Do physicians spend more time with non-English-speaking patients?
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OBJECTIVE: To determine whether physicians at a general internal medicine clinic spend more time with non-English-speaking patients. DESIGN: A time-motion study comparing physician time spent with non-English-speaking patients and time spent with English-speaking patients during 5 months of observation. We also tested physicians' perceptions of their time use with a questionnaire. SETTING: Primary care internal medicine clinic at a county hospital. PATIENTS/PARTICIPANTS: One hundred sixty-six established clinic patients, of whom 57 were non-English speaking and 109 were English speaking, and 15 attending physicians and 8 third-year resident physicians. MEASUREMENTS AND MAIN RESULTS: Outcome measures included total patient time in clinic, wait for first nurse or physician contact, time in contact with the nurse or physician, physician time spent on the visit, and physician perceptions of time use with non-English-speaking patients. After adjustment for demographic and comorbidity variables, non-English-speaking and English-speaking patients did not differ on any time-motion variables, including physician time spent on the visit (26.0 vs 25.8 minutes). A significant number of clinic physicians believed that they spent more time during a visit with non-English-speaking patients (85.7%) and needed more time to address important issues during a visit (90. 4%), (both p <.01). Physicians did not perceive differences in the amount they accomplished during a visit with non-English-speaking patients. CONCLUSIONS: There were no differences in the time these physicians spent providing care to non-English-speaking patients and English-speaking patients. An important limitation of this study is that we were unable to measure quality of care provided or patients' satisfaction with their care. Physicians may believe that they are spending more time with non-English-speaking patients because of the challenges of language and cultural barriers. (+info)
Initial results of 'Language for Health': cardiovascular disease nutrition education for English-as-a-second-language students.
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Low literacy skills may negatively affect health through misuse of medication, inability to follow medical directions or due to limitations placed on the consumer's ability to access health information. The association between low literacy among adults and cardiovascular disease has not been thoroughly investigated in some ethnic groups. The purpose of this comprehensive study is to describe the results of a nutritional-related cardiovascular health program for limited English proficient adults enrolled in English-as-a-second-language (ESL) classes. Subjects (n = 408), nearly 87% of whom were Latino, were exposed to either nutrition education (intervention group) or stress management (attention-placebo control group) classes designed specifically for ESL classes. Subjects completed physiological measures assessing blood pressure, total and high-density lipoprotein (HDL) cholesterol, waist and hip circumference, and body mass. Self-report surveys were administered to collect students' nutrition-related knowledge, attitudes and behaviors. Data were collected at baseline, 3 month post-test and 6 month follow-up. Analyses showed that differential group change was seen for fat avoidance, nutrition knowledge, HDL and total cholesterol:HDL ratio, but, for the two latter variables, the effect was not maintained at the 6 month follow-up. Both groups showed positive changes in blood pressure, total cholesterol and nutrition-related attitudes. Results showed moderate success of the intervention, but suggest contamination between experimental groups may have occurred. (+info)
Direct comparison of the neural substrates of recognition memory for words and faces.
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For the purpose of identifying the relatively specific brain regions related to word and face recognition memory on the one hand and the regions common to both on the other, regional cerebral blood flow associated with different cognitive tasks for recognition memory was examined using [H215O]PET in healthy volunteers. The tasks consisted of recognizing two types of stimuli (faces and words) in two conditions (novel and familiar), and two baseline tasks (reading words and gender classification). The statistical analyses used to identify the specific regions consisted of three subtractions: novel words minus novel faces, familiar words minus familiar faces, and reading words minus gender classification. These analyses revealed relative differences in the brain circuitry used for recognizing words and for recognizing faces within a defined level of familiarity. In order to find the regions common to both face and word recognition, overlapping areas in four subtractions (novel words minus reading words, novel faces minus gender classification, familiar words minus reading words, and familiar faces minus gender classification) were identified. The results showed that the activation sites in word recognition tended to be lateralized to the left hemisphere and distributed as numerous small loci, and particularly included the posterior portion of the left middle and inferior temporal gyri. These regions may be related to lexical retrieval during written word recognition. In contrast, the activated regions for face recognition tended to be lateralized to the right hemisphere and located in a large aggregated area, including the right lingual and fusiform gyri. These findings suggest that strikingly different neural pathways are engaged during recognition memory for words and for faces, in which a critical role in discrimination is played by semantic cueing and perceptual loading, respectively. In addition, the investigation of the regions common to word and face recognition indicates that the anterior and posterior cingulate have dissociable functions in recognition memory that vary with familiarity, and that the cerebellum may serve as the co-ordinator of all four types of recognition memory processes. (+info)
Activity of neurons in human temporal cortex during identification and memory for names and words.
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Extracellular recordings of human temporal cortical neuronal activity during identification and memory for object names or words were obtained from 31 neurons at 18 sites in 12 left language dominant patients undergoing left (10) or right (2) awake craniotomy for epilepsy under local anesthesia. Frequency of activity during identification was compared with perceptual controls, that during the encoding phase of recent memory to identification of the same material. Statistically significant changes in one or more temporal epoch (p < 0.005) of one or more comparisons were present for 27 of the 31 neurons in either hemisphere. Few neurons changed activity in the same direction for both words and names. The instruction to retain an item in recent memory changed activity in most neurons from that during identification of the same material, although the items presented were identical and overtly identified in each task. Any individual neuron usually changed activity in one direction for only one task. There are separate, widely distributed neural networks for identification or recent memory for each type of material. The majority of nearby neurons recorded through the same extracellular microelectrode were related to the networks for different tasks. The temporal characteristics of these changes were also investigated; 31% of the changes were "phasic": temporally related to presentation or response to the item. Most of the remaining neuron changes were sustained throughout a task, often for several minutes. These task-specific sustained changes may reflect effects of thalamo-cortical attentional systems. Individual neurons had both sustained and phasic changes to different tasks. (+info)
Impairments in verb morphology after brain injury: a connectionist model.
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The formation of the past tense of verbs in English has been the focus of the debate concerning connectionist vs. symbolic accounts of language. Brain-injured patients differ with respect to whether they are more impaired in generating irregular past tenses (TAKE-TOOK) or past tenses for nonce verbs (WUG-WUGGED). Such dissociations have been taken as evidence for distinct "rule" and "associative" memory systems in morphology and against the connectionist approach in which a single system is used for all forms. We describe a simulation model in which these impairments arise from damage to phonological or semantic information, which have different effects on generalization and irregular forms, respectively. The results provide an account of the bases of impairments in verb morphology and show that these impairments can be explained within connectionist models that do not use rules or a separate mechanism for exceptions. (+info)
"First aid for scalds" campaign: reaching Sydney's Chinese, Vietnamese, and Arabic speaking communities.
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OBJECTIVES: As a serious yet preventable problem, scald injuries in children have been a priority for prevention in Australia and other developed countries. Not only can the occurrence of scalds be prevented, but immediate first aid treatment offers an effective method for secondary prevention, reducing the severity of scalds. Despite the success of scald prevention initiatives, local evidence suggested that first aid knowledge was lacking in some minority ethnic groups. To redress this gap, the "First Aid for Scalds" campaign for those from a non-English speaking background was specifically targeted to three ethnic groups (Vietnamese, Chinese, and Arabic), with the aim of increasing the proportions of parents and caregivers who had correct knowledge of first aid treatment for scalds. The primary strategy was a media campaign, including advertisements on ethnic radio and in ethnic newspapers. METHODS: The evaluation design included formative research and impact evaluation. The impact evaluation study involved random population based telephone surveys with each of the three language groups, before and after the campaign, to assess the reach and effectiveness of the campaign. RESULTS: After the campaign, there were significant increases in the proportion of people who knew the correct first aid treatment for scalds. There were substantial variations in campaign recall and knowledge between each of the three language groups. The largest improvement was found in the Vietnamese group. CONCLUSION: The association between campaign recall and increase in correct knowledge, and the absence of any similar interventions during the campaign period, give credence to the conclusion that the changes observed were a result of the campaign. The results demonstrate the value of community based injury prevention campaigns specifically targeting linguistically diverse communities. (+info)
Right prefrontal cortex and episodic memory retrieval: a functional MRI test of the monitoring hypothesis.
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Though the right prefrontal cortex is often activated in neuroimaging studies of episodic memory retrieval, the functional significance of this activation remains unresolved. In this functional MRI study of 12 healthy volunteers, we tested the hypothesis that one role of the right prefrontal cortex is to monitor the information retrieved from episodic memory in order to make an appropriate response. The critical comparison was between two word recognition tasks that differed only in whether correct responses did or did not require reference to the spatiotemporal context of words presented during a previous study episode. Activation in a dorsal midlateral region of the right prefrontal cortex was associated with increased contextual monitoring demands, whereas a more ventral region of the right prefrontal cortex showed retrieval-related activation that was independent of task instructions. This functional dissociation of dorsal and ventral right prefrontal regions is discussed in relation to a theoretical framework for the control of episodic memory retrieval. (+info)
The evolution of language.
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The emergence of language was a defining moment in the evolution of modern humans. It was an innovation that changed radically the character of human society. Here, we provide an approach to language evolution based on evolutionary game theory. We explore the ways in which protolanguages can evolve in a nonlinguistic society and how specific signals can become associated with specific objects. We assume that early in the evolution of language, errors in signaling and perception would be common. We model the probability of misunderstanding a signal and show that this limits the number of objects that can be described by a protolanguage. This "error limit" is not overcome by employing more sounds but by combining a small set of more easily distinguishable sounds into words. The process of "word formation" enables a language to encode an essentially unlimited number of objects. Next, we analyze how words can be combined into sentences and specify the conditions for the evolution of very simple grammatical rules. We argue that grammar originated as a simplified rule system that evolved by natural selection to reduce mistakes in communication. Our theory provides a systematic approach for thinking about the origin and evolution of human language. (+info)