Vol. 152 No. 1314 (2022) | Swiss Medical Weekly

Carsten Surke, Michael Kunzli, Esther Vogelin, Daniel Garcia, Ruth M. Lollgen (Author)

An analysis of finger and hand injuries in children in a tertiary paediatric emergency department

AIMS OF THE STUDY: This study set out to examine the association between current subspecialty (paediatric and hand surgery) consultation practice for children with hand and finger injuries presenting to a tertiary paediatric emergency department and length of stay in the paediatric emergency department. Also, incidence and injury pattern of hand and finger injuries in this patient group were analysed.

METHODS: This was a retrospective cross-sectional study, which was undertaken as a clinical audit service. All patients under 17 years presenting to our paediatric emergency department with hand and finger injuries over a 17-month period were included in the analysis. We studied incidence and injury mechanism, current subspecialty referral practice, as well as paediatric emergency department and hospital length of stay.

RESULTS: We identified 929 children for inclusion in the analysis. The most frequent reasons for presentation were hand contusions (25.5%) and fractures (20.8%). Paediatric emergency medicine physicians alone managed 845 patients (90.6%), paediatric surgery referral occurred in 50 (5.4%) and hand surgery consultation in 37 (4.0%) cases. Mean length of stay in the paediatric emergency department was 154 min and significantly longer when subspecialty review occurred. Hospital admission occurred in 87 cases (9.3%).

CONCLUSIONS: Involvement of subspecialties in the care of hand and finger injuries was associated with significantly increased length of stay in the paediatric emergency department. We discuss obstacles and enablers for timely patient referral and management. We suggest the implementation of referral guidelines, tailored to the individual emergency department, to reduce unnecessary patient journey delays and to ensure higher quality repair of complex hand injuries by the appropriate surgeon, with better outcomes. Making use of the emergence of multiple surgical subspecialties for targeted treatment of paediatric finger and hand injuries might be desirable.

Barbara Meyer-Zehnder, Tobias E. Erlanger, Hans Pargger (Author)

Mortality 7 years after prolonged treatment on a surgical intensive care unit

AIMS OF THE STUDY: Long-term intensive care treatment confers a substantial physical, psychological and social burden on patients, their relatives and the treatment team. It is essential to know the outcome of patients with long-term treatment and to establish factors that possibly can predict mortality. Only few Swiss studies have previously addressed this issue.

METHODS: This retrospective observational study at a Swiss tertiary academic medical care centre included patients who were treated for ≥7 consecutive days at the surgical intensive care unit (ICU) between 1 January 2011 and 31 December 2012. Follow-up ended on 30 September 2018.

RESULTS: Two-hundred and fifty patients were included, and three were lost to follow-up. Fifty-two patients (21.1%) died in the ICU, 25 (10.1%) after transfer to the normal ward. Thirty-one patients (12.5%) died within one year after the beginning of intensive care treatment. Altogether, the one-year mortality was 43.7% (108 patients). At the end of follow-up, 99 patients (40.1%) were still alive. Polytrauma patients represent a special group with a survival of more than 90%. Median patient age was 66 years (interquartile range 56–75); two thirds were men. Patients who died within one year of beginning treatment in the ICU were significantly older (median 71 vs 63 years, p <0.001), had a higher Charlson comorbidity index (mean 2.3 vs 1.2, p <0.001), a longer intensive care stay (median 13.9 vs 10.6 days, p = 0.001), a higher SAPS-II score (mean 52.7 vs 45.6, p = 0.001), a higher NEMS score (mean 1772.4 vs 1230.4, p <0.001) and more complications (mean 2.9 vs 2.0, p <0.001) than patients who survived at least 1 year. Those who died within 1 year more often developed pneumonia (50.9% vs 29.5%, p = 0.001), pleural empyema (13.0% vs 2.9%, p = 0.005), septic shock (51.9% vs 20.1%, p <0.001) or critical illness polyneuropathy (16.7% vs 2.9%, p <0.001). Moreover, they more frequently (30.6% vs 15.1%, p = 0.006) required a renal replacement therapy.

CONCLUSIONS: Long-term mortality of patients with prolonged intensive-care treatment is high. Scores combined with factors shown to be associated with an increased short- and long-term mortality can help to identify patients at risk for death within one year after ICU treatment.

Oliver Hämmig, Joanna Herzig (Author)

Over-indebtedness, mastery and mental health: a cross-sectional study among over-indebted adults in Switzerland

OBJECTIVES: The aim is to investigate whether and why over-indebted individuals in German-speaking Switzerland have poorer mental health than the general population.

METHODS: A cross-sectional study among over-indebted people in the canton of Zurich was conducted in 2019. The study population (n = 219) was compared to the cantonal subsample of the general adult population selected from the nationally representative sample of the Swiss Health Survey 2017 (n = 1,997). Bivariate and multivariate statistical analyses were used to examine associations between over-indebtedness, mastery and health outcomes like mental stress and depression.

RESULTS: Over-indebted people have poorer mental health and weaker mastery than the general population. Low mastery is the strongest predictor of poor mental health (beta coefficient = 0.58/–0.62 for mental stress/depression respectively) among the over-indebted, followed by the perception of one’s health being affected by over-indebtedness (beta coefficient = –0.19/0.15). The amount of debt, anticipated time until repayment of debt and duration of indebtedness had no predictive effects.

CONCLUSION: Surprisingly, traditional debt parameters cannot explain the poor mental health of the over-indebted, in contrast to a strong sense of mastery, which was identified as a highly protective factor.

Shai Babecoff, Florence Mermillod, Denis Marino, Angèle Gayet-Ageron, Marc Ansari, Eugenio Fernandez, Fabienne Gumy-Pause (Author)

Long-term follow-up for childhood cancer survivors: the Geneva experience

AIMS OF THE STUDY: Although the 5-year survival for pediatric cancer in Switzerland today is over 85%, two thirds of the survivors will develop chronic health conditions due to the disease or to the toxicity of treatments. In this context, a long-term personalized follow-up program (LTFU program), was set up at the University Hospitals of Geneva (HUG) since 2015. We aimed to describe this program, more particularly the specialized follow-ups set up, the cumulative burden of the chronic health conditions, and finally assess the satisfaction of patients and/or their parents with it.

METHODS: A monocentric retrospective study was performed where data on follow-ups and chronic health conditions were collected from medical charts of people who had childhood cancer and who participated in the LTFU program. Chronic health conditions were classified and graded in severity with the Common Terminology Criteria of Adverse Events (CTCAE) classification, version 5.0. This study was completed by a satisfaction survey among patients and/or their parents.

RESULTS: Out of 83 eligible patients, 51 (61.4%) accepted to participate, with an average age of 17.4 years (range, 10 to 35) at the time of study. Mean delay since end of treatment was 9.8 years (range: 4.5–31). The prevalence of any chronic health condition is 82.3%, 43.1% for having 1 or 2 chronic health conditions and 39.2% for having more than 3 chronic health conditions. The total number of Grade CTCAE 1–4 chronic health conditions was 118 for the 51 participants, with a mean of 2.3 (range, 0 to 7) disorders per patient. The most frequently affected systems were neurological (14.4%), musculoskeletal (13.6%), endocrine (9.3%) and renal (9.3%) systems. Sarcoma, central nervous system tumors and neuroblastoma were the diagnoses associated with the highest average number of chronic health conditions. Among the 118 questionnaires sent to patients and/or parents, we received 82 (69.5%) responses. The level of satisfaction was good to excellent for more than 90% of the participants, for all the items evaluated.

CONCLUSIONS: Childhood cancer survivors present a significant number of chronic health conditions, confirming the need for appropriate long-term, multidisciplinary and patient-specific medical follow-up based on the primary diagnosis and therapies received. Moreover, the LTFU program at the HUG was highly appreciated by patients and/or their parents and this motivates its permanent conduct.

Clément Meier, Sarah Vilpert, Carmen Borrat-Besson, Ralf J. Jox, Jürgen Maurer (Author)

Health literacy among older adults in Switzerland: cross-sectional evidence from a nationally representative population-based observational study

BACKGROUND AND AIM: Despite being widely regarded as a major cause of health inequalities, little is known regarding health literacy and its association with certain personal characteristics among older adults in Switzerland. To fill this gap, this study assesses health literacy and its associations with individuals’ social, regional, and health characteristics in a nationally representative sample of adults aged 58 years and older in Switzerland.

METHOD: We use data of 1,625 respondents from a paper-and-pencil self-completion questionnaire (cooperation rate: 94.3%) that was administered as part of wave 8 (2019/2020) of the Survey of Health, Ageing and Retirement in Europe (SHARE) in Switzerland. Health literacy is measured using the short version of the European Health Literacy Survey questionnaire (HLS-EU-Q16). The scale includes 16 items whose dichotomised responses allow the construction of different indices and sub-indices aimed at measuring various aspects of health literacy. We use multivariable regressions to explore how respondents' sociodemographic characteristics are independently associated with health literacy.

RESULTS: Overall, 6.8% of the respondents had inadequate health literacy, 24.6% problematic health literacy, and 68.6% sufficient health literacy. There were significant associations between health literacy and individuals' gender, education, economic situation, and self-rated health. Women had higher levels of health literacy than men (p <0.001). Moreover, a higher education level (p <0.001), fewer financial difficulties (p<0.01), and higher self-rated health (p <0.001) were positively correlated with adequate/higher levels of health literacy.

CONCLUSION: One-third of older citizens have difficulties managing health-related issues in Switzerland. Individuals with low education, financial difficulties, and bad self-rated health are particularly at risk of being disadvantaged due to their inadequate health literacy level. These findings call for targeted interventions, such as using simplified health or eHealth information tools, improved patient-provider communication and shared decision-making, promoting lifelong learnings activities and health literacy screening for older patients to increase low health literacy and mitigate its consequences, thereby alleviating remaining social health inequalities in the Swiss population.

Camille Poroes, Yves Henchoz, Laurence Seematter-Bagnoud (Author)

Government recommendations during the COVID-19 epidemic in Switzerland: clarity, compliance and impact on the daily life of seniors in a population-based cohort

CONTEXT: In March 2020, the Swiss Federal Council issued recommendations for a partial lockdown, with an emphasis on people aged 65 years and over because of their vulnerability to COVID-19. This study investigated whether seniors clearly understood the meaning of four recommendations (do not go grocery shopping; do not use public transport; avoid personal contact; stay at home), whether they complied with them, and what was the impact of the partial lockdown on their daily life, including difficulties and opportunities.

METHODS: In April 2020, a questionnaire about how seniors experienced the partial lockdown was sent to the participants in the Lausanne Cohort Lc65+, a population-based study. The response rate reached 89%, with 2746 participants aged 72–86 years included in the analysis. Bivariable analyses and multivariable logistic models were used to identify sociodemographic and health-related characteristics associated with each outcome (clarity; compliance; impact).

RESULTS: Most seniors rated the recommendations as clear (84–91%, depending on the recommendation) and complied with them (70–94%). In multivariable analyses, men were more likely to rate the recommendations as unclear. Perceiving the recommendation as unclear and having a low level of fear of the virus were associated with noncompliance. People who complied with the recommendations were more likely to experience difficulties, but also to seize opportunities during the partial lockdown.

CONCLUSION: Most seniors followed the recommendations and found them clearly worded. However, some subgroups, such as men and seniors who do not fear the virus, were less likely to clearly understand the recommendations. As a correct understanding is a key factor for compliance, the findings emphasise the importance of tailoring public health communications to the characteristics of the target group, and of testing whether they are correctly understood.

Sarah Heiniger, Melanie Schliek, André Moser, Viktor von Wyl, Marc Höglinger (Author)

Differences in COVID-19 vaccination uptake in the first 12 months of vaccine availability in Switzerland – a prospective cohort study

BACKGROUND: Widespread vaccination uptake has been shown to be crucial in controlling the COVID-19 pandemic and its consequences on healthcare infrastructures. Infection numbers, hospitalisation rates and mortality can be mitigated if large parts of the population are being vaccinated. However, one year after the introduction of COVID-19 vaccines, a substantial share of the Swiss population still refrains from being vaccinated.

OBJECTIVES: We analysed COVID-19 vaccination uptake during the first 12 months of vaccine availability. We compared vaccination rates of different socioeconomic subgroups (e.g., education, income, migration background) and regions (urban vs rural, language region) and investigated associations between uptake and individual traits such as health literacy, adherence to COVID-19 prevention measures and trust in government or science.

METHODS: Our analysis was based on self-reported vaccination uptake of a longitudinal online panel of Swiss adults aged 18 to 79 (the “COVID-19 Social Monitor”, analysis sample n = 2448). The panel is representative for Switzerland with regard to age, gender, and language regions. Participants have been periodically surveyed about various public health issues from 30 March 2020, to 16 December 2021. We report uptake rates and age-stratified hazard ratios (HRs) by population subgroups without and with additional covariate adjustment using Cox regression survival analysis.

RESULTS: Higher uptake rates were found for individuals with more than just compulsory schooling (secondary: unadjusted HR 1.39, 95% confidence interval [CI] 1.10–1.76; tertiary: HR 1.94, 95% CI 1.52–2.47), household income above CHF 4999 (5000–9999: unadj. HR 1.42, 95% CI 1.25–1.61; ≥10,000 HR 1.99, 95% CI 1.72–2.30), those suffering from a chronic condition (unadj. HR 1.38, 95% CI 1.25–1.53), and for individuals with a sufficient or excellent level of health literacy (sufficient: unadj. HR 1.13, 95% CI 0.98–1.29; excellent: HR 1.21, 95% CI 1.10–1.34). We found lower rates for residents of rural regions (unadj. HR 0.79, 95% CI 0.70–0.88), those showing less adherence to COVID-19 prevention measures, and those with less trust in government or science.

CONCLUSIONS: Vaccination uptake is multifactorial and influenced by sociodemographic status, health literacy, trust in institutions and expected risk of severe COVID-19 illness. Fears of unwanted vaccine effects and doubts regarding vaccine effectiveness appear to drive uptake hesitancy and demand special attention in future vaccination campaigns.

Volume 152, No. 1314