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PubMed2006

Primary language of parent is associated with disparities in pediatric preventive care.

OBJECTIVES: To determine whether infants of parents whose primary language is not English are less likely to receive recommended preventive care than infants of parents whose primary language is English. STUDY DESIGN: We conducted a retrospective cohort study of all 38,793 1-year-old Medicaid-enrolled infants born in Washington state between January 1, 1999 and September 30, 2000. The main exposure was self-reported primary language of parents. Using multivariate regression, we estimated the relative risk of receiving appropriate and timely receipt of preventive care visits in the first year as recommended by the American Academy of Pediatrics and Washington state Medicaid. RESULTS: Fewer than 1 in 6 (15.4%) infants received all 6 recommended preventive care visits in their first year of life. Infants of parents whose primary language was not English were half as likely to receive all recommended preventive care visits compared with infants of parents whose primary language was English (adjusted relative risk = 0.53; 95% confidence interval = 0.49 to 0.58). This disparity was seen in white, Hispanic, and African-American infants, but not in Asian-American infants. CONCLUSIONS: Disparities based on primary language exist in receipt of recommended pediatric preventive care in white, Hispanic, and African-American infants enrolled in Medicaid.

Child Health Services↗
PubMed2007

Ethics and the pediatric surgeon.

PURPOSE: Care of infants and children with life-impairing or life-threatening congenital and acquired disorders often raises ethical concerns for pediatric surgeons. The purpose of this survey was to determine the level of interest in clinical ethics and how respondents would manage ethical dilemmas within several clinical case scenarios. METHODS: A 12-item validated questionnaire developed by the Ethics and Advocacy Committee was provided for the American Pediatric Surgical Association (APSA; www.eapsa.org) members on the organizational website. General categories of questions included informed consent, patient privacy, and what constitutes research. RESULTS: The survey was completed by 235 of the 825 APSA members; a response rate of 28.4%. The majority (62%) were in academic practice, 22% had additional education or an advanced degree in ethics, and 11% were members of a hospital ethics committee. There was a clear majority response for seven questions. Topics generating the most controversy included the impact of consent by minors, decision making in the neurologically devastated child, what constitutes research in pediatric surgery, the use of interpreters for consent, and patient privacy. Respondents chose a well-referenced manuscript as the preferred modality for ethics education of the APSA members. CONCLUSION: Pediatric surgeons have a general interest in clinical ethics as it relates to the care of their patients. An important mission of the Ethics and Advocacy Committee can be to provide education that gives guidance and knowledge to the members of APSA on timely topics in surgical ethics.

Adolescent↗
PubMed2004

The changing nature of women's sexual health concerns through the midlife years.

OBJECTIVE: Information about the sexual health care needs for midlife women is limited. This study compares and contrasts the nature and prevalence of sexual concerns for women as they progress through life and into menopause and the interest and experience these women have in discussing sexual concerns with their physicians. METHODS: Questionnaires were mailed to 2073 eligible women at military medical clinics in the early 1990s. Main outcome measures are self-reported sexual concerns and interest and experience in discussing these concerns with their physicians. RESULTS: Over 98% of women reported one or more sexual concerns. Type and intensity of sexual concerns changed as women aged. Most women had not had the topic of sexual health ever raised by their physicians. CONCLUSIONS: The sexual health concerns of women change as they age. Women desire to address their sexual health care needs with their physicians. Physicians should be aware of the common sexual concerns of women, and be comfortable in initiating discussion to address them.

Adult↗
PubMed2005

Defining cultural diversities experienced in patient care by nursing students in eastern Turkey.

The aim of this study was to determine the cultural diversities that nursing students experience between the patients and themselves while providing care to patients and to find the effects of the demographic variables of the students on these diversities. This research was a cross-sectional study and was conducted between January 2004 and April 2004 at the Nursing College of Atatürk University, in the provincial capital of Erzurum in Eastern Turkey. The research involved 330 students attending the first, second, third, and fourth year courses in the Nursing College at Atatürk University. No special selection was made in the population of the study; instead, 263 full time students who volunteered were included in the study. Sixty eight percentage (n = 181) of the students were determined to have experienced cultural diversities in patient care. The students who experienced cultural diversity in patient care were found to have experienced these diversities in communicating with the patients (44.2%), in religious beliefs (6.1%), and in the life style (8.8%). In general, it was observed that nursing students coming from regions other than Erzurum and Eastern Anatolia and being at the beginning stage of their studies experienced more cultural diversities while caring for patients.

Adolescent↗
PubMed2006

Why nurses make medication errors: a simulation study.

The purpose of this study was to investigate about the communication problems in the team nursing systems, if the requests for medication between nurses happen. For this study, we developed a simulation involving a nurse giving a medication prepared by another nurse. Baseline data was collected from 100 third-year nursing students and 163 nurses of two municipal hospitals further subdivided into three groups by their service years. The responders attributing to the errors in the simulation were compared. As a result, the more service years the fewer nurses there were who attributed medication errors to no explanation and no confirmation between nurses. The nurses whose service years were less than five years had a low level of awareness regarding no explanation of a nurse leader requesting the medications as well as the students. These findings suggested that there is the possibility that some medication errors occur due to preoccupation that nurses feel it is less necessary to explain and confirm everything related to medication administrations as their length of service increase. Nurses have a communication problem that is influenced by the relationship in the workplace in the team nursing system. Therefore, the requests for medication should no be permitted.

Adult↗
PubMed2006

Developing methods for assessing neurotoxic effects in Hispanic non-English speaking children.

Many factors affect the growth and development of children, including chemicals in the environment. Children have greater exposure to toxicants than adults due to both behavior and their increased food: body-mass ratio. Furthermore, the developing brain and organ systems of infants and children and their immature metabolism also make them more vulnerable to environmental toxins. Children from all cultures and backgrounds are at risk. However, minorities may be at greatest risk. In order to evaluate the impact of environmental exposures on neurodevelopment it is necessary to have effective methods that will allow accurate conclusions to be drawn. We have developed a battery to assess neurobehavioral performance in non-English speaking Hispanic children ages 4 years and older. This paper will examine the associations between age and performance and present test-retest correlations. Two hundred and forty one Hispanic children between the ages of 4 and 9 years completed a neurobehavioral test battery twice, approximately 1 month apart. The battery consists of computerized tests from the Behavioral Assessment and Research System, tests selected from the Pediatric Environmental Neurobehavioral Test Battery, and the Object Memory Test. Multiple regression was used to examine the association between age, gender and mother's education on performance. All of the tests, except for Continuous Performance, showed that performance improved as the child gets older. Gender differences were found on several tests with females generally performing worse than males. Correlation coefficients on performance retest measures ranged from .51 to .88. This study has demonstrated the utility of using this test battery to assess cognitive and motor performance in non-English speaking Hispanic children. Tests in the battery assess a range of functions and the measures are sensitive to differences in ages. Test-retest correlations show the reliability of the battery. These support the use of this battery in both cross-sectional and longitudinal studies.

Child↗
PubMedDate not supplied

Lessons learned: research with rural Mexican-American women.

The authors share lessons learned from 5 community-based research studies involving rural Mexican-American women. The 10 lessons revolved around compensation, confidentiality, recruitment, crossing paths, mailings, locating people, participation/attendance, translation, children, and closure. Despite their clinical knowledge and previous experiences in service with this population, researchers found recruiting and retaining participants and data collection far more challenging than expected. This article is significant as it illustrates the extensive time, expense, and effort required to conduct research with a rural population experiencing health disparities. Recommendations are provided to assist in planning and designing community-based and culturally sensitive research that has realistic time and budget allowances.

Adult↗
PubMed2006

The evaluation of acute pain in individuals with cognitive impairment: a differential effect of the level of impairment.

The present study investigated whether the level of cognitive impairment (CI) affects acute pain behavior and how it is manifested. Participants were 159 individuals (mean age 42+/-12), 121 with CI (divided into four groups according to the level of CI: mild, moderate, severe, profound) and 38 with normal cognition (controls). The behavior of the participants before and during acute pain (influenza vaccination) was coded by two raters with the Facial Action Coding System (FACS - scores facial reactions to pain) and the Non-Communicating Children's Pain Checklist (NCCPC-R - scores both facial and general body reactions). Individuals with severe-profound CI exhibited elevated FACS and NCCPC-R values at baseline compared with all other groups (p<0.01). Both FACS and NCCPC-R scores of individuals with mild-moderate CI and controls increased significantly during vaccination (p<0.001). In contrast, individuals with severe-profound CI exhibited high rates of "freezing reaction" (stillness) during vaccination, manifested mainly in the face and therefore resulting in elevation of only NCCPC-R scores but not of FACS's. The results suggest that the level of CI affects baseline as well as pain behavior and it is therefore necessary to choose an appropriate behavioral tool to measure pain in these individuals accordingly. For example, tools based on facial reactions alone might provide the false impression that individuals with severe-profound CI are insensitive to pain (due to freezing).

Acute Disease↗
PubMed2004

Assessment of mutual understanding of physician patient encounters: development and validation of a Mutual Understanding Scale (MUS) in a multicultural general practice setting.

Mutual understanding between physician and patient is essential for good quality of care; however, both parties have different views on health complaints and treatment. This study aimed to develop and validate a measure of mutual understanding (MU) in a multicultural setting. The study included 986 patients from 38 general practices. GPs completed a questionnaire and patients were interviewed after the consultation. To assess mutual understanding the answers from GP and patient to questions about different consultation aspects were compared. An expert panel, using nominal group technique, developed criteria for mutual understanding on consultation aspects and secondly, established a ranking to combine all aspects into an overall consultation judgement. Regarding construct validity, patients' ethnicity, age and language proficiency were the most important predictors for MU. Regarding criterion validity, all GP-related criteria (the GPs perception of his ability to explain to the patient, the patient's ability to explain to the GP, and the patient's understanding of consultation aspects), were well-related to MU. The same can be said of patient's consultation satisfaction and feeling that the GP was considerate. We conclude that the Mutual Understanding Scale is regarded a reliable and valid measure to be used in large-scale quantitative studies.

Adolescent↗
PubMed2006

Evaluation of a visit preparation intervention implemented in two rural, underserved counties of Northern California.

OBJECTIVE: Evaluate satisfaction with visit preparation at three rural resource center sites. METHODS: The resource centers sent eight employees and two volunteers for training at UCSF in Consultation Planning (CP). CP is a service to help patients make a list of questions before seeing their doctors. Researchers used multivariate ordered logistic regression analysis to investigate the variation in satisfaction among 99 CP Clients served by the resource centers in 2003. RESULTS: Sixty-seven CP Clients who completed surveys were highly satisfied (mean=8.67, standard deviation (S.D.)=1.85, range=5-10). Variation in satisfaction was associated only with whether or not the CP Provider was a breast cancer survivor serving a breast patient (p=0.005). Satisfaction was not associated with CP Client demographics; type of upcoming medical visit; or CP Provider age, remuneration status, nursing background, and volume of CP Clients. CONCLUSION: Community-based resource centers have implemented CP to the satisfaction of their clients. Further research should expand the delivery of CP to more underserved members of the community and evaluate its acceptability and impact. There may be a therapeutic alliance formed when survivors provide CP to newly diagnosed patients. PRACTICE IMPLICATIONS: CP should be considered by patient support programs wishing to expand their client services to include visit preparation.

Adult↗
PubMed2006

Physician overestimation of patient literacy: a potential source of health care disparities.

OBJECTIVE: To investigate physician overestimation of patient literacy level in a primary care setting. METHODS: The study sample consisted of 12 non-academic primary care physicians and 100 patients from a U.S. Department of Veterans Affairs Hospital in Houston, Texas. Patient literacy level was measured on a 1-4 scale using the Rapid Estimate of Adult Literacy in Medicine (REALM). Physicians rated each patient's literacy level on a corresponding scale. Chi-square was used to test for association of patient race/ethnicity and gender with: (1) patient REALM level and (2) discrepancy between patient REALM level and physician rating of patient literacy level. RESULTS: Patient REALM level was not statistically significantly associated with patient race/ethnicity or gender. Physicians overestimated the REALM level for 54% of African American, 11% of white non-Hispanic, and 36% of other race/ethnicity patients (p<.01). CONCLUSION: Physicians commonly overestimate patients' literacy levels, and this apparently occurs more often with minority patients, and particularly with African Americans, than with white non-Hispanic patients. This discordance in estimation of patient's literacy level may be a source of disparities in health care.

Black or African American↗
PubMedDate not supplied

The language of breathlessness: do families and health care providers speak the same language when describing asthma symptoms?

INTRODUCTION: Effective communication about symptoms is a critical prerequisite to appropriate treatment. Study aims were to: (a) document the symptoms that children with asthma and their parents associate with asthma, (b) identify differences between the "professional model "of asthma symptoms and the "lay model," (c) describe the family's proposed action in response to symptoms, and (d) investigate the congruence between parental assessment of "good control" and severity obtained using National Asthma Education and Prevention Program criteria. METHOD: Children with asthma and their parents (N = 228) were recruited from diverse clinical practice sites. Parents and children described symptoms they associated with an asthma exacerbation and their proposed action. Perceived asthma control was compared with a structured assessment of severity. RESULTS: One hundred and thirty-six unique symptoms were reported. While 78% of parents reported at least one standard asthma symptom, 48% also reported nonstandard asthma symptoms. Sixty-five percent of parents whose children's symptoms were consistent with severe asthma reported "good control." DISCUSSION: Improved communication about symptoms would improve asthma care. Proposed strategies include standardized screening questionnaires to assess symptoms, more frequent routine visits for children with persistent asthma, and wide dissemination of realistic goals for symptom control.

Adult↗
PubMedDate not supplied

The California Health Interview Survey 2001: translation of a major survey for California's multiethnic population.

The cultural and linguistic diversity of the U.S. population presents challenges to the design and implementation of population-based surveys that serve to inform public policies. Information derived from such surveys may be less than representative if groups with limited or no English language skills are not included. The California Health Interview Survey (CHIS), first administered in 2001, is a population-based health survey of more than 55,000 California households. This article describes the process that the designers of CHIS 2001 underwent in culturally adapting the survey and translating it into an unprecedented number of languages: Spanish, Chinese, Vietnamese, Korean, and Khmer. The multiethnic and multilingual CHIS 2001 illustrates the importance of cultural and linguistic adaptation in raising the quality of population-based surveys, especially when the populations they intend to represent are as diverse as California's.

Adolescent↗
PubMed2004

Understanding of informed consent in a low-income setting: three case studies from the Kenyan Coast.

In our research unit on the Kenyan Coast, parents sign consent for over 4000 children to be involved in research activities every year. Children are recruited into studies ranging from purely observational research to the testing of new procedures and drugs. Thousands more community members consent verbally or in writing to the interviews and sometimes invasive procedures required in community-based research. Although every study and consent form is reviewed in advance by independent national and international committees, the views and understanding of the 'subjects' of these activities had not been documented before this study. In this paper, we focus on participant understanding of one field-based and two hospital-based studies, all of which involve blood sampling. The findings highlight a range of inter-related issues for consideration in the study setting and beyond, including conceptual and linguistic barriers to communicating effectively about research, the critical and complex role of communicators (fieldworkers and nurses) in consent procedures, features of research unit-community relations which impact on these processes, and the special sensitivity of certain issues such as blood sampling. These themes and emerging recommendations are expected to be relevant to, and would benefit from, experiences and insights of researchers working elsewhere.

Adult↗
PubMed2004

Translators and mediators: bilingual young people's accounts of their interpreting work in health care.

The interpreting work bilingual young people do in health care settings has largely been seen as a social problem, indicating deficiencies either in parents' language skills or in the provision of professional interpreting services. Little research has addressed this contribution young people make to health care work from their perspectives. This study explored the accounts of bilingual young people from four linguistic groups in London, including those from established minority groups and those more recently arrived. Young people reported extensive experience of interpreting in a number of settings, and identified a range of benefits to themselves and their families arising from their contributions, as well as some problems faced in achieving successful encounters. Focusing on young people's own accounts enabled their work to be conceptualised not as merely 'inappropriate and inadequate interpreting' but as a varied contribution to the informal economy of health care that ranged from simple translation to complex mediation between families, the wider community and the health care system.

Adolescent↗
PubMed2005

Conflicts in how interpreters manage their roles in provider-patient interactions.

Interpreters face challenges because of the various role expectations that others have placed on them and then adopt specific strategies to manage these conflicts. This study examines the conflicts in medical interpreters' role performances, the sources of these conflicts, and interpreters' strategies for resolving conflicts. It is based on in-depth interviews with 26 medical interpreters from 17 languages in the Midwestern area of the USA. The results showed that interpreters experienced four sources of conflicts in their role performances: (a) others' communicative practices, (b) changes in participant dynamics, (c) institutional constraints, and (d) unrealistic role expectations. To resolve conflicts, interpreters justified their roles by identifying the source and location of an assignment, (re)defining the relationships and identities of the provider and the patient, and adopting specific communicative strategies. This study highlights the importance of speaker and contextual factors on interpreters' communicative strategies and management of role conflicts.

Communication Barriers↗