Barriers to use of interpreters in outpatient mental health care: Exploring the attitudes of psychotherapists

The support of professional interpreters is an essential component of adequate mental health care for migrants with limited language proficiency. Nevertheless, for varied reasons, only a small proportion of outpatient psychotherapists provide interpreter-mediated psychotherapy for migrants. This study explored the perspectives of psychotherapists who have not worked with professional interpreters in outpatient mental health care to identify factors that may prevent the use of interpreters in outpatient care and explore possible incentives to provide interpreter-mediated psychotherapy for migrants with limited language proficiency. Semi-structured interviews were conducted with 13 outpatient psychotherapists in Northern Germany who had not yet worked with professional interpreters in outpatient care. The interviews were audio recorded, transcribed and analysed using a structured content analysis approach. The psychotherapists named structural as well as subjective barriers and concerns. Findings suggest that improving structural factors, such as secure funding, minimal additional work, better preparation and training could facilitate the integration of professional interpreters into everyday treatment. Psychotherapists also mentioned concerns about their own confidence (e.g., insecurities regarding the triadic situation), the patient (e.g., reduced openness), the interpreter (e.g., doubts about suitability, motivation and empathy), as well as the therapeutic process (e.g., unclear allocation of roles). However, positive aspects and opportunities of interpreter-mediated psychotherapy were also described. These could be enhanced by the presence of conducive factors, such as existing trust between all parties and professional cooperation between interpreter and psychotherapist.

Epidemiology and outcome of penetrating injuries in a Western European urban region

PURPOSE

Severe life-threatening injuries in Western Europe are mostly caused by blunt trauma. However, penetrating trauma might be more common in urban regions, but their characteristics have not been fully elucidated.

METHODS

Retrospective analysis of data from patients admitted to our urban university level I trauma center between 2008 and 2013 with suspicion of severe multiple injuries. Collection of data was performed prospectively using a PC-supported online documentation program including epidemiological, clinical and outcome parameters.

RESULTS

Out of 2095 trauma room patients admitted over the 6-year time period 194 (9.3 %) suffered from penetrating trauma. The mean Injury Severity Score (ISS) was 12.3 ± 14.1 points. In 62.4 % (n = 121) the penetrating injuries were caused by interpersonal violence or attempted suicide, 98 of these by stabbing and 23 by firearms. We observed a widespread injury pattern where mainly head, thorax and abdomen were afflicted. Subgroup analysis for self-inflicted injuries showed higher ISS (19.8 ± 21.8 points) than for blunt trauma (15.5 ± 14.6 points). In 82.5 % of all penetrating trauma a surgical treatment was performed, 43.8 % of the patients received intensive care unit treatment with mean duration of 7.4 ± 9.3 days. Immediate emergency surgical treatment had to be performed in 8.0 vs. 2.3 % in blunt trauma (p < 0.001). Infectious complications of the penetrating wounds were observed in 7.8 %.

CONCLUSIONS

Specific characteristics of penetrating trauma in urban regions can be identified. Compared to nationwide data, penetrating trauma was more frequent in our collective (9.3 vs. 5.0 %), which may be due to higher crime rates in urban areas. Especially, self-inflicted penetrating trauma often results in most severe injuries.

Validation of food-grade salts of organic acids as ingredients to control Listeria monocytogenes on pork scrapple during extended refrigerated storage

This study was conducted to investigate control of Listeria monocytogenes on pork scrapple during storage at 4°C. In phase I, scrapple was formulated, with or without citrate-diacetate (0.64%), by a commercial processor to contain various solutions or blends of the following antimicrobials: (i) lactate-diacetate (3.0 or 4.0%), (ii) lactate-diacetate-propionate (2.0 or 2.5%), and (iii) levulinate (2.0 or 2.5%). Regardless of whether citrate-diacetate was included in the formulation, without the subsequent addition of the targeted antimicrobials pathogen levels increased ca. 6.4 log CFU/g within the 50-day storage period. In the absence of citrate-diacetate but when the targeted antimicrobials were included in the formulation, pathogen numbers increased by ca. 1.3 to 5.2 log CFU/g, whereas when citrate-diacetate was included with these antimicrobials, pathogen numbers increased only by ca. 0.7 to 2.3 log CFU/g. In phase II, in the absence of citrate-diacetate, when the pH of the lactate-diacetate-propionate blend (2.5%) was adjusted to pH 5.0 or 5.5 pathogen numbers remained unchanged (≤0.5 log CFU/g increase) over 50 days, whereas when citrate-diacetate was included with the lactate-diacetate-propionate blend adjusted to pH 5.0 or 5.5, pathogen numbers decreased by 0.3 to 0.8 log CFU/g. In phase III, when lower concentrations of the lactate-diacetate-propionate blend (1.5 or 1.94%) were adjusted to pH 5.5, pathogen numbers increased by ca. 6.0 and 4.7 log CFU/g, respectively, whereas when the mixture was adjusted to pH 5.0, pathogen numbers increased by ≤0.62 log CFU/g. Thus, scrapple formulated with lactate-diacetate-propionate (1.5 and 1.94% at pH 5.0) is an unfavorable environment for outgrowth of L. monocytogenes.

Effect of storage and subsequent reheating on viability of Listeria monocytogenes on pork scrapple

We evaluated the fate of Listeria monocytogenes on commercial pork scrapple, a regionally popular, ready-to-eat (RTE) meat. We also conducted an informal survey to address consumer practices for storing and reheating scrapple. Of the 129 consumers who responded to at least one of the eight questions posed in the survey, about half (46.4%; 52 of 112) considered scrapple RTE, the majority (69.7%; 76 of 109) stored it in the refrigerator, and all (100%; 112 of 112) preferred to reheat it prior to consumption. Most respondents (83.9%; 94 of 112) reheated the scrapple by pan frying for 1 to 10 min at medium to high temperature. To study pathogen behavior, slices of pork scrapple were surface inoculated with a five-strain cocktail of L. monocytogenes (ca. 2.0 log CFU/g), vacuum sealed, and stored for up to 60 days. Pathogen levels increased to 8.9, 9.5, and 9.9 log CFU/g after 44 (4 degrees C), 21 (10 degrees C), and 5 (21 degrees C) days, respectively. When slices 1.3 cm (ca. 55 g) and 1.9 cm (ca. 85 g) thick were surface inoculated with L. monocytogenes (ca. 7.0 log CFU/g) and then reheated in a skillet (191 degrees C) for 0.5 to 4 min per side or to target instantaneous internal temperatures of 48.9 to 71.1 degrees C, it was possible to achieve pathogen reductions ranging from ca. 2.2 to 6.5 log CFU/g. These data confirm that in the unlikely event of postprocessing contamination of pork scrapple by L. monocytogenes, proper reheating can appreciably reduce levels of the pathogen before consumption.

Comparison of methods of analysis using data of the panel study of the Federal Institute for Population Research (BIB)

The author compares methods of analysis using data from a panel study of the Federal Republic of Germany's Institute for Population Research. "This does not only involve a comparison of the methods as such, but above all also a comparison of the results (of these methods), of their presentation and of the possibilities of interpreting them. The three programmes selected for this paper represent methods for...so-called multivariate analysis, in particular for the analysis of non-metric data as they are included in the panel study...." Data are for a sample of 1,868 women interviewed at least twice and concern women's educational status and the qualities of motherhood.

Clinical infections in the noninstitutionalized geriatric age group: methods utilized and incidence of infections. The Pittsburgh Good Health Study

Because noninstitutionalized senior citizens comprise over 95% of the population 65 years of age and older, their health needs are a major concern. Data regarding infections in this population including the epidemiology, morbidity, and mortality are lacking. The authors recruited a study population of 417 free-living persons, all 65 years of age or older, from two neighborhoods in Pittsburgh, Pennsylvania. After the collection of self-reported baseline information from these persons, they were monitored for all clinical infections for 2 years, beginning July 1986 and through June 1988, using clinic visits, hospitalizations, or phone calls when needed. The baseline information showed the study population of 417 persons to be comparable with a neighborhood comparison group and with established populations for epidemiologic studies of the elderly in three other states. The 24 months of infection surveillance yielded 494 diagnosed infections in 224 or 54% of the subjects. Respiratory infections were most frequent with 259 or 52% of the total, followed by genitourinary infections with 24%, skin infections with 18%, gastrointestinal infections with 4%, and other types of infection with 2%. By comparing 22 self-reported baseline conditions with the occurrence of infection, 10 historic factors were univariately significant for infection. Of these 10 factors, only history of a lung problem (relative risk = 1.7, 95% confidence interval (CI) 1.1-2.9) and history of difficulty controlling urination (relative risk = 2.7, 95% CI 1.3-4.9) were statistically significant in multivariate analysis. To our knowledge, this study represents the first prospective data on infections in the noninstitutionalized elderly. The data demonstrate the wide variety of infections that occurred in this population and suggest that persons with a history of any one of several medical problems were possibly at greater risk for infection.

Impact of a needleless intravenous system in a university hospital

Needlestick injuries are a serious, but preventable problem in the healthcare industry. Industry has developed better devices to protect the healthcare worker. This study evaluates the impact of a "needleless" intravenous system on needlestick exposures and whether the increased cost of this new system could be justified. Exposures were defined and injury reports analyzed retrospectively and following introduction of the needleless IV system. This study indicates that the introduction of a needleless IV system can significantly reduce the number of IV-related injuries that occur in an institution, and is economically feasible. Other categories of exposure (needle-related, related to other sharps, and trash-related) also showed a drop, whereas exposure from the disposal of sharp devices into needle boxes showed a significant increase. This seems to support other findings that in-room needle-box containers have not thus far reduced the number of injuries related to sharps disposal.