OBJECTIVES:The aim of the study was to assess the feasibility of a national pre-exposure prophylaxis (PrEP) programme using smartphone-compatible data collection.METHODS:This was a multicentre cohort study (NCT03893188) enrolling individuals interested in PrEP in Switzerland. All centres participate in the SwissPrEPared programme, which uses smartphone-compatible data collection. Feasibility was assessed after centres had enrolled at least one participant. Participants were HIV-negative individuals presenting for PrEP counselling. Outcomes were participation (number enrolled/number eligible), enrolment rates (number enrolled per month), retention at first follow-up (number with first follow-up/number enrolled), and uptake (proportion attending first visit as scheduled). Participant characteristics were compared between those retained after baseline assessment and those who dropped out.RESULTS:Between April 2019 and January 2020, 987 individuals were assessed for eligibility, of whom 969 were enrolled (participation: 98.2%). The median enrolment rate was 86 per month [interquartile range (IQR) 52-137]. Retention at first follow-up and uptake were both 80.7% (782/969 and 532/659, respectively). At enrolment, the median age was 40 (IQR 33-47) years, 95% were men who have sex with men, 47% had a university degree, and 75.5% were already taking PrEP. Most reported multiple casual partners (89.2%), previous sexually transmitted infections (74%) and sexualized drug use (73.1%). At baseline, 25.5% tested positive for either syphilis, gonorrhoea or chlamydia. Participants who dropped out were at lower risk of HIV infection than those retained after baseline assessment.CONCLUSIONS:In a national PrEP programme using smartphone-compatible data collection, participation, retention and uptake were high. Participants retained after baseline assessment were at considerable risk of HIV infection. Younger, less educated individuals were underrepresented in the SwissPrEPared cohort.

Dans le cade du mandat de l’Office federal de la sante publique concernant le systeme de suivi de la strategie de lutte contre le VIH/Sida en Suisse, 2012-2016, l’Institut universitaire de medecine sociale et preventive de Lausanne a mene a trois reprises (1997, 2005 et 2016) une enquete nationale aupres des pharmacies au sujet de la remise et de la vente de materiel d’injection sterile ainsi que de la dispensation de traitements de substitution. Methode : Cette enquete a ete realisee de janvier a fevrier 2016 a l’aide d’un questionnaire en allemand, francais et italien adresse a l’ensemble des pharmacies de Suisse. La liste des pharmacies comprenait 1’347 membres de la Societe suisse des pharmaciens (SSPh, statistique au 08.01.2016) et 429 non membres. Les pharmacies devaient estimer le nombre moyen mensuel de seringues (seringues simples et boites Flash) vendues aux consommateurs de drogues pour la periode d’octobre a decembre de l’annee precedant l’enquete. Des questions portaient egalement sur l’evolution de cette demande, le mode de remise, les eventuelles restrictions liees a la remise de materiel d’injection sterile, les difficultes rapportees dans la remise de materiel d’injection sterile, et enfin sur le retour et l’elimination du materiel usage.

RATIONALE, AIMS AND OBJECTIVE Whereas the Patient Assessment of Chronic Illness Care (PACIC) instrument measures the extent to which care received by patients is congruent with the Chronic Care Model, the 5As model emphasizes self-management and community resources, 2 key components of the Chronic Care Model. We aimed at comparing evaluation of diabetes care, as reported by patients with diabetes and healthcare professionals (HCPs), using these instruments. METHODS Two independent samples, patients with diabetes (n = 395) and HCPs (including primary and secondary care physicians and nurses; n = 287), responded to the 20-item PACIC and the six 5As model questions. The PACIC-5A (questions scored on a 5-point scale, 1 = never to 5 = always) was adapted for HCPs (modified-PACIC-5A). In both samples, means and standard deviations for each question as well as proportions of responses to each response modality were computed, and an overall score was calculated for the 20-item PACIC. RESULTS Patients' and HCPs' overall scores were 2.6 (SD 0.9) and 3.6 (SD 0.5), respectively, with HCPs reporting higher scores for all questions except 1. Patients' education and self-management, referral/follow-up and participation in community programs were rated as low by patients and HCPs. CONCLUSION Healthcare professionals, particularly diabetes specialists, tended to report better PACIC scores than patients, suggesting that care was not reported similarly when received or provided. Evaluation differences might be reduced by a closer collaboration between patients and HCPs, as well as the implementation of community-based interventions considering more patients' perspectives such as patients' education and self-management.

Objectives: This study compares three methods to forecast the number of acute somatic hospital beds needed in a Swiss academic hospital over the period 2010-2030. Design: Information about inpatient stays is provided through a yearly mandatory reporting of Swiss hospitals, containing anonymized data. Forecast of the numbers of beds needed compares a basic scenario relying on population projections with two other methods in use in our country that integrate additional hypotheses on future trends in admission rates and length of stay (LOS). Results: The total number of beds in the hospital under study is projected to increase from 960 beds in 2010 to a range of 1188 to 1332 in 2030. This estimated growth equals to 24% to 39% of the hospital size at baseline, and these different figures are largely due to hypotheses about future reduction in LOS. Conversely, as the models' hypotheses regarding future demand have balanced effects on global admission rates, the three methods lead to similar projections for the number of stays, which is estimated to increase by 33% between 2010 and 2030. Conclusion: In the context of population aging, forecasting the number of hospital beds should not rely on a unique scenario. Using different hypotheses about admission rates and LOS, and comparing projected versus real use are important to avoid shortage of beds. (C) 2015 Published by Elsevier Masson SAS.

Background National trends in sexual behaviour have been assessed mainly in the context of the HIV related behavioural surveillance system set up in Switzerland between 1987 and 1992. Methods Several populations are included in the system. Repeated surveys have been regularly conducted among the general population and youth, men having sex with other men (MSM), injecting drug users (IDU). Data on sexual behaviour are regularly recorded among people living with HIV/Aids (PLWHA) included in the Swiss HIV Cohort. Results The main trends observed are : In young adults (aged 18–20): a steady increase in the proportion of sexually active at age 17 a stable median number of partners with a recent increase in the proportion of multipartners; a high and stable level of condom use among multipartners. Among MSM: an increase in the number of partners and a steady increase in unprotected anal intercourse since 1997, after a period of decreasing trends. Among IDU: a low and stable use of condoms with stable partners; a high and stable use of condoms with occasional and paying partners (only among women) with a possible recent decreasing trend. Among PLWHA: a high use of condoms with all types of partners with a recent decrease. Conclusions The behavioural surveillance system in place allowed to assess various trends in sexual behaviour in several populations such as: long term trends regarding sexual debut, stable trends and recent changes regarding different indicators of sexual activity in the general population, IDU and PLWHA, inversion of trends in sexual activity and condom use among MSM.

BACKGROUND A possible strategy for increasing smoking cessation rates could be to provide smokers who have contact with healthcare systems with feedback on the biomedical or potential future effects of smoking, e.g. measurement of exhaled carbon monoxide (CO), lung function, or genetic susceptibility to lung cancer. OBJECTIVES To determine the efficacy of biomedical risk assessment provided in addition to various levels of counselling, as a contributing aid to smoking cessation. SEARCH STRATEGY We systematically searched the Cochrane Collaboration Tobacco Addiction Group Specialized Register, Cochrane Central Register of Controlled Trials 2008 Issue 4, MEDLINE (1966 to January 2009), and EMBASE (1980 to January 2009). We combined methodological terms with terms related to smoking cessation counselling and biomedical measurements. SELECTION CRITERIA Inclusion criteria were: a randomized controlled trial design; subjects participating in smoking cessation interventions; interventions based on a biomedical test to increase motivation to quit; control groups receiving all other components of intervention; an outcome of smoking cessation rate at least six months after the start of the intervention. DATA COLLECTION AND ANALYSIS Two assessors independently conducted data extraction on each paper, with disagreements resolved by consensus. Results were expressed as a relative risk (RR) for smoking cessation with 95% confidence intervals (CI). Where appropriate a pooled effect was estimated using a Mantel-Haenszel fixed effect method. MAIN RESULTS We included eleven trials using a variety of biomedical tests. Two pairs of trials had sufficiently similar recruitment, setting and interventions to calculate a pooled effect; there was no evidence that CO measurement in primary care (RR 1.06, 95% CI 0.85 to 1.32) or spirometry in primary care (RR 1.18, 95% CI 0.77 to 1.81) increased cessation rates. We did not pool the other seven trials. One trial in primary care detected a significant benefit of lung age feedback after spirometry (RR 2.12; 95% CI 1.24 to 3.62). One trial that used ultrasonography of carotid and femoral arteries and photographs of plaques detected a benefit (RR 2.77; 95% CI 1.04 to 7.41) but enrolled a population of light smokers. Five trials failed to detect evidence of a significant effect. One of these tested CO feedback alone and CO + genetic susceptibility as two different intervention; none of the three possible comparisons detected significant effects. Three others used a combination of CO and spirometry feedback in different settings, and one tested for a genetic marker. AUTHORS' CONCLUSIONS There is little evidence about the effects of most types of biomedical tests for risk assessment. Spirometry combined with an interpretation of the results in terms of 'lung age' had a significant effect in a single good quality trial. Mixed quality evidence does not support the hypothesis that other types of biomedical risk assessment increase smoking cessation in comparison to standard treatment. Only two pairs of studies were similar enough in term of recruitment, setting, and intervention to allow meta-analysis.

Cette rubrique presente les resultats d'une revue systematique publiee par la Collaboration Cochrane dans la Cochrane Library au premier trimestre 2008 (www.cochrane.org/). Volontairement limite a un champ de recherche circonscrit, cet article reflete l'etat actuel des connaissances de ce domaine. Il ne s'agit donc pas de recommandations pour guider la prise en charge d'une problematique clinique consideree dans sa globalite (guidelines).

If many harmful effects of a sedentary lifestyle on health are well known, we still need to better understand how effectively promoting regular physical activity in the general population. Among the currently explored strategies, screening for sedentary lifestyle and promoting physical activity in the primary care setting seem promising. Despite recommendations from governmental agencies and professional associations in favor of physical activity counseling, this approach has not been widely adopted so far. This article summarizes the steps taken in Switzerland with an aim of developing physical activity counseling in the primary care setting. It describes how the early implication of primary care physicians influenced in a concrete way the development of a project dedicated to that task.