Interpreting practices in a psychiatric hospital : interpreters' experiences and accuracy of interpreting of key psychiatric terms

Thesis (MA (Psychology))--University of Stellenbosch, 2007.The main objective of this study was to investigate interpreting practices within the psychiatric hospital San Marco1, in the Western Cape. More specifically, the aim was to determine what factors might lead to the obstruction of accuracy by asking employees that act as official and unofficial interpreters to report on certain issues relating to interpreting practices. The second objective of the study was to gain some understanding of what interpreters experience when doing interpreting especially since unofficial interpreters (nurses, cleaners and administrative staff) are often used to act as interpreters within South Africa’s public health services and this may not only have implications for accuracy but also for interpreters’ own mental health. A cross-sectional qualitative interview design was used. The research participants consisted of eight employees of San Marco, (including two administrative clerks/ interpreters, two bilingual security guards, and four bilingual nurses), and two bilingual psychiatrists, who, though not being employees of San Marco, yet have experience in interpreting while working as psychiatrists within psychiatric institutions in South Africa. Participants were asked to respond to semi-structured questions. In addition, participants took part in a structured task in which they were asked to translate and back-translate commonly-used diagnostic questions. Content analysis was used to analyse data collected from semi-structured interviews and participants’ translations and back-translations were checked for inaccuracies. The analysis of interviews revealed the following information: • not all of the participants who act as interpreters are in fact functionally bilingual in the context with which they work • none of the interpreters are trained in interpreting; and • a clear distinction could be drawn between interpreters who have training in mental health compared to those who lack training in mental health or psychiatry. Furthermore participants’ translations of the nine questions were approximately right. Participants’ translations conveyed more or less the same messages as what was intended with the original English questions. In fact the translations were fairly accurate for untrained interpreters. However, participants were not always specific as to what they were asking about. Interpreters need to translate questions in such a way that it is diagnostically specific in order for the clinician to make an accurate diagnosis. It is crucial that patients have a clear understanding about what the interpreter are asking them and this was not always evident in participants’ translations. The abovementioned results may for obvious reasons lead to the obstruction of accurate interpretation however it should not be attributed to a lack of competence on the interpreters part but should rather be attributed to challenges in a health system which has inherited a history of discrimination and continues to discriminate against certain patients, even when clinicians and interpreters alike may be doing their best not to discriminate. The problem is structural rather than individual, and needs to be addressed as such, and in the context of competing demands in public health care. Although the interviews did reveal valuable information regarding the obstruction of accuracy it should be kept in mind that an analysis of actual recorded interpreting sessions between the clinician, patient and interpreter is necessary for a more in depth understanding of the obstruction of accuracy as investigated in this study and such a study is currently in the planning phase

Sleep quality and neurocognitive functioning in metabolic syndrome

Background: The incidence of metabolic syndrome (MetS), a cluster of metabolic risk factors in a single individual, is increasing worldwide, making it important to study the possible risk and protective factors. Accumulating evidence has suggested sleep deprivation and/or fragmentation is among the key factors involved in the onset and treatment resistance of MetS components. Moreover, bidirectional associations between sleep complaints and MetS have been described. In addition, there is mounting evidence of the effect of MetS on cognitive functioning. Aims: The aim of this study was to assess whether MetS and sleep complaints are associated with clinically determined neurocognitive disturbances in a sample of participants with MetS symptoms, ranging from none to all criteria met. Methods: Participants comprised 153 mixed race individuals from the Western Cape province of South Africa. Sleep (Pittsburgh Sleep Quality Index), neurocognition (Repeatable Battery for the Assessment of Neuropsychological Status) and anthropometric (MetS components) assessments were performed on all participants. A hierarchical regression model, including potentially confounding variables (e.g. IQ), demographic variables (e.g. age and gender) and clinical variables (e.g. [BMI] and cholesterol), was then constructed. Results: The model was significant: adjusted R square = 0.486; F(13, 110) = 9.952, p < 0.0001. The demographic variables accounted for 32.3% of variability. This increased to 48.5% when the clinical variables were added. Sleep and metabolic criteria only added 0.1%. Discussion: Although we did not find sleep and metabolic factors to significantly influence cognition when other factors were accounted for, further investigation into risk and outcome factors, such as these, may assist in the identification of mechanistic links, which may also improve management of patients who are at risk, thereby improving health outcomes

Associations of premorbid adjustment with type and timing of childhood trauma in first-episode schizophrenia spectrum disorders

CITATION: Smit, A. M. et al. 2021. Associations of premorbid adjustment with type and timing of childhood trauma in first-episode schizophrenia spectrum disorders. South African Journal of Psychiatry, 27:a1639, doi:10.4102/sajpsychiatry.v27i0.1639.The original publication is available at https://sajp.org.zaBackground: Childhood trauma may contribute to poorer premorbid social and academic adjustment which may be a risk factor for schizophrenia. Aim: We explored the relationship between premorbid adjustment and childhood trauma, timing of childhood trauma’s moderating role as well as the association of clinical and treatment-related confounders with premorbid adjustment. Setting: We conducted a secondary analysis in 111 patients with first-episode schizophrenia (FES) disorders that formed part of two parent studies, EONKCS study (n =73) and the Shared Roots study (n =38). Methods: Type of childhood trauma was assessed with the Childhood Trauma Questionnaire, short-form and premorbid adjustment using the Premorbid Adjustment Scale. Timing of childhood trauma was assessed using the Life Events Checklist and life events timeline. Linear regression analyses were used to assess the moderating effect of timing of childhood trauma. Clinical and treatment-related confounders were entered into sequential hierarchical regression models to identify independent predictors of premorbid adjustment across key life stages. Results: Childhood physical neglect was associated with poorer premorbid academic functioning during childhood and early adolescence, and poorer premorbid social functioning during early and late adolescence. By hierarchical regression modelling (r2 = 0.13), higher physical neglect subscale scores (p = 0.011) independently predicted poorer premorbid social adjustment during early adolescence. Timing of childhood trauma did not moderate the relationship between childhood trauma and premorbid functioning. Conclusion: In patients with FES, childhood physical neglect may contribute to poorer premorbid social functioning during early adolescence. This may provide us with an opportunity to identify and treat at-risk individuals earlier.https://sajp.org.za/index.php/sajp/article/view/1639Publisher's versio

A multi-objective genetic algorithm for optimisation of energy consumption and shop floor production performance

Increasing energy price and requirements to reduce emission are new chal-lenges faced by manufacturing enterprises. A considerable amount of energy is wasted by machines due to their underutilisation. Consequently, energy saving can be achieved by turning off the machines when they lay idle for a comparatively long period. Otherwise, turning the machine off and back on will consume more energy than leave it stay idle. Thus, an effective way to reduce energy consumption at the system level is by employing intelligent scheduling techniques which are capable of integrating fragmented short idle periods on the machines into large ones. Such scheduling will create opportunities for switching off underutilised resources while at the same time maintaining the production performance. This paper introduces a model for the bi-objective optimisation problem that minimises the total non-processing electricity consumption and total weighted tardiness in a job shop. The Turn off/Turn on is applied as one of the electricity saving approaches. A novel multi-objective genetic algorithm based on NSGA-II is developed. Two new steps are introduced for the purpose of expanding the solution pool and then selecting the elite solutions. The research presented in this paper is focused on the classical job shop envi-ronment, which is widely used in the manufacturing industry and provides considerable opportunities for energy saving. The algorithm is validated on job shop problem instances to show its effectiveness. Keywords: Energy efficient production plannin

Factors moderating the relationship between childhood trauma and premorbid adjustment in first-episode schizophrenia

CITATION: Kilian, S. et al. 2017. Factors moderating the relationship between childhood trauma and premorbid adjustment in first-episode schizophrenia. PLoS ONE, 12(1):e0170178, doi:10.1371/journal.pone.0170178.The original publication is available at http://journals.plos.org/plosoneChildhood trauma is a recognised risk factor for schizophrenia. It has been proposed that childhood trauma interferes with normal neurodevelopment, thereby establishing a biological vulnerability to schizophrenia. Poor premorbid adjustment is frequently a precursor to schizophrenia, and may be a manifestation of neurodevelopmental compromise. We investigated the relationship between childhood trauma and premorbid adjustment in 77 patients with first-episode schizophrenia spectrum disorders. We also investigated possible mediating roles for other selected risk factors in the relationship. We found several significant correlations between different trauma types and both social and academic premorbid adjustment from childhood to late adolescence. There were no significant moderating effects for family history of schizophrenia or family history of psychiatric disorder. History of obstetric complications, substance abuse and poor motor coordination weakened some of the associations between childhood trauma and premorbid adjustment, while poor sequencing of motor acts strengthened the association. Our results confirm previous studies indicating an association between childhood trauma and premorbid adjustment. Results indicate a general rather than specific association, apparent with different types of trauma, and affecting both social and academic components of premorbid adjustment across childhood, early and late adolescence. Further, our results suggest a complex interplay of various risk factors, supporting the notion of different pathways to psychosis.http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0170178Publisher's versio

Interpreting practices in a psychiatric hospital : interpreters' experiences and accuracy of interpreting of key psychiatric terms

Thesis (MA (Psychology))--University of Stellenbosch, 2007.The main objective of this study was to investigate interpreting practices within the psychiatric hospital San Marco1, in the Western Cape. More specifically, the aim was to determine what factors might lead to the obstruction of accuracy by asking employees that act as official and unofficial interpreters to report on certain issues relating to interpreting practices. The second objective of the study was to gain some understanding of what interpreters experience when doing interpreting especially since unofficial interpreters (nurses, cleaners and administrative staff) are often used to act as interpreters within South Africa’s public health services and this may not only have implications for accuracy but also for interpreters’ own mental health. A cross-sectional qualitative interview design was used. The research participants consisted of eight employees of San Marco, (including two administrative clerks/ interpreters, two bilingual security guards, and four bilingual nurses), and two bilingual psychiatrists, who, though not being employees of San Marco, yet have experience in interpreting while working as psychiatrists within psychiatric institutions in South Africa. Participants were asked to respond to semi-structured questions. In addition, participants took part in a structured task in which they were asked to translate and back-translate commonly-used diagnostic questions. Content analysis was used to analyse data collected from semi-structured interviews and participants’ translations and back-translations were checked for inaccuracies. The analysis of interviews revealed the following information: • not all of the participants who act as interpreters are in fact functionally bilingual in the context with which they work • none of the interpreters are trained in interpreting; and • a clear distinction could be drawn between interpreters who have training in mental health compared to those who lack training in mental health or psychiatry. Furthermore participants’ translations of the nine questions were approximately right. Participants’ translations conveyed more or less the same messages as what was intended with the original English questions. In fact the translations were fairly accurate for untrained interpreters. However, participants were not always specific as to what they were asking about. Interpreters need to translate questions in such a way that it is diagnostically specific in order for the clinician to make an accurate diagnosis. It is crucial that patients have a clear understanding about what the interpreter are asking them and this was not always evident in participants’ translations. The abovementioned results may for obvious reasons lead to the obstruction of accurate interpretation however it should not be attributed to a lack of competence on the interpreters part but should rather be attributed to challenges in a health system which has inherited a history of discrimination and continues to discriminate against certain patients, even when clinicians and interpreters alike may be doing their best not to discriminate. The problem is structural rather than individual, and needs to be addressed as such, and in the context of competing demands in public health care. Although the interviews did reveal valuable information regarding the obstruction of accuracy it should be kept in mind that an analysis of actual recorded interpreting sessions between the clinician, patient and interpreter is necessary for a more in depth understanding of the obstruction of accuracy as investigated in this study and such a study is currently in the planning phase

Interpreting within a South African psychiatric hospital : a detailed account of what happens in practice

Thesis (PhD)--Stellenbosch University, 2013.ENGLISH ABSTRACT: It is more than 18 years since South Africa became a democratic country. However, many South Africans are still discriminated against when accessing state services, such as healthcare services (Drennan, 1999). The problem is that healthcare practitioners, in the higher positions of the healthcare system, are commonly made up of professionals who speak only one or at most two of South Africa’s official languages (Swartz, 1998). Due to the lack of funding ad hoc arrangements are made for interpreter-services (Drennan, 1999). Anyone available that can speak even a fragment of the patient’s language, such as nurses, household aides and security guards are called to act as interpreters (Drennan, 1999; Smith, 2011). In many clinical settings, although not ideal, it is possible to treat patients even if there are minimal shared communicative resources (Anthonissen & Meyer, 2008). However, in psychiatric care, language is the primary diagnostic tool, and is one of the central instruments through which patients voice their symptoms (Westermeyer & Janca, 1997). In the Western Cape (one of the nine provinces in South Africa), clinicians working in psychiatric care are mainly fluent in English and Afrikaans. Many Black isiXhosa-speaking patients are not proficient in these languages. The aim of this dissertation is to gain a better understanding of the language barriers facing isiXhosa-speaking patients by focusing on natural conversations, which take place during psychiatric interviews within a particular psychiatric institution in the Western Cape. I made video-recordings of interpreter-mediated psychiatric interviews (n=13) as well as psychiatric interviews (n=12) conducted without the use of an interpreter. In addition, I had discussions (i.e. through semi-structured interviews) with registrars, interpreters and patients to understand their views about issues related to language barriers and interpreting practices. I used an ethnographic approach and the method of Conversation Analysis to understand the study findings. The findings, derived from the psychiatric interviews that were not interpreter-mediated, suggest that the Limited English Proficient (LEP) patients had great difficulty communicating with the registrars. The findings (emerging from the interpreter-mediated encounters and semi-structured interviews), strongly suggest that the haphazard use of hospital employees, who are not trained and employed to act as interpreters, have a significant impact on the goals of the psychiatric interview. In some instances, the use of ad hoc interpreters positively contributed to the successful achievement of the goals of the psychiatric interview. In most instances, the use of ad hoc interpreters inhibited the successful achievement of the goals of the psychiatric interview. One of the most significant findings was that interpreters’ interpretations of patients’ words at times suggest that patients appear to be more psychiatrically ill (increasing the risk for over-diagnosis) than it appears when looking at patients’ original responses. In essence, the lack of language services is unjust towards patients, clinicians, hospital staff acting as ad hoc interpreters, and LEP patients caught in a system, which construct them as voiceless, dependent, powerless, healthcare users.AFRIKAANSE OPSOMMING: Suid-Afrika is vir die afgelope 18 jaar `n demokratiese land, maar ongeag die afskaffing van apartheid word daar steeds teen baie Suid-Afrikaners gediskrimineer. Dit is veral die geval wanneer Suid-Afrikaners gebruik maak van gesondheidsdienste (Drennan, 1999). Baie gesondheidspraktisyne of dokters is alleenlik vaardig in een of op die meeste twee offisiële Suid-Afrikaanse tale (Swartz, 1998). Ongelukkig weens `n gebrek aan fondse, is die meeste hospitale nie instaat om amptelike tolke in diens te neem nie. Gevolglik word ad hoc reëlings getref wanneer pasiënte tolkdienste benodig. Gewoonlik word enige iemand, insluitende verpleegsters, skoonmakers en sekuriteitswagte, wat selfs net tot `n sekere mate die pasiënt se taal kan praat, gebruik as tolke (Drennan, 1999; Smith, 2011). Die gebrek aan tolkdienste is veral problematies wanneer dit kom by psigiatriese dienste. Dit is omdat in psigiatrie word taal en kommunikasie as primêre diagnostiese instrument gebruik, en pasiënte gebruik hoofsaaklik taal om hul simptome en ervaringe met die dokter mee te deel (Westermeyer & Janca, 1997). In die Wes-Kaap (een van Suid-Afrika se nege provinsies) is die meeste dokters wat in psigiatriese instansies werk hoofsaaklik Engels en / of Afrikaans-sprekend. Baie Swart isiXhosa-sprekende pasiënte, wat gebruik maak van psigiatriese staatsdienste, is egter nie vlot in Afrikaans en Engels nie. Die doel van my proefskrif is om hierdie probleem, wat baie siXhosa-sprekende pasiënte in die gesig staar, beter te verstaan. Ek het besluit om dit te doen deur te fokus op `n spesifieke aspek – natuurlike gesprekke tussen dokters en isiXhosa-sprekende pasiënte. Dokters en pasiënte kommunikeer onder andere gedurende psigiatriese onderhoude, en ek het besluit om video opnames van psigiatriese onderhoude te maak. Ek het die video opnames in `n spesifieke hospitaal in die Wes-Kaap gemaak. Die video opnames het ingesluit psigiatriese onderhoude (n=12) waarin die dokter en pasiënt in Engels kommunikeer, sowel as onderhoude (n=13) waarin die dokter en pasiënt deur middel van (d.m.v) `n ad hoc tolk kommunikeer. Ek het ook gesprekke gevoer (deur middel van semi-gestruktureerde onderhoude) met pasiënte, dokters, en ad hoc tolke om hulle insigte en opinies rakende die bogenoemde taalkwessies beter te verstaan. Verder het ek `n ethnografiese benadering en gespreksanaliese gebruik om die data te benader en verstaan. Die bevindinge wat voortgevloei het uit die psigiatriese onderhoude (beide waarin daar nie `n tolk gebruik was nie, sowel as die waarin daar `n tolk gebruik was) suggereer dat die gebrek aan tolkdienste dikwels die doel van psigiatriese onderhoud ondermyn. Dit komvoor dat in die psigiatriese onderhoude, waarin daar nie tolk gebruik was nie, die pasiënte dit baie moeilik gevind het om met die dokters in Engels te kommunkeer. Dit is waarskynlik omdat hulle nie oor die nodige taalvaardighede beskik om hulleself ten volle in Engels uit te druk nie. Dit kom wel voor dat in sommige gevalle gedurende die psigiatriese onderhoude, waarin die dokters en pasiënte d.m.v.`n tolk gekommunikeer het, het die gebruik van `n tolk `n positiewe impak gehad. Die probleem is egter dat in baie gevalle het dit geblyk het die gebruik van tolke `n ongewenste impak gehad. Een van die belangrikste voorbeelde hiervan is dat die tolke se weergawes van die pasiënte se woorde, dit dikwels laat voorkom asof pasiënte nie juis veel insig in hulle psigiatriese versteurings gehad het nie. Wanneer daar egter gekyk word na die pasiënte se oorspronklike weergawes is dit duidelik dat sommige pasiënte wel insig gehad het. Die bevindinge suggereer hoofsaaklik dat die gebrek aan offisieel en opgeleide tolkdienste onregverdig is teenoor die pasiënte, ad hoc tolke, en die dokters. Dit dra ook by tot `n gesondsheids-sisteem waarin isiXhosa-sprekende pasiënt uitgebeeld word as afhanklik, tot `n groot mate magteloos en sonder `n sê