The guidelines for the design of the posters: A0 (84,1 × 118,9 cm)
It is the same principle as in a Gallery. You can stand next to your poster and give explanations and your contact details if visitors are interested.
The posters are located in the same place as the breaks. It is recommended to be at the poster during the "poster flashes" and the breaks.
Here you can find the program overview with the poster flashes and the breaks.
Title Vitamin D level predictors in the pilot of the first Swiss national survey on children nutrition : menuCH-Kids
Name Christina Sader
Vitamin D is essential for proper growth and development, but few data are available on the predictors of vitamin D status among children and adolescents.
The first Swiss national survey on children nutrition, menuCH-Kids, aims at filling out the gap for Switzerland.
Pilot data gave preliminary results about associations between blood vitamin D and BMI, vitamin D supplementation, fish consumption, screen time and physical activity.
If those results are confirmed with the main phase larger sample, they could help to target vitamin D public health guidelines at some modifiable factors.
Title menuCH-Kids, pilot phase of the first Swiss national nutrition survey in children and adolescents
Name Julia Vincentini
Affiliation Unisanté, Mandate from the Federal Office of Food Security and Veterinary Affairs
menuCH-kids is a study mandated by the Federal Office for Food Safety and Veterinary Affairs (FSVO) and carried out by a dozen of Swiss scientific institutions. It is a nationally representative survey aiming at capturing food consumption and dietary and health behaviors of randomly selected children and adolescents aged 6 to 17 years, covering German-, French- and Italian-speaking parts of Switzerland. It includes the collection of food consumption data (24h recalls and food propensity questionnaire), lifestyle data, physical measurements, urine samples and voluntary blood sample. The pilot phase was conducted in the spring 2023, with a participation rate of 13.6% (186 children). As the pilot went well and validated the different procedures, the main phase will begin in September 2023 and last one year, with 1800 participants expected.
Title ASSOCIATION OF PLASMA ZINC LEVELS WITH ANTI-SARS-COV-2 IGG AND IGA SEROPOSITIVITY IN THE
GENERAL POPULATION: A CASE-CONTROL STUDY
Name Antoine Equey
Introduction: Some micronutrients have key roles in immune defence, including mucosal defence mechanisms and immunoglobulin production. Micronutrient deficiencies can weaken or dysregulate the immune system, which could partially explain the role of age and overweight in severe COVID-19. Consistently with this hypothesis, multiple studies show associations of lower zinc (Zn), selenium (Se) and iron (Fe) levels – but not lower copper (Cu) levels – with both COVID-19 incidence and severity. We assessed the associations of circulating copper, selenium, zinc, and vitamin D3 (25(OH)D3) with anti-SARS-CoV-2 IgG and IgA seropositivity in the Swiss community using early pandemic data.
Methods: Case-control study comparing the first PCR-confirmed COVID-19 symptomatic cases in the Vaud Canton (May to June 2020, n = 199) and controls (random population sample, n = 447), seronegative for IgG and IgA. The replication analysis included seropositive (n = 134) and seronegative (n = 152) close contacts from confirmed COVID-19 cases. Anti-SARS-CoV-2 IgG and IgA levels against the native trimeric spike protein were measured using the Luminex immunoassay. We measured plasma Zn, Se and Cu concentrations by ICP-MS, and 25(OH)D3 with LC-MS/MS and explored associations using multiple logistic regression.
Results: The 932 participants (54.1% women) were aged 48.6 ± 20.2 years (±SD), BMI 25.0 ± 4.7 kg/m2, with median C-Reactive Protein 1 mg/l. In logistic regressions, log2(Zn) plasma levels were negatively associated with IgG seropositivity (OR [95% CI]: 0.196 [0.0831; 0.465], P < 0.001; replication analyses: 0.294 [0.0893; 0.968], P < 0.05). Results were similar for IgA, which association remained significant after controlling for other micronutrients, age, gender, BMI, smoking status and CRP level. We found no association of Cu, Se, and 25(OH)D3 with anti-SARS-CoV-2 IgG or IgA seropositivity.
Conclusion: Low plasma Zn levels were associated with higher anti-SARS-CoV-2 IgG and IgA seropositivity in a Swiss population, when the initial viral variant was circulating, and no vaccination available. These results suggest that adequate Zn status may play an important role in protecting the general population against SARS-CoV-2 infection.
Title Population perspective on health system performance: evidence from a phone survey in Laos
Name Amit Aryal
Affiliation Swiss Tropical and Public Health Institute
AbstractThe Lancet Global Health Commission on High-Quality Health Systems (HQSS Commission) defined a high-quality health system as one that “consistently provides care that improves or maintains health, is trusted by the people, and responds to changing population needs.” To understand whether health systems are meeting these goals, it is critical to understand the experiences and perspectives of the people it is intended to serve. However, in many low- and middle-income countries, governments have limited information on how the population uses (or does not use) the primary care system, the coverage of key primary care services, and the population’s trust and confidence in the system. These measures can play an important role in informing health system improvements.
The People’s Voice Survey (PVS) is a novel phone-based survey designed to integrate people’s voices into primary care performance measurement. It enables rapid assessment of utilization patterns, coverage of primary care services, perceptions of health system quality and trust in the overall health system.
Using the PVS, we conducted a cross-sectional survey of the general adult (18+) population in Laos in 2022. Sampling was stratified by age, gender, region, and geographic area based on a target sample size consistent with recent nationwide household surveys. We called 11,835 unique phone numbers to reach 2,008 completed interviews, which translates to a response rate of 17%.
The study highlights substantial health system challenges as Laos aims to achieve universal health coverage by 2025. First, there is significant bypassing of the primary care system for hospital-based care. Almost two-thirds identified hospitals as their usual place for care compared to only 16% that identified health centers. Second, respondents gave very low ratings to the quality of care across all health facilities. Only 30% rated their health care experience in the last visit as excellent or very good, with even lower ratings for specific components such as provider knowledge about previous visit and inclusion in decisions about care by provider. Finally, there is evidence of significant inequities in health system utilization patterns. There is almost a three-fold difference of women receiving mammogram examination and cervical cancer screening between the wealthiest and least wealthy quintiles. And twice as many among the wealthiest had vision, teeth, blood glucose and cholesterol checked compared to the least wealthy.
Title Youth’s alcohol use: what are the differences between non-drinkers, non-heavy drinkers and heavy drinkers?
Name Yara Barrense-Dias
AbstractPurpose: To determine the characteristics of young non-, non-heavy and heavy drinkers. Methods: Data were drawn from a longitudinal study in the Fribourg canton among post-mandatory students and apprentices between 2015 (mean age 16) and 2018. In each wave, 2 questions related to alcohol use were asked: “Have you ever drank alcohol?” (Yes/No) and “Have you been drunk in the last 30 days?” (Yes/No), creating 3 categories: Non-drinkers (never drank); Light drinkers (ever drank but no drunkenness last 30 days) and Heavy drinkers (ever drank and drunkenness last 30 days). Five trajectories of drinking status were found by analysing the participants’ path (N=1645) in all the waves: non-drinkers, undecided drinkers, light drinkers, late onset light drinkers and heavy drinkers. For this study, we gathered undecided, light and late onset light drinkers in one group of non-heavy drinkers. The 3 groups (non-drinkers [16.8%], non-heavy drinkers [38.7%] and heavy drinkers [44.5%]) were compared on sociodemographic, family, academic, health and substance use data. Non-heavy drinkers were used as the reference category. Results are presented as relative risk ratio (RRR) with 95% confidence interval. Results: At the bivariate level, drinking status was associated to gender, age, parental situation (together/other), residence (urban/rural), place of birth (Switzerland/abroad), academic track (student/apprentice), tobacco and cannabis use. No associations were found with academic grades, relationship with parents, socioeconomic status, health perception, emotional well-being and sport activity. At the multivariate level, Non-drinkers were more likely to live in an urban area (RRR 2.19 [1.54-3.11]) and less likely to smoke (0.36 [0.22-0.61]). Heavy drinkers were more likely to be males (2.09 [1.55-2.82]), apprentices (1.88 [1.34-2.62]), Swiss-born (2.02 [1.18-3.48]), smokers (3.21 [2.32-4.45]) and cannabis users (4.54 [2.74-7.52]). They were less likely to have their parents together (0.70 [0.49-0.98]) and live in an urban area (0.50 [0.35-0.71]). Conclusions: Non-drinkers do not seem to differ much from non-heavy drinkers. However, the non-negligible rate of young non-drinkers and the differences that still exist with drinkers demonstrate the need to consider the former specifically in prevention. Heavy drinkers demonstrated more specificities and prevention should target precise contexts, especially in rural areas where alcohol (mis)use seems to be more present.
Title What are the reasons why some young people do not drink alcohol? A qualitative study
Name Lorraine Chok
Affiliation Unisanté, Groupe de Recherche sur la santé des ados
AbstractPurpose: To explore the reasons why some young people do not drink alcohol.
Methods: Between April-June 2022, 63 adolescents aged 14-20 years participated in 12 focus groups. Participants were separated according to their gender, age and alcohol status (drinkers/non-drinkers). A content analysis was performed.
Results: Different reasons for non-drinking were reported such as religion, health, family environment and rules, bad experiences and fear.
Religion was often the first reason reported by the participants. This reason also seemed to be the most respected by drinkers, as they do not make remarks to persuade them to drink.
For health, immediate and long-term effects of alcohol were discussed and sport was also reported as a reason not to drink. “By not drinking alcohol, I think you are in much better shape. I think that it can be much more beneficial, especially for people who play sport […].” (Male, 16, non-drinker).
Parents and family also influenced non-drinking among youth because of their role as models or family rules. “Normally this is where (in the family) you first see someone drinking […]. If you do not see someone (drinking) in your family […] maybe you do not want to do it.” (Female, 20, drinker).
Youth may also decide not to drink or to stop drinking because of bad personal, family or peer experiences related to alcohol. 'When I was 16, I had my first party and I went too far. […] That is why I did not drink anymore.” (Female, 19, non-drinker).
Finally, the fear of losing control was also reported to explain non-drinking. “[…] (One advantage of not drinking is) to be aware of what you are doing, especially not to have a total loss of control [...].' (Male, 16, non-drinker). In this line, drinking alcohol could also lead to victimization, including sexual violence. This was particularly reported among females. “I do not drink, because we hear so many stories about girls being assaulted and so on. Actually, it is really (because of) fear […] When you are a girl, you are basically easy prey for the aggressors. So I say to myself ‘If you are drinking on top of that...’.” (Female, 19, non-drinker).
Conclusions: There are different reasons why some young people do not drink alcohol. In terms of prevention, although we should not reinforce the normalization of alcohol use by asking non-drinkers to justify their non-use, young people should be aware of the possible reasons why some of them do not drink alcohol and of the importance to respect all of them.
Title Drinking consequences among Swiss men throughout their twenties: A Latent Transition Analysis on data from
a 10-year-long national cohort study
Name Marc Dupuis
Affiliation Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
AbstractBackground and aims: Alcohol use is associated with long-term (cancers, liver diseases) to short-term consequences (vehicle accidents and injuries). The development of models to longitudinally predict drinking consequences by drinking pattern trajectories represents thus a challenge to provide specific prevention and interventions. The aim of this study was thus to explore drinking consequences in terms of trajectories among men in their twenties.
Design: A prospective cohort study with four measurement times at about 20, 21, 25 and 28 years of age.
Setting: A general population-based sample of Swiss men.
Participants: A total of 6,528 men who participated in the study.
Measurements: Self-reported questionnaires covering nine drinking consequences experienced during the past 12 months, drug use during lifetime and for the past 12 months, alcohol and cannabis use disorders and major depressive disorders assessed at each wave of the study, and other associated factors.
Findings: Latent transition analyses were conducted on drinking consequences over time. There was supporting evidence for a solution with four latent classes at each wave: men experiencing few consequences (class 1), men experiencing more frequently drinking consequences (class 2), and men experiencing very frequently consequences including risky sexual behavior (class 3) and antisocial behaviors (class 4). To identify trajectories, subsequent latent class analyses were conducted on the resulting latent classes at each wave. Eight trajectories were identified. Interestingly, the stable antisocial trajectory was more prevalent than transient antisocial behaviors, whereas sexual risk-taking trajectories were rather transient than durable. Stable risky trajectories showed high prevalence of drug use and mental disorders.
Conclusions: The findings represent supportive evidence to develop prediction models for the early identification of drinking pattern trajectories and specific prevention.
Title Analysis of the development of burnout patients undergoing inpatient treatment regarding age distribution and
urban-rural differences / nxgen6.2
Name Leonard Dushi
Affiliation LUKS / Nxgen Medical Services
AbstractBurnout is a psychological condition characterized by emotional exhaustion, cynicism, and a diminished sense of self-actualization. Stress-related illness, burnout, has increased in recent years. It typically occurs as a result of continuous stress and mainly affects people in very stressful occupations, such as professionals and managers. Some studies suggest that lifestyle in urban areas may also influence the development of burnout. One factor among many that can influence the risk of burnout is certainly the place of residence. However, it should be noted that further research is needed to arrive at a more comprehensive understanding of the impact of place of residence on Burnout risk in Switzerland. Over the last decade, awareness of burnout has increased in Switzerland and efforts have been made to address the problem, particularly through workplace interventions and legislative changes. Studies have shown that burnout is on the rise in Switzerland, especially among the younger generation and in certain industries, which are more common in urban areas than in rural areas.
In this research paper, we want to find out how the treatment of burnout patients has developed and been distributed over the last 20 years in terms of hospital admissions and treatment duration in the cantons regarding the age groups. For the study, BAG hospital data from 1999 to 2020 will be used. The data analysis is focused on cases reported with burnout (ICD10 Z73) as the main diagnosis and treated as inpatients in the hospital for each canton. With the obtained data, we want to show whether and where the numbers are increasing and compare whether an urban-rural gap is recognizable, to be able to predict possible statements about future development.
Title Exploring medication safety structures and processes in nursing homes: a cross-sectional study
Name Lauriane Favez
Affiliation University of Basel
AbstractBackground: Medication safety is important to limit adverse events for nursing home residents. Several factors, such as interprofessional collaboration with pharmacists and medication reviews, have been shown in the literature to influence medication safety processes.
Aim: We aimed 1) to assess the organization and infrastructure at facility and unit level in connection with the medication use process, 2) to determine the extent of medication safety-relevant processes, and 3) to explore the involvement of pharmacies and pharmacists in medication-related processes in nursing homes.
Method: Cross-sectional, multicenter, survey data (2018-2019) from a convenience sample of 118 Swiss nursing homes were used. Data was collected about facility and unit characteristics, pharmacy services, as well as structures and processes related to medication safety. Descriptive statistics were used.
Results: The majority of nursing homes have an electronic resident record system that supports medication safety in some ways (e.g., medication lists, interaction checks). Electronic data exchanges with outside partners were available for less than half the nursing homes (between 10.6% and 46.3% depending on the partner). Pharmacists working in collaboration with nursing homes were mainly involved in logistics support tasks. Medication reviews were said to be conducted regularly by two thirds of the facilities, and geriatricians were primarily initiating them.
Conclusion: A high proportion of Swiss nursing homes have diverse processes and structures in place that support medication use and safety for residents, but their collaboration with pharmacists remains relatively limited.
Title Administrative burden in Swiss nursing homes and its association with care workers’ outcomes
- A multicenter cross-sectional survey study
Name Lauriane Favez
Affiliation University of Basel
AbstractBackground: Care workers in nursing homes often perform tasks that are rather related to organizational or management activities than ‘direct patient care’. ‘Indirect care activities’ related to residents, such as documentation, or other administrative tasks are often considered by care workers as a burden. They increase overall workload, keep them away from caring for residents, and documentation especially is therefore often implicitly rationed. So far, there is little investigation into what kind of administrative tasks are being performed in nursing homes, by which type of care workers, and to which extent, nor how administrative burden is associated with care workers’ outcomes.
Purpose: The objective of this study is to describe care workers’ administrative burden in Swiss nursing homes and their association with four care worker outcomes (i.e., job dissatisfaction, emotional exhaustion, intention to leave the current job and the profession).
Methods: This multicenter cross-sectional study used survey data from the Swiss Nursing Homes Human Resources Project 2018. It included a convenience sample of 118 nursing homes and 2207 care workers (i.e., registered nurses, licensed practical nurses) from Switzerland’s German- and French-speaking regions. Care workers completed questionnaires assessing the administrative tasks and burden, staffing and resource adequacy, leadership ability, implicit rationing of nursing care and care worker characteristics and outcomes. For the analysis, we applied generalized linear mixed models, including individual-level nurse survey data and data on unit and facility characteristics.
Results: Overall, 73.9% (n=1561) of care workers felt strongly or rather strongly burdened, with one third (36.6%, n=787) reporting to spend 2h or more during a 'normal' day performing administrative tasks. Ratings for administrative burden ranged from 42.6% (n=884; ordering supplies and managing stocks) to 75.3% (n=1621; filling out the patient’s medical record). One out of four care workers (25.5%, n=561) intended to leave the profession, whereby care workers reporting higher administrative task burden (OR=1.24; 95%CI: 1.02-1.50) were more likely to leave the profession.
Conclusion: This study provides first insights on care workers’ administrative burden in nursing homes, which can inform the development of interventions to reduce the workload related to ‘indirect care activities’ and to improve care workers’ job satisfaction and retention in the profession.
Title Impact of the COVID-19 pandemic on HPV vaccinations in Switzerland and Greece: road to recovery
Name Andrea Favre-Bulle
Affiliation MSD Switzerland
AbstractObjectives: The COVID-19 pandemic led to significant interruptions of human papilloma virus (HPV) vaccinations in Europe resulting in a substantial number of adolescents missing an opportunity to get protected against HPV. Although a slow recovery in vaccination rates was observed, the dose deficit remains uncleared. This study aims to estimate the cumulative number of vaccine doses missed due to pandemic and capacity required to clear the deficit in Switzerland and Greece.
Methods: A published COVID-19 recovery tool (Saxena 2022) was used to project the dose deficit accumulated due to the pandemic and to estimate the expected time and vaccination catch-up rates required to clear the deficit in Switzerland and Greece. Country-specific monthly number of HPV vaccine doses disseminated before (2019) and during the COVID-19 pandemic (2020-2021) was used to estimate the cumulative deficit at the start of the catch-up period commencing in March/2022 and September/2022 in Switzerland and Greece, respectively.
Results: Compared to 2019, the decrease in the number of HPV vaccines disseminated during the first pandemic year (2020) was -14.8% in Switzerland and -4.8% in Greece; during the second year (2021), a decrease of -12.3% was observed in Greece and 7.9% in Switzerland. The dose deficit accumulated until the commencement of a catch-up period was -24.4% in Switzerland and -21.7% in Greece. To clear the dose deficit by December 2025, monthly vaccination rates need to be increased by 6.3% (930 additional doses/month) and 6.0% (715 additional doses/month) compared to 2019 rates in Switzerland and Greece, respectively.
Conclusions: The projected cumulative deficit of missed doses during the COVID-19 pandemic was substantial in both Greece and Switzerland. A sustained increase in vaccination rates over the upcoming years will be required to reverse the deficit and prevent long-term public health and economic consequences.
Title Impact of COVID-19 Pandemic on Measles Vaccination in Switzerland
Name Andrea Favre-Bulle
Affiliation MSD Switzerland
Background: Routine measles vaccination for children is necessary to reduce measles morbidity and mortality. The Covid-19 pandemic has disrupted vaccination programs worldwide. We investigated potential gaps in measles vaccination in Switzerland.
Objectives: We estimated missed doses of measles containing vaccines (MCV) in cohorts eligible for vaccination during the COVID-19 pandemic as compared with the pre-pandemic average. We further estimated catch-up rates needed to return to pre-pandemic levels.
Methods: Total MCV doses disseminated nationwide by month during the pandemic period (January 2020-May 2022) were aggregated and compared to the pre-pandemic (2015-2018) average to calculate doses missed during the pandemic. The additional number of months required to administer missed doses was estimated using monthly catch-up rates of 5-30%, where catch-up was defined as the percentage of additional doses disseminated above the regular average.
Results: Prior to the pandemic, annual MCV doses disseminated averaged 245,000 doses per year, or 20,000 per month. During the COVID-19 pandemic, there was a 7% drop in doses disseminated. If MCV doses remain at 2022 levels, catching up missed doses is estimated to take 7 months at 30% monthly catch-up rate, and 42 months at 5% catch-up rate. If MCV disseminated doses return to pre-pandemic levels, catching up missed doses will take 6 months at 30% catch-up rate and 38 months at 5% catch-up rate.
Conclusion: Results suggest a potential decline in MCV doses disseminated in Switzerland may have occurred during pandemic. Sustained catch-up may be required to return to the pre-COVID-19 levels. Further information on distribution of doses among subpopulations may be needed to better understand pandemic impact.
Title Non-heterosexual women: a national study on their health
Name Diana Fernandes
AbstractAim: To compare young women who have sex with men and/or women (WSMW) with women who have sex only with men (WSM) in terms of sexual/mental health, and substance use. Methods: Data were drawn from a 2017 Swiss national study on sexual health and behaviours among young adults (24-26 years old). The sample was comprised of sexually active women (n = 2331) and was dichotomized based on three questions measuring multidimensional sexual orientation (sexual attraction, sex of lifetime partners, and self-identification): women having had sex exclusively with men (WSM; n = 1883; 80.8%) and women having had sex with men and women or with women exclusively (WSMW; n = 448; 19.2%). Both groups were compared on sexually transmitted infections (STI), risky sexual behaviours, substance use and mental health. Bivariate and multivariate analyses were performed using WSM as the reference category. Results are presented as adjusted odd ratio (aOR) in the logistic regression. Results: WSMW reported a younger mean age (15.8) at first sexual experience than WSM (16.6). Sexual orientation was associated with education level (tertiary/other), socioeconomic status (average/below average), HIV testing, STI diagnosis, having multiple sexual partners at once, participating in three-ways, having sex under the influence of alcohol or drugs, the number of lifetime sexual partners, current tobacco, cannabis and other illegal drugs use, and poorer mental health. No associations were found for birthplace (Switzerland/other), HPV vaccine, having already consulted a gynaecologist, and current alcohol misuse. There were more WSMW reporting having had more than 8 sexual partners in their lifetime (53.4%) than WSM (29.2%). WSMW also reported not using contraceptive/protective barriers during their last intercourse (17.3% vs 8.8% WSM). WSMW reported poorer mental health (21.9%) than WSM (16.1%). At multivariate level, WSMW were more likely to have experienced three-ways (aOR 7.20), to have their first sexual experience at a younger age (aOR 0.82), and to have used cannabis in the last 30 days (aOR 1.92). Conclusion: WSMW reported more risky sexual behaviours such as higher number of sexual partners, and rarer use of contraception/protection. Furthermore, they reported higher rate of substance use and worse mental health than WSM. Leaving WSMW out of prevention campaigns is an important overlook, and campaigns should aim to be more inclusive of this population.
Title Entscheidung im Graubereich: Finden Eltern online die gewünschten Informationen zu Kinderimpfungen?
Name Anita Geutjes
Affiliation Medizinische Fakultät der Universität Basel / Institute of Health Sciences der Zürcher Hochschule für
AbstractFür die Prävention übertragbarer Krankheiten sind die Anliegen von Eltern und ihr Informationsbedarf rund um Kinderimpfungen zentral. Sie sollten in der Gesundheitskommunikation adäquat adressiert werden.
Wir untersuchten ein häufig genutztes Schweizer Elternforum und identifizierten geäusserte Impffragen und -anliegen. Antworten auf Forumsfragen zur Impfsicherheit suchten wir auf öffentlichen Webseiten von Schweizer pädiatrischen und Public Health Organisationen.
Mittels Webcrawling wurden Elternforum-Diskussionsinhalte von 2007 bis 2019 gesammelt und mit linguistischen und qualitativen Verfahren strukturiert. Es wurden 31 Forumsdiskussionen zum Thema Impfen identifiziert, an denen sich 315 Nutzer*innen beteiligten. Diese wurden retrospektiv mittels qualitativer Inhaltsanalyse ausgewertet, Impfdiskussionsthemen erfasst und kategorisiert.
Daraus konnten 6 konkrete Fragen zur Sicherheit von Impfungen im Kindes- und Jugendalter und impfpräventablen Erkrankungen abgeleitet werden. 2022 wurde mit einem strukturierten Suchschema auf im Forum als Informationsquellen erwähnten Webseiten (pädiatrie schweiz, Bundesamt für Gesundheit, Infovac, Swissmom) nach Antworten gesucht.
Forumsnutzer*innen möchten komplexe und multidimensionale Informationen für eine individuell optimale Impfentscheidung. Dabei betrachten sie Impfungen, alternative Präventionsmassnahmen und ein Erkranken als valable Optionen und diskutieren jeweils deren Sicherheit, Wirksamkeit, Notwendigkeit, Entwicklung, Epidemiologie sowie offizielle und private Empfehlungen und Erfahrungen.
Die Forumsfragen zu Sicherheit wurden auf den untersuchten Webseiten nur teilweise beantwortet. Es mangelte an verständnisfördernden Erklärungen und Begründungen.
Forumsnutzer*innen fühlen sich von Gesundheitsfachpersonen oder -organisationen nicht zufriedenstellend informiert, sodass Elternforen eine wichtige ergänzende Informationsquelle darstellen. Die identifizierten Themen der Elterndiskussionen und unbeantworteten Fragen können zukünftig einer elternzentrierten Gesundheitskommunikation in Public Health und in der pädiatrischen Praxis dienen.
Öffentliche Webseiten mit Informationen zu Impfungen können entsprechend vertieftere und differenziertere Erklärungen und Hintergrundwissen digital zur Verfügung stellen und somit Elternberatungen in der Praxis unterstützend ergänzen.
Title Challenges and facilitators to conduct community-based participatory research to improve health equity among
homeless people in Switzerland: an ethnographic fieldwork
Name Evelyne Hangartner
Affiliation Centre universitaire de médecine générale et santé publique, Lausanne
AbstractBackground & objective: Emerging findings indicate that community-based participatory research is well positioned to improve health equity among populations with social and medical vulnerabilities, such as homeless people. However, less is known about the articulations needed to conduct research projects with and for homeless people in the complex contexts of low-threshold structures. In response, this case study aimed to describe the challenges and facilitators experienced during the data collection period (April to august 2022) of a larger participatory research project. This larger study called “Homeless people in French-speaking Switzerland and integrative medicine: Desirable? Feasible?” aims to understand the health needs and inequities among homeless people in Switzerland.
Methods: The analysis was based on field observation notes taken during 38 data collection visits to homeless people structures. This ethnographic data were analyzed through thematic analysis.
Results: This study highlighted three areas of challenges: a) logistics of collecting data in structures for homeless people ; b) participants’ recruitment planning; c) collecting health-related data in collective environments ; and two areas of facilitators : a) iteration throughout the field experiences; b) feedback from homeless people and social workers. Findings showed that the difficulties were mainly related to the functioning of the data collection sites. To overcome these barriers and adapt strategies to successfully approach participants, it was necessary to continuously learn from experience in the field and rely on involved people’s feedback and recommendations.
Conclusion: Findings suggest that ethnographic fieldwork coupled with participatory paradigm are well positioned to help face encountered challenges in this field of research. Whereas ethnographic fieldwork allowed us to achieve a deep understanding of the homeless people structure’ functioning and to identify potential problems with data collection, the participatory paradigm enabled a reliance on the expert knowledge of involved individuals and adjust strategies accordingly when necessary.
Title Surveillance of FFP2 Masking Compliance on Modes of Public Transportation throughout Italy
Name Mae Horne
Affiliation University of South Florida
AbstractThe COVID-19 pandemic spurred revisions in public health policies, prompting travel bans, lockdowns, mask mandates, and social distancing. Through literature review and field research focused on the epidemiology of COVID-19 and the impact of policy enforcement on community behaviors, this project will evaluate the effectiveness of public health systems in Italy during the pandemic. The data collection process took place from July 2022-August 2022 in Milan, Bologna, Florence, and Rome, cities determined to be epidemiological hotspots during the first wave of the COVID-19 outbreak. Qualtrics was utilized to conduct an observational cross-sectional survey to analyze the association between the mandatory FFP-2 masking mandate in all modes of transportation and mask wearing behaviors - primarily on metros and buses. Data was collected on demographics, public health policies, group social distancing behaviors, and mask-wearing compliance. A regression analysis will reveal if the implementation of a mandatory masking policy will increase the odds of travelers fully wearing an FFP-2 mask on modes of public transit throughout hotspot cities in Italy. Understanding how foreign public health policies influence community behavior can inform the implementation of future global health initiatives.
Title Value-based healthcare in the digital transition phase
Name Daniel Josef Lindegger
Affiliation University of Geneva
AbstractSwitzerland has a decentralised health-care system with primary care provided by a network of general practitioners which are coordinated by public health initiatives on national and cantonal level. Value-based healthcare is a system theory model which emphasises outcome and patient experience as opposed to transactional healthcare delivery which rewards any care delivered independent of its quality. While not always formally defined, value-based concepts are already implemented in the Swiss health care system on different levels. In the course of the Swiss digital health strategy, primary care pathways will be reviewed, modernised and reprioritised in context of digital innovations. This requires reflection and re-evaluation of the role of value-based healthcare in Switzerland. Specifically, the interaction between primary care and tertiary referral hospitals requires revaluation in terms of integration of digital health solutions to provide better value for healthcare stakeholders. Existing concepts on value-based healthcare during digital transition are outlined and transferred to the Swiss context along the priorities of the Swiss eHealth strategy.
Title Colorectal cancer risk factors and use of screening tests: Baseline results from a pilot randomized controlled trial
Name Ekaterina Plys
Affiliation Center for Primary Care and Public Health (Unisanté), University of Lausanne
Abstract1 Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland;
2 CERPOP, UMR1295 Inserm, Université Toulouse III Paul Sabatier, Toulouse, France;
3 Institute of Primary health care (BIHAM), University of Bern, Bern, Switzerland;
4 Department of Gastroenterology, University of Basel, Basel, Switzerland;
5 Department of Public Health, Erasmus Medical Centre, Rotterdam, the Netherlands;
6 Kaiser Permanente, San Francisco, California, the US.
Screening for colorectal cancer (CRC) reduces incidence and mortality from CRC. Individual 15-year risk for CRC is influenced by genetics, lifestyle, and several diseases, and varies from <1% to >15%. Personalized screening could improve the risk-benefit balance of screening and optimize use of colonoscopy resources. We present the use of screening tests and CRC risk factors in Vaud canton.
Vaud citizens not yet invited to the Vaud Screening Program were mailed invitations for a pilot randomized controlled trial (Clinicaltrials.gov NCT05357508). We collected their history of CRC screening, CRC risk factors, intention for screening (on a scale of 1 to 5), knowledge about CRC screening, screening recommendations provided by physicians, and sociodemographic variables. Individual CRC risk was calculated using the QCancer calculator. We considered <3% as low, 3-6% as moderate, and >6% as high risk.
Of 898 respondents, 51% were women and the average age was 52.6 (SD=2.9). Some 37% (n=336) were ineligible for screening. There were the following reasons for ineligibility (many reasons are possible): up to date with FIT (n=37, 11%) or colonoscopy (n=224, 69%), having genetic risk (n=41, 13%), inflammatory bowel diseases (n=6, 2%), polyp surveillance (n=59, 19%), other serious disease (n=2, 1%), unexplained weight loss (n=7, 2%), blood in stool (n=32, 10%), and changes in bowel habits (n=79, 25%). Among eligible participants (63%), the mean intention for screening was 4.1 (SD=1.2); 42% preferred FIT, 25% colonoscopy, and 29% had no preference. Risk of CRC ranged between 0.9% and 7%, and 96% of all participants were at low risk (score <3). Most of those who had had a colonoscopy were at low risk (88%), and aged between 50-55 years (73%). The main sources of information about CRC screening were physicians (27%), participants’ acquaintances (22%), newspapers (11%), and the internet (10%). One third (34%) of participants reported receiving suggestions to do screening from their physician. 52% of participants believed that screening was recommended for healthy people, 31% that it was recommended for people with CRC symptoms, and 17% responded that they didn’t know.
In this population of primarily 50 to 54 year olds, the majority of persons already screened for CRC had done a colonoscopy, despite being at low risk. Most of those eligible for screening were at low risk, emphasizing potential of discussion regarding different screening approaches including FIT.
Title Health Needs, Expectations and Experiences of the Homeless Individuals in the Canton of Vaud
Name Luana Schaad
Affiliation Department of Vulnerabilities and Social Medicine, Unisanté
AbstractContext and Objectives: International studies show that homelessness has a major impact on health. Still, homeless individuals (HI) face many barriers and challenges in their care. Despite the importance of improving health equity in this population, few studies explored HI’s health in Switzerland. This mixed-method study explored HI’s health needs, expectations, and experiences in the canton of Vaud.
Method: In total, 123 HI completed a questionnaire about their health needs and expectations. Eighteen HI and 14 professionals working with HI (PHI) participated in qualitative interviews about the HI’s health needs, expectations, and experiences in healthcare. Data were processed by descriptive statistics and inductive conventional content analysis.
Results: The most frequently reported health problems were osteoarticular (27%), dental (15%), psychiatric (14.5%) and cardiovascular (9%). HI’s most common means of seeking care were through emergency rooms (31%), a homeless daily clinic (27%) and outreach programs (19%). Only 7% reported having seen a general practitioner in the last 6 months. Quality of life (QoL; score from 0-100, the higher the better the QoL) was 65.3 for physical health, 68.3 for psychological health, 53.8 for social, and 48.2 for environmental. Other findings showed that up to half participants reported psychological distress (32% moderate and 17% high distress). Next, the following results emerged from the qualitative inquiry. According to HI and PHI, HI lacked follow-up in psychiatric and somatic care as well as prevention. Specific programs for HI were perceived positively (e.g., outreach programs) but had some limitations (e.g., delay to get appointments). Homelessness’ negative impact on health was reported (e.g., causing psychological distress). Good experiences in healthcare were reported along with bad experiences. PHI reported HI’s lack of trust in the healthcare system as a barrier to access to care. Other cited barriers were low health literacy, lack of health insurance and difficulties navigating the healthcare system. Finally, according to the PHI, HI delayed care by prioritizing primary needs and seek care only in emergency situations.
Conclusion: In line with international studies, findings revealed various unmet health needs, concerning levels of QoL and psychological distress, and complex barriers to access healthcare among HI in the canton of Vaud. These findings call for improvements to better address HI’s health needs.
Title Outpatient before inpatient changes in Switzerland
Name Yves Staudt
Affiliation Fachhochschule Graubünden
In Switzerland, as in Europe, health care costs are rising. To counteract this increase, the Swiss government has introduced the outpatient before inpatient hospitalization initiative (AVOS). In 2019 the first six treatments were changed from an inpatient hospitalization to an outpatient one. The goal is to reduce healthcare costs without compromising patient safety or the risk of complications. In this study we examine the impact of AVOS on the length of hospital stays for eye diseases and its appendages (ICD H00-H59). Additionally, the impact is measured for each age. With the help of data visualization and small multiple graphics, we compare the length of stay along the given appendages and ages. As we consider the movements over time, trends and changes for each appendage along the age can be observed and compared to other selected cases. Our results show that the proportion of patients hospitalized increases with age. That means that older patients have longer stays compared to young patients. This can be due to the difference in health condition, whereas older patients have mostly more chronic diseases and need more medications. However, the length of hospital stay has a decreasing trend for all age classes over the years, whereas the advance in medical technology needs to be considered. The changes in the length of stay are varying along the appendages. In some there is a monotonic decrease, whereas for others we have a wiggly change. However, since 2019 in all cases a decrease can be observed. Hence, the impact of the AVOS initiative can be statistically proven for the eye disease and its appendage.
Title Cervical cancer and HPV vaccination / nxgen1.fem1
Name Sanjana Warambhey
Affiliation UZH / Nxgen Medical Services
AbstractWomen's health is greatly affected by cervical cancer and other HPV-associated cancers. Cervical cancer is the second most common cancer among women worldwide, and it is often caused by certain strains of human papillomavirus (HPV). It is likely that HPV vaccination is an important protective factor against this cancer and has helped to reduce the incidence of cervical cancer in Switzerland. According to a 2020 study, the vaccination coverage rate among 15-year-old girls in Switzerland is around 80%. This shows how effective HPV vaccination is. In our work, we analyzed the impact of HPV vaccination in terms of the number of reported cervical and HPV cancer cases in Switzerland. Over the years, we observe a dramatic decrease in some cancer cases. This finding is consistent with the results of the study. However, for some other HPV cancers, the number of cases remains stable. This shows the importance of vaccination and screening of cervical and HPV cancers to reduce the number of cases. Vaccination and screening should remain accessible to all and be expanded to a wider population.
Title Prevalence of endometriosis in Switzerland / nxgen1.fem2
Name Sanjana Warambhey
Affiliation UZH / Nxgen Medical Services
AbstractEndometriosis is a common condition affecting a significant proportion of women of childbearing age. Since endometriosis is often asymptomatic, it is likely that the actual prevalence is higher than reported. Unfortunately, there are no current and accurate data on the prevalence of endometriosis in Switzerland because the disease is often not recognized and therefore does not appear in national statistics. Due to the lack of accurate data, it is difficult to provide precise figures on how many women are affected by endometriosis in Switzerland. However, there are estimates that endometriosis occurs in 10-15% of women of childbearing age. Accurate figures on hospitalizations for endometriosis do not exist in Switzerland, as the condition is often treated as an outpatient and there is no central collection of this data. Diagnosis of endometriosis can be difficult because symptoms are often nonspecific and may resemble those of other gynecologic conditions. Common symptoms include pain in the lower abdomen or lower back, especially during or just before menstruation, and pain during or after sexual intercourse. Other symptoms may include infertility, bowel and bladder problems, and prolonged or heavy menstrual bleeding. Diagnosis usually requires a combination of physical examination, history and imaging. The gold standard for diagnosis is laparoscopic examination, in which a small incision is made in the abdomen to examine the inside of the pelvis and remove tissue samples. However, there are a large number of women affected by this condition and it is important that they are appropriately diagnosed and treated. It is difficult to accurately determine the prevalence of endometriosis in Switzerland, as the disease is often asymptomatic and therefore often undiagnosed. It is a common condition that is often only recognized at an advanced stage and is often associated with infertility and pain. It is important to emphasize that not all women with endometriosis require hospitalization and most patients can be treated as outpatients. This depends on the severity of the disease and the individual needs of the patient.
Title Legionnaires’ disease – Patients’ perspective on care delivery and recovery
Name Manuel Wiederkehr
Affiliation Swiss Tropical and Public Health Institute
AbstractIn Switzerland, the number of reported Legionnaires’ disease (LD) cases significantly increased in the past decades. LD most frequently manifests as severe bacterial pneumonia with a case fatality rate of 5 to 10%. There is concern that LD has long-term effects on health and overall quality of life. Due to current clinical guidelines on pneumonia management, LD is almost exclusively diagnosed at the hospital-level. Thus, LD patients’ care pathways are often fragmented across different clinical levels (i.e. primary and tertiary care) hence, challenging the care continuum and health outcomes. Generally, a patient’s experience with care delivery, adherence to therapy and health literacy to self-care optimise health outcome after the acute phase. However, little is known on the disease experience and perspectives of patients with LD. Therefore, we aim to capture the experience and perspectives of LD patients in the early phase of their convalescence from a Legionella infection. Specifically, we explore their understanding and perceived causes of pneumonia, their challenges, needs and concerns at this time.
This study is a part of a national case-control and molecular source attribution study on LD in Switzerland (SwissLEGIO). The study population consists of recently diagnosed, confirmed community-acquired LD patients. A subset of patients (n = 40) are included in a satellite study (longLEGIO), where disease experience and long-term health and social impacts are explored in-depth. In this presentation, we show baseline quantitative and qualitative data from interviewing patients who were either still hospitalised or recently discharged. The qualitative data will be analysed using thematic content analysis.
Efficiency-driven efforts to strengthen (outpatient) care may impact patients’ health literacy. Our results will provide meaningful insights to assess the efficacy of information and care delivery from a patient’s perspective.
Title Demographic changes according to incidence and prevalence of Diabets in Switzerland comparing urban vs.
Name Murat Yilmaz
Affiliation Luzerner Kantonsspital
AbstractDiabetes remains a disease effecting significant part of the patients. Because of its long duration and multi-organ dysfunction diabetes causes a lot of costs. OBSAN collected data on Diabetes since years. We analyzed in a Metha-Analysis the Development of Diabetes in Switzerland.
In our study we could demonstrate that Typ 1 diabetes was significant more prevalent in woman than man. Furthermore Typ 1 Diabetes in woman doubled during the last 10 years.
On the other Side man developed significant more Diabetes Type 2 with aging. In Average the prevalence of diabetes was increasing during the last 20 years with more than 2 percent.
The most increase of Diabetes showed the age population after the age of 55.
The woman age group of 65 to 74 showed a decrease in prevalence of diabetes.
One reason for that can be the healthy lifestyle.
We also did an investigation in the prevalence of Diabetes in different cantons.
We saw that the cantons Geneva, Appenzell, St. Gallen and Neuchatel have the highest prevalence.
Zurich is the fifth highest canton in prevalence.
The other big cantons like Bern and Basel remains stable and under the average of Switzerland.
Our analysis showed that in French and Italian speaking parts of Switzerland the prevalence for diabetes was higher around 1%.
The prevalence was higher in urban regions compared to rural regions.
This could be because of the medical supply. In urban regions patients are going more frequently to the doctor then in rural regions.
Additionally, the lack of physical activities in city’s compared to rural regions, where agriculture is associated with more physical activity can lead to more diabetes in urban regions.
It is interesting to observe that almost no difference can be observed in prevalence along the education level for men. The prevalence was at the highest in patients with secondary education.
Compared to woman, there was a significant difference in prevalence along the education level. Tertiary level educated woman had the lowest prevalence.
One important risk factor for woman is new onset on pregnancy. In both groups the difference between Swiss Citizens and foreigners living in Switzerland was the same, even more Swiss citizens suffered from diabetes.
For this result, attention needs to be given, as the statistic could be biased as Swiss citizens are visiting doctors more frequently.
In the last 20 years there is a significant increase of costs of the diabetes.
In our meth- analyses the saw, the diseases caused by diabetes secondary are responsible for the highest costs.
On one hand medical service is getting better and more expensive.
The primary diabetes therapy did not significantly differ between stationary hospitalization and ambulant treatment.
But the interventions, due to diabetes leading to secondary problems such as high blood pressure, Arteriosclerosis, and heart and kidney failure, are causing the most costs.
Patients with heart or kidney failure had the highest costs. The estimated costs for diabetes have doubled over the last 20 years.
One reason for that is the development of new medications. The indirect costs, such as loss of work, or operations, and loss of years out of hospital had an increase of 2 times higher during the years.
To show this we generated an Model to illustrate and estimate the development for diabetes for the next 10 years. In our poster we want to show in an illustration the expected development of diabetes in different cantons for the next 10 years.
In Conclusion, diabetes remains a significant problem. Even more, the numbers will increase because of the aging population. Newer therapies are very expensive. Therefore, some regulations and programs are needed.
Title Climate Change, Developmental Origins of Health and Disease, and One Health: Evolutionary Considerations for
Name Nicole Bender
Affiliation University of Zurich
AbstractIntroduction: Climate change is a major health threat since decades. The United Nations developed strategies and goals to improve global health by 2030, which are part of the Sustainable Development Goals (SDGs). It is predicted that among the biggest health threats arising from climate change will be undernutrition and food insecurity. Especially the most vulnerable populations, such as pregnant women and their growing offspring in low- and middle-income countries (LMICs), will be affected most gravely, due to climate change induced extreme weather events, droughts and flooding, crop failures, and reduced food production.
Main content: We will discuss the impact of malnutrition during the perinatal period, a critical and plastic phase of the offspring’s growth. We will focus on the interaction of undernutrition during the perinatal period, resulting in premature birth and low birth weight, and the paradoxical risk for metabolic syndrome in adult life, a process called „developmental programming“ through epigenetic mechanisms. This effect is known as Developmental Origins of Health and Disease (DOHaD) hypothesis.
If the predicted fetal environment differs from the postnatal environment, the fetal programming can lead to a so-called „mismatch“, further increasing the risk for metabolic syndrome. The risk for “mismatch” is especially high in offspring growing up in LMICs, which are either going through 1) a process of rapid urbanization toward energy-dense nutrition and low energy expenditure lifestyles; or 2) experience displacement and migration, for instance due to climate change, toward Western countries. Pregnant women with such a migration background are more and more common in Western primary care facilities.
Discussion: We will introduce and discuss the role of the One Health approach in facing climate change, avoid DOHaD effects, and help to reach the SDGs. The One Health approach has the potential to influence policy making in a sustainable way, by recognizing that human health is interconnected with and dependent on animal and environmental health. Primary care practitioners in LMICs, but also in Western countries, should profit from such policies to better support pregnant women and help mitigate DOHaD effects in the offspring.
Title SwissLEGIO – The journey to diagnosis and effective care of Legionnaires’ disease patients
Name Melina Bigler
Affiliation Swiss TPH
AbstractLegionnaires’ disease (LD) is a severe form of pneumonia caused by Legionella spp. bacteria and is notifiable to the Federal Office of Public Health (FOPH). The FOPH was notified of about 550 community-acquired LD cases in 2021. Despite the availability of a rapid urinary antigen test (UAT), diagnostic testing for LD is rarely initiated within the primary healthcare setting. An important reason for this originates from the Swiss clinical guidelines, which recommend aetiological testing primarily for hospitalised pneumonia patients. In addition, only accredited laboratories are permitted to perform the UAT. Therefore, the majority of detected LD patients in Switzerland has passed through the hospital. Thus, the severity of community-acquired pneumonia and individual health-seeking behaviour is likely a strong determinant for the detection of LD cases and for the initiation of appropriate treatment.
It remains unknown where and when during the course of their illness, LD patients initially seek care. Similarly, we do not know if the limitation of Legionella diagnostics to the hospital setting influences LD case detection and LD patients’ clinical management. Within the scope of our ongoing SwissLEGIO national case-control and molecular source attribution study, we are, thus, currently collecting data on community-acquired LD patients’ general health seeking, initial access to the Swiss health system and their treatment prior to hospitalisation.
We present findings from 230 community-acquired LD patients that were notified by the SwissLEGIO hospital network since August 2022. The network consists of 20 university- and cantonal hospitals which report to us all patients with a confirmed LD diagnosis. We describe LD patients’ health-seeking behaviour and its impact on timing when LD-specific diagnostic testing is initiated and appropriate antibiotic treatment started. The study provides important insights into whether more (targeted) diagnostic testing and treatment for community-acquired LD on a primary care level would benefit patients. We also contribute to a more accurate assessment of how many mild LD cases might remain undetected and thus underreported to the national notification system of the FOPH.
Title Reasons for non-participation in an organized CRC screening program in Switzerland: A mixed methods study
Name Karen Brändle
AbstractIntroduction: Organized colorectal cancer (CRC) screening programs are progressively implemented in Switzerland since 2016. Evidence from the first evaluation of the Vaud CRC screening program revealed that participation is below the recommended threshold. Organized cancer screening programs can efficiently reduce CRC mortality with sufficient participation. Reasons for non-attendance in organized CRC screening programs in Switzerland have not yet been explored. This study aims at investigating the barriers to participation in the Vaud CRC screening program.
Methods: As part of a mixed-method cross-sectional study, a self-administered questionnaire was mailed to a random sample of 6000 people invited by the Vaud CRC screening program between January 2018 and December 2020 who did not respond to the invitation (NP), as well as to 800 participants (P) to the screening program. In order to minimize respondent burden, the questionnaire had a core module for all participants and two modules (health and barriers) submitted each to only half of the sample. Barriers were assessed along the six dimensions of the HBM.
Results: Overall response rate was low (784 valid questionnaires). Among the 523 respondents who did not participate to screening (NP), 180 were eligible. The responses on barriers was obtained for 86 NP and 144 P. The mean age was 59 years, 49% were women (44% and 52% respectively of P and NP).Participants and non-participants to screening differed significantly regarding their perceived benefit of CRC screening (OR: 0.3, 95% CI: 0.1-0.8 for non-participants vs participants), the perceived barriers (discomfort, fear, too complicated) (OR: 3.2, CI: 1.3-8.0 ) and perceived self-efficacy (OR: 0.3, CI: 02.-0.8). Not knowing that CRC screening is intended for asymptomatic persons was also associated with non-participation (OR: 0.4, CI: 0.2-0.8). Perceived susceptibility to and severity of CRC as well as having received information on CRC screening from more than one source did not significantly differ between the groups .
Conclusions: The main drivers of non-participation were perceived practical implications (perceived benefit, barriers and knowledge about CRC screening) and knowledge about the purpose of screening. Non-participants did not differ from participants regarding fear-related dimensions of screening (susceptibility, severity). The main limitation of the study is the low participation rate and the resulting small sample size.
Title 20 years of evaluation of breast cancer screening programmes in Switzerland with cancer registries data:
results, lessons and perspectives
Name Karen Brändle
AbstractObjectives: Breast cancer screening programmes have been staggered in Switzerland, in parallel with opportunistic screening. National coverage by organized screening programmes has increased from 18% in 1999 to 59% in 2023. Evaluation and monitoring of the 10 Swiss cantonal programmes are regularly performed to maximize the quality and benefit-risk ratio of mammography screening.
Methods: Anonymous records of 1.92 million invited women aged 50-74 years were extracted for each cantonal programme. Participation, quality and effectiveness of screening were monitored over the period 2010-2018 for 10 Swiss programmes based on European indicators. For three longstanding programmes (GE, VD, VS), screening participants were probabilistically linked to the corresponding cancer registries to identify interval cancers. Cumulated risks of recall and false-positive results over 10 and 20 years were estimated.
Results: Participation to organised screening increased from 40.5% in 2014 to 49.5% in 2018 with a strong attenuation of regional differences. Quality of screening slightly improved over time. It was generally in line with recommended levels, but varied substantially across programmes (2016-18, cancer detection rate: 4.9/1000 to 7.6 /1000; false-positive rates: 2.1% to 5.5%). Among women screened for the first time, those aged 50-51 had a 3-fold higher risk to experience a false-positive result than older women. Women aged 70-74 had the highest likelihood of a screen-detected cancer.
The risk of a false-positive result was between 15.5% and 21.6% over 5 participations and between 24.0% and 31.2% over 10 participations. In the 2nd year after screening, the relative risk of breast cancer diagnosis of participants was half the risk of the general population. Interval cancers showed a prognostic profile between that of screen-detected breast cancers and that of symptomatic tumours, were significantly more often triple-negative (8.3% vs 4.6%) and associated with BI RADS-D breasts (7.0% vs 2.7%) than screen-detected cancers.
Conclusions: This is the largest and most comprehensive analysis of Swiss mammography screening to date. Difficulties in comparing performance of recent and old screening programmes and in uniformly linking data from several programmes and cancer registries were mostly overcome. Estimating the impact of organised screening on breast cancer mortality in presence of opportunistic screening and efficient treatments remains a major challenge.
Title Effects of pollen exposure on systolic and diastolic blood pressure in adults (EPOCHAL study)
Name Alexandra Bürgler
Affiliation 1. Swiss Tropical and Public Health Institute, Allschwil, Switzerland; 2. University of Basel, Basel, Switzerland
AbstractBACKGROUND AND AIM: The dose-response relationship between pollen exposure and acute systemic health effects, such as elevated blood pressure (BP), has been inadequately studied. The EPOCHAL cohort study (Effects of Pollen on Cardiorespiratory Health and ALlergies) aims to investigate the association between pollen exposure and six different health outcomes, including BP. As a change in BP is a risk factor for cardiovascular disease, it is critical to investigate any potential pollen-BP relationship.
METHOD: We collected adult seated systolic and diastolic BP (BPsys, BPdia) repeatedly over six weeks during the typical symptomatic period. A skin prick test was performed to confirm pollen sensitization to 14 plants. We computed novel personalized pollen exposure measures: We summed up individual hourly mean exposure to all plant pollen to which the individual was confirmed to be sensitized, for the last 3h, 6h, 12h and 24h. We applied mixed linear regression models to relate BPsys and BPdia with personal pollen exposure in the 3/6/12/24 hours prior to each measurement. Personal pollen exposure (grains per m3) was log-transformed prior to analysis. We adjusted for age, sex, BMI, caffeine/alcohol consumption, smoking/medication use/exercise before the assessment, time of day and weekday vs. weekend and time-varying environmental confounders: Air pollution (NO2, PM10), temperature and relative humidity.
RESULTS: A total of 326 adults (63% female) completed a median of 16 blood pressure measurements. Of these, 77% reported suffering from pollen allergies and 23% were non-allergic adults. Allergen tests confirmed a median of 6 plant sensitizations and 73% sensitization to at least 3 out of 15 plants. The most common plant sensitizations were ash, olive and grass. We consistently found small and positive relationships between average personal pollen exposure in the last 3/6/12/24 hours and BPsys and BPdia.
CONCLUSION: In this preliminary analysis, we found small changes in BPsys and BPdia related to individual pollen exposure. After completion of skin prick test data collection (N=405) in March 2023, we will investigate lagged pollen exposure and splines to further describe pollen-BP dose-response relationships. Examination of a potential pollen-BP effect in subgroups (e.g. men/women, weight status) will be performed and critical to inform personalized medicine.
Title Does stronger primary care improve health service access for persons with spinal cord injury? Evidence from
eleven European countries
Name Olena Bychkovska
Affiliation Swiss Paraplegic Research
AbstractBackground: There is evidence that countries with strong primary care provide improved access. However, those with complex conditions, e.g. spinal cord injury (SCI) have greater difficulties accessing care in general and primary care in particular due to various systemic and personal access restrictions. This study aims to determine the association between the primary care strength and access to follow-up health services among persons with chronic SCI across 11 European countries.
Methods: Data analysis of the International Spinal Cord Injury (2017-2019) cross-sectional, community-based questionnaire: first worldwide survey on various aspects of experience of persons with SCI. The study had 6, 658 participants from 11 countries (France, Germany, Greece, Italy, Lithuania, the Netherlands, Norway, Poland, Romania, Spain, Switzerland). Analysis: logistic regression analysis.
Results: Twelve percent of the participants reported unmet health needs: the highest in Poland (25%) and lowest in Switzerland and Spain (7%). The most prevalent access problem was service unavailability (7%). Stronger primary care was associated with lower odds of reporting unmet health needs, service availability, affordability and acceptability. Females, persons of younger age and lower health status had higher odds of reporting unmet needs.
Conclusions: In all investigated countries, persons with chronic SCI face access barriers, especially with the service availability. Specific unavailable services, along with possible solutions, should be further investigated. Stronger primary care for the general population might also be associated with benefits for persons with SCI.
Title Evaluer la maturité des pôles de santé vaudois en termes de soins intégrés selon une démarche participative
impliquant des acteurs internes et externes aux pôles
Name Tania Carron
AbstractIntroduction : Trois pôles de santé regroupant sous une même gouvernance les différentes prestations et institutions de soins au niveau régional existent dans le canton de Vaud. Ils ont pour but d’améliorer la coordination et la continuité des soins et de garantir l’accès aux soins de la population dans des régions de moyenne montagne. Le but du projet SCIROCCO-POL est d’évaluer, selon une démarche participative et d’amélioration continue, la performance indirecte de ces trois pôles de santé par l’évaluation de leur degré de maturité en termes de soins intégrés.
Méthodes : L’outil SCIROCCO – développé à l’échelle européenne et validé scientifiquement – a été choisi comme outil d’évaluation de la maturité des pôles. Suivant la méthodologie SCIROCCO, les parties prenantes des trois pôles de santé ont été invitées à évaluer (individuellement puis dans le cadre de groupes de discussions successifs) la maturité de leur organisation en termes de soins intégrés. L’évaluation porte sur 12 dimensions qui ont été identifiées par l’outil SCIROCCO (par ex. structure et gouvernance, financement, infrastructure numérique ou coordination des processus). Pour ce faire, l’outil SCIROCCO a été adapté afin que 1) la description de chaque dimension soit adaptée au contexte de l’évaluation d’un pôle de santé et non pas d’un pays et 2) au langage utilisé par les acteurs locaux, suisses. Des acteurs internes aux pôles de santé et externes mais collaborant avec eux ont été sollicités pour réaliser l’évaluation. Afin d’obtenir un diagnostic le plus objectif possible, les personnes sollicitées ont été choisies parmi des niveaux décisionnels et organisationnels différents tant en interne qu’en externe.
Résultats et prochaines étapes : Le projet est actuellement en cours. À l’issue du processus d'évaluation, un diagnostic de maturité pourra être posé pour chacun des trois pôles de santé. Les résultats permettront à chacun des pôles de rédiger une feuille de route stratégique pour chacune des 12 dimensions ainsi des plans d’action détaillés pour trois dimensions considérées comme prioritaires. Nous proposons de présenter la version adaptée de l'outil SCIROCCO et la démarche participative mise en œuvre pour parvenir au diagnostic du niveau de maturité de chaque pôle.
Title Renoncement aux soins et présentéisme chez les médecins de premier recours en Suisse romande
Name Christine Cohidon
Affiliation Département de médecine de famille, Unisanté
AbstractObjectif: L’objectif de cette étude était de décrire la prévalence du renoncement aux soins et du présentéisme (présence au travail malgré l’existence de symptômes physiques ou psychiques justifiant un arrêt) chez les médecins de premier recours (MPR) en Suisse romande et d’en étudier les facteurs associés.
Méthodes: Une étude transversale sur la santé des MPR a été menée dans les régions romandes de Suisse en 2020. Un échantillon aléatoire de 1000 médecins a été sollicité pour participer à une enquête par questionnaire (taux de réponse 50%). Celui-ci incluait notamment des questions sur le renoncement à consulter et à s’arrêter de travailler, alors que l’état de santé le nécessitait, au cours de l'année précédente. Des données sociodémographiques, de santé personnelle ainsi que des données professionnelles complétaient le recueil. Des régressions logistiques ont permis d’étudier les facteurs prédictifs de ces comportements.
Résultats: 37% des MPR romands ont rapporté au moins un épisode de renoncement aux soins et 29% ont rapporté un épisode de renoncement à prendre un congé maladie, lors de l’année précédente. Par ailleurs, 53% d’entre eux n’avaient pas de médecin traitant. La lourdeur de la charge de travail était la raison la plus fréquemment évoquée pour le renoncement aux soins. Le présentéisme était associé au sexe féminin, au jeune âge, au fait d'avoir une maladie chronique, de travailler zone périphérique d’une ville et à temps plein. Aucune association n'a été trouvée entre les caractéristiques sociodémographiques, personnelles et professionnelles et le renoncement aux soins.
Conclusion: Les nouvelles générations de médecins de premier recours devraient faire l'objet d'un suivi attentif quant à cette problématique encore souvent méconnue. Des solutions spécifiques devraient être recherchées pour diminuer ces comportements, non seulement pour le bien des médecins et mais aussi pour la qualité des soins délivrés aux patients et la durabilité de notre système de première ligne.
Title Maintenance of sufficient vaccination coverage rates – lessons learned and adaptations for Switzerland
Name Daniel Desgrandchamps
Affiliation Département de médecine de famille, Unisanté
Vaccination coverage rates in Switzerland are highly variable across regions and time periods. In 2020, a decline was observed in the number of doses distributed for various vaccinations such as MMR, TBE, and HPV due to the COVID-19 pandemic (1). Furthermore, the pandemic has resulted in a lower willingness of getting routine vaccinations in Switzerland compared to other countries (Coronavirus - Geimpfter Bevölkerungsanteil nach Ländern | Statista).
Vaccinations are an efficient and cost-effective way to protect populations from vaccine-preventable diseases (VPD). Vaccination across the life-course results in significant benefits at the individual, community and socioeconomic level, and mitigate health risks due to infectious diseases and antimicrobial resistance (2, 3). An analysis in 23 European countries has shown, that for a healthy individual, the median annual cost per person of vaccination was 27.9-fold lower than the equivalent cost of hospitalization and the median annual vaccine acquisition costs per person was 2.2-fold lower than the equivalent cost of anti-infective medications (4). As example, increasing HPV vaccination has unrealized potential to prevent disease, financial cost, and psychological distress (5).
A life-course approach to immunization (LCAI) acknowledges the crucial role of immunization as a strategy to prevent diseases and optimize health life-long, regardless of the individual’s current age. A LCAI requires that immunization schedules and access to vaccination reflect the individual’s stage in life, its lifestyle and the specific risks to infectious diseases that the individual may face (6).
Five key areas need to be addressed to maintain optimal life course immunization schedules (2, 4):
1. Improving surveillance and data for vaccination beyond childhood
2. multidisciplinary coordination across all levels such as policymakers, patient organizations, academia, healthcare professionals (HCPs) and industry to ensure the importance of a LCAI is prioritized;
3. engaging HCPs: improving knowledge among HCPs, e.g. pharmacists, in vaccine delivery;
4. change of public perception of vaccination by addressing vaccine hesitancy;
5. integration of vaccination into school-based programs and workplaces.
Further efforts are needed from policymakers, healthcare professionals, and public health organizations to ensure that the benefits of vaccines are widely understood and accepted in the population across all ages (2).
1) Bundesamt für Gesundheit BAG. BAG-Bulletin 16 vom 19. April 2021. Durchimpfung von 2-, 8- und 16-jährigen Kindern und Jugendlichen in der Schweiz, 2017–2019. Available online. Last accessed on 12th January 2023.
2) Tate J., Aguado T., De Belie J. et al. The life-course approach to vaccination: Harnessing the benefits of vaccination throughout life. Vaccine 37 (2019) 6581–6583.
3) The Boston Consulting Group. 2018. Vaccines to tackle drug resistant infections: An evaluation of R&D opportunities. London: BCG
4) Goran Bencina, André Bento-Abreu, Ugne Sabale, Eleana Tsoumani, Valerie Laigle, Nicolas Dauby, Olivier Ethgen & Stina Salomonsson (2023): Estimating the lifetime cost of vaccination in 23 European Countries: a modeling study, Expert Review of Vaccines, DOI: 10.1080/14760584.2023.2157266
5) Shapiro, G.K. HPV Vaccination: An Underused Strategy for the Prevention of Cancer. Curr. Oncol. 2022, 29, 3780–3792. https://doi.org/10.3390/curroncol29050303
6) Taylor M., Jody T., Suzanne W., and Jonathon S. The Health Policy Partnership. Implementing a Life-Course Approach to Immunization Lessons learned from international best practice in policy and programming. 2019. Available online. Last accessed on 12th January 2023.
Title A Mediterranean Diet and Frailty Incidence in Community-Dwelling Adults 70+: The 3-Year DO-HEALTH Study
Name Stephanie Gängler
Affiliation Center for Aging and Mobility, University of Zurich
AbstractThe Mediterranean diet has been associated with many health benefits. Therefore, we investigated whether the degree of adherence to the Mediterranean diet at baseline, or changes in adherence over time, were associated with the incidence of pre-frailty or frailty in generally healthy older adults. This study used the DO-HEALTH trial data. We evaluated Mediterranean diet adherence with Panagiotakos’ MedDietScore at baseline and at 3-year follow-up; frailty was assessed annually with the Fried frailty phenotype. We used minimally and fully adjusted mixed logistic regression models to estimate the exposure–disease relationship. We included 1811 participants without frailty at baseline (mean age 74.7 years; 59.4% women). Baseline adherence, as reflected by the MedDietScore, was not associated with becoming pre-frail [OR(95%CI) = 0.93 (0.83–1.03) for five-point greater adherence] or frail [OR(95%CI) = 0.90 (0.73–1.12) for five points]. However, a five-point increase in the MedDietScore over three years was associated with lower odds of becoming pre-frail [OR(95%CI) = 0.77 (0.68–0.88)] and frail [OR(95%CI) = 0.77 (0.64–0.92)]. In generally healthy and active older adults, baseline adherence to the Mediterranean diet was not associated with the incidence of pre-frailty or frailty over a 3-year follow-up. However, improved adherence to the Mediterranean diet over time was associated with significantly lower odds of becoming pre-frail or frail.
Title COVID19 Vaccine survey among refugees, IDPs, returnees, and host communities in Northern governorates of Iraq
Name Mohammed Gubari
Affiliation Department of Family and Community Medicine, College of Medicine, University of Sulaimani
Background: Controlling COVID-19 was made possible after the vaccine was developed; however, people’s unwillingness to be vaccinated has remained a global challenge. Acceptance or refusal of COVID-19 vaccination can be affected by various sociodemographic factors. Among Iraq’s eligible population, two-dose COVID-19 vaccine coverage is <30% at national level. The present study was carried out to investigate COVID-19 vaccination coverage among populations of internally displaced persons, refugees, returnees, and host communities in selected governorates of northern Iraq, and the related underlying factors.
Materials and methods: Through a cluster cross-sectional study conducted in five governorates in April-May 2022, 4564 individuals in 550 clusters were surveyed. Required data were collected through an adapted questionnaire designed to gather data on participants’ sociodemographic characteristics, medical illnesses, source of information regarding COVID-19 and acceptance of and concerns regarding COVID-19 vaccine. The collected data were analyzed in STATA 17.0 using descriptive and analytical statistics.
Results: Data of 4564 subjects were included (59.55% were 19 to 45 years old; 54.51% males). The results revealed that 50.48% of the participants had been vaccinated by at least one doses of COVID-19 vaccine, while 49.5% had not vaccinated. 40.84% of participants had been vaccinated by two doses, 8.09% by one doses and 1.56% by 3 doses. COVID-19 immunization is higher in age higher than 18 years (p<0.0001), while women are less willing to prescribe the COVID-19 vaccine (p=0.033). Nationality (p=0.010), place of residence (p<0.0001), level of education (p<0.05) and occupation (p<0.05) were associated with COVID-19 immunization. Moreover, fear of being unsafe (p<0.0001), not being effective (p<0.0001), COVID-19 is not dangerous (p<0.0001), fear of infection following vaccination (p<0.0001), inappropriate attitude against the principle of vaccination in general (p<0.0001), religious reasons (p<0.0001) and believing on traditional and local medicine (p<0.0001) were the important personal barriers against COVID-19 vaccination.
Conclusion: Among the population surveyed, COVID-19 vaccination coverage was much higher than the national average. Sociodemographic characteristics, including place of residence, age, gender, level of education, occupation and nationality are decisive factors in COVID-19 vaccination coverage.
Title Digital Tools to Improve Parenting Behavior in Low Income Settings: A Mixed-Methods Feasibility Study in Peru
Name Lena Jäggi
Affiliation Universität Basel, Swiss TPH
Introduction: Home visiting programs are one of the most promising interventions for low-income settings (Jeong et al., 2021). A recent evaluation of the Peruvian national Early Childhood Development (ECD) home visiting program (Programa Nacional Cuna Más) has shown positive impacts on ECD and cost-effectiveness at scale (Araujo et al., 2021). However, as in many countries, the program does not have the capacity to serve all vulnerable families. Digital parenting interventions are increasingly considered as potentially cost-effective means for addressing gaps in access to ECD services in Peru, as well as in many other low-income settings. This 5- month mixed-methods feasibility pilot extensively tested reach, reception, and use of Afinidata, a comprehensive Facebook-Messenger based digital parenting intervention, in a remote rural setting in Peru. We also explored necessary adaptations to local context in preparation for a currently ongoing full-scale RCT. Afinidata provides parents of small children with activities that support early development and learning, leveraging artificial intelligence to customize activity recommendations based on user feedback (Castellanos, 2020).Study Population: This feasibility study was conducted in three provinces in the Cajamarca region of Peru from February 2021 to July 2021. Choosing 49 representative communities in the area we enrolled 180 mothers with children aged between 2-24 months who had regular access to a smartphone.
Methods: This study used mixed-methods to conduct extensive field-testing. After measuring internet and cellphone connectivity in the community we interviewed mothers three times in-person. Selected mothers also participated in focus groups or in-depth qualitative interviews.
Results: Despite the rural and remote study site, 88% of local families with children between 0- 24 months had access to internet and smartphones. Overall, Afinidata was received positively. Two months after baseline, 84% of all mothers reported using the platform at least once, and of those, 87% rated it as useful to very useful. Mothers cited time constraints as the main barrier for participation. The most important lesson learned from the detailed qualitative and quantitative feedback on Afinidata was the need to assist mothers in navigating the platform independently. We thus added a laminated booklet containing general information on child development, sample activities and detailed instructions on how to self-enroll in case of lost phones. Results showed high access to smart phones and despite declines in use over time, the positive reception in very remote areas of Peru suggests that digital parenting interventions could be a promising path forward for supporting low-income families in remote parts of Latin America.
Title Sources of information related to complementary and alternative medicine among adults in Ajman, UAE
Name Swetha Kannan
Affiliation Gulf medical University
AbstractObjectives: This study aims to identify the various sources of information regarding CAM and to assess their reliability among the adults in Ajman, UAE.
Materials and Methods: A cross-sectional study was performed using an interview-administered questionnaire. Participants’ sources of information regarding CAM were elicited in addition to socio-demographic characteristics. The questionnaires were distributed to 414 participants individually after obtaining their written consent. SPSS version 27 was used to perform the Chi-square test and the association between sources of information and use of CAM was derived. P-value ≤ 0.05 was considered statistically significant.
Results: From the results of the study, it was found that 67.2% of the respondents gained information on CAM through family, 55.8% through friends and 46.4% through Internet/social media. Healthcare professionals were the main source for 36.5% of the participants. Television was reported as the major source by 29.5%. The least reported source of information on CAM was magazines/newspapers, used by 25.1% of the participants.
Conclusion: Among the 414 participants in the study, the primary source of information regarding CAM is family (67.2%), followed by friends, internet/social media, healthcare professionals, and television. Newspapers and magazines were the least reported sources to acquire information. The study recommends healthcare educators to disseminate appropriate information regarding reliable and authentic sources of information regarding CAM, which would determine their favourable attitude and approach towards it.
Title Mutualiser les efforts dans le domaine de la prévention : l’exemple de www.jemebouge.ch
Name Tiffany Martin
Les prestations visant l’adoption de modes de vie favorables à la santé sont insuffisamment connues et utilisées par les personnes atteintes de maladies chroniques ou maladies non transmissibles (MNT) ainsi que par les personnes sédentaires et à risque de développer une MNT, notamment les plus vulnérables sur le plan socio-économique. L’offre d’activité physique (AP) est importante mais organisée par maladie et parfois peu adaptée aux différents besoins individuels. Ces constats sont partagés par les ligues de la santé vaudoises et associations de patient·e·s liées aux diverses MNT (Vettori & al., 2015), qui ont souhaité mutualiser leurs ressources grâce au projet « Je me bouge pour ma santé », fruit d’un consortium de partenaires (diabètevaud, la Ligue vaudoise contre le cancer, la Ligue pulmonaire vaudoise, la Ligue vaudoise contre le rhumatisme, la Ligue vaudoise contre les maladies cardiovasculaires, le Graap-Fondation, Unisanté et la Ligue suisse contre le cancer).
Le site www.jemebouge.ch, principal résultat du projet, présente près de 500 offres d’AP adaptées proposées par plus de 170 prestataires, de façon harmonisée et accessible tant aux personnes souhaitant se remettre à bouger qu’aux professionnel·le·s qui les conseillent et orientent à ce sujet. En 2022, ce sont plus de 13’000 personnes qui ont visité le site, dont 130 ayant rempli un formulaire de pré-inscription.
Ces résultats sont possibles grâce à la collaboration efficiente des acteurs·trices autour d’objectifs communs. Ces solides partenariats permettent de centraliser et mutualiser les efforts développés autour de l’AP adaptée dans les cantons de Vaud, Neuchâtel et Jura. En outre, ces collaborations favorisent les synergies entre projets qui ciblent les besoins des personnes, notamment les plus vulnérables, ainsi qu’une réflexion sur la qualité et l’adéquation des offres. La plateforme offre une suite aux programmes de réadaptation et favorise une continuité dans les parcours de vie, ainsi que l’autonomisation des personnes visées. Fort de son succès, la plateforme a pu déployer activement ses offres d’AP dans les cantons de Neuchâtel et du Jura depuis avril 2022, grâce au service de la santé publique du canton de Neuchâtel ainsi que la Fondation O2 et au soutien de Promotion Santé Suisse et du canton de Vaud. Pour la suite, elle entend s’étendre sur l’entièreté du territoire romand.
Title Effect of Social Marginalization on COVID-19 Vaccine Hesitancy among Slum Dwellers of Old Fadama, Ghana.
Name Joe Mensah
Affiliation University of Education, Winneba, Ghana
AbstractAlthough studies have looked at social marginalization and its effect on spread of COVID-19, related deaths, access to health care and insurance package, the margin of influence of how the dimensions of social marginalisation affect vaccine hesitance is understudied. Using a cross-sectional research design, simple random technique, and a sample of 386 respondents/household heads from Old Fadama, this study sought to assess the types of social marginalization in Old Fadama, assess the dimensions of COVID-19 hesitance in Old Fadama, and assess the effect of social marginalization on COVID-19 vaccine hesitance in Old Fadama. The result found five types of social marginalization (political, spatial, time, economic, and cultural) and six dimensions of COVID-19 vaccine hesitance (cost to vaccinate, treatment by health personnel, cost to vaccinate, vaccination schedule, risk/benefit, and fear of vaccine). The result of the study also found a positive effect of social marginalization on COVID-19 vaccine hesitance for the third objective. The study recommends that the Ministry of Health should embark on education on COVID-19 vaccine while setting up vaccination points in the community. Accra Metropolitan Assembly should focus on social intervention programs to help reduce social marginalization.
Key words: social marginalization, COVID-19, slum, vaccine hesitance, Old Fadama
Title Motorcyclists' Safety in Iran: Implication of Haddon Matrix in Safe Community setting
Name Alireza Moghisi
AbstractBackground: Three studies were conducted aiming to design specific interventions with aiming motorcyclist's safety by using Haddon matrix in 14 cities of Iran.
Methods: Motorcyclists' fatality data was extracted in 14 cities (5 safe community practicing and 9 safe community non practicing cities) during 2006-2007. As the next step a cross sectional study on Knowledge, Attitude, Practice (KAP) (Knowledge, Attitude and Practice) of motorcyclists about helmet was performed. A range of variables relevant to motorcyclists' injury research and prevention were developed and organized according to the Haddon matrix. The risky Behaviors, including over speeding, acrobatic movement, no helmet or not properly wearing helmet were considered. Data were analyzed with chi-square and ANOVA method using STATA software.
Results: The highest mortality rate was revealed in Niriz city (NSC) and the least was reported from Arsanjan city (SC) in Fars Province. In Busher province, the highest death rate was detected in the Busher city (SC) and the least was in the Genaveh city (NSC). In Khorasan , the highest death rate was reported from the Torbat-e-hydarieh city (NSC) and the lowest was from Bardscan (SC). Male drivers of 19-39 years old were the most affected age groups. The rate of helmet usage in overall was 13% while 97% owned a helmet. Embarrassing of wearing helmet was mentioned by 70% of participants as a reason for not wearing helmet. Participants believed that public education and re-enforcement of mandatory helmet law are two important ways to raise the helmet usage.
Conclusions: Constant public education in addition to attention to traffic rules are two important factors to promote helmet wearing rate.
Title Facing the pandemic: A mixed-method analysis of asylum seekers' experiences and worries
Name Kevin Morisod
Affiliation Unisanté and University of Lausanne
Background and Objectives: The burden of the COVID-19 pandemic remains high among migrant populations, especially asylum seekers (AS). Moreover, the social impact of COVID-19 public health measures disproportionally affected AS. In this context, we aimed to better understand the pandemic experiences and sources of worries of AS, as well as the associated social and structural factors.
Methods: We conducted a cross-sectional mixed-method study among AS in the canton of Vaud, Switzerland, which combined and integrated the results of the following quantitative and qualitative methods. First, participants answered questions in an online or paper survey about their worries, sleep problems and fear of dying. The associations with their socio-demographic characteristics were investigated using multivariable logistic regressions. Second, we conducted in person semi-structured interviews with participants who had not completed the survey. We performed an inductive thematic analysis focusing on how social and living conditions affected their experiences and worries.
Results: 203 participants answered the surveys and 13 took part in interviews. AS in community centres experienced more sleep disorders related to the COVID-19 pandemic than those living in private apartments. (aOR 2.01, p=0.045). Similarly, those with lower education had greater fear for their life due to the COVID-19 pandemic compared to AS with higher education (aOR 2.31, p=0.015). In addition, interviews showed that having to share living spaces was an important source of worries for AS. Protective measures were perceived to increase social isolation, with negative effects on their pandemic experiences.
Conclusion: Our study results suggest that a better understanding of AS experiences and worries could help decision-makers adapt public health policies for this population. These include avoiding high-density facilities, encouraging the transfer of AS from community centres to private facilities, and tailoring health recommendations to the language, cultural and health literacy barriers of AS.
Title Mixed methods for selecting postgraduate EPAs for General Internal Medicine in Switzerland
Name Valérie Pittet
Affiliation Unisanté - DESS
AbstractIntroduction: Entrustable Professional Activities (EPAs) are concrete daily clinical tasks requiring appropriate deployment of multiple competencies a trainee should be able to deal with. Before accomplishing these tasks independently, trainee doctors must gain the trust of their supervisors. Defining and selecting a final list of EPAs to be mastered by the end of postgraduate training (PGT) is therefore critical to setting clear expectations for autonomous practice. We aimed to define and select EPAs relevant for PGT in General Internal Medicine (GIM) in Switzerland.
Methods: We used a 3-steps method. We first did a systematic literature review to identify already existing EPAs. Then, we conducted 4 focus groups (FG) discussions (2 with doctors from hospital and 2 from ambulatory settings; 2 in French and 2 in German; total of 28 participants) to challenge the list of existing EPAs and complement it with new EPAs. We submitted the final list of EPAs to a panel of Swiss experts using a modified RAND appropriateness method (RAM) with two rounds of rating. Ratings were made on a 9-point Likert scale. Relevance was categorized as high (median (med) 7-9), low (med 1-3) or uncertain (med 4-6 or disagreement (1/3 of ratings 1-3 and 7-9).
Results: A total of 308 potential EPAs were identified in the literature review. After careful reviewing (reformulation and elimination), we retained a list of 204 EPAs. The analysis of FG helped to complement this list with 43 additional EPAs (N=247). A total of 34 internists with various years of experience as clinical supervisors were invited to rate the EPAs; 28 participated to the first round of individual rating (10 women, 12 from ambulatory practice, from the German (12), French (13) and Italian speaking region (3)) and 11 of them to the expert panel meeting. 223/247 (90%) EPAs were deemed relevant for PGT in GIM. 179 (72%) were considered relevant to both training tracks, 19 (7%) for the hospital track and 27 (11%) to the ambulatory track. 61% of EPAs were ranked with very-high relevance (median score 8.5-9) for both training tracks. Low-ranked EPAs related to pregnancy, newborn or child care. Most new EPAs from FG were ranked highly relevant.
Conclusions: We were able to establish and select a list of EPAs for PGT in GIM, using a national consensus process with a mixed qualitative and qualitative approach. The results of this study will provide a solid foundation for structuring the future Swiss PGT programs in GIM.
Title Patient and public involvement (PPI) in health services research: A survey study among Swiss health
Name Carina Prelucan
Affiliation University of Lucerne
AbstractBackground: The relevance of patient and public involvement (PPI) is increasingly recognized in research and the health system. Involving patients in health services research is essential to ensure that research is responsive to the needs and priorities of the patients and that the results can be applied in a way that improves the quality and effectiveness of health services. There are clear trends toward shared decision-making in health and patient-oriented research in Switzerland, but implementation varies greatly. Even though significant efforts have been made, such as the Swiss Clinical Trial Organization (SCTO), which has developed a guide for clinical researchers on how to include patients in clinical trials and also mapped out patient involvement initiatives in Switzerland, the focus still remains mainly on clinical research. Less systematic attention has been paid to patient involvement in health services research, with no clear overview of PPI activities in health services research in Switzerland.
Aim: This study aims (1) at describing researchers' current practices and experiences with respect to involving patients and the public in their research and (2) at identifying researchers' needs for conducting meaningful research that involves patients and the public.
Methods: Based on the available literature and similar studies from other countries a cross-sectional survey was developed, which will be conducted online between January and March 2023. Study participants will be researchers in the field of health services research from Switzerland and will be recruited through snowball sampling.
Results and Implications: There is a need for more systematic PPI in research. Understanding health service researchers' experiences, views, and needs are essential for enabling systematic PPI. The results will inform recommendations for capacity building and resources needed for driving the efforts of involving patients in health services research in Switzerland.
Title Follow-up of terminations of pregnancy in the canton of Vaud between 2003 and 2021
Name Sophie Stadelmann
AbstractIntroduction: In Switzerland, terminations of pregnancy (TP) have to be reported to the competent public health authority for statistical monitoring purposes. The aim of this study is to present the main results on the evolution of TP in the canton of Vaud between 2003 and 2021, detailing the characteristics of the woman and the procedure.
Methods: Data were collected with an anonymous form, filled by the gynaecologist who conducted the intervention. We performed descriptive statistics on the indicators. In addition, population-based data from Statistique Vaud were used to calculate the rate of TP/1000 women aged 15-49 living in the canton of Vaud and the ratio of TP/100 live births for this same group of women.
Results: Each year, nearly 1500 TP are conducted in the canton of Vaud, 90% of them on women living in the canton. TP concern all strata of society as women of all ages, origins or socio-demographic levels have undergone one. The trend in the ratio of TP to live births according to the women’s origin has reversed in recent years. It is now more frequent among women of Swiss origin than among those of foreign origin (17% vs 14% in 2021). The rate of TP/1000 Vaud residents follows the same trend, although the inversion has not yet taken place. For almost a third of women who already have children, the TP occurred in the same year or the year following their last delivery. The proportion of TP carried out with the medicinal method is constantly increasing (76% in 2021). Finally, there is a small decrease in the rate of TPs conducted at the CHUV, leading to a proportional increase in regional hospitals since 2020.
Conclusions: At first sight, a great stability of the data can be observed. However, thanks to the long-term follow-up available in the canton of Vaud, it is possible to see certain slow evolutions taking place. These have an implication for the first line of gynaecological care. The information obtained from this epidemiological surveillance contributes to the definition and orientation of health policies at the cantonal level. It should also be noted that the rate of TP/1000 women residing in the canton of Vaud, although higher than the overall Swiss rate (7‰ vs 6‰ in 2021), remains low compared to the situation in other neighbouring countries.
Title Development of costs and utilization in health care sector in Switzerland
Name Yves Staudt
Affiliation Fachhochschule Graubünde
AbstractIn Switzerland, as in Europe, healthcare costs are rising. This has as a conclusion an increase of the premium. The federal government is trying to slow down the costs through federal initiatives. However, these are often poorly received by health care providers or health insurance companies. This is because the initiatives are often implemented without a data basis. To gain a better understanding of health care costs, we conducted qualitative interviews with physicians. In the interviews, physicians were asked about changing treatments and costs. For many physicians there is a change in treatments, which are caused by digitalization. This often shortens the length of stay and the duration of treatment. Unfortunately, the increase in digitization and the shortened treatment time has a great influence on the costs, which have been rising in recent years according to the doctors' estimates. In which we have interviewed three specialties, this change can be confirmed overall. In addition to the qualitative interviews, we have analyzed at Corona times how the occupation of the intensive care units changes depending on the reported numbers in relation to the age groups. These results were analyzed per canton over time and visualized on the Swiss map. The graphical map and combination of variables allows us to visualize characteristics that are not feasible with univariate and multiple graphical representation. Both analyses allow to get a good understanding of the current health care system and to propose conclusions and improvements for the health care system.
Title Introduction of comprehensive coding of diagnoses in outpatient care in Switzerland - benefits and challenges
Name Michael Stucki
Affiliation ZHAW Zurich University of Applied Sciences
AbstractBackground: The Swiss Health Insurance Act mandates the coding of diagnoses and treatments in outpatient care. While treatments are coded by tariff positions, a systematic coding of diagnoses is still lacking. It is also unclear which diagnostic classification should be applied. Consequently, there is a substantial lack of transparency regarding the diseases treated in outpatient care and the changes in their epidemiology.
Method: We explored the potential benefits of diagnostic coding in outpatient care as well as the main challenges from the point of view of the various stakeholders. We defined the criteria for suitable diagnostic classifications and examined the strength and weaknesses of potential classifications. We conducted a literature review, evaluated current diagnostic coding by selected health care providers in claims data, and performed 27 stakeholder interviews with health professionals, health insurers, researchers and statistical and health authorities. The study was commissioned by the Federal Statistical Office.
Results: To date, diagnoses are rarely and inconsistently recorded on outpatient care invoices in Switzerland. While different potential uses of diagnostic coding in claims data are known, there is no consensus on which purpose should be prioritized and who should own and process this data. A decision on the type of use is however required for the choice of a suitable type of diagnostic classification. In contrast to other countries, reimbursement of ambulatory care is currently not linked with diagnostic coding. For service providers the introduction of diagnostic coding would thus lead to additional administrative efforts without clear benefits.
Conclusions: The type of utilization of diagnostic coding in outpatient care and its implementation should be developed in a participatory process with the stakeholders involved. For a successful introduction of a comprehensive and good quality diagnostic coding, its purpose and its implementation must be in line with the incentives of service providers.
Title Enabling personalised metabolic health for all
Name Christopher Wall
Affiliation Maven Health
AbstractTo maintain affordable and high-quality healthcare services, a pivot from curative health care into preventive health care is needed. To achieve effective preventive health care, personalised tests are key. Primary care health professionals are eager to use new methods to accommodate this but lack the technology, scale and data science. Current blood tests are invasive, infrequent and inaccurate in predicting the risk for metabolic diseases early in the disease progression. Our metabolic testing platform delivers an accurate snapshot of a patient's metabolic health to primary healthcare providers. Our core product is an AI-driven data platform which provides analyses and predictions to primary healthcare providers. The input data comes from metabolite levels in saliva, collected noninvasively by primary health care providers. Data are processed by our software platform delivering an accurate report of current metabolic health. With our platform, we strive to be the gold standard for diagnosing all metabolic related diseases.
Title Coverage of policies to improve Antimicrobial Stewardship and national implementation measures to optimize
antimicrobial use in low and middle income countries: Results from the first Global Survey of Experts on Antimicrobial
Name Kyaw Zay Ya
Affiliation Swiss Tropical and Public Health Institute
AbstractBackground: Antimicrobial resistance (AMR) constitutes a major threat to global health security. While antimicrobial misuse or overuse is a one of the main drivers for AMR, little is known regarding the extent to which this is due to a lack national government-led efforts to enforce rational antimicrobial use in low and middle-income countries (LMICs).
Methods: To assess antimicrobial stewardship and national implementation measures currently in place for optimizing antimicrobial use and slowing the spread of AMR through expert’s lens, we invited public health experts from 138 LMICs to participate in an online survey, Global Survey of Experts on Antimicrobial Resistance (GSEAR). Key coverage measures as reported by experts were compared to those collected in the 2020-21 World Health Organization (WHO) organized Tripartite AMR Country Self-assessment Survey (TrACSS).
Findings: A total of 352 completed surveys from 118 LMICs were analyzed. Experts in 67% of the surveyed countries reported a national action plan (NAP) on AMR, 64% reported legislative policies on antimicrobial use, 58% reported a national training programs for health professionals, and 10% reported national monitoring systems for antimicrobials. 51% of LMICs had specific targeted policies to limit the sale and use of protected or reserve antibiotics. While 72% of LMICs had prescription requirements for accessing antibiotics, getting antibiotics without a prescription was reported to be possible in practice in 74% of LMICs. We found a substantial disagreement between two surveys and TrACSS reported more coverage of policies compared to GSEAR.
Interpretation: The results suggest major gaps in the implementation and enforcement of policies to reduce the risk of AMR in many LMICs. Improved monitoring of national efforts as well as increased national efforts in the areas of enforcement and monitoring of antibiotic use are urgently needed to reduce inappropriate use and overuse in LMICs and to slow the spread of AMR globally.
Title Complementary medicine in homeless people in Switzerland: Desirable? A mixed-method descriptive study
Name Véronique S. Grazioli
Affiliation Unisanté, Département Vulnérabilités et médecine sociale
AbstractBACKGROUND AND OBJECTIVES: Bordetella parapertussis can be responsible for whopping cough (pertussis).
The resurgence of pertussis in Switzerland and Europe raises the question of how to contain outbreaks in structures
that host high-risk populations (such as nurseries). We aim to report on an outbreak in a nursery and a primary school
as well as the measures taken.
METHODS: We collected epidemiological information on cases of B. parapertussis in a school community (nursery
and primary school) between 11 January and 7 February 2023 and analysed them in the light of the recommendations
of the Federal Office of Public Health (FOPH)i for management of pertussis outbreaks.
RESULTS: The outbreak was identified by the detection of two cases of B. parapertussis confirmed by PCR in two
children in a classroom of a primary school. A total of 82 children and 23 adults contacts were identified (total: 105)
and a PCR testing B. parapertussis was performed in 74 of them. Six additional cases were identified; three in the
same classroom, two in a nursery and two in the family and social environment (median age: 3.7 years; Q1-Q3: 2.6-
5.4). After the first positive cases were evicted and symptomatic contacts tested, and considering an advanced outbreak
and limited local capacity for testing, we decided not to perform further testing and to consider symptomatic persons
as probable cases. We focused on preventive measures on high-risk groups (i.e. infants under 6 months and pregnant
women in their third trimester) and their contacts, with the recommendation to consult and receive antibiotic prophylaxis
if indicated. Among 105 persons reported as contacts, 75 were considered close contacts (71%). An antibiotic treatment
was offered to 45 persons (43%), including 37 as prophylaxis (35%). Another important control measure was directed
at professionals in contact with children under 6 months of age, with the indication to receive antibiotic prophylaxis (and
to wear a surgical mask until the 6th day after the start of treatment) or, in case of refusal of treatment, to wear a
surgical mask for 21 days.
DISCUSSION: B. parapertussis is an acute and highly contagious respiratory disease that can lead to large outbreaks,
also considering that vaccine immunity is lower compared to B.pertussis. It therefore requires prompt and agile infection
Title BORDETELLA PARAPERTUSSIS OUTBREAK IN A NURSERY AND PRIMARY SCHOOL IN THE CANTON OF WALLIS
Name Larissa Vernier
1. Unité cantonale des maladies transmissibles, Institut Central des Hôpitaux, Hôpital du Valais, Sion, Switzerland
2. Service des maladies infectieuses, Institut Central des Hôpitaux, Hôpital du Valais, Sion, Switzerland
3. Office du médecin cantonal, Service de la santé publique, Canton du Valais, Sion, Switzerland
BACKGROUND AND OBJECTIVES: Bordetella parapertussis can be responsible for whopping cough (pertussis). The resurgence of pertussis in Switzerland and Europe raises the question of how to contain outbreaks in structures that host high-risk populations (such as nurseries). We aim to report on an outbreak in a nursery and a primary school as well as the measures taken.
METHODS: We collected epidemiological information on cases of B. parapertussis in a school community (nursery and primary school) between 11 January and 7 February 2023 and analysed them in the light of the recommendations of the Federal Office of Public Health (FOPH)i for management of pertussis outbreaks.
RESULTS: The outbreak was identified by the detection of two cases of B. parapertussis confirmed by PCR in two children in a classroom of a primary school. A total of 82 children and 23 adults contacts were identified (total: 105) and a PCR testing B. parapertussis was performed in 74 of them. Six additional cases were identified; three in the same classroom, two in a nursery and two in the family and social environment (median age: 3.7 years; Q1-Q3: 2.6- 5.4). After the first positive cases were evicted and symptomatic contacts tested, and considering an advanced outbreak and limited local capacity for testing, we decided not to perform further testing and to consider symptomatic persons as probable cases. We focused on preventive measures on high-risk groups (i.e. infants under 6 months and pregnant women in their third trimester) and their contacts, with the recommendation to consult and receive antibiotic prophylaxis if indicated. Among 105 persons reported as contacts, 75 were considered close contacts (71%). An antibiotic treatment was offered to 45 persons (43%), including 37 as prophylaxis (35%). Another important control measure was directed at professionals in contact with children under 6 months of age, with the indication to receive antibiotic prophylaxis (and to wear a surgical mask until the 6th day after the start of treatment) or, in case of refusal of treatment, to wear a surgical mask for 21 days.
DISCUSSION: B. parapertussis is an acute and highly contagious respiratory disease that can lead to large outbreaks, also considering that vaccine immunity is lower compared to B.pertussis. It therefore requires prompt and agile infection control interventions.
Title Opportunities and Barriers for the Use of Mental Health Apps -Reimbursement by Health Insurances
Name Andrea Preuss
Affiliation Masterarbeit MAS Public Health
AbstractBackground and Objective: App-based mental health interventions with proven clinical benefits could provide support when access to psychotherapy is limited. At the onset of this study, mental health apps existed for several disorders but reimbursement in Switzerland was only possible through supplemental insurance schemes. The thesis aims to explore how Swiss insurers take decisions on the reimbursement of mental health apps.
Methods: Interviews were conducted based on a semi-structured interview guide with eleven representatives of seven Swiss insurance companies. Interviews were transcribed and assessed by qualitative content analysis. Results were put in perspective based on the relevant scientific literature.
Results: Reimbursement of mental health apps within supplemental insurances has to a larger extent been established opportunistically for available solutions with clinical evidence. Great market power was attributed to providers of such apps and other digital interventions and health insurers found ways to deal with multiple marketing approaches from solution providers. There was a consensus that solutions in a health area as fundamental as mental health should be available to everybody and not only to clients who are able to pay for an appropriate insurance. All insurers reported to put higher priority on their clients’ benefit than on their own financial benefit, reinforced by the fact that the cost contribution of an app is relatively small. Also, there was wide agreement that the use of mental health apps should be embedded in a care setting, but the proposed integration of mental health apps into a patient’s healthcare context ranged from mandatory professional support to no discussion of such a requirement. However, involving service providers in the dissemination of mental health apps was viewed critical for success. Differences were observed with respect to assessment criteria for selection of specific interventions. Large insurers prefer to carry out their own assessments while smaller insurers would prefer to rely on a seal of approval. Effectiveness was described as the most important criterion, however needs to comprise the demonstration of cost savings beyond clinical efficacy. It became clear that it is not straightforward to determine appropriate prices and even less to assess cost-effectiveness of mental health apps.
Conclusion: As of today, healthcare insurers in Switzerland are facing challenges when making evidence-based decisions regarding the reimbursement of mental health apps. Challenges exist with respect to costbenefit assessments as well as appropriate implementation routes including the use of mental health apps with or without guidance.
Title Cognitive Abilities and Attitudes/Behaviors towards End-of-Life Care Planning in Older Adults: Evidence from a
Swiss National Population Study
Name Robert Reinecke
Affiliation FORS (Swiss Centre of Expertise in the Social Sciences)
AbstractObjectives: Individuals tend to wait until the last moment to plan their end-of-life (EOL) care. Yet decision-making capacity decreases with age, which could compromise the writing of advance directives (ADs). Little is known concerning the association between cognitive abilities and attitudes/behaviors towards EOL care planning in older adults. The present study aims to better understand the association of cognitive competence with attitudes and behaviors towards EOL care planning in a nationally representative sample of older adults in Switzerland.
Methods: We analyzed data from 1’936 respondents aged 55+ from a paper-and-pencil self-completion questionnaire that was administered as part of wave 6 (2015) of the Survey of Health, Ageing and Retirement in Europe (SHARE) in Switzerland. Method. Using multivariable logistic regression models and controlling for key socio-demographic characteristics, we investigated the associations of individual and simultaneous measures of cognitive functions – verbal fluency, immediate and delayed memory, temporal orientation and basic calculation skills – with attitudes and behaviours towards EOL care planning.
Findings: Respondents with reduced global cognitive competence are less likely (i) to have discussed their EOL preferences with others and (ii) to have a living will. Impairment in verbal fluency is negatively associated with approving ADs, having discussed EOL preferences, and having a living will.
Conclusion: Our findings highlight that low global cognitive performance in general and low verbal fluency in particular can be considered a barrier regarding EOL care planning.
Public Significance: EOL care planning is a complex process involving discussions of EOL preferences and the completion of advance directives, which, according to our findings, appears to benefit from intact cognitive abilities. To increase the prevalence rates of discussing and completing advance directives in the population aged 55 and older, it is highly advisable to initiate discussions of EOL preferences before the onset and, more importantly, in the early stages of cognitive impairment. One possible strategy is to offer individuals the opportunity to familiarize themselves with EOL care planning in routine consultations with health care providers.