Effects of nutritional services to pregnant mothers on the school performance of treated and untreated children

The school performance of children whose mothers received nutritional services from the Montreal Diet Dispensary during their pregnancy and who were delivered at the Royal Victoria Hospital, Montreal, is evaluated using standardized achievement tests. The treated subjects' scores are compared with those of a retrospectively matched control group and with those of next older and next younger siblings. Results are reported for 845 children representing 96% of those traced and eligible. These comprise 406 cases, 153 siblings and 286 controls. Since the children attended either English or French schools, test results were divided by language of instruction. Among those in the English schools, all scores are lower for those in the treated group (‘cases’) and the differences on the reading sub-test are statistically significant. In the French schools a similar trend is noted, although none of the results is significant. It is concluded that overall there is no measurable beneficial effect of this intervention in terms of school performance.     

The SOL formulas for converting SMOG readability scores between health education materials written in Spanish, English, and French

The SMOG formula is widely used to determine how easy written health education materials are to read and comprehend. This study was conducted to assess whether the SMOG formula, originally developed and tested in English, was also valid for texts written in Spanish and French. Readability scores from a sample of passages written in Spanish, English, and French were analyzed. Study results showed that the SMOG formula seemed to be consistent in measuring readability in the three languages. However, SMOG scores varied from language to language. Two hypotheses are being laid out to explain these results. First, the SMOG equation is systematically biased for texts in Spanish or French. Second, English is more readable than French, and French is more readable than Spanish. Under the assumption of a systematic bias in the SMOG formula, the so-called SOL formulas are presented here to convert SMOG scores between Spanish, English, and French. In addition, a new scale for grading reading difficulty is proposed based on SMOG scores obtained from classical literature. This is important to the extent that it will provide Spanish speaking and French speaking health communicators with a readability formula for preparing written materials appropriate to the level of comprehension of specific target audiences.     

The SOL Formulas for Converting SMOG Readability Scores Between Health Education Materials Written in Spanish,English, and French

The SMOG formula is widely used to determine how easy written health education materials are to read and comprehend. This study was conducted to assess whether the SMOG formula, originally developed and tested in English, was also valid for texts written in Spanish and French. Readability scores from a sample of passages written in Spanish, English, and French were analyzed. Study results showed that the SMOG formula seemed to be consistent in measuring readability in the three languages. However, SMOG scores varied from language to language. Two hypotheses are being laid out to explain these results. First, the SMOG equation is system atically biased for texts in Spanish or French. Second, English is more readable than French, and French is more readable than Spanish. Under the assumption of a systematic bias in the SMOG formula, the so-called SOL formulas are presented here to convert SMOG scores between Spanish, English, and French. In addition, a new scale for grading reading difficulty is proposed based on SMOG scores obtained from classical literature. This is important to the extent that it will provide Spanish speaking and French speaking health communicators with a readability formula for preparing written materials appropriate to the level of comprehension of specific target audiences.     

Discontinuity in the Health Care Financing Administration's published standardized mortality ratios due to underestimation bias across multiple admissions case selection methods

Case counts below 50 can compromise the careful use of disease- or procedure-specific standardized mortality ratio comparisons across small hospitals in predominantly rural areas. Linking data series where data are of the same quality and are continuous across the series is one way of handling the problem of small case sizes. Examination of three different annual reports of Health Care Financing Administration (HCFA) mortality findings for 1987 of one state's providers showed significantly lower actual and predicted mortality rates reported in 1989, compared with the same mortality rates reported about 1987 published in 1988 and 1987. One hypothesis for the downward trend is the change in case selection method used for constructing the mortality model from last discharge (used in 1987 and 1988 reports) to random selection of cases with multiple admissions (initiated in 1989). A test of both case selection methods is presented and shows the consequences of mortality model changes that create discontinuities with previously reported findings, changes that limit or at least need to be taken into account when linking current HCFA mortality data series with historic series.     

Limited English proficiency and breast and cervical cancer screening in a multiethnic population

OBJECTIVES: We examined the relationship between ability to speak English and receipt of Papanicolaou tests, clinical breast examinations, and mammography in a multiethnic group of women in the United States. METHODS: We used longitudinal data from the Study of Women Across the Nation to examine receipt of breast and cervical cancer screening among Chinese, Japanese, Hispanic, and White women who reported reading and speaking (1) only a language other than English, (2) another language more fluently than English, or (3) only English or another language and English with equal fluency. Logistic regression was used to analyze the data. RESULTS: Reading and speaking only a language other than English and reading and speaking another language more fluently than English, were significantly and negatively associated with receipt of breast and cervical cancer screening in unadjusted models. Although these findings were attenuated in adjusted models, not speaking English well or at all remained negatively associated with receipt of cancer screening. CONCLUSIONS: These findings suggest that language barriers contribute to health disparities by impeding adequate health communication.     

Comparison of French and English versions of the American Thoracic Society respiratory questionnaire in a bilingual working population

Standardized French and English versions of the American Thoracic Society (ATS) respiratory disease questionnaire were administered to 204 English-speaking and 406 French-speaking male blue-collar aviation workers unexposed to occupational respiratory hazards. After adjusting for smoking status, age, years of education, foreign birth and maternal language other than French or English, no significant differences between the two questionnaires were found for response rates to usual cough, usual phlegm, mild or moderate dyspnoea, and chronic bronchitis. French-speaking workers reported significantly less wheeze with colds (OR = 0.60, p less than 0.02) and wheeze apart from colds (OR = 0.55, p less than 0.05) than the English-speaking group, but, the occurrence of wheeze on most days or nights was similar for both groups (OR = 1.02, NS). For 66 bilingual workers who completed both French and English questionnaires at a time interval of approximately two months, highly consistent results were found for sociodemographic data, smoking habits, cough, phlegm, breathlessness and chronic bronchitis, but not for wheeze with or apart from colds (agreement less than 90%; Kappa less than 0.50). These results reflect the difficulties in translating the concept of 'wheeze' from English to French. We conclude that most symptoms elicited by the French questionnaire may be generalized to English-speaking populations, but that questions pertaining to wheeze on most days or nights may be preferable to other questions concerning wheeze.     

Comparison of the HA genes of type B influenza viruses in herald waves and later epidemic seasons.

From January 1985 to May 1991, herald strains of influenza B virus were isolated in 1987 and 1989 in Japan. In both cases, influenza epidemics caused by the same type followed in the next winter season. The HA gene sequences of the influenza B viruses isolated in Japan from 1987-91, which covers two herald waves of influenza B viruses, were analysed and located on the phylogenetic tree for influenza B viruses after the B/Singapore/64 strain. Co-circulation of at least two evolutionary lineages of the HA genes existed for influenza B viruses in Japan during the period of this study. The herald viruses in one wave (1987) were genetically close to the winter isolates and were considered to be the parental viruses for the following influenza season, while in the other wave (1989) winter isolates belonged to another lineage on which one of the herald viruses was located, but they were genetically and antigenically different from the herald viruses.     

Language background,English language proficiency and medical communication skills of medical students

Associations between language background, English language proficiency and medical communication skills were investigated in a group of 149 third year undergraduate medical students studying at an Australian university. Written and aural English proficiency were assessed with the Screening Test for Adolescent Language (STAL). Medical communication skills and the fluency of spoken language were scored during an Observed Structured Clinical Interview (OSCI), rated by a standardized patient and a clinician. An association was found between language background, performance on the STAL and spoken language proficiency. Satisfactory performance in medical communication skills was not associated with language background or overall performance on the STAL. In this study it was the global rating of unsatisfactory spoken language fluency that was associated with poorer performance in medical communication skills under examination conditions.     

International Development of the Patient-Reported Outcome Indices for Multiple Sclerosis (PRIMUS)

BackgroundThe Patient-Reported Indices for Multiple Sclerosis (PRIMUS) comprises a suite of three scales for assessing symptoms, activity limitations, and quality of life in multiple sclerosis (MS). It was developed in the UK and has been shown to have excellent psychometric properties. This study describes the adaptation of eight language versions for Canadian English, Canadian French, French, German, Italian, Spanish, Swedish, and US English.MethodsThe PRIMUS was translated using the dual-panel process. Cognitive debriefing interviews conducted with MS patients assessed face and content validity. Psychometric and scaling properties were assessed via a two-administration postal survey conducted in each country involving the PRIMUS, the Nottingham Health Profile (NHP), the Unidimensional Fatigue Impact Scale (U-FIS), and demographic questions.ResultsCognitive debriefing interviews demonstrated the acceptability of the new language versions. Analysis of survey data showed that the new language versions of the three PRIMUS scales were unidimensional (as indicated by fit to the Rasch model) and that they had good internal consistency and reproducibility. PRIMUS scale scores correlated as expected with those on the NHP and the U-FIS. The scales in all countries were able to discriminate between groups of patients on the basis of their self-reported MS severity, general health, and employment status.ConclusionsThe PRIMUS was successfully adapted into eight new languages. Most of the tests showed the PRIMUS to have good unidimensionality and to have good internal consistency, reproducibility, and construct validity. The measure is now available for use in clinical studies and trials involving these countries and the UK. Further work is required to assess the measure's responsiveness.     

Development of an Innovative Online Dietary Assessment Tool for France: Adaptation of myfood24

myfood24 is an innovative dietary assessment tool originally developed in English for use in the United Kingdom. This online 24 h recall, a tool commonly used in nutritional epidemiology, has been developed into different international versions. This paper aims to describe the creation of its French version. We used a consistent approach to development, aligned with other international versions, using similar methodologies. A nutritional database (food item codes, portion groups and accompaniments, etc.) was developed based on commonly used French food composition tables (CIQUAL 2017). Portion sizes were adapted to French dietary habits (estimation, photographs of French portion sizes, assessment of the photograph series and their angle (aerial vs. 45 degrees)). We evaluated the new tool, which contained nearly 3000 food items with 34 individuals using the System Usability Scale. We validated the French food portion picture series using EFSA criteria for bias and agreement. The results of the picture evaluation showed that the angle with which photos are taken had limited impact on the ability to judge portion size. Estimating food intake is a challenging task. Evaluation showed “good” usability of the system in its French version. myfood24 France will be a useful addition to nutritional epidemiology research in France.     

Initial responses of first-year medical students to problem-based learning in a behavioural science course: role of language background and course content

A trial of problem-based learning (PBL) was conducted with first-year undergraduate medical students who had no background knowledge of behavioural science and who included a substantial proportion with a first language other than English. Responses to standardized and open-ended evaluation questions showed greater variability and there was no clear preference for PBL over traditional methods. Students found the PBL exercise time-consuming and felt they needed more guidance. Feedback from clinicians and working in groups were seen as positive aspects of the exercise. Students with a first language other than English reported that language, but not cultural background, was an impediment to effective participation. It is recommended that this group of students be offered extra support for PBL in a subject-based setting, and that all students would benefit from a formal induction session.     

Study of cost by type of diagnosis in Switzerland.

Lengths of stay, for a given diagnosis, are poorly correlated between Switzerland, the USA., and Australia; and between 5 hospitals within Switzerland. Three different sets of DRG cost weightings (U.S., French A, French B) are also poorly correlated. Hospital operating efficiencies, standardized by DRG, were estimated and compared. The three sets of cost weightings used all yielded very similar estimates of hospital operating efficiency. The use of current existing systems of cost weightings may, therefore, provide a rapid and cheap means of comparing hospital operating efficiency. In the long run, more precise and detailed cost data will enable national cost weightings to be obtained. Associated issues, such as costing methodologies and perspectives on utilization, are also discussed.     

Substance use in high school students in New South Wales, Australia, in relation to language spoken at home.

PURPOSE: To examine for the first time adolescent substance use by ethnicity, given the high proportion of migrants from non-English-speaking countries in New South Wales, (NSW), Australia. METHODS: Data from four surveys of NSW secondary school students in 1983, 1986, 1989, and 1992 were used for this analysis. The prevalence of substance use by whether English was spoken at home was stratified by sex and age using data from the most recent survey year. Adjusted odds ratios and 95% confidence intervals were produced by simultaneous logistic regression, adjusting for sex, age group, and the interaction term of sex and age for each of these substances, and for each survey year separately. Data from 1989 and 1992 were pooled together to examine rates of substance use by ethnic subgroups which reflect migration patterns. RESULTS: The prevalence of smoking and alcohol and illicit drug use was consistently lower among NSW adolescents speaking a language other than English at home, compared with those speaking English at home in all survey years. Only the prevalence of solvent sniffing was higher among younger adolescents speaking a language other than English at home. Students from Southeast Asia showed consistently lower rates of usage of all substances compared to all other groups. CONCLUSIONS: There may be different opportunities for the prevention of adolescent substance use among native English speakers to be gained from non-English-speaking cultures.     

Role of the Orvosi Hetilap in the development of Hungarian gastroenterology. Part 3: 1948-1989

The editions of Orvosi Hetilap published between 1905 and 1944 exceeded the amount of publications of the previous period (1857-1904). Most of the knowledge was transferred from German literature. AIM: Evaluation of papers dealing with diseases of the gastrointestinal tract published in Orvosi Hetilap between 1948 and 1989. METHOD: The author manually reviewed the journal volumes published between 1948 and 1989. The original articles, journal and book reviews were identified and classified according to their subject and origin. The publication rates of the editorial periods (1857-1904, 1905-1944, 1948-1989, respectively) were statistically compared. RESULTS: Between 1948 and 1989, a total of 2175 original articles were published about the diseases of the gastrointestinal tract, constituting 11.1% of the total publications. There was a continuous increase in the publication rate in the periods studied. Liver and biliary tract diseases were most often studied (24.1%), especially viral hepatitis (18.0%). Endoscopy was studied in 124 articles (4.7%), while radiology achieved a figure of 101 (3.9%). 3965 articles were reviewed from 268 journals, constituting a significant increase as compared to the previous period. 62.2% of the reviews were published in 15 core journals. 52.2% of the journals were English, 39.4% were German, and only 2.9% French. The formerly major German sources were replaced by English literature during the 1960s. The number of book reviews increased from 95 to 211. Endoscopy witnessed the emergence of fiberoptic instruments and, later, video technique. The reception of inflammatory bowel diseases began in 1935 and expanded gradually in the epidemiologic, pathogenetic and therapeutic studies of these conditions. CONCLUSION: The rate of gastroenterologic publications in Orvosi Hetilap increased considerably between 1948 and 1989, as compared to the prior periods. English journals became the main source of information in the 1960s.     

The evaluation of undergraduate students' written English language skills

CONTEXT: Writing is an important skill for practitioners and students, yet this is a skill rarely taught in a formal capacity at medical school. At the University of Adelaide many students are from non-English speaking backgrounds and have varying proficiencies in English. We wished to devise a method and instrument which could identify students who may benefit from formative feedback and tuition in writing. OBJECTIVES AND METHOD: Students' written account of a short clinical interview with a standardized patient was assessed using a new instrument (the Written Language Rating Scale) designed especially for this study. The assessment of writing was made by one rater with qualifications in teaching English as a second language. SUBJECTS: 127 second-year medical students enrolled at the University of Adelaide, Australia. INSTRUMENTS AND RESULTS: The scale appeared to have good internal consistency, face and construct validity, and test security was not an issue. However, it had questionable concurrent validity with a standardized language test, although this may be partly due to the period of time which had elapsed between administration of the two tests. CONCLUSIONS: This study was useful in providing a means to objectively rate students' written English language skills and to target students in need of formative feedback and tuition. However, further research is necessary for both evaluation of medical writing and interventions for its improvement.     

Vaccine-criticism on the internet: New insights based on French-speaking websites

The internet is playing an increasingly important part in fueling vaccine related controversies and in generating vaccine hesitant behaviors. English language Antivaccination websites have been thoroughly analyzed, however, little is known of the arguments presented in other languages on the internet. This study presents three types of results: (1) Authors apply a time tested content analysis methodology to describe the information diffused by French language vaccine critical websites in comparison with English speaking websites. The contents of French language vaccine critical websites are very similar to those of English language websites except for the relative absence of moral and religious arguments. (2) Authors evaluate the likelihood that internet users will find those websites through vaccine-related queries on a variety of French-language versions of google. Queries on controversial vaccines generated many more vaccine critical websites than queries on vaccination in general. (3) Authors propose a typology of vaccine critical websites. Authors distinguish between (a) websites that criticize all vaccines (“antivaccine” websites) and websites that criticize only some vaccines (“vaccine-selective” websites), and between (b) websites that focus on vaccines (“vaccine-focused” websites) and those for which vaccines were only a secondary topic of interest (“generalist” websites). The differences in stances by groups and websites affect the likelihood that they will be believed and by whom. This study therefore helps understand the different information landscapes that may contribute to the variety of forms of vaccine hesitancy. Public authorities should have better awareness and understanding of these stances to bring appropriate answers to the different controversies about vaccination.     

Multilingual translation of the Functional Assessment of Cancer Therapy (FACT) quality of life measurement system

There is need for multilingual cross-culturally valid quality of life (QOL) instrumentation to assess the QOL endpoint in international oncology clinical trials. We therefore initiated a multilingual translation of the Functional Assessment of Cancer Therapy (FACT) Quality of Life Measurement System (Version 3) into the following languages: Dutch, French, German, Italian, Norwegian and Swedish. Prior to this project, the FACT Measurement System was available in English, Spanish and Canadian French. The FACT is a self-report instrument which measures multidimensional QOL. The FACT (Version 3) evaluation system uses a 29–49 item compilation of a generic core (29 Likert-type items) and numerous subscales (9–20 items each) which reflect symptoms associated with different diseases, symptom complexes and treatments. The FACT-G (general version) and eight of 18 available cancer-related subscales were translated using an iterative forward-backward translation sequence. After subsequent review by 21 bilingual health professionals, all near final language versions underwent pretesting with a total of 95 patients in the native countries. Available results indicate good overall comprehensibility among native language-speakers. Equivalent foreign language versions of the FACT will permit QOL evaluation of people from diverse cultural backgrounds.Supported by grants from Amgen Incorporated, Bristol-Myers Squibb Company, Eli Lilly International Corporation, Rhone-Poulenc Rorer Pharmaceuticals Incorporated and Sandoz Pharmaceuticals.     

Rising Disparities in Severe Adverse Birth Outcomes Among Haitians in Québec, Canada, 1981–2006

Perinatal health data for Haitians are scant. We evaluated adverse birth outcomes for Haitians in Québec, Canada. We analyzed 2,124,909 live births from 1981 to 2006. Haitian ethnicity was assessed using maternal birth country (Haiti, other Caribbean country, other foreign country, Canada) and home language (Creole, French/English but Creole mother tongue, French/English, other). Associations between ethnicity and preterm birth (PTB), low birth weight (LBW), and small-for-gestational-age (SGA) birth were calculated. Adverse birth outcomes were more common among mothers with Haitian ethnicity. Relative to Canadian-born mothers, odds for Haitian-born mothers were 4 times greater for extreme PTB (≤27 weeks), twice greater for very PTB (28–31 weeks), and 25% higher for moderate PTB (32–36 weeks). Patterns were similar for SGA birth and severe cases of LBW. Despite overall decreases LBW and SGA birth, relative and absolute inequalities increased over time. Perinatal health inequalities are increasing for Haitian-born mothers.