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PubMedDate not supplied

Active Learning Centre: design and evaluation of an educational World Wide Web site.

OBJECTIVE: A new medium--World Wide Web (WWW)--has grown rapidly over the last few years. It provides opportunities for development of new educational tools and facilitates learning through interactivity, self-paced study and easy access. The aim of this project was to devise all educational WWW site (Active Learning Centre) that would take advantage of the capabilities of the new medium and assess its utilization by users. METHODS: Active Learning Centre provides customizable computer-generated feedback tests, searchable databases (currently Microbiology, Pharmacology, Vaccines, and Spanish-language Cardiovascular Medications), remote WWW-based database authoring, and multilingual support. Its modular architecture allows easy expansion into new areas of knowledge. To evaluate the Active Learning Centre we conducted a study evaluating utilization of the site and user feedback. RESULTS: The site is being used by thousands of patrons from around the world, the majority of whom are health professionals/health profession students from English-speaking countries. Customizable interactive tests are the most popular feature of the site. Most users give the site high ratings and would like it to expand further. CONCLUSION: The paradigm of combining interactive feedback tests with searchable % reference databases has been successful. Further expansion of the site to incorporate other areas of knowledge is planned.

Computer-Assisted Instruction↗
PubMed1995

Future of dietary exposure assessment.

Nutritional epidemiology depends on valid assessment of exposure of individuals to food-borne factors. The tools being applied are generally blunt instruments that are simple for the scientist to administer and analyze. The burden of aggregating foods, combining amounts, drawing on episodic or generic memory, and interpreting the questions is placed on the subjects. Alternative approaches include enhanced use of biomarkers of exposure as external, internal, and target tissue markers. Because biomarkers exist for only a few substances of interest at the exposure time of interest, the future of subjective measures is likely to be in the development of subjective dietary assessment methods that apply modern technology, including audio systems to overcome literacy barriers and allow multilingual interviews, and pictures for identifying foods. Automated methods can ensure that all questions have been responded to and all responses outside of normal ranges have been double-checked. Computer-assisted self-interviewing (CASI) may prove to be the most economic and cognitively supportive approach for assessment of food-borne exposures in the future.

Biomarkers↗
PubMed2003

Homocysteine and cognitive function in the Sacramento Area Latino Study on Aging.

BACKGROUND: Elevated plasma homocysteine (hyperhomocysteinemia), an independent risk factor for vascular disease, has been reported to be inversely correlated with objective measures of cognitive function in patients with Alzheimer disease and in community-dwelling older adults. OBJECTIVE: We evaluated the cross-sectional relation between total plasma homocysteine concentration and cognitive function in elderly Latinos (aged > or = 60 y; n = 1789) participating in the Sacramento Area Latino Study on Aging. DESIGN: Global cognitive function was assessed by using the Modified Mini-Mental State Examination, and specific cognitive functions were assessed by using 6 instruments developed for cross-cultural and multilingual neuropsychological evaluation of older persons. Associations between the cognitive function scores and total plasma homocysteine concentrations were then measured by multiple regression analysis with control for potential confounding by nutrient status (red blood cell folate, plasma vitamin B-12), kidney function (serum creatinine), demographic variables (age, sex, education, acculturation), and depressive symptoms. RESULTS: Modest inverse associations were found between homocysteine concentrations and several indexes of cognitive function, including the global Modified Mini-Mental State Examination assessment and the picture-association, verbal attention-span, and pattern-recognition tests (P < or = 0.05). Demographic variables, particularly age and education, were more strongly associated with cognitive function scores than was homocysteine. CONCLUSIONS: Homocysteine is a modest independent predictor of cognitive function in community-dwelling elderly Latinos. Reducing plasma homocysteine concentrations by administering B-vitamin supplements may provide some protection against cognitive decline in this and other elderly populations, but the effect may be limited.

Age Factors↗
PubMed2003

Relation between cognitive function and mortality in middle-aged adults: the atherosclerosis risk in communities study.

An independent, inverse association between cognitive function and all-cause mortality has been reported in elderly cohorts. The purpose of this study was to determine whether the same association exists in middle-aged persons. The Atherosclerosis Risk in Communities Study is a cohort study initiated in 1987 to investigate the development of atherosclerosis in middle-aged persons. Three cognitive function measures were included in the second cohort examination conducted from 1990 to 1992 when the participants were aged 48-67 years: the Delayed Word Recall Test (DWRT), the Digit Symbol Substitution Test (DSST) (a subtest from the Wechsler Adult Intelligence Scale-Revised), and the Word Fluency Test from the Multilingual Aphasia Examination. Cox proportional hazards modeling was used to determine whether all-cause mortality ascertained through 1997 was associated with each measure after adjustment for sociodemographic, biologic, psychologic, and behavioral risk factors. Without adjustment, there was a significantly lower mortality hazard associated with higher scores on all three measures. After covariate adjustment, the hazard ratios for the DWRT and the DSST remained significant (hazard ratio1-point DWRT score increment = 0.90, 95% confidence interval: 0.84, 0.97; hazard ratio 7-point DSST score increment = 0.86, 95% confidence interval: 0.80, 0.93). Cognitive function measured in middle age appears to have prognostic importance for life expectancy similar to that reported in elderly adults.

Aged↗
PubMed2003

The Profile of Multiple Language Proficiencies: A Measure for Evaluating Language Samples of Deaf Children.

This article reports the process of creating a developmental measure that assesses the multilingual capabilities of deaf children and the problems that were encountered. Because deaf children may be using more than one method of communication (e.g., sign language skills and spoken language skills), it is important to evaluate their skills as completely as possible. In a pilot study, we used a nominal scale that assessed language skills based on a single continuum, with good English and good American Sign Language (ASL) skills as its two extremes and approximately equal skills in both as the midpoint. In the main study, a more complete measure was created, the Profile of Multiple Language Proficiencies (PMLP). The PMLP uses a single scale that represents the different stages of language development that can be observed in both English and ASL. The PMLP showed reasonable initial reliability and has good promise as an easy-to-use measure of developing language skills in children who use multiple modalities of communication. Using the PMLP as a prototype, we discuss some of the issues that influence the reliability and validity in evaluating such a scale and how these can be overcome or avoided.

Journal Article↗
PubMed1997

The trouble with family medicine.

BACKGROUND: The trouble with family medicine is that the perceptual framework it uses to view the phenomena of health and illness is at variance with the frameworks traditionally used by medicine generally. This creates difficulties in communication between those in family medicine and those in other disciplines, and sometimes leads to misunderstanding of the nature of the discipline of family medicine and its place in the health care system. Those who practise family medicine need to be 'multilingual', able to understand and speak the language and use the metaphors of family medicine, yet equally able to use the language and metaphors of other disciplines. OBJECTIVES: This paper, which begins with a clinical scenario, reviews the contemporary biomedical paradigm, proposes an alternative, and examines the conceptual frameworks which underpin the discipline of family medicine.

Adult↗
PubMed1999

The Clock Drawing Test: utility for dementia detection in multiethnic elders.

BACKGROUND: Disproportionate increases in dementia morbidity in ethnic minorities challenge established screening methodologies because of language and culture barriers, varying access to health services, and a relative paucity of cross-cultural data validating their use. Simple screening techniques adapted to a range of health and social service settings would accelerate dementia detection and social and health services planning for demented minority elders. METHODS: The effectiveness of the Clock Drawing Test (CDT) for dementia detection was compared with that of the Mini-Mental State Examination (MMSE) and the Cognitive Abilities Screening Instrument (CASI) in community-dwelling elders of diverse linguistic, ethnic, and educational backgrounds. Subjects (N = 295) were tested at home in their native languages (English, n = 141; another language, n = 154). An informant-based clinical dementia history and functional severity index derived from the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) protocols were used to classify subjects as probably demented (n = 170), and probably not demented (n = 125). RESULTS: All tests were significantly affected by education (p < .001) but not by primary language (p > .05). Sensitivities and specificities for probable dementia were 82% and 92%, respectively, for the CDT; 92% and 92% for the MMSE; and 93% and 97% for the CASI for subjects completing each test. However, in poorly educated non-English speakers, the CDT detected demented subjects with higher sensitivity than the two longer instruments (sensitivity and specificity 85% and 94% for the CDT, 46% and 100% for the MMSE, and 75% and 95% for the CASI). Moreover less information was lost due to noncompletion of the CDT than the MMSE or CASI (severe dementia or refusal: CDT 8%, MMSE 12%, and CASI 16%). CONCLUSIONS: Overall, the CDT may be as effective as the MMSE or CASI as a first-level dementia screen for clinical use in multiethnic, multilingual samples of older adults. Its brevity (1-5 minutes), minimal language requirements, high acceptability, and lack of dependence on specialized testing materials are well adapted for screening of non-English-speaking elderly persons in settings where bilingual interpreters are not readily available and screening time is at a premium.

Aged↗
PubMed1993

Issues in the long-term evaluation of diet in longitudinal studies.

Longitudinal studies are very useful for studying diet/disease relationships. The fundamental components of a longitudinal study are that: 1) data are collected for two or more distinct time periods; 2) the subjects are the same or comparable from one time period to the next; and 3) data are compared between or among time periods in the analysis. A longitudinal study is often assumed to be synonymous with a cohort study, but there are at least four possible definitions for a longitudinal study. While focusing on cohort studies, the paper describes the nature of longitudinal studies, including a discussion of how the different definitions differ from a cohort study and a set of important assumptions necessary to cohort studies. It also highlights some of the major issues associated with such studies, including the selection of a dietary survey methodology; data collection issues in multicultural, multilingual societies; the importance of nutrient databases; measurement error and misclassification in nutrient intake and energy adjustment.

Cohort Studies↗
PubMed2001

Validation of the WHOQOL-100: pain management improves quality of life for chronic pain patients.

OBJECTIVE: The study aimed to validate a new, multidimensional, multilingual instrument (the WHOQOL-100) for assessing QOL in chronic pain patients. METHODS: Chronic pain patients (N = 106) who agreed to participate in an established pain management program (PMP) were assessed for quality of life (QOL) before and one month after the intervention. The WHOQOL-100 is a generic profile containing 25 facets of QOL organized in 6 domains. It was administered concurrently with the MOS Short Form-36, the Beck Depression Inventory, and measures of pain intensity, duration, disruption and distress. RESULTS: The patients were outpatients and inpatients with a mean age of 44 years and mean pain duration of 8 years. The sample included 70 (66%) women. After the PMP, QOL had significantly improved generally. and in the physical, psychological and independence domains, as well as in 10 facets of QOL including pain and discomfort. Good QOL is consistently associated with low levels of pain severity and pain distress and little pain disruption. Overall internal consistency reliability was good and for most facets and domains but marginal for the pain facet. When compared with the SF-36. the WHOQOL-100 shows good concurrent validity, greater comprehensiveness and very good responsiveness to clinical change. DISCUSSION: The WHOQOL-100 indicates significant improvements to QOL for those entering a PMP and is validated for the clinical assessment of chronic pain patients and for use in multi-national clinical trials, clinical governance and audit.

Adult↗
PubMed1999

Assessment of executive function in patients with mild traumatic brain injury.

BACKGROUND: The nature of functional deficit after mild traumatic brain injury (TBI) defined by Glasgow Coma Score of 13-15 is not fully described. This study explored the sensitivity of several neuropsychological tests to identify sequelae of mild traumatic brain injury (TBI). METHODS: Eleven adult patients with mild TBI admitted to a Level 1 trauma center were studied. The battery of tests included the Wechsler Intelligence Scale for Children -Revised: Mazes Subtest, Trails A and B, the Boston Naming Test, The Multilingual Aphasia Examination: Controlled Oral Word Association Test, and the Paced Auditory Serial Addition Task. RESULTS: Control subjects performed significantly better than patients with mild TBI on Trails A and B, the Controlled Oral Word Association Test, and Paced Auditory Serial Addition Task (subtests 2-4). No significant differences in performances between patients and controls was found for the Wechsler Intelligence Scale for Children -Revised: Mazes Subtest, Boston Naming Test, and Paced Auditory Serial Addition Task Subtest 1. CONCLUSION: The results suggest that tests of specific frontal lobe executive functions are valuable in diagnosing and monitoring recovery from mild TBI.

Adult↗
PubMedDate not supplied

Role of research in reconstructing global healthcare for the 21st century.

Nursing as the largest healthcare discipline is central within every healthcare system worldwide. This centrality provides the unique opportunity and the express responsibility for the creation of new knowledge through research in reconstructing global healthcare in the 21st century. International nursing research requires collaboration among culturally diverse team members and data collection with multilingual participants. The critical role of ethical research is exemplified by the diverse cultural norms. Language translation of not only the words but also their meanings is paramount to the relevant application of the study results. Institutions and schools of nursing in developed countries must acknowledge and act on the opportunities available and necessary for global collaboration afforded through the technological resources of the 21st century. Clinical nursing scholars who are the expert care providers must be involved in the conduct and application of research if any reconstruction of global healthcare is to succeed.

Cooperative Behavior↗
PubMed2001

Overcoming the language barrier in visual field testing.

PURPOSE: To evaluate the effect of using recorded instructions in patients' native language compared with interpreter-assisted instructions on the reliability and duration of the visual field test. PATIENTS AND METHODS: Sixty patients referred for visual field testing were included in the study. Thirty-five had limited or no knowledge of the Hebrew language, and 25 control patients were fluent in Hebrew, the native language. None had previous experience with automated perimetry. Patients were randomized to receive recorded instructions on the visual field test in their native language or translator-assisted instructions by the technician before performing the test. For each patient, the time required for instructions and test performance and the reliability indices were documented. RESULTS: The method of instruction (recorded or interpreter-assisted) did not affect the time required for patient instructions (66 +/- 24 seconds and 57 +/- 30 seconds, respectively), the time for test performance (7.2 +/- 1.5 minutes and 7.8 +/- 1.8 minutes, respectively), and test reliability as measured by the rate of fixation losses. Regardless of the method of explanation, the time required for instructions and for performing the test were significantly shorter for Hebrew speakers than for non-Hebrew speakers. CONCLUSION: The use of a recorded explanation in the patient's native language before visual field testing is an applicable method for patient instruction. Clinics in areas with multilingual populations may use this method to save technicians time, without adversely affecting the time required for performing the test and its reliability.

Aged↗
PubMed1998

A PC-based Braille library system for the sightless.

This paper presents a novel multiclient braille reading system developed around a single low cost personal computer. The system primarily addresses the needs of the Braille libraries, where different texts are needed to be read by different users simultaneously. Moreover, the system can simultaneously cater to different texts written in different languages. This feature makes it specially suitable for use by multilingual nationalities. The major advantage of this system is its low cost, compared to the other systems available and is specially attractive for the developing or underdeveloped countries. The paper describes the system, first from the user point of view and then presents the hardware and software design details. The system performance has been evaluated by the sightless users and has shown encouraging results.

Blindness↗
PubMed2004

Online handwritten script recognition.

Automatic identification of handwritten script facilitates many important applications such as automatic transcription of multilingual documents and search for documents on the Web containing a particular script. The increase in usage of handheld devices which accept handwritten input has created a growing demand for algorithms that can efficiently analyze and retrieve handwritten data. This paper proposes a method to classify words and lines in an online handwritten document into one of the six major scripts: Arabic, Cyrillic, Devnagari, Han, Hebrew, or Roman. The classification is based on 11 different spatial and temporal features extracted from the strokes of the words. The proposed system attains an overall classification accuracy of 87.1 percent at the word level with 5-fold cross validation on a data set containing 13,379 words. The classification accuracy improves to 95 percent as the number of words in the test sample is increased to five, and to 95.5 percent for complete text lines consisting of an average of seven words.

Algorithms↗
PubMedDate not supplied

The Gambro system for home daily dialysis.

Safety and reliability have been the main emphasis when developing our system for home daily dialysis. The AK 95 is part of a comprehensive system of appropriate products consisting additionally of a silent water treatment module, an ultrafilter, and a range of dry disposables for dialysis fluid preparation and disinfection. The dialyzer can be selected from a family of synthetic, biocompatible filters, both low and high flux. To complete the system, a modern data management tool for online or off-line surveillance and multilingual training manuals in both conventional format as well as animated software are available.

Equipment Design↗
PubMed2005

Theme-oriented discourse analysis of medical encounters.

APPROACH: Theme-oriented discourse analysis looks at how language constructs professional practice. Recordings of naturally occurring interactions are transcribed and combined with ethnographic knowledge. Analytic themes drawn primarily from sociology and linguistics shed light on how meaning is negotiated in interaction. Detailed features of talk, such as intonation and choice of vocabulary, trigger inferences about what is going on and being talked about. These affect how interactants judge each other and decisions are made. Interactions also have larger rhetorical patterns used by both patients and doctors to persuade each other. EXAMPLES: Two settings are used to illustrate this approach: genetic counselling and primary care consultations in multilingual areas. In genetic counselling, interactions are organised around the tension between the risks of knowing and the risks of occurrence. This can lead to a 'rhetorical duel' between health professionals and patients and their families. In intercultural primary care settings, talk itself may be the problem when interpretive processes cannot be taken for granted. Even widely held models of good practice can lead to misunderstandings under these conditions. CONCLUSION; Through discourse analysis, the talk under scrutiny can be slowed down to show the interpretive processes and overall patterns of an activity. Discourse analysts and health professionals, working together, can look at problems in new ways and develop interventions and tools for a better understanding of communication in medical life.

Clinical Competence↗
PubMed1995

European postcoital tests: opinions and practice.

OBJECTIVE: To assess differences in opinion and practice with regard to the postcoital test in Europe. DESIGN: Multilingual questionnaire survey among heads of departments of obstetrics and gynaecology with large fertility clinics in 16 European countries. SUBJECTS: Of 203 heads of departments, each responsible for 882 infertility cases per year (95% CI 657-1107) 145 (71%) responded. INFORMATION SOUGHT: Use of the postcoital test: its timing in relation to cycle and coitus, methodology used for the test, cut-off level of normality and treatments applied for abnormal test results. RESULTS: The postcoital test is used in 92% (and routinely in 68%) of departments. There are large differences in timing of the test in relation to menstrual cycle and coitus, in microscopic magnification used, and in cut-off levels of normality. More than 10 different treatments are applied for abnormal test results. CONCLUSION: Guidelines of the World Health Organisation are not followed and divergence in practice and opinion is wide enough to question whether infertile couples are better off with than without the test.

Attitude of Health Personnel↗
PubMed2006

Folic acid knowledge and use in a multi-ethnic pregnancy cohort: the role of language proficiency.

OBJECTIVE: To investigate the role of language proficiency as determinant of folic acid knowledge and use in a multi-ethnic pregnancy cohort. DESIGN: Prospective cohort study. SETTING AND POPULATION: Pregnant women from Amsterdam attending obstetric care for their first antenatal visit. Number approached: 12,373 women, response rate: 67% (8266 women aged 14-49 years). Ethnicity was based on the country of birth: the Netherlands, Surinam, Antilles, Turkey, Morocco, Ghana, other non-Western and other Western countries. MAIN OUTCOME MEASURES: Knowledge about and use of folic acid supplements in pregnancy as elicited in a multilingual questionnaire, as well as determinants of these in ethnic groups separately. RESULTS: Both periconceptional folic acid use and knowledge were significantly lower among Ghanaian, Moroccan, Turkish, and other non-Western women than among women born in the Netherlands or other Western countries. Language proficiency in Dutch was a major determinant of knowledge in all the ethnic groups with a mother tongue other than Dutch [adjusted odds ratios (OR): Western 3.2, non-Western (all countries combined) 7.5], while educational attainment was of secondary importance. Knowledge in turn was the strongest determinant of use (adjusted OR: Western 17.4, non-Western 27.0). CONCLUSIONS: Periconceptional folic acid supplement use among women born in non-Dutch-speaking non-Western countries is low, reflecting a lack of knowledge that is determined by the inability to speak and understand the language of the country of residence. Measures to tackle this problem include the provision of linguistically appropriate information via ethnic health advisors, and language courses integrating health education for immigrants.

Adolescent↗