Zeitschrift für Präventivmedizin

Das Problem der präventiven Maßnahmen gegen Enterointektionen ist nach wie vor aktuell und von Zeit zu Zeit sogar akut. Es wird über veränderte epidemiologische Faktoren in der Welt gesprochen, die als Folge der Massenbewegungen im allgemeinen und des auf alle Kontinente ausgedehnten Massentourismus im besonderen zu betrachten sind. Die orale Immunisierung bietet eine Möglichkeit, sich vor Enteroinfektionen zu schützen. Es werden die orale Immunisierung gegen Typhus und Paratyphus, die schon eine gewisse Tradition haben, und ein neuer Vorschlag der oralen Immunisierung gegen Cholera besprochen.

With some 30 000 dependent persons, opiate addiction constitutes a major public health problem in Switzerland. The Swiss Federal Office of Public Health (FOPH) has long played a leading role in the prevention and treatment of opiate addiction and in research on effective means of containing the epidemic of opiate addiction and its consequences. Major milestones on that path have been the successive “Methadone reports” published by that Office and providing guidance on the care of opiate addiction with substitution treatment. In view of updating the recommendations for the appropriateness of substitution treatment for opiate addiction, in particular for the prescription of methadone, the FOPH commissioned a multi-component project involving the following elements. The present report documents the process and summarises the results of the latter element above. The RAND appropriateness method (RAM) was used to distil from literature-based evidence and systematically formulated expert opinion, areas where consensus exist on the appropriateness (or inappropriateness) of methadone maintenance treatment (MMT) and areas where disagreement or uncertainty persist and which should be further pursued. The major areas which were addressed by this report are Summary statements for each of the above categories are derived from the panel meeting and presented in the report. In the “first round”, agreement was observed for 31% of the 553 theoretical scenarios evaluated. The “second round” rating, following discussion of divergent ratings, resulted in a much higher agreement among panellists, reaching 53% of the 537 scenarios. Frank disagreement was encountered for 7% of all scenarios. Overall 49% of the clinical situations (scenarios) presented were considered appropriate. The areas where at least 50% of the situations were considered appropriate were “initial assessment of candidates for MMT”, the “appropriate settings for initiation of MMT”, the “appropriate settings for methadone supportive treatment” and “Appropriateness of other (non-methadone) substitution treatment”. The area where there was the least consensus on appropriateness concerned ”appropriateness of withdrawal from MMT” (6%). The report discusses the implications and limitations of the panel results and provides recommendations for the dissemination, application, and future use of the criteria for the appropriateness of MMT. The RAND Appropriateness Method proved to be an accepted and appreciated method to assess the appropriateness of methadone maintenance treatment for opiate addicts. In the next step, the results of the expert panel process must now be combined with those of the Swiss and international literature reviews and the survey of current attitudes and practices in Switzerland, to be synthesized into formal practice guidelines. Such guidelines should be disseminated to all concerned, promoted, used and rigorously evaluated for compliance and outcome.

Die schweizerischen Gesundheitsligen lassen sich nur schwer gemeinsam charakterisieren. Sie unterscheiden sich in bezug auf ihr Arbeitsfeld, ihre Dienstleistungen, die Zahl und Art ihrer Mitglieder, ihre Führungsstruktur ohne Stellung im öffentlichen Gesundheitswesen und ihre Finanzierung sehr stark. Mit Hilfe von privaten Spenden, Mitteln der öffentlichen Hand und starkem ehrenamtlichem Einsatz von Fachleuten und Laien bieten sie ein vielfältiges, speziellen Bedürfnissen angepasstes Angebot von Dienstleistungen, das eine wertvolle, in der Diskussion um Kosten und Struktur oft vergessene Ergänzung zu unserem öffentlichen Gesundheitswesen darstellt.

The need to create surveillance systems that go beyond data release and generate useful, relevant and accessible information has been widely recognized. To reach this goal the design and implementation of surveillance systems should consider not only technical issues but aspects that guarantee their sustainability and utility and more important, the utilization of surveillance data for resource allocation and planning of health programs and interventions. Until now key issues have been neglected, such as political will, community involvement, decision-making processes and accountability in surveillance outcomes. For many years we have faced the same problems, all within an epidemiological mosaic where infectious and communicable diseases coexist, with limited capacity to conduct surveillance, low priority given by decision-makers, lack of resources, scarce utilization of information, competing priority between chronic, infectious diseases and risk factors surveillance. Technical, management and political approaches involving new partnerships, new ways to involve different stakeholders in the process, new methods and tools, ways to overcome resource restrictions and improve surveillance effectiveness, have to be achieved. An alternative approach has been suggested to meet the above problems and to make surveillance socially responsible; relevant and effective, not only for reporting, but for its contribution to produce the needed health changes and sustain these outcomes. The vision, strategies, methods, tools and results of a community-based surveillance system are presented. Three aspects are addressed, the context in which the surveillance is applied; the theory supporting behavioural risk factor surveillance; the perspectives, goals, solutions and lessons learned from previous experience.