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Biomedical subjects

Ariel Eytan

Publications and source records attributed to Ariel Eytan.

16 recordsLinked to original sources
PubMed2006

Health status of returnees to Kosovo: do living conditions during asylum make a difference?

OBJECTIVE: From August 1999 to July 2001, asylum seekers who had come to Switzerland from Kosovo were repatriated. The present study aimed to assess the relationship between living conditions during asylum in Switzerland and health status among returnees. STUDY DESIGN: Cross-sectional survey of 319 ethnic Albanian families in Kosovo, selected from a list of 12900 heads of households who had received repatriation aid. METHODS: Consenting household members aged 16 years or more who had received asylum in Switzerland were interviewed during the autumn of 2001. Questions explored living conditions during asylum, present socio-economic conditions (World Bank Kosovo Poverty Assessment Survey), subjective physical and mental health [Medical Outcomes Study 36-item Short Form Health Survey (SF-36)], traumatic events (Harvard Trauma Questionnaire) and symptoms of post-traumatic stress disorder (PTSD; Mini International Neuropsychiatric Interview). RESULTS: Ninety-four per cent of selected households were located. Among the 580 participants, 25.5% suffered from PTSD and 65% lived in extreme poverty. Subjective health scores, measured by SF-36, were low, particularly for those affected by PTSD. Among living conditions in the host country, duration of stay longer than 26 weeks was associated with lower mental health scores, particularly among people with PTSD. CONCLUSIONS: Two years after the conflict, returnees had low health scores. The association between duration of stay and lower mental health scores may reflect the stress of adapting to asylum or the consequence of compulsory repatriation. This study has implications for the emerging healthcare system in Kosovo and for policies of asylum in host countries.

Adolescent↗
PubMed2006

Posttraumatic stress disorder and the use of general health services in postwar Kosovo.

Studies conducted in high-income countries have demonstrated that posttraumatic stress symptoms are positively correlated with increased use of general health services; however, comparative data are lacking in postwar settings. This survey was conducted in Kosovo after the end of the conflict; 996 people, age 16 or older, were interviewed. Older age, lower education level, worse physical health, and current diagnosis of posttraumatic stress disorder (PTSD) were associated with higher use of any health services. After adjusting for gender, age, place of residence, type of education, poverty, refugee status, and subjective physical health, PTSD remained associated with an increased use of most health care services. Our results underline the importance of taking into account PTSD when restoring health services in postwar countries.

Adolescent↗
PubMed2006

Screening for major depression and posttraumatic stress disorder among asylum seekers: adapting a standardized instrument to the social and cultural context.

OBJECTIVE: To adapt the PTSD and MDE sections of a validated psychiatric diagnostic instrument, we used the Mini International Neuropsychiatric Interview (MINI) during an initial health assessment into a primary care facility for asylum seekers. METHOD: A 3-step process was carried out. First, items of the original version of the MINI were adapted to the specific context of life of asylum seekers in the host country (by a multidisciplinary group that included public health nurses, a primary care physician, a psychologist, a psychiatrist, and an epidemiologist). Second, we submitted the reworded and original versions of the MINI to 14 interpreters' who tested for general and cultural acceptability. Each diagnostic criterion was rated according to interpreters' comments on a 4-point Likert scale (1 = an item good for translation and 4 = an unusable or completely inadequate item). In the third step, we rephrased the most problematic items identified by the interpreters. RESULTS: Some original items were considered particularly ill-adapted for this context, and 4 had to be dropped. This final rewording took into account cultural inadequacies and lack of structure (including temporal organization) of the everyday life of newly arrived asylum seekers. CONCLUSION: The reworded MINI was successfully tested, and its items are presented in the final part of the study.

Comorbidity↗
PubMed2005

[From Kosovo to Switzerland: mental health perceptions and practical implications for health professionals].

A survey was conducted in Kosovo between 2002 and 2003 among 57 health professionals. Covered topics encompassed mental health and disease representations and access to mental health care in Kosovo following the war. At the time of the survey, health services were still widely disorganized and uncoordinated at the local level, with poor access to health care. This work shows that mental disorders remain very stigmatizing for patients and their relatives. Benzodiazepines are the first choice medication, to the detriment of other psychotropic categories. Traditional and religious representations of mental disease prevail in the general population. A few recommendations addressed to professionals taking care of Kosovar patients, in Switzerland or elsewhere, are drawn from these results.

Cultural Characteristics↗
PubMed2005

Variations in smoking during hospitalization in psychiatric in-patient units and smoking prevalence in patients and health-care staff.

BACKGROUND: Smoking and exposure to smoke are important concerns, especially in psychiatric in-patient services. AIMS: Our aims were to study variations in smoking after hospitalization for psychiatric in-patients, and to evaluate smoking-related concerns and prevalence for both patients and health-care staff. METHODS: A similar survey was mailed to staff members and proposed individually to all recently admitted patients; participation rates were 39% and 79% respectively. RESULTS: Three days after admission, 4/10 patients had increased and 3/10 had decreased their daily tobacco use. Univariate analysis of variance showed nicotine dependence scores to be associated with variations in consumption (p = .005): whereas 74% of heavy smokers decreased cigarette consumption, 80% of light and 57% of moderate smokers increased their consumption. The prevalence of current smoking was twice as high in patients (72%) as compared to health-care professionals (31%). Patients were also more nicotine dependent (Heaviness of Smoking Index (HSI) = 3.97/vs. 1.81), and half of the patients were heavy smokers (> 20 cigarettes/day), as opposed to only 6.3% of the staff. CONCLUSIONS: Smoking prevalence and daily tobacco consumption are very high in psychiatric patients. After hospitalization, light and moderate smokers increased whereas heavy smokers decreased smoking.

Adult↗
PubMed2005

A case of non-psychotic autocastration: the importance of cultural factors.

Male genital self-mutilation has been known to occur in psychotic patients. We report a case of premeditated autocastration in the absence of clinical disorder, both at the time of the mutilation and upon follow-up. Coming from a strict Slavic family, this patient repressed gender identity issues for decades. After migrating to Western Europe, his sexual ambiguity became actuated. His motives can be understood in the light of his personal and cultural background. This case shows that cultural factors may contribute to explaining male genital self-mutilation behaviors.

Attitude to Health↗
PubMed2004

Patients' satisfaction with hospitalization in a mixed psychiatric and somatic care unit.

A patient satisfaction survey was undertaken in a mixed psychiatric and somatic care unit. An anonymous self-report questionnaire covering setting and satisfaction with care was completed by 60 patients. Median age was 42 (range 20-64), and the majority female (63%). Main ICD-10 diagnostic categories were depressive disorders (51.7%), substance-related disorders (33%) and personality disorders (25%). Somatic comorbidity was present in 60% of patients. Overall satisfaction with care and setting was high. Higher satisfaction was significantly associated with a history of previous hospitalizations in a psychiatric hospital and with being referred to the program by a psychiatrist. These findings emphasize the perceived advantages of mixed units, such as decreased stigmatization of psychiatric inpatients and opportunity to receive adequate treatment for both physical and mental problems during a single hospital stay.

Adult↗
PubMed2004

Determinants of postconflict symptoms in Albanian Kosovars.

During the period from 1998 to 1999, more than 1 million civilians from the province of Kosovo in the Balkans were displaced as a consequence of organized violence and war. The aim of the present study was to determine the prevalence of posttraumatic stress disorder (PTSD) in a sample of the Albanian Kosovar population more than 2 years after the end of the conflict and to assess the effect of exposure to war-related events. A total of 340 households were randomly selected among 12,900 families returned from a country of asylum (Switzerland). All adults in each household were invited to participate (N = 996). The following instruments were used: the Albanian translations of the PTSD section of the Mini International Neuropsychiatric Interview and of the Medical Outcomes Study 36-Item Short Form, and a list of traumatic events adapted from the Harvard Trauma Questionnaire. The overall prevalence of PTSD was 23.5%. A strong cumulative effect of trauma was observed, with odds ratios for PTSD rising steeply with the number of events to which people were exposed. After taking into account traumatic events, multivariable analysis indicated that female gender, older age, and having left Kosovo during the conflict were significantly associated with higher frequency of PTSD, whereas significant heterogeneity among municipalities was observed. Stratified analysis for people who stayed and left the province during the war suggested that different patterns of trauma may be relevant in the two subsamples, with forced separation and isolation strongly associated with PTSD in people who stayed in Kosovo. PTSD diagnosis was also significantly associated with lower scores on all dimensions of the Medical Outcomes Study 36-Item Short Form and lower economic status. The results suggest that responding to medium-term and long-term mental health consequences of conflict is a necessary task for the global rehabilitation of health care systems in a war devastated country.

Adolescent↗
PubMed2004

Persistent severe depressive episode with mood-congruent psychotic features associated with left temporal ischemia.

OBJECTIVE: The authors describe the case of a patient suffering from a persistent severe depressive episode with mood-congruent psychotic features following left temporal ischemia. BACKGROUND: Depression is a frequent disorder that may stem from psychosocial factors or occur after brain damage. Cases of poststroke depression with associated psychotic symptoms are rarely described in the literature, and, to our knowledge, no case of depression with psychotic symptoms in the presence of a focal lesion has yet been reported. METHOD: History included psychiatric, neurologic, and neuropsychological as well as EEG data and CT scan and magnetic resonance images. RESULTS AND CONCLUSIONS: Neurologic and psychiatric dimensions may be associated and difficult to disentangle, even when the patient presents the classic symptoms of a depressive disorder. This case underlines the importance of investigating possible neurologic signs or symptoms, even when the psychiatric presentation is prototypical of a determined mental disorder. This may be crucial for the patient's evolution.

Brain Ischemia↗
PubMed2003

Language barriers between nurses and asylum seekers: their impact on symptom reporting and referral.

The objective of this study was to determine whether language barriers during the screening interview affected the reporting of asylum seekers' health problems and their referral to further health care. Seven hundred and twenty-three standard screening questionnaires, administered by nurses to asylum-seekers at the time of entry into Geneva/Switzerland between June and December 1998, were reviewed, as well as information pertaining to language use during the interview. Language concordance between nurses and asylum seekers was assessed by considering the presence/absence of an interpreter, the type of interpreter present (trained, untrained), and the nurse's self-assessed proficiency in the language used during the medical interview. Nurses also recorded their own subjective assessment of the overall quality of communication during the interview. More than half of the asylum seekers came from Europe, mainly the Balkan regions, and a third of them from Africa. Most asylum seekers were men (72%). The median age was 26.5 years, and 50% were younger than 25 years. Severe physical and psychological symptoms were reported by 19% and traumatic events prior to migration were reported by 63%. The nurses referred 36% of all refugees to further medical care and 6% to psychological care. Professional interpreters were used in 8% of the interviews and ad hoc interpreters in 16%. Adequate, partial and inadequate language concordance was reported for 54%, 27% and 18% of the consultations respectively. Adequate language concordance was significantly associated with higher reporting of past experience of traumatic events and of severe psychological symptoms, contrasting with much fewer referrals to psychological care when language concordance was inadequate. These results suggest the importance of addressing language barriers in primary care centres in order to adequately detect and refer traumatised refugees. To address this problem, the use of professional interpreters is recommended.

Adult↗
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↗
PubMed2002

Fire-settng behavior associated with Klinefelter syndrome.

This is a report on a male patient with a previous history of psychotic disorder who was arrested for arson. During the following hospitalization in a psychiatric unit, a genetic syndrome, namely Klinefelter syndrome (47,XXY), was diagnosed. The association between firesetting behavior and Klinefelter syndrome is reviewed, and the underlying explanatory hypothesis is discussed.

Adult↗