Health literacy as the missing link in the provision of immigrant health care: A qualitative study of Southeast Asian immigrant women in Taiwan

ObjectivesLanguage and communication barrier are main contributors to poor health outcomes and improper use of health care among immigrants. The purpose of this study was to explore and understand specific language and communication problems experiences by Southeast Asian immigrant women in Taiwan.DesignThis qualitative study used focus groups and in-depth interviews to uncover the experiences of immigrant women regarding their access to and utilization of health care in Taiwan.ParticipantsEight focus groups were conducted with 62 Southeast Asian immigrant women and 23 individual in-depth interviews with a wide range of stakeholders who had diverse background and intimate knowledge of immigrant-relating health care issues were performed.ResultsDirected content analysis was applied and identified four major themes concerning conditions that influenced immigrant women's use of health information and services: (1) gaining access to health information, (2) navigating in health care delivery system, (3) interactions during health care encounters, and (4) capability of using health information and services. Findings from this study suggest that, without basic language and literate skills, the majority of immigrant women had inadequate health literacy to manage health information and navigate the Taiwan health care system. Interpersonal communication gap between immigrant women and health care providers exists because of lack of health literacy in addition al language and cultural barriers.ConclusionWith limited language and health literacy skills, immigrant women face numerous challenges in navigating the health care system, interacting with health care providers, and gaining access to proper health care. Future efforts are necessary to enhance individual's health literacy and establish health literate environment.     

Image-guided spine surgery: state of the art and future directions

Navigation technology is a widely available tool in spine surgery and has become a part of clinical routine in many centers. The issue of where and when navigation technology should be used is still an issue of debate. It is the aim of this study to give an overview on the current knowledge concerning the technical capabilities of image-guided approaches and to discuss possible future directions of research and implementation of this technique. Based on a Medline search total of 1,462 publications published until October 2008 were retrieved. The abstracts were scanned manually for relevance to the topics of navigated spine surgery in the cervical spine, the thoracic spine, the lumbar spine, as well as ventral spine surgery, radiation exposure, tumor surgery and cost-effectivity in navigated spine surgery. Papers not contributing to these subjects were deleted resulting in 276 papers that were included in the analysis. Image-guided approaches have been investigated and partially implemented into clinical routine in virtually any field of spine surgery. However, the data available is mostly limited to small clinical series, case reports or retrospective studies. Only two RCTs and one metaanalysis have been retrieved. Concerning the most popular application of image-guided approaches, pedicle screw insertion, the evidence of clinical benefit in the most critical areas, e.g. the thoracic spine, is still lacking. In many other areas of spine surgery, e.g. ventral spine surgery or tumor surgery, image-guided approaches are still in an experimental stage. The technical development of image-guided techniques has reached a high level as the accuracies that can be achieved technically meet the anatomical demands. However, there is evidence that the interaction between the surgeon (‘human factor’) and the navigation system is a source of inaccuracy. It is concluded that more effort needs to be spend to understand this interaction.     

心内膜三维重建及系统导航定位精度的基础研究

目的 基于低频电场方式对右心室进行三维重构,并对系统导航定位精度进行验证. 方法在实验动物猪体表粘贴三对皮肤电极,由此产生经胸空间正交的低频交流电场覆盖心脏区域,以普通导管电极在心腔内探测电场数据,对右心室心内膜进行三维重构,然后在重构模型的基础上,通过起搏右心室的方法对系统的导航定位精度进行验证. 结果 10例重构的右心室心内膜模型虽然存在变形.但结构相似,不影响导航定位.右心室起搏心电图显示即刻复位符合率100%,3h后复位符合率60%. 结论本方法重建右心室三维模型存在一定程度的形变,但导航定位精度高,即刻重复性好.     

黄芩苷对温敏凝胶的模板作用及其形态和性能功能

以黄酮类化合物黄芩苷作为功能单体,在二甲基甲酰胺溶液中制备得到不同黄芩苷含量的聚异丙基丙烯酰胺水凝胶。通过红外、紫外、扫描电镜和热分析等方法研究了所得凝胶的结构、形态、温敏性和力学性能。结果表明：黄芩苷的加入导致聚合凝胶由无色变为黄色,所得凝胶孔壁出现褶皱,孔洞尺寸随黄芩苷含量的增加而增加。黄芩苷在凝胶基体中主要起到模板作用,它的引入并未改变纯凝胶的体积相转变温度(VPTT）,VPTT仍保持在32~34 °C,但温度敏感性能得到了明显改善,同时改善了纯凝胶的溶胀度和温度脉冲响应性,提高了储能模量。     

快速成型胸椎个体化导航模板精确度实验研究

目的：观察快速成型胸椎个体化导航模板的精确度,为快速成型个体化导航模板的临床使用提供参考。方法：选取12个完整的胸椎干燥骨标本,根据其CT扫描资料,利用计算机辅助设计及快速成型技术设计制作出相应的胸椎模型及个体化导航模板,通过个体化导航模板在胸椎标本及其模型上应用直径2．0mm的钻头模拟椎弓根螺钉置钉手术,直视观察钻头在椎弓根及椎体内的位置及走行方向。用精确度为0．02mm的游标卡尺对快速成型胸椎模型的精确性进行测量。结果：个体化导航模板和相应的胸椎标本及其模型后部解剖结构之间轮廓一致,贴附吻合良好,置入椎弓根进钉通道的钻头均完全位于椎弓根及椎体内,其走行方向和椎弓根的走行方向一致;所有胸椎模型和相应胸椎标本的解剖形态完全一致,胸椎标本和模型之间的误差范围在（0．49±0．28）mm之间。结论：虽然快速成型模型与实物之间有一定的误差,但其误差不影响对椎弓根准确定位及定向的精度要求。     

模板DNA质量对单核苷酸多态性分析的影响

目的探索在单核苷酸多态性分析中模板DNA质量对实验的影响以及提高模板DNA质量的途径。方法用PCR—RFLP法研究SNPrs1024611（G／A）的基因分型,从样本保存方式、保存时间及DNA提取方法三方面进行对比实验,观察其对模板DNA质量及SNP分析的影响。结果从抗凝血中提取DNA模板的得率比非抗凝血高,在SNP分析中,EDTA抗凝血效果最好、肝素抗凝血效果不好;基因组DNA在全血中的有效保存时间比提纯的DNA有效时间长;试剂盒法提取DNA的得率和纯度均高于传统的酚-氯仿法。结论可通过以下途径提高SNP研究中DNA模板的质量：采集血样用EDTA抗凝、分装成小份在-20℃冻存,避免反复冻融。使用前在37℃水浴中快速解冻,用试剂盒法提取DNA更适合于SNP的研究,提取的模板DNA要及时实验或分装后冻存于-20℃,若需长期保存模板DNA,保存全血优于保存纯化的DNA。     

Navigational expertise may compromise anterograde associative memory

Grey matter volume increases have been associated with expertise in a range of domains. Much less is known, however, about the broader cognitive advantages or costs associated with skills and their concomitant neuroanatomy. In this study we investigated a group of highly skilled navigators, licensed London taxi drivers. We replicated findings from previous studies by showing taxi drivers had greater grey matter volume in posterior hippocampus and less grey matter volume in anterior hippocampus compared to matched control subjects. We then employed an extensive battery of tests to investigate the neuropsychological consequences of being a skilled taxi driver. Their learning of and recognition memory for individual items was comparable with control subjects, as were working memory, retrograde memory, perceptual and executive functions. By contrast, taxi drivers were significantly more knowledgeable about London landmarks and their spatial relationships. However, they were significantly worse at forming and retaining new associations involving visual information. We consider possible reasons for this decreased performance including the reduced grey matter volume in the anterior hippocampus of taxi drivers, similarities with models of aging, and saturation of long-term potentiation which may reduce information-storage capacity.     

Developmental topographical disorientation: case one

Topographical disorientation is the inability to orient within the environment, usually acquired from lesions to different cerebral regions participating in the attentional, perceptual or memory functions involved during navigation. We present the first case of a patient with topographical disorientation in the absence of any structural lesion and with intact sensory and intellectual function. Experimental tests in both real and virtual environments revealed a selective impairment in forming a mental representation of the environment, namely a cognitive map. Consistent with the patient's behavioural findings, a functional magnetic resonance imaging (fMRI) study showed lack of activation in the hippocampal complex and the retrosplenial cortex while forming a cognitive map of the environment. Although the lack of neural activity results in a negative finding that generally has low interpretative value, in this specific case our findings may provide useful information. First, in a group of healthy control subjects performing the same task, activity within the hippocampal complex and retrosplenial cortex were detected in each individual participant. Second, we found that within the same regions (showing lack of neural activity while forming a cognitive map of the environment) increased neural activity was detected while the patient was performing a different navigation task. This case is the first evidence reported in the literature showing that topographical disorientation may occur as a developmental defect causing a lifelong disorder affecting daily activities.     

真皮组织微观化重建的探索性研究

目的 从微观角度探讨真皮基质三维结构对Fb生物学行为的影响.方法 借鉴平面几何、三角函数分析真皮组织三维结构,按照真皮组织由黏附成分和非黏附成分组成的原理,通过计算机辅助设计不同参数具有细胞黏着作用的点状结构阵列;运用微图案印刷和分子自组装法,建立4种(8μm×3 μm、间距6 μm,16 μm×3μm、间距6 μm,16 μm×5μm、间距8 μm,20 μm×3 μm、间距2 μm)具有细胞黏附点的桥墩样结构阵列细胞培养基质(MPGCC)培养人Fb,以无MPGCC培养的Fb为对照.利用免疫组织化学、荧光免疫组织化学、噻唑蓝法、羟脯氨酸含量测定法,检测培养Fb中骨架蛋白α-平滑肌肌动蛋白(α-SMA)表达、细胞活力和细胞分泌情况.结果 数学推导结果提示,真皮组织三维结构可用MPGCC进行模拟.用上述4种规格MPGCC培养的Fb其α-SMA表达百分率依次为(49±3)%、(61±3)%、(47±4)%、(51±3)%,与对照组(12±3)%比较,差异有统计学意义(P<0.05);Fb活力依次为0.12±0.03、0.13±0.04、0.14±0.03、0.19±0.03,与对照组0.35±0.04比较显著下降(P<0.05);羟脯氨酸含量依次为(0.95±0.04)、(0.87±0.03)、(0.81±0.03)、(0.77±0.03)μg/mg,与对照组(0.53±0.03)μg/mg比较显著上升(P<0.05).通过调整桥墩角度和桥墩间阵列参数,4组阵列相互对比,α-SMA表达、细胞活力和羟脯氨酸含量差异均有统计学意义(P<0.05).结论 MPGCC可能是真皮模板的基本功能单位或称为真皮模板单元,不同的真皮组织三维环境可产生不同的模板效应和创面愈合结局.     

黏着斑微操控在创伤和组织修复中的作用

目的 探讨真皮模板单元-黏着斑微操控制对皮肤成纤维细胞生物学行为影响. 方法 采用微图案方法制作微凸阵列,运用分子自组装在微凸上自组装结构蛋白分子,在自制细胞培养仪模拟皮肤生物力学进行细胞牵拉2周,并行形态学观察和细胞免疫组织化学分析. 结果 细胞牵拉2周后,细胞形态多样、丰满,分泌增加,呈现顺应性.细胞免疫组织化学分析发现,整合素β1、α5表达较对照显著减少,张力蛋白tensin表达显著降低. 结论 通过黏着斑微操控,增生性瘢痕成纤维细胞在形态学及生物学行为上发生改变.