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Louis Loutan

Publications and source records attributed to Louis Loutan.

25 records · Page 2Linked to original sources
PubMed2003

Improving communication between physicians and patients who speak a foreign language.

BACKGROUND: Communication between physicians and patients is particularly challenging when patients do not speak the local language (in Switzerland, they are known as allophones). AIM: To assess the effectiveness of an intervention to improve communication skills of physicians who deal with allophone patients. DESIGN OF STUDY: 'Before-and-after' intervention study, in which both patients (allophone and francophone) and physicians completed visit-specific questionnaires assessing the quality of communication. SETTING: Two consecutive samples of patients attending the medical outpatient clinic of a teaching hospital in French-speaking Switzerland. METHOD: The intervention consisted of training physicians in communicating with allophone patients and working with interpreters. French-speaking patients served as the control group. The outcomes measured were: patient satisfaction with care received and with communication during consultation; and provider (primary care physician) satisfaction with care provided and communication during consultation. RESULTS: At baseline, mean scores of patients' assessments of communication were lower for allophone than for francophone patients. At follow-up, five out of six of the scores of allophone patients showed small increases (P < 0.05) when compared with French-speaking patients: explanations given by physician; respectfulness of physician; communication; overall process of the consultation; and information about future care. In contrast, physicians' assessments did not change significantly. Finally, after the intervention, the proportion of consultations with allophone patients in which professional interpreters were present increased significantly from 46% to 67%. CONCLUSIONS: The quality of communication as perceived by allophone patients can be improved with specific training aimed at primary care physicians.

Adolescent↗
PubMed2002

Screening of mental disorders in asylum-seekers from Kosovo.

OBJECTIVE: To determine how the use of trained and ad hoc interpreters during a medical screening interview affects referral to medical and psychiatric care. METHODS: We reviewed 319 structured interviews conducted by nurses with asylum-seekers from Kosovo during a systematic medical screening at time of entry, consisting of questions about health conditions, past exposure to traumatic events, and posttraumatic symptoms. RESULTS: The majority (72%) of asylum-seekers were male and the median age was 24 years. Forty-eight per cent were single and 55% declared having relatives already living in Switzerland. Screening interviews resulted in 36% of asylum-seekers being referred to a general practitioner and 6% to a psychiatrist. Relatives served as ad hoc interpreters in 18% of interviews and trained interpreters in 16%. The detection of traumatic events and psychological symptoms significantly improved when trained interpreters were present (traumatic events: no interpreters 55%, ad hoc interpreters 46%, trained interpreters 77%, P = 003; psychological symptoms: 12%, 14%, 33%, respectively, P = 0.001). Adjusted for traumatic events and posttraumatic symptoms, referral to medical care was more frequent when relatives served as ad hoc interpreter (OR: 1.9, 95% CI 1.0-3.6), while interviews conducted with trained interpreters were not significantly associated with increased referral to medical (OR: 1.3, 95% CI 0.6-2.6) and psychiatric care (OR: 2.3, 95% CI 0.7-7.0). CONCLUSION: The use of trained interpreters improved the quality of communication, the detection of severe symptoms and traumatic situations, and facilitated therapeutic orientation of traumatized asylum-seekers.

Adolescent↗
PubMedDate not supplied

Immunogenicity of booster vaccination with a virosomal hepatitis A vaccine after primary immunization with an aluminum-adsorbed hepatitis A vaccine.

BACKGROUND: Increasing numbers of individuals are traveling to areas of high hepatitis A endemicity and require immunization against the hepatitis A virus (HAV). The option of using a virosomal, aluminum-free, HAV vaccine (Epaxal) for booster immunization following primary vaccination with an aluminum-adsorbed vaccine has been assessed. METHODS: In total, 142 healthy subjects, 79 men and 63 women, aged 12 to 72 years, were injected intramuscularly with a booster dose of Epaxal (0.5 mL containing < or =500 RIA units of HAV antigen) 6 to 24 months after primary vaccination with Havrix (0.5 or 1.0 mL containing 720 or 1440 ELISA units of HAV antigen, respectively, adsorbed onto aluminum hydroxide). Anti-HAV antibody titers were measured on days 0 and 28 by an enzyme immunoassay. Adverse events were recorded for 1 month postinjection. RESULTS: Overall, 98/118 subjects (83%) with no serologic evidence of past HAV infection were still seroprotected at enrolment (anti-HAV antibody titer < or = 20 mIU/mL). The seroprotection rate was 87% in those primed with Havrix 1440 6 to 12 months earlier (n=93) and 60% in those primed < or =12 months before enrolment (n=20, mean 16 months). The geometric mean anti-HAV antibody titer increased from 65 mIU/mL at day 0 to 1,722 mIU/mL at day 28 after a single booster dose with Epaxal in evaluable subjects who were primarily vaccinated with either a single dose of Havrix 1440 (n=111) or two separate doses of Havrix 720 (n=4). All subjects were seroprotected at day 28, and 98% showed at least a four-fold increase in anti-HAV antibody titer. Epaxal was well tolerated and no serious adverse events were reported. At day 28, the tolerability of the vaccination was judged as either "very good" or "good" by 96% of vaccinees and by all investigators. CONCLUSION: Epaxal can be successfully used to boost immunization following primary vaccination with an aluminum-adsorbed vaccine, and is well tolerated.

Adolescent↗
PubMedDate not supplied

African tick-bite fever: four cases among Swiss travelers returning from South Africa.

BACKGROUND: African tick-bite fever (ATBF) is a recently described disease belonging to the spotted fever group. It is caused by Rickettsia africae, and cases are mainly diagnosed in travelers returning from sub-Saharan Africa. METHODS: We report four cases of ATBF among Swiss travelers returning from a 1-month trip in rural South Africa. Diagnosis was made on the basis of clinical, epidemiologic and serologic findings that we describe in detail. Serology was performed using microimmunofluorescence (MIF) assay 2 weeks, 6 weeks and 14 months after the commencement of symptoms. RESULTS: All patients developed the typical eschar and a rash; two had a local lymphadenopathy and one a lymphangitic reaction. Two patients developed transient neuropsychiatric symptoms such as headache, irritability and depressed mood. All four patients had rises in both IgM and IgG classes of anti-R. africae antibodies. After 1 year, only two patients still had measurable circulating antibodies. Cross-reactions with R. conorii were noted. Three patients were cured after a short course of doxycycline; one required 15 days of treatment. CONCLUSIONS: ATBF is a benign disease increasingly being diagnosed in travelers. After ruling out malaria, ATBF diagnosis relies upon a detailed travel history and the classical findings of influenza-like symptoms, fever, one or more necrotic eschars, and rash. Serologic tests usually help to confirm the diagnosis. Neuropsychiatric symptoms specifically associated with ATBF are reported here for the first time.

Adolescent↗