<b>Background. </b> Although antipsychotic medications are primarily intended to treat schizophrenia and psychotic symptoms in adults, they are commonly administered to nursing home residents as pharmacotherapy for "off-label" indications such as disruptive behaviour. However, clinical trials have demonstrated limited efficacy and serious side-effects of antipsychotics among the elderly. As previous studies have reported inappropriate use in several countries, their use in nursing home residents ought to be monitored to detect and reduce inappropriate administration. <br /><br /> <b>Objectives. </b> The aim of this study was a) to determine and compare prevalence rates of antipsychotic use in Ontario and Swiss nursing homes, b) to identify determinants of antipsychotics use in these two countries, by means of a cross-sectional design, and c) to investigate the impact of antipsychotic use on behaviours over time in Ontario and Swiss residents, by means of a longitudinal design. <br /><br /> <b>Methods. </b> This study involved secondary data analysis of 1932 residents from 24 nursing homes in the province of Ontario in Canada and 1536 residents from 4 nursing homes in a German-speaking canton in Switzerland. Residents were assessed with the Minimum Data Set (MDS) tool. Resident characteristics and prevalence rates were compared internationally with the chi-square test. Demographic and clinical determinants of antipsychotic use, as well as behavioural change associated with antipsychotics, were analyzed using logistic regression. <br /><br /> <b>Results. </b> Although Ontario nursing home residents had an overall heavier-care profile than Swiss residents, antipsychotics were administered to 25% of the Ontario residents compared to 29. 5% of the Swiss residents. The adjusted rate among residents without appropriate conditions was also lower in Ontario (14%) than in Switzerland (24. 5%). Apart from schizophrenia, bipolar disorder and cognitive impairment, antipsychotic use was determined by a different range of characteristics in these two countries. Antipsychotic use was not predictive of behavioural improvement. <br /><br /> <b>Conclusion. </b> The high adjusted rates of antipsychotic use in Ontario and Swiss nursing home residents, as well as the presence of "inappropriate indications" and "facility" as determinants of their use, raise concerns about the appropriateness of their administration in both countries. Their lack of effectiveness to improve behaviours also questions their use as long-term treatment for behaviour disturbances. Changes in practice patterns and implementation of policies are warranted to reduce inappropriate prescribing practices to enhance the quality of care provided to residents in nursing homes.

Masteropgave. / Format: PDF. Bibl.

Thesis (doctoral)--Universität, Zürich, 2003. / Includes bibliographical references.

No description available.

The purpose of this dissertation is to examine the politics of separatism in multinational federations. Switzerland, Canada, and India are investigated in detail. Switzerland is a multinational federation that has not experienced a separatist movement for more than one hundred and fifty years. In Canada, there is a significant separatist movement in the province of Quebec. India has experienced a number of violent secessionist crises in a number of states over the past two decades. The cases thus exhibit a range in the dependent variable (presence or absence of secessionist movements). This study adopts a legal-institutional approach to the problem of secession in multinational federations. This approach marries the classical understanding of federalism as a system of government with divided sovereignty to the more recent state-society and new institutional approaches in political science. Federalism is operationalized around three core institutions: constitutions, intergovernmental fiscal relations, and party systems. These three institutions are situated as the independent variables in the study. The dissertation argues that the institutional structure of federalism is a critical determinant of stability or instability (the presence or absence of secessionism) in multinational federations.

L'introduction des OGM dans le domaine agricole soulève diverses préoccupations. Qu'il s'agisse du type d'agriculture ou des aliments que nous privilégions pour l'avenir, de la sauvegarde des écosystèmes et des patrimoines culturels, des questions de justice, d'équité et d'éthique, les choix de société que suscitent les OGM sont nombreux. Notre argumentation est à l'effet que, seul un processus démocratique offrant aux citoyens la possibilité d'exprimer leurs préoccupations, commentaires et opinions sur le développement des aliments transgéniques est en mesure de permettre une prise de décision éclairée des autorités quant à ces choix de société. Les gouvernements de nombreux pays démontrent par ailleurs leur volonté d'ouvrir le dialogue avec le grand public sur les enjeux que suscitent ces nouvelles technologies. Notre étude analyse différents modèles de participation du public aux décisions portant sur les OGM au sein de trois pays, la France, la Suisse et le Canada. Nous avons organisé ces modèles en les classant sous trois rubriques : les instruments de la démocratie directe, l'implication de membres de la société dans les processus d'évaluation, les débats publics. Nous constatons alors que malgré les efforts des autorités pour démocratiser les prises de décisions en cette matière, de nombreux facteurs, tels la logique technicienne dans laquelle s'inscrivent les décisions ainsi que les lacunes inhérentes au régime représentatif, ne permettent pas une véritable prise en compte de l'opinion des citoyens. Il s'agit donc de s'interroger sur la pertinence et l'opportunité d'utiliser le référendum afin de traiter des questions associées aux OGM. / The introduction of GMOs into agri-business has brought forth many public concems, such as the type of agriculture or the kind of foods we choose for our future, the safekeeping of our ecosystems and our cultural heritage, or matters of justice linked to ethics and equity. Our argumentation is that only a democratic process that offers to the citizens the possibility to express their views and concems on the development of GMOs will allow the authorities to make enlightened decisions on these matters. Moreover, many govemments have already shown interest in opening communication lines with the general public on the stakes created by these new technologies. This study analyzes different forms of public participation in the decision-making process conceming GMOs in three different countries, France, Switzerland and Canada. These models have been divided into three categories : the instruments of direct democracy, participation of different members of society in the evaluation processes, and public debates. We note that in spite of the efforts of the govemments to democratize decisionmaking in these matters, many factors such as technical reasoning into which decisions are inscribed as weIl as the inherent gaps of the representative model, prevent from taking the opinions of citizens into consideration. Therefore, we should ask ourselves about the relevance and the convenience of using the referendum to treat the concems associated with GMOs. / "Mémoire présenté à la Faculté des études supérieures en vue de l'obtention du grade de Maître en droit (LL.M.)"

The official language policies and their basic concepts, the principle of personality in Canada and the principle of territoriality in Switzerland, are critically analyzed. The two democratic federations are compared as two multination states since 'nation' is defined in cultural terms. Language survival is justified in liberal theory through minority rights. The principle of territoriality that assures the dominance of the linguistic majority over a territory within the federation is in accordance with liberal democracy if fundamental rights are protected. The principle of territoriality contributes thus to political stability within a multination federation. There is no movement in Switzerland that is fed by a language-based grievance despite the existence of three linguistic minorities: Switzerland accommodates successfully linguistic diversity. In Canada, the perception that the survival of the French language might not be sustained fuels a secessionist movement threatening the unity of the federation.

Land use and cover change (LUCC) is increasingly recognised as one of the most visible impacts of humans on nature. In rural areas, most of the observed LUCC is associated with agricultural activities. This has traditionally been attributed to the interplay of the socio-economic and political milieu, and the opportunities and constraints arising from the climatic conditions and physical attributes of land. Although there is no doubt that these factors influence farmer decisions, the mosaic of farming systems suggests that farmers do not always behave uniformly, even in areas with comparable socio-economic and environmental conditions. While the multi-facetted and varying nature of farmer decision-making is considered to be established knowledge in rural sociology, it is often neglected in LUCC models that typically describe it as homogeneous and rational in economic terms. This thesis presents an application of mixed-method social survey which aims at improving the representation of the diversity and complexity of farmer decision-making process in LUCC models. Different data collection methods (in-depth, semi-structured interviews, questionnaire) and analyses (thematic analysis, principal components analysis, cluster analysis, choice-based conjoint analysis) were used complementarily to identify the factors that facilitate or constrain farmer participation in environmental management practices (a), to identify the dominant farmer profiles (b) and to assess farmer preferences that influence land use decisions (c). Data collection was conducted in a study area located in the Canton of Aargau, Switzerland, where there is limited knowledge about farmer decision-making drivers and actions. Research findings were used to empirically inform an agent-based model that simulates farmer decisions. Paremeterised storylines were used to explore farmer decisions in alternative futures. An advanced and context-specific representation of human agents in modeling frameworks can make LUCC models valuable tools both for landscape analysis and policy making. In the face of new policy reforms, this thesis contributes to the achievement of this objective, by presenting an approach to explore and organize the heterogeneity of farmer behaviour and to make this usable in agent-based modeling frameworks.

Grandson is a district in the French speaking canton of Vaud with no particular feature. Prosaic, it resembles many other regions of Switzerland. Such an uneventful area, with smooth social changes taking place over the course of centuries, seemed tailor-made to conduct a combined study of population and landownership. By bringing two vastly different domains of social sciences, demography and rural economy into harmony within a single study, issues of encompassing both methods, theoretically and practically, are discussed. However, the essence of this type of study is the availability of documentation. The registers of land and parish are to be structured for an automatic data processing. The analysis of databases for both the population and the landowners points to unsuspected movements of inhabitants under study, casting doubts on some received ideas on the past population of rural areas in Swiss communities. Proposing to observe eight small neighbouring villages within a limited span of time would privilege empirical aspects. This monograph attempts to picture landownership and population in the 18th century Grandson area. In doing so, some issues were clarified. Nonetheless some others could only be raised.

Faced with mounting health care costs, the United States needs to learn more cost-cutting options. The U.S. ranks at the top of lists on health care spending by country.1 The factors that drive American spending are complicated, and experts disagree with each other about which ones are most responsible for the country’s high medical costs; some commonly cited cost drivers include Medicaid, Medicare, fee-for-service and malpractice law. There are currently a number of methods employed by the government, hospitals, and insurance companies to keep costs down, including the increased use of Licensed Practical Nurses and Physicians Assistants, acute care and cost shifting,and Health Maintenance Organizations. In order to learn more about ways to save money on health care, the United States should look to other countries for examples. Switzerland enacted universal health care in 1994; in the nearly twenty years since, the government and insurance companies have instituted measures to control spending. These are practices and policies such as, blue letters of warning for seemingly frivolous doctors, no special insurance program or extra coverage for the elderly, and increased competition. Switzerland spends less on health care each year than the United States and yet has a higher life expectancy. 2 Furthermore, Switzerland celebrates twenty years of universal health care in the same year the individual mandate takes effect in the United States, 2014. Now is a timely moment to see if studying Switzerland’s health care system illuminates the options to American policymakers. Drawing information from scholarly articles, web articles, and website data, I will begin with a literature review section that underscores why a comparison between the Swiss and American health care systems can deepen our understanding of the policy options facing contemporary U.S. policymakers. I will then compare and contrast some specific features of the two health care systems. I will conclude by reflecting on whether and how lessons learned from Switzerland's health care policy can guide the American health care debate. / Department of Political Science