Elisabeth Zemp Stutz

Length of maternity leave and health of mother and child – a review

SummaryObjectives:Assessment of the literature on the length of maternity leaves and health of mothers and children; evaluation of the Swiss situation in view of the maternity leave policy implemented in 2005.Methods:Review of thirteen original studies identified by PubMed using topic-related terms.Results:A positive association was shown between the length of maternity leave and mother’s mental health and duration of breastfeeding. Extended maternity leaves were also associated with lower perinatal, neonatal and post-neonatal mortality rates as well as lower child mortality; however, results are obtained in ecological studies. There is less evidence regarding other health outcomes. The new policy in Switzerland extends maternity leave for a considerable number of women to 14 weeks. With this prolongation, fewer depressive symptoms and longer breastfeeding duration can be expected, while benefits regarding other health outcomes would warrant longer leaves.Conclusions:Longer maternity leaves are likely to produce health benefits. The new policy in Switzerland will probably improve the situation of those women, who previously were granted only minimal leave and/or mothers with additional social risk factors.

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.

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.

Cold extremities and difficulties initiating sleep: evidence of co‐morbidity from a random sample of a Swiss urban population

Difficulties initiating sleep (DIS) can frequently occur in psychiatric disorders but also in the general population. The primary vasospastic syndrome is a functional disorder of vascular regulation in otherwise healthy subjects complaining of thermal discomfort from cold extremities (TDCE). Laboratory studies have shown a close relationship between long sleep onset latency and increased distal vasoconstriction in healthy young subjects. Considering these findings, the aims of the Basel Survey were to assess the prevalence rates for DIS and TDCE and to determine whether both symptoms can be associated in the general population. In a random population sample of Basel‐Stadt, 2800 subjects (age: 20–40 years) were requested to complete a questionnaire on sleep behavior and TDCE (response rate: 72.3% in women, n = 1001; 60.0% in men, n = 809). Values of DIS and TDCE were based on questionnaire‐derived scores. In addition, TDCE was externally validated in a separate group of subjects (n = 256) by finger skin temperature measurements—high TDCE values were significantly associated with low finger skin temperature. A total of 31.1% of women and 6.9% of men complain of TDCE. In contrast, prevalence rates of DIS were only slightly higher in women in comparison to men (9.3% versus 6.7%, P < 0.1). Irrespective of gender, each seventh subject complaining of TDCE had concomitant DIS and the relative risk in these subjects was approximately doubled. Therefore, a thermophysiological approach to DIS may be relevant for its differential diagnosis and its treatment.

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

BackgroundResearch 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.MethodsThe 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.ResultsAlthough 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.ConclusionsThe 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.

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

BackgroundResearch 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.MethodsData 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.ResultsThe 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.ConclusionsThe 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.

Gender and hearing aids: patterns of use and determinants of nonregular use.

Objective: Research addressing gender and hearing has focused mainly on differences in the auditory systems of men and women, communication, and psychological issues. Differences between men and women in the use of hearing aids are less clear. To date, no study has examined the effects of gender on hearing aid use as a primary aim. However, use patterns and underlying reasons for not using hearing aids may differ between men and women, or there might be a gender difference in the impact of some determinants on hearing aid use. A consideration of such factors could increase hearing aid use. Therefore, the aim of the present investigation was to provide information about gender-related influences on hearing aid use by examining differences in usage patterns and determinants of nonregular use. Design: This study used cross-sectional survey data from 4979 adult male and 3410 adult female hearing aid owners in Switzerland in 2005. The survey data, including self-reported hearing aid use, were matched to the hearing loss data and the hearing aid technical information. Descriptive analyses were performed for the use patterns, age at first fitting, and audiogram slope. The determinants of nonregular use were examined using logistic regression models that were stratified by gender. Results: Compared with men, women reported a higher prevalence of daily and regular use and a longer daily duration of use of hearing aids. Men more commonly indicated a limited benefit as a reason for nonregular use. The multivariate analyses showed that nonregular use was significantly less likely in women. The audiogram slope strongly contributed to this difference. Stratified analyses showed that for both men and women, poor handling and low satisfaction were associated with a higher likelihood for nonregular hearing aid use. Associations were discrepant for asymmetric hearing loss, which was a risk factor in women but a protective factor in men. Higher risks of nonregular use were found in men with steeper audiogram slopes and longer durations of ownership of their current aids, in women fitted with their first aid in the previous 2 to 5 yr, and in women older than 65 yr. Conclusions: Overall, the present study provides evidence of gender-specific factors that influence hearing aid use patterns in men and women and of groups at higher risk for nonregular hearing aid use. Men with steeper audiogram slopes and the other subgroups of men and women with an increased risk for nonregular use should given particular attention when fitting their aids. As common risk factors for nonregular use, poor handling and low satisfaction should be addressed during the fitting process for all users. Further research is needed to clarify the differential influence of asymmetric hearing loss on hearing aid use in men and women. This information could improve hearing aid use and should be incorporated into daily clinical practice.

Aging images as a motivational trigger for smoking cessation in young women

Recruiting adolescents into smoking cessation programs has been challenging, and there is a lack of effective smoking cessation interventions for this age group. We aimed to assess whether the approach of using aging images can be used to recruit young, female smokers for a smoking cessation course. In this study, 853 14- to 18-year-old subjects were photographed (2006–2007). After software-aided aging, the images evoked strong emotions, especially in subjects with an advanced motivational stage to quit. Twenty-four percent of current smokers reported that the aging images increased their motivation to quit smoking (pre-contemplation: 8%; contemplation: 32%; and preparation: 71%). In multivariate analyses, the aged images had a high motivational impact to quit smoking that was associated with an increased readiness to stop smoking and the individual’s assessment of the aging images as shocking, but not with the number of previous attempts to quit and the assessment of the pictures as realistic. However, it was not possible to recruit the study population for a smoking cessation course. We concluded that aging images are a promising intervention for reaching young women and increasing their motivation to stop smoking. However, smoking cessation courses may not be appropriate for this age group: none of the recruits agreed to take a cessation course.

Relationship between gender role, anger expression, thermal discomfort and sleep onset latency in women

BackgroundWomen with thermal discomfort from cold extremities (hands and feet; TDCE) often suffer from prolonged sleep onset latency (SOL). Suppressed anger could contribute to the genesis of both TDCE and prolonged SOL. The aim of the study was to test the hypothesis whether stereotypic feminine gender socialization (SFGS) is related to anger suppression (experienced anger inwards, Anger-In), which in turn could affect TDCE and SOL.Methods148 women, a sub-sample of a larger survey carried out in the Canton Basel-Stadt (Switzerland), sent back detailed postal questionnaires about SOL, TDCE, anger expression (STAXI, state -trait -anger -expression -inventory) and SFGS using a gender power inventory, estimating the degree of gender specific power expression explicitly within women by stereotypic feminine or male attribution. Statistics was performed by path analysis.ResultsA significant direct path was found from stereotypic feminine attribution to Anger-In and prolonged SOL. Additionally, a further indirect path from Anger-In via TDCE to SOL was found. In contrast, stereotypic male attribution was not related to Anger-In but was significantly associated with outwardly expressed anger.LimitationsSelf-reported data, retrospective cross-sectional survey, prospective studies are required including physiological measurements.ConclusionStereotypic feminine gender socialization may play an important determinant for anger suppression, which subsequently can lead to thermal discomfort from cold extremities and prolonged sleep onset latency.

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.