Swiss School of Public Health

English Current socioeconomic transformations that have brought into existence postindustrial labour market and family structures are generating new social needs and demands, labelled new social risks (NSRs). These include reconciling work and family life, lone parenthood, long-term unemployment, being among the working poor, or having insufficient social security coverage. These new risks tend to be concentrated among women, the young and the low skilled. This article shows that these groups have little mobilising capacity and that if policies covering their needs are to be adopted, this is likely to happen as a result of alliances and political exchange with other political actors pursuing different policy objectives.

Abstract Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities 1,2 . This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity 3–6 . Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017—and more than 80% in some low- and middle-income regions—was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing—and in some countries reversal—of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.

Western welfare states were built during the postwar years, with one key objective: to protect family (male) breadwinners against the consequences of losing their ability to extract an income from the labor market. Structures of social risk, however, have changed dramatically since then, so that current social risks include precarious employment, long-term unemployment, being a working poor, single parenthood, or inability to reconcile work and family life. Changes in structures of social risk have resulted in the adaptation of welfare states only in the Nordic countries but much less in continental and southern Europe. To account for this divergence in social policy trajectories, this article argues that the reorientation of the Nordic welfare state was possible because new social risks emerged before the maturation of the postwar welfare states. The argument is demonstrated through comparative statistical analysis relating the timing of key socioeconomic developments to current levels of spending in relevant policies.

Achieving a malaria-free world presents exciting scientific challenges as well as overwhelming health, equity, and economic benefits. WHO and countries are setting ambitious goals for reducing the burden and eliminating malaria through the "Global Technical Strategy" and 21 countries are aiming to eliminate malaria by 2020. The commitment to achieve these targets should be celebrated. However, the need for innovation to achieve these goals, sustain elimination, and free the world of malaria is greater than ever. Over 180 experts across multiple disciplines are engaged in the Malaria Eradication Research Agenda (malERA) Refresh process to address problems that need to be solved. The result is a research and development agenda to accelerate malaria elimination and, in the longer term, transform the malaria community's ability to eradicate it globally.

BACKGROUND: The study aim was to objectively assess levels of sedentary time, light, moderate and vigorous physical activity (PA) among 10-12 year olds across five European countries and to examine differences in sedentary time and PA according to gender and country. METHODS: 686 children (mean age = 11.6 ± 0.8 years, 53% girls, mean BMI = 19.0 ± 3.4 kg/m(2)) from Belgium, Greece, Hungary, the Netherlands and Switzerland wore Actigraph accelerometers and had at least 2 weekdays with minimum 10 h-wearing time and 1 weekend day with minimum 8 h-wearing time. Data were analyzed using multivariate analyses of covariance. RESULTS: Girls spent significantly more time sedentary (500 minutes/day) than boys (474 minutes/day) and significantly less time in light (267 minutes/day) and moderate-to-vigorous PA (32 minutes/day) than boys (284 minutes/day; 43 minutes/day respectively; p < 0.001). 4.6% of the girls and 16.8% of the boys met moderate-to-vigorous PA recommendations of at least 60 minutes/day. Greek boys were more sedentary (510 minutes/day; all at p < 0.05) than other boys. Dutch girls were less sedentary (457 minutes/day; all at p < 0.05) than other girls. Swiss girls displayed more moderate-to-vigorous PA (43 minutes/day; at p < 0.05) than other girls. CONCLUSIONS: Large proportions of children across different European countries did not meet PA recommendations and spent a lot of time sedentary. Mean time spent in moderate-to-vigorous PA was significantly lower than the recommended 60 minutes. Obesity prevention programmes focusing on both decreasing sedentary time and increasing light, moderate and vigorous PA are needed for European children, particularly girls.

A circular economy limits the consumption of virgin resources, fosters cleaner production, and promotes the efficient utilization of resources. However, many companies still struggle with its implementation. In this study, we explore the barriers that companies encounter internally and externally when implementing circular economy measures. Based on 59 interviews with Swiss small- and medium-sized enterprise managers from three industries, we identify six company-internal barriers (risk aversion, short-term orientation, economically dominated thinking, unwillingness to engage in trade-offs, shortage of resources, and lack of knowledge) and four levels of company-external barriers (technology, market, legislative, and society and consumers). We further identify their interrelationships and integrate them into a holistic sustainable strategic management framework. Finally, we present six broader strategic recommendations building on the study framework.

BACKGROUND: Premature atrial contractions (PACs) are independent predictors of atrial fibrillation, stroke, and death. However, little is known about PAC frequency in the general population and its association with other cardiovascular risk factors. METHODS AND RESULTS: We performed a cross-sectional analysis among participants of the population-based Swiss cohort Study on Air Pollution and Lung Diseases in Adults (SAPALDIA). 24-hour Holter electrocardiograms to assess PAC prevalence and frequency were performed in a random sample of 1742 participants aged ≥50 years. The median (interquartile range) number of PACs per hour was 0.8 (0.4-1.8), 1.1 (0.5-2.4), 1.4 (0.7-4.6), 2.3 (0.8-6.9), and 2.6 (1.2-6.5) among participants aged 50 to 55, 55 to 60, 60 to 65, 65 to 70, and ≥70 years, respectively (P<0.0001). Only 18 (1.0%) participants did not have at least 1 PAC during Holter monitoring. In multivariable negative binomial regression models, PAC frequency was significantly associated with age (risk ratio [RR] per SD 1.80; P<0.0001), height (RR per SD 1.52; P<0.0001), prevalent cardiovascular disease (RR 2.40; P<0.0001), log-transformed N-terminal pro B-type natriuretic peptides (RR per SD 1.27; P<0.0001), physical activity ≥2 hours per day (RR 0.69; P=0.002), and high-density lipoprotein cholesterol (RR per SD 0.80; P=0.0002). Hypertension and body mass index were not significantly related to PAC frequency. CONCLUSIONS: To our knowledge, this is the first study to assess risk factors for PAC frequency in the general population aged ≥50 years. PACs are common, and their frequency is independently associated with age, height, history of cardiovascular disease, natriuretic peptide levels, physical activity, and high-density lipoprotein cholesterol. The underlying mechanisms of these relationships need to be addressed in future studies.

The Olympic Winter Games are partly held in mountain resorts and are thus closer to nature, a fact that has frequently led them to encounter strong opposition from environmental organizations. This paper recalls these episodes and explores how the ideas of environmental protection and sustainable development have been slowly incorporated in the Olympic rhetoric. It shows how a set of environmental principles developed through the experiences of local organizers at most Winter Games since the 1970s, and how the International Olympic Committee adopted them in the 1990s and incorporated them in the Olympic ideal. The article also explains why Olympic environmental concerns can be considered as one of the major non-material legacies that the winter games have bequeathed to the Olympic movement.

Abstract Wearables paired with data analytics and machine learning algorithms that measure physiological (and other) parameters are slowly finding their way into our workplace. Several studies have reported positive effects from using such “physiolytics” devices and purported the notion that it may lead to significant workplace safety improvements or to increased awareness among employees concerning unhealthy work practices and other job‐related health and well‐being issues. At the same time, physiolytics may cause an overdependency on technology and create new constraints on privacy, individuality, and personal freedom. While it is easy to understand why organizations are implementing physiolytics, it remains unclear what employees think about using wearables at their workplace. Using an affordance theory lens, we, therefore, explore the mental models of employees who are faced with the introduction of physiolytics as part of corporate wellness or security programs. We identify five distinct user types each of which characterizes a specific viewpoint on physiolytics at the workplace: the freedom loving, the individualist, the cynical, the tech independent, and the balancer. Our findings allow for better understanding the wider implications and possible user responses to the introduction of wearable technologies in occupational settings and address the need for opening up the “user black box” in IS use research.

Intrusion detection systems are widely utilized in the cyber security field, to prevent and mitigate threats. Intrusion detection systems (IDS) help to keep threats and vulnerabilities out of computer networks. To develop effective intrusion detection systems, a range of machine learning methods are available. Machine learning ensemble methods have a well-proven track record when it comes to learning. Using ensemble methods of machine learning, this paper proposes an innovative intrusion detection system. To improve classification accuracy and eliminate false positives, features from the CICIDS-2017 dataset were chosen. This paper proposes an intrusion detection system using machine learning algorithms such as decision trees, random forests, and SVM (IDS). After training these models, an ensemble technique voting classifier was added and achieved an accuracy of 96.25%. Furthermore, the proposed model also incorporates the XAI algorithm LIME for better explainability and understanding of the black-box approach to reliable intrusion detection. Our experimental results confirmed that XAI LIME is more explanation-friendly and more responsive.

Transparency in the activities of government and public service agencies has become a democratic sine qua non, legislated by access to information laws in many countries. While these laws have increased the amount of information available to the public, it is evident that numerous public organizations still try to conceal information, although no public or private interest of any importance justifies such behaviour. This article will develop a typology of these forms of behaviour which will allow for a better understanding of the origins of such dynamics and pave the way for a better evaluation of the point of equilibrium between administrative privilege and transparency.

PURPOSE: Awareness of being monitored can influence participants' habitual physical activity (PA) behavior. This reactivity effect may threaten the validity of PA assessment. Reports on reactivity when measuring the PA of children and adolescents have been inconsistent. The aim of this study was to investigate whether PA outcomes measured by accelerometer devices differ from measurement day to measurement day and whether the day of the week and the day on which measurement started influence these differences. METHODS: Accelerometer data (counts per minute [cpm]) of children and adolescents (n = 2081) pooled from eight studies in Switzerland with at least 10 h of daily valid recording were investigated for effects of measurement day, day of the week, and start day using mixed linear regression. RESULTS: The first measurement day was the most active day. Counts per minute were significantly higher than on the second to the sixth day, but not on the seventh day. Differences in the age-adjusted means between the first and consecutive days ranged from 23 to 45 cpm (3.6%-7.1%). In preschoolchildren, the differences almost reached 10%. The start day significantly influenced PA outcome measures. CONCLUSIONS: Reactivity to accelerometer measurement of PA is likely to be present to an extent of approximately 5% on the first day and may introduce a relevant bias to accelerometer-based studies. In preschoolchildren, the effects are larger than those in elementary and secondary schoolchildren. As the day of the week and the start day significantly influence PA estimates, researchers should plan for at least one familiarization day in school-age children and randomly assign start days.

Dupuis, J., and P. Knoepfel 2013. The adaptation policy paradox: the implementation deficit of policies framed as climate change adaptation. Ecology and Society 18(4): 31. https://doi.org/10.5751/ES-05965-180431

The causality of observed associations between air pollution and respiratory health in children is still subject to debate. If reduced air pollution exposure resulted in improved respiratory health of children, this would argue in favor of a causal relation. We investigated whether a rather moderate decline of air pollution levels in the 1990s in Switzerland was associated with a reduction in respiratory symptoms and diseases in school children. In nine Swiss communities, 9,591 children participated in cross-sectional health assessments between 1992 and 2001. Their parents completed identical questionnaires on health status and covariates. We assigned to each child an estimate of regional particles with an aerodynamic diameter < 10 microg/m3 (PM10) and determined change in PM10 since the first survey. Adjusted for socioeconomic, health-related, and indoor factors, declining PM10 was associated in logistic regression models with declining prevalence of chronic cough [odds ratio (OR) per 10-microg/m3 decline = 0.65, 95% confidence interval (CI), 0.54-0.79], bronchitis (OR = 0.66; 95% CI, 0.55-0.80), common cold (OR = 0.78; 95% CI, 0.68-0.89), nocturnal dry cough (OR = 0.70; 95% CI, 0.60-0.83), and conjunctivitis symptoms (OR = 0.81; 95% CI, 0.70-0.95). Changes in prevalence of sneezing during pollen season, asthma, and hay fever were not associated with the PM10 reduction. Our findings show that the reduction of air pollution exposures contributes to improved respiratory health in children. No threshold of adverse effects of PM10 was apparent because we observed the beneficial effects for relatively small changes of rather moderate air pollution levels. Current air pollution levels in Switzerland still exceed limit values of the Swiss Clean Air Act; thus, children's health can be improved further.

Abstract If childcare policy has become topical in most OECD countries over the last ten years or so, actual developments display huge cross‐national variations. Countries like Sweden and Denmark spend around 2 per cent of GDP on this service, and provide affordable childcare places to most children below school age. At the other extreme, in Southern Europe, only around 10 per cent of this age group has access to formal daycare. Against this background, this article aims to account for cross‐national variations in childcare services. It distinguishes two dependent variables: the coverage rate and the proportion of GDP spent subsidising childcare services. Using a mix of cross‐sectional and pooled times‐series methods, it tests a series of hypotheses concerning the determinants of the development of this policy. Its main conclusion for the coverage rate is that key factors are public spending and wage dispersion (both positive). For spending, key factors are the proportion of women in parliaments (positive) and spending on age‐related policies (negative).

The ongoing development of business and the most recent advances in artificial intelligence (AI) allow for the many business practices to be improved by the capacity to establish new forms of collaboration, which is a significant competitive advantage. This rapidly developing technology enables to offer brand services and even some new forms of business interactions with consumers and personnel. The digitalization of AI concurrently emphasized for businesses that they need concentrate on their present strategies while also routinely and early pursuing new chances in the market. Not only in business but also in different industry sectors, Al techniques are being used and revolutionized different industry sectors. This review focuses on the application of AI techniques in business and different industries.

Objective To assess the prevalence, timing, and functional impact of psychiatric, cognitive, and motor abnormalities in Huntington disease (HD) gene carriers, we analyzed retrospective clinical data from individuals with manifest HD. Methods Clinical features of patients with HD were analyzed for 6,316 individuals in an observational study of the European Huntington's Disease Network (REGISTRY) from 161 sites across 17 countries. Data came from clinical history and the patient-completed Clinical Characteristics Questionnaire that assessed 8 symptoms: motor, cognitive, apathy, depression, perseverative/obsessive behavior, irritability, violent/aggressive behavior, and psychosis. Multiple logistic regression was used to analyze relationships between symptoms and functional outcomes. Results The initial manifestation of HD is increasingly likely to be motor and less likely to be psychiatric as age at presentation increases and is independent of pathogenic CAG repeat length. The Clinical Characteristics Questionnaire captures data on nonmotor symptom prevalence that correlate specifically with validated clinical measures. Psychiatric and cognitive symptoms are common in HD gene carriers, with earlier onsets associated with longer CAG repeats. Of patients with HD, 42.4% reported at least 1 psychiatric or cognitive symptom before motor symptoms, with depression most common. Each nonmotor symptom was associated with significantly reduced total functional capacity scores. Conclusions Psychiatric and cognitive symptoms are common and functionally debilitating in HD gene carriers. They require recognition and targeting with clinical outcome measures and treatments. However, because it is impossible to distinguish confidently between nonmotor symptoms arising from HD and primary psychiatric disorders, particularly in younger premanifest patients, nonmotor symptoms should not be used to make a clinical diagnosis of HD. Trial Registration Information ClinicalTrials.gov Identifier: [NCT01590589][1] CI= : confidence interval; EHDN= : European Huntington's Disease Network; HADS= : Hospital Anxiety/Depression Scale; HD= : Huntington disease; HDCCQ= : HD Clinical Characteristics Questionnaire; ICD-10= : International Classification of Disease, 10th revision ; OR= : odds ratio; PBA-s= : short form of the Problem Behaviours Assessment; PREDICT-HD= : Neurobiological Predictors of Huntington's Disease; REGISTRY= : An Observational Study of the European Huntington's Disease Network; SDMT= : Symbol-Digit Modalities Test; SIS= : Snaith Irritability Scale; TFC= : total functional capacity; TMS= : total motor score; UHDRS= : Unified Huntington's Disease Rating Scale [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01590589&atom=%2Fneurology%2F96%2F19%2Fe2395.atom

Through a partnership with the National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, and Department of Defense, the development of Sport-Related Concussion (SRC) Common Data Elements (CDEs) was initiated. The aim of this collaboration was to increase the efficiency and effectiveness of clinical research studies and clinical treatment outcomes, increase data quality, facilitate data sharing across studies, reduce study start-up time, more effectively aggregate information into metadata results, and educate new clinical investigators. The SRC CDE Working Group consisted of 32 worldwide experts in concussion from varied fields of related expertise divided into three Subgroups: Acute (<72 h post-concussion), Subacute (3 days-3 months post-concussion) and Persistent/Chronic (>3 months post-concussion). To develop CDEs, the Subgroups reviewed various domains, then selected from, refined, and added to existing CDEs, case report forms and field-tested data elements from national registries and funded research studies. Recommendations were posted to the NINDS CDE Website for Public Review from February 2017 to April 2017. Following an internal Working Group review of recommendations, along with consideration of comments received from the Public Review period, the first iteration (Version 1.0) of the NINDS SRC CDEs was completed in June 2017. The recommendations include Core and Supplemental-Highly Recommended CDEs for cognitive data elements and symptom checklists, as well as other outcomes and end-points (e.g., vestibular, oculomotor, balance, anxiety, depression), and sample case report forms (e.g., injury reporting, demographics, concussion history) for domains typically included in clinical research studies. The NINDS SRC CDEs and supporting documents are publicly available on the NINDS CDE website www.commondataelements.ninds.nih.gov . Widespread use of CDEs by researchers and clinicians will facilitate consistent SRC clinical research and trial design, data sharing, and metadata retrospective analysis.

OBJECTIVES: Seroprevalence studies to assess the spread of SARS-CoV-2 infection in the general population and subgroups are key for evaluating mitigation and vaccination policies and for understanding the spread of the disease both on the national level and for comparison with the international community. METHODS: Corona Immunitas is a research program of coordinated, population-based, seroprevalence studies implemented by Swiss School of Public Health (SSPH+). Over 28,340 participants, randomly selected and age-stratified, with some regional specificities will be included. Additional studies in vulnerable and highly exposed subpopulations are also planned. The studies will assess population immunological status during the pandemic. RESULTS: Phase one (first wave of pandemic) estimates from Geneva showed a steady increase in seroprevalence up to 10.8% (95% CI 8.2-13.9, n = 775) by May 9, 2020. Since June, Zurich, Lausanne, Basel City/Land, Ticino, and Fribourg recruited a total of 5973 participants for phase two thus far. CONCLUSIONS: Corona Immunitas will generate reliable, comparable, and high-quality serological and epidemiological data with extensive coverage of Switzerland and of several subpopulations, informing health policies and decision making in both economic and societal sectors. ISRCTN Registry: https://www.isrctn.com/ISRCTN18181860 .

This article proposes an alternative interpretation of political disorder in Ethiopia's Somali Regional State since the rise to power of the Ethiopian People's Revolutionary Democratic Front (EPRDF) in 1991. Some observers have perceived contemporary politics in the former Ogaden as an example of ‘internal colonisation’ by highland Ethiopians. Others attribute political instability to the ‘nomadic culture’ inherent in the Somali clan structure and the ineptness of its political leaders. This study argues that neither of these two politicised narratives grasps the contradictory interactions between the federal Ethiopian government and its Somali periphery, nor the recursive relations between state and society. With reference to the literature on neo-patrimonialism, I elucidate political disorder in the Somali Region by empirically describing hybrid political domination, institutional instability, and patronage relations, showing how neo-patrimonial rule translates into contested statehood in the region and political devices ranging from military coercion to subtle co-optation. Rather than unilateral domination, a complex web of power and manipulation between parts of the federal and regional authorities animates political disorder in Ethiopia's Somali Region.