[Social determinants of health - how gendergot lost on the way]. / Déterminants sociaux de la santéen Suisse ­ comment le genres'est perdu en chemin.

Since four decades epidemiological research has emphasised the necessity to consider social determinants and the social distribution of illnesses in the Swiss population, particularly by gender. Gender influences social position, living conditions as well as health behaviours over the life-course which all together influence health outcomes. Despite this evidence, national health policies and strategies tend to consider gender as a background factor, if not to omit its influence on health. The Health2020 policy and the recent specific national strategies are particularly illustrative. To exclude or reduce gender as a mere biological factor however hampers the implementation of specific interventions aiming at reducing health inequalities in the name of the social justice principle.

Depuis quatre décennies, la recherche épidémiologique a mis en évidence la nécessité de considérer les déterminants sociaux et la distribution sociale des maladies dans la population suisse, en particulier en fonction du genre. Le genre influence la situation sociale, les conditions et les parcours de vie et les comportements en matière de santé qui influencent ensemble la santé. Malgré ces acquis, les politiques et stratégies nationales de santé tendent à considérer le genre comme un facteur de second plan, voire à omettre totalement son influence sur la santé. La politique Santé2020 et les stratégies nationales spécifiques récentes en témoignent tout particulièrement. Or, exclure ou réduire le genre à un facteur biologique entrave la mise en place d'interventions spécifiques visant la réduction des inégalités de santé au nom du principe de justice sociale.

Sex-specific associations of cardiovascular risk factors with carotid stiffness--results from the SAPALDIA cohort study.

OBJECTIVE: Manifestation of cardiovascular disease (CVD) occurs with clear sex differences. Carotid stiffness (CS) parameters are increasingly used for CVD risk assessment but the sex-specific association with CVD risk factors as well as association patterns between CS parameters are largely unknown, which we investigated in SAPALDIA population-based cohort participants. METHODS: Risk factors of 2545 participants without clinically manifest disease were evaluated in 2001-2003 and different CS parameters were assessed in carotid ultrasound scans in 2010-2011. Stratified and non-stratified mixed linear models and multivariate regression analyses were used to examine sex-specific associations, differences and association patterns of single risk factors and CS parameters. RESULTS: HDL cholesterol was the only significant protective determinant of reduced CS for both sexes (ranges of CS parameters: -3.7; -0.8% of changes in geometric mean per 1SD of the risk factor on an inverted scale) and significant adverse risk factors were BMI (-0.5; 4.7%), systolic (-1.23; 4.7%) and diastolic blood pressure (1.4; 4.4%), heart rate (2.7; 7.9%), C-reactive protein (0.6; 3.3%) and smoking (-2.82; 1%), all p-values of multivariate analyses were <0.01. Sex differences with stiffer CS parameters in men were observed for increased heart rate (p = 0.001) and LDL cholesterol (p < 0.001) and in women for triglyceride (p < 0.003). Similar association patterns were found for most CS parameters. CONCLUSION: Sex-specific associations of cardiovascular risk factors may reflect a sex-specific burden of atherosclerotic risk factors and similar association patterns across different CS parameters within men and women may allow the use of CS parameters in an exchangeable manner.

Responding to a crying infant - you do not learn it overnight: a phenomenological study.

OBJECTIVE: to examine the views and practices of first-time and experienced mothers in response to infant crying during the first 12 weeks post birth. DESIGN: longitudinal, qualitative study using an interpretive, phenomenological approach. SETTING: postnatal hospital and home settings in Switzerland. PARTICIPANTS: maximum variation sampling of 15 new mothers of diverse parity and educational background who had given birth to a full-term healthy neonate. METHODS: participant observations in the postnatal ward and two narrative interviews at participants' homes at 6-8 and 12-14 weeks post partum. Data analysis used interpretive approaches of case analysis, thematic analysis and exemplars. FINDINGS: first-time mothers showed some soothing skills from the beginning, but fine-tuned their practices of handling the crying infant and managing their own reactions. With growing experience mothers acquired a differentiated understanding of the crying's reason and urgency and used more successful soothing techniques. At the same time they learned to assess and mitigate their own stress reactions by self-soothing and adopting realistic expectations of normal infant behaviour. Experienced mothers knew the infant's frequent crying would diminish after a while whereas first-time mothers coped without this positive expectation. KEY CONCLUSIONS: with increasing child-care experience mothers' skills and attitudes towards crying changed, leading to a calmer and less escalating response to their crying infant. IMPLICATIONS FOR PRACTICE: inexperienced mothers need information on neonatal crying behaviour and on parents' stress response. They should be taught how to recognise and respond to the new-born's signals, and how to cope with their own stress. Postnatal care should provide novice mothers to learn from experienced role models.

Predictors of early postpartum mental distress in mothers with midwifery home care--results from a nested case-control study.

PRINCIPLES: The prevalence of early postpartum mental health conditions is high. Midwives and other health professionals visiting women at home may identify mothers at risk. This seems crucial given decreasing trends of length of hospital stay after childbirth. This study aimed to identify predictors of maternal mental distress in a midwifery home care setting. METHODS: Using the statistical database of independent midwives' services in Switzerland in 2007, we conducted a matched nested case-control study. Out of a source population of 34,295 mothers with midwifery home care in the first ten days after childbirth, 935 mothers with maternal distress and 3,645 controls, matched by midwife, were included. We analysed whether socio-demographic, maternal and neonatal factors predict maternal mental distress by multivariable conditional logistic regression analysis. RESULTS: Infant crying problems and not living with a partner were the strongest predictors for maternal distress, whereas higher parity was the most protective factor. Significantly elevated risks were also found for older age, lower educational levels, breast/breastfeeding problems, infant weight gain concerns, neonatal pathologies and use of midwifery care during pregnancy. A lower likelihood for maternal distress was seen for non-Swiss nationality, full-time employment before birth, intention to return to work after birth and midwife-led birth. CONCLUSION: The study informs on predictors of maternal mental distress identified in a home care setting in the early postpartum period. Midwives and other health care professionals should pay particular attention to mothers of excessively crying infants, single mothers and primipara, and assess the need for support of these mothers.

The baby-friendly hospital initiative in Switzerland: trends over a 9-year period.

BACKGROUND: This article reports the trends over a 9-year period for 4 steps of the Baby-Friendly Hospital Initiative (BFHI) (exclusive breastfeeding, uninterrupted rooming-in, no use of pacifiers, and initiation of breastfeeding within the first 2 hours after birth) during hospital stays in Switzerland. METHODS: Data were collected annually over a period of 9 years from a monitoring survey of all BFHI-accredited hospitals in Switzerland (between 41 and 65 hospitals). The number of participants included in the study per year ranged between 15 627 and 31 141 healthy mother-newborn pairs. RESULTS: Significant improvements were found for 3 of the 4 steps of the BFHI between 2000 and 2008: rates of exclusive breastfeeding during postpartum stay (35.9%-57.6%, P < .001), uninterrupted rooming-in (48.2%-73.1%, P < .001), and no use of pacifiers (33.6%-48.1%, P < .001). Initiation of breastfeeding within the first 2 hours after birth was always > 90% and did not change significantly over the 9 years. Exclusive breastfeeding during hospital stay was significantly related to no use of pacifiers (P < .001) and to uninterrupted rooming-in (P < .001) in the years when exclusive breastfeeding particularly increased (2003, 2004, and 2008). CONCLUSION: Rates of exclusive breastfeeding during hospital stay and uninterrupted rooming-in increased significantly over the 9 years. Continued promotion of the BFHI may be needed to maintain or further improve the breastfeeding rates and to find ways to deal with difficulties that hospitals face when applying the 10 steps of the BFHI.

Gender differences in disordered eating and weight dissatisfaction in Swiss adults: which factors matter?

BACKGROUND: Research results from large, national population-based studies investigating gender differences in weight dissatisfaction and disordered eating across the adult life span are still limited. Gender is a significant factor in relation to weight dissatisfaction and disordered eating. However, the reasons for gender differences in these conditions are still poorly understood. The aim of this study was to examine gender differences in weight dissatisfaction and disordered eating in the general Swiss adult population and to identify gender-specific risk factors. METHODS: The study population consisted of 18156 Swiss adults who completed the population-based Swiss Health Survey 2007. Self-reported weight dissatisfaction, disordered eating and associated risk factors were assessed. In order to examine whether determinants of weight dissatisfaction and disordered eating (dieting to lose weight, binge eating, and irregular eating) differ in men and women, multivariate logistic regressions were applied separately for women and men. RESULTS: Although more men than women were overweight, more women than men reported weight dissatisfaction. Weight category, smoking status, education, and physical activity were significantly associated with weight dissatisfaction in men and women. In women, nationality and age were also significant factors. Gender-specific risk factors such as physical activity or weight category were identified for specific disordered eating behaviours. CONCLUSIONS: The results suggest that gender specific associations between predictors and disordered eating behaviour should be considered in the development of effective prevention programs against disordered eating.

Marital status, living arrangement and mortality: does the association vary by gender?

BACKGROUND: Men appear to benefit more from being married than women with respect to mortality in middle age. However, there is some uncertainty about gender differences in mortality risks in older individuals, widowed, divorced and single individuals and about the impact of living arrangements. METHODS: Longitudinal data with 1990 census records being linked to mortality data up to 2005 were used (Swiss National Cohort). The sample comprised all residents over age 44 years in Switzerland (n=2,440,242). All-cause mortality HRs for marital status and living arrangements were estimated by Cox regression for men and women and different age groups with adjustment for education and socio-professional category. RESULTS: The benefit of being married was stronger for men than for women; however, mortality patterns were similar, with higher mortality in divorced and single individuals compared with widowed individuals (<80 years). After adjustment for living arrangements, the gender difference by marital status disappeared. Stratification by living arrangement revealed that mortality risks were highest for 45-64-year-old divorced (HR 1.72 (95% CI 1.67 to 1.76)) and single men (HR 1.67 (95% CI 1.63 to 1.71)) who lived alone. In women of the same age, the highest mortality risk was observed for those who were single and living with a partner (HR 1.70 (95% CI 1.58 to 1.82)). In older age groups, the impact of marital status decreased. CONCLUSIONS: Evaluation of living arrangements is crucial for identifying and explaining gender differences in mortality risks by marital status. The impact of living alone and living with a partner seems to be different in men and women.

The interrelation between premenstrual syndrome and major depression: results from a population-based sample.

BACKGROUND: Research about the relationship between premenstrual syndrome (PMS) and major depression is limited. This study examined the relationship between moderate to severe PMS and major depression in a population-based sample of women of reproductive age. The objectives of the study were to assess the association between premenstrual syndrome and major depression, to analyse how PMS and major depression differ and to characterise the group of women who report both PMS and major depression. METHODS: Data were obtained from the Swiss Health Survey 2007. Included in the analysis was data from women under the age of 55 without hysterectomy and who answered the questions on PMS symptoms. The population-based sample consisted of 3518 women. Weighted prevalence rates were calculated and relative risk ratios for PMS, major depression and women who reported both PMS and major depression, were calculated with logistic multinominal logit regression. RESULTS: The prevalence of major depression was 11.3% in women screening positive for moderate PMS and 24.6% in women screening positive for severe PMS. Compared to women without any of these conditions, women who reported moderate to severe alcohol consumption had a lower risk for PMS. Women reporting use of antidepressants, and use of oral contraceptives had a higher risk for major depression compared to women without any of these conditions. Women reporting work dissatisfaction had a higher risk for PMS. A higher relative risk to report both PMS and major depression compared to women without PMS or major depression was related to factors such as high psychological distress, low mastery, psychotropic drug consumption, and low self-rated health. CONCLUSIONS: The results suggested that women who suffer from both PMS and major depression are more impaired compared to women with only one disorder. The results further indicated that PMS and major depression are different disorders that can, however, co-occur.

Crying babies, tired mothers - challenges of the postnatal hospital stay: an interpretive phenomenological study.

BACKGROUND: According to an old Swiss proverb, "a new mother lazing in childbed is a blessing to her family". Today mothers rarely enjoy restful days after birth, but enter directly into the challenge of combining baby- and self-care. They often face a combination of infant crying and personal tiredness. Yet, routine postnatal care often lacks effective strategies to alleviate these challenges which can adversely affect family health. We explored how new mothers experience and handle postnatal infant crying and their own tiredness in the context of changing hospital care practices in Switzerland. METHODS: Purposeful sampling was used to enroll 15 mothers of diverse parity and educational backgrounds, all of who had given birth to a full term healthy neonate. Using interpretive phenomenology, we analyzed interview and participant observation data collected during the postnatal hospital stay and at 6 and 12 weeks post birth. This paper reports on the postnatal hospital experience. RESULTS: Women's personal beliefs about beneficial childcare practices shaped how they cared for their newborn's and their own needs during the early postnatal period in the hospital. These beliefs ranged from an infant-centered approach focused on the infant's development of a basic sense of trust to an approach that balanced the infants' demands with the mother's personal needs. Getting adequate rest was particularly difficult for mothers striving to provide infant-centered care for an unsettled neonate. These mothers suffered from sleep deprivation and severe tiredness unless they were able to leave the baby with health professionals for several hours during the night. CONCLUSION: New mothers often need permission to attend to their own needs, as well as practical support with childcare to recover from birth especially when neonates are fussy. To strengthen family health from the earliest stage, postnatal care should establish conditions which enable new mothers to balance the care of their infant with their own needs.

Emergency hormonal contraception in Switzerland: a comparison of the user profile before and three years after deregulation.

OBJECTIVES: To evaluate the time lapse between sexual intercourse and request for emergency hormonal contraception (EHC) from pharmacies and to analyse the profiles of EHC users shortly after deregulation and three years later, assuming EHC became better-known and more easily accessed. METHODS: Official EHC written assessment forms were collected from pharmacies in Switzerland. RESULTS: Written assessment forms from 729 women aged 15-49 years (380 forms pertaining to the 2003 period and 349 for the 2006 period) were collected in 18 pharmacies. Due to the presence of more women aged less than 18, women in Group 2006 were significantly younger than those in Group 2003 (p = 0.014). Nearly one quarter (23.6%) of the women went to a pharmacy for EHC within 6 h of unprotected sexual intercourse. The median access time was 12 h in 2003 and 14 h in 2006 (p < 0.05). Variance analysis showed a relationship between time to access and the contraceptive methods used (p < 0.001) with male condom users going to a pharmacy the earliest after unprotected intercourse, followed by pill users and by women without any contraception. The number of women who did not use any contraception doubled from 2003 to 2006. CONCLUSIONS: Dispensing EHC through Swiss community pharmacies allows women to seek EHC easily and rapidly after unprotected sex. The observed changes in user profiles do not support the concern regarding enhanced sexually risky behaviour, more frequent use or misuse due to free access to EHC. The findings support a more liberal access to EHC.

Changes in oral health over a 10-yr period in Switzerland.

The Swiss Health Surveys are conducted every 5 yr, and alternate surveys contain information on oral health. Worldwide the population is ageing and oral health is improving. The aim of this study was to identify if these trends are continuing in a relatively affluent society with low levels of edentulousness. Participants in the 1992 and 2002 surveys completed a written questionnaire including items on oral health (response rates 75% and 86% respectively). Data were weighted and bivariate analyses were performed to calculate the average number of missing teeth and the prevalence of different prosthetic dental restorations for each cohort. Over the 10-yr period the proportion of subjects retaining all natural teeth increased, and the mean number of teeth increased, on average, by 1.3. Among those who required prosthetic dental restorations, fixed restorations increased and complete denture use was reduced. Strikingly, 4.4% of this sample reported having oral implants in 2002. Greater numbers of missing teeth and a higher prevalence of use of removable prostheses were still seen in women, in those who had only completed compulsory education, in subjects from families with low income, in those who smoke, and in those who were overweight, in 2002.