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1.
BMC Psychiatry ; 21(1): 425, 2021 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-34465305

RESUMO

BACKGROUND: Inpatient treatment is not the most beneficial treatment setting for many patients with psychiatric disorders and overcrowding is a recurrent problem for psychiatric hospitals. Therefore, it is important to develop strategies to limit avoidable inpatient treatment. This study sought to evaluate the impact of an emergency hotline that was developed to better manage psychiatric patients, particularly for identifying those requiring a hospital admission. METHODS: This pre-post intervention quality improvement study compared changes in the management of psychiatric patients' admission before and after the introduction of an emergency hotline where a specialist in psychiatry examines all inpatient referral from private practitioners. Main outcomes were the change in proportion of hospital admissions after referral from a private practitioner before and within 3 months after the intervention. Secondary outcomes were the average length of hospital stay, proportion of non-voluntary admission, the time required for triage and the impact of the intervention on treatments' costs. Fisher's Exact test was used to test the primary hypothesis of difference in the proportion of hospitalized patients before and after introduction of the emergency hotline. Secondary outcomes were tested with Student's t-test for continuous variables and Fishers's Exact test for proportions. RESULTS: Among 45 admission requests from private practitioners during the 3 months after introduction of the new emergency hotline, 25 (55.6%) were accepted as inpatient treatment, while 20 (44%) were redirected to more appropriate outpatient treatments. There was a highly significant difference from the baseline period during which all 34 requests were accepted (44% vs 100%, p < 0.001). In addition, for the patients hospitalized after the introduction of the emergency hotline there was a trend-level reduction of the average length of stay (9.32 days vs 17.35 days). CONCLUSION: Implementation of an emergency hotline manage by a specialist in psychiatry for admissions to acute psychiatric wards is feasible and simple to use. Importantly, it allows to significantly decrease the proportion of hospitalizations. Additional studies are needed to assess the generalizability of these exploratory results to other health care settings.


Assuntos
Hospitalização , Linhas Diretas , Serviço Hospitalar de Emergência , Humanos , Suíça , Centros de Atenção Terciária
2.
Swiss Med Wkly ; 151(33-34)2021 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-34495598

RESUMO

BACKGROUND: Patients on maintenance dialysis are at high risk for serious complications from COVID-19 infection, including death. We present an overview of local experience with dialysis unit management and reorganisation, local epidemiology and outcomes during the COVID-19 outbreak in Geneva, Switzerland, where SARS-CoV-2 incidence was one of the highest in Europe. METHODS: All SARS-CoV-2-positive outpatients on maintenance dialysis were transferred from their usual dialysis facility to the Geneva University Hospitals dialysis unit to avoid creation of new clusters of transmission. Within this unit, appropriate mitigation measures were enforced, as suggested by the institutional team for prevention and control of infectious diseases. RESULTS: From 25 February to 31 December 2020, 82 of 279 patients on maintenance dialysis tested positive for SARS-CoV-2 during two distinct waves, with an incidence rate of 73 cases per 100,000 person-days during the first wave and 342 cases per 100,000 during the second wave, approximately four- to six-fold higher than the general population. The majority of infections (55%) during both waves were traced to clusters. Most infections (62%) occurred in men. Sixteen patients (34%) died from COVID-19 related complications. Deceased patients were older and had a lower body mass index as compared with patients who survived the infection. CONCLUSION: SARS-CoV-2 is associated with high infection and fatality rates in the dialysis population. Strict mitigation measures seemed to be effective in controlling infection spread among patients on maintenance dialysis outside of clusters. Large scale epidemiological studies are needed to assess the efficacy of preventive measures in decreasing infection and mortality rates within the dialysis population.


Assuntos
COVID-19 , Pandemias , Humanos , Masculino , Diálise Renal , SARS-CoV-2 , Suíça/epidemiologia
3.
Swiss Med Wkly ; 151(33-34)2021 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-34495600

RESUMO

INTRODUCTION: The COVID-19 pandemic and the associated restrictions may have modified the activities of the Swiss population and thus altered trauma patterns. MATERIALS AND PATIENTS: All adult patients with major trauma admitted to our institution in 2019 and 2020 were assessed using the Injury Severity Score (ISS), by body region involved, type of injury, age, admission to an intensive care unit and 30-day mortality. RESULTS: In 2020, 454 patients with major trauma were admitted to our institution, 17% fewer than in the previous year. The drop in the number of major trauma patients proceeded with and overlapped both the first and second peaks in incidence of the pandemic and the associated restrictions. The median ISS was higher in 2020 (25, interquartile range [IQR] 17-26.5) than in 2019 (22, IQR 16-26, p = 0.04). There were no significant differences in body region involved, type of injury or age (p >0.05). In 2020, a higher percentage of patients were admitted to an intensive care unit (86.5% vs 77.7%, p <0.001) and died within 30 days (8.8% vs 5.0%, p = 0.015). The 30-day mortality was higher in 2020 than in 2019, with an odds ratio of 1.80 (95% confidence interval 1.04-3.10, p= 0.036) after adjustment for the following potential confounders: ISS, age, gender and type of injury. CONCLUSION: In the first year of the COVID-19 pandemic, fewer patients with major trauma were admitted to our institution. However, the patients admitted were more severely injured and more often died within 30 days. Understanding the differences in injury patterns and admissions in major trauma patients under special conditions - such as a pandemic - could help to allocate rare resources adequately.


Assuntos
COVID-19 , Ferimentos e Lesões , Adulto , Estudos de Coortes , Humanos , Escala de Gravidade do Ferimento , Pandemias , Estudos Retrospectivos , SARS-CoV-2 , Suíça/epidemiologia , Centros de Traumatologia , Ferimentos e Lesões/epidemiologia
4.
Swiss Med Wkly ; 151: w30057, 2021 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-34499459

RESUMO

In anticipation of an interseasonal respiratory syncytial virus (RSV) epidemic, a clinician-led reporting system was rapidly established to capture RSV infections in Swiss hospitals, starting in January 2021. Here, we present details of the reporting system and first results to June 2021. An unusual epidemiology was observed with an interseasonal surge of RSV infections associated with COVID-19-related non-pharmacological interventions. These data allowed real-time adjustment of RSV prophylaxis guidelines and consequently underscore the need for and continuation of systematic nationwide RSV surveillance.


Assuntos
COVID-19 , Infecções por Vírus Respiratório Sincicial , Vírus Sincicial Respiratório Humano , Infecções Respiratórias , Humanos , Lactente , Infecções por Vírus Respiratório Sincicial/epidemiologia , Infecções por Vírus Respiratório Sincicial/prevenção & controle , SARS-CoV-2 , Suíça/epidemiologia
5.
Artigo em Inglês | MEDLINE | ID: mdl-34501566

RESUMO

Our study aimed at investigating the way not having the choice to be reassigned was associated to a poorer experience of reassignment among health care workers (HCWs) during the first wave of the coronavirus disease 2019 (COVID-19), and indirectly to a lower workplace well-being and reduced intent to stay at the hospital. We also investigated the moderating role of the perceived hospital management responsiveness on these associations. A cross sectional survey was sent to all professionals from 11 hospitals and clinics in the French-speaking part of Switzerland, in July 2020. Out of 2811 professionals who completed the survey, 436 were HCWs reassigned to COVID-19 units during the first wave of the pandemic and constituted our analysis sample. Results indicated that hospital management responsiveness moderated the association between lack of choice and reassignment experience, indicating that the more HCWs perceived responsiveness, the less the lack of choice affected their experience of reassignment and thus their intent to stay and workplace well-being. Lack of choice during reassignments can reduce intent to stay and workplace well-being, in particular if hospital management is not perceived to be responsive during the crisis. Attempts by hospital management to find solutions, such as flexibility in working hours or extraordinary leaves, can alleviate the perceived constraints of reassignment and be considered signs of responsiveness from hospital management.


Assuntos
COVID-19 , Local de Trabalho , Estudos Transversais , Pessoal de Saúde , Humanos , SARS-CoV-2 , Suíça
6.
Artigo em Inglês | MEDLINE | ID: mdl-34501799

RESUMO

The speed and innovation of the COVID-19 vaccine development has been accompanied by insecurity and skepticism. Young adults' attitude to vaccination remains under investigation, although herd immunity cannot be reached without them. The HEalth in Students during the Corona pandemic study (HES-C) provided the opportunity to investigate vaccination intention in 1478 students in the sixth survey wave (January 2021), including vaccination intention, psychological antecedents of vaccine hesitancy, trust in government's vaccination strategy, and vaccination history. Associations with vaccination intention were analyzed with multivariate ordinal regression and predicted margins were calculated adjusting for gender, age, anxiety, health profession, and subjective health status. A third was decided (yes 25.1%, no 7.6%), and 68% were unsure about getting the COVID-19 vaccine when available. Next to demographic characteristics, vaccination history (influenza vaccination OR = 1.39; 95% CI: 1.06-1.83, travel vaccination OR = 1.29; 95% CI: 1.04-1.60), trust in vaccination strategy (OR = 2.40; 95% CI: 1.89-3.05), and 5C dimensions were associated with vaccination intention: confidence (OR = 2.52; 95% CI: 2.09-3.03), complacency (OR = 0.79; 95% CI: 0.66-0.96), calculation (OR = 0.79; 95% CI: 0.70-0.89), constraints (OR = 1.18; 95% CI: 0.99-1.41), and collective responsibility (OR = 4.47; 95% CI: 3.69-5.40). Addressing psychological antecedents and strengthening trust in official strategies through targeted campaigns and interventions may increase decisiveness and result in higher vaccination rates.


Assuntos
COVID-19 , Universidades , Vacinas contra COVID-19 , Estudos Transversais , Humanos , Intenção , SARS-CoV-2 , Estudantes , Suíça/epidemiologia , Vacinação , Adulto Jovem
7.
BMC Health Serv Res ; 21(1): 1007, 2021 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-34551742

RESUMO

BACKGROUND: The meaningful sharing of health data between different stakeholders is central to the advancement of science and to improve care offered to individual patients. However, it is important that the interests of individual stakeholders involved in this data sharing ecosystem are taken into account to ensure fair data sharing practices. In this regard, this qualitative study investigates such practices from the perspectives of a subset of relevant Swiss expert stakeholders, using a distributive justice lens. METHODS: Using purposive and snowball sampling methodologies, 48 expert stakeholders from the Swiss healthcare and research domains were recruited for semi-structured interviews. After the experts had consented, the interviews were audio-recorded and transcribed verbatim, but omitting identifying information to ensure confidentiality and anonymity. A thematic analysis using a deductive approach was conducted to identify fair data sharing practices for secondary research purposes. Themes and subthemes were then identified and developed during the analysis. RESULTS: Three distributive justice themes were identified in the data sharing negotiation processes, and these are: (i) effort, which was subcategorized into two subthemes (i.e. a claim to data reciprocity and other reciprocal advantages, and a claim to transparency on data re-use), (ii) compensation, which was subcategorized into two subthemes (i.e. a claim to an academic compensation and a claim to a financial compensation), and lastly, (iii) contribution, i.e. the significance of data contributions should be matched with a corresponding reward. CONCLUSIONS: This qualitative study provides insights, which could inform policy-making on claims and incentives that encourage Swiss expert stakeholders to share their datasets. Importantly, several claims have been identified and justified under the basis of distributive justice principles, whilst some are more debatable and likely insufficient in justifying data sharing activities. Nonetheless, these claims should be taken seriously and discussed more broadly. Indeed, promoting health research while ensuring that healthcare systems guarantee better services, it is paramount to ensure that solutions developed are sustainable, provide fair criteria for academic careers and promote the sharing of high quality data to advance science.


Assuntos
Ecossistema , Disseminação de Informação , Humanos , Motivação , Pesquisa Qualitativa , Suíça
8.
Chimia (Aarau) ; 75(7): 642-646, 2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-34523405

RESUMO

Single particle Inductively Coupled Plasma Time-of-Flight Mass Spectrometry (sp-ICP-TOFMS), in combination with online microdroplet calibration, allows the determination of particle number concentrations (PNCs) and the masses of elements in individual particles. Because sp-ICP-TOFMS analyses of environmental samples produce rich datasets composed of both single-metal nanoparticles (smNPs) and many types of multimetal NPs (mmNPs), interpretation of these data is well suited to automated analysis schemes. Here, we present a data analysis approach that includes automatic particle detection and elemental mass determinations based on online microdroplet calibration, and unsupervised clustering analysis of mmNPs to identify unique classes of NPs based on their element compositions. To demonstrate the potential of our approach, we analyzed wastewater samples collected from the influent and effluent of five wastewater treatment plants (WWTPs) across Switzerland. We determined elemental masses in individual NPs, as well as PNCs, to estimate the NP removal efficiencies of the individual WWTPs. Through hierarchical clustering, we identified NP classes conserved across all WWTPs; the most abundant particle types were those rich in Ce-La, Fe-Al, Ti-Zr, and Zn-Cu. In addition, we found particle types that are unique to one or a few WWTPs, which could indicate point sources of anthropogenic NPs.


Assuntos
Nanopartículas Metálicas , Purificação da Água , Análise por Conglomerados , Suíça , Águas Residuárias
9.
Chimia (Aarau) ; 75(7): 681-689, 2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-34523411

RESUMO

Digitalization is having an increasing impact on all industrial sectors, including the chemical and biotechnological industries. Aiming for innovative research and development, the Swiss Universities of Applied Sciences play a pivotal role in transferring academic knowledge and know-how to industrial practice. We review selected examples of projects related to the digitalization of processes and bioprocesses at four different institutions across Switzerland. These developments cover the whole spectrum of digital technologies, including big data, connectivity, analytics and automation. They are conducted in close collaboration with industrial partners and aim to support the growth of this important industrial sector.


Assuntos
Biotecnologia , Universidades , Suíça
10.
Chimia (Aarau) ; 75(9): 788-799, 2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34526185

RESUMO

In today's societies, climate-damaging and finite fossil resources such as oil and natural gas serve a dual purpose as energy source and as carbon source for chemicals and plastics. To respond to the finite availability and to meet international climate goals, a change to a renewable energy and raw material basis is inevitable and represents a highly complex task. In this review, we assess possible technology paths for Switzerland to reach these goals. First, we provide an overview of Switzerland's current energy demand and discuss possible renewable technologies as well as proposed scenarios to defossilize the current energy system. In here, electric vehicles and heat pumps are key technologies, whereas mainly photovoltaics replace nuclear power to deliver clean electricity. The production of chemicals also consumes fossil resources and for Switzerland, the oil demand for imported domestically used chemicals and plastics corresponds to around 20% of the current energetic oil demand. Thus, we additionally summarize technologies and visions for a sustainable chemical sector based on the renewable carbon sources biomass, CO2 and recycled plastic. As biomass is the most versatile renewable energy and carbon source, although with a limited availability, aspects and proposed strategies for an optimal use are discussed.


Assuntos
Gases de Efeito Estufa , Dióxido de Carbono/análise , Eletricidade , Fontes Geradoras de Energia , Suíça
11.
Swiss Med Wkly ; 151: w30021, 2021 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-34495604

RESUMO

BACKGROUND: Healthcare workers are more frequently exposed to SARS-CoV-2 than the general population. Little is known about healthcare settings outside of hospitals. We studied the seroprevalence of SARS-CoV-2 among healthcare workers in outpatient facilities and retirement or nursing homes in the Canton of Solothurn, Switzerland in the first wave of the COVID-19 pandemic. METHODS: Longitudinal seroprevalence study among healthcare workers with examinations at baseline and 2 months between June and September 2020. The Abbott SARS-CoV-2 IgG and Liaison/Diasorin SARS-CoV-2 S1/S2 IgG assay were used to detect antibodies against SARS-CoV-2. All participants provided demographic information. We report descriptive statistics and calculated the seroprevalence with 95% confidence intervals. RESULTS: We included 357 healthcare workers; their median age was 43 years (interquartile range 29-54), and 315 (88.2%) were female. Forty-nine (13.7%) were physicians, 87 (24.4%) practice assistants and 221 (61.9%) nurses. Overall seroprevalence among healthcare workers in outpatient facilities and retirement or nursing homes was 3.4% (12/357). The 12 seropositive healthcare workers were all nurses (12/221, 5.5%); 11 worked at retirement or nursing homes and one at the hospital's outpatient clinic. Symptoms such as loss of smell or taste, shortness of breath, and fever were more prevalent among seropositive healthcare workers than seronegative healthcare workers. No close contact had detectable antibodies against SARS-CoV-2. CONCLUSIONS: Seroprevalence among healthcare workers was low, but higher among nursing staff of retirement or nursing homes. Healthcare workers at private practices were able to protect themselves well during the first wave of the COVID-19 pandemic.


Assuntos
COVID-19 , SARS-CoV-2 , Adulto , Anticorpos Antivirais , Feminino , Pessoal de Saúde , Humanos , Casas de Saúde , Pacientes Ambulatoriais , Pandemias , Aposentadoria , Estudos Soroepidemiológicos , Suíça/epidemiologia
12.
Ann Clin Microbiol Antimicrob ; 20(1): 64, 2021 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-34493302

RESUMO

BACKGROUND: Bacterial superinfections associated with COVID-19 are common in ventilated ICU patients and impact morbidity and lethality. However, the contribution of antimicrobial resistance to the manifestation of bacterial infections in these patients has yet to be elucidated. METHODS: We collected 70 Gram-negative bacterial strains, isolated from the lower respiratory tract of ventilated COVID-19 patients in Zurich, Switzerland between March and May 2020. Species identification was performed using MALDI-TOF; antibiotic susceptibility profiles were determined by EUCAST disk diffusion and CLSI broth microdilution assays. Selected Pseudomonas aeruginosa isolates were analyzed by whole-genome sequencing. RESULTS: Pseudomonas aeruginosa (46%) and Enterobacterales (36%) comprised the two largest etiologic groups. Drug resistance in P. aeruginosa isolates was high for piperacillin/tazobactam (65.6%), cefepime (56.3%), ceftazidime (46.9%) and meropenem (50.0%). Enterobacterales isolates showed slightly lower levels of resistance to piperacillin/tazobactam (32%), ceftriaxone (32%), and ceftazidime (36%). All P. aeruginosa isolates and 96% of Enterobacterales isolates were susceptible to aminoglycosides, with apramycin found to provide best-in-class coverage. Genotypic analysis of consecutive P. aeruginosa isolates in one patient revealed a frameshift mutation in the transcriptional regulator nalC that coincided with a phenotypic shift in susceptibility to ß-lactams and quinolones. CONCLUSIONS: Considerable levels of antimicrobial resistance may have contributed to the manifestation of bacterial superinfections in ventilated COVID-19 patients, and may in some cases mandate consecutive adaptation of antibiotic therapy. High susceptibility to amikacin and apramycin suggests that aminoglycosides may remain an effective second-line treatment of ventilator-associated bacterial pneumonia, provided efficacious drug exposure in lungs can be achieved.


Assuntos
Antibacterianos/farmacologia , COVID-19/microbiologia , Bactérias Gram-Negativas/efeitos dos fármacos , Sistema Respiratório/microbiologia , COVID-19/complicações , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Bactérias Gram-Negativas/isolamento & purificação , Humanos , Testes de Sensibilidade Microbiana , Pneumonia Associada à Ventilação Mecânica/microbiologia , Estudos Prospectivos , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/genética , Pseudomonas aeruginosa/isolamento & purificação , SARS-CoV-2/isolamento & purificação , Suíça
13.
Swiss Med Wkly ; 151: w30005, 2021 09 13.
Artigo em Inglês | MEDLINE | ID: mdl-34519459

RESUMO

The SARS-CoV-2 pandemic has claimed many lives and disrupted the quality of life of most individuals. Diagnostic tests not only serve to confirm past exposure but can provide information crucial for guiding healthcare options for patients. Current diagnostic tests for the presence of the SARS-CoV-2 virus or anti-spike protein antibodies do not address the question whether longer lasting cellular immunity is mounted in most individuals. Using an activation marker flow cytometric immunoassay (SARS-CoV-2 lymphocytes analysis), we showed that both CD4+/CD8+ T cell and B cell activation differ between naïve and infected individuals up to 11 months after infection. On the basis of the specificity of this diagnostic tool for detecting both SARS-CoV-2-experienced T and B cells, we propose that this assay could benefit immunocompromised individuals who are unable to mount sustained antibody responses, by determining cellular immunity as possible partial protection, and for studying immune correlates of protection - thereby increasing knowledge of COVID-19 in a wider range of patient groups.


Assuntos
COVID-19 , Anticorpos Antivirais , Linfócitos B , Humanos , Qualidade de Vida , SARS-CoV-2 , Suíça
14.
BMC Health Serv Res ; 21(1): 982, 2021 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-34537032

RESUMO

BACKGROUND: The guiding principle of disability insurance in Switzerland is 'rehabilitation before pension'. Access to rehabilitation measures to restore, maintain or improve the earning capacity of individuals with disabilities is essential. Gainful employment enables them to be an active part of society, improves their quality of life, and may mitigate the adverse health effects of disability pension receipt. The aim of this study was therefore to identify factors for disability insurance benefit application in Switzerland. METHODS: A novel dataset was created linking the 2010 Social Protection and Labour Market cross-section with administrative register data on disability insurance benefit application (2009-2018). Multiple logistic regression was employed to examine the associations between long-term health-related activity limitation, region of residence, demographic and socioeconomic characteristics and disability insurance benefit application in adults aged 18-55 (N = 18,448). Sensitivity analysis based on age was performed in individuals aged 18 to retirement age and aged 25 to 55. RESULTS: The regression results showed higher odds of disability insurance benefit application for individuals suffering from long-term health-related activity limitations (OR 2.88; 95% CI 1.29-6.44; p-value 0.010); born outside of Switzerland (OR 1.75; 95% CI 1.32-2.32; p-value 0.000); living without a working partner (OR 1.54; 95% CI 1.17-2.02; p-value 0.002); living without a child aged 0-14 years (OR 1.70; 95% CI 1.29-2.26; p-value 0.000); aged 18-39 (OR 1.41; 95% CI 1.09-1.83; p-value 0.009); with a learnt occupation in 'Manufacturing' (OR 2.75; 95% CI 1.68-4.50; p-value 0.000), 'Construction and mining' (OR 2.03; 95% CI 1.13-3.66; p-value 0.018), 'Trade and transport' (OR 2.12; 95% CI 1.30-3.45; p-value 0.003), 'Business and administration' (OR 1.68; 95% CI 1.03-2.72; p-value 0.036), and 'Health, teaching, culture and science' (OR 1.55; 95% CI 1.05-2.29; p-value 0.026); and renters (OR 1.44; 95% CI 1.00-1.94; p-value 0.016). The results were robust to alternative samples defined by age - albeit with some differences in regional and learnt occupational patterns. CONCLUSIONS: The results suggested that disability insurance benefit application is more than a health-related phenomenon in Switzerland. However, the results provided a less consistent picture on the role of marginalization in application than in other European countries.


Assuntos
Pessoas com Deficiência , Seguro por Invalidez , Adulto , Criança , Humanos , Pensões , Qualidade de Vida , Suíça
15.
Int J Public Health ; 66: 1603992, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34471402

RESUMO

Objectives: We aimed to evaluate the effectiveness of the SwissCovid digital proximity tracing (DPT) app in notifying exposed individuals and prompting them to quarantine earlier compared to individuals notified only by manual contact tracing (MCT). Methods: A population-based sample of cases and close contacts from the Zurich SARS-CoV-2 Cohort was surveyed regarding SwissCovid app use and SARS-CoV-2 exposure. We descriptively analyzed app adherence and effectiveness, and evaluated its effects on the time between exposure and quarantine among contacts using stratified multivariable time-to-event analyses. Results: We included 393 SARS-CoV-2 infected cases and 261 close contacts. 62% of cases reported using SwissCovid and among those, 88% received and uploaded a notification code. 71% of close contacts were app users, of which 38% received a warning. Non-household contacts notified by SwissCovid started quarantine 1 day earlier and were more likely to quarantine earlier than those not warned by the app (HR 1.53, 95% CI 1.15-2.03). Conclusion: These findings provide evidence that DPT may reach exposed contacts faster than MCT, with earlier quarantine and potential interruption of SARS-CoV-2 transmission chains.


Assuntos
COVID-19 , Busca de Comunicante , Aplicativos Móveis , Quarentena , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , Estudos de Coortes , Busca de Comunicante/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis/estatística & dados numéricos , Quarentena/estatística & dados numéricos , Suíça/epidemiologia , Fatores de Tempo
16.
Front Public Health ; 9: 682365, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34485215

RESUMO

Immunity certificates related to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) have been under discussion since the beginning of the pandemic with conflicting opinions. In order to identify arguments in favor of and against the possible implementation of documents certifying immunity of an individual based on serological testing, we developed a qualitative study in Geneva, Switzerland. The study took place between two lockdowns with a sense of semi-normalcy during summer 2020 in Switzerland but at a time when no vaccine was available and seroprevalence was below 21%. Eleven focus groups with members of the public and 14 semi-structured interviews with stakeholders were conducted between July and November 2020, with a total of 68 participants with an age range between 24 and 77 years. Interviews and focus groups transcripts were coded with the ATLAS.ti CAQDAS. Few participants considered immunity certificates based on serological testing as an acceptable public health measure. Major concerns included the reliability of scientific data related to COVID-19 immunity and serological testing potential re-infection as well as the possibility that the use of certificates could result in deleterious outcomes. Discrimination, counterfeiting, incitement for self-infection, invasion of the private sphere, violation of personal integrity, and violation of medical secrecy were perceived as the major risks. Benefits of immunity certificates were more perceived when in relation to vaccination, and included gains in medical knowledge and protection in certain contexts involving leisure or work-related activities. The consequences of implementing immunity certificates are numerous, and the acceptability by the general population has to be considered when engaging in such policy. Even if the results provide a snapshot of arguments discussed around immunity certificates based on serological testing before the implementation of the COVID-19 vaccine, most of the issues discussed are central in the current debates about vaccination certificates.


Assuntos
COVID-19 , Adulto , Idoso , Vacinas contra COVID-19 , Controle de Doenças Transmissíveis , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , SARS-CoV-2 , Estudos Soroepidemiológicos , Suíça , Adulto Jovem
19.
Swiss Med Wkly ; 151: w20569, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34375985

RESUMO

AIM OF THE STUDY: To compare admission characteristics, predictors and outcomes of patients with confirmed coronavirus disease 2019 (COVID-19) hospitalised in a tertiary care hospital in Switzerland during the first and second waves of the pandemic. METHODS: This retrospective observational analysis included adult patients with  severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection confirmed by a real-time reverse transcriptase polymerase chain reaction (RT-PCR) or rapid antigen test and hospitalised at the Cantonal Hospital Aarau from 26 February to 30 April 2020 (first wave) and from 1 October to 31 December 2020 (second wave). The primary endpoint was all-cause in-hospital mortality. The secondary endpoints were transfer to the intensive care unit (ICU) and length of hospital stay (LOS). RESULTS: Overall, 486 patients (mean age 65.9 years ± 14.7 SD, 65% male) were included. Ninety-two patients (19%) died during the hospital stay and 92 patients (19%) were transferred to the ICU. Admission characteristics, including comorbidities and frailty, were similar for patients of the first (n = 100) and second wave (n = 386). However, during the second wave the median time from symptom onset to presentation to the emergency department (ED) was shorter (7 days, interquartile range [IQR] 4–9 vs 8 days, IQR 4–11; p = 0.02). In the second wave, most patients received high-dose glucocorticoid treatment (0% vs 76%, p <0.01). In-hospital mortality was similar among COVID-19 patients in the first (19/100, 19%) and second wave (73/386, 19%); this finding persisted after full adjustment in multiple regression models (adjusted odds ratio [aOR] 1.18, 95% confidence interval [CI] 0.49–2.80; p = 0.71). Risk for ICU admission was also similar (24% vs 18%; aOR 0.98, 95% CI 0.46–2.06; p = 0.95). More patients were transferred to rehabilitation facilities in the second wave (18% vs 31%; aOR 2.06, 95% CI 1.04–4.07; p = 0.04) and LOS was 2.5 days shorter (9.0 vs 6.5 days; adjusted difference −2.53 days, 95%-CI −4.51 to −0.54; p = 0.01). Main predictors for in-hospital death were patient age (aOR 1.07, 95% CI 1.02–1.11; p <0.01), male sex (aOR 2.41, 95% CI 1.05–5.55; p = 0.04) and the age-adjusted Charlson comorbidity index (aOR 1.27, 95% CI 1.09–1.48 p <0.01). CONCLUSION: Despite differing treatment regimens, mortality and ICU admission remained largely unchanged for COVID-19 patients admitted during the second wave of the pandemic in our tertiary care hospital. However, discharge processes were optimised with patients leaving the hospital earlier and going to rehabilitation facilities more often.  .


Assuntos
COVID-19 , Adulto , Idoso , Comorbidade , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Masculino , Estudos Retrospectivos , SARS-CoV-2 , Suíça/epidemiologia , Centros de Atenção Terciária
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