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PubMed2004

Between the confusion of tongues and the gift of tongues. Or working as a psychoanalyst in a foreign language.

The author worked as a psychoanalyst for 5 years in Germany. In this paper, he attempts to answer the question 'How was it possible that, in spite of his imperfect knowledge of German, notwithstanding a deepening understanding of the language during his residence in the country, he was able to successfully treat so many patients? ' He starts by putting forward some distinctions between the activity of interpretation as translation of the unconscious with the patient in session and the activity of translation of texts. After a brief exegetic review of the myths of Babel and Pentecost, he suggests that the analyst working in a foreign language moves between 'the confusion of tongues' and the 'gift of tongues', that is, between Babel and Pentecost. He presents some vignettes to illustrate typical situations he encountered in his practice. Finally, he draws some conclusions from this experience of psychoanalytic polyglotism, mainly on the basis of the communicative function that modern infant research assigns to affect attunement and verbal language.

Adult↗
PubMed2005

Los Degradados: out, down, dead. Transmitted and inflicted trauma as encountered in the analysis of a 6-year-old girl.

The author presents the analysis of a precocious traumatized little girl, which reveals the ways in which historical trauma is transmitted and intrafamilial trauma is both disguised and represented. The play as it evolves is seen to simultaneously communicate what the child struggles with and to resolutely try to hide what has actually happened. Analyst and child together participate in play which utilizes displacement, enactment and interactive enactment, the latter play mode being the very hallmark of profound traumatic experience. Carlotta, the child, helps the analyst to follow her quest for meaning making even as the interaction between them adheres to and departs from the deepening pentimenti of traumatic experience, which needs to be unraveled and reconstructed in order that her own developmental progression can be rejoined. The analysis facilitates Carlotta's capacity to play in a more unfettered fashion and to assist her family's recovery as well.

Aggression↗
PubMed1996

Television captions for hearing-impaired people: a study of key factors that affect reading performance.

Closed captions are broadcast with television programs for special-needs viewers such as hearing-impaired people. We examined how caption presentation rate, small amounts of induced dioptric blur, and English learned as a second language affect the reading performance of good readers. Thirty-two college graduates with normal hearing and vision, half of whom learned English as a second language, read television captions that consisted of white capital letters equivalent in size to 20/92 Snellen letters on a black background. Text was presented at rates of 55, 120, and 216 words/min. Lenses of 0, 0.5, 1.0, or 1.5 diopters (D) were worn over the person's best refractive correction. The fastest text rate and small amounts of blur significantly disrupted reading performance. People who learned English as a second language were hindered more by presentation rate than by dioptric blur. Surprisingly, people with refractive errors (even though they were optically corrected) were hindered less by induced blur than were people with normally clear vision.

Adult↗
PubMed2001

How was this story told in the mother tongue? An integrative perspective.

Most of the psychoanalytic literature on the mother tongue has focused on the clinical therapeutic encounter. The authors applied findings from therapy research using the Thematic Apperception Test (TAT) to tease out differences and similarities in how stories are told in the mother tongue versus the acquired language. This projective test provides a rich medium to explore the individual's inner world, fantasies, thoughts, wishes, sense of self, and self-in-relation-to-other via a narrative that is spontaneously produced in response to standardized stimuli. The TAT was administered to four participants in both the mother tongue and the acquired language. The narratives were then analyzed using two different rating systems. Differences in sense of self, self-in-relation-to-other, and level of pathology were identified using one participant's narratives. Although no global generalizations can be made from one study, the authors suggest that people tell their story differently when speaking in the mother tongue versus the acquired language.

Adult↗
PubMed2005

Language-related activations in the left prefrontal regions are differentially modulated by age, proficiency, and task demands.

It remains to be elucidated how cortical activations are modulated by factors of age, proficiency, and language task demands when mastering first language (L1) and a second language (L2). Using functional magnetic resonance imaging, we tested subjects aged 13 (the age 13 group) and 19 (the age 19 group), thereby comparing the cortical activations involved in past-tense verb identification with those involved in verb matching. We found that the activation in the dorsal triangular part of the left inferior frontal gyrus (IFG) was lower, corresponding to a higher proficiency in English (L2) in the older subjects, suggesting that the proficiency level plays a major role in the activation of this region during L2 acquisition. Moreover, the lower activation in the triangular and orbital parts of the left IFG (F3t/F3O) for the irregular past tense corresponding to a higher proficiency in L2, together with the nonsignificant activation for the regular past tense when its performance almost reached perfection for age 19, suggests that the modulation of the left F3t/F3O activation reflects language task demands for identifying correct past-tense forms. On the other hand, the left F3t/F3O activation in Japanese (L1) for age 13 was significantly greater than that for age 19, despite the matched performances in L1. These results suggest that the left IFG subserves language-specific functions that are critically required when mastering any language.

Adolescent↗
PubMed2003

Errors in medical interpretation and their potential clinical consequences in pediatric encounters.

BACKGROUND: About 19 million people in the United States are limited in English proficiency, but little is known about the frequency and potential clinical consequences of errors in medical interpretation. OBJECTIVES: To determine the frequency, categories, and potential clinical consequences of errors in medical interpretation. METHODS: During a 7-month period, we audiotaped and transcribed pediatric encounters in a hospital outpatient clinic in which a Spanish interpreter was used. For each transcript, we categorized each error in medical interpretation and determined whether errors had a potential clinical consequence. RESULTS: Thirteen encounters yielded 474 pages of transcripts. Professional hospital interpreters were present for 6 encounters; ad hoc interpreters included nurses, social workers, and an 11-year-old sibling. Three hundred ninety-six interpreter errors were noted, with a mean of 31 per encounter. The most common error type was omission (52%), followed by false fluency (16%), substitution (13%), editorialization (10%), and addition (8%). Sixty-three percent of all errors had potential clinical consequences, with a mean of 19 per encounter. Errors committed by ad hoc interpreters were significantly more likely to be errors of potential clinical consequence than those committed by hospital interpreters (77% vs 53%). Errors of clinical consequence included: 1) omitting questions about drug allergies; 2) omitting instructions on the dose, frequency, and duration of antibiotics and rehydration fluids; 3) adding that hydrocortisone cream must be applied to the entire body, instead of only to facial rash; 4) instructing a mother not to answer personal questions; 5) omitting that a child was already swabbed for a stool culture; and 6) instructing a mother to put amoxicillin in both ears for treatment of otitis media. CONCLUSIONS: Errors in medical interpretation are common, averaging 31 per clinical encounter, and omissions are the most frequent type. Most errors have potential clinical consequences, and those committed by ad hoc interpreters are significantly more likely to have potential clinical consequences than those committed by hospital interpreters. Because errors by ad hoc interpreters are more likely to have potential clinical consequences, third-party reimbursement for trained interpreter services should be considered for patients with limited English proficiency.

Ambulatory Care Facilities↗
PubMed2003

The truth about language barriers: one residency program's experience.

OBJECTIVE: To describe perceptions of how a lack of house staff Spanish proficiency adversely affects communication with Spanish-speaking families with limited English proficiency (LEP). METHODS: An anonymous, structured questionnaire was administered to the house staff an of urban, university-affiliated children's hospital that serves a population in which 10%-20% have LEP. RESULTS: Ninety-four percent (59 of 63) completed the questionnaire. Sixty-eight percent (40 of 59) reported that they spoke little or no Spanish (although 36 of 40 expressed a desire to learn Spanish). Fifty-three percent (21 of 40) of these nonproficient residents reported that they used their inadequate language skills in the care of patients "often" or "every day." Many of these residents believed that LEP families under their care "never" or only "sometimes" understood their child's diagnosis (21 of 40), medications (11 of 40), discharge instructions (17 of 40), or follow-up plan (16 of 40). Eighty percent (32 of 40) admitted to avoiding communication with such families. Although all (40 of 40) agreed that hospital interpreters were effective, 30 of 40 nonproficient residents reported use of hospital interpreters "never" or only "sometimes." Fifty-three percent (21 of 40) of these nonproficient residents reported calling on their proficient colleagues "often" or "every day" for assistance. Thirty-two percent (19 of 59) of residents described themselves as "fluent" or "proficient" in Spanish. Fifty-eight percent (11 of 19) reported that they were asked to interpret for fellow residents "often" or "every day." Proficient residents estimated that they spent a mean of 2.3 hours per week interpreting for other residents. CONCLUSIONS: Despite a perception that they are providing suboptimal communication, nonproficient residents rarely use professional interpreters. Instead, they tend to rely on their own inadequate language skills, impose on their proficient colleagues, or avoid communication with Spanish-speaking families with LEP.

Adolescent↗
PubMed2005

Recommending a minimum English proficiency standard for entry-level nursing.

When nurses who are educated internationally immigrate to the United States, they are expected to have English language proficiency in order to function as a competent nurse. The purpose of this research was to provide sufficient information to the National Council of State Boards of Nursing (NCSBN) to make a defensible recommended passing standard for English proficiency. This standard was based upon the Test of English as a Foreign Language (TOEFL). A large panel of nurses and nurse regulators (N = 25) was convened to determine how much English proficiency is required to be minimally competent as an entry-level nurse. Two standard setting procedures, the Simulated Minimally Competent Candidate (SMCC) procedure and the Examinee Paper Selection Method, were combined to produce recommendations for each panelist. In conjunction with collateral information, these recommendations were reviewed by the NCSBN Examination Committee, which decided upon an NCSBN recommended standard, a TOEFL score of 220. Because the adoption of this standard rests entirely with the individual state, NCSBN has little more to do with implementing the standard, other than answering questions and providing documentation about the standard.

Communication Barriers↗
PubMed2005

Cross-cultural equivalence and psychometric properties of the Portuguese version of the Depressive Cognition Scale.

There is a great need for researchers to have access to reliable and valid research instruments in their own language to measure a concept of interest or concern. Therefore, the purpose of this study was to determine semantic equivalency and psychometric properties of the Depressive Cognition Scale (DCS) in a Brazilian sample of diabetics. Back-translation and field testing methodology was used to determine the DCS semantic equivalency and psychometric properties. A convenience sample of 40 bilingual Brazilian adults was used to conduct the field testing of the scale. The findings suggested that the translation of the DCS was adequate and initial estimates of internal consistency and construct validity were adequate for both the DCS and its Portuguese version. Psychometric testing of the Portuguese language version of the DCS in this small sample appears to have sufficient reliability and validity for use in examining depressive cognitions in Brazilian adults. Further psychometric testing of the Portuguese version of the DCS in a larger Portuguese-speaking sample with diabetes is recommended.

Adult↗
PubMed1998

The effects of reinforcement rate on the spontaneous social initiations of socially withdrawn preschoolers.

Social skills priming was used to increase the spontaneous social initiations of 2 socially withdrawn preschoolers, 1 of whom had been diagnosed with autism. During priming sessions, the teacher prompted and reinforced social behaviors (e.g., smiling, verbal initiations). We varied the rate of reinforcement during priming sessions and measured the effects of this manipulation on the rate of spontaneous social initiations during the subsequent classroom activity. Spontaneous initiations were more frequent after high rates of reinforcement than after low rates of reinforcement.

Autistic Disorder↗
PubMed2005

Limited English proficiency and breast and cervical cancer screening in a multiethnic population.

OBJECTIVES: We examined the relationship between ability to speak English and receipt of Papanicolaou tests, clinical breast examinations, and mammography in a multiethnic group of women in the United States. METHODS: We used longitudinal data from the Study of Women Across the Nation to examine receipt of breast and cervical cancer screening among Chinese, Japanese, Hispanic, and White women who reported reading and speaking (1) only a language other than English, (2) another language more fluently than English, or (3) only English or another language and English with equal fluency. Logistic regression was used to analyze the data. RESULTS: Reading and speaking only a language other than English and reading and speaking another language more fluently than English, were significantly and negatively associated with receipt of breast and cervical cancer screening in unadjusted models. Although these findings were attenuated in adjusted models, not speaking English well or at all remained negatively associated with receipt of cancer screening. CONCLUSIONS: These findings suggest that language barriers contribute to health disparities by impeding adequate health communication.

Acculturation↗
PubMed2005

Latina grandmothers raising grandchildren: acculturation and psychological well-being.

Grandparent involvement in raising grandchildren has become increasingly prevalent and represents the family's strength for managing crises and transitions. This study examined acculturation, socioeconomic resources, and family factors related to well-being among 357 Latina caregiving grandmothers. Positive affect was related to greater language acculturation and factors suggesting participation in mainstream society-income and health. In contrast, higher life satisfaction and lower negative affect were more evident among the less acculturated. These relationships disappeared with controls, explained by greater social resources among less acculturated grandmothers: more were married and had the parent at home; fewer assumed care because of the parent's substance-related problems. The parent's presence in the household was related to a higher level of grandmother's well-being until more sensitive family factors were considered. Furthermore, raising grandchildren with behavior problems was related to the grandmother's negative affect. Results suggest that professions should target economic needs of new immigrants, as well as assisting with troubled grandchildren and dysfunctional parents.

Acculturation↗
PubMed1997

Effect of a bicultural community health worker on completion of diabetes education in a Hispanic population.

OBJECTIVE: To determine the effect of a bicultural community health worker (CHW) on completion of diabetes education in an inner-city Hispanic patient population and to evaluate the impact of completion of the education program on patient knowledge, self-care behaviors, and glycemic control. RESEARCH DESIGN AND METHODS: Patients were randomized into CHW intervention and non-CHW intervention groups. All patients received individualized, comprehensive diabetes education from a certified diabetes nurse educator after baseline demographic information, diabetes knowledge, diabetes self-care practices, and glycohemoglobin levels were assessed. Rates of education program completion were determined. Diabetes knowledge, self-care practices, and glycohemoglobin levels were reassessed at program completion and at a later postprogram follow-up medical appointment and compared to baseline. Logistic regression analysis and the Mantel-Haenszel chi 2 statistic were used to determine the effect of the CHW assignment on program completion. Analyses of covariance were performed with end-of-treatment behavior scores, knowledge scores, and glycohemoglobin levels as outcome variables, controlling for baseline values and testing for the effect of CHW assignment. RESULTS: Of 64 patients enrolled in the study, 40 (63%) completed and 24 (37%) dropped out before completing the diabetes education program. Of the patients having CHW intervention, 80% completed the education program, compared with 47% of patients without CHW intervention (P = 0.01). "Dropouts" were younger (age 47.5 +/- 12.5 years [mean +/- SD]) compared with patients who completed the program (55.9 +/- 9.9 years) (P = 0.004). Dropout status showed no significant relationship to educational level achieved or literacy level. For the program "completers," knowledge levels and selected self-care practices significantly improved, and glycohemoglobin levels improved from a baseline level of 11.7% to 9.9% at program completion (P = 0.004) and 9.5% at the postprogram follow-up (P < 0.001). The effect of the CHW assignment on program completion, controlling for financial status and language spoken, was extremely robust (P = 0.007). The effect of the CHW on knowledge, self-care behavior, or glycohemoglobin outcome variables was not statistically significant. CONCLUSIONS: These findings suggest that intervention with a bicultural CHW improved rates of completion of a diabetes education program in an inner-city Hispanic patient population irrespective of literacy or educational levels attained. Our data further suggests that completion of individualized diabetes educational strategies leads to improved patient knowledge, self-care behaviors, and glycemic control.

Adult↗
PubMed2005

Effects of regular switching between languages during random number generation.

Random number generation is a task that engages working memory and executive processes within the domain of number representation. In the present study we address the role of language in number processing by switching languages during random number generation (numbers 1-9), using German (L1) and English (L2), and alternating L1/L2. Results indicate large correspondence between performance in L1 and L2. In contrast to nonswitching performance, randomization with alternating languages showed a significant increase of omitted responses, whereas the random sequences were less stereotyped, showing significantly less repetition avoidance and cycling behavior. During an intentional switch between languages, errors in language sequence appeared in 23% of responses on the average, independently of the quality of randomization but associated with a clear persistence of L2. These results indicate that random number generation is more closely linked to auditory-phonological representation of numerals than to visual arabic notation.

Adult↗
PubMed2005

Familiarity and older adults' transcriptions of native and nonnative speech.

24 adults ages 60+ yr. transcribed 60 words and 30 sentences spoken by native speakers of English, Taiwanese, and Spanish to assess whether familiarity with the nonnative English speakers' accents improved transcription scores. The accuracy of listeners' transcription scores on the first half of the stimulus items was compared with accuracy of listeners' scores on the second half. Analysis indicated accuracy of transcriptions declined on words but improved for sentences, so familiarity and length of the stimuli may influence listeners' accurate transcribing of accented speech.

Aged↗
PubMed2005

Comparison of spectrographic records of two syllables pronounced from scripts in hiragana and romaji by students with different familiarity with English.

The same syllables /mu/ and /ra/ written in Japanese hiragana and romaji given on a standard speeded naming task elicited phonetically or acoustically different responses in a syllabic hiragana condition and a romaji condition. The participants were two groups of Japanese college students (ns = 15 and 16) with different familiarity with English as a second language. The results suggested that the phonetic reality of syllables represented in these scripts can differ, depending on the interaction between the kind of script and speakers' orthographic familiarity.

Adolescent↗