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Leickly E, Townley G. Left Behind: Experiences of Community Mental Health Center Clients with Serious Mental Illness During the COVID-19 Pandemic. Community Ment Health J 2024; 60:1131-1140. [PMID: 38546909 DOI: 10.1007/s10597-024-01264-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/01/2024] [Indexed: 06/27/2024]
Abstract
While some international qualitative research has interviewed people with serious mental illnesses (SMI) about their experiences in the initial months of the COVID-19 pandemic, few US studies have explored their experiences and perspectives as the pandemic has continued. Drawing from disability studies perspectives, this qualitative study conducted in 2022 explored the experiences of people with SMI seeking services at community mental health centers during the COVID-19 pandemic. Fifteen clients who identified as living with an SMI and were clients during March 2020 were interviewed. Using narrative analysis, we identified an overarching tenor of client experiences: feeling left behind by institutions and society. This feeling of being left behind was conceptualized as three themes. As the literature around the COVID-19 pandemic grows and we attempt to integrate it into community mental health policy and practice, it is essential to include the experiences and perspectives of clients with lived experience of SMI.
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Affiliation(s)
- Emily Leickly
- Washington State University, 412 E Spokane Falls Blvd, Spokane, WA, 99202, USA.
| | - Greg Townley
- Portland State University, 1721 SW Broadway, Portland, OR, 97201, USA
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2
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Attafuah PYA, Everink IH, Lohrmann C, Abuosi A, Schols JM. Health and social needs of older adults in slum communities in Ghana: a phenomenological approach used in 2021. Arch Public Health 2023; 81:74. [PMID: 37106445 PMCID: PMC10134515 DOI: 10.1186/s13690-023-01056-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/08/2023] [Indexed: 04/29/2023] Open
Abstract
Slum-dwellers lack several essential amenities (such as water, sanitation, and electricity) which make them more vulnerable than non-slum dwellers. As there is limited to no access to health and social care services in slums, the slum environment is expected to be an even more dangerous environment for older adults, negatively impacting their quality of life (QoL). To provide an overview of the perceived (unmet) health and social care needs and how it affects the QoL, this study aims to explore the self-perceived health and social needs of older adults in urban slums in Ghana. Using a phenomenological approach, 25 semi-structured interviews were conducted between May and June 2021, in the homes of older adults in two slums in Ghana. After coding and analysing the transcripts, five main themes emerged: (a) perception of health; (b) (de)motivators of health service use; (c) perception of social care, (d) social needs, and (e) influence of phenomena on QoL. It appeared that older adults believed that spiritual powers were causing illnesses and influenced their use of formal health services. Other factors such as expired insurance cards and the attitude of healthcare workers served as demotivators for using health services.Perceived health needs were mainly current disease conditions (arthritis, diabetes, hypertension, vision/hearing challenges), challenges with health insurance, the behaviour of some health professionals, the proximity of health facilities, and unnecessary queues at major health facilities. Unmet social needs identified by this study were a sense of neglect by family (need for companionship), requiring assistance with activities of daily living, and the need for financial support. Participants had more health needs than social needs. Health providers do not usually prioritize the care of slum-dwelling older adults. Most participants still have challenges with the National Health Insurance Scheme (NHIS). Their social needs were mainly related to financial difficulties and help with some activities of daily living. Participants expressed that they desired companionship (especially the widowed or divorced ones) and the lack of it made them feel lonely and neglected. Home visits by health professionals to older adults should be encouraged to monitor their health condition and advocate for family members to keep older adults company. Healthcare providers should exhibit positive attitudes and educate older patients on the advantages of formal health services use, as well as the need to seek early treatment as this will influence their QoL to a large extent.
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Affiliation(s)
- Priscilla Yeye Adumoah Attafuah
- School of Nursing and Midwifery, University of Ghana, Legon, Ghana.
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.
| | - Irma Hj Everink
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Aaron Abuosi
- Health Services Management Department, University of Ghana Business School, Legon, Ghana
| | - Jos Mga Schols
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
- Department of Family Medicine and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
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Borelli WV, Xavier LDL, Ornell F, Schuch JB, Von Diemen L. The hidden stigma of aging and COVID-19: aggravating factors and strategies to mitigate the impact of the pandemic in older adults, a text mining analysis. Aging Ment Health 2022; 26:881-889. [PMID: 33949899 DOI: 10.1080/13607863.2021.1910793] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To identify factors associated with mental health of older adults during the pandemic and to provide strategies to mitigate their psychosocial impact in the elderly. METHOD An integrative text mining analysis in Medline was performed to identify studies on the mental health of older adults during the pandemic. Subsequently, statistical topic modeling was performed to identify the most prevalent terms and topics discussed in included studies. RESULTS A total of 29 studies were retrieved until July 1st 2020, including a majority of letters (12 studies) and commentaries (8 studies). The most frequent terms overall were: loneliness (n = 137), support (n = 132), home (n = 102), suicide (n = 96) and help (n = 94). The most prevalent terms were then divided in five topics: home (33%), suicide (32%), apps (15%), loneliness (12%) and physical activity (9%). Additionally, a section focused on low- and middle-income countries was included. A summary of strategies to mitigate the effects of pandemic in mental health of older adults was also provided. CONCLUSION These factors demonstrate the importance of developing strategies for psychosocial support that take into consideration the particularities of the elderly. Different levels of care are immediately necessary to diminish the devastating impact of the pandemic in the mental health of older adults.
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Affiliation(s)
| | - Laura de Lima Xavier
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Felipe Ornell
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Psiquiatria e Ciências Do Comportamento, Departamento de Psiquiatria e Medicina Legal, Faculdade de Medicina, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Jaqueline Bohrer Schuch
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS, Brazil
| | - Lisia Von Diemen
- Center for Drug and Alcohol Research, Hospital de Clínicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS, Brazil
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Murphy JK, Khan A, Sun Q, Minas H, Hatcher S, Ng CH, Withers M, Greenshaw A, Michalak EE, Chakraborty PA, Sandanasamy KS, Ibrahim N, Ravindran A, Chen J, Nguyen VC, Lam RW. Needs, gaps and opportunities for standard and e-mental health care among at-risk populations in the Asia Pacific in the context of COVID-19: a rapid scoping review. Int J Equity Health 2021; 20:161. [PMID: 34253198 PMCID: PMC8274266 DOI: 10.1186/s12939-021-01484-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/28/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic is expected to have profound mental health impact, including in the Asia Pacific Economic Cooperation (APEC) region. Some populations might be at higher risk of experiencing negative mental health impacts and may encounter increased barriers to accessing mental health care. The pandemic and related restrictions have led to changes in care delivery, including a rapid shift to the use of e-mental health and digital technologies. It is therefore essential to consider needs and opportunities for equitable mental health care delivery to the most at-risk populations. This rapid scoping review: 1) identifies populations in the APEC region that are at higher risk of the negative mental health impacts of COVID-19, 2) identifies needs and gaps in access to standard and e-mental health care among these populations, and 3) explores the potential of e-mental health to address these needs. METHODS We conducted a rapid scoping review following the PRISMA Extension for Scoping Reviews (PRISMA-ScR). We searched Medline, Embase and PsychInfo databases and Google Scholar using a search strategy developed in consultation with a biomedical librarian. We included records related to mental health or psychosocial risk factors and COVID-19 among at-risk groups; that referred to one or more APEC member economies or had a global, thus generalizable, scope; English language papers, and papers with full text available. RESULTS A total of 132 records published between December 2019 and August 2020 were included in the final analysis. Several priority at-risk populations, risk factors, challenges and recommendations for standard and e-mental health care were identified. Results demonstrate that e-mental health care can be a viable option for care delivery but that specific accessibility and acceptability considerations must be considered. Options for in-person, hybrid or "low-tech" care must also remain available. CONCLUSIONS The COVID-19 pandemic has highlighted the urgent need for equitable standard and e-mental health care. It has also highlighted the persistent social and structural inequities that contribute to poor mental health. The APEC region is vast and diverse; findings from the region can guide policy and practice in the delivery of equitable mental health care in the region and beyond.
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Affiliation(s)
- Jill K Murphy
- Department of Psychiatry, Faculty of Medicine; APEC Digital Hub for Mental Health, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada.
| | - Amna Khan
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, 2255 Westbrook Mall, Vancouver, BC, V6T 2A1, Canada
| | - Qiumeng Sun
- Sol Price School of Public Policy, University of Southern California, 650 Childs Way, Los Angeles, CA, 90089, USA
| | - Harry Minas
- Global and Cultural Mental Health, Level 4, 207 Bouverie Street, Melbourne, Australia
- The University of Melbourne, Melbourne School of Population and Global Health, Carlton, Victoria, 3010, Australia
| | - Simon Hatcher
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Roger Guindon Hall, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Chee H Ng
- Healthscope Chair of Psychiatry, Department of Psychiatry, The University of Melbourne, Carlton, Victoria, 3010, Australia
| | - Mellissa Withers
- USC Keck School of Medicine, USC Institute on Inequalities in Global Health, Los Angeles, USA
- APRU Global Health Program, 2001 N Soto Street SSB 318G, Los Angeles, CA, 90089, USA
| | - Andrew Greenshaw
- Department of Psychiatry, Scientific Director, APEC Digital Hub for Mental Health, Faculty of Medicine & Dentistry, 4-142M Katz Group Centre for Pharmacy and Health Research, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada
| | - Erin E Michalak
- APEC Digital Hub for Mental Health, University of British Columbia, 420-5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Promit Ananyo Chakraborty
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Karen Sharmini Sandanasamy
- Mental Health, Substance Abuse and Violence Injury Prevention, Non-Communicable Disease Section, Disease Control Division, Ministry of Health, Level 2, Block E3, Putrajaya, Malaysia
- Precinct 1, Federal Government Administrative Complex, 62590, Putrajaya, Malaysia
| | - Nurashikin Ibrahim
- Mental Health, Substance Abuse and Violence Injury Prevention, Non-Communicable Disease Section, Disease Control Division, Ministry of Health, Level 2, Block E3, Putrajaya, Malaysia
- Precinct 1, Federal Government Administrative Complex, 62590, Putrajaya, Malaysia
| | - Arun Ravindran
- Global Mental Health Affairs & The Office of Fellowship Training, Department of Psychiatry, Graduate Faculty, Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 100 Stokes St, Toronto, ON, M6J 1H4, Canada
| | - Jun Chen
- Office for Clinical Research Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wan Ping Rd, Xuhui District, Shanghai, China
| | - Vu Cong Nguyen
- Institute of Population, Health and Development, ICON4 Tower, 243a Đường La Thành, Láng Thượng, Đống Đa, Hà Nội, 117222, Vietnam
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
- Mood Disorders Centre, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada
- APEC Digital Hub for Mental Health, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada
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Davison KM, Thakkar V, Lin S(L, Stabler L, MacPhee M, Carroll S, Collins B, Rezler Z, Colautti J, Xu C(C, Fuller-Thomson E, Hey B, Kelly K, Mullaly L, Remick R, Ravindran A, Paric A, D’Andreamatteo C, Smye V. Interventions to Support Mental Health among Those with Health Conditions That Present Risk for Severe Infection from Coronavirus Disease 2019 (COVID-19): A Scoping Review of English and Chinese-Language Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7265. [PMID: 34299716 PMCID: PMC8303838 DOI: 10.3390/ijerph18147265] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 12/02/2022]
Abstract
This study aimed to address knowledge gaps related to the prevention and management of mental health responses among those with a condition that presents risk of severe COVID-19 infection. A scoping review that mapped English and Chinese-language studies (2019-2020) located in MEDLINE (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, Sociological Abstracts, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Data, and Airiti Library was undertaken. Search terms related to COVID-19, mental health, and physical health were used and articles that included all three of these factors were extracted (n = 77). With the exception of one hospital-based pilot study, there were no intervention studies targeting mental health in those at risk of severe COVID-19 infection. Promising practices such as integrated care models that appropriately screen for mental health issues, address health determinants, and include use of digital resources were highlighted. Patient navigator programs, group online medical visits, peer support, and social prescribing may also support those with complex needs. Future policies need to address digital health access inequities and the implementation of multi-integrated health and social care. Furthermore, research is needed to comprehensively assess multi-integrated interventions that are resilient to public health crises.
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Affiliation(s)
- Karen M. Davison
- Health Science Program, Kwantlen Polytechnic University, 12666 72 Ave, Surrey, BC V3W 2M8, Canada;
| | - Vidhi Thakkar
- Health Science Program, Kwantlen Polytechnic University, 12666 72 Ave, Surrey, BC V3W 2M8, Canada;
| | - Shen (Lamson) Lin
- Factor-Inwentash Faculty of Social Work, University of Toronto, 46 Bloor St W, Toronto, ON M5S 1V4, Canada; (S.L.); (E.F.-T.)
| | - Lorna Stabler
- CASCADE Children’s Social Care Research and Development Centre, School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff CF10 3BD, UK;
| | - Maura MacPhee
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada;
| | - Simon Carroll
- Department of Sociology, Cornett Building, University of Victoria, A333, Victoria, BC V8W 3P5, Canada;
| | - Benjamin Collins
- Department of Anthropology, University of Manitoba, 432 Fletcher Argue Building, 15 Chancellor Circle, Winnipeg, MB R3T 2N2, Canada;
| | - Zachary Rezler
- Health Sciences Program, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada; (Z.R.); (J.C.); (C.X.)
| | - Jake Colautti
- Health Sciences Program, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada; (Z.R.); (J.C.); (C.X.)
| | - Chaoqun (Cherry) Xu
- Health Sciences Program, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada; (Z.R.); (J.C.); (C.X.)
| | - Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 46 Bloor St W, Toronto, ON M5S 1V4, Canada; (S.L.); (E.F.-T.)
| | - Brandon Hey
- COVID 19 Policy, Programs and Priorities, Mental Health Commission of Canada, 350 Albert Street, Suite 1210, Ottawa, ON K1R 1A4, Canada;
| | - Krystal Kelly
- Mental Health Advancement, Mental Health Commission of Canada, 350 Albert Street, Suite 1210, Ottawa, ON K1R 1A4, Canada; (L.M.); (K.K.)
| | - Laura Mullaly
- Mental Health Advancement, Mental Health Commission of Canada, 350 Albert Street, Suite 1210, Ottawa, ON K1R 1A4, Canada; (L.M.); (K.K.)
| | - Ron Remick
- Lookout Housing and Health Society, 544 Columbia St, New Westminster, BC V3L 1B1, Canada;
| | - Arun Ravindran
- Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, 1001 Queen St W, Toronto, ON M6J 1H4, Canada; (A.R.); (A.P.)
| | - Angela Paric
- Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, 1001 Queen St W, Toronto, ON M6J 1H4, Canada; (A.R.); (A.P.)
| | - Carla D’Andreamatteo
- Department of Food and Human Nutritional Sciences, University of Manitoba, 209 Human Ecology Building, Winnipeg, MB R3T 2N2, Canada;
| | - Victoria Smye
- Arthur Labatt School of Nursing, Western University, 1151 Richmond Street, London, ON N6A 3K7, Canada;
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Gaertner B, Fuchs J, Möhler R, Meyer G, Scheidt-Nave C. Older people at the beginning of the COVID-19 pandemic: A scoping review. JOURNAL OF HEALTH MONITORING 2021; 6:2-37. [PMID: 35586562 PMCID: PMC8832372 DOI: 10.25646/7857] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/12/2021] [Indexed: 12/23/2022]
Abstract
This scoping review focuses on evidence gaps regarding the effects on health, social participation and life contexts of older people at the beginning of the COVID-19 pandemic. It is based on a systematic search strategy of the international literature covering a period between December 2019 and June 2020. The review is supplemented by a search of the websites of selected organisations in Germany (cut-off date: 29 June 2020). Search hits were differentiated by types of publication (empirical study, review, discussion paper). The contents were summarised in tabular form according to topic. The publications mainly discussed the high risks of suffering severe courses of COVID-19 faced by older people, specifically those belonging to certain subgroups. In addition, further main topics were the pandemic’s indirect impacts on physical and mental health, physical and cognitive functions and participation in society. Social isolation, loneliness, reduced levels of physical activity and difficulties in maintaining care were discussed as major health risks. Ageism was an issue that was addressed across all of the identified topics. The publications highlighted the need, but also the opportunity, for raising public awareness of the needs of older people in various life contexts. Publications pointed to the urgent need for research into the biological and social causes of older peoples’ high infection risk and how measures could be adapted in a differentiated manner (infection prevention and control measures, social support, medical and nursing care).
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Affiliation(s)
- Beate Gaertner
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Judith Fuchs
- Robert Koch Institute, Berlin Department of Epidemiology and Health Monitoring
| | - Ralph Möhler
- Heinrich Heine University Düsseldorf, Institute for Health Services Research and Health Economics.,Bielefeld University, School of Public Health, Department of Health Services Research and Nursing Science
| | - Gabriele Meyer
- Martin Luther University Halle-Wittenberg, Institute for Health and Nursing Science
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Moser A, Carlander M, Wieser S, Hämmig O, Puhan MA, Höglinger M. The COVID-19 Social Monitor longitudinal online panel: Real-time monitoring of social and public health consequences of the COVID-19 emergency in Switzerland. PLoS One 2020; 15:e0242129. [PMID: 33175906 PMCID: PMC7657546 DOI: 10.1371/journal.pone.0242129] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/27/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic challenges societies in unknown ways, and individuals experience a substantial change in their daily lives and activities. Our study aims to describe these changes using population-based self-reported data about social and health behavior in a random sample of the Swiss population during the COVID-19 pandemic. The aim of the present article is two-fold: First, we want to describe the study methodology. Second, we want to report participant characteristics and study findings of the first survey wave to provide some baseline results for our study. METHODS Our study design is a longitudinal online panel of a random sample of the Swiss population. We measure outcome indicators covering general well-being, physical and mental health, social support, healthcare use and working state over multiple survey waves. RESULTS From 8,174 contacted individuals, 2,026 individuals participated in the first survey wave which corresponds to a response rate of 24.8%. Most survey participants reported a good to very good general life satisfaction (93.3%). 41.4% of the participants reported a worsened quality of life compared to before the COVID-19 emergency and 9.8% feelings of loneliness. DISCUSSION The COVID-19 Social Monitor is a population-based online survey which informs the public, health authorities, and the scientific community about relevant aspects and potential changes in social and health behavior during the COVID-19 emergency and beyond. Future research will follow up on the described study population focusing on COVID-19 relevant topics such as subgroup differences in the impact of the pandemic on well-being and quality of life or different dynamics of perceived psychological distress.
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Affiliation(s)
- André Moser
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Maria Carlander
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Simon Wieser
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Oliver Hämmig
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Milo A. Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Marc Höglinger
- Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland
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