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Biomedical subjects

J P Zellweger

Publications and source records attributed to J P Zellweger.

At least 19 recordsLinked to original sources
PubMed2006

[Smoking cessation intervention: 2006 update].

Recent Swiss reports confirmed that several chemical products added to cigarettes may increase the level of dependence and therefore the consumption of cigarettes. Observational studies demonstrated the association between smoking and type II diabetes, that smoking one to four cigarettes daily increases significantly the risk of disease and that the relative risk of breast cancer among non smoking women exposed to passive smoking is increased by 30%. The safety of nicotine replacement therapy for patients with cardiovascular disorders has been confirmed. Among new pharmacological approaches, varenicline, rimonabant, topiramate and nicotine vaccine all appear promising.

Humans↗
PubMed2006

[Reduction of cigarette consumption: an intermediate stage before a total stop?].

Reduction of cigarette consumption is a natural tendency of many undecided smokers and can be an intermediate stage before a total stop. It does not offer proven benefits regarding smoking-associated morbidity or mortality but seems to increase the motivation of smokers without intention to quit and the long-term chance of cessation. Smoking reduction can be offered to some smokers with smoking-related diseases as a transition before complete cessation. It can be obtained more easily with the use of nicotine replacement therapy.

Humans↗
PubMed2006

Intra-observer and overall agreement in the radiological assessment of tuberculosis.

OBJECTIVE: To assess the intra-observer and overall agreement in the interpretation of chest X-rays (CXRs) performed for detecting tuberculosis (TB) among immigrants in Switzerland. METHOD: Four hundred digitalised CXRs from the files of immigrant registration centres were selected and read twice in random order by three readers. The readers had to assess (1) if the picture was normal or abnormal; (2) if an abnormality was suggestive of TB; and (3) if the suspicion of TB needed an immediate examination (potentially smear-positive TB). The intra-observer and overall agreements were expressed as kappa with standard error. RESULTS: Due to losses for technical reasons, 377 of the 400 pictures were analysed. The intra-observer agreement was 0.39-0.90 for any abnormality, and 0.60-0.82 for TB needing an urgent examination. The overall agreements were: 0.55 (all three readers) and 0.84 (two best readers) for any abnormality, and 0.64 (all three readers) and 0.80 (two best readers) for active TB. CONCLUSIONS: The intra-observer and overall agreements for the detection of abnormalities on digitalised CXRs and for the presence of possible active TB depend on the reader's experience. It was good between experienced readers and fair between and within the inexperienced reader.

Emigration and Immigration↗
PubMed2005

Perception of the damaging effects of smoking, and brief cessation counselling by doctors.

An open prospective study was conducted among the patients visiting an urban medical policlinic for the first time without an appointment to assess whether the immigrants (who represent more than half of our patients) are aware of the health effects of smoking, whether the level of acculturation influences knowledge, and whether doctors give similar advice to Swiss and foreign smokers. 226 smokers, 105 Swiss (46.5%), and 121 foreign-born (53.5%), participated in the study. 32.2% (95% CI [24.4%; 41.1%]) of migrants and 9.6% [5.3%; 16.8%] of Swiss patients were not aware of negative effects of smoking. After adjustment for age, the multivariate model showed that the estimated odds of "ignorance of health effects of smoking" was higher for people lacking mastery of the local language compared with those mastering it (odds ratio (OR) = 7.5 [3.6; 15.8], p < 0.001), and higher for men (OR = 4.3 [1.9; 10.0], p < 0.001). Advice to stop smoking was given with similar frequency to immigrants (31.9% [24.2%; 40.8%] and Swiss patients (29.0% [21.0%; 38.5%]). Nonintegrated patients did not appear to receive less counselling than integrated patients (OR = 1.1 [0.6; 2.1], p = 0.812). We conclude that the level of knowledge among male immigrants not integrated or unable to speak the local language is lower than among integrated foreign-born and Swiss patients. Smoking cessation counselling by a doctor was only given to a minority of patients, but such counselling seemed irrespective of nationality.

Adult↗
PubMed2004

Directly observed therapy for tuberculosis in a low prevalence region: first experience at the Tuberculosis Dispensary in Lausanne.

AIM: Evaluation of first experience of the directly observed therapy (DOT) programme for tuberculosis introduced in the Canton of Vaud in 1997. METHOD: Retrospective analysis of tuberculosis patients included in a DOT programme from October 1997 to March 2000 under the supervision of the TB Dispensary in Lausanne. RESULTS: 54 patients were included, 49 of whom were new cases and 5 relapses. 70% were asylum seekers and illegal immigrants. The indications for DOT were immigrant status, social problems, and physical or psychiatric comorbidities. Treatment was fully supervised in 67% and partially in 33%. The outcome was favourable (cure or treatment completion) in 88.9% and unfavourable in 11.1%. A similar success rate was observed in full and partial DOT and there was no difference in success rates between the various structures where DOT was administered. By comparison, the success rate in a historical group from the same institution was 70% in 1990. The biggest problem was communication with the patients and within the team. CONCLUSION: Treatment of tuberculosis under DOT in the Canton of Vaud resulted in improvement of the treatment success rate.

Adolescent↗
PubMed2004

Mycobacterium bovis tuberculosis: from animal to man and back.

Rare cases of tuberculosis due to Mycobacterium bovis have been described in humans who have been exposed to cattle or other infected animals. We report a case of tuberculosis in cattle exposed to a patient infected with M. bovis, where the strain isolated in the cattle and the patient were identical. As the patient is reported to have been exposed and contaminated during childhood, this seems to be the first documented case of transmission of M. bovis from animal to man and back to animal.

Aged↗
PubMed2004

The oxygen concentrator: an appropriate technology for treating hypoxaemic children in developing countries.

The World Health Organization (WHO) recommends supplying oxygen in developing countries by concentrators because cylinders pose considerable logistic and financial problems. This technology was employed to treat children in a hospital in Ndioum, Senegal, who met the WHO oxygenation criteria. There were clear clinical and financial benefits, but neither the nurses' knowledge of the various techniques of oxygen supply nor the maintenance service were satisfactory. The use of concentrators should be encouraged in developing countries. A strategy including technical training, maintenance and monitoring should be adopted. Corrective actions were undertaken in Ndioum, and several concentrators are now being used on a regular basis.

Child, Preschool↗
PubMed2004

Outcome of tuberculosis retreatment in routine conditions in Cotonou, Benin.

SETTING: National Tuberculosis Programme (NTP), Cotonou, Benin. OBJECTIVE: To study the patient characteristics and outcome of tuberculosis retreatment cases in a well-functioning NTP. METHODS: A retrospective, register-based study of all smear-positive pulmonary tuberculosis cases put on retreatment (2SERHZ/1ERHZ/5R3H3E3) between 1992 and 2001 in Cotonou. For comparison, information on new smear-positive cases in Cotonou in 1999 was entered and analysed. RESULTS: Of 8103 tuberculosis patients registered, 642 were put on retreatment. The analysis is mainly based on the 236 patients whose initial treatment regimen records were available (113 relapses, 84 failures, 39 returns after default). Most of the relapse (57%) and return after default (72%) cases were put on retreatment within 12 months after stopping their initial treatment. Overall, the retreatment results were satisfactory (78% success) and comparable with those of new cases (82%); the failure rates were low (3%), as were those for initial treatment (1%). There were more defaulters from retreatment among those who had already defaulted from initial treatment (21%). Treatment success rates were better among women than men. CONCLUSION: The standardised retreatment regimen is effective in Cotonou, probably because the NTP is functioning well, there are no drug shortages, drug taking is strictly supervised, and a good treatment plan is followed.

Adult↗
PubMed2003

[Smoking cessation for HIV infected patients].

Cigarette smoking is one of the leading health problems of the general and also of the HIV population. At the HIV clinic at the University Hospital in Basel, Switzerland, many patients expressed the desire to quit smoking. Therefore, an evidence based smoking cessation program was established. The program bases on the two intervention strategies, which have been evaluated as most effective in the state-of-the-art literature: Nicotine substitution and counseling. Counseling bases on dialogues and empowerment. Our smoking cessation program includes a short-term intervention, general information, and a counseling program in several parts. Until recently, in Switzerland, mainly physicians have conducted smoking cessation programs. Moreover, in the German-speaking realm, no publications exist about effective nursing interventions regarding smoking cessation. Thus, the aim of this article is to present an evidence based smoking cessation program offered by both nurses and physicians. Practice experiences indicate that the combination of nicotine substitution and counseling in several parts may be a successful interdisciplinary intervention.

Combined Modality Therapy↗
PubMed2001

Epidemiological and economical impact of tuberculosis in an adolescent girl in Lausanne (Switzerland).

UNLABELLED: Patients with pulmonary tuberculosis (TB) can infect people in their environment but children and adolescents are rarely contagious. A recent case of an adolescent girl in Lausanne, however, proved to be infectious and required extensive contact tracing. SUBJECTS AND METHODOLOGY: The source case was a 15-years-old adolescent girl of African origin. Upon her arrival in Switzerland in 1994 the tuberculin skin test was 14 mm. The patient did not receive preventive treatment. She developed smear-positive pulmonary tuberculosis in May 1999. Contact tracing identified contacts in the surrounding population. The contact persons were divided into 3 groups according to their proximity. The first group consisted of close family and friends, the second of classmates and teachers and the third of more distant contacts. Costs were also evaluated. RESULTS: Of the 53 people examined, 24 (45%) were infected and required treatment. Eight out of 9 cases (88%) were infected in the first group (including another case of culture-positive pulmonary tuberculosis). Fourteen out of 33 cases (42%) in the second group and 2 of 11 (18%) to the third group. Passing from one proximity group to the next decreased the relative risk of infection 4 fold. The costs of contact tracing and treatment are estimated at over CHF 24,000. CONCLUSIONS: (1) Pulmonary TB can be contagious even in adolescents. (2) Subdividing contacts into proximity groups allows for better targeting of the people to be screened. (3) Contact tracing and the high costs involved could have been avoided if the patient had received preventive chemotherapy upon her arrival in Switzerland.

Adolescent↗
PubMed2001

Anti-Smoking therapies: is harm reduction a viable alternative to smoking cessation?

Smoking cessation should be proposed to all smokers by healthcare workers; however, severely dependent smokers are frequently unable or unwilling to quit smoking. For some of them, particularly if they have failed in previous cessation attempts and have smoking-related disorders, a long term reduction of tobacco consumption may be proposed as the 'second best' attitude and may offer a perspective for reduction of some of the risk factors associated with smoking. This attitude, which cannot be regarded as a general health policy, usually requires the prolonged use of nicotine replacement therapy. From available studies, it does not seem that a period of sustained smoking reduction decreases the chance of future cessation, it may even increase it.

Attitude of Health Personnel↗
PubMed2000

Smoking reduction with oral nicotine inhalers: double blind, randomised clinical trial of efficacy and safety.

OBJECTIVES: To determine whether use of an oral nicotine inhaler can result in long term reduction in smoking and whether concomitant use of nicotine replacement and smoking is safe. DESIGN: Double blind, randomised, placebo controlled trial. Four month trial with a two year follow up. SETTING: Two university hospital pulmonary clinics in Switzerland. PARTICIPANTS: 400 healthy volunteers, recruited through newspaper advertisements, willing to reduce their smoking but unable or unwilling to stop smoking immediately. INTERVENTION: Active or placebo inhaler as needed for up to 18 months, with participants encouraged to limit their smoking as much as possible. MAIN OUTCOME MEASURES: Number of cigarettes smoked per day from week six to end point. Decrease verified by a measurement of exhaled carbon monoxide at each time point compared with measurement at baseline. RESULTS: At four months sustained reduction of smoking was achieved in 52 (26%) participants in the active group and 18 (9%) in the placebo group (P<0.001; Fisher's test). Corresponding figures after two years were 19 (9.5%) and 6 (3.0%) (P=0.012). CONCLUSION: Nicotine inhalers effectively and safely achieved sustained reduction in smoking over 24 months. Reduction with or without nicotine substitution may be a feasible first step towards smoking cessation in people not able or not willing to stop abruptly.

Administration, Inhalation↗
PubMed2000

Surveillance of antituberculosis drug resistance in Switzerland 1995-1997: the central link.

The purpose of the present paper is to investigate the usefulness of routine notification of antituberculosis drug susceptibilities. In Switzerland, laboratories have to report susceptibilities to isoniazid, rifampicin, ethambutol, and pyrazinamide to the Federal Office of Public Health. All clinical and laboratory information on every single tuberculosis case is routinely linked. Proportions of drug resistance were calculated and logistic regression was applied to evaluate the role of potential risk factors. Eighty percent (1056) of all culture-positive tuberculosis cases reported between October 1995 and December 1997 were analysed. The strains of 66 (6.3%) patients had resistances to at least one drug. Risk factors identified were previous antituberculosis treatment (adjusted odds ratio 7.3, 95% confidence interval 3.9-13.6), male sex (1.4, 1.1-2.0), and age <65 yrs (1.5, 1.0-2.3). Fourteen cases (1.3%), 13 of them foreign-born, were resistant to at least isoniazid and rifampicin. Reporting of drug susceptibilities allows routine assessment of the proportion of drug resistant tuberculosis and populations at risk. This proportion was found to be small in Switzerland. Risk factors were previous treatment for tuberculosis, male sex, and age <65 yrs. Resistance to at least isoniazid and rifampicin was predominantly found in foreign-born patients.

Adult↗
PubMed2000

Occupational exposure to inhalative irritants and methacholine responsiveness.

OBJECTIVES: Occupational exposures to inhalative irritants have been associated with an increased reporting of respiratory symptoms in previous studies. Methacholine responsiveness represents a continuous measure of airway responsiveness. As such, it may be less subject to recall bias and more sensitive to detecting effects of occupational exposure on airways. Such effects may be stronger among atopic persons. The objective of the study was to examine the relationship between self-reports of occupational exposure to dusts, gases, vapors, aerosols, and fumes and methacholine responsiveness. METHODS: A sample was studied of never smokers (N=3044) chosen randomly from 8 areas in Switzerland. Atopy was defined as any positive skin test to 8 inhalative allergens. Nonspecific bronchial reactivity was tested using methacholine chloride and quantified by calculating the slope of the dose-response. RESULTS: The methacholine slopes were 19% [95% confidence interval (95% CI) 6-32] higher for never smokers with exposure to dusts, fumes, vapors, gases, or aerosols than for the unexposed group. When only atopic never smokers were examined. the increase was larger (37%, 95% CI 7-75), and for persons with >2 positive skin prick tests the effect was still higher (42%, 95% CI -1.5-104). Exposure to vapors and aerosols was strongly associated with increased methacholine slopes among the atopic subjects. CONCLUSIONS: Occupational exposure, particularly to dusts and fumes, was associated with increased bronchial reactivity in never smokers in this study. The magnitude of the effect was larger among atopic subjects.

Adolescent↗
PubMed1999

[Clinical epidemiology and treatment of tuberculosis in elderly patients].

In developed countries the incidence of tuberculosis is higher in patients aged 65 and over than in any other age group, with the exception of HIV positive subjects. This high incidence is a consequence of the very high rate of infection in our countries in the first part of the century, and of the diminished efficiency of the aging immune system. In this age group, most cases of tuberculosis are reactivations of dormant mycobacteria. However, the possibility of a newly acquired infection must be kept in mind, especially in institutionalized patients. The clinical presentation is often insidious and non-specific, as is the radiological presentation (i.e. infiltrates in middle or lower lobes); the large number of cases discovered at autopsy illustrates the difficulty of clinical diagnosis. Extra-thoracic involvement is less frequent than in younger adults (15% of cases). Mortality is high, even in treated patients, and increases with age. The frequency of drug-induced hepatitis under tuberculostatic treatment increases with age: signs of hepatic toxicity should be monitored regularly; furthermore, compliance with treatment may be jeopardized by cognitive impairment: directly observed treatment should be set up when there is the slightest doubt as to compliance. Prophylactic treatment with isoniazid is indicated in recent tuberculin converters (after exclusion of active disease), in patients with diabetes or on immunosuppressive therapy, and in patients with radiological fibrotic lesions without serious co-morbidities. In institutionalized subjects regular tuberculin testing is warranted to detect nosocomial infection.

Adult↗
PubMed1999

Long-term ambient air pollution and respiratory symptoms in adults (SAPALDIA study). The SAPALDIA Team.

The association between long-term exposure to ambient air pollution and respiratory symptoms was investigated in a cross-sectional study in random population samples of adults (aged 18 to 60 yr, n = 9,651) at eight study sites in Switzerland. Information on respiratory symptoms was obtained with an extended version of the European Community Respiratory Health Survey questionnaire. The impact of annual mean concentrations of air pollutants was analyzed separately for never-, former, and current smokers. After controlling for age, body mass index, gender, parental asthma, parental atopy, low education, and foreign citizenship, we found positive associations between annual mean concentrations of NO2, total suspended particulates, and particulates of less than 10 micrometers in aerodynamic diameter (PM10) and reported prevalences of chronic phlegm production, chronic cough or phlegm production, breathlessness at rest during the day, breathlessness during the day or at night, and dyspnea on exertion. We found no associations with wheezing without cold, current asthma, chest tightness, or chronic cough. Among never-smokers, the odds ratio (95% confidence interval) for a 10 micrograms/ m3 increase in the annual mean concentration of PM10 was 1. 35 (1.11 to 1.65) for chronic phlegm production, 1.27 (1.08 to 1.50) for chronic cough or phlegm production, 1.48 (1.23 to 1.78) for breathlessness during the day, 1.33 (1.14 to 1.55) for breathlessness during the day or at night, and 1.32 (1.18 to 1.46) for dyspnea on exertion. No associations were found with annual mean concentrations of O3. Similar associations were also found for former and current smokers, except for chronic phlegm production. The observed associations remained stable when further control was applied for environmental tobacco smoke exposure, past and current occupational exposures, atopy, and early childhood respiratory infections when restricting the analysis to long-term residents and to non- alpine areas, and when excluding subjects with physician-diagnosed asthma. The high correlation between the pollutants makes it difficult to sort out the effect of one single pollutant. This study provides further evidence that long-term exposure to air pollution of rather low levels is associated with higher prevalences of respiratory symptoms in adults.

Adolescent↗