrument and allows assessing the supply and demand of children's health care services. The study provides for the first time estimates for several factors associated with the large variation in the utilization and provision of paediatric health care resources in Switzerland.

Differential effects of anti-hypertensive treatment on the retinal microcirculation: an Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) sub- study

Changes in the retinal microcirculation are associated with hypertension and predict cardiovascular mortality. There are few data describing the impact of antihypertensive therapy on retinal vascular changes. This substudy of the Anglo-Scandinavian Cardiac Outcomes Trial compared the effects of an amlodipine-based regimen (373 patients) with an atenolol-based regimen (347 patients) on retinal microvascular measurements made from fundus photographs. The retinal photographs were taken at a stage in the trial when treatments were stable and blood pressure was well controlled. Amlodipine-based treatment was associated with a smaller arteriolar length:diameter ratio than atenolol-based treatment (13.32 [10.75 to 16.04] versus 14.12 [11.27 to 17.81], median [interquartile range]; P<0.01). The association remained significant after adjustment for age, sex, cholesterol, systolic and diastolic blood pressures, body mass index, smoking, and statin treatment. This effect appeared to be largely attributable to shorter retinal arteriolar segment lengths in the amlodipine-treated group and is best explained by the vasodilator effects of amlodipine causing the visible emergence of branching side vessels. Photographic assessment of the retinal vascular network may be a useful approach to evaluating microvascular structural responses in clinical trials of antihypertensive therapy.

Kultdissenz und umstrittene «Nation»: Der Totenkult um die Kommunarden von 1871 in Paris aus vergleichender Perspektive

Mit der Anbringung einer Marmorplakette am Mur des Fédérés auf dem Pariser Friedhof Père Lachaise 1908 zum Gedenken an die Ermordeten des Communeaufstandes von 1871 endete eine seit den frühen 1880er Jah­ren konfliktbeladene Initiative zum öffentlichen Totenkult. Seine linken Verfechter stilisierten die Kommune zum Referenzpunkt für die emanzipatorisch-egalitäre Nation. Von diesem Deutungsmuster distanzierte sich der regierende 'opportunisme' allerdings energisch. Konfliktträchtig blieb auch die rituelle Praxis des Totengedenkens auf dem Père Lachaise in Form politischer Demonstrationen linker Gruppierungen, die jedoch ihrer heterogenen Struktur wegen über einen punktuellen Protest kaum hinausgelangten. So blieb der Mur des Fédérés ein umstrittener Ort des Totenkults, für seine Verteidiger Symbol einer radikal-sozialistischen Zielutopie, für seine Gegner gleichsam memoriale Bürde bei dem Versuch, die Commune aus dem Gedächtnisvorrat der französischen Nation zu verbannen. Im Vergleich mit den erfolglosen Kultversuchen um die Märztoten in Berlin seit den 1880er Jahren tritt einmal mehr zutage, dass der politisierte Totenkult programmatisch wie rituell-symbolisch als Vehikel für den Entwurf nationaler Geschichtsbilder dienen konnte.

Book review of “Germany in Transit: Nation and Migration, 1955-2005”. 588 pages, University of California Press, 2007, by Deniz Göktürk, David Gramling and Anton Kaes (eds.)

Though migration is an age-old feature of human activity, driven by various circumstances, its current place in the midst of global dynamics and the phenomenon of globalization is becoming increasingly critical. International immigration and its regulation have been largely shaped by the policies in the receiving countries, often determining preferences for nationality cohorts and work skills to satisfy their labor and human capital requirements. When immigration has been necessitated by political strife, host countries have displayed immense magnanimity as well. However, the growing realization of resource limitations and the strange quirks of cultural pluralism are in turn creating waves of dissonance. Literature and the media are now replete with an in depth look into the immigration debate in various nations of the world in trying to seek new directions and satisfactory solutions.