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PubMed2004

Selective alteration of native, but not second language articulation in a patient with foreign accent syndrome.

The present study deals with a right-handed female polyglot suffering from a Foreign Accent Syndrome (FAS) which affects her native language (L1), but not her other languages learnt since the age of 12. She had a small infarct in the left corona radiata as the result of a carotid occlusion. Her L1 was Spanish, but she also had a good command of French, English and Catalan (L2). Aphasia tests did not reveal any other significant alteration in any language. Analyses of pre-morbid and post-morbid voice recordings revealed that FAS affected Spanish dramatically, but no important changes were observed for French. Results were interpreted as showing that different brain areas control articulation of L1 and L2 learnt after a critical period.

Acoustic Stimulation↗
PubMed2005

Brain correlates of sentence translation in Finnish-Norwegian bilinguals.

We measured brain activation with functional magnetic resonance imaging (fMRI) while Finnish-Norwegian bilinguals silently translated sentences from Finnish into Norwegian and decided whether a later presented probe sentence was a correct translation of the original sentence. The control task included silent sentence reading and probe sentence decision within a single language, Finnish. The translation minus control task contrast activated the left inferior frontal gyrus (Brodmann's area 47) and the left basal ganglia. The left inferior frontal activation appears to be related to active semantic retrieval and the basal ganglia activation to a general action control function that works by suppressing competing responses.

Adult↗
PubMed2005

Articulation in early and late bilinguals' two languages: evidence from functional magnetic resonance imaging.

The network of cortical and subcortical regions that contribute to articulation was examined in bilinguals using functional magnetic resonance imaging. Participants were all fluent in French and English: half were bilingual from birth and half were 'late bilinguals' who had learned French after the age of 12. Overt articulation resulted in the bilateral activation of the motor cortex, basal ganglia and cerebellum, and also the supplementary motor area, independent of the language spoken. Furthermore, the threshold and extent of the network involved in articulation was identical for the two bilingual groups with the exception of greater variation in the left putamen for the late bilinguals. These data challenge claims that age of acquisition results in fundamental differences in the neural substrates that subserve language in bilinguals.

Adult↗
PubMed2002

Working with interpreters: an interactive Web-based learning module.

OBJECTIVE: Medical students are presented with unique challenges when they care for patients with limited English proficiency. Students must learn a complex set of skills needed to care for patients across cultural and language barriers and to understand the impact of their own attitudes and beliefs about caring for these patients. We developed and piloted a multimedia interactive Web-based module aimed at teaching students effective strategies for working with interpreters and diverse patient populations, and at raising their awareness of important legal, ethical, and cultural issues. DESCRIPTION: First the learner completes a 37-multiple-choice-question (MCQ) pre-test that assesses attitudes, factual knowledge, and ability to analyze written clinical scenarios relevant to the module's content. Learners are then shown a series of professionally produced video vignettes, which reflect diverse patient populations, interpreters, and effectiveness of interpretation strategies (e.g., a Russian-speaking woman with chest pain whose daughter interprets, a medical student interpreting for a Chinese-speaking man using herbal medication, a Haitian woman told of an abnormal mammogram through a trained simultaneous interpreter). In each case, learners submit short answers to on-screen questions analyzing the effectiveness of the interpretation strategies demonstrated. Immediate feedback is given comparing student responses with those of experts. At any time during the module, the learners may view video commentary by legal, ethics, and cultural experts, or access a glossary and Web site links. Students conclude the module by again taking the MCQ test. A final screen compares their pre- and post-MCQ test responses and shows best answers, allowing them to assess their learning. The learners also complete a survey, providing personal cultural information and feedback on the module. DISCUSSION: All 160 first-year medical students completed the module and evaluated its effectiveness this year. On average, students improved by 20% on the MCQ post-test and 86% of the students were satisfied with the learning experience and acquired new knowledge. As a result of their participation in the module, students examined their own cultural and linguistic backgrounds and made the following comments: "I am interested in exploring the way my own culture and cultural biases could impact my working with patients from other cultures"; "This module has opened my eyes to the fears and concerns of immigrants who do not speak English." Therefore, this pilot of the module effectively imparted guidelines for, and raised awareness of, medical interpreting. The most common critique of the module was that as a result of technical difficulties, it was time-consuming. A more rigorous evaluation is planned for the next academic year. We are also working to enrich and enhance the module for more experienced clinicians (GME and CME). As a complementary educational tool, the Internet has the advantages of allowing students to work at their own paces, view engaging video clips, and participate in interactive learning with immediate feedback and self-assessment.

Communication Barriers↗
PubMed2003

Training medical students to communicate with a linguistic minority group.

Effective communication is central to a successful physician-patient relationship. Communication is usually enhanced when the linguistic and cultural attributes of patients are incorporated in health care delivery. With this purpose in mind, the Faculty of Medicine at the University of Ottawa has developed a French-language stream to train future physicians for the francophone minority population of Ontario. As part of this project, a communication skills laboratory was created for francophone students in 1996, since all three tertiary care teaching hospitals operated in English only. The laboratory consists of a controlled environment where francophone students conduct interviews in French while being observed by clinicians trained in observation and feedback techniques. It makes use of simulated patients trained to play specific roles and to give feedback to students. Laboratory sessions take place throughout the first and second years and expose students to 15 scenarios covering different themes in each year. Each scenario includes a communication problem. Facilities are in place for filming the encounters for review by students. The project has had favorable outcomes. Both students and clinician-supervisors find that the laboratory offers an excellent learning environment and describe the cases as realistic and instructive. Clerkship preceptors are pleased with the students' communication skills. Because of the success of the laboratory, faculty authorities plan to translate the scenarios and offer similar sessions to students in the English-language stream. The teaching methods used in the communication skills laboratory may be of interest to other medical schools that serve linguistic minority populations.

Communication↗
PubMed2004

Challenging linguistic barriers to health care: students as medical interpreters.

Inadequate medical interpretation services are a barrier to the delivery of optimal health care to persons with limited English proficiency. Even though Title VI of the Civil Rights Act of 1964 requires that interpretation services be available to persons speaking limited English, many health care institutions are struggling to reach full compliance. Communication through untrained interpreters is likely to include mistranslations or omissions of physicians' questions, truncated or slanted patient responses, and inadequate information to facilitate accurate diagnosis and treatment. The Interpreter's Aide Program (IAP) is a service-learning program that was implemented at Brown Medical School in 1997. The IAP is a collaborative effort among Brown students, the Rhode Island Hospital Department of Social Work, and Brown Medical School. This three-way partnership strengthens the IAP and expands interpretation services to Spanish- and Portuguese-speaking patients at Rhode Island Hospital. Bilingual undergraduate and medical students become trained medical interpreters and render community service while developing cross-cultural skills. The authors review the development and implementation of the IAP. There is potential for other academic health centers to develop similar partnerships with local colleges and universities, and to provide service-learning opportunities for future physicians and health care consumers.

Communication Barriers↗
PubMedDate not supplied

A Chinese translation of the EdFED-Q and assessment of equivalence.

The purpose of this study was to translate the Edinburgh Feeding Evaluation in Dementia Questionnaire (EdFED-Q) from the original English into a Chinese language version and to assess the equivalence of the English and Chinese EdFED-Q versions. To use a directly translated instrument without minimal explanation of the procedures for determining the equivalence between the original and secondary language instrument is questionable. Ensuring equivalence of a translated Chinese version of the EdFED-Q for patients with dementia is an essential prerequisite for identifying culturally specific expressions of feeding difficulty under investigation. Phase 1 consisted of experts doing the initial translation into Chinese and then English back-translations of the questionnaire. Six experts determined the equality of the Chinese and English versions, and five monolingual nurses provided information for the C-EdFED-Q. In phase 2, two bilingual gerontological nurses rated 33 residents with dementia to determine equivalence across time. In phase 3, three groups of bilingual nurses used the Chinese, English, and finally both versions simultaneously to judge a model case's feeding behavior on the videotape. In phase 1, the rating on the equality of the items on the Chinese and English versions was 0.969. In phase 2, kappa coefficients for all items on the C-EdFED-Q and E-EdFED-Q ranged from 0.44 to 1.00. In determining the consistency of the scores for the C-EdFED-Q and E-EdFED-Q between the two raters across time, the intraclass correlation coefficient for the absolute agreement was found to range from 0.85 to 0.90. In phase 3, except for items 6 and 9, all items showed no significant difference among the three groups. Further studies to assess the relationship between constructs and to compare it with known and predicted relationships are recommended.

Dementia↗
PubMed2001

Psychometric evaluation of Breast Health Behavior Questionnaire: Spanish version.

The purpose of the study was to test the psychometric properties of a culturally sensitive and theory-based instrument: the Breast Health Behavior Questionnaire. This instrument was translated into Spanish and back-translated at a third- to fourth-grade reading level. The pilot group consisted of 70 Hispanic women who attended a class at a local church. Subsequent to pilot testing, another 40 Hispanic women who attended a class at the local health department comprised the study sample. The participants responded to the 15-item questionnaire, which is formatted as a Likert scale. Content validity of the Breast Health Behavior Questionnaire was determined by a panel of experts. A factor analysis of this instrument showed five separate dimensions accounting for 71.82% of the instrument's variance. The three major components of self-regulation theory (schema, coping, and appraisal criteria) were found clustered within the first three dimensions after three items were discarded. The Breast Health Behavior Questionnaire demonstrated an internal consistency reliability coefficient of .7172. The psychometric properties of the Spanish version of this questionnaire warrant further research. The instrument may support a better understanding of the Hispanic woman's practice of breast health behavior. Eventually, the Breast Health Behavior Questionnaire may assist nurses in the formulation of culturally grounded interventions.

Adult↗
PubMed2002

Bilingual children referred for psychiatric services: associations of language disorders, language skills, and psychopathology.

OBJECTIVE: To investigate (1) the prevalence of language deficits and disorders and (2) the relationship of bilingual language skills and psychopathology, in Spanish-English bilingual children referred for child and adolescent psychiatry services. METHOD: Bilingual language skills, emotional/behavioral problems, sociodemographics, immigration variables, and nonverbal IQ were studied in 50 consecutively referred children. RESULTS: Estimated prevalence was high for language deficits (48%) and disorders (41%), with most cases (>79%) being of the mixed receptive-expressive type. In children with clinically significant emotional/behavioral problems, bilingual language skills were strongly and inversely correlated with problem scores, particularly global problems (r = -0.67, p < .001); social, thought, and attention problems (r > or = -0.54; p < .004); delinquency (r = -0.66, p < .001); and aggression (r = -0.52, p < .01). These correlations remained significant after IQ adjustment. CONCLUSIONS: Prior findings from monolingual children were confirmed in this bilingual sample, namely (1) the high prevalence of mixed receptive-expressive and other language disorders and delays and (2) the close tie between poor language skills and emotional/behavioral problems. The data strongly suggest the clinical importance and feasibility of language assessment and the significance of receptive problems in bilingual children referred for psychiatric services. A safe approach is to fully assess language skills, rather than misattributing these children's language delays to normal bilingual acquisition processes.

Adolescent↗
PubMed2004

Associations among familism, language preference, and education in Mexican-American mothers and their children.

Latino families who express a higher degree of familism are characterized by positive interpersonal familial relationships, high family unity, social support, interdependence in the completion of daily activities, and close proximity with extended family members. Retention of cultural values, such as familism, may be linked to positive health outcomes; however, little is known about how families retain culture of origin values in the face of acculturation pressures. The current study explores acculturation influences as indexed by language preference and household education on maternal and child familism. Mothers and children of Mexican descent (fourth grade students) (n = 219) completed measures of demographics, household education, language preference, and familism. Three hypotheses were examined. First, we predicted that lower household education would be correlated with higher familism scores. However, contrary to our prediction, a higher familism score was significantly associated with a higher level of household education (p <.05). Second, we predicted that higher child familism would be associated with the preference for speaking Spanish. Children who preferred to use both English and Spanish (p <.01) or English alone (p <.05) had higher familism scores than those who preferred Spanish. Third, we predicted that lower child familism scores would be associated with greater differences in mother and child language preferences. There were no significant differences in child familism based on differences between parent and child language. Protective influences of cultural maintenance deserve further attention in longitudinal studies and in relation to the physical and mental health of youth.

Acculturation↗
PubMed1997

Long-term mental sequelae of torture in Iran--who seeks treatment?

In this study, we investigated long-term mental sequelae of torture in Iran and explored differences between treatment seekers and nontreatment seekers. Thirty-four torture victims suffering from enduring mental sequelae and now living in Germany were examined. According to DSM-III-R, depressive, anxiety, and somatoform disorders were diagnosed with a high degree of comorbidity and with posttraumatic stress disorder (PTSD) being the most frequent diagnosis. Treatment seekers had a higher level of psychopathology, particularly the PTSD symptoms of intrusion and increased arousal, and a poorer knowledge of German. They reported different ways of coping. The differences found between the two groups may reflect more or less successful adaptation to conditions in the host country and contribute to the motivation to seek treatment.

Acculturation↗