Search PubMed⌕ Search

Biomedical subjects

C Hatz

Publications and source records attributed to C Hatz.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Advice to HIV infected persons travelling to tropical or subtropical destinations].

Many HIV-infected persons travel from temperate zones to (sub)tropical destinations. HIV-specific immigration issues, medical resources abroad and problems regarding travel with multiple medication need to be anticipated. When prescribing immunisations and specific chemoprophylaxis, the stage of immunodeficiency as well as drug interactions with antiretrovirals must be taken into account. Live vaccines may be contraindicated. With good pretravel advice the risk of severe health problems is low for most HIV-infected travellers.

Anti-HIV Agents↗
PubMed2000

[Medical travel counseling and vaccinations].

The art of travel advice is based on clear and regularly updated information. It aims at covering the specific needs of individual travellers and benefits from the experience of the professional advisor. Frequently occurring and life-threatening health problems are deal with in the first place. Recommendations on prophylactic measures are a challenge for the advisor as they require the active collaboration of the traveller. Vaccinations on the other hand require less compliance of the traveller. Routine vaccinations against hepatitis A and B, diphtheria and tetanus, and against measles are discussed in line with compulsory vaccinations for certain countries (yellow fever, cholera, meningitis A + C) and with vaccinations against special risks.

Communicable Disease Control↗
PubMed2000

Towards a rational malaria management at district hospital level: exploratory case series of febrile adult patients in a holoendemic area of Tanzania.

One hundred and sixty eight febrile adult outpatients were investigated at St Francis Designated District Hospital in fakara, a holoendemic area in Tanzania. We wanted to assess the potential anamnestic and clinical risk indicators for malaria and to establish a rational strategy for malaria management. Blood slide investigations showed that 14% of all patients were positive for P. falciparum. All the positive cases were found during the rainy season. No reliable criteria for malaria were found in the history taking and physical examinations. Signs and symptoms of respiratory tract infection such as difficulties during breathing, sore throat, chest pain, cough, pathological findings in lung auscultation and combinations of these were negatively associated with malaria parasitaemia. The same was true for lymph node swelling and a clinical diagnosis other than malaria. Quality control of blood slide results from the hospital revealed a sensitivity of 55%, a specificity of 72%, and positive and negative predictive values of 24% and 91%. The main recommendations for malaria management in adults were to improve the quality of blood slide examinations and to use a different diagnostic strategy during the dry and rainy seasons. During the dry season blood slides of febrile adult patients should only be performed if there is a suspicion of malaria and antimalarial drugs should only be administered if blood slide results are positive. During the rainy season all febrile adults without obvious cause of fever other than malaria should be treated with antimalarials without previous blood slide examination.

Adolescent↗
PubMed1999

[Parallel use of medical services? Patterns of using complementary medicine and biomedicine].

In order to identify behavioural patterns within the pluralistic medical system, 38 patients have been observed over a period of two years. The most notable quality of behaviour is its flexibility. Single patients use complementary medicine and biomedicine in pragmatic and differentiated ways that change over time. Parallelism can be observed among the offered medical services, while their use is to be divided into parallel, alternate, alternative and complementary forms. Phases of exclusive use of complementary medicine occur, but during the two year period under investigation, all patients have made use of biomedicine.

Adult↗
PubMed1999

[Diagnostic and therapeutic difficulties with tertian malaria].

Diagnosis of malaria tertiana is not uncommonly missed or delayed because of a long incubation period, relapses after an unnoticed primary attack or due to suppressed parasitemia under antibiotics or antimalarials. The presently available rapid tests are not suitable for diagnosis of malaria tertiana. Malaria tertiana acquired in Southeast Asia carries a considerable risk of resistance to chloroquine. In this situation mefloquine is used in first place at total dose of 1000-1500 mg. Relapse of malaria tertiana even after primaquine have been described in travellers returning from the tropics. The efficacy of primaquine can be improved by raising the dose. Hereby an increased risk of hemolysis in concomitant glucose-6-phosphate-dehydrogenase deficiency and, more commonly, gastrointestinal side effects have to be considered.

Humans↗
PubMed1999

Resolution and resurgence of schistosoma haematobium-induced pathology after community-based chemotherapy in ghana, as detected by ultrasound.

Community-based treatment is recommended for endemic populations with urinary schistosomiasis; however, the optimal target group for treatment and retreatment interval have not been established. Using ultrasound, this study identified subpopulations whose lesions were most likely to respond to treatment and characterized resurgence of pathology. Ultrasound examination of 1202 infected patients was followed by chemotherapy with praziquantel. A sample of 698 patients was followed for 18 months after treatment. Nearly all types of bladder pathologies resolved after treatment, regardless of patient's age or intensity of initial infection. However, many patients' upper urinary tract pathologies (62.5%) did not resolve. During the 18-month follow-up period, reappearance of severe bladder pathologies was rare, and <10% of persons had resurgence of mild bladder pathologies. For this population, retreatment is not needed annually but might be cost effective if given several years later. Confirmation from other areas is required before general policies can be formed.

Adolescent↗
PubMed1999

Human infection due to Ebola virus, subtype Côte d'Ivoire: clinical and biologic presentation.

In November 1994 after 15 years of epidemiologic silence, Ebola virus reemerged in Africa and, for the first time, in West Africa. In Côte d'Ivoire, a 34-year-old female ethologist was infected while conducting a necropsy on a wild chimpanzee. Eight days later, the patient developed a syndrome that did not respond to antimalarial drugs and was characterized by high fever, headache, chills, myalgia, and cough. The patient had abdominal pain, diarrhea, vomiting, and a macular rash, and was repatriated to Switzerland. The patient suffered from prostration and weight loss but recovered without sequelae. Laboratory findings included aspartate aminotransferase and alanine aminotransferase activity highly elevated, thrombocytopenia, lymphopenia, and, subsequently, neutrophilia. A new subtype of Ebola was isolated from the patient's blood on days 4 and 8. No serologic conversion was detected among contact persons in Côte d'Ivoire (n = 22) or Switzerland (n = 52), suggesting that infection-control precautions were satisfactory.

Adult↗
PubMed1999

Pretravel advice neglects rabies risk for travelers to tropical countries.

BACKGROUND: While the risk of acquiring rabies in Europe is low, there have been a number of reports on cases of human rabies "imported" from abroad in recent years. Few studies have been conducted concerning pretravel advice for international travelers about the risk of rabies. METHODS: One-hundred and fifty German and 150 Swiss general practitioners (GPs) who give pretravel advice were interviewed to assess their awareness of the risk of rabies for travelers, and of the relevant preventive measures, using a pretested telephone interview followed by a written questionnaire with a multiple choice list. GPs were asked specifically about pretravel health advice for journeys to Thailand and Kenya. RESULTS: During the telephone interview a majority (76%) of the 300 GPs recommended "nothing" as a preventive measure against rabies for travelers. One or two important preventive measures were mentioned by only a few GPs. No major differences were detected between the German and the Swiss groups concerning their recommendations for rabies prevention. The 119 German and 121 Swiss GPs who returned the completed questionnaire said they would recommend the three important preventive measures in the future significantly more often than they had recommended them to their clients in the past. CONCLUSIONS: The risk of rabies in travelers to tropical countries appears to be neglected in pretravel advice provided by Swiss and German GPs. The recommendations on travel advice published in the Swiss Bulletin of the Federal Office of Public Health (BFOPH) and in the "Deutsches Arzteblatt" should be extended to "other specific health risks." In Switzerland this has now been done.

Attitude of Health Personnel↗
PubMed1998

[1998 malaria therapy].

A review of the principal antimalarial drugs is presented as the basis for specific recommendations on the treatment of malaria. These are adapted to conditions in Switzerland. Considering that the majority of Plasmodium falciparum infections imported into this country are acquired in areas with a high prevalence of chloroquine resistance, mefloquine is generally considered the first-line drug for the treatment of uncomplicated falciparum malaria. For severe tropical malaria, or if parasitaemia exceeds 2%, quinine remains the drug of choice. The pharmacological decision must estimate the risk of drug-resistant malaria and consider the clinical condition, possible intolerance and drug interactions. Prognosis is always difficult in falciparum malaria; hence hospitalization is always strongly recommended if the course is in doubt and if close monitoring of the patient is not otherwise guaranteed. In hospital, ancillary treatment (e.g. exchange transfusion) must receive timely consideration. Special considerations must be borne in mind with regard to the treatment of malaria in children and during pregnancy.

Adult↗
PubMed1998

[Asylum seekers and refugees in general practice: problems and possible developments].

Health and health services provided to asylum seekers and refugees by the Swiss National Health System have so far not been systematically investigated. The aim of this cross-sectional study was to describe the attending asylum seekers and refugees demographically and clinically, to identify main problem areas as perceived by general practitioners and to highlight options and venues for improvements. 272 questionnaires have been filled in by GPs of eight "federal districts" (Kantone) and the consultations of 1477 asylum seekers and refugees have been documented during one month in 193 surgeries. The documented asylum seekers and refugees reflected the distribution of this population in Switzerland. Low consultation rates of asylum seekers and refugees in the majority of surgeries and high diversity of this population in respect to places of origin, education and proficiency in languages appear to be the major determinants of the difficulties in providing adequate health services to them. Readily available information on the past medical history and on the ethnic background of these patients and continuing education on specific topics concerning health care for asylum seekers and refugees were thought to be particularly useful. This needs to be considered in the planning of services for this group. General practitioners specialized in health care for asylum seekers and refugees is an option for providing improved specific services (interpreters, institutional links, culturally adapted medical care).

Adolescent↗
PubMed1998

[Asylum seekers and refugees in the medical polyclinic: a comparison between the Basel, Bern and Geneva polyclinics].

This cross-sectional study describes the state of health of asylum seekers and refugees and the health services provided to them by the medical outpatient departments of three major Swiss university hospitals, Basel, Berne and Geneva. The comparison of outpatient departments differing in organisational structure facilitated the identification of positive and negative determinants of health service provision. Questionnaires have been filled in by all physicians of the three medical outpatient departments (Basel: 10, Berne: 1, Geneva: 36). All consultations of asylum seekers and refugees have been recorded during the study period (Basel: 42, Berne: 93, Geneva: 187). Interviews have been done with the physicians who coordinated the study. During the study period the majority of the patients originated from former Yugoslavia, Turkey, Sri Lanka, Somalia, Angola and Zaire. One of the most prominent features of the population investigated has been its diversity in respect to countries of origin, languages, ability to communicate and education. Diversity and low consultation rates per physician could explain many of the problems which have been observed, e.g. the lack of experience in specific approaches to these patients or difficulties to provide interpreters. To improve the health care for this group of patients in medical outpatient departments small teams of physicians should be selected. By these means adequate levels of experience could be achieved and organizational problems could be dealt with more effectively. In addition, the relationship between specific problems of asylum seekers and refugees and more general issues of the interaction between physicians and patients are discussed in view of tasks in research and training.

Adolescent↗
PubMed1998

[Asylum seekers and refugees in the emergency department].

This cross-sectional study describes the health problems and the health care of asylum seekers and refugees from the point of view of accident & emergency (A & E) physicians at the major hospital in St. Gallen, Switzerland. The physicians filled in a detailed questionnaire and documented all consultations of asylum seekers/refugees and of a control group of patients during eleven weeks (2 x 98 consultations). 76% of these asylum seekers/refugees originated from former Yugoslavia. The distribution of the main ICD-coded diagnoses did not differ between asylum seekers/refugees and the control group after correction for age. In comparison with the asylum seekers and refugees attending GPs, injuries were much more common in the A & E department attenders (37% vs. 8%). Asylum seekers/refugees and the patients in the control group did not differ in respect to being classified as an emergency case (58% vs. 65%). There were also no differences in hospitalisation rates (29% vs. 36%). Asylum seekers/refugees who were registered with a GP attended the A & E department more often during the night than during the day compared to patients who were not registered with a GP. Consultations which have been classified as emergencies occurred more frequently during the day than at night time. The time of residence in Switzerland was negatively associated with the registration with a GP and with being classified as an emergency case. A lack of experience in caring for asylum seekers and refugees and of specific training in this field has been the major complaint by the A & E physicians. Asylum seekers should be introduced to the tasks and functions of the various sectors of the national health care system as early as possible. Registration with a GP in the community should be promoted.

Adolescent↗
PubMed1998

Efficacy and safety of CGP 56697 (artemether and benflumetol) compared with chloroquine to treat acute falciparum malaria in Tanzanian children aged 1-5 years.

A randomized, open trial involving 260 Tanzanian children, aged 1-5 years, with acute Plasmodium falciparum malaria was conducted to evaluate the efficacy of the combination antimalarial CGP 56697 (artemether and benflumetol), and to compare it with chloroquine, the standard drug used for malaria treatment in the Kilombero area. Children who had received rescue medication within the first 48 h or had a negative slide at the same time were excluded. Seven-day parasitological cure rates were 94% (95% CI 88-97.5) for CGP 56697 and 35.4% (95% CI 25.9-45.8) for chloroquine. Using the same definition, the 14-day parasitological cure rates were 86.4% (95% CI 78.5-92.2) for CGP 56697 and 10.3% (95% CI 5.1-18.1) for chloroquine. Gametocytes were more effectively suppressed by CGP 56697 than by chloroquine. There were no major adverse events with either drug. CGP 56697 is highly efficacious against P. falciparum in this area of Tanzania. The study contributes to the discussion on treatment strategies, particularly whether chloroquine may still fulfil its role as first-line drug in an area of high malaria transmission and very high levels of chloroquine resistance.

Acute Disease↗
PubMed1998

Distinction of recrudescences from new infections by PCR-RFLP analysis in a comparative trial of CGP 56 697 and chloroquine in Tanzanian children.

OBJECTIVE: To test the efficacy of a new compound drug (CGP 56697) against acute, uncomplicated falciparum malaria. METHOD: Reappearing parasites were analysed by PCR-RFLP within a randomized controlled trial. 130 patients received chloroquine and 130 patients were treated with CGP 56697. Samples from 96 patients with parasitological failure were tested by PCR-RFLP for MSP2 of Plasmodium falciparum. Seven days after treatment 32 patients of the chloroquine control group with reappearing parasites were tested by PCR and one infection was unequivocally determined as a new infection. After 7 days, in the CGP 56697 group, 6 samples were tested in which one new infection was identified. Similar observations were made one and three weeks later in both groups. RESULTS: Although a high multiplicity of infections on admission was observed, there was no significant correlation between multiplicity and either recrudescence or new infection. Patients in both treatment groups with subsequent recrudescent parasites had higher initial mean parasite densities than patients who cleared. Those of the patients with recrudescent parasites who were treated with CGP 56697 had higher initial parasite densities than those treated with chloroquine. The rate of re-infection increased with time as expected in holoendemic areas and appeared to be higher in chloroquine patients. Generally, CGP 56697 showed a superior clearance rate, successfully cleared higher parasite densities and suppressed new infections over a longer period of time. CONCLUSION: The PCR analysis confirmed that reinfections beyond day 7 are significant in areas highly endemic for malaria and showed the necessity of excluding these when estimating 14 day clearance rates. Provided new infections are excluded, the 28-day clearance rate can also be used to determine the efficacy of antimalarial drugs in highly endemic areas, and adds to our knowledge of drug resistance and dynamics of infections in people living in such areas.

Acute Disease↗
PubMed1997

[Physician-patient interaction from the migrant's viewpoint: suggestions for medical practice].

The quality of communication between physicians and migrants with psychosocial problems is critical to success of therapy and satisfaction with its course. Recommendations stress the importance of a patient-centered approach including a careful and migration-specific history-taking and of cooperation with colleagues and non-medical professionals, including migrants. These issues should be included in the medical training and in interventions made at the political level.

Adult↗
PubMed1997

[Asylum seekers and refugees in ambulatory health care: communication between physician and patient].

Communication between asylum seekers/refugees and general practitioners/physicians of the three main outpatient sectors for the Swiss national Health System (general practice, medical outpatient and accident & emergency departments) are being described and analysed. The data have been collected during three cross-sectional studies investigating the health status of asylum seekers and refugees and the health services provided to them. These studies addressed the problem exclusively from the point of view of the health care providers. Data on language capabilities, sociocultural aspects of communication and the necessity and availability of interpreters have been collected with questionnaires. The main results of the questionnaires have been followed up in group discussions with general practitioners. The majority of general practitioners/physicians felt that most of the communication problems were related to speaking a common language. Only about one out of two adult asylum seekers/refugees knew German, French, Italian or English. Particularly during the group discussions it was brought forward that cultural and social factors additionally complicate communication during patient-doctor interactions. When the data of the outpatient consultations of the main studies were analysed, it became obvious that interpreters were significantly more often present in consultations with patients with psychological/psychosocial diagnoses than those with somatic diagnoses (72% vs. 55%). This can be interpreted in two ways: (1) if a patient suffers from a psychological/psychosocial problem, it is more likely that an interpreter will be asked to assist during the consultation or (2) if an interpreter is present during a consultation, it is more likely that a psychological/psychosocial problem will be detected. With the exception of children, most of the general practitioners/physicians felt that non-professional interpreters (relatives, friends) were adequate for coping with most of the tasks. The following areas for improvements were identified: (1) availability of professional interpreters and quality as well as organisational issues related to interpretation, (2) language training for asylum seekers and refugees and (3) creation of awareness among general practitioners/physicians towards cultural and socioeconomic determinants of patient-doctor interactions and training.

Adult↗