Medical use of cannabis in Switzerland: analysis of approved exceptional licences

In recent years, the Swiss Federal Office of Public Health (FOPH) granted exceptional licenses for the medical use of cannabinoids, typically for 6 months with possible extensions. A systematic review of cannabinoids for medical use commissioned by the FOPH supports the use of cannabinoids for the treatment of chronic pain and spasticity. However, little is known about the patients treated with cannabinoids. We aimed to study medical uses of cannabinoids as part of the FOPH's programme of exceptional licenses.; We examined all requests for medical use of cannabinoids sent to FOPH in 2013 and 2014. A standardised data sheet was developed to extract data from the files of approved requests. We extracted the duration of the licence, the year it was granted, and the payer of the therapy. At the level of the patient we collected the date of birth, sex, region of residence, diagnosis and the indication. Ethical approval was granted by the Ethics Committee of the Canton of Bern.; We analysed 1193 patients licenced for cannabinoid treatment in 2013 or 2014. During 2013, 542 patients were treated under the exceptional licencing programme (332 requesting physicians) compared with 825 in 2014 (446 physicians). Over half of patients (685; 57%) were women. The mean age was 57 years (standard deviation 15.0), chronic pain (49%) and spasticity (40%) were the most common symptoms, and co-medication was reported for 39% of patients. Seventy-eight different diagnoses were recorded, including multiple sclerosis (257 patients, 22%), soft tissue disorders (119, 10%), dorsalgia (97, 8.1%), spinal muscular atrophy (65, 5.5%) and paraplegia/tetraplegia (62, 5.2%). Licence extensions were granted to 143 patients (26.4%) in 2013 and 324 patients (39.3%) in 2014. There were substantial regional variations of the rates of patients treated with cannabinoids. On average, eight patients per 100 000 residents received an exceptional licence. Most patients (1083, 91%) paid out of pocket.; Exceptional licences for medical use of cannabinoids have increased substantially in Switzerland, with the programme including patients with a wide range of conditions

Vaccination willingness for COVID-19 among healthcare workers: a cross-sectional survey in a Swiss canton.

AIMS OF THE STUDY Vaccination is regarded as the most promising response to the COVID-19 pandemic. We assessed opinions about COVID-19 vaccination, willingness to be vaccinated, and reasons for vaccination hesitancy among healthcare workers. METHODS We conducted a cross-sectional, web-based survey among 3,793 healthcare workers in December 2020 in the Canton of Solothurn, Switzerland, before the start of the national COVID-19 vaccination campaign. RESULTS Median age was 43 years (interquartile range [IQR] 31-53), 2,841 were female (74.9%). A total of 1,511 healthcare workers (39.8%) reported willingness to accept vaccination, whereas 1,114 (29.4%) were unsure and 1,168 (30.8%) would decline vaccination. Among medical doctors, 76.1% were willing, whereas only 27.8% of nurses expressed willingness. Among the 1,168 healthcare workers who would decline vaccination, 1,073 (91.9%) expressed concerns about vaccine safety and side effects. The willingness of healthcare workers to be vaccinated was associated with older age (adjusted odds ratio [aOR] 1.97, 95% confidence interval [Cl] 1.71-2.27) and having been vaccinated for influenza this year (aOR 2.70, 95% Cl 2.20-3.31). Healthcare workers who reported a lack of confidence in government were less likely to be willing to be vaccinated (aOR 0.58, 95% Cl 0.40-0.84), and women were less willing to be vaccinated than men (OR 0.33, 95% CI 0.28-0.38). CONCLUSION Less than half of healthcare workers reported willingness to be vaccinated before the campaign start, but proportions varied greatly depending on profession and workplace. Strategies with clear and objective messages that particularly address the concerns of healthcare workers are needed if their willingness to be vaccinated against COVID-19 is to be further increased

Seroprevalence of SARS-CoV-2 in healthcare workers from outpatient facilities and retirement or nursing homes in a Swiss canton.

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

Transmission risk of SARS-CoV-2 to healthcare workers -observational results of a primary care hospital contact tracing.

BACKGROUND The coronavirus disease (COVID)-19 epidemic is evolving rapidly. Healthcare workers are at increased risk for infection, and specific requirements for their protection are advisable to ensure the functioning of the basic healthcare system, including the availability of general practitioners (GPs). Understanding the transmission risk is particularly important for guiding evidence-based protective measures in the primary healthcare setting. METHODS Healthcare worker contacts of an initially undiagnosed COVID-19 case, who were without personal protective equipment, in particular not wearing facemasks, were screened with nasopharyngeal swabs and polymerase chain reaction tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), irrespective of respiratory symptoms or fever seven days after initial contact. The details of exposure to the index case were obtained during routine contact investigation after unintentional pathogen exposure. RESULTS Twenty-one healthcare workers reported contacts with the index case. Three healthcare workers reported respiratory symptoms (cough) or low-grade fever within 4 days. None of them tested positive for SARS-CoV-2 at the time of symptom onset. All 21 healthcare workers tested SARS-CoV-2 negative 7 days after initial index case contact, including the three healthcare workers with previous symptoms. Ten of the 21 healthcare workers reported a cumulative exposure time of >15 minutes. Longer cumulative contact times were associated with more individual contacts, reduced contact time per contact and activities with physical patient contact. The closest relative of the index patient tested SARS-CoV-2 positive 2 days after the index case presented at the hospital emergency department. CONCLUSION We found a low risk of SARS-CoV-2 transmission in a primary care setting. These findings are compatible with previous reports of the highest transmission probability in household settings with prolonged close contacts. The current protective measures for healthcare workers, including strict adherence to basic standard hygiene and facemasks, offer considerable protection during short periods of contact with symptomatic COVID-19 cases by diminishing the risk of direct and indirect transmission

Patient satisfaction with divided anesthesia care.

BACKGROUND Up to now, no prospective cohort study using a validated questionnaire has assessed patients' expectation and perception of divided anesthesia care and its influence on patient satisfaction. OBJECTIVE We assessed patient satisfaction with divided anesthesia care in a district general hospital in Switzerland. We hypothesized that patient expectations, combined with their perceptions of the (un)importance of continuous anesthesia care would influence patient satisfaction. MATERIAL AND METHODS A total of 484 eligible in-patients receiving anesthesia from October 2019 to February 2020 were included and received preoperative information about divided care via a brochure and face-to-face. The primary outcome was the assessment of patient satisfaction with divided anesthesia care using a validated questionnaire. In group 1 continuity of care was considered important but not performed. In group 2 continuity was ensured. In group 3 continuity was regarded as not important and was not performed. In group 4 patients could not remember or did not answer. A psychometrically developed validated questionnaire was sent to patients at home after discharge. RESULTS A total of 484 completed questionnaires (response rate 81%) were analyzed. In group 1 (n = 110) the mean total dissatisfaction score was 25% (95% confidence interval [CI] 21.8-28.1), in group 2 (n = 61) 6.8% (95% CI 4.8-8.7), in group 3 (n = 223) 12.1% (95% CI 10.7-13.4), and in group 4 (n = 90) 15% (95% CI 11-18); ANOVA: p < 0.001, η = 0.43. Of the patients 286 (59%) considered continuity of care by the same anesthetist relatively unimportant (34%) or not important at all (25%). The other 40% considered it important (22%) or very important (18%). CONCLUSION Despite receiving comprehensive preoperative information about divided anesthesia care, 40% of patients still considered continuity of care by the same anesthetist important. We recommend further research evaluating whether and how patient expectations can be modified towards the common practice of divided care and patient satisfaction can be increased

Quantifying Local and Mesoscale Drivers of the Urban Heat Island of Moscow with Reference and Crowdsourced Observations

Urban climate features, such as the urban heat island (UHI), are determined by various factors characterizing the modifications of the surface by the built environment and human activity. These factors are often attributed to the local spatial scale (hundreds of meters up to several kilometers). Nowadays, more and more urban climate studies utilize the concept of the local climate zones (LCZs) as a proxy for urban climate heterogeneity. However, for modern megacities that extend to dozens of kilometers, it is reasonable to suggest a significant contribution of the larger-scale factors to the temperature and UHI climatology. In this study, we investigate the contribution of local-scale and mesoscale driving factors of the nocturnal canopy layer UHI of the Moscow megacity in Russia. The study is based on air temperature observations from a dense network consisting of around 80 reference and more than 1,500 crowdsourced citizen weather stations for a summer and a winter season. For the crowdsourcing data, an advanced quality control algorithm is proposed. Based on both types of data, we show that the spatial patterns of the UHI are shaped both by local-scale and mesoscale driving factors. The local drivers represent the surface features in the vicinity of a few hundred meters and can be described by the LCZ concept. The mesoscale drivers represent the influence of the surrounding urban areas in the vicinity of 2–20 km around a station, transformed by diffusion, and advection in the atmospheric boundary layer. The contribution of the mesoscale drivers is reflected in air temperature differences between similar LCZs in different parts of the megacity and in a dependence between the UHI intensity and the distance from the city center. Using high-resolution city-descriptive parameters and different statistical analysis, we quantified the contributions of the local- and mesoscale driving factors. For selected cases with a pronounced nocturnal UHI, their respective contributions are of similar magnitude. Our findings highlight the importance of taking both local- and mesoscale effects in urban climate studies for megacities into account. Furthermore, they underscore a need for an extension of the LCZ concept to take mesoscale settings of the urban environment into account.DFG, 437467569, ENLIGHT – ENabling the anaLysIs of Global urban Hea

Trends in the use of mammography for early breast cancer detection in Switzerland: Swiss Health Surveys 2007 and 2012.

AIMS Breast cancer is the most common cancer in women worldwide. We assessed changes in the use of breast cancer screening 2007-2012 in Switzerland, and associations with socioeconomic and health-related determinants. METHODS We used the nationwide and representative data from the Swiss Health Surveys 2007 and 2012. We analysed the self-reported use of mammography in the last 12 months (proportion of population) among women aged 40-79 years, and opportunistic (without clinical symptoms, initiated by the woman or a physician) and programmatic screening mammography (as part of a systematic screening programme). We performed multivariate logistic regression analyses (presented as adjusted odds ratios, aORs). RESULTS The use of any mammography in the last 12 months declined from 19.1% (95% confidence interval [CI] 17.7-20.5%) in 2007 to 11.7% (95% CI 10.7-12.6%) in 2012. This decline was more pronounced in regions with a long-standing or no cantonal breast cancer screening programme (aOR 0.5, 95% CI 0.4-0.6, and aOR 0.5, 95% CI 0.4-0.6, respectively), but remained relatively stable in regions with a recently introduced programme (aOR 0.9, 95% CI 0.6-1.3, p-value from test for interaction 0.01). Opportunistic screening dropped from 12.0% (95% CI 10.9-13.2%) in 2007 to 6.2% (95% CI 5.5-6.9%; p <0.001) in 2012, whereas the use of programmatic mammography remained stable at 3.1% (95% CI 2.6-3.7%). Use of any mammography was higher in women aged 50-69 years, residing in a region with a systematic screening programme in place, and women having a private hospital stay insurance, but was not associated with education level and non-Swiss citizenship. CONCLUSIONS Overall attendance of breast cancer screening is low in Switzerland and decreased between 2007 and 2012, despite expanding cantonal mammography screening programmes. Many factors may have contributed to this decline, including the ongoing scientific and public debates on the value of breast cancer screening

CrowdQC+—A Quality-Control for Crowdsourced Air-Temperature Observations Enabling World-Wide Urban Climate Applications

In recent years, the collection and utilisation of crowdsourced data has gained attention in atmospheric sciences and citizen weather stations (CWS), i.e., privately-owned weather stations whose owners share their data publicly via the internet, have become increasingly popular. This is particularly the case for cities, where traditional measurement networks are sparse. Rigorous quality control (QC) of CWS data is essential prior to any application. In this study, we present the QC package “CrowdQC+,” which identifies and removes faulty air-temperature (ta) data from crowdsourced CWS data sets, i.e., data from several tens to thousands of CWS. The package is a further development of the existing package “CrowdQC.” While QC levels and functionalities of the predecessor are kept, CrowdQC+ extends it to increase QC performance, enhance applicability, and increase user-friendliness. Firstly, two new QC levels are introduced. The first implements a spatial QC that mainly addresses radiation errors, the second a temporal correction of the data regarding sensor-response time. Secondly, new functionalities aim at making the package more flexible to apply to data sets of different lengths and sizes, enabling also near-real time application. Thirdly, additional helper functions increase user-friendliness of the package. As its predecessor, CrowdQC+ does not require reference meteorological data. The performance of the new package is tested with two 1-year data sets of CWS data from hundreds of “Netatmo” CWS in the cities of Amsterdam, Netherlands, and Toulouse, France. Quality-controlled data are compared with data from networks of professionally-operated weather stations (PRWS). Results show that the new package effectively removes faulty data from both data sets, leading to lower deviations between CWS and PRWS compared to its predecessor. It is further shown that CrowdQC+ leads to robust results for CWS networks of different sizes/densities. Further development of the package could include testing the suitability of CrowdQC+ for other variables than ta, such as air pressure or specific humidity, testing it on data sets from other background climates such as tropical or desert cities, and to incorporate added filter functionalities for further improvement. Overall, CrowdQC+ could lead the way to utilise CWS data in world-wide urban climate applications.DFG, 437467569, ENLIGHT – ENabling the anaLysIs of Global urban Hea