Perceptions of mental health and utilization of mental health services among new immigrants in Canada: A qualitative study.

The impact of immigration on individuals' overall health, including mental health, is complex. New immigrants' concepts of mental health, mental healthcare utilization, and their knowledge of existing services in Regina, Canada were explored using a hermeneutic phenomenological approach. Three focus groups were conducted with 37 participants recruited from English language classes provided by a non-governmental organization in the city. Irrespective of country of origin, participants recognized the impact of mental health on general wellbeing. Access to existing mental healthcare was hindered by language barriers, inadequate information about existing healthcare services, and individuals' perceptions about what and when services should be accessed. Despite challenges, participants viewed relocation positively and exhibited resilience when dealing with daily stress. Participants had knowledge gaps surrounding the role of family physicians in managing mental health conditions. Information on ways to access existing healthcare services should be delivered in collaboration with community organizations serving new immigrants.

Impacts of English language proficiency on healthcare access, use, and outcomes among immigrants: a qualitative study.

BACKGROUND: Immigrants from culturally, ethnically, and linguistically diverse countries face many challenges during the resettlement phase, which influence their access to healthcare services and health outcomes. The "Healthy Immigrant Effect" or the health advantage that immigrants arrive with is observed to deteriorate with increased length of stay in the host country. METHODS: An exploratory qualitative design, following a community-based research approach, was employed. The research team consisted of health researchers, clinicians, and community members. The objective was to explore the barriers to healthcare access among immigrants with limited English language proficiency. Three focus groups were carried out with 29 women and nine men attending English language classes at a settlement agency in a mid-sized city. Additionally, 17 individual interviews were carried out with healthcare providers and administrative staff caring for immigrants and refugees. RESULTS: A thematic analysis was carried out with transcribed focus groups and healthcare provider interview data. Both the healthcare providers and immigrants indicated that limited language proficiency often delayed access to available healthcare services and interfered with the development of a therapeutic relationship between the client and the healthcare provider. Language barriers also impeded effective communication between healthcare providers and clients, leading to suboptimal care and dissatisfaction with the care received. Language barriers interfered with treatment adherence and the use of preventative and screening services, further delaying access to timely care, causing poor chronic disease management, and ultimately resulting in poor health outcomes. Involving untrained interpreters, family members, or others from the ethnic community was problematic due to misinterpretation and confidentiality issues. CONCLUSIONS: The study emphasises the need to provide language assistance during medical consultations to address language barriers among immigrants. The development of guidelines for recruitment, training, and effective engagement of language interpreters during medical consultation is recommended to ensure high quality, equitable and client-centered care.

In-situ Raman spectroscopic measurements of the deformation region in indented glasses.

This paper describes the design and integration of a custom-built optical instrument for in-situ Raman microscopy suitable for collecting high-quality spectroscopic data during the indentation of glass materials. It will further show that the reported experimental setup enables meaningful in-situ spectroscopic observations during indentation of fused silica at forces in the millinewton range. The aim of the paper is to demonstrate the vital importance of matching the analysis volume of the Raman microscope with the indentation-induced deformation volume to capture the full extent of the related spectral alterations by minimizing spectral contributions from the unperturbed bulk material (in-situ and ex-situ) and indenter probe (in-situ only). In this context, the paper will also touch upon possible pitfalls in ex-situ and in-situ Raman measurements on indented glasses in cases where the analysis and deformation volumes are not well matched and describe the misinterpretations that may result.

In situ spectroscopic study of the plastic deformation of amorphous silicon under non-hydrostatic conditions induced by indentation.

Indentation-induced plastic deformation of amorphous silicon (a-Si) thin films was studied by in situ Raman imaging of the deformed contact region of an indented sample, employing a Raman spectroscopy-enhanced instrumented indentation technique. Quantitative analyses of the generated in situ Raman maps provide unique, new insight into the phase behavior of as-implanted a-Si. In particular, the occurrence and evolving spatial distribution of changes in the a-Si structure caused by processes, such as polyamorphization and crystallization, induced by indentation loading were measured. The experimental results are linked with previously published work on the plastic deformation of a-Si under hydrostatic compression and shear deformation to establish a sequence for the development of deformation of a-Si under indentation loading. The sequence involves three distinct deformation mechanisms of a-Si: (1) reversible deformation, (2) increase in coordination defects (onset of plastic deformation), and (3) phase transformation. Estimated conditions for the occurrence of these mechanisms are given with respect to relevant intrinsic and extrinsic parameters, such as indentation stress, volumetric strain, and bond angle distribution (a measure for the structural order of the amorphous network). The induced volumetric strains are accommodated solely by reversible deformation of the tetrahedral network when exposed to small indentation stresses. At greater indentation stresses, the increased volumetric strains in the tetrahedral network lead to the formation of predominately five-fold coordination defects, which seems to mark the onset of irreversible or plastic deformation of the a-Si thin film. Further increase in the indentation stress appears to initiate the formation of six-fold coordinated atomic arrangements. These six-fold coordinated arrangements may maintain their amorphous tetrahedral structure with a high density of coordination defects or nucleate as a new crystalline ß-tin phase within the a-Si network.

Impacts of UVB provision and dietary calcium content on serum vitamin D3 , growth rates, skeletal structure and coloration in captive oriental fire-bellied toads (Bombina orientalis).

Many amphibian species are dependent on ex situ conservation interventions for their long-term persistence. However, projects have been jeopardised by husbandry issues involving poor calcium metabolism and nutritional metabolic bone disease (NMBD). Healthy calcium metabolism requires appropriate dietary calcium content and access to vitamin D3 . In many animals, vitamin D3 can be photobiosynthesised in skin exposed to UVB radiation, as well as extracted from the diet, but the extent of vitamin D3 photobiosynthesis in amphibians is poorly known. Additionally, prey insects for captive amphibians are deficient in calcium and calcium content must be artificially increased, but the effects of different levels of augmentation and their interaction with UVB exposure are also little understood. We fed captive fire-bellied toads (Bombina orientalis) with crickets augmented to contain 5% and 10% calcium and housed them with and without UVB exposure. Despite additional dietary vitamin D3 supplementation, we found that toads exposed to UVB radiation exhibited significantly higher serum vitamin D3 levels, indicating that this species may partly rely on photobiosynthesis sources of vitamin D3 . These data are the first to show a direct link between UVB exposure and serum vitamin D3 in an amphibian. We found significant positive effects of UVB exposure and 10% dietary calcium content on skeletal structure, as well as complex interactions between treatments. We also found UVB radiation exposure resulted in more rapid natural coloration acquisition. Together, this indicates that standard calcium plus vitamin D3 supplementation methods may not fully substitute for UVB exposure and for increased feeder insect calcium content. This may have implications for the success of ex situ amphibian conservation, as well as for the welfare of captive amphibians in general. Our data lend support for the provision of UVB radiation for captive, basking amphibians.

Indentation device for in situ Raman spectroscopic and optical studies.

Instrumented indentation is a widely used technique to study the mechanical behavior of materials at small length scales. Mechanical tests of bulk materials, microscopic, and spectroscopic studies may be conducted to complement indentation and enable the determination of the kinetics and physics involved in the mechanical deformation of materials at the crystallographic and molecular level, e.g., strain build-up in crystal lattices, phase transformations, and changes in crystallinity or orientation. However, many of these phenomena occurring during indentation can only be observed in their entirety and analyzed in depth under in situ conditions. This paper describes the design, calibration, and operation of an indentation device that is coupled with a Raman microscope to conduct in situ spectroscopic and optical analysis of mechanically deformed regions of Raman-active, transparent bulk material, thin films or fibers under contact loading. The capabilities of the presented device are demonstrated by in situ studies of the indentation-induced phase transformations of Si thin films and modifications of molecular conformations in high density polyethylene films.

Depletion of antigen-presenting cells by clodronate liposomes reverses the psoriatic skin phenotype in KC-Tie2 mice.

BACKGROUND: There is ongoing debate regarding the initiation of psoriatic plaque as primarily arising from an anomaly in epidermal keratinocytes (KCs) or from abnormalities in immunocytes that secondarily activate otherwise normal KCs. In mice engineered to overexpress the angiopoietin receptor Tie2 in KCs, skin spontaneously develops the characteristic clinical, histological and immune cell phenotypes of psoriasis which can be reversed with either transgene repression or ciclosporin administration, suggesting key roles for both KCs and T cells in mediating the skin disease in this murine model. OBJECTIVES: To determine if antigen-presenting cells (APCs) and macrophages alone are sufficient to sustain psoriasiform inflammation in the KC-Tie2 murine model of psoriasis. METHODS: Clodronate liposomes were intradermally injected into involved dorsal skin of KC-Tie2 or control animals once a week for 6weeks and acanthosis, angiogenesis, immune cell infiltration and cytokine production were quantitated using immunohistochemistry and interactive image analyses, enzyme-linked immunosorbent assay (ELISAs) and quantitative real-time polymerase chain reaction (qRT-PCR). RESULTS: Clodronate liposome injection eliminated CD11c+, F4/80+ and CD11b+ cells in the skin and returned CD8+ T-cell numbers to control mouse levels. APC depletion in KC-Tie2 mouse skin resulted in resolution of the acanthotic skin phenotype, decreased dermal angiogenesis, and a return to control mouse levels for interleukin (IL)-1α, IL-6, IL-23 and tumour necrosis factor (TNF)-α expression and modest reductions in interferon-γ and IL-17. CONCLUSIONS: These findings suggest a critical role for APCs and myeloid cell-derived IL-23 and TNF-α and underscore the importance of Th1 and Th17 T cells in maintaining the psoriasiform skin phenotype in the KC-Tie2 mouse model.

Breathing intensity and word use in individuals with COPD.

Shifts in natural or spontaneous language have been reported with psychological and physical changes, as well as shifts in predetermined words selected to describe dyspnea. Less evidence exists for natural language shifts and breathing intensity, particularly for everyday life and for negative emotion. Therefore, this study purpose was to describe the relationship between levels of everyday breathing intensity and the natural language word categories used in describing breathing, including a negative emotion category. A longitudinal descriptive research design and a convenience sample of 45 individuals were used. Natural language was analyzed as rates of word used based on three levels of breathing intensity. Non-parametric statistics were used to test differences between rates of word use and non-use on low, moderate, and high breathing intensity days, as well as correlations to subscales that measured negative emotion on the Bronchitis-Emphysema Symptom Checklist (BESC) and the Breathing Standard Index. Statistically significant associations were reported between level of breathing intensity and negative emotion, anger, cause, insight, time, and body words. Several significant correlations were reported with the psychosocial measures, including negative emotion and anxiety words with the BESC hopelessness/helplessness, time subscale, and negative emotion words with the inverse of typical breathing (i.e., atypical breathing). By showing significant associations between key word categories, in particular negative emotion and anger word use, levels of breathing intensity, and selected psychosocial measures, this study contributes to the body of knowledge about the influence of levels of breathing intensity on natural word use in everyday life.

Learning to visually perceive the relative mass of colliding balls in globally and locally constrained task ecologies.

Novice observers differ from each other in the kinematic variables they use for the perception of kinetic properties, but they converge on more useful variables after practice with feedback. The colliding-balls paradigm was used to investigate how the convergence depends on the relations between the candidate variables and the to-be-perceived property, relative mass. Experiment 1 showed that observers do not change in the variables they use if the variables with which they start allow accurate performance. Experiment 2 showed that, at least for some observers, convergence can be facilitated by reducing the correlations between commonly used nonspecifying variables and relative mass but not by keeping those variables constant. Experiments 3a and 3b further demonstrated that observers learn not to rely on a particular nonspecifying variable if the correlation between that variable and relative mass is reduced.

Individual differences and the use of nonspecifying variables in learning to perceive distance and size: comments on McConnell, Muchisky, and Bingham (1998).

McConnell, Muchisky, and Bingham (1998) showed that observers are able to judge the distance and size of falling, rolling, and swinging balls and that performance improves after practice with feedback. They concluded that observers use information that specifies the spatial scales of the different event types--namely, event duration in combination with event-specific constants. The improvement was interpreted as the calibration of the event-specific constants. We argue that their analyses should have considered the use of optical variables that do not specify the to-be-perceived metrics and individual differences in variable use. Furthermore, we propose convergence on the more useful variables as an alternative explanation for the observed improvement. The viability of these arguments is demonstrated with an experiment in which participants are trained with feedback to judge the distance and size of freely falling balls.

Information and action in punching a falling ball.

Lee, Young, Reddish, Lough, and Clayton (1983) reported that the timing control of jumping and vertically punching a dropping ball exploits the inverse of the rate of change of optical expansion, tau(r). We raise a number of methodological and logical criticisms against their experiment and conclusions and attempt to rectify them by examining elbow joint angles only, in seated punchers, under both monocular and binocular conditions, with two ball sizes, dropped from two heights. Differences between the binocular and monocular cases suggest the exploitation of different information. We present several techniques to help determine the operative variable(s) controlling the action. The optical variable used to initiate and guide flexion appeared to be expansion velocity (looming), rather than tau(r); extension appeared to be under the control of different variables in the monocular and binocular cases. Simulations using single variables and single perceptuo-motor intervals were of mixed success.

Stimulus-response compatibility for absolute and relative spatial correspondence in reaching and in button pressing.

Three experiments tested whether stimulus-response (S-R) compatibility might be a function of absolute (as opposed to relative) spatial correspondence--that is, the distance between a stimulus and the place of response. Experiment 1 studied reaching movements toward one of two targets in response to one of six visual stimuli. Stimulus-response pairs that shared relative position were faster than those that did not, and reaction time was faster when the stimulus and one of the potential targets were in close proximity. In Experiment 2 the same effects were found when the hands started from a different position, implicating stimulus-target distance, rather than stimulus-hand distance as the critical variable. Experiment 3 employed keypress responses instead of reaches, and the distance effect was nearly absent. The implications of these results are discussed in terms of categorical (e.g. left-right) vs. quantitative (e.g. distance) S-R variables in spatial compatibility.

Outcome from injury: general health, work status, and satisfaction 12 months after trauma.

OBJECTIVE: We evaluated outcomes 12 months after trauma in terms of general health, satisfaction, and work status. METHODS: Two hundred forty-seven patients without severe neurotrauma were evaluated by interview during admission and by mailed self-report 6 and 12 months after trauma. Data were obtained from the Trauma Registry, interviews, and survey instruments. Baseline assessment was obtained with the Short Form 36 (SF36) and the Sickness Impact Profile (SIP) work scale. Outcome measures were the SF36, SIP work scale, Brief Symptom Inventory (BSI) depression scale, the Civilian Mississippi Scale for Posttraumatic Stress Disorder (PTSD), and a satisfaction questionnaire. Three regressions were determined for outcome. The dependent variables were general health and work status (linear) and satisfaction (logistic). Each regression controlled for baseline status and mental health, Injury Severity Score (ISS), and 12-month SF36 physical function before evaluating the effect of outcome mental health. RESULTS: Follow-up data were available for 75% of the patients at 6 months and 51% at 12 months. The mean age of patients was 37.2 +/- 0.9 years (+/-SEM), and 73% were male. Their average ISS was 13.9 +/- 0.6. Seventy percent of injuries were blunt force, 13.5 % were penetrating, and 16.5 % were burn injuries (mean total body surface area, 13.3 +/- 1.5%). Sixty-four percent of the patients had returned to work at 12 months. Follow-up SF36 mental health was associated with the dependent outcome in each regression. After controlling for baseline status and mental health, ISS, and outcome SF36 physical function, outcome mental health was associated with outcome SF36 general health (p < 0.001), SIP work status (p = 0.017), and satisfaction with recovery (p = 0.005). Outcome SF36 mental health was related to baseline mental health, 12-month PTSD and BSI depression scores, and increased drug and alcohol use. CONCLUSIONS: Twelve months after trauma, patients' work status, general health, and overall satisfaction with recovery are dependent on outcome mental health. This dependency persists despite measured baseline status, ISS, or physical recovery. The mental disease after trauma is attributable to poor mental health, the development of symptoms of PTSD and depression, and increased substance abuse. Trauma centers that fail to recognize, assess, and treat these injury-related mental health outcomes are not fully assisting their patients to return to optimal function.

Learning to perceive the relative mass of colliding balls: the effects of ratio scaling and feedback.

The theory of direct perception holds that competent observers are able to detect optical patterns that specify the relative mass of colliding balls. Heuristic theorists, on the other hand, claim that judgments of relative mass are based on variables that do not specify relative mass. We contrasted these views with an experiment in which participants were given feedback on their ratio-scaled estimates of the relative mass of simulated colliding balls. Correlations between judged relative mass and various kinetic and kinematic measures of the collisions revealed that (1) judgments of relative mass become more accurate with feedback, (2) different observers use different variables, (3) during training, many observers change which variables they use, (4) before training, observers tend to use nonspecifying variables or combinations thereof, (5) after a minimal amount of training, at least some observers seem to detect mass-specifying information, and (6) the judgments do not support a generalization of the heuristic model of Gilden and Proffitt (1989, 1994). These findings suggest that direct perception of relative mass is a skill that can be developed through appropriate training.

Posttraumatic stress disorder in injured adults: etiology by path analysis.

OBJECTIVE: Posttraumatic Stress Disorder (PTSD) impairs outcome from injury. We present a path analysis of factors related to the development of PTSD in injured adults. METHODS: A prospective cohort of 250 patients without severe neurotrauma was evaluated by interview during admission and by mailed self-report 6 months later. Data were gathered from the trauma registry (age, injury mechanism, and Injury Severity Score), social history (gender, income, education, and social support), and survey instruments. Baseline assessment used the Michigan Critical Events Perception Scale (peritraumatic dissociation and subjective threat to life), the Life Experience Survey (stressful exposure history), and the SF36 (general and mental health). PTSD at 6 months was identified with the civilian Mississippi Scale for PTSD. Data are listed as mean +/- SEM or percent (%). Path analysis was conducted by linear regression and significant (p<0.05) variables are shown. Factors are listed with the standardized beta. A negative beta suggests a protective effect. RESULTS: The 176 patients (72%) who completed the 6-month follow-up were 37.7+/-0.88 years old; 75% were men; and blunt (70%), penetrating (13.5%), and burn (16.4%) mechanisms caused the injuries. Assault was involved in 14.5% of the cases. Average income was $44,300+/-2,700/yr, education was 13.0+/-0.15 years, and Injury Severity Score was 13.9+/-0.50. A total of 42.3% of the patients developed PTSD. The 39.7% of the variance in PTSD explained by the model was due to intentional injury (beta = 0.27), male gender (beta = -0.21), age (beta = -0.20), peritraumatic dissociation (beta = 0.174), baseline mental health (beta = -0.21), and prior life-threatening illness (beta = -0.29). Peritraumatic dissociation was due to the patient's sense of threat to life (beta = -0.47), and threat was related to Injury Severity Score (beta = 0.2), assault(beta = 0.14), education (beta = -0.15), and age (beta = -0.19). Baseline SF36 mental health was related to social support (beta = 0.27) and income (beta = 0.21). Income was contingent on education (beta = 0.21). CONCLUSION: PTSD occurred in 42.3% of injured adults 6 months after trauma and was related to assault, dissociation, female gender, youth, poor mental health, and prior illness. By modeling PTSD, we may learn more of the etiology, risk stratification, and potentials for the treatment of this common and important morbidity of injury.

Posttraumatic stress disorder after injury: impact on general health outcome and early risk assessment.

OBJECTIVE: To evaluate prospectively components of general health outcome after trauma and to report on the further validation of the Michigan Critical Events Perception Scale (MCEPS), an instrument that predicts increased risk for posttraumatic stress disorder (PTSD). METHODS: Adults without neurologic injury admitted to a Level I trauma center in 1997 were interviewed during hospitalization. Baseline data included demographics, injury mechanism, Injury Severity Score, the Short Form 36 (SF36), and the MCEPS, which measures peri-traumatic dissociation (the sense of depersonalization or derealization during an injury event). Surveys sent by mail and completed 6 months later included the SF36 and civilian Mississippi Scale for PTSD. RESULTS: A total of 140 patients were interviewed; the 70% (n = 100 patients) who completed the 6-month assessment form the study group. Injuries were categorized as 71% blunt, 13% penetrating, and 16% burn. Mean Injury Severity Score was 13.7+/-0.52. PTSD at 6 months occurred in 42% of the patients and was directly related to MCEPS dissociation (p = 0.001; odds ratio = 3.1; 95% confidence interval, 1.6, 5.9). A stepwise linear regression explains 40% of the variance in 6-month SF36 general health outcome (adjusted R2 = 0.402). The model controls for individual factors related to dissociation, PTSD, and general health outcome. Development of PTSD was independently and inversely related to general health outcome as measured by the SF36 at 6 months (p < 0.001, beta = -0.404). The R2 change of 0.132 for PTSD (vs. 0.082 for 6-month physical function) illustrates that PTSD contributes more to the patient's perceived general health at 6 months than the degree of physical function or injury severity. CONCLUSIONS: Within hours of injury, the MCEPS identifies patients who are three times more likely to develop PTSD. PTSD compromises self-reported general health outcome in injured adults independent of baseline status, Injury Severity Score, or degree of physical recovery. These data suggest that psychological morbidity is an important part of the patient's perceived general health.

Shedding some light on catching in the dark: perceptual mechanisms for catching fly balls.

To catch a lofted ball, a catcher must pick up information that guides locomotion to where the ball will land. The acceleration of tangent of the elevation angle of the ball (AT) has received empirical support as a possible source of this information. Little, however, has been said about how the information is detected. Do catchers fixate on a stationary point, or do they track the ball with their gaze? Experiment 1 revealed that catchers use eye and head movements to track the ball. This means that if AT is picked up retinally, it must be done by means of background motion. Alternatively, AT could be picked up by extraretinal mechanisms, such as the vestibular and proprioceptive systems. In Experiment 2, catchers reliably ran to intercept luminous fly balls in the dark, that is, in absence of a visual background, under both binocular and monocular viewing conditions. This indicates that the optical information is not detected by a retinal mechanism alone.