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Background Antiretroviral therapy (ART)-related weight gain is of particular concern in people with HIV (PWH). Although weight gain was observed among PWH receiving tenofovir alafenamide (TAF), little is known about the potential reversibility after TAF discontinuation. We evaluated weight and metabolic changes 12 months after TAF discontinuation in the Swiss HIV Cohort Study. Methods We included participants who received at least 6 months of TAF-containing ART between January 2016 and March 2023. Using multivariable mixed-effect models, changes in weight and lipid levels were compared between individuals who continued TAF and those who switched to one of the following TAF-free regimens: (1) tenofovir disoproxil fumarate (TDF)-based ART, (2) dolutegravir/lamivudine (DTG/3TC), or (3) long-acting cabotegravir/rilpivirine (CAB/RPV). Results Of 6555 participants (median age 54 years, 24.3% female, 13% Black), 5485 (83.7%) continued, and 1070 (16.3%) stopped TAF. Overall, discontinuing TAF was associated with an adjusted mean weight change of −0.54 kg (95% confidence interval [CI] −.98 to −.11) after 12 months. In stratified analyses, switching from TAF to TDF led to an adjusted mean weight decrease of −1.84 kg (95% CI −2.72 to −.97), and to a decrease in mean total cholesterol (−0.44 mmol/L) and triglycerides (−0.38 mmol/L) after 12 months. Switching from TAF-based ART to DTG/3TC (−0.17 kg, 95% CI −.82 to.48) or long-acting CAB/RPV (−0.64 kg, 95% CI −2.16 to.89) did not lead to reductions in weight. Conclusions Replacing TAF with TDF in PWH led to a decrease in body weight and an improved lipid profile within 1 year. Weight changes were not observed among individuals who switched to DTG/3TC or long-acting CAB/RPV. [ABSTRACT FROM AUTHOR]

Classroom management is an important topic in teacher education, as it has a strong impact on students' engagement. However, untangling the concepts influencing teachers' classroom management practices is a question that needs further investigation. Using data from a survey of 154 vocational teachers participating in teacher education, this study examined associations between classroom management practices, teaching experience, and teachers' beliefs (general pedagogical beliefs, beliefs about student motivation, and self-efficacy beliefs). Results highlighted associations between the different types of beliefs, and between teachers' beliefs and practices. Teaching experience was positively related to self-efficacy and beliefs in constructivism but did not impact practices.

Land‐use intensification in grassland ecosystems (i.e. increased mowing frequency, intensified grazing) has a strong negative effect on biodiversity and ecosystem services. However, accurate information on grassland‐use intensity is difficult to acquire and restricted to the local or regional level. Recent studies have shown that mowing events can be mapped for large areas using satellite image time series. The transferability of such approaches, especially to mountain areas, has been little explored, however, and the relevance for ecological applications in biodiversity and conservation has hardly been investigated. Here, we used a rule‐based algorithm to produce annual maps for 2018–2021 of grassland‐management events, that is, mowing and/or grazing, for Switzerland using Sentinel‐2 and Landsat 8 satellite data. We assessed the detection of management events based on independent reference data, which we acquired from daily time series of publicly available webcams that are widely distributed across Switzerland. We further examined the relationships between the generated grassland‐use intensity measures and plant species richness and ecological indicator values derived from a nationwide field survey. The webcam‐based verification for 2020 and 2021 revealed that most detected management events were actual mowing/grazing events (≥78%), but that a substantial number of events were not detected (up to 57%), particularly grazing events at higher elevations. We found lower plant species richness and higher mean ecological indicator values for nutrients and mowing tolerance with more frequent management events and those starting earlier in the year. A large proportion of the variance was explained by our use‐intensity measures. Our findings therefore highlight that remotely assessed management events can characterise land‐use intensity at fine spatial and temporal resolutions across broad scales and can explain plant biodiversity patterns in grasslands. [ABSTRACT FROM AUTHOR]

Study goal: We compared the survival rates of women with breast cancer (BC) detected within versus outside the mammography screening program (MSP) "donna". Methods: We merged data from the MSP with the data from corresponding cancer registries to categorize BC cases as within MSP (screen-detected and interval carcinomas) and outside the MSP. We analyzed the tumor stage distribution, tumor characteristics and the survival of the women. We further estimated hazard ratios using Cox-regressions to account for different characteristics between groups and corrected the survival rates for lead-time bias. Results: We identified 1057 invasive (ICD-10: C50) and in-situ (D05) BC cases within the MSP and 1501 outside the MSP between 2010 and 2019 in the Swiss cantons of St. Gallen and Grisons. BC within the MSP had a higher share of stage I carcinoma (46.5% vs. 33.0%; p < 0.01), a smaller (mean) tumor size (19.1 mm vs. 24.9 mm, p < 0.01), and fewer recurrences and metastases in the follow-up period (6.7% vs. 15.6%, p < 0.01). The 10-year survival rates were 91.4% for women within and 72.1% for women outside the MSP (p < 0.05). Survival difference persisted but decreased when women within the same tumor stage were compared. Lead-time corrected hazard ratios for the MSP accounted for age, tumor size and Ki-67 proliferation index were 0.550 (95% CI 0.389, 0.778; p < 0.01) for overall survival and 0.469 (95% CI 0.294, 0.749; p < 0.01) for BC related survival. Conclusion: Women participating in the "donna" MSP had a significantly higher overall and BC related survival rate than women outside the program. Detection of BC at an earlier tumor stage only partially explains the observed differences. [ABSTRACT FROM AUTHOR]

Populist radical right (PRR) parties have attracted anti-migration voters by claiming to serve the interests of nationally defined in-groups. Recently, several European PRR parties have shifted focus from protecting traditional values to protecting so-called modern Western values, including lesbian, gay, bisexual, and transgender rights. Here, we study whether PRR parties managed to attract voters who hold these modern values. In contrast with previous research, we do not position these voters with "modern values" as necessary opponents of nativist voters. European Social Survey data linked to 29 elections demonstrate that the likelihood to vote for PRR parties is somewhat lower among lesbian and gay rights people, but not for those who have strong anti-migration attitudes. However, this effect differs across countries and in some cases, the "sexually modern nativists" have the highest PRR voting likelihoods. This is not directly related to the parties' position on modern family values, but to the party system and alternative right-wing parties present.

Background: The burden of herpes zoster (shingles) virus and associated complications, such as post-herpetic neuralgia, is higher in older adults and has a significant impact on quality of life. The incidence of herpes zoster and post-herpetic neuralgia is increased in people living with HIV (PLWH) compared to an age-matched general population, including PLWH on long-term antiretroviral therapy (ART) with no detectable viremia and normal CD4 counts. PLWH – even on effective ART may- exhibit sustained immune dysfunction, as well as defects in cells involved in the response to vaccines. In the context of herpes zoster, it is therefore important to assess the immune response to varicella zoster virus vaccination in older PLWH and to determine whether it significantly differs to that of HIV-uninfected healthy adults or younger PLWH. We aim at bridging these knowledge gaps by conducting a multicentric, international, non-randomised clinical study (SHINGR'HIV) with prospective data collection after vaccination with an adjuvant recombinant zoster vaccine (RZV) in two distinct populations: in PLWH on long-term ART (> 10 years) over 50 years of and age/gender matched controls. Methods: We will recruit participants from two large established HIV cohorts in Switzerland and in France in addition to age-/gender-matched HIV-uninfected controls. Participants will receive two doses of RZV two months apart. In depth-evaluation of the humoral, cellular, and innate immune responses and safety profile of the RZV will be performed to address the combined effect of aging and potential immune deficiencies due to chronic HIV infection. The primary study outcome will compare the geometric mean titer (GMT) of gE-specific total IgG measured 1 month after the second dose of RZV between different age groups of PLWH and between PLWH and age-/gender-matched HIV-uninfected controls. Discussion: The SHINGR'HIV trial will provide robust data on the immunogenicity and safety profile of RZV in older PLWH to support vaccination guidelines in this population. Trial registration: ClinicalTrials.gov NCT05575830. Registered on 12 October 2022. Eu Clinical Trial Register (EUCT number 2023-504482-23-00). [ABSTRACT FROM AUTHOR]

This study's objective is to test one of the key theoretical orientations in the literature on intergroup relations, realistic conflict theory, from a dynamic perspective. In this study, we focus on adolescents who are, according to the 'impressionable years'-hypothesis, most likely to change in their rejection of equal opportunities. Realistic conflict theory is applied in a dynamic way by taking into account economic characteristics related to the adolescent and the household. We employ Swiss panel data covering the period 1999–2017, containing information of both adolescents and the household they live in. Results demonstrate that there is relatively little variation within adolescents in rejection of equal opportunities for foreigners. Despite of using a broad range of characteristics related to adolescents' as well as the household's economic situation, the changes that do occur within individuals could hardly be explained by those economic changes. Socialisation theories on direct parental influences appeared to better explain changes in rejection of equal opportunities. [ABSTRACT FROM AUTHOR]

Objectives: Our objective was to obtain long‐term data on the incidence of sexually transmitted infections (STIs) and their association with behavioural factors after widespread pre‐exposure prophylaxis (PrEP) implementation. Methods: This was a time‐to‐event analysis of a national PrEP cohort in Switzerland (SwissPrEPared study). Participants were people without HIV interested in taking PrEP with at least two STI screening visits. Primary outcomes were incidence rate of gonorrhoea, chlamydia, and syphilis. The association between behavioural factors and STI diagnosis was expressed using hazard ratios. We adjusted for testing frequency and calendar year. Results: This analysis included 3907 participants enrolled between April 2019 and April 2022, yielding 3815.7 person‐years of follow‐up for gonorrhoea (15 134 screenings), 3802.5 for chlamydia (15 141 screenings), and 3858.6 for syphilis (15 001 screenings). The median age was 39 years (interquartile range [IQR] 32–47), 93.8% (n = 3664) identified as men who have sex with men (MSM). The incidence was 22.8 (95% confidence interval [CI] 21.3–24.4) per 100 person‐years for gonorrhoea, 26.3 (95% CI 24.7–28.0) for chlamydia, and 4.4 (95% CI 3.8–5.1) for syphilis. Yearly incidence rates decreased between 2019 (all bacterial STIs: 81.6; 95% CI 59.1–109.9) and 2022 (all bacterial STIs: 49.8; 95% CI 44.6–55.3). Participants reporting chemsex substance use were at higher risk of incident STIs, as were those reporting multiple sexual partners. Younger age was associated with a higher risk of gonorrhoea and chlamydia. Conclusions: Incidence rates of bacterial STIs decreased over time. Young MSM, those with multiple partners, and those using chemsex substances were at increased risk of STIs. [ABSTRACT FROM AUTHOR]

A public demonstration of laser ablation inductively coupled plasma mass spectrometry (LA-ICPMS) for fast and sensitive qualitative elemental analysis of solid everyday objects is described. This demonstration served as a showcase model for modern instrumentation (and for elemental analysis, in particular) to the public. Several steps were made to adapt conventional laboratory-based ICP-MS instrumentation to bring it to the outreach event and also to improve ease-of-use, which helped facilitate discussion with attendees. Rather than the conventional closed-cell design, this setup consisted of a laser ablation (LA) system that allowed for ablation in ambient conditions which enabled swift sample exchange during the demonstration. A gas exchange device was operated between the LA system and the ICP-MS instrument allowing for the replacement of ambient gases with argon. This particular setup was utilized during an open day event to demonstrate how LA-ICPMS can be used for qualitative analysis of major and trace elemental components in objects. In particular, visitors were encouraged to present objects for elemental analysis. Complete elemental analysis of supplied samples such as keys, coins, rings, and necklaces was demonstrated by recording full mass spectra. Variation of the elemental composition across different regions of objects was shown by scanning the laser beam and acquiring transient elemental signals.

In emerging adulthood, being committed to and making progress on important personal goals constitutes a source of identity and well-being. Goal striving, however, does not always go without problems. Even though highly committed to a goal, individuals may experience recurring setbacks and, consequently, increasing doubts about the goal that might culminate in an "action crisis", that is, an intra-psychic decisional conflict about whether to disengage from or to continue on their way. Action crises have been shown to lead to negative consequences on well-being and performance. Besides these negative consequences, however, an action crisis is hypothesized to have an adaptive side that is addressed in the present paper. Actively questioning the pursuit of a goal should allow for weighing up the focal goal against alternative and possibly more desirable goals. This open-minded "re"-evaluation, in the event of goal disengagement, is assumed to avoid the emergence of action crises in subsequently formed goals. As expected, in a longitudinal study over one and a half years with n = 207 freshman students, the degree of experienced action crisis prior to goal disengagement predicted the desirability and decisional certainty of the subsequently formed alternative goal. Theoretical implications of the results for research on self-regulation and identity formation in emerging adulthood are discussed.

Determination of alkali elements is important to Earth scientists, yet suitable and reliable microanalytical reference materials are lacking. This paper proposes a new albite reference material and evaluates the potential for future K‐feldspar reference materials. The proposed Piz Beverin albite reference material from Switzerland yields a homogeneous composition at the centimetre‐ to micrometre‐scale for Si, Al and Na with < 2000 μg g‐1 total trace elements (mostly heterogeneously distributed Ca, K and Sr). EPMA and LA‐ICP‐MS measurements confirm a composition of 99.5(2)% albite component, which is supported further by bulk XRF measurements. A round robin evaluation involving nine independent EPMA laboratories confirms its composition and homogeneity for Si, Al and Na. In addition, a set of five distinct clear K‐feldspar samples was evaluated as possible reference materials. The first two crystals of adular and orthoclase yield unacceptable inhomogeneities with > 2% relative local variations of Na, K and Ba contents. The three other investigated sets of K‐feldspar crystals are yellow sanidine crystals from Itrongay (Madagascar). Despite distinct compositions, EPMA confirms they are each homogeneous at the centimetre to micrometre scale for Si, Al and K and have no apparent inclusions; further investigation to find larger amounts of these materials is therefore justified. [ABSTRACT FROM AUTHOR]

Ammonia (NH3) emissions negatively impact air, soil, and water quality, hence human health and biodiversity. Significant emissions, including the largest sources, originate from single or multiple structures, such as livestock facilities and wastewater treatment plants (WWTPs). The inverse dispersion method (IDM) is effective in measuring total emissions from such sources, although depositional loss between the source and point of measurement is often not accounted for. We applied IDM with a deposition correction to determine total emissions from a representative dairy housing and WWTP during several months in autumn and winter in Switzerland. Total emissions were 1.19 ± 0.48 and 2.27 ± 1.53 kg NH3 d-1 for the dairy housing and WWTP, respectively, which compared well with literature values, despite the paucity of WWTP data. A concurrent comparison with an inhouse tracer ratio method at the dairy housing indicated an offset of the IDM emissions by < 20%. Diurnal emission patterns were evident at both sites mostly driven by changes in air temperature with potential lag effects such as following sludge agitation. Modeled deposition corrections to adjust the concentration loss detected at the measurement point with the associated footprint were 22-28% of the total emissions and the cumulative fraction of deposition to emission modeled with distance from the source was between 7% and 12% for the measurement distances (60-150 m). Although estimates of depositional loss were plausible, the approach is still connected with substantial uncertainty, which calls for future validation measurements. Longer measurement periods encompassing more management activities and environmental conditions are required to assess predictor variable importance on emission dynamics. Combined, IDM with deposition correction will allow the determination of emission factors at reduced efforts and costs, thereby supporting the development and assessment of emission reducing methods and expand the data availability for emission inventories. Implications: Ammonia emissions must be measured to determine emission factors and reporting national inventories. Measurements from structures like farms and industrial plants are complex due to the many different emitting surfaces and the building configuration leading to a poor data availability. Micrometeorological methods provide high resolution emission data from the entire structure, but suffer from uncertainties, as the instruments must be placed at a distance from the structure resulting in a greater loss of the emitted ammonia via dry deposition before it reaches the measurement. This study constrains such emission measurements from a dairy housing and wastewater treatment plant by applying a simple correction to account for the deposition loss and compares the results to other methods. [ABSTRACT FROM AUTHOR]

The pharmaceutical supply in hospitals in German-speaking countries shows inadequate structural and procedural characteristics with regard to the quality of supply and security of supply. The question arises: How should a business model be designed to control and optimize the internal pharmaceutical supply in hospitals in German-speaking countries? With an adapted Analytic Hierarchy Process (AHP), pharmaceutical supply in hospitals in German-speaking countries is examined by means of two online surveys (2017, 2021) among managers of hospital pharmacies in Austria, Germany and Switzerland (2017: N = 412; n = 61, rr = 14.8%; 2021: N = 332, n = 44, rr = 13.3%). In addition to cross-sector trends in procurement and logistics, the communication and interaction among members of the health professions and the pharmacy and the associated relationship of trust are decisive for the security of supply and the quality of patient care. Targeted communication, digitization and performance measurement are relevant levers for a targeted development and optimization of pharmaceutical supply in hospitals. The business model of the hospital pharmacy must be designed and applied conceptually and strategically. In addition to innovative logistics tools, also includes special communication approaches and interprofessional knowledge management. [ABSTRACT FROM AUTHOR]

Background: Different dimensions of oppositional defiant disorder (ODD) have been found as valid predictors of further mental health problems and antisocial behaviors in youth. The present study aimed at testing the construct, concurrent, and predictive validity of ODD dimensions derived from parent- and self-report measures. Method: Confirmatory factor analyses were performed to test a three-dimensional model (ODD-irritability, ODD-headstrong, and ODD-hurtful) and a two-dimensional model (ODD-irritability, ODD-headstrong/hurtful) based on items of the Child Behavior Checklist (CBCL) and the Youth Self Report (YSR) collected in a Swiss community study of 1,031 adolescents (519 boys, 512 girls) aged between 10.7 and 17.9 (M = 13.85, SD = 1.63) years. Logistic regression analyses were applied to predict scores in the clinical range of concurrent CBCL/YSR-anxiety/depression, CBCL/YSR-attention problems, and CBCL/YSR-delinquent behavior and depression as measured by the Center for Epidemiological Studies Depression Scale (CES-D) as well as to predict the presence of adult criminal convictions. Results: CFA findings were in favor of a three-dimensional model rather than a two-dimensional model of ODD. The CBCL/YSR-ODD-irritability scale was related to concurrent self-reported depression, but also to attention problems and delinquent behavior. CBCL/YSR-ODD-hurtful and less strongly also the combined YSR-headstrong/hurtful scale predicted adult criminal outcomes. Conclusions: As proposed by the DSM-5 workgroup, different ODD-dimensions were confirmed by the present study. ODD-irritability predicts psychiatric comorbidity and ODD-hurtful symptoms should be specifically considered in youth at risk for criminal outcomes.

In Switzerland, the highest rates of suicide are observed in persons without religious affiliation and the lowest in Catholics, with Protestants in an intermediate position. We examined whether this association was modified by concomitant psychiatric diagnoses or malignancies, based on 6,909 suicides (ICD-10 codes X60-X84) recorded in 3.69 million adult residents 2001-2008. Suicides were related to mental illness or cancer if codes F or C, respectively, were mentioned on the death certificate. The protective effect of religion was substantially stronger if a diagnosis of cancer was mentioned on the death certificate and weaker if a mental illness was mentioned. (Contains 2 tables and 1 figure.) [Additional supporting information may be found in the online version of this article.]

Background: The Ehlers-Danlos syndromes are a group of clinically and genetically heterogeneous hereditary diseases affecting the connective tissue. They are characterized by hypermobility of the joints, hyperextensible skin and friable tissue. According to current classification, 13 subtypes can be distinguished, of which the hypermobile and the classical subtype are the most prevalent. This study aimed to evaluate patients with classical (cEDS) and hypermobile (hEDS) Ehlers-Danlos syndrome regarding temporomandibular disorder (TMD), chronic pain, and psychological distress. Methods: Support groups from Germany, Austria, and Switzerland were contacted, and social media were used to recruit participants. Free text questions, the German version of the Depression Anxiety and Stress Scale (DASS), and the German version of the Graded Chronic Pain Status (GCPS) were used. Results: 259 participants were included (230 hEDS/29 cEDS). At least 49.2% of the participants had painful or restricted jaw movements, and at least 84.9% had pain in the masticatory muscles, with 46.3% already having a diagnosed TMD. Multivariate analysis showed a significant correlation between TMJ involvement and chronic pain with a 2.5-fold higher risk of chronic pain with a diagnosed TMD. 22.8% of participants had a critical score for depression, 53.3% had a critical score for anxiety, and 34.0% had a critical score for stress. Conclusion: There is a high prevalence of TMD problems and chronic pain in patients with cEDS and hEDS. The lack of knowledge about these problems can create psychological distress. More research is needed to provide adequate treatment for patients with EDS. [ABSTRACT FROM AUTHOR]

Despite decreased numbers of sexual partners, the COVID-19 pandemic had limited impact on the prevalence of attending private sex parties, traveling for sex within Switzerland, and practicing chemsex in men with HIV who have sex with men. COVID-19 risk perception was low, and STI-diagnosis incidence rates remained stable over time. [ABSTRACT FROM AUTHOR]

The Middle-Jurassic Opalinus Clay is the foreseen host rock for radioactive waste disposal in central northern Switzerland. An extensive drilling campaign aiming to characterize the argillaceous formation resulted in a comprehensive drill core data set. The rheologically weak Opalinus Clay is only mildly deformed compared to the over- and underlying rock units but shows a variety of natural fractures. While these structures are hydraulically indistinguishable from macroscopically non-deformed Opalinus Clay today, their analysis allows for a better understanding of the deformation behaviour in the geological past. Here, we present an overview of the different fracture and fault types recorded in the Opalinus Clay and a detailed microstructural characterization of veins—natural dilational fractures healed by secondary calcite and celestite mineralizations. Macroscopic drill core analysis revealed five different natural fracture types that encompass tension gashes of various orientations with respect to bedding and small-scale faults with displacements typically not exceeding the drill core diameter. The occurrence of different fault types generally fits well with the local tectonic setting of the different drilling sites and with respect to the neighbouring regional fault zones. The microstructural investigations of the various vein types revealed their often polyphase character. Fibrous bedding-parallel veins of presumable early age were found to be overprinted by secondary slickenfibres. The polyphase nature of fibrous bedding parallel veins and slickenfibres is supported by differing elemental compositions, pointing towards repeated fracturing and mineralization events. Direct dating of vein calcites with U–Pb was unsuccessful. Nevertheless, age constraints can be inferred from structural orientations and fault slip kinematics. Accordingly, some of the veins already formed during sediment compaction in Mesozoic times, others possibly relate to Early Cenozoic foreland uplift. The youngest veins are most likely related to Late Cenozoic regional tectonic events, such as the Jura fold-and-thrust belt to the south and the Hegau-Lake Constance Graben to the northeast of the study area. During these latest tectonic events, previously formed veins acted as rheologically stiff discontinuities in the otherwise comparably weak Opalinus Clay along which deformation of the rock formation was re-localized. [ABSTRACT FROM AUTHOR]

Swiss landscape quality payments (LQPs) are a form of agricultural subsidy that provides funding for farmers engaged in maintaining or creating different elements that contribute to landscape quality. This study is the first step to analyse the effect of different measures to increase landscape quality using four indicators of perceived landscape quality (beauty, authenticity, uniqueness and complexity) from two nationally representative public surveys conducted in 2011 and 2020. While most LQP categories do not have a significant effect, both payments for productive grassland and those connected to stone structures have an effect on more than one of the four indicators of perceived landscape quality. These payments seem to cause a visible change in the landscape or preserve elements that are important for landscape quality. Such payments help to provide ecosystem services, while those not causing any visible change can be conceptualised as a form of rent-seeking. In the future, more efforts are needed to evaluate the payments to enable evidence-based policy-making and steer payments towards measures that result in improvements to landscape quality that are visible and notable to the public. [ABSTRACT FROM AUTHOR]

In the Swiss HIV Cohort Study, 61 of 222 (27%) HIV–suppressed persons with chronic hepatitis B virus (HBV) infection had HBV replication after 2 years on tenofovir, of whom 77% were suppressed thereafter. Self-reported adherence to therapy and HBV viral load at tenofovir initiation were predictors of persistent replication. [ABSTRACT FROM AUTHOR]

FGM/C is a harmful practice that involves injury of the external female genitalia without medical purpose. It is mainly practiced in Africa, Asia, and the Middle East. However, with the migratory flows, women and girls with FGM/C and its consequences live all over the world. The lack of knowledge on how to care for women and girls living with FGM/C extends among all categories of health professionals involved in women's health, including infectious disease specialists. This is a national, exploratory descriptive cross-sectional study aimed to generate descriptive statistics about FGM/C among HIV-infected migrant women included in the Swiss HIV Cohort Study (SHCS). Among the 387 women interviewed about FGM/C and who provided an answer, 80 (20.7%) reported to have undergone FGM/C. Fifty-six of the 80 women (70.0%) who reported having undergone FGM/C, also reported that they had never discussed their cutting with a health professional before. Our study demonstrates how common female genital mutilation is in women living with HIV and who have migrated to Switzerland and suggest how care and prevention could be improved significantly. [ABSTRACT FROM AUTHOR]

We report on the commissioning results of the cold neutron multiplexing secondary spectrometer CAMEA (Continuous Angle Multi-Energy Analysis) at the Swiss Spallation Neutron Source at the Paul Scherrer Institut, Switzerland. CAMEA is optimized for efficient data acquisition of scattered neutrons in the horizontal scattering plane, allowing for detailed and rapid mapping of low-energy excitations under extreme sample environment conditions. [ABSTRACT FROM AUTHOR]

Aims/Objectives: Patients with bleeding disorders are a rare and complex population in catheter ablation (CA) procedures. The most common types of bleeding disorders are von Willebrand disease (VWD) and hemophilia A (HA). Patients with VWD or HA tend to have a higher risk of bleeding complications compared to other patients. There is a lack of data concerning peri- and postinterventional coagulation treatment. We sought to assess the optimal management of patients with VWD and HA referred for catheter ablation procedures. Methods and Results: In this study, we analyzed patients with VWD or HA undergoing CA procedures at two centers in Germany and Switzerland between 2016 and 2021. Clotting factors were administered in conjunction with hemostaseological recommendations. CA was performed as per the institutional standard. During the procedure, unfractionated heparin (UFH) was given intravenously with respect to the activated clotting time (ACT). Primary endpoints included the feasibility of the procedure, bleeding complications, and thromboembolic events during the procedure. Secondary endpoints included bleeding complications and thromboembolic events up to one year after catheter ablation. A total of seven patients (three VWD Type I, one VWD Type IIa, three HA) underwent 10 catheter ablation procedures (pulmonary vein isolation (PVI): two × radiofrequency (RF), one × laser balloon (LB), one × cryoballoon (CB); PVI + cavotricuspid isthmus (CTI): one × RF; PVI + left atrial appendage isolation (LAAI): one × RF; Premature ventricular contraction (PVC): three × RF; Atrioventricular nodal reentrant tachycardia (AVNRT): one × RF). VWD patients received 2000–3000 IE Wilate i.v. 30 to 45 min prior to ablation. Patients with HA received 2000–3000 IE factor VIII before the procedure. All patients undergoing PVI received UFH (cumulative dose 9000–18,000 IE) with a target ACT of >300 s. All patients after PVI were started on oral anticoagulation (OAC) 12 h after ablation. Two patients received aspirin (acetylsalicylic acid; ASA) for 4 weeks after the ablation of left-sided PVCs. No anticoagulation was prescribed after slow pathway modulation in a case with AVNRT. No bleeding complications or thromboembolic events were reported. During a follow-up of one year, one case of gastrointestinal bleeding occurred following OAC withdrawal after LAA occlusion. Conclusions: After the substitution of clotting factors, catheter ablation in patients with VWD and HA seems to be safe and feasible. [ABSTRACT FROM AUTHOR]

Background: Centralisation of highly specialised medicine (HSM) has changed practice and outcome in pancreatic surgery (PS) also in Switzerland. Fewer hospitals are allowed to perform pancreatic surgery according to nationally defined cut-offs. Objective: We aimed to examine trends in PS in Switzerland. First, to assess opinions and expected trends among Swiss pancreatic surgeons in regard of PS practice and second, to assess the evolution of PS performance in Switzerland by a nationwide retrospective analysis. Methods: First, a 26-item survey among all surgeons who performed PS in 2016 in Switzerland was performed. Then, nationwide data from 1998 to 2018 from all hospitals performing PS was analysed including centre volume, perioperative morbidity and mortality, surgical indications and utilisation of minimally invasive pancreatic surgery (MIPS). The national cut-off for regulatory accredited volume centres (AVC) was ≥ 12. Additionally, an international benchmark definition for high volume (≥ 20 surgeries/year) was used. Results: Among 25 surgeons from 15 centres (response rate 51%), the survey revealed agreement that centralisation is important to improve perioperative outcomes. Respondents agreed on a minimum case load per surgeon or centre. Within the nationwide database, 8534 pancreatic resections were identified. Most resections were performed for pancreatic ductal adenocarcinoma (58.9%). There was a significant trend towards centralisation of PS with fewer non-accredited volume centres (nAVC) (36 in 1998 and 17 in 2018, p < 0.001) and more AVC (2 in 1998 and 18 in 2018, p < 0.001). A significantly higher adjusted mortality after pancreatoduodenectomy (PD) was observed in low-volume compared to high-volume hospitals (OR 1.45 [95% CI 1.15–1.84], p = 0.002) and a similar trend compared among AVC and nAVC (OR 1.25 [95% CI 0.98–1.60], p = 0.072), while mortality after distal pancreatectomy (DP) was not influenced by centre volume. Conclusions: Over the last two decades, centralisation of PS towards higher-volume centres was observed in Switzerland with a decrease of mortality after PD and low mortality after DP. Further centralisation is supported by most pancreatic surgeons. However, the ideal metric and outcome measures for the allocation of highly specialised medicine need further discussion to allow a fair and outcome-focused allocation. [ABSTRACT FROM AUTHOR]

Introduction: Worldwide health systems are being faced with unprecedented COVID-19-related challenges, ranging from the problems of a novel condition and a shortage of personal protective equipment to frequently changing medical guidelines. Many institutions were forced to innovate and many hospitals, as well as telehealth providers, set up online forward triage tools (OFTTs). Using an OFTT before visiting the emergency department or a doctor's practice became common practice. A policy can be defined as what an institution or government chooses to do or not to do. An OFTT, in this case, has become both a policy and a practice. Methods: The study was part of a broader multiphase sequential explanatory design. First, an online survey was carried out using a questionnaire to n = 176 patients who consented during OFTT usage. Descriptive analysis was carried out to identify who used the tool, for what purpose, and if the participant followed the recommendations. The quantitative results shaped the interview guide's development. Second, in-depth interviews were held with a purposeful sample of n = 19, selected from the OFTT users who had consented to a further qualitative study. The qualitative findings were meant to explain the quantitative results. Third, in-depth interviews were held with healthcare providers and authorities (n = 5) that were privy to the tool. Framework analysis was adopted using the five-factor framework as a lens with which to analyze the qualitative data only. Results: The five-factor framework proved useful in identifying gaps that affected the utility of the COVID-19 OFTT. The identified gaps could fit and be represented by five factors: primary, secondary, tertiary, and extraneous factors, along with a lack of systems thinking. Conclusion: A theory or framework provides a road map to systematically identify those factors affecting policy implementation. Knowing how and why policy practice gaps come about in a COVID-19 OFFT context facilitates better future OFTTs. The framework in this study, although developed in a universal health coverage (UHC) context in South Africa, proved useful in a telehealth context in Switzerland, in Europe. The importance of systems thinking in developing digital tools cannot be overemphasized. [ABSTRACT FROM AUTHOR]

There is ongoing debate about whether specialized treatment is effective to reduce sexual recidivism in juveniles who have sexually offended (JSOs). Although most treatment programs are based on cognitive behavioral therapy principles for preventing sexual offending, accordant scientific evidence is poor. Following CONSORT guidelines, the present study aimed to evaluate two versions of a short-term outpatient treatment program for JSOs in Switzerland: (a) the Therapy Program for Adequate Sexual Behaviors Version 1 (ThePaS-I), which included offending-specific skills training; (b) the ThePaS-II, which included general socioemotional skills training. Based on changes in self-reported mental health, sexual behaviors, victim empathy, and therapist-rated risk, as well as comprehensive data on sexual and general recidivism, we found some similarities regarding the effects of the two treatments. ThePaS-II showed better short-term changes in self-reported mental health than the ThePaS-I. However, JSOs in the ThePaS-I showed lower rates of sexual reoffending (but not general reoffending) after treatment than those in the ThePaS-II. Despite some methodological limitations, the current findings favor offending-specific skills-based therapy over general skills-based ones for preventing sexual reoffenses. The findings may encourage further methodologically sound studies to examine different treatment approaches for juveniles and adults who have committed criminal offenses. [ABSTRACT FROM AUTHOR]

The article "The quality of implementation of measures in probation and prison: Implementation research in tertiary prevention" emphasizes the importance of implementing measures in probation and prison. Studies show that the quality of implementation has a direct impact on the effectiveness of the measures. Various factors for successful implementation are mentioned, such as the support of all practitioners and adherence to guidelines. The text also emphasizes the importance of competencies, organizational factors, and factors at the management level for successful implementation. Various studies on the implementation of measures in probation and prison are presented, highlighting the importance of implementation quality for the success of the measures. The text deals with the need to develop support systems for measuring implementation quality in the German-speaking region. It is noted that there are international examples and developments, but they are not available in translated form for Germany. Successful establishment of implementation activities and examination of implementation outcomes in probation and criminal justice could lead to an improvement in the quality and effectiveness of services. The article deals with innovation processes in the field of criminal justice, particularly in probation. Considerations on innovations in social work and the public sector are discussed, as well as findings from innovation research and the examination of an innovation process in probation. The article describes subsidies as a funding instrument to ensure an effective and modern prison system in Switzerland. Probation in French-speaking Switzerland is conducted as a pilot project to improve practice and strengthen the identity of probation. The desistance approach is tested and evaluated, aiming to promote desistance from crime. The text addresses the question of innovation in the field of criminal justice and probation in Switzerland. It emphasizes that innovations should go beyond what is already known and bring new substantive aspects. The dissemination of innovations to other contexts and the safety and risks of innovation in criminal justice and probation are also discussed. The text discusses whether innovations in the field of criminal justice and probation can raise public awareness of these issues and lead to a change in their image. It emphasizes that the long-term effects of innovations in criminal justice and probation should be examined. [Extracted from the article]

Biological invasions strongly increased during the last centuries and are challenging environmental managers worldwide. In this context, public acceptance of management measures is a key factor determining the long-term success of the control of invasive species. However, in the case of charismatic and iconic invasive species, the public has often been unwilling to accept strict management measures. Here, we studied the public perception of the Chinese windmill palm (Trachycarpus fortunei) in Switzerland, which is declared as invasive in southern Switzerland but also recognized as iconic. We conducted a nation-wide online survey in the multilingual and multicultural context of Switzerland, investigating the influence of social and cultural factors on the knowledge of, the attitude toward, and the willingness to control the invasive T. fortunei. Results confirm that the knowledge and perception of invasive plants have a strong social and cultural component and may vary greatly as a function of the cultural background, education level, age, and other social characteristics. Furthermore, information on the invasiveness of the focal species provided during the survey significantly affected informants' perceptions, which are closely related to the acceptance of possible management and control measures. This allows us to highlight the importance of a holistic approach that includes targeted public information when dealing with biological invasions, especially in the case of charismatic and iconic species. Based on the obtained results, we suggest avenues for refining management and control strategies of T. fortunei in Switzerland, many of which generally applicable to other cases of invasive species. [ABSTRACT FROM AUTHOR]

Ensuring that railways provide excellent service requires the execution of maintenance interventions. As railway use intensifies, this becomes increasingly difficult due to the conflict between track possession used for train operation and the execution of interventions. One way to improve the consistency of train schedules, and thus user comfort, is to impose closure-free periods, in which no interventions are planned. The imposition of closure-free periods forces asset managers to group their interventions either before or after the closure-free periods. This encourages asset managers to exploit synergies between interventions which can reduce costs and the negative effects on users. However, it also means that maintenance interventions may need to be executed earlier or later than the times suggested when considering only their optimal life cycles. To deal with this issue, this paper investigated the effect of imposing closure-free periods on the development of intervention programs in terms of intervention costs and disruptions to service. We used a network-flow optimization model to determine the optimal intervention programs for a 5-year planning period without and with the imposition of a minimal 2-year closure-free period on a railway line in Switzerland. The effects of the closure-free period on intervention costs and service were discussed, along with the losses of executing interventions at different points in time from those suggested using optimal asset life cycles. [ABSTRACT FROM AUTHOR]

SHCS#879 is an ongoing Switzerland-wide multicenter observational study conducted within the Swiss HIV Cohort Study (SHCS) for the prospective follow-up of people living with HIV (PLWH) receiving long-acting injectable cabotegravir-rilpivirine (LAI-CAB/RPV). All adults under LAI-CAB/RPV and part of SHCS are enrolled in the project. The study addresses an integrated strategy of treatment monitoring outside the stringent frame of controlled clinical trials, based on relevant patient characteristics, clinical factors, potential drug-drug interactions, and measurement of circulating blood concentrations. So far, 91 blood samples from 46 PLWH have been collected. Most individuals are less than 50 years old, with relatively few comorbidities and comedications. The observed concentrations are globally in accordance with the available values reported in the randomized clinical trials. Yet, low RPV concentrations not exceeding twice the reported protein-adjusted 90% inhibitory concentration have been observed. Data available at present confirm a considerable between-patient variability overall. Based on the growing amount of PK data accumulated during this ongoing study, population pharmacokinetic analysis will characterize individual concentration-time profiles of LAI-CAB/RPV along with their variability in a real-life setting and their association with treatment response and tolerability, thus bringing key data for therapeutic monitoring and precision dosage adjustment of this novel long-acting therapy. [ABSTRACT FROM AUTHOR]

The coherent backscatter opposition effect (CBOE) enhances the backscatter intensity of electromagnetic waves by up to a factor of 2 in a very narrow cone around the direct return direction when multiple scattering occurs in a weakly absorbing, disordered medium. So far, this effect has not been investigated in terrestrial snow in the microwave spectrum. It has also received little attention in scattering models. We present the first characterization of the CBOE in dry snow using ground-based and spaceborne bistatic radar systems. For a seasonal snowpack in the Ku-band (17.2 GHz), we found backscatter enhancement of 50 %–60 % (+1.8 –2.0 dB) at a zero bistatic angle and a peak half-width at half-maximum (HWHM) of 0.25 ∘. In the X-band (9.65 GHz), we found backscatter enhancement of at least 35 % (+1.3 dB) and an estimated HWHM of 0.12 ∘ in the accumulation areas of glaciers in the Jungfrau–Aletsch region, Switzerland. Sampling of the peak shape at different bistatic angles allows estimating the scattering and absorption mean free paths, ΛT and ΛA. In the VV polarization, we obtained ΛT=0.4±0.1 m and ΛA=19±12 m at the Ku-band and ΛT=2.1±0.4 m and ΛA=21.8±2.7 m at the X-band, assuming an optically thick medium. The HH polarization yielded similar results. The observed backscatter enhancement is thus significant enough to require consideration in backscatter models describing monostatic and bistatic radar experiments. Enhanced backscattering beyond the Earth, on the surface of solar system bodies, has been interpreted as being caused by the presence of water ice. In agreement with this interpretation, our results confirm the presence of the CBOE at X- and Ku-band frequencies in terrestrial snow. [ABSTRACT FROM AUTHOR]

• The COVID-19 outbreak led to changes in forest visitation patterns in Switzerland. • We analyze changes in forest visitation patterns from before, during and after the COVID-19 pandemic. • Motivations, activities and locations visited changed during the lockdown phase. • Some changes have persisted despite decreased infection rates and vaccinations. • Forest managers should be aware of altered visitor patterns during and after such a crisis. Lockdown measures implemented during the COVID-19 pandemic led to a rise in people's visits to forests and urban green spaces. However, as vaccination efforts progressed and infection rates declined, it remained uncertain whether forest visitation levels would return to pre-pandemic norms or even decreased. To explore the post-crisis status of forest visits, we conducted a comprehensive analysis using data from a representative online panel survey conducted in Switzerland. Specifically, we compared data collected one week prior to the lockdown (in March 2020), on visit frequency, duration, activities and locations visited, with data collected two weeks after the lockdown was enforced (2020), and also with data from the summer of 2021. We aimed to determine if forest visitation had returned to normal by the time of the third survey. Our findings indicate that during times of crisis, visitation patterns and recreational preferences in urban green spaces, such as forests, undergo changes, with some of these changes exhibiting greater persistence than others. Meanwhile the activities during a forest visit as well as motivations of forest visits seem to return to their initial levels after the crisis, for example, the changes in the frequency or lengths of the visits appear to be more persistent. Recognizing and understanding these changes are crucial for urban planners and forest management authorities to adapt policies and effectively address the evolving needs of visitors. [ABSTRACT FROM AUTHOR]

Background and Purpose: Central retinal artery occlusion (CRAO) often leads to permanent monocular blindness. Hence, early recognition and rapid re-perfusion is of paramount importance. This study aims to describe prehospital pathways in CRAO compared to stroke and study the knowledge about CRAO. Methods: (1) Description of baseline characteristics, prehospital pathways/delays, and acute treatment (thrombolysis/thrombectomy vs. standard of care) of patients with CRAO and ischemic stroke registered in the Swiss Stroke Registry. (2) Online survey about CRAO knowledge amongst population, general practitioners (GPs) and ophthalmologists in Eastern Switzerland. Results: Three hundred and ninety seven CRAO and 32,816 ischemic stroke cases were registered from 2014 until 2019 in 20 Stroke Centers/Units in Switzerland. In CRAO, 25.6% arrived at the hospital within 4 h of symptom onset and had a lower rate of emergency referrals. Hence, the symptom-to-door time was significantly longer in CRAO compared to stroke (852 min. vs. 300 min). The thrombolysis/thrombectomy rate was 13.2% in CRAO and 30.9% in stroke. 28.6% of the surveyed population recognized CRAO-symptoms, 55.4% of which would present directly to the emergency department in contrast to 90.0% with stroke symptoms. Almost 100% of the ophthalmologist and general practitioners recognized CRAO as a medical emergency and 1/3 of them considered IV thrombolysis a potentially beneficial therapy. Conclusions: CRAO awareness of the general population and physician awareness about the treatment options as well as the non-standardized prehospital organization, seems to be the main reason for the prehospital delays and impedes treating CRAO patients. Educational efforts should be undertaken to improve awareness about CRAO. [ABSTRACT FROM AUTHOR]

This article explores the reasons for the local rejection of a proposed national park in Switzerland. Using a mixed-methods approach and resorting to qualitative and quantitative data, we follow the thread of trust issues in the participatory planning process of a protected area. Different rationales and discourses, both project-specific but also more general, influenced the opinions of local stakeholders. Connecting these different opinions was the issue of (dis)trust, which weaves in and out of prominent lines of argumentation and informs individual sentiments. The application of a multidimensional trust framework helps to understand the influence of different types of trust on protected area negotiations. We discuss how a focus on rational trust building can help to sharpen the diverse goals of contemporary protected areas with integrated conservation and economic development schemes, as well as enable the emergence of other types of trust to facilitate conservation debates. [ABSTRACT FROM AUTHOR]

This study compares the excess mortality impact of the COVID-19 pandemic in 2020 with that of other pandemics and mortality events dating back more than 100 years in Switzerland, Sweden, and Spain—3 European countries that have reliable continuous data on death counts and were militarily neutral during both world wars. Visual Abstract. Excess Mortality During the COVID-19 Pandemic in Switzerland, Sweden, and Spain.: This study compares the excess mortality impact of the COVID-19 pandemic in 2020 with that of other pandemics and mortality events dating back more than 100 years in Switzerland, Sweden, and Spain—3 European countries that have reliable continuous data on death counts and were militarily neutral during both world wars. Background: Excess mortality quantifies the overall mortality impact of a pandemic. Mortality data have been accessible for many countries in recent decades, but few continuous data have been available for longer periods. Objective: To assess the historical dimension of the COVID-19 pandemic in 2020 for 3 countries with reliable death count data over an uninterrupted span of more than 100 years. Design: Observational study. Setting: Switzerland, Sweden, and Spain, which were militarily neutral and not involved in combat during either world war and have not been affected by significant changes in their territory since the end of the 19th century. Participants: Complete populations of these 3 countries. Measurements: Continuous series of recorded deaths (from all causes) by month from the earliest available year (1877 for Switzerland, 1851 for Sweden, and 1908 for Spain) were jointly modeled with annual age group–specific death and total population counts using negative binomial and multinomial models, which accounted for temporal trends and seasonal variability of prepandemic years. The aim was to estimate the expected number of deaths in a pandemic year for a nonpandemic scenario and the difference in observed and expected deaths aggregated over the year. Results: In 2020, the number of excess deaths recorded per 100 000 persons was 100 (95% credible interval [CrI], 60 to 135) for Switzerland, 75 (CrI, 40 to 105) for Sweden, and 155 (CrI, 110 to 195) for Spain. In 1918, excess mortality was 6 to 7 times higher. In all 3 countries, the peaks of monthly excess mortality in 2020 were greater than most monthly excess mortality since 1918, including many peaks due to seasonal influenza and heat waves during that period. Limitation: Historical vital statistics might be affected by minor completeness issues before the beginning of the 20th century. Conclusion: In 2020, the COVID-19 pandemic led to the second-largest infection-related mortality disaster in Switzerland, Sweden, and Spain since the beginning of the 20th century. Primary Funding Source: Foundation for Research in Science and the Humanities at the University of Zurich, Swiss National Science Foundation, and National Institute of Allergy and Infectious Diseases. [ABSTRACT FROM AUTHOR]

Background: In Switzerland, HIV-1 transmission among men who have sex with men (MSM) has been dominated by subtype B, whilst non-B subtypes are commonly attributed to infections acquired abroad among heterosexuals. Here, we evaluated the temporal trends of non-B subtypes and the characteristics of molecular transmission clusters (MTCs) among MSM.Methods: Sociodemographic and clinical data and partial pol sequences were obtained from participants enrolled in the Swiss HIV Cohort Study. For non-B subtypes, maximum likelihood trees were constructed, from which Swiss MTCs were identified and analyzed by transmission group.Results: Non-B subtypes were identified in 8.1% (416/5116) of MSM participants. CRF01_AE was the most prevalent strain (3.5%), followed by subtype A (1.2%), F (1.1%), CRF02_AG (1.1%), C (0.9%), and G (0.3%). Between 1990 and 2019, an increase in the proportion of newly diagnosed individuals (0/123 [0%] to 11/32 [34%]) with non-B subtypes in MSM was found. Across all non-B subtypes, the majority of MSM MTCs were European. Larger MTCs were observed for MSM than heterosexuals.Conclusions: We found a substantial increase in HIV-1 non-B subtypes among MSM in Switzerland and the occurrence of large MTCs, highlighting the importance of molecular surveillance in guiding public health strategies targeting the HIV-1 epidemic. [ABSTRACT FROM AUTHOR]

Introduction: Following the 'Swiss statement' in 2008 it became an option to omit the use of condoms in serodiscordant couples and to conceive naturally. We analysed its impact on condom use and pregnancy events. Methods: In all, 3023 women (aged 18–49 years) participating in the Swiss HIV Cohort Study were included. Observation time was divided into pre‐ and post‐Swiss statement phases (July 2005–December 2008 and January 2009–December 2019). We used descriptive statistics, Poisson interrupted time series analysis for pregnancy incidence, and logistic regression to identify predictors of live births, spontaneous and induced abortions. Results: Condomless sex in sexually active women increased from 25% in 2005 to 75% in 2019, while pregnancy incidence did not. Women after 2008 experienced higher spontaneous abortion rates (12.1% vs. 17.2%, p = 0.02) while induced abortion and live birth rates did not change significantly. Spontaneous abortions were more common in older women [adjusted odds ratio (aOR) = 1.4, 95% CI: 1.2–1.7, p < 0.001], in women consuming alcohol (aOR = 2.8, 95% CI: 1.9–4.1, p < 0.001) and in those with non‐suppressed viral load (aOR = 0.2, 95% CI: 0.1–0.4, p ≤ 0.001). Induced abortions were more likely in women with depression (aOR = 3.4, 95% CI: 1.8–6.3, p < 0.001) and non‐suppressed viral load (aOR = 0.3, 95% CI: 0.2–0.7, p = 0.003). Conclusions: The publication of the Swiss statement resulted in more condomless sex in heterosexual women, but this did not result in a higher incidence of pregnancy. Maternal age and spontaneous abortion rates increased over time, while induced abortion rates were not significantly affected. Women living with HIV in Switzerland have an unmet need regarding family planning counselling. [ABSTRACT FROM AUTHOR]

Background: Minimally invasive surgery (MIS) has profoundly changed standards of care and lowered perioperative morbidity, but its temporal implementation and factors favoring MIS access remain elusive. We aimed to comprehensibly investigate MIS adoption across different surgical procedures over 20 years, identify predictors for MIS amenability and compare propensity score-matched outcomes among MIS and open surgery. Methods: Nationwide retrospective analysis of all hospitalizations in Switzerland between 1998 and 2017. Appendectomies (n = 186,929), cholecystectomies (n = 57,788), oncological right (n = 9138) and left hemicolectomies (n = 21,580), rectal resections (n = 13,989) and gastrectomies for carcinoma (n = 6606) were included. Endpoints were assessment of temporal MIS implementation, identification of predictors for MIS access and comparison of propensity score-matched outcomes among MIS and open surgery. Results: The rates of MIS increased for all procedures during the study period (p ≤ 0.001). While half of all appendectomies were performed laparoscopically by 2005, minimally invasive oncological colorectal resections reached 50% only by 2016. Multivariate analyses identified older age (p ≤ 0.02, except gastrectomy), higher comorbidities (p ≤ 0.001, except rectal resections), lack of private insurance (p ≤ 0.01) as well as rural residence (p ≤ 0.01) with impaired access to MIS. Rural residence correlated with low income regions (p ≤ 0.001), which themselves were associated with decreased MIS access. Geographical mapping confirmed strong disparities for rural and low-income areas in MIS access. Matched outcome analyses revealed benefits of MIS for length of stay, decreased surgical site infection rates for MIS appendectomies and cholecystectomies and higher mortality for open cholecystectomies. No consistent morbidity or mortality benefit for MIS compared to open colorectal resections was observed. Conclusion: Unequal access to MIS exists in disfavor of older and more comorbid patients and those lacking private insurance, living in rural areas, and having lower income. Efforts should be made to ensure equal MIS access regardless of socioeconomic or geographical factors. [ABSTRACT FROM AUTHOR]

Background: Late 2019, a new highly contagious coronavirus SARS-CoV-2 has emerged in Wuhan, China, causing within 2 months a pandemic with the highest disease burden in elderly and people with pre-existing medical conditions. The pandemic has highlighted that new and more flexible clinical trial approaches, such as trial platforms, are needed to assess the efficacy and safety of interventions in a timely manner. The two existing Swiss cohorts of immunocompromised patients (i.e., Swiss HIV Cohort Study (SHCS) and Swiss Transplant Cohort Study (STCS)) are an ideal foundation to set-up a trial platform in Switzerland leveraging routinely collected data. Within a newly founded trial platform, we plan to assess the efficacy of the first two mRNA SARS-CoV-2 vaccines that reached market authorization in Switzerland in the frame of a pilot randomized controlled trial (RCT) while at the same time assessing the functionality of the trial platform.Methods: We will conduct a multicenter randomized controlled, open-label, 2-arm sub-study pilot trial of a platform trial nested into two Swiss cohorts. Patients included in the SHCS or the STCS will be eligible for randomization to either receiving the mRNA vaccine Comirnaty® (Pfizer/BioNTech) or the COVID-19 mRNA Vaccine Moderna®. The primary clinical outcome will be change in pan-lg antibody response (pan-Ig anti-S1-RBD; baseline vs. 3 months after first vaccination; binary outcome, considering ≥ 0.8 units/ml as a positive antibody response). The pilot study will also enable us to assess endpoints related to trial conduct feasibility (i.e., duration of RCT set-up; time of patient recruitment; patient consent rate; proportion of missing data). Assuming vaccine reactivity of 90% in both vaccine groups, we power our trial, using a non-inferiority margin such that a 95% two-sided confidence interval excludes a difference in favor of the reference group of more than 10%. A sample size of 380 (190 in each treatment arm) is required for a statistical power of 90% and a type I error of 0.025. The study is funded by the Swiss National Science Foundation (National Research Program NRP 78, "COVID-19").Discussion: This study will provide crucial information about the efficacy and safety of the mRNA SARS-CoV-2 vaccines in HIV patients and organ transplant recipients. Furthermore, this project has the potential to pave the way for further platform trials in Switzerland.Trial Registration: ClinicalTrials.gov NCT04805125 . Registered on March 18, 2021. [ABSTRACT FROM AUTHOR]

Background: Tenofovir-based antiretroviral therapy (ART) has become first-line in all major HIV treatment guidelines. Compared with tenofovir disoproxil fumarate (TDF), tenofovir alafenamide (TAF) has a favorable renal and bone safety profile, but concerns about metabolic complications remain.Objective: To assess weight changes, the development of overweight/obesity, and changes in lipid levels 18 months after replacing TDF with TAF.Design: Cohort study.Setting: 5 university hospitals, affiliated hospitals, and private physicians in Switzerland.Participants: 4375 adults living with HIV who received TDF-containing ART for 6 months or longer.Measurements: Changes in weight and lipid levels were assessed using mixed-effect models. Differences in proportions of newly overweight/obese participants were calculated using 2-proportions Z tests.Results: 4375 individuals were included, with follow-up between 1 January 2016 and 31 July 2019. Median age was 50 years (interquartile range, 43 to 56 years), 25.9% were female, and 51.7% had a normal body mass index (BMI); 3484 (79.6%) switched to TAF and 891 (20.4%) continued TDF. After 18 months, switching to TAF was associated with an adjusted mean weight increase of 1.7 kg (95% CI, 1.5 to 2.0 kg), compared with 0.7 kg (CI, 0.4 to 1.0 kg) with the continued use of TDF (between-group difference, 1.1 kg [CI, 0.7 to 1.4 kg]). Among individuals with a normal BMI, 13.8% who switched to TAF became overweight/obese, compared with 8.4% of those continuing TDF (difference, 5.4 percentage points [CI, 2.1 to 8.8 percentage points]). Switching to TAF led to increases in adjusted mean total cholesterol (0.25 mmol/L [9.5 mg/dL]), high-density lipoprotein cholesterol (0.05 mmol/L [1.9 mg/dL]), low-density lipoprotein cholesterol (0.12 mmol/L [4.7 mg/dL]), and triglyceride (0.18 mmol/L [16.1 mg/dL]) levels after 18 months.Limitation: Short follow-up, small subgroup analyses, and potential residual confounding.Conclusion: Replacing TDF with TAF is associated with adverse metabolic changes, including weight increase, development of obesity, and worsening serum lipid levels.Primary Funding Source: Swiss National Science Foundation. [ABSTRACT FROM AUTHOR]

We constrain the Holocene development of the active Bleis Marscha rock glacier (Err–Julier area, eastern Swiss Alps) with 15 cosmogenic nuclide exposure ages (10 Be, 36 Cl), horizontal surface creep rate quantification by correlating two orthophotos from 2003 and 2012, and finite element modeling. We used the latter to separate the control on surface movement exerted by topography and material properties. Bleis Marscha is a stack of three overriding lobes whose formation phases are separated by time gaps expressed morphologically as over-steepened terrain steps and kinematically as a sharp downslope decrease in surface movement. The three discrete formation phases appear to be correlated to major Holocene climate shifts: Early Holocene low-elevation lobes (∼8.9 –8.0 ka, after the Younger Dryas), Middle Holocene lobe (∼5.2 –4.8 ka, after the Middle Holocene warm period), and Late Holocene high-elevation lobes (active since ∼2.8 ka, intermittently coexisting with oscillating Bleis Marscha cirque glacierets). The formation phases appear to be controlled in the source area by the climate-sensitive accumulation of an ice-debris mixture in proportions susceptible to rock glacier creep. The ongoing cohesive movement of the older generations requires ice at a depth which is possibly as old as its Early–Middle Holocene debris mantle. Permafrost degradation is attenuated by "thermal filtering" of the coarse debris boulder mantle and implies that the dynamics of the Bleis Marscha lobes that once formed persisted over millennia are less sensitive to climate. The cosmogenic radionuclide inventories of boulders on a moving rock glacier ideally record time since deposition on the rock glacier root but are stochastically altered by boulder instabilities and erosional processes. This work contributes to deciphering the long-term development and the past to quasi-present climate sensitivity of rock glaciers. [ABSTRACT FROM AUTHOR]

Background: Hazardous alcohol consumption and HIV infection increase the risk of neurocognitive impairment (NCI). We examined the association between alcohol consumption and specific neurocognitive domain function in people with HIV (PWH) taking modern antiretroviral therapy. Methods: The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study is a prospective, longitudinal, multicentre and multilingual (French, German and Italian) study of patients aged ≥45 years old enrolled in the Swiss HIV Cohort Study (SHCS). Baseline data from 981 study participants were examined. Five neurocognitive domains were evaluated: motor skills, speed of information processing, attention/working memory, executive function and verbal episodic memory. NCI was examined as binary (presence/absence) and continuous (mean z-score) outcomes against Alcohol Use Disorders Identification Test for Consumption (AUDIT-C) scores using logistic and linear regression models, respectively. Results: Most participants (96.2%) had undetectable viral loads and 64% were aged >50 years old. Hazardous alcohol consumption was observed in 49.4% of participants and binge drinking in 4.2%. While alcohol consumption frequency and quantity were not associated with NCI, the practice of binge drinking was significantly associated with impaired motor skills and overall neurocognitive function in both binary (odds ratio, OR ≥2.0, P <0.05) and continuous (mean z-score difference -0.2 to -0.4, P ≤0.01) outcomes. A significant U-shaped distribution of AUDIT-C score was also observed for motor skills and overall neurocognitive function. Conclusions: In this cohort of PWH with well-controlled HIV infection, NCI was associated with the practice of binge drinking rather than alcohol consumption frequency or quantity. Longitudinal analysis of alcohol consumption and NCI in this population is currently underway. [ABSTRACT FROM AUTHOR]

Switzerland is currently in a lockdown and other lockdowns are looming world-wide. Many countries in the West are now experiencing a third COVID-19 wave. While some scientists are aiming for Zero Covid, calls to learn to live with the virus are becoming prominent as anti-lockdown protests spread across Europe. A health system is defined as all organizations, institutions and resources that produce actions whose primary purpose is to improve health. A health care system on the other hand, is defined as institutions, people and resources involved in delivering health care to individuals. Many countries that have health systems previously thought to be world class, have also been tested, pushed to the edge and in some ways found wanting. The pandemic took all countries by some surprise and the discussion on appropriate national and global strategies is very diverse. Lessons from similar earlier outbreaks seem to suggest, that living and learning to live with the virus could be the way forward. Others argue that the virus is new, not like any other we have fought before, calling for novel ways of containing the virus. Irrespective of standpoint, being a high-, middle- or low-income country, pandemic fatigue is setting in, while new variants are being discovered. It is urgent and unprecedented. The pandemic is here and more pandemics are expected to follow. What does, 'living with the virus,' mean in practical terms? The purpose of this viewpoint is to stimulate debate on how we can move towards pandemic proof health care systems. [ABSTRACT FROM AUTHOR]

Background: Dolutegravir (DTG)-based dual therapy is becoming a new paradigm for both the initiation and maintenance of HIV treatment. The SIMPL'HIV study investigated the outcomes of virologically suppressed patients on standard combination antiretroviral therapy (cART) switching to DTG + emtricitabine (FTC). We present the 48-week efficacy and safety data on DTG + FTC versus cART.Methods and Findings: SIMPL'HIV was a multicenter, open-label, non-inferiority randomized trial with a factorial design among treatment-experienced people with HIV in Switzerland. Participants were enrolled between 12 May 2017 and 30 May 2018. Patients virologically suppressed for at least 24 weeks on standard cART were randomized 1:1 to switching to DTG + FTC or to continuing cART, and 1:1 to simplified patient-centered monitoring versus standard monitoring. The primary endpoint was the proportion of patients virologically suppressed with <100 copies/ml through 48 weeks. The secondary endpoints included virological suppression at 48 weeks according to the US Food and Drug Administration (FDA) snapshot analysis. Non-inferiority of DTG + FTC versus cART for viral suppression was assessed using a stratified Mantel-Haenszel risk difference, with non-inferiority declared if the lower bound of the 95% confidence interval was greater than -12%. Adverse events were monitored to assess safety. Quality of life was evaluated using the PROQOL-HIV questionnaire. Ninety-three participants were randomized to DTG + FTC, and 94 individuals to cART. Median nadir CD4 count was 246 cells/mm3; median age was 48 years; 17% of participants were female. DTG + FTC was non-inferior to cART. The proportion of patients with viral suppression (<100 copies/ml) through 48 weeks was 93.5% in the DTG + FTC arm and 94.7% in the cART arm in the intention-to-treat population (risk difference -1.2%; 95% CI -7.8% to 5.6%). Per-protocol analysis showed similar results, with viral suppression in 96.5% of patients in both arms (risk difference 0.0%; 95% CI -5.6% to 5.5%). There was no relevant interaction between the type of treatment and monitoring (interaction ratio 0.98; 95% CI 0.85 to 1.13; p = 0.81). Using the FDA snapshot algorithm, 84/93 (90.3%) participants in the DTG + FTC arm had an HIV-1 RNA viral load of <50 copies/ml compared to 86/94 (91.5%) participants on standard cART (risk difference -1.1%; 95% CI -9.3% to 7.1%; p = 0.791). The overall proportion of patients with adverse events and discontinuations did not differ by randomization arm. The proportion of patients with serious adverse events was higher in the cART arm (16%) compared to the DTG + FTC arm (6.5%) (p = 0.041), but none was considered to be related to the study medication. Quality of life improved more between baseline and week 48 in the DTG + FTC compared to the cART arm (adjusted difference +2.6; 95% CI +0.4 to +4.7). The study's main limitations included a rather small proportion of women included, the open label design, and its short duration.Conclusions: In this study, DTG + FTC as maintenance therapy was non-inferior to cART in terms of efficacy, with a similar safety profile and a greater improvement in quality of life, thus expanding the offer of 2-drug simplification options among virologically suppressed individuals.Trial Registration: ClinicalTrials.gov NCT03160105. [ABSTRACT FROM AUTHOR]

Background: Replacing tenofovir disoproxil fumarate (TDF) with tenofovir alafenamide (TAF) improves renal tubular markers in HIV-infected individuals but the impact on estimated glomerular filtration rate (eGFR) remains unclear.Methods: In all participants from the Swiss HIV Cohort Study who switched from TDF to TAF-containing antiretroviral regimen or continued TDF, we estimated changes in eGFR and urine protein-to-creatinine ratio (UPCR) after 18 months using mixed-effect models.Results: Of 3520 participants (26.6% women, median age 50 years), 2404 (68.5%) switched to TAF. Overall, 1664 (47.3%) had an eGFR <90 mL/min and 1087 (30.9%) an UPCR ≥15 mg/mmol. In patients with baseline eGFR ≥90 mL/min, eGFR decreased with the use of TDF and TAF (-1.7 mL/min). Switching to TAF was associated with increases in eGFR of 1.5 mL/min (95% confidence interval [CI], .5-2.5) if the baseline eGFR was 60-89 mL/min, and 4.1 mL/min (95% CI, 1.6-6.6) if <60 mL/min. In contrast, eGFR decreased by 5.8 mL/min (95% CI, 2.3-9.3) with continued use of TDF in individuals with baseline eGFR <60 mL/min. UPCR decreased after replacing TDF by TAF, independent of baseline eGFR.Conclusions: Switching from TDF to TAF improves eGFR and proteinuria in patients with renal dysfunction. [ABSTRACT FROM AUTHOR]

Introduction: Physical fitness benefits health. However, there is a research gap on how physical fitness, particularly aerobic endurance capacity and muscle power, is influenced by residential altitude, blood parameters, weight, and other cofactors in a population living at low to moderate altitudes (300–2100 masl). Materials and Methods: We explored how endurance and muscle power performance changes with residential altitude, Body Mass Index (BMI), hemoglobin and creatinine levels among 108,677 Swiss men aged 18–22 years (covering >90% of Swiss birth cohorts) conscripted to the Swiss Armed Forces between 2007 and 2012. The test battery included a blood test of about 65%, a physical evaluation of about 85%, and the BMI of all conscripts. Results: Residential altitude was significantly associated with endurance (p < 0.001) but not with muscle power performance (p = 0.858) after adjusting for all available cofactors. Higher BMI showed the greatest negative association with both endurance and muscle power performance. For muscle power performance, the association with creatinine levels was significant. Elevated C-reactive protein (CRP) and hemoglobin levels were stronger contributors in explaining endurance than muscle power performance. Conclusion: We found a significant association between low to moderate residential altitude and aerobic endurance capacity even after adjustment for hemoglobin, creatinine, BMI and sociodemographic factors. Non-assessed factors such as vitamin D levels, air pollution, and lifestyle aspects may explain the presented remaining association partially and could also be associated with residential altitude. Monitoring the health and fitness of young people and their determinants is important and of practical concern for disease prevention and public health implications. [ABSTRACT FROM AUTHOR]

Background: Suicide is a major and complex public health problem. In Switzerland, suicide accounts for about 1000 deaths yearly and is the fourth leading cause of mortality. The first nationwide Swiss study of suicides identified eight male and four female occupations with statistically significant excess of suicide compared to the general Swiss population. Working time, self-employer status, low socio-economic status and low skill level required for occupation were associated with increase in suicide risk. Presently, we aim to compare the distribution of suicide risk across occupations with the prevalence of somatic and psychiatric morbidity in Swiss working-aged adults. We hypothesized that some diseases would cluster in particular occupations, indicating potential work-relatedness of suicides found in these occupations. Methods: We used the Swiss National Cohort (SNC) and included 10575 males and 2756 females deceased by suicide between 1990 and 2014. We estimated the prevalence of 16 categories of concomitant diseases in each occupation, using national mortality records, and assessed the homogeneity of diseases distribution across occupations. For diseases, which prevalence varied significantly across occupations, we analyzed the correlation with the distribution of suicide risk, estimated as the standardized mortality ratio (SMR) of suicide. Results: Mental and behavioral disorders were the most commonly reported concomitant diseases in our population. In men, the prevalence of these disorders and more specifically, the prevalence of substance-related and addictive disorders, and of psychotic disorders varied significantly across occupations and was correlated with the SMR of suicide. The prevalence of malignant neoplasms and the prevalence of diseases of the musculoskeletal system and connective tissue also varied significantly across male occupations, while in women, such a variation was observed for neoplasms of uncertain or unknown behavior and diseases of the nervous system and sense organs, without being correlated with the SMR of suicide. Conclusion: Some of the identified morbidities can be occupation-related and could negatively affect the working capacity and the employability, which in turn could be related to the suicide. Disentangling concomitant diseases according to their work-relatedness and relationship with the suicide risk is important for identifying occupation-related suicides, understanding their characteristics, and developing appropriated interventions for their prevention. [ABSTRACT FROM AUTHOR]

Objectives: To investigate type and load of productive activities as potential determinants of mental health and well-being in elderly persons with a physical disability. Methods: We used data from a Swiss population-based sample of 314 adults at or past the legal retirement age (65 for men, 64 for women) who live with a chronic physical disability, spinal cord injury. Engagement in housework, volunteering, and paid work were dichotomized (no; some engagement) and three groups of engagement types were constructed (none; housework only; volunteering and/or paid work). Load of engagement was appraised using a sumscore on the overall frequency as well as the total number of performed activities. We used regression modelling to draw causal inference regarding the associations of type and load of engagement with general mental health (Mental Health Inventory, SF-36), self-reported depression (Self-Administered Comorbidity Questionnaire, SCQ), and well-being (WHOQoL-BREF items). Results: Engagement in volunteering was positively related to well-being. Persons engaged only in housework reported better well-being and lower prevalence of depression than non-engaged persons, however, persons engaged in volunteering or paid work reported the highest well-being and the lowest prevalence of depression. The productivity sumscore tertiles and the number of performed activities were both positively linked to well-being and negatively linked to depression, while their association with general mental health was less pronounced. Conclusion: Strengthening the engagement in productive activities among the elderly with a chronic physical disability is suggested as a promising strategy to promote well-being and reduce the prevalence of depression. [ABSTRACT FROM AUTHOR]