Bertino Somaini

Quality of generalist vs. speciality care for people with HIV on antiretroviral treatment: a prospective cohort study

To describe health‐care use by persons with HIV in an urban area of Switzerland (Zurich). Further, to compare the different health‐care settings.

A continuing concern: HIV and hepatitis testing and prevalence among drug users in substitution programmes in Zurich, Switzerland.

Phase I of the Zurich Prometheus Study is a cross-sectional study focusing on an up-to-date serology for HIV and hepatitis B/C and associated risk factors for all clients in four participating clinics offering opiate substitution in Zurich, Switzerland. The mean age of the 603 respondents is 30.7 years (SD = 6.2) and 38% of them are women. Seventy-five per cent of the respondents have a history of injecting drug use (IDU), and over half have injected within the past six months. Laboratory-confirmed seroprevalence for HBV (50%) and HCV (57%) is twice that of HIV (24%). There is an 80% risk reduction for all three viral infections among those starting IDU after 1991 - when harm reduction efforts were in full swing - compared to those who began before 1988-before clean needles were widely available. These findings suggest a strongly protective effect of harm reduction measures. But while a stabilization in HIV prevalence at 15% can be seen among drug users who started injecting after 1991, prevalence rates for HBV and HCV still remain several times higher. The prevalence data in this study support data showing continued high incidence rates for HBV and HCV, even among new injectors in the harm reduction era.

Trends in age at AIDS diagnosis in Europe and the United States : evidence of pronounced 'ageing' among injecting drug users

Objectives:To analyse trends in age at diagnosis for adult AIDS cases reported in Europe and the United States. Design:We used AIDS surveillance data for the seven European countries with the highest cumulative number of AIDS cases reported through June 1994 and for the United States through June 1993. Mean age at AIDS diagnosis over time was calculated by sex, transmission category and country. Linear regression yielded annual increase in age and permitted statistical evaluation of the trends observed. Annual AIDS incidence was calculated for homo-/bisexual men and injecting drug users (IDU) by 5-year age groups over time. Results:We found an overall increase in age at AIDS diagnosis among the main transmission categories in Europe and the United States. The epidemiologic profiles of the two regions were highly similar, despite the lower average age among IDU in Europe compared with the United States (30.6 versus 36.7 years) and lower annual increases in age in the United States. In contrast to homo-/bisexual men, the increase in age at diagnosis is strikingly uniform and pronounced among IDU. Between 1986 and 1993, IDU in all countries exhibited at least a 6-month increase in age at diagnosis per annum. Although annual AIDS incidence remains consistent between various age groups of homo-/bisexual men, IDU aged 30–49 years show continuing increase, whereas their younger counterparts show signs of stabilization or decrease. Conclusions:Despite different epidemic profiles and prevention policies, the age trends for the European countries examined and the United States were strikingly similar. The meaning of this general increase in age among the main transmission categories and the especially high increase among IDU may provide important insight into epidemic dynamics and intervention assessment.

Completeness of AIDS reporting in Switzerland: a study based on deaths between December 1987 and June 1990.

ObjectivesTo assess completeness and determinants of reporting to the AIDS registry of the Swiss Federal Office of Public Health. Design and methodsDeath certificates indicative of AIDS or HIV for deaths occurring between December 1987 and June 1990 were reviewed and compared with reports to the AIDS registry. ResultsThe completeness of the AIDS registry was 68%. However, almost all cases have now been ascertained, because more than 90% of unreported AIDS cases are detected when death certificates are reviewed. Thus, the ongoing review of death certificates adds to the total case ascertainment. The most important determinant of reporting was the reporting source: specialized AIDS clinics reported 85% of their cases, while all other sources reported only 48%. ConclusionThe investigation of the heterogeneity of reporting is important. It can wrongly suggest regional and national differences in the epidemic and lead to a decrease in completeness of reporting over time without actual changes in reporting behavior.

Costs of treatment of Swiss patients with HIV on antiretroviral therapy in hospital-based and general practice-based care: a prospective cohort study

Abstract Some ambulant people with HIV are cared for primarily by their general practitioner and some in an outpatient clinic. Costs and patterns of care in these settings were studied in 65 such patients based in Zürich, from a limited societal perspective (excluding patient costs) based on medical resource use. Antiretroviral therapy (ART), other medications and patient variables were collected prospectively, and non-medication resources (professional time and investigations) and treatment history data were collected from medical records and by record linkage to the Swiss HIV Cohort Study database. Cost differences between the settings were estimated using multiple regression, controlling for differences in case-mix. ART comprised 80% of the total cost, non-medication costs 15% and non-ART medications 5%. Total costs were higher in the outpatient clinic (estimated additional cost after controlling for case-mix = 3489 Swiss Francs per year at 1999 prices, 95% confidence interval 742 to 6236, p=0.017). The difference was accounted for by higher ART costs in the outpatient clinic, not through a tendency to use more expensive drugs or higher doses but rather through the use of more drugs concurrently. Differences in ART prescribing patterns between the doctors in the outpatient clinic and the general practitioners were considerable and appear worthy of further investigation.

Perceived stress and health-related outcomes in a Swiss population sample 1This research was supported by grants from the Swiss Federal Office of Public Health, the Swiss Foundation of Health Promotion and the Swiss Federal Office of Sports.

This cross-sectional study aimed at analysing the perception of stress and its relation to health-related outcomes in the Swiss population. A sample drawn from this population included 992 participants aged 15 to 64 years. The interview covered socio-demographic data, perceived stress, psychological and somatic symptoms as well as perceived general health status. Patterns of stress were grouped into three categories. “Stressed” included persons who reported that they felt overwhelmed by stressful situations during the previous month. “Challenged” included those who reported that they experienced stressful situations but could manage those well. “Not stressed” consisted of respondents who did not experience stress. Results indicated that 38.6% of the sample reported being stressed, 33.3% challenged and 28.1% not stressed. Analysis of the distribution of perceived stress showed that, in particular, women, younger people, single parents, students and the self-employed felt stressed relatively often. In a log...

Morbiditätserfassung in der Praxis

A system of morbidity registration in the domain of primary health care is presented on the basis of experiences made abroad. A pilot project (Sentinella) functions in the environments of Berne since November 1984. Its extension to the whole of Switzerland is scheduled for the middle of 1986.

Eine Qualitätskultur für die Gesundheitsförderung

Quality and quality management are omnipresent as notions in the daily life of projects but there exists neither a clear conception nor a homogeneous quality understanding. This expresses the fact that a critical and self-reflecting project culture is not rooted strongly enough. A good project and quality management is indispensable to optimize the goal attainment. Up to now, however, concrete implementations as far as quality improvement in the daily lift of projects is concerned, were lacking. This article shows the necessity of health promotion being confronted with quality and what can be gained by that. It presents a project of the Institute of Social and Preventive Medicine of the University of Zurich in which quality promotion is specifically put into practice. In co-operation with project leaders, instruments for a quality management are being developed and tested which support and steer the constant process of quality promotion.

Epidemiologie und Prävention von AIDS in der Bevölkerung

Routes of transmission of HIV which play an important role in the population are known. Sexual transmission, infection through needle sharing by i.v. drug addicts, accidental blood contacts and transmission from the infected pregnant mother to her child are seen. The number of new infections depends on the number of already infected individuals, the rapidity of spread and the spread potential. The infection can be rapidly spread among drug addicts, several drug users may be infected at the same time through needle sharing. In the general population the spread potential through sexual transmission is high. The AIDS prevention campaign in Switzerland aims at preventing new infections and at building up solidarity. With the STOP-AIDS campaign a broad effect in the population could be reached. The most important goals in the near future are to have an effect in depth in some target groups and to promote individual counselling.