Impact of the COVID-19 Pandemic on Elective and Emergency Inpatient Procedure Volumes in Switzerland – A Retrospective Study Based on Insurance Claims Data

Background: The severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) pandemic forced hospitals to redistribute resources for the treatment of patients with coronavirus disease 2019 (COVID-19), yet the impact on elective and emergency inpatient procedure volumes is unclear. Methods: We analyzed anonymized data on 234 921 hospitalizations in 2017-2020 (55.9% elective) from a big Swiss health insurer. We used linear regression models to predict, based on pre-pandemic data, the expected weekly numbers of procedures in 2020 in the absence of a pandemic and compared these to the observed numbers in 2020. Compensation effects were investigated by discretely integrating the difference between the two numbers over time. Results: During the first COVID-19 wave in spring 2020, elective procedure numbers decreased by 52.9% (95% confidence interval -64.5% to -42.5%), with cardiovascular and orthopedic elective procedure numbers specifically decreasing by 45.5% and 72.4%. Elective procedure numbers normalized during summer with some compensation of postponed procedures, leaving a deficit of -9.9% (-15.8% to -4.5%) for the whole year 2020. Emergency procedure numbers also decreased by 17.1% (-23.7% to -9.8%) during the first wave, but over the whole year 2020, net emergency procedure volumes were similar to control years. Conclusion: Inpatient procedure volumes in Switzerland decreased considerably in the beginning of the pandemic but recovered quickly after the first wave. Still, there was a net deficit in procedures at the end of the year. Health system leaders must work to ensure that adequate access to non-COVID-19 related care is maintained during future pandemic phases in order to prevent negative health consequences. Keywords: COVID-19; Hospitals; Inpatient; Surgery; Switzerland; Undertreatment

Inferior control of low-density lipoprotein cholesterol in women is the primary sex difference in modifiable cardiovascular risk: A large-scale, cross-sectional study in primary care

BACKGROUND AND AIMS Sex differences in cardiovascular prevention have been reported, yet the role of sex with regard to different modifiable risk factors such as low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (BP), and glycated hemoglobin (HbA1c) in primary care settings is unclear. Therefore, we studied sex differences in assessment and measured values of LDL-C, BP, and HbA1c in primary and secondary cardiovascular prevention delivered by general practitioners. METHODS This cross-sectional study was based on electronic medical records of 59,092 primary care patients (51.9% women) aged 40-79 years in Switzerland. Multilevel regression was used to model associations of sex with assessment and measured values of LDL-C, BP, and HbA1c in 2018. RESULTS In both primary and secondary prevention, women had lower LDL-C assessment rates (age-adjusted odds ratio (aOR) 0.71 [95% confidence interval (CI) 0.67 to 0.75] and 0.70 [CI 0.51 to 0.95]), and higher measured LDL-C values than men (age-adjusted difference 0.30 mmol/L [CI 0.25 to 0.35] and 0.28 mmol/L [CI 0.07 to 0.48]). Compared with men, women in primary prevention displayed lower BP and HbA1c assessment frequencies (aOR 0.77 [CI 0.73 to 0.81] and 0.76 [CI 0.71 to 0.80]) and measured values (age-adjusted difference -2.49 mmHg [CI -2.99 to -1.79] and -0.19% [CI -0.24 to -0.14]), while there was no sex difference in secondary prevention. Age-dependent increases in measured values of LDL-C, BP, and HbA1c were greater in women than men. CONCLUSIONS Control of LDL-C in women in primary care should be improved to reduce sex-based inequalities in prevention of cardiovascular disease

Evaluating debris-flow and anthropogenic disturbance on 10Be concentration in mountain drainage basins: implications for functional connectivity and denudation rates across time scales

We examine the sensitivity of 10Be concentrations (and derived denudation rates), to debris-flow and anthropogenic perturbations in steep settings of the Eastern Alps, and explore possible relations with structural geomorphic connectivity. Using cosmogenic 10Be as a tracer for functional geomorphic connectivity, we conduct sampling replications across four seasons in Gadria, Strimm and Allitz Creek. Sampling sites encompass a range of structural connectivity configurations, including the conditioning of a sackung, all assessed through a geomorphometric index (IC). By combining information on contemporary depth of erosion and sediment yield, disturbance history and post-LGM (Last Glacial Maximum) sedimentation rates, we constrain the effects of debris-flow disturbance on 10Be concentrations at the Gadria sites. Here, we argue that bedrock weakening imparted by the sackung promotes high depth of erosion. Consequently, debris flows recruit sediment beyond the critical depth of spallogenic production (e.g., >3 m), which in turn, episodically, due to predominantly muogenic production pathways, lowers 10Be concentration by a factor of 4, for at least 2 years. In contrast, steady erosion in Strimm Creek yields very stable 10Be concentrations through time. In Allitz Creek, we observe two- to fourfold seasonal fluctuations in 10Be concentrations, which we explain as the combined effects of water diversion and hydraulic structures on sediment mixing. We further show that 10Be concentration correlates inversely with the IC index, where sub-basins characterized by high concentrations (long residence times) exhibit low IC values (structurally disconnected) and vice versa, implying that, over millennial time scales a direct relation exists between functional and structural connectivity, and that the IC index performed as a suitable metric for structural connectivity. The index performs comparably better than other metrics (i.e., mean slope and mean normalized channel steepness index) previously used to assess topographic controls on denudation rates in active unglaciated ranges. In terms of landscape evolution, we argue that the sackung, by favouring intense debris-flow activity across the Holocene, has aided rapid postglacial reshaping of the Gadria basin, which currently exhibits a topographic signature characteristic of unglaciated debris-flow systems. \ua9 2020 John Wiley & Sons, Ltd