Interkulturelle Kommunikation im Krankenhaus: eine Fallstudie aus Italien

Ziel dieser Masterarbeit war es, die Kommunikation zwischen ausländischen PatientIn-nen und italienischen ÄrztInnen unter Berücksichtigung der Sprach-und Kulturbarrieren zu erforschen. Die Analyse dieser Interaktion erfolgte auf drei verschiedenen Ebenen: der gesetzlichen, der sprachlichen und der kulturellen. Zuallererst wurden die Migrationsströme und die infolgedessen getroffenen Maß-nahmen in Betracht gezogen, um die Zusammensetzung der Bevölkerung in Italien ins-besondere in der Lombardei zu bestimmen und die Anpassungen der italienischen Re-gierung festzustellen. Diese wurden später im Interview mit der Leiterin des Außenbü-ros des Krankenkauses besprochen, welches als Ausgangspunkt für weitere Recherchen diente. Im Gespräch mit der Leiterin wurde nicht nur auf die nationale Gesetzeslage, sondern auch auf die regionalen bzw. europäischen Initiativen wie das Projekt „Health Promoting Hospitals (HPH)“ eingegangen, in deren Mittelpunkt der Multikulturalismus und die Mehrsprachigkeit liegen. Um den kulturellen bzw. sprachlichen Herausforderungen gerecht zu werden, stellt das Krankenhaus seinem Personal verschiedene Kommunikationsmöglichkeiten zur Verfügung. Diese umfassen die Beiziehung einer Dolmetscherin bzw. eines Dol-metschers, die Unterstützung einer Kulturmittlerin bzw. eines Kulturmittlers und der Einsatz schriftlicher Hilfsmittel wie des Anamnesefragebogens. Um die Vorgehensweise der ÄrztInnen mit ausländischen PatientInnen zu beobachten, wurde eine einwöchige Feldstudie in der Notaufnahme dieses lombardischen Krankenhauses geplant. Die ge-wonnenen Daten zeigten, dass professionelle DolmetscherInnen nur selten beigezogen werden und erst, wenn sich der Patient bzw. die Patientin überhaupt nicht verständigen kann. LaiendolmetscherInnen werden in allen anderen Fällen bevorzugt, auch wenn die von ihnen vermittelte Kommunikation nicht immer reibungslos verläuft. Schriftliche Hilfsmittel werden viel seltener als professionelle DolmetscherInnen eingesetzt, da sie zeitaufwendig sind. Anhand der aufgenommenen bzw. beobachteten Arztgespräche konnte man fest-stellen, dass die Kommunikation hauptsächlich in vereinfachtem Italienisch mithilfe von einigen Gesprächsstrategien wie kurzen Sätzen, Verzicht auf Fachausdrücke, Re-formulierungen, Wiederholungen und Bestätigungselementen erfolgte. Dies verhinderte jedoch nicht das Auftreten von Schwierigkeiten und Missverständnissen, die Übermitt-lung überflüssiger Informationen und Unterbrechungen seitens der ÄrztInnen infolge des Themawechsels der PatientInnen, um das medizinische Gespräch wieder auf die richtige Bahn zu lenken. Der Analyse der gewonnenen Daten kann man entnehmen, dass die Kommunika-tion teilweise auch in vereinfachtem Italienisch bzw. mithilfe von LaiendolmetscherIn-nen möglich ist, obwohl der Verzicht auf professionelle Unterstützung des Öfteren ei-nen erhöhten Zeitaufwand verursacht, den man seitens des Krankenhauses allerdings zu vermeiden sucht.This Master’s thesis aims to analyse the communication process between Italian doctors and foreign patients with special consideration for linguistic and cultural barriers. The research has been carried out at several levels such as the legal, the linguistic and the cultural ones. First of all, migration flows are analysed in order to find out the composition of the Italian population especially in the Lombardy region, and migration laws are re-viewed to determine in which areas the Italian government has taken action. These sub-jects were discussed later in an interview with the director of external office of a hospi-tal in the Lombardy region. The information collected during the interview served as the starting-point for further research. Moreover regional and European initiatives which take multiculturalism and multilingualism into account, like the Health Promoting Hos-pitals Project (HPH), are discussed. In order to meet the cultural and linguistic challenges the Lombardian hospital promoted some of the above mentioned regional and European initiatives which enable doctors to engage professional interpreters, to be helped by cultural mediators and to use written communication aids such as medical history questionnaires. A field study was organised in the Lombardian hospital’s emergency room so as to observe the medical staff’s approach to communicating with foreign patients. The data gathered revealed that professional interpreters are primarily engaged when the patients’ language skills are so poor that they cannot communicate at all. Ad-hoc interpreters are preferred to professional ones even though the interaction did not always develop smoothly. Written communication aids are normally avoided because they are highly time-consuming. The conversations recorded and observed show that the communication developed above all in simple Italian with the help of some discourse strategies such as short sentences, avoidance of medical terms, reformulations, repetitions and the use of consent formulas. These expedients could not prevent some difficulties and misunderstandings, superfluous information and patients’ interruptions due to their sudden change of topic. The analysis of the data collected reveals that sometimes communication in simple Italian or with ad-hoc interpreters is possible although the absence of a professional interpreter often has an impact on the time requirements which doctors aim to reduce

Impact of tire debris on in vitro and in vivo systems

BACKGROUND: It is estimated that over 80% of respirable particulate matter (PM(10)) in cities comes from road transport and that tire and brake wear are responsible for the 3–7% emission of it. Data on the indicators of environmental impact of tire debris (TD), originated from the tire abrasion on roads, are extremely scarce, even though TD contains chemicals (zinc and organic compounds) which can be released in the environment. METHODS: TD particle morphology was analysed with SEM, TEM and FIB instruments. TD eluates and TD organic extracts were tested at dilution series on human cell lines and Xenopus laevis embryos. 50 and 100 g/L TD were used for the eluates obtained after 24 h at pH 3 and the quantity of zinc present was measured with a ICP-AES. Eluates diluted to 1%, 10%, 50% in culture media and undiluted were used on X. laevis embryos in the FETAX test. HepG2 cells were exposed for 24 h to 0.05 – 50 μg/ml of zinc salt while A549 cells were exposed for 24, 48 and 72 h to 10, 50, 60, or 75 μg/ml of TD extract. X. laevis embryos were exposed to 50, 80, 100, or 120 μg/ml TD extract. RESULTS: The solution of undiluted 50 g/L TD produced 80.2% mortality (p < 0.01) in X. laevis embryos and this toxic effect was three times greater than that produced by 100 g/L TD. Zn accumulation in HepG2 cells was evident after 4 h exposure. A549 cells exposed to TD organic extract for 72 h presented a modified morphology, a decrease in cell proliferation and an increase in DNA damage as shown by comet assay. The dose 80 μg/ml of TD extract produced 14.6% mortality in X. laevis embryos and 15.9% mortality at 120 μg/ml. Treatment with 80, 100, or 120 μg/ml TD organic extract increased from 14.8% to 37.8% malformed larvae percentages compared to 5.6% in the control. CONCLUSION: Since the amount of Zn leached from TD is related to pH, aggregation of particles and elution process, the quantity of TD present in the environment has to be taken into account. Moreover the atmospheric conditions, which may deeply influence the particle properties, have to be considered. The TD organic fraction was toxic for cells and organisms. Thus, because of its chemical components, TD may have a potential environmental impact and has to be further investigated

Ash leachates from some recent eruptions of Mount Etna (Italy) and Popocatépetl (Mexico) volcanoes and their impact on amphibian living freshwater organisms

Leaching experiments were carried out on fresh ash samples from Popocatépetl 2012, Etna 2011, and Etna 2012 eruptions, in order to investigate the release of compounds in both double-deionized and lake (Lake Ohrid, FYR of Macedonia) waters. The experiments were carried out using different grain sizes and variable stirring times (from 30 min to 7 days). Results were discussed in the light of changing pH and release of compounds for the different leachates. In particular, Etna samples induced alkalinization, and Popocatépetl samples induced acidification of the corresponding leachates. The release of different elements does not show correlation with the stirring time, with the measured maximum concentrations reached in the first hours of washing. General inverse correlation with grain size was observed only for Na+, K+, Cl-, Ca2+, Mg2+, SO2-4 , and Mn2+, while the other analysed elements show a complex, scattering relationship with grain size. Geochemical modelling highlights leachates' saturation only for F and Si, with Popocatépetl samples sometimes showing saturation in Fe. The analysed leachates are classified as undrinkable for humans on the basis of European laws, due to excess in F-, Mn2+, Fe, and SO2-4 (the latter only for Popocatépetl samples). Finally, the Etna 2012 and Popocatépetl leachates were used for toxicity experiments on living biota (Xenopus laevis). They are mildly toxic, and no significant differences exist between the toxic profiles of the two leachates. In particular, no significant embryo mortality was observed; while even at high dilutions, the leachates produced more than 20% of malformed larvae

Recovery ability of human adipose stem cells exposed to cobalt nanoparticles: outcome of dissolution

Aim: To demonstrate that cobalt nanoparticles doses are safe for use in humans and to understand the consequences of the particulate effects, which may persist inside the cells. Materials & methods: Human adipose stem cells were used. We evaluated cell recovery by viability test, morphology and ultrastructure using electronic and optical microscopy, while gene expression was assessed utilizing real-time PCR. Results: After exposure, most stem cells recovered their normal function. Co3O4-nanoparticles remained inside the cell for the entirety of the considered time. A slight modification of gene expression was observed in the exposed cells. Conclusion: After exposure to 100 M cobalt nanoparticles, most cells returned to normal function. Nanoparticle toxicity was due to ions released by dissolution as well as from the nanoparticles themselves

Role of air pollutants mediated oxidative stress in respiratory diseases

Airborne particulate (PM) components from fossil fuel combustion can induce oxidative stress initiated by reactive oxygen species (ROS) that are strongly correlated with airway inflammation and asthma. A valid biomarker of airway inflammation is fractionated exhaled nitric oxide (FENO). The oxidative potential of PM2.5 can be evaluated with the dithiothreitol (DTT) dosage, which represents both ROS chemically produced and intracellular ROS of macrophages. This correlates with quality indicators of the internal environment and ventilation strategies such as dilution and removal of airborne contaminants

Antibacterial, antibiofilm, and antiviral farnesol-containing nanoparticles prevent Staphylococcus aureus from drug resistance development

Multidrug antimicrobial resistance is a constantly growing health care issue associated with increased mortality and morbidity, and huge financial burden. Bacteria frequently form biofilm communities responsible for numerous persistent infections resistant to conventional antibiotics. Herein, novel nanoparticles (NPs) loaded with the natural bactericide farnesol (FSL NPs) are generated using high-intensity ultrasound. The nanoformulation of farnesol improved its antibacterial properties and demonstrated complete eradication of Staphylococcus aureus within less than 3 h, without inducing resistance development, and was able to 100% inhibit the establishment of a drug-resistant S. aureus biofilm. These antibiotic-free nano-antimicrobials also reduced the mature biofilm at a very low concentration of the active agent. In addition to the outstanding antibacterial properties, the engineered nano-entities demonstrated strong antiviral properties and inhibited the spike proteins of SARS-CoV-2 by up to 83%. The novel FSL NPs did not cause skin tissue irritation and did not induce the secretion of anti-inflammatory cytokines in a 3D skin tissue model. These results support the potential of these bio-based nano-actives to replace the existing antibiotics and they may be used for the development of topical pharmaceutic products for controlling microbial skin infections, without inducing resistance development.Peer ReviewedPostprint (published version

Development of a discontinuous Galerkin solver for the simulation of turbine stages

A high-order Discontinuous Galerkin (DG) solver is assessed in the computation of the flow through an Organic Rankine Cycle turbine nozzle and stage. The flow features are predicted with a RANS (Reynolds averaged Navier&shy;Stoke) approach and the k-log() turbulence model in a multi reference frame, where interfaces between fixed and rotating zones are treated with a mixing plane approach, and non reflecting boundary conditions are used. Primitive variables based on pressure and temperature logarithms are adopted to ensure non-negative thermodynamic variables at a discrete level. The fluid can be modeled with the polytropic ideal gas law and the Peng-Robinson equation of state

Milano summer particulate matter (PM10) triggers lung inflammation and extra pulmonary adverse events in mice

Recent studies have suggested a link between particulate matter (PM) exposure and increased mortality and morbidity associated with pulmonary and cardiovascular diseases; accumulating evidences point to a new role for air pollution in CNS diseases. The purpose of our study is to investigate PM10sum effects on lungs and extra pulmonary tissues. Milano PM10sum has been intratracheally instilled into BALB/c mice. Broncho Alveolar Lavage fluid, lung parenchyma, heart and brain were screened for markers of inflammation (cell counts, cytokines, ET-1, HO-1, MPO, iNOS), cytotoxicity (LDH, ALP, Hsp70, Caspase8-p18, Caspase3-p17) for a putative pro-carcinogenic marker (Cyp1B1) and for TLR4 pathway activation. Brain was also investigated for CD68, TNF-\u3b1, GFAP. In blood, cell counts were performed while plasma was screened for endothelial activation (sP-selectin, ET-1) and for inflammation markers (TNF-\u3b1, MIP-2, IL-1\u3b2, MPO). Genes up-regulation (HMOX1, Cyp1B1, IL-1\u3b2, MIP-2, MPO) and miR-21 have been investigated in lungs and blood. Inflammation in the respiratory tract of PM10sum-treated mice has been confirmed in BALf and lung parenchyma by increased PMNs percentage, increased ET-1, MPO and cytokines levels. A systemic spreading of lung inflammation in PM10sum-treated mice has been related to the increased blood total cell count and neutrophils percentage, as well as to increased blood MPO. The blood-endothelium interface activation has been confirmed by significant increases of plasma ET-1 and sP-selectin. Furthermore PM10sum induced heart endothelial activation and PAHs metabolism, proved by increased ET-1 and Cyp1B1 levels. Moreover, PM10sum causes an increase in brain HO-1 and ET-1. These results state the translocation of inflammation mediators, ultrafine particles, LPS, metals associated to PM10sum, from lungs to bloodstream, thus triggering a systemic reaction, mainly involving heart and brain. Our results provided additional insight into the toxicity of PM10sum and could facilitate shedding light on mechanisms underlying the development of urban air pollution related diseases

Consensus statement of the Italian society of pediatric allergy and immunology for the pragmatic management of children and adolescents with allergic or immunological diseases during the COVID-19 pandemic

The COVID-19 pandemic has surprised the entire population. The world has had to face an unprecedented pandemic. Only, Spanish flu had similar disastrous consequences. As a result, drastic measures (lockdown) have been adopted worldwide. Healthcare service has been overwhelmed by the extraordinary influx of patients, often requiring high intensity of care. Mortality has been associated with severe comorbidities, including chronic diseases. Patients with frailty were, therefore, the victim of the SARS-COV-2 infection. Allergy and asthma are the most prevalent chronic disorders in children and adolescents, so they need careful attention and, if necessary, an adaptation of their regular treatment plans. Fortunately, at present, young people are less suffering from COVID-19, both as incidence and severity. However, any age, including infancy, could be affected by the pandemic. Based on this background, the Italian Society of Pediatric Allergy and Immunology has felt it necessary to provide a Consensus Statement. This expert panel consensus document offers a rationale to help guide decision-making in the management of children and adolescents with allergic or immunologic diseases