Participation, retention and uptake in a multicentre pre-exposure prophylaxis cohort using online, smartphone-compatible data collection.

OBJECTIVES: The aim of the study was to assess the feasibility of a national pre-exposure prophylaxis (PrEP) programme using smartphone-compatible data collection. METHODS: This was a multicentre cohort study (NCT03893188) enrolling individuals interested in PrEP in Switzerland. All centres participate in the SwissPrEPared programme, which uses smartphone-compatible data collection. Feasibility was assessed after centres had enrolled at least one participant. Participants were HIV-negative individuals presenting for PrEP counselling. Outcomes were participation (number enrolled/number eligible), enrolment rates (number enrolled per month), retention at first follow-up (number with first follow-up/number enrolled), and uptake (proportion attending first visit as scheduled). Participant characteristics were compared between those retained after baseline assessment and those who dropped out. RESULTS: Between April 2019 and January 2020, 987 individuals were assessed for eligibility, of whom 969 were enrolled (participation: 98.2%). The median enrolment rate was 86 per month [interquartile range (IQR) 52-137]. Retention at first follow-up and uptake were both 80.7% (782/969 and 532/659, respectively). At enrolment, the median age was 40 (IQR 33-47) years, 95% were men who have sex with men, 47% had a university degree, and 75.5% were already taking PrEP. Most reported multiple casual partners (89.2%), previous sexually transmitted infections (74%) and sexualized drug use (73.1%). At baseline, 25.5% tested positive for either syphilis, gonorrhoea or chlamydia. Participants who dropped out were at lower risk of HIV infection than those retained after baseline assessment. CONCLUSIONS: In a national PrEP programme using smartphone-compatible data collection, participation, retention and uptake were high. Participants retained after baseline assessment were at considerable risk of HIV infection. Younger, less educated individuals were underrepresented in the SwissPrEPared cohort.

[Promotion of physical activity in the primary care setting: what is the situation in Switzerland?]. / Promotion de l'activité physique au cabinet médical: où en sommes- nous en Suisse?

If many harmful effects of a sedentary lifestyle on health are well known, we still need to better understand how effectively promoting regular physical activity in the general population. Among the currently explored strategies, screening for sedentary lifestyle and promoting physical activity in the primary care setting seem promising. Despite recommendations from governmental agencies and professional associations in favor of physical activity counseling, this approach has not been widely adopted so far. This article summarizes the steps taken in Switzerland with an aim of developing physical activity counseling in the primary care setting. It describes how the early implication of primary care physicians influenced in a concrete way the development of a project dedicated to that task.

Diabetes care: Comparison of patients' and healthcare professionals' assessment using the PACIC instrument.

RATIONALE, AIMS AND OBJECTIVE: Whereas the Patient Assessment of Chronic Illness Care (PACIC) instrument measures the extent to which care received by patients is congruent with the Chronic Care Model, the 5As model emphasizes self-management and community resources, 2 key components of the Chronic Care Model. We aimed at comparing evaluation of diabetes care, as reported by patients with diabetes and healthcare professionals (HCPs), using these instruments. METHODS: Two independent samples, patients with diabetes (n = 395) and HCPs (including primary and secondary care physicians and nurses; n = 287), responded to the 20-item PACIC and the six 5As model questions. The PACIC-5A (questions scored on a 5-point scale, 1 = never to 5 = always) was adapted for HCPs (modified-PACIC-5A). In both samples, means and standard deviations for each question as well as proportions of responses to each response modality were computed, and an overall score was calculated for the 20-item PACIC. RESULTS: Patients' and HCPs' overall scores were 2.6 (SD 0.9) and 3.6 (SD 0.5), respectively, with HCPs reporting higher scores for all questions except 1. Patients' education and self-management, referral/follow-up and participation in community programs were rated as low by patients and HCPs. CONCLUSION: Healthcare professionals, particularly diabetes specialists, tended to report better PACIC scores than patients, suggesting that care was not reported similarly when received or provided. Evaluation differences might be reduced by a closer collaboration between patients and HCPs, as well as the implementation of community-based interventions considering more patients' perspectives such as patients' education and self-management.

Motivating for cancer prevention.

Effective habit change usually requires a combination of psycho-educational, behavioural, and social learning strategies. Motivational interview and shared decision making are likely to be the most efficient approaches. Assessing the current motivation can be based on the transtheoretical model of change (TTM) with the goal to move from one behaviour to another healthier one. In a daily busy clinical practice, brief counselling interventions of one to three visits can substantially help patients change problematic behaviours, particularly in the areas of smoking cessation and exercise. The acronym FRAMES has been used to define the elements of an effective brief intervention which helps to trigger the patient motivation to change; giving Feedback based on a thorough assessment; helping the patient take Responsibility for changing; giving clear Advice on what behaviour must change; offering a Menu of options for making the change; expressing Empathy for the ambivalence and difficulty in making changes; enhancing Self-efficacy to foster commitment and confidence. This chapter reviews relevant aspects of clinician-patient communication with regard to cancer prevention, especially smoking cessation and exercise.

Biomedical risk assessment as an aid for smoking cessation.

BACKGROUND: A possible strategy for increasing smoking cessation rates could be to provide smokers who have contact with healthcare systems with feedback on the biomedical or potential future effects of smoking, e.g. measurement of exhaled carbon monoxide (CO), lung function, or genetic susceptibility to lung cancer. We reviewed systematically data on smoking cessation rates from controlled trials that used biomedical risk assessment and feedback. OBJECTIVES: To determine the efficacy of biomedical risk assessment provided in addition to various levels of counselling, as a contributing aid to smoking cessation. SEARCH STRATEGY: We systematically searched he Cochrane Collaboration Tobacco Addiction Group Specialized Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966 to 2004), and EMBASE (1980 to 2004). We combined methodological terms with terms related to smoking cessation counselling and biomedical measurements. SELECTION CRITERIA: Inclusion criteria were: a randomized controlled trial design; subjects participating in smoking cessation interventions; interventions based on a biomedical test to increase motivation to quit; control groups receiving all other components of intervention; an outcome of smoking cessation rate at least six months after the start of the intervention. DATA COLLECTION AND ANALYSIS: Two assessors independently conducted data extraction on each paper, with disagreements resolved by consensus. MAIN RESULTS: From 4049 retrieved references, we selected 170 for full text assessment. We retained eight trials for data extraction and analysis. One of the eight used CO alone and CO + Genetic Susceptibility as two different intervention groups, giving rise to three possible comparisons. Three of the trials isolated the effect of exhaled CO on smoking cessation rates resulting in the following odds ratios (ORs) and 95% confidence intervals (95% CI): 0.73 (0.38 to 1.39), 0.93 (0.62 to 1.41), and 1.18 (0.84 to 1.64). Combining CO measurement with genetic susceptibility gave an OR of 0.58 (0.29 to 1.19). Exhaled CO measurement and spirometry were used together in three trials, resulting in the following ORs (95% CI): 0.6 (0.25 to 1.46), 2.45 (0.73 to 8.25), and 3.50 (0.88 to 13.92). Spirometry results alone were used in one other trial with an OR of 1.21 (0.60 to 2.42). Two trials used other motivational feedback measures, with an OR of 0.80 (0.39 to 1.65) for genetic susceptibility to lung cancer alone, and 3.15 (1.06 to 9.31) for ultrasonography of carotid and femoral arteries performed in light smokers (average 10 to 12 cigarettes a day). AUTHORS' CONCLUSIONS: Due to the scarcity of evidence of sufficient quality, we can make no definitive statements about the effectiveness of biomedical risk assessment as an aid for smoking cessation. Current evidence of lower quality does not however support the hypothesis that biomedical risk assessment increases smoking cessation in comparison with standard treatment. Only two studies were similar enough in term of recruitment, setting, and intervention to allow pooling of data and meta-analysis.

X-ray imaging of the chest in Switzerland in 1998: a nationwide survey.

The use in Switzerland of three chest X-ray imaging modalities is studied. The frequency and dosimetric aspects associated with chest radiography, chest CT, and photofluorography are investigated and the Swiss figures are compared with those of other countries. The frequencies are established by means of a nationwide survey performed in 1998, whereas the doses are determined by modelling, based on the technical parameters of the examinations. The annual frequencies of chest radiography, chest CT, and photofluorography are 201, 7, and 7 per thousand population, respectively. The standard effective doses related to these three types of examinations are 0.057, 9, and 0.13 mSv, respectively. The collective dose associated with chest X-ray imaging amounts to 606 man.Sv, representing 8.5% of the total collective dose due to diagnostic and interventional radiology. The geographic and seasonal variations, as well as the distribution with the medical specialty and with the age of the patient, are established. The Swiss results compare well with the average data published in the literature for other countries of similar health care level. Chest radiography shows a significant decrease with time. It dropped by a factor of 2 in 20 years. The conformity of the indication of chest X-ray modalities with referral guidelines is also investigated.

Isapres abiertas: resultados financieros 1990-1999 / Isapres open: financial results 1990-1999

Se describen algunos resultados financieros de las 16 Isapres vigentes en 1999. Se procesaron los datos de la década del 90 al 99. Siete Isapres logran una concentración del mercado del orden del 87 por ciento. Todas las cifras siguientes se refieren a estas 7 Isapres, expresadas en moneda de 1999. La utilidad neta del período fue de 182.480 millones de pesos. En Unidades de Fomento: 12.111.269 y en dólares americanos: 339.043.514. La tasa de retorno del patrimonio fue de 32,2 por ciento. Se pagaron dividendos por 47.596 millones de pesos. En Unidades de Fomento: 3.158.965 y en dólares americanos: 88.432.240. Los aumentos, en los rubros que se señalan, entre el 90 y el 99 fueron los siguientes: patrimonio: 74 por ciento, cotizantes: 80,4 por ciento, ingresos operacionales: 145,9 por ciento, y costos operacionales: 168,0 por ciento

El costo estándar: teoría y aplicación / Standard cost: theory and application

El estudio muestra las ventajas de aplicar el Costo Estándar en instituciones de salud, tomando como ejemplo un Laboratorio Central perteneciente a un Hospital Docente-Asistencial. La investigación es de carácter descriptivo y analítico utilizando las pruebas estadística de promedio y desviación estándar para comparar los costos estándar con los costos observados. En la institución estudiada, la variación total de los costos debido a cambios de precio, cantidad y volumen, según factores trabajo e insumo, resulta desfavorable en los dos primeros meses del año. En Enero por cantidad y en Febrero por precio. Este tipo de estudio permite estándares y, en consecuencia, conocer las variaciones en relación a él (eficiencia), el análisis de sus causas y la toma de decisiones. Este sistema de costo permite la determinación de precios "reales" y avala, por tanto, la negociación con las instituciones financiadoras