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Biomedical subjects

T V Perneger

Publications and source records attributed to T V Perneger.

At least 73 records · Page 4Linked to original sources
PubMed1998

Randomised trial of heroin maintenance programme for addicts who fail in conventional drug treatments.

OBJECTIVE: To evaluate an experimental heroin maintenance programme. DESIGN: Randomised trial. SETTING: Outpatient clinic in Geneva, Switzerland. SUBJECTS: Heroin addicts recruited from the community who were socially marginalised and in poor health and had failed in at least two previous drug treatments. INTERVENTION: Patients in the experimental programme (n=27) received intravenous heroin and other health and psychosocial services. Control patients (n=24) received any other conventional drug treatment (usually methadone maintenance). MAIN OUTCOME MEASURES: Self reported drug use, health status (SF-36), and social functioning. RESULTS: 25 experimental patients completed 6 months in the programme, receiving a median of 480 mg of heroin daily. One experimental subject and 10 control subjects still used street heroin daily at follow up (difference 44%; 95% confidence interval 16% to 71%). Health status scores that improved significantly more in experimental subjects were mental health (0.58 SD; 0.07 to 1.10), role limitations due to emotional problems (0.95 SD; 0.11 to 1.79), and social functioning (0.65 SD; 0.03 to 1.26). Experimental subjects also significantly reduced their illegal income and drug expenses and committed fewer drug and property related offences. There were no benefits in terms of work, housing situation, somatic health status, and use of other drugs. Unexpectedly, only nine (38%) control subjects entered the heroin maintenance programme at follow up. CONCLUSIONS: A heroin maintenance programme is a feasible and clinically effective treatment for heroin users who fail in conventional drug treatment programmes. Even in this population, however, another attempt at methadone maintenance may be successful and help the patient to stop using injectable opioids.

Adult↗
PubMed1998

Transforming laboratory test results to improve clinical outcome predictions in HIV patients. Swiss HIV Cohort Study.

Transforming natural units of laboratory markers of HIV disease may improve their ability to predict clinical outcomes. The authors examined this issue within a prospective study of 394 patients enrolled in the Swiss HIV Cohort Study (SHCS) between 1991 and 1993. Baseline predictors included CD4+ and CD8+ cell counts, HIV RNA levels, beta2-microglobulin, and age. Outcomes were death and clinical progression. A range of power transformations was applied to each predictor, and the goodness-of-fit of the corresponding proportional hazards models was assessed. The prognostic value of all laboratory variables could be improved on by power transformations. To predict either outcome variable, the "best" transformation of HIV RNA copies and CD8+ cell counts was the logarithm; for beta2-microglobulin, it was power -2. For CD4+ cell counts, the best transformation depended on the outcome variable: it was power 0.2 when predicting survival, and power 0.4 when predicting clinical progression. The single best predictor variable was the ratio of HIV RNA copies per CD4+ cell, for both death (logarithmic transformation) and clinical progression (power -0.1 transformation). Natural units of laboratory variables are not optimal for the prediction of clinical events in HIV-infected patients. Which transformation is best depends on the predictor under consideration.

Adolescent↗
PubMed1998

A critical assessment of the prognostic value of HIV-1 RNA levels and CD4+ cell counts in HIV-infected patients. The Swiss HIV Cohort Study.

OBJECTIVE: To determine to what extent human immunodeficiency type 1 (HIV-1) RNA levels and CD4+ cell counts predict clinical outcomes in a general HIV-1-infected population. METHODS: Community-based prospective study (Swiss HIV Cohort Study) including 394 HIV-1-infected patients, randomly selected from 4 strata of CD4+ cell counts (0 to < 0.05, 0.05 to < 0.20, 0.20 to < 0.50, and > or = 0.50 x 10(9)/L). Levels of HIV-1 RNA, CD4+ cell counts, and other variables were evaluated from samples collected between 1991 and 1993 for their ability to predict death and clinical progression. RESULTS: Patients were followed up on average for 29 months. Baseline HIV-1 RNA levels, CD4+ cell counts, clinical stage, and beta 2-microglobulin levels independently predicted survival, whereas only HIV-1 RNA levels and CD4+ cell counts independently predicted clinical progression. Multivariate relative hazards (RHs) for death ranged from 1.0 to 5.4 across quartiles of CD4+ counts, but only from 1.0 to 1.8 across quartiles of HIV-1 RNA. For clinical progression, gradients of risk were similar for CD4+ counts (1.0-4.2) and for HIV-1 RNA (1.0-3.1). In patients with CD4+ cell counts less than 0.05 x 10(9)L, HIV-1 RNA levels predicted neither death nor clinical progression. Finally, the number of HIV-1 RNA copies per CD4+ cell was the best predictor of death (multivariate RH, 1.0-9.7 across quartiles) and clinical progression (multivariate RH, 1.0-4.1). CONCLUSIONS: Levels of HIV-1 RNA and CD4+ cell counts provided independent and complementary information on clinical outcomes. The RNA/CD4+ ratio was the best single predictor. In patients who had fewer than 0.05 x 10(9)/L CD4+ cells, HIV-1 RNA levels had little prognostic value.

Adult↗
PubMed1998

Collecting saliva samples by mail.

Collecting saliva samples by mail can serve numerous purposes in epidemiologic research. The objectives of this study were to assess what proportion of participants in a mail survey would provide a saliva sample and whether incentives could improve participation. In 1995, 2,994 students, faculty, and staff members of Geneva University, Geneva, Switzerland, were randomized to receive, together with a mailed questionnaire about smoking, a saliva vial, a ballpoint pen, the offer of a lottery, or any combination of these. After one mailing and a reminder letter, response rates were 52% among those who had been requested to provide saliva and 63% among controls (p < 0.001). In the former group, most respondents (98%) provided a saliva sample. Incentives improved participation only among those who were asked to provide saliva (lottery: +11% response, p = 0.003; pen: +6% response, p = 0.1). The final participation, after up to three reminders, was 76% overall. The authors conclude that while the collection of saliva samples by mail is feasible it tends to decrease response rates.

Adolescent↗
PubMed1998

The French SF-36 Health Survey: translation, cultural adaptation and preliminary psychometric evaluation.

This article reports on the main developmental stages and on the preliminary psychometric assessment of the final French version of the SF-36. A standard forward/backward translation procedure was followed. When translating survey items, the emphasis was placed on conceptual equivalence. When translating response choices, we attempted to select a set of response choices that replicate the U.S. version. The distance between the response choices was checked using visual analogue scales (N = 30). The adaptation procedure also included formal ratings of the difficulty of the translation, of the quality of the translation, and of the equivalence between the American source version and the French target version. The face validity was checked during lay panel sessions at which the translated questionnaire was administered to subjects from the general public, hospital employees, and subjects with a low level of education. Standard psychometric techniques were used to evaluate the cultural adaptation of the SF-36, using data from a general population survey. The main objective of this analysis was to determine how well the scaling assumptions (summated rating or Likert-type scaling construction) of the SF-36 were satisfied. The results support the claim that the scaling properties of the French version of the SF-36 are adequate and that health outcomes may be reliably assessed using this version of the instrument.

Cross-Cultural Comparison↗
PubMed1998

COOP Charts in French: translation and preliminary data on instrument properties.

This paper describes the procedure used to translate the COOP Charts into French and provides preliminary information on the instrument's acceptability, reliability and validity. The charts were translated in several steps: seven initial translations were combined into a first pilot version, which was then tested for acceptability, clarity and alternative wordings in two convenience samples taken from the general population (n = 53). The modified version was then reviewed by a lay panel and another translator and submitted by mail to 209 congress participants to test several construct validity hypotheses through known-groups comparisons. A panel of public health professionals discussed the content validity of the charts. Finally, test-retest reliability and concurrent validity with SF-36 Health Survey scores were examined among 65 patients with end-stage renal disease. The translation process identified a wide variability in translation options for several items. The acceptability of the charts was excellent. The test-retest correlations ranged from 0.60 to 0.87. Content validity appeared to be appropriate, except for the chart on 'social support', which combines the questions of need and availability of social support. The utility of illustrations was questioned by some respondents: many claimed not to have used the illustrations in selecting their response, while others found them to be not expressive enough. Most preliminary tests of construct validity were consistent with theory. This French translation of the COOP Charts appears to be ready for more extensive testing in the intended target population of ambulatory patients.

Adolescent↗
PubMed1998

Predictors of inappropriate hospital days in a department of internal medicine.

BACKGROUND: This study aimed to identify predictors of inappropriate hospital days in a department of internal medicine, as a basis for quality improvement interventions. METHODS: The appropriateness of 5665 hospital days contributed by 500 patients admitted to the Department of Internal Medicine, Geneva University Hospitals, Switzerland, was assessed by means of the Appropriateness Evaluation Protocol. Predictor variables included patient's age and sex, manner of admission and discharge, and characteristics of hospital days (weekend, holiday, sequence). RESULTS: Overall, 15% of hospital admissions and 28% of hospital days were rated as inappropriate. In multivariate models, inappropriate hospital days were more frequent among patients whose admission was inappropriate (odds ratio [OR] = 5.3, 95% CI: 3.1-8.4) and among older patients (80-95 years: OR = 3.6, 95% CI: 1.7-7.0, versus <50 years). The likelihood of inappropriateness also increased with each subsequent hospital day, culminating on the day of discharge, regardless of the total length of stay. CONCLUSIONS: This study identified both the admission and the discharge processes as important sources of inappropriate hospital use in a department of internal medicine. The oldest patients were also at high risk of remaining in the hospital inappropriately. Surprisingly, long hospital stays did not generate a higher proportion of inappropriate days than short hospital stays. This information proved useful in developing interventions to improve the hospitalization process.

Adolescent↗
PubMed1998

Contribution of individual items to the performance of the Norton pressure ulcer prediction scale.

OBJECTIVES: To assess the specific contribution to overall scale performance of each of the five items that constitute the Norton pressure ulcer prediction scale. DESIGN: A comparison of statistical models based on cross-sectional surveys of hospitalized patients. SETTING: An urban teaching hospital in Geneva, Switzerland. PARTICIPANTS: 2373 hospitalized patients who were free of pressure ulcers on admission. MEASUREMENTS: Norton scale items measuring activity, mobility, physical condition, mental condition, and incontinence on a 4-point scale were examined as predictors of stage 1 or greater pressure ulcers. RESULTS: A total of 245 new pressure ulcers occurred between admission and patient observation. After adjustment for other independent predictors in proportional hazards models, only the activity and mobility items remained associated significantly with the risk of pressure ulcer. A simplified 2-item scale was more strongly associated with pressure ulcer risk than was the classic 5-item Norton scale. CONCLUSIONS: Our study suggests that the activity and mobility items of the Norton scale are sufficient to express the risk of pressure ulcers in hospitalized patients. Confirmation of this finding in prospective studies is warranted.

Adolescent↗
PubMed1998

Health care expenditures after introduction of a gatekeeper and a global budget in a Swiss health insurance plan.

STUDY OBJECTIVES: To assess whether the introduction of "managed care" (capitated budget and utilisation control by general practitioners) in a Swiss health insurance plan caused a selective disenrolment of plan members, and whether it achieved its goal of reducing health care expenditures. DESIGN: Controlled before-after analysis of health insurance claims. SETTING: Health insurance plan of the University of Geneva, Switzerland, which introduced managed care at the end of 1992, and comparison plan, which reimbursed health care expenditures without setting a budget or controlling access. PARTICIPANTS: Analysis of self selection: university plan members who accepted (3993) or refused (659) transfer to managed care. Analysis of change in expenditures: cohorts of persons continuously enrolled in the university (1575) and comparison (3384) plans in 1992 and 1993. MAIN RESULTS: During 1992, the year before the transformation of the university plan, persons who refused managed care had generated 35% higher expenditures than those who accepted managed care (p < 0.001). Between 1992 and 1993, expenditures per member decreased by 9% in the university cohort and increased by 11% in the comparison cohort (p = 0.004). Technical procedures (laboratory tests, physical therapy, drugs) decreased most in the university plan. No impact on hospital admissions was detected. CONCLUSIONS: Introduction of gatekeeping and budget management by physicians caused a favourable self selection process for the university plan. In addition, the managed care plan achieved a substantial decrease in overall health care expenditures in its first year of operation, chiefly by reducing outlays for technical procedures.

Adult↗
PubMed1998

Familial aggregation of renal disease in a population-based case-control study.

Family history of renal disease has been associated with an increased risk of end-stage renal disease (ESRD). It is uncertain whether this risk is mediated by familial aggregation of risk factors for ESRD, such as diabetes and hypertension. The association of ESRD with familial aggregation of renal disease was examined in a large, population-based case-control study conducted in Maryland, Virginia, West Virginia, and Washington, DC. The number of first-degree relatives who were affected with any type of renal disease was compared between 689 newly treated ESRD patients registered in the Medicare ESRD program (92% of all eligible incident cases presenting between January and July of 1991) and 361 control subjects without ESRD who were selected by random-digit dialing (90% response rate). Patients and control subjects were frequency matched by age; patients with ESRD caused by polycystic kidney disease and other known hereditary kidney diseases were excluded. Analysis was conducted using multiple logistic regression. After controlling for the proband's age, gender, race, family size, socioeconomic status, and personal and family histories of diabetes and hypertension, having one first-degree relative with renal disease increased the odds of ESRD by 1.3 (95% confidence interval, 0.7 to 2.6) and having two or more affected first-degree relatives increased the odds of ESRD by 10.4 (95% confidence interval, 2.7 to 40.2). These data support familial aggregation of renal disease in excess of that predicted by clustering of diabetes and hypertension within families, suggesting that either genetic susceptibility or environmental exposures shared within families increase the risk of developing ESRD. This risk is also much higher when two or more first-degree relatives have renal disease. Unraveling the molecular basis of this increase in risk may provide new avenues for treatment and prevention of ESRD.

Adult↗
PubMed1997

Risk factors for a medically inappropriate admission to a Department of Internal Medicine.

OBJECTIVE: To identify patient- and admission-related risk factors for a medically inappropriate admission to a department of internal medicine. METHODS: Cross-sectional study of a systematic sample of 500 admissions to the department of internal medicine of an urban teaching hospital. The appropriateness of each admission and reasons for inappropriate admissions were assessed using the Appropriateness Evaluation Protocol. Risk factors included the time (day of week and holidays) and manner (through emergency department or direct admission) of admission, patient age and sex, health status of patient and spouse, living arrangements, formal home care services, and informal support from family or friends. RESULTS: Overall, 76 (15.2%) hospital admissions were rated as medically inappropriate by the Appropriateness Evaluation Protocol. In multivariate analysis, the likelihood of an inappropriate admission was increased by better physical functioning of the patient (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.1-2.1 [for 1 SD in Physical Functioning scores]), lower mental health status of the patient's spouse (OR, 2.6; 95% CI, 1.3-5.6), receipt of informal help from family or friends (OR, 3.3; 95% CI, 1.5-7.2), and hospitalization by one's physician (OR, 3.6; 95% CI, 1.7-7.5). Receiving formal adult home care was not associated with inappropriateness of hospitalization. CONCLUSIONS: Inappropriate admissions to internal medicine wards are determined by a mix of factors, including the patient's health and social environment. In addition, the private practitioners' discretionary ability to hospitalize their patients directly may also favor medically inappropriate admissions.

Adolescent↗
PubMed1997

[Health status, health behavior and attitudes of young Geneva adults].

This study was aimed at assessing the health status, health-related life-styles and health concerns among young urban adults, 41% of them university students. Two mailed surveys were conducted in Geneva (Switzerland), in 1992 among 1007 persons and in 1993 among 1424 persons. Participation rates were over 80%. Study participants were aged 18-45 (mean age 31 years in 1993). For most health status dimensions, men declared to be healthier than women. Mental health-related concerns were frequent, especially among university students. Prevalence of health-related life-styles were: smoking 39%, drinking-and-driving at least once in past year 18%, always wear a seat belt 35%, had several sexual partners in past year but did not always use condoms 11%, exercise each week 46%. The more educated persons had healthier life styles, for all aspects except for unprotected sex with several sexual partners. These results are worrying and call for more active prevention strategies, directed at mental health problems, use of seat belts, drinking-and-driving, smoking and sexually transmitted diseases.

Adolescent↗
PubMed1997

Primary HIV infection: follow-up of patients initially randomized to zidovudine or placebo.

A randomized trial of 77 patients with primary HIV infection concluded that a 6-month course of zidovudine significantly reduced the incidence of opportunistic infections and improved CD4 cell counts. Follow-up was extended over a mean of 28 months to assess whether these benefits persisted beyond the trial period under conditions of routine care. In the post-trial period, antiviral drugs were prescribed with similar frequency in the zidovudine (248 treatment days per patient) and placebo arms (239 days, P=0.59). At the end of follow-up, patients initially assigned to zidovudine had still accumulated fewer disease progression events (three) than those given placebo (eight), but contrary to the initial analysis, the difference was no longer statistically significant (logrank test, P=0.07). The incidence of progression events tended to increase over time in the zidovudine group, and to decrease in the placebo group (trends tested in Weibull survival models, P=0.04). Similarly, initial gains in CD4 counts in the zidovudine arm diminished progressively after the trial, as CD4 counts declined faster in this group than in placebo-treated patients (-5.0 vs. -3.2 cells/mm3/month, P=0.06). In summary, initial clinical and immunological benefits of a 6-month course of zidovudine in patients with primary HIV infection eroded over time, suggesting that longer and more potent antiviral treatment should be given consideration.

Adult↗
PubMed1997

Validating a satisfaction questionnaire using multiple approaches: a case study.

We examined the validity of a questionnaire designed to measure the satisfaction of users of health services, using multiple tests of construct validity. Members of 2 health insurance plans in Geneva (Switzerland) answered a mailed questionnaire in 1992 (n = 1007) and 1993 (n = 1424). Response rates were 82% participants were 18-44 years old in 1992. The questionnaire included 22 questions on satisfaction with medical care received during the past 12 months. Most items were adapted from the Patient Satisfaction Questionnaire. Four dimensions of satisfaction were measured: satisfaction with physician services (8 items), communication (8 items), access (4 items) and insurance services (2 items). Reliability (Cronbach's alpha) was satisfactory for the 2 former dimensions (alpha = 0.81 and 0.82 respectively), but lower than desired for the 2 latter (alpha = 0.63 and 0.49 respectively). Participants who gave positive open-ended comments had satisfaction scores 0.7-1.2 standard deviation units higher than participants who gave negative comments. Satisfaction scores were weakly correlated with satisfaction with private life, which indicates that the instrument did not simply measure a general tendency to be satisfied. Participants who said that care received in 1993 was worse than care received in 1992 (retrospective assessment) experienced a decrease in satisfaction scores between 1992 and 1993 (prospective assessment). Most validation procedures provided independent but partial evidence for the validity of the instrument. Triangulation of several validation methods, as illustrated in this paper, may greatly improve the understanding of an instrument's properties.

Consumer Behavior↗
PubMed1997

Analysis of non-response bias in a mailed health survey.

The objective of this study was to identify characteristics of non-respondents and late respondents to a mailed health survey. Persons who returned and those who did not return the questionnaire were compared using health insurance data, which indicated their age, sex, and health care expenditures in the previous year. Insurance and questionnaire data were used to compare early and late survey respondents and to compare categories of non-respondents. Questions covered use of health services, health status, and sociodemographic characteristics. Participants were members of health insurance plans in Geneva, Switzerland, 19-45 years old (n = 1822). Respondents (n = 1424) and non-respondents (n = 398) were of similar age and sex. The proportion of persons who had health care expenditures greater than zero Swiss francs (SFr) was higher among respondents (75%) than among non-respondents (69%, p = 0.03). Among non-respondents, expenditures of persons who explicitly refused to participate (2378 SFr) were higher than expenditures of persons who moved out of Geneva (1085 SFr) or who failed to return the questionnaire (1592 SFr, p = .02). Among respondents, being born in a Switzerland, having completed elementary school, having generated health care expenditures, and reporting good physical health were independent predictors of early response. In conclusion, low response rates to mailed health surveys may result in overestimating the utilization of health services. However, non-respondents did not constitute a homogeneous group, and the strength and even direction of non-response bias depended on the mechanisms of non-response.

Adult↗