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The Swiss healthcare system is renowned for its excellence yet is complex, presenting challenges that may lead to suboptimal patient choices. This doctoral thesis aims to break down these complexities by addressing three research questions and empower patients with data-derived insights, using comprehensive data from Helsana, a major health insurance in Switzerland. All three key studies were retrospective and included descriptive and statistical analyses using a comprehensive dataset that included socio-demographic, insurance-related, and other variables. Study 1 investigates opioid prescriptions after knee replacement, revealing unexpectedly high opioid usage postoperatively, with associated risk factors identified. Study 2 explores the relationship between hospital volumes for abdominal cancer procedures and treatment outcomes, finding no clear volume-outcome association. Study 3 delves into biosimilar prescriptions, showing a low proportion of biosimilars with specific determinants influencing biosimilars use. Different key insights are derived from these studies: Study 1 advocates for more frequent consideration of alternative pain management options post knee replacement surgery due to high opioid use found. Study 2 proposes that healthcare planners should consider multiple factors beyond annual hospital volume for optimizing treatment outcomes. Study 3 underscores the importance of physician-patient engagement in therapy decisions due to the low uptake of biosimilars despite potential cost saving potential. Overall, this research contributes to optimizing healthcare provision and promoting patient-centered care in Switzerland. Thus, these findings advocate for integrating patient preferences and beliefs with evidence-based medicine to enhance therapy choices. More specifically, they inform policy decisions aimed at improving pain management post-surgery, enhancing service provision quality in hospitals, and optimizing the use of biologica, + UNILU Diss 2024 F5 EL

Background: Due to the majority of males within the population of persons with spinal cord injuries (SCI), a male-oriented perception of persons with SCI might affect care provision in the way of prioritizing male needs. Objective: The objective of this cross-sectional study is to describe the patient experience of persons with SCI by gender. Methods: This study was based on the International Spinal Cord Injury Survey with 12,588 participants from 22 countries. An interval-based patient experience score was attained by partial credit model. Regression analysis was used in exploring the association between patient experience and gender. Results: Participants reported very good and good patient experience. Respectful treatment was reported by 78 % of participants; clear explanations by 75 %; involvement in decision-making by 71 %; satisfaction with services by 62 %. The average patient experience score was equal among males and females (average: 64, range: 0–100), with the highest score in participants from the USA (78) and the lowest – in Morocco (44). Patient experience score was not associated with gender. Females had lower odds of reporting better decision-making involvement, yet higher odds of better satisfaction. Older participants, with higher household income and better self-rated health, had lower odds of being satisfied. Conclusion: The majority of persons with SCI rated their experience as good or very good. Females were more likely to report higher satisfaction with services and lower involvement in decision-making. For other patient experience categories and the overall patient experience score, no association with gender was found.

The human body hosts diverse communities of microorganisms, collectively known as the indigenous microbiota, which are modulated by the body's processes. Individuals with spinal cord injury (SCI) have changes in their bodies secondary to the injury and their microbiomes have changed as well. The microbiome is the collective genome of  microorganisms, their by-products, and their environment. The diet and the immune system are the primary modulator of the gut microbiome in individuals with SCI. The shift in balance in the interaction of the body and the gut microbiome can give rise to increase risks to diseases. Thus, in exploring the microbiomes of individuals with SCI we look into the immune system and characterize the gut microbiome in the population with SCI and investigate possible areas, such as diet, for modulation of microbiomes. This thesis employed systematic reviews, meta-analysis, and results from a crosssectional study. We found that there is significant difference in the immune status of individuals with SCI. There was significantly higher leukocyte, neutrophil and IgM concentrations, higher interleukin (IL)-6 and c- reactive protein (CRP) concentrations in the blood compared to those without SCI. There was significantly higher leukocyte and neutrophil concentrations in the semen and significantly higher activation of the mast cells in the urothelium vs those without SCI. Injury-relevant (phase of injury, completeness of injury, sympathetic innervation impairment, age and sex) and study related characteristics (sample size, study design and use of serum vs plasma) contributed to the heterogeneity in the pooled estimates. Moreover, there is a significantly lower functional capabilities of the immune cells in individuals with chronic SCI. This relates to the observed differences in the microbiomes of individuals with SCI vs those without SCI in our systematic review. There is significant gut micr, + UNILU Diss 2024 F5 EL

Developmental dysplasia of the hip (DDH) is a significant health problem that can lead to lifelong treated or disabled individuals if the diagnosis is missed in the first weeks of life. In Mongolia, an ultrasonic method (Graf) of DDH screening was introduced, piloted, and expanded as a nationwide newborn screening program in 2010. Trained neonatologists or pediatricians perform the hip ultrasound screening following standardized procedures and are responsible for the flexion-abduction treatment, if necessary. Complete documentation of all cases is mandatory. Screening, follow-up monitoring, and flexionabduction treatment are offered free of charge. The program aims to screen every newborn baby using hip ultrasound and provide early preventive treatment to eliminate disability due to DDH. As Mongolia is the first Asian country to launch a program of universal ultrasound screening for DDH, we needed to determine its coverage and treatment rate. During the implementation of the screening, we documented that physiological immaturity (Graf’s Type 2a) hips degrade and develop DDH. In these cases, unfavorable mechanical conditions may exist after birth since traditional Mongolian swaddling requires a tight wrapping with stretched legs, and the hips are held in an adducted position. Therefore, traditional swaddling possibly increases the risk for DDH. This hypothesis was tested with a randomized controlled trial. Another challenge of the nationwide screening program was a human resources issue. Because resources are limited, adequately trained physicians are not always available, especially in remote rural areas. Thus we compared the quality and interpretation of hip ultrasound between trained nurses and junior physicians with no previous ultrasound experiences. This thesis demonstrated that a simplified diagnostic and therapeutic framework for hip ultrasound DDH screening for newborns was successfully deployed in Mongolia, providing high,  + UNILU Diss 2024 F5 EL