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Biomedical subjects

L Loutan

Publications and source records attributed to L Loutan.

At least 19 recordsLinked to original sources
PubMed2006

[Human helminthiasis transmitted by fishes].

The consumption of dishes made from raw fresh- or see-water fishes exposes many individuals (residents, visitors or migrants) from tropical to arctic regions to the risk of helminthiasis. Anisakiasis, diphyllobothriasis, clonorchiasis, opistorchiasis and gnathostomiasis have distinct parasitic cycles and various clinical presentations, from sub-clinical infections to life-threatening hemorragic or tumoral complications. In-depth history, clinical presentation, stool examination for ova and parasites and serology usually allow for a specific diagnosis to be made. The common anti-parasitic drugs, such as albendazole, ivermectin and praziquantel, are efficacious against most of these helminthiasis. Sufficient cooking or freezing of fishes before consumption are very efficient preventive measures.

Animals↗
PubMed2006

[Travel and psychiatric problems].

Despite a spectacular increase of international travels, related psychiatric problems remain understudied. Travelling is a stressing factor that may trigger or aggravate mood disorders, anxiety disorders or substance related problems. Expatriates are especially at elevated risk for adaptation problems due to the length of their stays abroad. Some destinations with strong symbolic or mystical connotations are associated with acute psychotic episodes. Anticipating changes and being prepared to face new solicitations to come allows to reduce risks for mental health while travelling.

Humans↗
PubMed2006

[Imported malaria in Geneva: 1998-2004].

Epidemiological surveillance of malaria cases reported in Geneva between 1998 and 2004 is analysed and compared to a similar retrospective study conducted in 1988-1994. A total of 426 cases have been reported, with a mean of 61 cases per year and an increase of 29,4% compared to the initial study. Most of the increase was seen in patients of African origin, from 115 to 170 cases, of whom 56% visited friends and relatives. Malaria was acquired predominantly in sub-Saharan Africa (88,5%), mainly West and Central Africa. P. falciparum was the predominant species (75,3%), with significant seasonality during the summer and in January. This was not the case for other species. Two third of cases did not take any chemoprophylaxis. These results stress the importance of the disease and the need for adequate protection of travellers.

Adolescent↗
PubMed2005

[Cultural diversity and stereotyping: implication for the medical practice].

Increasing number of migrants worldwide brings doctors to treat patients of various origins. Patients' diversity enriches health professionals but also induces a risk of mutual incomprehension, due to cultural and language barriers. Multicultural context stimulates unwittingly stereotyping, based on a simplistic assessment of the patient's culture. Stereotyping is also influenced by the political and media coverage. Studies underscored that universally, minorities patients have an unequal access to health care in host countries. Health professionals should be aware that racial stereotyping exists in medical practice: it is a first step to bridge cultural gap between them and their patients.

Cultural Diversity↗
PubMed2005

[Travelling when pregnant? possible, but...].

Travelling when pregnant? possible, but... Travelling when pregnant is possible. We recommend to travel during the 2nd trimester, avoid region of high malaria endemicity, choose destination where good medical service exist, check for adequate insurance coverage, favour comfortable type of travel, without long air or road transportation, avoid travelling if at risk pregnancy. For any vaccination or medication risks and benefits should be carefully weighed, pregnant women are more vulnerable and at higher risk of complications.

Female↗
PubMed2004

Safety and immunogenicity profile of an experimental hepatitis B vaccine adjuvanted with AS04.

The reactogenicity and safety of an experimental hepatitis B (HB) vaccine containing adjuvant system (AS04) was compared with a licensed vaccine in a phase III, single-blind, randomised study in healthy volunteers >or=15 years of age. A total of 1303 subjects were enrolled to receive either two doses of HB-AS04 (0, 6 months) or three doses of the comparator vaccine (0, 1, 6 months). Two doses of HB-AS04 elicited seroprotection rates close to 100% and two-fold higher GMTs than the comparator vaccine. Results showed that both vaccines were well tolerated and the general safety profile of HB-AS04 was similar to that of the comparator vaccine.

Adjuvants, Immunologic↗
PubMed2003

Malaria: still a threat to travellers.

Each year, some 25-30 million international travellers from non-tropical regions visit malaria endemic countries. Up to 10,000 cases of malaria are imported into industrialised countries with an average case fatality rate of around 1%. Malaria still poses a real threat to travellers, particularly in areas with high transmission such as sub-Saharan Africa, Papua New Guinea and the South Pacific islands. The spread of malaria resistant to an increasing number of drugs forces us to adjust chemoprophylaxis regimens. Although new drugs are available and can protect travellers effectively, the number of imported cases to Europe and North America remains substantial. An increasing proportion of imported cases is seen in migrants and foreign-born residents visiting friends and relatives (VFR) in endemic countries. New easy-to-use drugs, better understanding of risk perception of travellers, finding new and innovative ways to reach at risk travellers such as VFRs are among the new challenges to improve malaria prevention for international travellers.

Animals↗
PubMed2003

Prospective evaluation and comparison of the direct agglutination test and an rK39-antigen-based dipstick test for the diagnosis of suspected kala-azar in Nepal.

The diagnosis of visceral leishmaniasis (kala-azar) remains difficult in rural endemic areas and practical and reliable tests are badly needed. Two serological tests, the Direct Agglutination Test (DAT) and an rK39-antigen-based dipstick test, were compared to parasitological diagnosis in a group of 184 patients presenting at a tertiary care centre in south-eastern Nepal with a history of fever > or = 14 days and splenomegaly; 139 patients had a parasitologically proven kala-azar and 45 patients had a negative parasitological work-up. The rK39 dipstick showed a sensitivity of 97% and a specificity of 71%. The DAT was up to 99% sensitive with a low cut-off titre (1:400) but its specificity did not exceed 82% even with a high cut-off titre (1:51 200). Both tests could be used for screening suspect patients in endemic areas. However, their use as confirmatory tests should be restricted to situations where the proportion of kala-azar among clinical suspect patients is high. The rK39 dipstick is cheaper and easier to use than the DAT and could be used widely provided that both its performance and production remain stable.

Adult↗
PubMed2002

Long-term immunogenicity of an inactivated virosome hepatitis A vaccine.

The aim of this study was to predict the long-term protection induced after immunisation with inactivated, aluminium-free virosome hepatitis A vaccine. The study population consisted of adult volunteers enrolled in four different clinical trials. Lower 95% confidence interval limits and seroconversion rate were calculated by using a linear mixed model to estimate the persistence of serum antibodies over time. To assess the robustness of the mathematical model, several sensitivity analyses were performed with more conservative protective threshold (20 mIU/ml vs. 10 mIU/ml), higher yearly decline rate, and exclusion of volunteers who had increasing titres over time. Based on 190 volunteers with at least two valid assessments of titres from year 3 onward, the median duration of protection was 55.5 years, with a lower limit of the 95% CI of 48.7 years. Duration below 25.3 years was predicted for only 5% of the subjects. Women tended to have higher titres to start with, but their rate of decline was higher, resulting in similar duration of protection overall. The use of a more conservative threshold, higher yearly decline rate, and exclusion of volunteers with increasing titres over time did not affect these results. According to this model, 95% of the volunteers should have anti-HAV titres above the minimum protective threshold for 20 years or more following immunisation with two doses of this aluminium-free vaccine.

Female↗
PubMed2001

Importance of patients' perceptions and general practitioners' recommendations in understanding missed opportunities for immunisations in Swiss adults.

Over the last decades, tremendous efforts have been made to strengthen childhood immunisation programs. However, the burden of influenza and pneumococcal infections remains disturbingly high in adults and elderly. We conducted a cross-sectional self-administered mail survey to identify characteristics associated with low use of recommended vaccines in adult patients attending routine primary care appointments in Switzerland. Tetanus vaccination was reported by 84% of respondents aged 16-34, and by only 42% of respondents aged 65 or more. For influenza and pneumococcal vaccination, of high-risk patients (age > or =65 or history of diabetes, kidney, heart, or chronic pulmonary disease), only 41% were on schedule for influenza and 6% for pneumococcal vaccination. Compared with patients from the German- and Italian-speaking areas of the country, patients from the French-speaking region were more likely to report past immunisation against influenza and pneumococcal disease or a recent physician's recommendation for immunisation against influenza, but equally likely to have ever refused influenza vaccination. For all three diseases, area of residence, physician's recommendation for immunisation, and patient's perceived usefulness of vaccination were independently and significantly associated with vaccination status. Although patient's opinion is an important determinant of vaccination coverage in adults, lack of physician's encouragement accounted for most missed vaccination opportunities in this study. The higher vaccination coverage among patients from the French-speaking area suggests that the promotion campaigns carried out in this region effectively improved influenza vaccine use. Interventions designed to increase vaccination coverage in adults must help providers incorporate immunisation in routine health care.

Adolescent↗
PubMed2001

A totally synthetic polyoxime malaria vaccine containing Plasmodium falciparum B cell and universal T cell epitopes elicits immune responses in volunteers of diverse HLA types.

This open-labeled phase I study provides the first demonstration of the immunogenicity of a precisely defined synthetic polyoxime malaria vaccine in volunteers of diverse HLA types. The polyoxime, designated (T1BT(*))(4)-P3C, was constructed by chemoselective ligation, via oxime bonds, of a tetrabranched core with a peptide module containing B cell epitopes and a universal T cell epitope of the Plasmodium falciparum circumsporozoite protein. The triepitope polyoxime malaria vaccine was immunogenic in the absence of any exogenous adjuvant, using instead a core modified with the lipopeptide P3C as an endogenous adjuvant. This totally synthetic vaccine formulation can be characterized by mass spectroscopy, thus enabling the reproducible production of precisely defined vaccines for human use. The majority of the polyoxime-immunized volunteers (7/10) developed high levels of anti-repeat Abs that reacted with the native circumsporozoite on P. falciparum sporozoites. In addition, these seven volunteers all developed T cells specific for the universal epitope, termed T(*), which was originally defined using CD4(+) T cells from protected volunteers immunized with irradiated P. falciparum sporozoites. The excellent correlation of T(*)-specific cellular responses with high anti-repeat Ab titers suggests that the T(*) epitope functioned as a universal Th cell epitope, as predicted by previous peptide/HLA binding assays and by immunogenicity studies in mice of diverse H-2 haplotypes. The current phase I trial suggests that polyoximes may prove useful for the development of highly immunogenic, multicomponent synthetic vaccines for malaria, as well as for other pathogens.

Adult↗
PubMed2001

[Malaria--chemoprophylaxis 2001].

An estimated 20,000 to 30,000 cases of imported malaria are annually diagnosed in industrialised countries. Some 700 of them concern Swiss travellers and foreign guests. Exposure prophylaxis and chemoprophylaxis for high risk destinations lower the risk of malarial disease. The latter is defined as regular intake of antimalarial drugs in subtherapeutic dosage in order to suppress the development of clinical disease. Drugs are usually taken from one week before travel until four weeks after return from an endemic area. Mefloquine, doxycycline, chloroquine plus proguanil, and presumably soon also atovaquone plus proguanil are available in Switzerland for chemoprophylaxis.

Africa↗
PubMed1999

Addressing language barriers to health care, a survey of medical services in Switzerland.

Two descriptive, quantitative cross-sectional surveys including all services of internal medicine and psychiatric services examined how Swiss medical services address the problem of language barriers in health care and how they respond to the high number of allophone patients. Of all the medical services (MS), 244 responded to the questionnaire (Internal medicine: 166; Psychiatry: 78; overall response rate 86.6%). Half of them (51%) estimated the proportion of allophone to the total number of patients at 1-5%. Only 4% of the MS collected statistics on the number of allophone patients (2 internal medicine, 8 psychiatric services). A third of the MS perceive communication with allophone patients as significantly difficult. Only 14% often use qualified interpreters, while 79% often use relatives, 75% often health staff, 43% often employees. Qualified interpreters are less frequently used in internal medicine than in psychiatry. There is an expressed need for qualified interpreters speaking Albanian, Bosnian/Serbo-croat, Tamil and Kurdish. Only 11% of the studied MS have a budget for interpreters, and 17% have access on an interpreter service. 48% express the need to have access to interpreter services. There is a need to raise the awareness of health professionals on the advantages of having access to trained interpreters and on the limits of using relatives as translators. This calls for coordination at national level, policy development and training, in order to ensure adequate communication and quality care for migrants.

Cross-Sectional Studies↗
PubMed1999

Medical interpreters have feelings too.

All 22 members of the interpreter service of the Geneva Red Cross were invited to answer an anonymous questionnaire with questions about their work with refugees and asylum seekers. Five (28%) reported having been exposed to a major traumatic event such as war, torture, detention, being beaten. Seven interpreters reported that more than 50% of their sessions involved patients exposed to violence. Five interpreters (28%) frequently experienced difficult feelings during sessions. Twelve (66%) had frequently painful memories. The proportion of interpreters having painful feelings and symptoms increases with the number of sessions with victims of violence. Interpreters also expressed a strong need to talk and share feelings after the session with the medical doctor (83%) or with relatives or spouse (44%). Fifteen (83%) reported seeing patients again outside the consultation. Doctors should be aware of these pressures and give time to interpreters to share their feelings and emotions, to help them cope with their reactions.

Adult↗
PubMed1999

Language difficulties in an outpatient clinic in Switzerland.

This small-scale study attempts to examine the languages spoken in medical consultations during a one-month period in an outpatient clinic in Geneva and the ways health professionals use to communicate with their allophone patients, in particular by using interpreters. Patients of foreign origin accounted for 58% of all the consultations during the survey. Of these, 37% were Non-French-speakers (NFS). The four major language groups of NFS were Albanian, Somali, Tamil and Serbo-croat. Qualified interpreters were used in 24% of the consultations, relatives acting as interpreters in 17%, and in the other consultations without anyone interpreting (59%), a common language had to be negotiated: French, English, Italian, Spanish or German. In only 14% of the consultations without interpreters, both patient's and doctors ability to speak a common language was rated as good. Our data suggest that there has been an increasing awareness of the possible language barriers in the medical outpatient clinic. Even if proxy solutions (informal interpreters or the use of a common language) still play an important role, access to an interpreter service has been widely used. This calls for systematic and regular interpreter use, planning the interpreting needs in a timely manner. In the future, training in working with interpreters should become an integral part to the introductory sessions for the junior physicians assigned to the outpatient clinic.

Ambulatory Care Facilities↗