Overcoming language barriers with foreign-language speaking patients: a survey to investigate intra-hospital variation in attitudes and practices

Background Use of available interpreter services by hospital clincial staff is often suboptimal, despite evidence that trained interpreters contribute to quality of care and patient safety. Examination of intra-hospital variations in attitudes and practices regarding interpreter use can contribute to identifying factors that facilitate good practice. The purpose of this study was to describe attitudes, practices and preferences regarding communication with limited French proficiency (LFP) patients, examine how these vary across professions and departments within the hospital, and identify factors associated with good practices. Methods A self-administered questionnaire was mailed to random samples of 700 doctors, 700 nurses and 93 social workers at the Geneva University Hospitals, Switzerland. Results Seventy percent of respondents encounter LFP patients at least once a month, but this varied by department. 66% of respondents said they preferred working with ad hoc interpreters (patient's family and bilingual staff), mainly because these were easier to access. During the 6 months preceding the study, ad hoc interpreters were used at least once by 71% of respondents, and professional interpreters were used at least once by 51%. Overall, only nine percent of respondents had received any training in how and why to work with a trained interpreter. Only 23.2% of respondents said the clinical service in which they currently worked encouraged them to use professional interpreters. Respondents working in services where use of professional interpreters was encouraged were more likely to be of the opinion that the hospital should systematically provide a professional interpreter to LFP patients (40.3%) as compared with those working in a department that discouraged use of professional interpreters (15.5%) and they used professional interpreters more often during the previous 6 months. Conclusion Attitudes and practices regarding communication with LFP patients vary across professions and hospital departments. In order to foster an institution-wide culture conducive to ensuring adequate communication with LFP patients will require both the development of a hospital-wide policy and service-level activities aimed at reinforcing this policy and putting it into practice

Ultra-Deep Sequencing Reveals the microRNA Expression Pattern of the Human Stomach

Background: While microRNAs (miRNAs) play important roles in tissue differentiation and in maintaining basal physiology, little is known about the miRNA expression levels in stomach tissue. Alterations in the miRNA profile can lead to cell deregulation, which can induce neoplasia. Methodology/Principal Findings: A small RNA library of stomach tissue was sequenced using high-throughput SOLiD sequencing technology. We obtained 261,274 quality reads with perfect matches to the human miRnome, and 42% of known miRNAs were identified. Digital Gene Expression profiling (DGE) was performed based on read abundance and showed that fifteen miRNAs were highly expressed in gastric tissue. Subsequently, the expression of these miRNAs was validated in 10 healthy individuals by RT-PCR showed a significant correlation of 83.97% (P<0.05). Six miRNAs showed a low variable pattern of expression (miR-29b, miR-29c, miR-19b, miR-31, miR-148a, miR-451) and could be considered part of the expression pattern of the healthy gastric tissue. Conclusions/Significance: This study aimed to validate normal miRNA profiles of human gastric tissue to establish a reference profile for healthy individuals. Determining the regulatory processes acting in the stomach will be important in the fight against gastric cancer, which is the second-leading cause of cancer mortality worldwide.Governo do Para/SEDECT/FAPESPAPROPESP/UFPAFADESPCAPES (Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior

Games of Incomplete Information and Myopic Equilibria

A new concept of an equilibrium in games is introduced that solves an open question posed by A. Neyman

A model for homeopathic remedy effects: low dose nanoparticles, allostatic cross-adaptation, and time-dependent sensitization in a complex adaptive system

BACKGROUND: This paper proposes a novel model for homeopathic remedy action on living systems. Research indicates that homeopathic remedies (a) contain measurable source and silica nanoparticles heterogeneously dispersed in colloidal solution; (b) act by modulating biological function of the allostatic stress response network (c) evoke biphasic actions on living systems via organism-dependent adaptive and endogenously amplified effects; (d) improve systemic resilience. DISCUSSION: The proposed active components of homeopathic remedies are nanoparticles of source substance in water-based colloidal solution, not bulk-form drugs. Nanoparticles have unique biological and physico-chemical properties, including increased catalytic reactivity, protein and DNA adsorption, bioavailability, dose-sparing, electromagnetic, and quantum effects different from bulk-form materials. Trituration and/or liquid succussions during classical remedy preparation create “top-down” nanostructures. Plants can biosynthesize remedy-templated silica nanostructures. Nanoparticles stimulate hormesis, a beneficial low-dose adaptive response. Homeopathic remedies prescribed in low doses spaced intermittently over time act as biological signals that stimulate the organism’s allostatic biological stress response network, evoking nonlinear modulatory, self-organizing change. Potential mechanisms include time-dependent sensitization (TDS), a type of adaptive plasticity/metaplasticity involving progressive amplification of host responses, which reverse direction and oscillate at physiological limits. To mobilize hormesis and TDS, the remedy must be appraised as a salient, but low level, novel threat, stressor, or homeostatic disruption for the whole organism. Silica nanoparticles adsorb remedy source and amplify effects. Properly-timed remedy dosing elicits disease-primed compensatory reversal in direction of maladaptive dynamics of the allostatic network, thus promoting resilience and recovery from disease. SUMMARY: Homeopathic remedies are proposed as source nanoparticles that mobilize hormesis and time-dependent sensitization via non-pharmacological effects on specific biological adaptive and amplification mechanisms. The nanoparticle nature of remedies would distinguish them from conventional bulk drugs in structure, morphology, and functional properties. Outcomes would depend upon the ability of the organism to respond to the remedy as a novel stressor or heterotypic biological threat, initiating reversals of cumulative, cross-adapted biological maladaptations underlying disease in the allostatic stress response network. Systemic resilience would improve. This model provides a foundation for theory-driven research on the role of nanomaterials in living systems, mechanisms of homeopathic remedy actions and translational uses in nanomedicine

Conventional cytogenetic characterization of a new cell line, ACP01, established from a primary human gastric tumor

Gastric cancer is the second most frequent type of neoplasia and also the second most important cause of death in the world. Virtually all the established cell lines of gastric neoplasia were developed in Asian countries, and western countries have contributed very little to this area. In the present study we describe the establishment of the cell line ACP01 and characterize it cytogenetically by means of in vitro immortalization. Cells were transformed from an intestinal-type gastric adenocarcinoma (T4N2M0) originating from a 48-year-old male patient. This is the first gastric adenocarcinoma cell line established in Brazil. The most powerful application of the cell line ACP01 is in the assessment of cytotoxicity. Solid tumor cell lines from different origins have been treated with several conventional and investigational anticancer drugs. The ACP01 cell line is triploid, grows as a single, non-organized layer, similar to fibroblasts, with focus formation, heterogeneous division, and a cell cycle of approximately 40 h. Chromosome 8 trisomy, present in 60% of the cells, was the most frequent cytogenetic alteration. These data lead us to propose a multifactorial triggering of gastric cancer which evolves over multiple stages involving progressive genetic changes and clonal expansion

Sobrepeso em adolescentes de 14 a 19 anos em um município da região Sul do Brasil Overweight in adolescents aged 14 to 19 years old in a Southern Brazilian city

OBJETIVOS: identificar a freqüência de sobrepeso em adolescentes, bem como os fatores ambientais, biológicos e socioeconômicos associados, no município de Toledo, Paraná. MÉTODOS: estudo transversal desenvolvido com adolescentes matriculados no ensino médio, de 14 a 19 anos, do período diurno da área urbana do município. Adotou-se o índice de massa corporal/idade para diagnosticar exposição ao risco de sobrepeso. Utilizou-se um questionário pré-testado para levantamento dos dados pessoais, antropométricos, biológicos e hábitos, como: usar TV, vídeo e computador, praticar esportes e freqüência das refeições. Para a situação socioeconômica, foi utilizado o critério de Classificação Econômica Brasil da Associação Nacional de Empresas de Pesquisa. RESULTADOS: dos adolescentes, 3,8% apresentaram baixo peso e 10,2% sobrepeso. Associação estatisticamente significativa foi encontrada para a freqüência de sobrepeso entre os adolescentes que realizavam quatro ou mais refeições/dia (5,5%) e entre aqueles que realizavam até três refeições/dia (16,3%). Ao estratificar o sobrepeso por classes econômicas, as freqüências mostram uma tendência de decréscimo de sobrepeso com a queda da classe econômica. CONCLUSÕES: a prevalência de sobrepeso é superior à de baixo peso, o qual se encontra abaixo dos índices identificados em outros municípios brasileiros. Menor número de refeições e classes econômicas mais elevadas apresentaram associação com o sobrepeso.<br>OBJECTIVES: to identify overweight incidence in adolescents as well as associated environmental, biological, social and economic factors in the municipality of Toledo, Paraná. METHODS: a cross sectional study was performed with adolescents enrolled in middle school aged 14 to 19 years old, in day classes of the urban area in the municipality. Body mass/age rates were used to diagnose the risk of overweight exposure. A pretested questionnaire was used to survey personal, anthropometric, biologic and life style related data such as: the use of TV, video and computer, practicing of sports and number of meals. To establish social and economic status the criterion used was that of the Economic Classification of Brazil from the National Survey Companies Association. RESULTS: 3.8% of the adolescents were underweight and 10.2% were overweight. A statistically significant association was determined for the incidence of overweight among adolescents who had four or more meals per day (5.5%) and among the ones who had up to three meals a day (16.3%). When stratifying overweight by classes of income, the overweight incidence rate had a tendency of decreasing as the economic class decreased. CONCLUSIONS: overweight prevalence is higher than underweight; the last is below the rates determined in other Brazilian municipalities. Less frequency of meals and higher income classes were associated to overweight