How language can be another barrier

People in the U.S. with limited English proficiency often put off needed medical care, are less likely to have a regular doctor and don’t take their medicine properly. Now, researchers find they’re more vulnerable to medical errors too.

For seven months, researchers taped and transcribed encounters between Spanish-speaking parents and health-care providers at an outpatient clinic. Among the 13 taped encounters, six involved professional hospital interpreters and the rest were ad hoc interpreters, usually nurses, social workers, and in one case, an 11-year-old sibling of a patient. An analysis of the 474 pages of transcripts revealed that nearly 400 interpretation errors occurred, about 31 on average at each visit.

About half were errors of omission, such as the interpreter not asking the parent about drug allergies or leaving out instructions on antibiotic dosage. Those errors made by the ad hoc interpreters were most likely to have serious consequences, which is a strong argument for trained interpreters, says lead author Glenn Flores, associate professor of pediatrics, epidemiology and health policy at the Medical College of Wisconsin and Children’s Hospital of Wisconsin in Milwaukee.

The study is in the January issue of the journal Pediatrics.

For chronically depressed men, testosterone may help boost mood

When antidepressants fail to lift a man’s mood, a testosterone booster may help. Now that the male hormone is easily administered in a gel, researchers at McLean Hospital in Belmont, Mass., were able to test its suspected antidepressant effects on a small group of men with persistent depression.

Each day for eight weeks, participants received an oral antidepressant along with either a placebo gel or a gel containing 100 milligrams of testosterone. Of the 10 men who used the hormone, three reported marked improvements in energy level, sex drive and psychological symptoms of depression, such as feelings of guilt, depressed mood and anxiety.

“Testosterone is not a blanket treatment for all depressed men, but for a certain subgroup it may be a promising advance,” says lead author Harrison G. Pope Jr., director of the biological psychiatry laboratory at McLean Hospital and professor of psychiatry at Harvard Medicine School. The study appears in the January issue of the American Journal of Psychiatry.

A word of warning about putting off Pap smears

Longer intervals between Pap smears, as some groups are now proposing for many women, may not be as effective as annual exams after all.

A report in the current issue of Obstetrics & Gynecology says that the risk of cancer doubles when a Pap smear is delayed two to three years. Although the study found the risk of developing an invasive cervical cancer during the first three years after a negative Pap smear is small, the longer one waits for the next screening, the higher the risk.

Nearly 1,500 women at the Kaiser Permanente HMO in Northern California participated in the study comparing 482 women with squamous cell cervical cancer to 934 healthy women.

The researchers found little difference between two- and three-year intervals, but women who waited more than three years and up to five years to have a Pap smear had triple the risk of cancer compared to those who had an annual screening, says lead researcher Marie Grisham Miller, now president of a health research company.

“About 62% of women who die [of cervical cancer] haven’t been screened in five years. These are lives that wouldn’t have been lost if we had more prevalent cancer screening,” says Jonathan S. Berek, chief of the division of gynecologic oncology at the UCLA’s Jonsson Comprehensive Cancer Center.