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PubMed2002

Pain measurement tools and methods in clinical research in palliative care: recommendations of an Expert Working Group of the European Association of Palliative Care.

An Expert Working Group was convened under the auspices of the Steering Committee of the Research Network of the European Association of Palliative Care to review the status of the use of pain measurement tools (PMTs) in palliative care research conducted in a multilingual-multicenter setting. Based on a literature review and on the experts' opinion, the present work recommends that standardized methods should be applied for the use of PMTs in research in palliative care. Visual analogue scales, numerical rating scales, and verbal rating scales are considered valid to assess pain intensity in clinical trials and in other types of studies. Among the multidimensional questionnaires designed to assess pain, the McGill Pain Questionnaire and Brief Pain Inventory are valid in many multilingual versions. Specific recommendations for PMT use and administration, depending on the study type and aim, are reviewed. Special population requirements specific of clinical situations encountered in palliative care (elderly, terminal, cognitively impaired patients, pediatric patients) are also considered.

Europe↗
PubMed1998

Relief for maritime medical emergencies through telematics.

MERMAID is a European Union (EU)-financed maritime telemedicine project with global reach and 24-h multilingual capability, so as to serve multinational crews working in the isolation of the world's oceans. It provides a model for the provision of healthcare services based on the electronic transmission of medical information via ISDN-based video conferencing. This model is not limited to medical diagnostics, but it encompasses all cases in which the actual delivery of healthcare services involves a patient who is not located where the provider is. Its implementation requires the commissioning of an extensive telecommunications infrastructure that includes both satellite transmission for ship to shore communication and an extensive ground-based network for summoning expert medical help from around the world so as to meet the project's multilinguality requirements and, therefore, the exploration of a number of solutions. In fact, all categories of telemedical applications (audio and video conferencing, multimedia communications, flat file and image transfer with low-, medium-, and high-bandwidth data requirements) are considered, while the full range of network choices (digital land lines, cellular/wireless, satellite, and broadband) are being tested in terms of cost/performance tradeoffs that are inherent to them and the developmental stage each of these options occupies in their lifecycle. Finally, out of that, MERMAID utilizes advanced land-based line transmission technologies to aid the remote patient by making available the specialist care that is best suited in the particular case.

Emergency Treatment↗
PubMed2006

Ethnic differences in decisional balance and stages of mammography adoption.

Behavioral theories developed through research with mainstream, English-speaking populations have been applied to ethnically diverse and underserved communities in the effort to eliminate disparities in early breast cancer detection. This study tests the validity of the transtheoretical model (TTM) decisional balance measure and the application of the TTM stages of change in a multiethnic, multilingual sample. A random sample of 1,463 Filipino, Latino, African American, Chinese, and White women aged 40 to 74 completed a phone survey of mammography beliefs and practices. Consistent with the TTM and independent of ethnicity, decisional balance was associated with mammography stage in all five ethnic groups when controlling for socioeconomic and other factors. In addition, having private insurance and a regular physician and being a long-time resident in the United States were positively associated with mammography maintenance. The application of the TTM for mammography is supported in a multiethnic and multilingual sample.

Adult↗
PubMed2005

Utility of two cancer organization websites for a multiethnic, public hospital oncology population: comparative cross-sectional survey.

BACKGROUND: While information websites have been developed by major cancer organizations, their appropriateness for patients in multiethnic, multilingual public hospital settings has received limited attention. OBJECTIVE: The objective of the study was to determine the utility of cancer information websites for a public hospital patient population. METHODS: A 70-item questionnaire was developed to evaluate cancer information seeking behavior, Internet access and use, and content appropriateness of two cancer information websites: People Living with Cancer from the American Society of Clinical Oncology (ASCO) and Breast Cancer Info from the Susan Komen Breast Cancer Foundation (SKF). Interviews were conducted with consecutive consenting oncology patients seen in a public hospital oncology clinic. RESULTS: Fifty-nine persons participated in the survey. The response rate was 80%. Participants were Caucasian (25%), African American (19%), Hispanic (42%), and Asian/Pacific Islander (11%). English was the primary language in 53% of participants, 56% had a high school education or less, and 74% had an annual income less than US 35000 dollars. With respect to computer and Internet use, 71% had computer access, and 44% searched for cancer information online, with more being interested in obtaining online information in the future (63%). Participants who had computer access were likely to be English speaking (P = .04). Those less likely to have previously used a computer tended to have a lower annual income (P = .02) or to be males aged 55 years or older (P < .05). When shown sample content from the two websites, almost all participants stated that it was "easy to understand" (ASCO 96%, SKF 96%) and had "easy to understand terms" (ASCO 94%, SKF 92%). Somewhat fewer respondents agreed that the websites provided "information they could use" (ASCO 88%, SKF 80%) or that they would return to these websites (ASCO 73%, SKF 68%). The majority planned to "discuss website information with their oncologists" (ASCO 82%, SKF 70%). CONCLUSIONS: Multiethnic, multilingual cancer patients at a public county hospital commonly had Internet access and found the content of two websites representative of major cancer organizations to be both understandable and useful.

American Cancer Society↗
PubMed2002

Interactive voice response: review of studies 1989-2000.

A systematic review of the use of interactive voice response (IVR) was conducted. IVR is a telephone interviewing technique in which the human speaker is replaced by a high-quality recorded interactive script to which the respondent provides answers by pressing the keys of a touch telephone (touchphone). IVR has numerous advantages, including economy, autonomy, confidentiality, access to certain population groups, improved data quality, standardized interviewing, multilingual interfaces, and detailed longitudinal assessments. Despite this, there have been few applications of IVR. Previous studies have been in the areas of information services, reminder calls, monitoring, assessment, experimentation, interventions, and surveys. Areas that have received little attention have been the systematic evaluation of voice, multilingual interfaces, touchphone prevalence, survey response rates, use by the elderly, and acceptability.

Humans↗
PubMed1998

A multi-agent softbot to retrieve medical information on Internet.

World-Wide Web is a media where information is unstructured, distributed, multimedia and multilingual. Many tools have been developed to help users search for information: subject hierarchies, general search engines, browsers and search assistants. Although helpful, they show serious limitations, mainly in terms of precision, multilingual indexing and distribution. The M.A.R.V.I.N. project (Multi Agent Retrieval Vagabond on Information Networks) proposes solutions with a distribution of the indexing task in agents specialized in a given domain. M.A.R.V.I.N. has been successfully applied to the medical domain. The medical index and its associated search engine MedHunt (Medical Hunter) demonstrate the interest of such an approach with currently 50,000 indexed medical sites and more than 100,000 accesses each month.

Abstracting and Indexing↗
PubMed1999

European and Latin-American countries associated in a networked database of outstanding guidelines in unusual clinical cases (ELCANO).

The aim of ELCANO, an EU-funded project, is to build a virtual multilingual multimedia library of unusual clinical cases related to gastroenterology. Based on a standardisation of the format to report and the representation of clinical information on WWW, the multilingual multimedia case has been developed and till now 350 cases have been included. User satisfaction and user acceptance of ELCANO are under evaluation.

Databases as Topic↗
PubMed2000

Changes in educational placement and speech perception ability after cochlear implantation in children.

OBJECTIVE: The purpose of this study was to evaluate the effect and relationship of paediatric cochlear implantation on educational placement and speech perception ability and to determine the effect of a multilingual background on educational placement and speech perception ability after cochlear implantation. DESIGN: This study consisted of a retrospective chart review of 83 implanted patients and a questionnaire sent to parents of 80 implanted children. SETTING: This study was conducted in a cochlear implant program at a tertiary care centre. METHODS AND OUTCOME MEASURES: From the chart review, the educational placements and speech perception scores of implanted children were determined before and after implantation. In the questionnaire, parents were asked about their preferred educational placement for their child, the language spoken at home, and their impressions of the chosen school program for their child. RESULTS: Of the children who were in nonmainstream school programs at implantation (n = 30), 50% moved toward mainstream with 9 (30%) reaching mainstream placement. Of the children who were preschool at implantation (n = 34), 24 (70%) were placed or planned to be placed in mainstream after implantation. The rate of improvement in speech perception ability was significantly higher in those children who moved toward or remained in mainstream than those who stayed at the same nonmainstream educational placement or moved away from mainstream. Children from a multilingual background were able to achieve similar educational placements and similar rates of progress of speech perception outcome as the only English-speaking children. CONCLUSIONS: Children with cochlear implants have increased educational opportunities, with those children in mainstream and those who have moved toward mainstream demonstrating improved progress in speech perception ability.

Child↗
PubMed1995

Current trends with natural language processing.

Natural Language Processing in the medical domain becomes more and more powerful, efficient, and ready to be used in daily practice. The needs for such tools are enormous in the medical field, due to the vast amount of written texts for medical records. In the authors' point of view, the Electronic Patient Record (EPR) is achieved neither with Information Systems of all kinds nor with commercially available word processing systems. Natural Language Processing (NLP) is one dimension of the EPR, as well as Image Processing and Decision Support Systems. Analysis of medical texts to facilitate indexing and retrieval is well known. The need for a generation tool is to produce progress notes from menu driven systems. The computer systems of tomorrow cannot miss any single dimension. Since 1988, we've been developing an NLP system; it is supported by the European program AIM (Advanced Informatics in Medicine) within the GALEN and HELIOS consortium and the CERS (Commission d'Encouragement á la Recherche Scientifique) in Switzerland. The main directions of development are: a medical language analyzer, a language generator, a query processor, and dictionary building tools to support the Medical Linguistic Knowledge Base (MLKB). The knowledge representation schema is essentially based on Sowa's conceptual graphs, and the MLKB is multilingual from its design phase; it currently incorporates the English and the French languages; it will also continue using German. The goal of this demonstration is to provide evidence of what exists today, what will be soon available, and what is planned for the long term. Complete sentences will be processed in real time, and the browsing capabilities of the MLKB will be exercised. In particular, the following features will be presented: Analysis of complete sentences with verbs and relatives, as extracted from clinical narratives, with special attention to the method of "proximity processing" as developed in our group and the rule based approach to language description to resolve the specific surface language problems as well as the language independent semantic situations. Comparison of results for English, French, and German sentences, showing the commonalities between these languages and, therefore, the re-usable features and the language specific aspects. Generation of noun phrases in English and French, showing the opportunities for translation between these two languages. Application of the analyzer to build a knowledge representation of ICD under the form of conceptual graphs and presentation of the possibilities of a natural language encoding of diagnosis. Strategies for query processing through a sample of abdominal ultrasonography reports, which have been analyzed and stored under the form of conceptual graphs. Feeding in and browsing of the Medical Linguistic Knowledge Base and other Dictionary Building Tools, using the perspective of an international initiative to converge towards a multilingual universal solution, valid for the medical domain. The demonstration platform is Microsoft Windows 4 on a PC, with Microsoft Visual Basic as the GUI and Quintus Prolog as NLP tools language. The same programs were originally developed for Unix-based workstations and are available on multiple platforms under Motif and X11. .

European Union↗
PubMedDate not supplied

Dyslexia and bilingual children--does recent research assist identification?

This paper analyses some of the recent research into dyslexia in relation to monolingual and bilingual children. It focuses on the phonological approach to the identification of dyslexia. It reviews the literature on those aspects of phonological development which allow dyslexic children to be identified at increasingly younger ages. The literature on the phonological development of children who speak English as an additional language, and who are bilingual or multilingual, is then reviewed to compare the possibilities for identification of these children in comparison with those for monolingual children. Some methodological issues are critically appraised and suggestions are made for future research and developments in this area.

Child↗
PubMed2007

Neural basis of first and second language processing of sentence-level linguistic prosody.

A fundamental question in multilingualism is whether the neural substrates are shared or segregated for the two or more languages spoken by polyglots. This study employs functional MRI to investigate the neural substrates underlying the perception of two sentence-level prosodic phenomena that occur in both Mandarin Chinese (L1) and English (L2): sentence focus (sentence-initial vs. -final position of contrastive stress) and sentence type (declarative vs. interrogative modality). Late-onset, medium proficiency Chinese-English bilinguals were asked to selectively attend to either sentence focus or sentence type in paired three-word sentences in both L1 and L2 and make speeded-response discrimination judgments. L1 and L2 elicited highly overlapping activations in frontal, temporal, and parietal lobes. Furthermore, region of interest analyses revealed that for both languages the sentence focus task elicited a leftward asymmetry in the supramarginal gyrus; both tasks elicited a rightward asymmetry in the mid-portion of the middle frontal gyrus. A direct comparison between L1 and L2 did not show any difference in brain activation in the sentence type task. In the sentence focus task, however, greater activation for L2 than L1 occurred in the bilateral anterior insula and superior frontal sulcus. The sentence focus task also elicited a leftward asymmetry in the posterior middle temporal gyrus for L1 only. Differential activation patterns are attributed primarily to disparities between L1 and L2 in the phonetic manifestation of sentence focus. Such phonetic divergences lead to increased computational demands for processing L2. These findings support the view that L1 and L2 are mediated by a unitary neural system despite late age of acquisition, although additional neural resources may be required in task-specific circumstances for unequal bilinguals.

Adult↗
PubMed2001

The bilingual brain: bilingual aphasia.

Since most people in the world know more than one language, bilingual aphasia is an important line of research in clinical and theoretical neurolinguistics. From a clinical and ethical viewpoint, it is no longer acceptable that bilingual aphasics be assessed in only one of the languages they know. Bilingual aphasic patients should receive comparable language tests in all their languages. In the present work, language recovery of 20 bilingual Friulian-Italian aphasics was investigated. Thirteen patients (65%) showed a similar impairment in both languages (parallel recovery), four patients (20%) showed a greater impairment of L2, while three patients (15%) showed a greater impairment of L1. Despite the many hypotheses advanced to account for nonparallel recovery, none of them seems to provide satisfactory explanations. The study of bilingual aphasics with parallel impairment of both languages allows us to verify the hypothesis whereby grammatical disorders in aphasia depend on the specific structure of each language. As far as rehabilitation programs for multilingual aphasics are concerned, several questions have been raised, many of which still need a satisfactory answer.

Adolescent↗
PubMed2001

The bilingual brain: cerebral representation of languages.

The present article deals with theoretical and experimental aspects of language representation in the multilingual brain. Two general approaches were adopted in the study of the bilingual brain. The study of bilingual aphasics allows us to describe dissociations and double dissociations between the different subcomponents of the various languages. Furthermore, symptoms peculiar to bilingual aphasia were reported (pathological mixing and switching and translations disorders) which allowed the correlation of some abilities specific to bilinguals with particular neurofunctional systems. Another approach to the study of the bilingual brain is of the experimental type, such as electrophysiological investigations (electrocorticostimulation during brain surgery and event-related potentials) and functional neuroanatomy studies (positron emission tomography and functional magnetic resonance imaging). Functional neuroanatomy studies investigated the brain representation of languages when processing lexical and syntactic stimuli and short stories. Neurophysiologic and neuroimaging studies evidenced a similar cerebral representation of L1 and L2 lexicons both in early and late bilinguals. The representation of grammatical aspects of languages seems to be different between the two languages if L2 is acquired after the age of 7, with automatic processes and correctness being lower than those of the native language. These results are in line with a greater representation of the two lexicons in the declarative memory systems, whereas morphosyntactic aspects may be organized in different systems according to the acquisition vs learning modality.

Brain↗
PubMed2002

Visual attention to words in different languages in bilinguals: a magnetoencephalographic study.

We recorded evoked magnetic fields from bilingual subjects while they were visually presented with words. The task was to count words in a target language when most of the words were in another language and there were also nontarget deviants in a third language. Our results indicate that in a multilingual visual environment there is a different need for attention to a nontarget language depending on whether the subject is attending to words in the subject's first (L1) or second (L2) language. When words in L2 are attended to, more effort appears to be devoted to words in the nontarget language than when words in L1 are attended to. In addition, attention to the nontarget language while counting words in L2 does not seem to depend on the age of acquisition of L2.

Adolescent↗
PubMed2004

A high-field functional MRI study of quadri-lingual subjects.

We assessed six multilingual subjects by functional MRI using a Noun Verb Generation task in four different languages. We hypothesised that the degree of proficiency in each language would be related to the extent of functional activity measured in a region of interest analysis. Proficiency in each language was quantified using two neuropsychological tests. All four languages activated overlapping brain areas, corresponding to the major language regions. The number of activated voxels correlated with proficiency, so that the activated volume increased for languages in which a subject had poorer proficiency. Activation did not appear to be dependent on the age at which the language was learnt.

Adult↗
PubMed2005

Repetitive transcranial magnetic stimulation may induce language switching in bilingual patients.

The dorsolateral prefrontal cortex (DLPFC) may participate in the process of language switching in multilingual individuals. We present two cases of bilingual patients who experienced unexpected language switching after receiving high-frequency, repetitive transcranial magnetic stimulation (rTMS) to the left DLPFC as a treatment for major depression. These preliminary findings support the role of the DLPFC in language switching in polyglots and highlight the potential value of rTMS for non-invasively investigating language function in humans. Further investigation is warranted.

Adult↗
PubMed2006

Language awareness in the bilingual healthcare setting: a national survey.

BACKGROUND: The significance of effective interpersonal communication in healthcare is well established, as is the importance of overcoming language barriers. This has a particular bearing for minority language speakers, where denying language choice can compromise the quality of healthcare provision. Nevertheless, there is limited empirical research exploring language awareness in healthcare and the factors that influence language choice for minority language speakers. OBJECTIVES: This paper reports on the nurses, midwives and health visitors (NMHV) data set of the first phase of a large-scale national study, commissioned by the Welsh Assembly Government, to examine the nature and extent of Welsh language awareness amongst healthcare professionals in Wales, UK. DESIGN: The study involved a questionnaire survey of healthcare professionals working in the public, private and voluntary sectors of healthcare. PARTICIPANTS: A stratified random sample of 3358 healthcare professionals was surveyed, of which 1842 (55%) were nurses, midwives and health visitors. The researcher-designed self-administered questionnaire was distributed by post to participants between July and September 2003. A total of 1042 (57%) NMHV returned their questionnaires for analysis. RESULTS: A strong positive correlation is identified between the NMHV use of the Welsh language in practice and their Welsh language proficiency (p<.01); language attitudes (p<.01); and language region (p<.01). Mean language attitude scores are more positive than expected, particularly amongst those with limited Welsh language proficiency and those working in regions with the lowest proportions of Welsh speakers. CONCLUSIONS: In view of the universal drive for culturally and linguistically appropriate healthcare practice, the findings have important implications for bilingual and multilingual healthcare settings worldwide. The evidence emerging from this survey confirms that cross-cultural communication is enhanced by NMHV language attitudes as well as their proficiency levels. Language awareness training is therefore recommended as a way of enhancing care delivery for minority language speakers.

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↗