An analysis of patients' understanding of 'routine' preoperative blood tests and HIV screening. Is no news really good news?

OBJECTIVES: Many patients may believe that HIV screening is included in routine preoperative work-ups. We examined what proportion of patients undergoing preoperative blood testing believed that they had been tested for HIV. METHODS: All patients hospitalized for elective orthopaedic surgery between January and December 2007 were contacted and asked to participate in a 15-min computer-assisted telephone interview (n = 1330). The primary outcome was to determine which preoperative tests patients believed had been performed from a choice of glucose, clotting, HIV serology and cholesterol, and what percentage of patients interpreted the lack of result communication as a normal or negative test. The proportion of patients agreeable to HIV screening prior to future surgery was also determined. RESULTS: A total of 991 patients (75%) completed the questionnaire. Three hundred and seventy-five of these 991 patients (38%) believed incorrectly that they had been tested for HIV preoperatively. Younger patients were significantly more likely to believe that an HIV test had been performed (mean age 46 vs. 50 years for those who did not believe that an HIV test had been performed; P < 0.0001). Of the patients who believed that a test had been performed but received no result, 96% interpreted lack of a result as a negative HIV test. Over 80% of patients surveyed stated that they would agree to routine HIV screening prior to future surgery. A higher acceptance rate was associated with younger age (mean age 47 years for those who would agree vs. 56 years for those who would not; P < 0.0001) and male sex ( P < 0.009). CONCLUSIONS: Many patients believe that a preoperative blood test routinely screens for HIV. The incorrect assumption that a lack of result communication indicates a negative test may contribute to delays in HIV diagnoses.

[Sex workers: limited access to healthcare]. / Travailleuses du sexe: un accès aux soins limité?

Sex workers constitute a heterogeneous group possessing a combination of vulnerability factors such as geographical instability, forced migration, substance addiction and lack of legal residence permit. Access to healthcare for sex workers depends on the laws governing the sex market and on migration policies in force in the host country. In this article, we review different European health strategies established for sex workers, and present preliminary results of a pilot study conducted among 50 sex workers working on the streets in Lausanne. The results are worrying: 56% have no health insurance, 96% are migrants and 66% hold no legal residence permit. These data should motivate public health departments towards improving access to healthcare for this vulnerable population.

Patterns of sex work contact among men in the general population of Switzerland, 1987-2000.

OBJECTIVES: To analyse the prevalence of lifetime recourse to prostitution (LRP) among men in the general population of Switzerland from a trend and cohort perspective. METHODS: Using nine repeated representative cross-sectional surveys from 1987 to 2000, age-specific estimates of LRP were computed. Trends and period effect were analysed as the evolution of cross-sectional population estimates within age groups and overall. Cohort analysis relied on cohorts constructed from the 1989 survey and followed in subsequent waves. Age and cohort effects were modelled using logistic regression and non-parametric monotone regression. RESULTS: Whereas prevalence for the younger groups was found to be logically lower, there was no consistent increasing or decreasing trend over the years; there was no significant period effect. For the 17-30 year age group, the mean estimate over 1987-2000 was 11.5% (range 8.3 to 12.7%); for the 31-45 year group, the mean was 21.5% (range over 1989-2000 20.3 to 23.0%). Regarding cohort analysis, the prevalence of LRP was found to increase steeply in the youngest ages before reaching a plateau near the age of 40 years. At the age of 43 years, the prevalence was estimated to be 22.6% (95% CI 21.1% to 24.1%). CONCLUSIONS: The steep increase in the cohort-wise prevalence of LRP in younger ages calls for a concentration of prevention activities in young people. If the plateauing at approximately 40 years of age is not followed by a further increase later in life, which is not known, then consumers of paid sex would be repeat buyers only, a fact that should be taken into account by prevention.

[Prevention practices of primary health care physicians in Switzerland in the context of the HIV/Aids epidemic: changes between 1990 and 2002]. / Evolution, entre 1990 et 2002, des activités préventives des médecins de premier recours en Suisse dans le cadre de l'épidémie de VIH/sida.

BACKGROUND: Individual preventive counseling offered to the general public by private doctors working in primary health care is an essential component of the Swiss National Aids Prevention strategy. Surveys were conducted to assess to what extent they fulfill this role and how this may have changed over time. METHODS: Three cross-sectional surveys were conducted in 1990, 1995, and 2002 by anonymous mailed questionnaire in a random sample of primary health care physicians. Dimensions of the physicians HIV prevention practices investigated were: practice of HIV risk assessment, content and frequency of HIV pretest counseling, and, in 2002 only, care of patients living with HIV/AIDS. Trends over the 12-year period were calculated; logistic regressions were performed to investigate factors associated with the frequency of counseling given to HIV positive patients. RESULTS: Risk assessment has increased dramatically over the period for certain groups of patients (patients requesting contraception, young people and new patients). In 2002, routine screening is often or always performed by 93% of physicians for intravenous drug patients or patients with a sexually transmitted infection; 77% for homosexuals; 76% for patients requesting contraception; 63% for young people. It is less frequent in other groups (migrants: 40%; separated/divorced patients: 29%). More than half of physicians care for patients with HIV. Around two-thirds of physicians regularly discuss with their HIV positive patients issues related to patients' professional, social and private life. There are few differences among specialties regarding the propensity to discuss these topics. CONCLUSION: Prevention activities by primary care physicians have increased in the last decade. Nonetheless, potential for increased prevention still exists in some areas of risk assessment and counseling.

Anxiety in a cohort of Swiss women participating in a mammographic screening programme.

OBJECTIVES: To follow up anxiety in a cohort of women screened for breast cancer. METHODS: Within the framework of a pilot screening programme for breast cancer in the Canton of Vaud (Switzerland), a cohort of 924 participants aged 50-70 years were invited to answer questions on anxiety related to mammography screening. Anxiety was measured using a specific tool, the psychological consequences questionnaire (PCQ), and a new single item, direct question, breast cancer anxiety indicator (BCA). Participants were asked to fill in the questionnaire at four different phases: at screening, before the result, and 2 and 8 weeks after the result. The final response rate was 93.7%. Predictors of anxiety at each phase were assessed using multiple regression. RESULTS: Among those screening negative (94.7%), anxiety at screening was very low and remained so during the screening process. Among those screening false positive, anxiety was significantly higher 8 weeks after having received a negative diagnosis. Predictors of anxiety before screening were lower education and higher age, with a strong exogenous anxiety component. For subsequent phases, the initial anxiety score and education were the main determinants. Furthermore, a false positive result at screening was the most important predictor of anxiety 2 months after negative diagnosis. Anxiety measured with the BCA was strongly correlated with the PCQ. CONCLUSION: Anxiety was very low at screening and remained so during the process for negative women. Initial anxiety level was a strong predictor of anxiety during the entire process, up to 8 weeks after a negative result, and could be easily assessed using the BCA. The sustained higher anxiety level among those screening false positive is an undesirable side effect of the programme.

Antiretroviral therapies from the patient's perspective.

Thirty-seven patients receiving antiretroviral therapy were interviewed in depth in preparation for a quantitative study of patients' perceptions of their treatment. Patients described three types of difficulty with treatment: conflict between treatment recommendations and daily life, side effects (immediate and long term) and fear that treatment would reveal their seropositivity. These problems interfered with treatment adherence which was otherwise generally good. The problems are rarely evoked during medical consultations: certain patients think they are not pertinent, and physicians give priority to clinical and laboratory examinations. Training must be carried out in order to permit physicians to raise all the factors (including psychosocial factors) that are liable to reduce the quality of treatment adherence.

[Practice and needs of Swiss physicians in matters of prevention of HIV infection in their office--experience, reflections and recommendations]. / Pratiques et besoins des médecins suisses en matière de prévention de l'infection VIH au cabinet médical--synthèse des expériences, éléments de réflexion et recommandations.

General practitioners play an important role in HIV/AIDS prevention. They are expected to take patients' risk histories, to assess gaps in knowledge and preventive behaviours, and to practise individualised counselling. This article reviews research conducted between 1988 and 1994 on preventive activities of Swiss general practitioners. Proposals are made for improving pre- and post-graduate training, for sensitizing the audience, and concerning cost policy. Aimed at intensifying prevention efforts, these suggestions reflect the increasing recognition of counselling and patient education as key elements in prevention and treatment.

Methadone treatment and risk of HIV infection in drug users without legal access to clean injection equipment.

The particular situation of the Swiss canton of Vaud (population 550,000) provides favourable observational conditions to assess the efficacy of a methadone treatment scheme in reducing the risk of human immunodeficiency virus (HIV) infection among drug users. On the one hand, the canton has a long tradition of methadone treatment dispensed by medical practitioners. On the other hand, no legal access to clean injection equipment was provided up to 1989. For the 754 drug addicts having entered at least one course of treatment at the end of 1988, HIV status was assessed through two surveys conducted at mid-1986 and at end 1988 among the private practitioners and in the screening centers, hospitals, medico-social institutions and prisons. The overall annual HIV seroconversion rate shifted only slightly from 13% in the first study period (1984 to mid-1986) to 11% in the second period (mid-1986 to end 1988). In both periods, patients no longer on treatment, mostly stable abstainers, were the less exposed to HIV infection with a relative risk of 0.65 (p < 0.05). For those still on treatment, the risk of infection was associated directly (p < 0.001) with the frequency of courses and inversely (p < 0.001) with the duration. Between patients with more than 18 months spent on treatment and those with less than 6 months, the relative risk gradient was 0.8 and 1.4 before mid-1986 and widened out to 0.3 and 2.1 later on. This is mainly due to an increasing HIV incidence among newcomers into treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[HIV epidemic: a study among physicians in Vaud]. / Epidémie VIH: une étude parmi les praticiens vaudois.

A two-phase survey was conducted in the Canton of Vaud among the 1006 registered private practitioners (response rate 98%). The first phase aimed at determining the proportion of these physicians involved in the care of HIV+ persons. The results showed that 43% of the practitioners had been consulted by HIV+ patients. In the second phase, all institutions (hospitals, prisons and IV-drug user rehabilitation and testing centers) and a representative sample of the physicians with HIV+ patients were asked about the transmission category of their HIV+ patients. A mathematical method was used to estimate the true number of known HIV+ individuals by December 1988. Approximately 60% of the HIV+ persons had been seen exclusively by the private practitioners. IV-drug users represented 57% of all HIV+ persons compared to only 27% of the AIDS cases registered in 1988, suggesting that an important change in the transmission categories of AIDS cases is to be expected in the near future. These observations underscore the evolving nature of the HIV epidemic on the one hand, and the crucial role of the private practitioners in the prevention of the HIV infection on the other. This also points to the need for methods specifically designed to monitor HIV and AIDS epidemics respectively.

Methadone treatment in medical private practice: outcome according to the number of courses followed.

In the Swiss Canton of Vaud, methadone treatment is mostly provided by the private medical practitioners. 562 opioid dependent persons followed at least one course of treatment between 1976 and 1986; at that time, 209 of them had completed a first course, 118 a second one and 31 a third one. Evolution of the persons was observed from the end of their last course to the end of the study. Outcome was evaluated according to the rank of the last course. Whatever its rank, each course resulted in about 17% of stable abstainers and 6% of chronic opioid-dependent persons. In contrast, the risks to start a new course, to be imprisoned and to enter into a therapeutic community showed a clear gradient with the rank of the course: they were about 38%, 27% and 10% respectively one year after a first or a second course, and rose to 43%, 38% and 28% one year after a third course.

[Follow-up of substance-dependent patients treated with methadone in the canton of Vaud (1976-1986)--preliminary results]. / Etude du devenir des toxicomanes pris en charge à l'aide de méthadone dans le canton de Vaud (1976-1986)--résultats préliminaires.

A survey of a methadone treated population of 562 heroin addicts was undertaken to determine which factors linked to certain characteristics of the individual or to the cures, might be associated with either a positive outcome or failure. Furthermore it enabled the recording of various modifications with regard to social and professional integration, as well as tracing the penal career, both during the cure and to the cut-off date (31 July 1986). This paper presents the preliminary results of the survey in relation, firstly, to certain aspects of the individual's career in drug abuse, within a specific population; secondly, the various efforts towards detoxification and lastly the situation with regard to their state of drug addiction at the cut-off date.

[Attitudes and practices of Vaud women concerning the self examination of breasts]. / Attitudes et pratiques des femmes vaudoises vis-à-vis de l'auto-examen des seins (AES).

A survey by personal interviews on this subject was carried out in 1984 with a representative sample of 499 women living in the Canton of Vaud. The response rate was 76.6%. Among the respondents, 61.3% practice BSE, but only 27% do so regularly. A complementary inquiry of a group of women who refused the interviews shows a lower practice rate. Women aged 40-49 years, who have benefited more than other groups from related information through their physicians, are those who do BSE most. Our results indicate that such personalized information from a doctor is strongly and positively associated with BSE practice (p less than .001), when compared with "extra-medical" information (mainly from the mass media). There are some negative reactions (fear, reluctance) when the question of BSE is taken up, but they are not major ones and do not influence the interest of the majority of the women (63.3%) in wanting to be better informed on the subject.