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Objectives: Communication is a main challenge in migrant health and essential for patient safety. The aim of this study was to describe the satisfaction of caregivers with limited language proficiency (LLP) with care related to the use of interpreters and to explore underlying and interacting factors influencing satisfaction and self-advocacy., Design: A mixed-methods study., Setting: Paediatric emergency department (PED) at a tertiary care hospital in Bern, Switzerland., Participants and Methods: Caregivers visiting the PED were systematically screened for their language proficiency. Semistructured interviews were conducted with all LLP-caregivers agreeing to participate and their administrative data were extracted., Results: The study included 181 caregivers, 14 of whom received professional language interpretation. Caregivers who were assisted by professional interpretation services were more satisfied than those without (5.5 (SD)±1.4 vs 4.8 (SD)±1.6). Satisfaction was influenced by five main factors (relationship with health workers, patient management, alignment of health concepts, personal expectations, health outcome of the patient) which were modulated by communication. Of all LLP-caregivers without professional interpretation, 44.9% were satisfied with communication due to low expectations regarding the quality of communication, unawareness of the availability of professional interpretation and overestimation of own language skills, resulting in low self-advocacy., Conclusion: The use of professional interpreters had a positive impact on the overall satisfaction of LLP-caregivers with emergency care. LLP-caregivers were not well-positioned to advocate for language interpretation. Healthcare providers must be aware of their responsibility to guarantee good-quality communication to ensure equitable quality of care and patient safety., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The aim of our study was to analyze the use of interpreter services and improve communication during health encounters with families with limited language proficiency (LLP) at the pediatric emergency department (ED) of the University Hospital of Bern.This study is a pre- and post-intervention study analyzing the use of interpreter services for LLP families. All families originating from a country with a native language other than German, English or French presenting to the ED were eligible to participate in the study. If they agreed to participate, the language proficiency of the caregiver present during the health encounter was systematically assessed during a phone interview within a few days after the consultation, using a standardized screening tool. If screened positive (relevant LLP), a second phone interview with an interpreter was conducted. Further variables were extracted including nationality, age, gender and date of visit using administrative health records. To increase the use of interpreter services, a package of interventions was implemented at the department during 3 months. It consisted of: i) in person and online transcultural teaching ii) awareness raising through the regular information channels and iii) the introduction of a pathway to systematically identify and manage LLP families.The proportion of LLP families who received an interpreter was 11.0% (14/127) in the pre-intervention period compared to 14.8% (20/135) in the post-intervention period. The interpreter use was therefore increased by 3.8% (95% CI - 0.43 to 0.21; p = 0.36).The assessed level of language proficiency of caregivers differed from the self-reported level of language proficiency. Of the study participants in the interview whose language proficiency was screened as limited, 77.1% estimated their language proficiency level as intermediate. More than half of the LLP families who did not receive an interpreter and participated in the interview reported, that they would have liked an interpreter during the consultation.Conclusions: Interpreter services are largely underused during health encounters with LLP families. Relying on caregivers´ self-assessed language proficiency and their active request for an interpreter is not sufficient to ensure safe communication during health encounters. Systematic screening of language proficiency and standardized management of LLP families is feasible and needed at health care facilities to ensure equitable care. Further studies are needed to analyze personal and institutional barriers to interpreter use and find interventions to sustainably increase the use of interpreter services for LLP families., (© 2022. The Author(s).)

Mindfulness-based interventions have demonstrated efficacy with regard to diverse psychological symptoms across populations. Few studies have evaluated the efficacy of mindfulness-based interventions for firefighters. This pilot randomized clinical trial (RCT) is designed to determine the preliminary efficacy, feasibility, and acceptability of a novel mindfulness-based workshop (entitled "Healthy Action Zone Mindful Attention Training" [HAZMAT]) developed for firefighters (Clinical Trials Identifier: NCT04909216). An anticipated sample size of 100 firefighters from a large fire department in the southern U.S. will be recruited. Firefighters will be randomized to: (1) HAZMAT workshop or (2) waitlist comparison condition. Outcomes will be assessed at baseline and five follow-up time-points: post-workshop, 1-week follow-up, 1-month follow-up, 3-month follow-up, and 6-month follow-up. First, we will evaluate the acceptability of the HAZMAT workshop as defined by firefighters' self-reported satisfaction with the workshop. Feasibility will be defined by the proportion of firefighters who start and complete the full workshop. Second, we will examine the efficacy of the HAZMAT workshop, as compared to waitlist, on psychological symptom reduction , as defined by: self-reported symptom severity of PTSD, depression, anxiety, suicidal ideation, and alcohol use at each follow-up time-point. Third, we will evaluate the impact of the HAZMAT workshop, as compared to waitlist, on putative treatment targets, indexed via self-reported levels of (1) mindful attention and (2) nonjudgmental acceptance each follow-up time-point., (© 2022 The Authors.)

Background: In the last decade an increasing number of asylum-seeking children arrived in Europe and local healthcare systems have been challenged to adapt to their health needs. The aim of this study was to compare the spectrum of disease and management of asylum-seeking and non-asylum-seeking children requiring hospital admission., Methods: This was a retrospective cohort study including health data from recently arrived asylum-seeking and non-asylum-seeking children admitted between January 2016 and December 2017. Data were collected using electronic administrative and medical records., Results: Of 11,794 admissions of 9407 patients, 149 (1%) were asylum-seeking and 11,645 (99%) from non-asylum-seeking children. In asylum-seeking children the median age was 4 years (interquartile range [IQR] 0–13) with 61% males and in non-asylum-seeking children 4 years (IQR 0–11) years with 56% males. Respiratory infections accounted for 17–19% of admissions in both groups. Rare infectious diseases were more frequent in asylum-seeking children (15 vs 7%; difference in proportions 0.08, 95% confidence interval [CI] 0.02–0.14; p <0.001,). Injuries were more frequent in non-asylum-seeking children (22 vs 13%; difference in proportions 0.09, 95% CI 0.04–0.014; p <0.01). Admissions for mental health disorders were infrequent but more common in asylum-seeking children (6 vs 3%; difference in proportions 0.03, 95% CI −0.01 – 0.07; p = 0.02) Prescription of analgesics was lower in asylum-seeking than non-asylum-seeking children (3.4 vs 6.5 accounting units per admission). Antibiotic prescription was comparable in both groups., Conclusion: Asylum-seeking children represent a small number of total admissions. Age distribution and main reason for admission being diseases of the respiratory system were comparable in asylum-seeking and non-asylum-seeking children. Rare infections and mental health disorders are important diseases in asylum-seeking children and require special attention and training of staff working with paediatric asylum seekers.

This study compared across Hispanic and Caucasian firefighters the relative fit of the four-factor Emotional Numbing and Dysphoria posttraumatic stress disorder models to the more recently proposed Dysphoric Arousal five-factor model. As hypothesized, the Dysphoric Arousal five-factor model emerged as the best fitting model within each ethnic group and it also showed measurement invariance between groups (configural invariance). Results of multigroup confirmatory factor analyses and a bias-corrected bootstrap confidence intervals analytic approach indicated that the five factor model also demonstrated invariance in factor loadings (metric invariance) and item-level intercepts (scalar invariance) across the two ethnic groups. Results indicate that the Dysphoric Arousal five factor model captures similar psychological constructs across Caucasian and English-speaking Hispanic firefighters. Therefore, observed factor scores are comparable across ethnic groups and can be combined when examining predictors of posttraumatic stress disorder severity.

Non-healing and partially healing wounds are an important problem not only for the patient but also for the public health care system. Current treatment solutions are far from optimal regarding the chosen material properties as well as price and source. Biodegradable polyurethane (PUR) scaffolds have shown great promise for in vivo tissue engineering approaches, but accomplishment of the goal of scaffold degradation and new tissue formation developing in parallel has not been observed so far in skin wound repair. In this study, the mechanical properties and degradation behavior as well as the biocompatibility of a low-cost synthetic, pathogen-free, biocompatible and biodegradable extracellular matrix mimicking a PUR scaffold was evaluated in vitro . The novel PUR scaffolds were found to meet all the requirements for optimal scaffolds and wound dressings. These three-dimensional scaffolds are soft, highly porous, and form-stable and can be easily cut into any shape desired. All the material formulations investigated were found to be nontoxic. One formulation was able to be defined that supported both good fibroblast cell attachment and cell proliferation to colonize the scaffold. Tunable biodegradation velocity of the materials could be observed, and the results additionally indicated that calcium plays a crucial role in PUR degradation. Our results suggest that the PUR materials evaluated in this study are promising candidates for next-generation wound treatment systems and support the concept of using foam scaffolds for improved in vivo tissue engineering and regeneration.

Purpose: To establish the threshold level of canthaxanthin crystals in the retina of cynomolgus monkeys. To correlate the spatial distribution of all-trans canthaxanthin and its metabolites with the grade of crystals., Methods: Monkeys were orally administered 0, 0.2, 0.6, 1.8, 5.4, 16.2, and 48.6 mg/kg body wt canthaxanthin daily for 2.5 to 3 years. A second group of monkeys were administered 200 and 500 mg/kg body wt/d for 5 years. Ophthalmoscopy, electroretinography (ERG), retina and carotenoid analysis were performed as previously reported., Results: Crystals in the retina periphery were observed by ophthalmoscopy preterminally only in the extreme high doses of 200 to 500 mg/kg body wt/d. There were no adverse effects on visual functions as measured by ERG. Crystals in the peripheral retina, and/or in the macula, were detected microscopically in all canthaxanthin treated groups except at the lowest dose of 0.2 mg/kg body wt/d. The grade of crystals increased up to a dose of 16.2 mg/kg body wt/d. Dose-dependent increases in canthaxanthin content also were noted in the retina, the liver, and in plasma. All-trans canthaxanthin was the major compound in the peripheral and paracentral retina of very highly dosed animals, where its concentration correlated largely with the grade of inclusions. In the macula, 4'-OH-echinenone was the dominant canthaxanthin metabolite., Conclusions: The grade of crystals in monkey retinas was dose dependent with a threshold level at 0.6 mg canthaxanthin/kg body wt/d. It correlated in the retinal periphery with the concentrations of all-trans-canthaxanthin and in the macula with its metabolites.

Purpose: To reproduce and investigate in a primate animal model the phenomenon of the red carotenoid canthaxanthin (beta, beta-carotene-4'4'-dione) to induce crystal-like retinal deposits as they have been observed in the ocular fundus of humans after high canthaxanthin intake (i.e., more than 30 mg/day)., Methods: Groups of four cynomolgus monkeys (Macaca fascicularis) per gender and dose were administered 5.4, 16.2, or 48.6 mg canthaxanthin/kg body weight daily by oral gavage for 2.5 years. Eight control animals received placebo. In vivo ophthalmoscopy was performed at intervals of 3 months along with electroretinography after 12 and 24 months and retinal biomicroscopy just before the monkeys were killed. Retinal wholemounts or frozen sections were investigated postmortem by polarization, bright field, and differential interference contrast microscopy. Retinal and preterminal plasma canthaxanthin concentrations were determined by high-performance liquid chromatography (HPLC)., Results: By ophthalmoscopy and retinal biomicroscopy in vivo, no crystals or other light-reflecting particles were observed in the central paramacular retina. However, postmortem polarization microscopy of all 24 canthaxanthin-treated animals showed a circular zone in the peripheral retina containing birefringent, polymorphous red, orange, or white inclusions. The density of these inclusions was diminished within 1 to 8 mm posterior to the ora serrata. These inclusions were located mainly in the inner retinal layers, that is the nerve fiber layer and ganglion cell layer, inner plexiform layer, and inner nuclear layer. Twelve of the 24 canthaxanthin-treated animals showed yellow, golden birefringent inclusions in the macula. Retinas of placebo-treated monkeys were free of birefringent, crystal-like inclusions. The HPLC confirmed the presence of all-trans canthaxanthin, and 4-OH-echinenone and isozeaxanthin as well, in the retinas of all canthaxanthin-treated animals. Neither electroretinography nor histopathology indicated any adverse effects of the canthaxanthin-induced retinal inclusions seen in this study., Conclusions: A high intake of canthaxanthin for 2.5 years led to the deposition of crystal-like birefringent inclusions in the inner layers of the peripheral retina and, to some extent, the central retina of cynomolgus monkeys. The presence of these deposits did not interfere with morphology nor with retinal function.

Two different peptides have been purified from human liver, similar to those previously reported (Schoenenberger, G.A., and Wacker, W.E.C. (1966) Biochemistry 5, 1375--1379) to be present in human urine, which may serve as metabolic regulators of lactate dehydrogenase (EC 1.1.1.27) isoenzymes (LDH-M4 = muscle type; LDH-H4 = heart type). By trichloroacetic acid precipitation, ultrafiltration, Sephadex G-25 and Bio-Gel P-2 columns, affinity chromatography on immobilized LDH-isozymes and HPLC two peptides which differed with respect to molecular weight, retention on the affinity columns and amino acid composition were isolated. No effect was observed when native, tetrameric lactate dehydrogenase was incubated with these peptides. However, when lactate dehydrogenase was dissociated to monomers at low pH and allowed to reassociate by adjusting the pH to 7.5 complete inhibition of the reactivation occurred when the inhibitors were incubated together with respective reassociating monomeric isozymes. The two peptides showed no cross-specificity, i.e. each peptide exhibited inhibitory activity only on one of the two isozymes LDH-M4 or LDH-H4. From the amino acid analyses, gel filtrations and PAGE + SDS, molecular weights of 1800 for the M4 and approximately 2700 for the H4 inhibitor were calculated. An apparent Ki of approximately 3 X 10(-5) mM for the H4 and approximately 7 X 10(-5) mM for the H4 inhibitor was estimated. The interaction of the inhibitors with the enzyme system showed strong cooperativity with Hill coefficients of 2.9 (LDH-M4-specific) and 2.4 (LDH-H4-specific). Mathematical modelling of the reassociation and reactivation of lactate dehydrogenase and its specific inhibition by the peptides led to the conclusion that the peptides react with monomers, dimers or a transition state during the tetramerisation process. kappa 1 for the dimerisation step of M4 = 2.0 X 10(5) M-1 . S-1 and of H4 = 8.2 X 10(4) M-1 . S-1; kappa 2 for the tetramerisation step of M4 = 2.8 X 10(5) M-1 . S-1 and of H4 = 1.2 X 10(5) . M-1 S-1, were calculated, the second step still being the faster one (Rudolf, R. and Jaenicke, R. (1976) Eur. J Biochem. 63, 409--417).

Previously reported experiments with animals suggested that reduced renal arterial flow might be the actual cause for the pathogenicity of nephroptosis. Clinical studies now give evidence that measurements of urinary LDH may be a criterion equal to the isotope nephrogram (ING) in considering this disease. Patients with a "mobile" kidney verified by i.v. pyelography were examined by an ING and a 1-day test for urinary LDH. In accordance with periodic kidney displacement total urinary LDH activities were measured in a 8-h urine volume in the supine position and a 8-h urine volume in the erect position of the patients. Evaluations were all expressed as percentage increase of LDH activity of the patient in the erect versus supine position and correlated with his ING-pattern. Among 45 nephroptotic individuals 34 showed, in accordance with a pathological ING, a mean LDH increase of more than a 100%. Eleven individuals had normal INGs and less than 20% increase equal to a group of 16 normal controls. We postulated a 30% increase as the upper limit between normal and pathological urinary LDH. The percentage distribution of isoenzymes was also altered within the pathological LDH range: LDH-I, which increases in normal controls, now decreased in nephroptotic patients. LDH-IV and V, which decrease in controls, now increased. Homomeric isoenzymes obviously show reciprocal behavior. The degree of kidney descent in cm does not correlate with percentage increase of urinary LDH, i.e. it is not a criterion for pathogenicity. Biopsies taken during nephropexy revealed that from an anamnestic duration of 50 weeks onwards the kidney is significantly affected and tissue damages become evident. If patients were re-investigated after nephropexy they showed normal i.v. pyelograms and normal LDH and no longer had clinical symptoms.

In 29 patients with nephroptosis two different methods of nephropexy were compared; nephropexy using sutures passing through the parenchyma (n = 16) and nephropexy using tissue adhesives (n = 13). The first group was mobilized 3.5 days after operation, whereas the second group was mobilized one day after operation. On later follow-up 79% of the patients had no or minor complaints. Those patients who had the same disturbances as preoperatively had all been treated by nephropexy using sutures passing through the parenchyma. In 56% of this group radiological recurrence was seen, whereas in the group using tissue adhesives there was only 8% radiological recurrence. We think therefore that the nephroxepy using tissue adhesive is the simplest and least traumatic method.

From previous investigations with nephroptotic patients increased urinary LDH was assumed to be a reliable marker indicating a renal tissue defect due to the organs descent in erect position. Animal experiments now allowed correlation of this enzymatic activity with controlled changes of anatomical and physiological parameters. Changes of the renal hemodynamics or urinary flow induced in acute experiments in dogs simulated kidney displacement in nephroptotic patients. Both ureters were cannulated for separate urine collection and one kidney was manipulated. The renal arterial or venous flow was reduced or the ureter was occluded under electromagnetic blood-flow control. Arterial constriction alone (30%/15 min) selectively caused a drastic decrease (approximately 80%) of Xenon wash-out (= nutrient-flow) in the renal cortex. Under the same conditions radio-labeled microspheres injected intracardially showed a centralization of the renal capillary blood flow from the outer cortex to the juxtamedullary zone. Urinary LDH activities increased up to 800% immediately after arterial constriction. In accordance with total LDH activity the percentage distribution of isoenzymes changed: LDH-I increased and the LDH-V decreased. Neither constriction of the renal vein nor ureteral occlusion had similar effects. In long-term experiments backward fixation of one kidney in rats would reflect the effects of kidney displacement over years in nephroptotic patients: animals were unilaterally nephrectomized and the remaining kidney was dislocated backwards (approximately 2,5 vertebrae) and fixed to the lateral pelvic wall. "Ptotic" rats showed during the following examinations a constant increase of urinary LDH up to 50% by 26 weeks postoperatively. In accordance with increased LDH the isotope nephrogram was pathological and arteriographies showed a stretched and narrowed renal artery. In a number of rats "ptotic" fixation was not effective enough. All these animals showed normal LDH, isotope nephrograms and arteriographies. Both animal experiments documented that reduced flow/hypoxia is essentially responsible for the tissue damage in the kidney manifested by increased release of urinary LDH.