Bills, babies, and (language) barriers: Associations among economic strain, parenting, and primary language during the newborn period

Abstract WMP80: Stroke Mimic Treatment Rates and Physician-patient Language Discordance

Stroke ◽

10.1161/str.47.suppl_1.wmp80 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Sara K Rostanski ◽

Olajide Williams ◽

Joshua Stillman ◽

Amelia K Boehme ◽

Randolph S Marshall ◽

...

Keyword(s):

Group Versus ◽

Language Barriers ◽

Final Diagnosis ◽

Primary Language ◽

Chi Square ◽

Diagnostic Uncertainty ◽

Language Discordance ◽

Stroke Mimic ◽

Physician Patient

Intro: While thrombolysis in stroke mimics (SM) is considered safe, recent data highlights the excess cost associated with treatment of these patients. Several studies have identified common demographic features of SM, however less is known about whether language barriers between patient and physician influence SM treatment rates. We sought to evaluate the role of physician-patient language discordance on the rate of SM treatment at a single center serving a large Spanish-speaking population. Hypothesis: Stroke mimic treatment rates are higher when there are language barriers between physician and patient due to greater diagnostic uncertainty Methods: We reviewed the electronic medical record (EMR) for all patients who received tPA in the ED from 7/2011 to 7/2015. Patient’s primary language was obtained from the EMR; language fluency of treating neurologists was obtained via questionnaire; final diagnosis (SM, imaging negative, imaging confirmed) was the attending physician’s impression at discharge. We compared baseline characteristics and SM rates between encounters where the treating neurologist and patient spoke the same language (concordant group) versus those where they did not (discordant group). Means were compared via t test, medians via Mann Whitney U test and dichotomized variables via chi square test. Results: During this period 311 patients received tPA. English was the primary language for 158 (51%), Spanish for 144 (46%), and other languages for 9 (3%); 183 (59%) encounters were classified as concordant and 128 (41%) as discordant. Final diagnosis was SM for 37 (12%); among those with a final diagnosis of stroke, 65 (24%) were imaging negative. There were no significant differences in mean age (67 vs. 70, p=0.1), male sex (38% vs. 32%, p=0.3), and median NIHSS (7 vs. 7, p=0.4) between concordant and discordant groups. We found higher rates of SM in the concordant group (16% vs. 6%, p=0.01). When imaging negative strokes were included with SM, these differences were no longer significant (33% vs. 32%, p=0.9). Conclusion: At our institution, language discordancy does not contribute to higher rates of SM treatment. Careful observation of how language discordant pairs communicate is needed to understand the role of interpreters in these findings

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Limited English Proficiency, Primary Language at Home, and Disparities in Children's Health Care: How Language Barriers are Measured Matters

Public Health Reports ◽

10.1177/003335490512000409 ◽

2005 ◽

Vol 120 (4) ◽

pp. 418-430 ◽

Cited By ~ 105

Author(s):

Glenn Flores ◽

Milagros Abreu ◽

Sandra C. Tomany-Korman

Keyword(s):

Health Care ◽

Health Status ◽

Health Care Disparities ◽

English Proficiency ◽

Language Barriers ◽

Children's Health ◽

Children’S Health ◽

Primary Language ◽

Language Spoken At Home ◽

At Home

Background. Approximately 3.5 million U.S. schoolchildren are limited in English proficiency (LEP). Disparities in children's health and health care are associated with both LEP and speaking a language other than English at home, but prior research has not examined which of these two measures of language barriers is most useful in examining health care disparities. Objectives. Our objectives were to compare primary language spoken at home vs. parental LEP and their associations with health status, access to care, and use of health services in children. Methods. We surveyed parents at urban community sites in Boston, asking 74 questions on children's health status, access to health care, and use of health services. Results. Some 98% of the 1,100 participating children and families were of non-white race/ethnicity, 72% of parents were LEP, and 13 different primary languages were spoken at home. “Dose-response” relationships were observed between parental English proficiency and several child and parental sociodemographic features, including children's insurance coverage, parental educational attainment, citizenship and employment, and family income. Similar “dose-response” relationships were noted between the primary language spoken at home and many but not all of the same sociodemographic features. In multivariate analyses, LEP parents were associated with triple the odds of a child having fair/poor health status, double the odds of the child spending at least one day in bed for illness in the past year, and significantly greater odds of children not being brought in for needed medical care for six of nine access barriers to care. None of these findings were observed in analyses of the primary language spoken at home. Individual parental LEP categories were associated with different risks of adverse health status and outcomes. Conclusions. Parental LEP is superior to the primary language spoken at home as a measure of the impact of language barriers on children's health and health care. Individual parental LEP categories are associated with different risks of adverse outcomes in children's health and health care. Consistent data collection on parental English proficiency and referral of LEP parents to English classes by pediatric providers have the potential to contribute toward reduction and elimination of health care disparities for children of LEP parents.

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Working With Interpreters to Support Students Who Are English Language Learners

Perspectives of the ASHA Special Interest Groups ◽

10.1044/persp1.sig16.15 ◽

2016 ◽

Vol 1 (16) ◽

pp. 15-27 ◽

Cited By ~ 3

Author(s):

Henriette W. Langdon ◽

Terry Irvine Saenz

Keyword(s):

United States ◽

English Language Learners ◽

Language Learners ◽

English Language ◽

First Language ◽

The United States ◽

The Other ◽

Primary Language ◽

Second Best ◽

Support Students

The number of English Language Learners (ELL) is increasing in all regions of the United States. Although the majority (71%) speak Spanish as their first language, the other 29% may speak one of as many as 100 or more different languages. In spite of an increasing number of speech-language pathologists (SLPs) who can provide bilingual services, the likelihood of a match between a given student's primary language and an SLP's is rather minimal. The second best option is to work with a trained language interpreter in the student's language. However, very frequently, this interpreter may be bilingual but not trained to do the job.

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