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PURPOSE: Patients with cancer who have limited English proficiency are more likely to experience inequities in cancer knowledge, timely care, and access to clinical trials. Matching patients with language-concordant clinicians and working with professional interpreters can effectively reduce language-related disparities, but little data are available regarding the impact of language-concordant interactions in oncology care. This study aimed to assess the use of the Roter Interaction Analysis System (RIAS) in language-concordant and -discordant interactions for patients with non-English language preference presenting for an initial oncology visit at four New York City hospitals. METHODS: We used the RIAS, a validated tool for qualitative coding and quantitative analysis, to evaluate interactions between 34 patients and 16 clinicians. The pairings were stratified into dyads: English language-concordant (n = 12); professionally interpreted (n = 11); partially language-concordant (n = 4, partially bilingual clinicians who communicated in Spanish and/or used ad hoc interpreters); and Spanish language-concordant (n = 7). A trained Spanish-speaking coder analyzed the recordings using established RIAS codes. RESULTS: Spanish language-concordant clinicians had almost two-fold greater number of statements about biomedical information than English language-concordant clinicians. Spanish language-concordant patients had a higher tendency to engage in positive talk such as expressing agreement. The number of partnership/facilitation-related statements was equivalent for English and Spanish language-concordant groups but lower in professionally interpreted and partially language-concordant dyads. CONCLUSION: Language concordance may facilitate more effective biomedical counseling and therapeutic relationships between oncology clinicians and patients. Future research should further explore the impact of language concordance on cancer-specific health outcomes.

Treatment of chronic hypercapnic failure in COPD patients with home noninvasive ventilation (HNIV) remains unclear.To create a curated cohort of all COPD patients on HNIV in Catalonia, perform a cluster analysis, and evaluate mortality evolution.This study was a multicenter, observational study including all COPD patients on HNIV on 1st January of 2018. Patients were selected through the Catalan Health Service, and administrative and clinical data were obtained in the previous four years. Principal component analysis of mixed data and hierarchical clustering were performed to identify clusters of patients. Mortality was evaluated from 1 January 2018 until 31 December 2020.A total of 247 patients were enrolled. They were mostly male (78.1%), with a median (SD) age of 70.4 (9.4) years old. In 60%, 55% and 29% of patients, obesity, sleep apnea and heart failure coexisted, respectively. Cluster analysis identified four well-differentiated groups labeled for their clinical characteristics: (1) obese smokers, (2) very severe COPD, (3) sleep apnea and (4) older comorbid males. Patients belonging to Clusters (2) and (4) had a worse prognosis than patients in Clusters (1) and (3).A high heterogeneity in the prescription of HNIV was demonstrated. Cluster analysis identifies four different groups, of which only one had COPD as the main cause of ventilation, while the other three clusters showed a predominance of other comorbidities. This leads to different survival outcomes, including an overlapping phenotype of obesity-related disease and sleep apnea with better survival.

To improve language-concordant, equitable healthcare for Spanish speakers, many United States medical schools offer medical Spanish education. However, there is no clinically contextualized, standardized approach to medical student language assessment. This article reports on the development and effectiveness of a training curriculum to prepare raters to use a new rubric, the Physician Oral Language Observation Matrix (POLOM), to reliably rate medical student Spanish oral proficiency after observing videorecorded encounters between students and standardized patients. Curriculum effectiveness was primarily evaluated by examining each rater trainee’s level of agreement with expert consensus POLOM ratings (i.e., inter-rater reliability as measured by the generalizability theory dependability coefficient). Out of the study’s nine rater trainees, who were from either medical or linguistic professional backgrounds, five proceeded to the calibration phase, and four attained the reliability threshold required for calibration. The paper concludes that this rater training curriculum can successfully train raters to use the POLOM reliably when evaluating medical student Spanish oral proficiency during videorecorded healthcare encounters. To allow for improved assessment of student language skills prior to use in patient care, future efforts should focus on POLOM validity assessment and larger scale rater recruitment, training, calibration, and maintenance.

Linguistic and cultural discordance between clinicians and patients contributes to suboptimal care of Latinx patients with diabetes. Bilingual pedagogies may help learners with pre-existing Spanish skills to improve health communication with linguistic minorities.We designed a diabetes workshop for health professions students that applied the educational principles of bilingual pedagogies, focus on learners with prior Spanish skills, and intersectionality of language and culture. The session introduced diabetes concepts in Spanish and English, applied Latinx cultural beliefs to clinical conversations about diabetes and explored the impact of clinician language and cultural skills on diabetes-related communication.Voluntary surveys evaluated learner knowledge, confidence and attitudes before and after the intervention. Of 60 attendees, 57 participants (95%) completed surveys. Comparison of pre and post responses yielded statistically significant increases in respondents' cultural knowledge and confidence in explaining diabetes concepts in Spanish (all p 0.001). When controlling for Spanish level, most items still showed a significant improvement. Latinx and heritage learners were more likely to express lower confidence in explaining diabetes post-workshop (p 0.05), suggesting an increased awareness of limitations.Bilingual educational interventions that emphasise culturally appropriate clinical skills may be an effective way to prepare health professions students who are heritage Spanish or second-language learners to better communicate with Latinx patients about diabetes. We provide actionable recommendations for clinical educators interested in incorporating communication skills training for linguistically diverse patient care.

Introduction Many burn injuries are preventable, yet burn prevention information may be inadequate or inaccessible to communities with non-English language preference. Out of the estimated 480,000 people in the US that are treated annually for burns, 14% identify as Latinx. Among the 60 million Latinx individuals living in the US, 33% report limited English proficiency. As a result, many Latinx persons rely on health information in Spanish. The availability and quality of Spanish language information regarding burn prevention has not previously been studied but presents an important opportunity to reduce burn-related injuries for the US Latinx population. Our objective was to systematically analyze the content accuracy, website quality, and readability of Spanish language online information for burn prevention in the home. Methods We conducted a search on Google, Bing, and Yahoo using the following key burn prevention terms in Spanish: “prevención de quemaduras,” “prevenir quemaduras,” “evitar quemaduras,” and “impedir quemaduras”. The top 10 results from each search engine and key term were recorded. Using recommendations from national organizations and a burn care expert team, two reviewers independently evaluated the content accuracy of each website and met to reach consensus. We assessed website quality by three major categories based on the Health on the Net Code of Conduct (HONcode): accessibility/usability, credibility, and currency. We scored readability of each website by utilizing five validated readability tests for the Spanish language and generating an average grade reading level needed to understand the article. Results After removing duplicates and irrelevant search results, 23 websites in Spanish met inclusion criteria. Across all websites, the content accuracy of information broken down by type of burn was as follows: scald 35%, electrical 28%, contact 20%, and flame 17%. Out of 21 possible points, the top website scored 14 (66.7%) and the average score was 6.6 (31.4%). Using the intraclass correlation coefficients, the interrater reliability was 0.935. For website quality, the average score was 50.2%. The average grade level needed to read the websites was 8.6. Conclusions Spanish language online information on burn prevention in the home is often inaccurate and incomplete. Furthermore, overall website quality was lower than 50% according to the HONcode, and the average grade level needed to read the articles is higher than the sixth-grade recommendation from the American Medical Association. Applicability of Research to Practice This research highlights the lack of reliable and accessible information in Spanish on home burn prevention. Not only does this research suggest that Spanish-speaking patients should be provided education on burn prevention by their healthcare providers, but more importantly, we propose a call to action to increase the quality of online Spanish materials for burn prevention for the US Latinx community.

Purpose While many schools teach medical Spanish to improve communication with the growing Spanish-speaking population, a standardized assessment methodology is lacking. This study evaluates validity evidence for a newly developed Spanish Communication and Interpersonal Skills (CIS) scale. Method The authors developed the Comunicacion y Habilidades Interpersonales (CAI, pronounced /kī/) scale by culturally and linguistically adapting a 14-item validated English CIS scale. Sources of validity evidence were gathered targeting content, response process, internal structure, relations to other variables, and consequences. The CAI was administered as part of an objective structured clinical examination at 2 medical schools from April to June 2020. Results The authors mapped CAI items onto USMLE Step 2 CIS behavioral functions and medical Spanish learner competencies to examine content validity. The mean item difficulty and item discrimination estimates are 2.86 (SD = .34) and .81 (SD = .08), respectively, demonstrating good psychometric properties at the item level. Internal-consistency reliability for a single case was .96. Learner variance accounted for 12% of total variance, demonstrating ability to differentiate higher and lower performing learners; the person-case interaction accounted for 44% of total variance, indicating strong case specificity. Conclusions The CAI has higher case specificity than previously reported in English, suggesting that the nuanced contextual elements of individual cases may matter even more when learners are using limited language skills. Implementing the CAI more widely may promote inclusion of patient-centered communication skills as part of curricular content and activities. This study's validity evidence may inform the development of a future medical Spanish certification examination.

To communicate with linguistically diverse patients, medical students and physicians often use their non-English language skills. However, there is no standard protocol to determine whether those skills are adequate prior to patient care. This causes many physicians, institutions, educators, and learners to forgo non-English language proficiency assessment altogether. The purpose of this study is to report on the development, refinement, and interrater reliability of the Physician Oral Language Observation Matrix (POLOM), a rater-based tool assessing 6 language skill categories observed during clinical interactions: comprehension, fluency/fluidity, vocabulary, pronunciation, grammar, and communication. This study focused on the use of the POLOM in Spanish interactions.The authors adapted an existing language observation tool for use in clinical settings, creating the preliminary POLOM. Next, they iteratively refined the tool from April to July 2021 using videorecorded medical student-standardized patient encounters from a U.S.-based medical Spanish program. In each refinement iteration, 4 bilingual raters (2 physicians and 2 linguists) independently rated 3 to 6 encounters and convened to discuss ratings with the goals of improving instrument instructions, descriptors, and subsequent rater agreement. Using the final POLOM, raters independently rated 50 videos in rotating interdisciplinary pairs. Generalizability theory was applied to estimate reliability via interrater agreement (dependability) coefficients (range 0-1) for each POLOM category and the total score.POLOM total score dependability equaled 0.927 (single rater) and 0.962 (averaged across 2 raters). The highest mean score was observed for the comprehension category (4.15; range: 1-5) while the lowest was for communication (3.01; range 1-5).Raters achieved a high level of agreement on POLOM assessments of students' medical oral Spanish proficiency. The POLOM is the first such assessment tool that provides examinees and instructors with both a holistic and detailed review of clinician non-English oral language skills as contextualized for patient care.

Despite the rapid development of virtual medical Spanish educational materials, online resources lack transparency and a peer-review process. The purpose of this interdisciplinary study was to provide a critical inventory of virtual resources for medical Spanish education, thereby providing a panorama of the current state of online medical Spanish.Research team members conducted iterative searches to identify medical Spanish online resources, which were then screened for predetermined inclusion/exclusion criteria. Between June and August 2020, a panel of medical and language experts then adapted and applied a previously published evaluation tool to determine whether resources that met study criteria would help learners achieve medical Spanish core competencies and to what extent each resource incorporated communicative language activities. Consensus meetings were conducted to resolve disagreements and identify gaps in online education.Out of 465 resources, 127 were further screened, and eight were selected for evaluation. Medical and language specialists independently scored each resource and, following discussions, achieved consensus. Overall, no resource met suitability criteria for all five medical Spanish learner competencies or cultural elements, and only one was suitable for achieving the self-assessment competency.Interdisciplinary consensus meetings provide an important avenue for resolving differences of opinion and for integrating both language and medical perspectives into the evaluation process. Existing online resources should be used in conjunction with other materials to ensure that all core competencies for medical Spanish education are addressed. This study revealed important gaps in online resources, including a need to target advanced Spanish learners, apply authentic communicative activities, include assessment opportunities, and integrate culture in the learning program. Based on the current state of online medical Spanish, we offer recommendations for future resources.

The concept of limited English proficiency (LEP) presents significant challenges when applied to the healthcare needs of the diverse and growing multilingual population in the U.S. We expound on the following ways in which the concept of LEP is problematic: the ethnocentric notion of a “primary language,” the ambiguous idea of “limited ability,” and the deficit-oriented construct of “language assistance.” We provide examples that illustrate the negative healthcare impact of LEP terminology, including the unaccounted-for complexities of health communication within the concept of “primary language,” the “limited abilities” of health professionals whose language skills are often unassessed, and the ignored role of “language assistance” resources such as interpreters as essential collaborators. Finally, we propose rethinking LEP by (a) reframing patient language using the term non-English language preference and (b) assessing health professional non-English language skills. These actionable strategies have the potential to improve language-appropriate healthcare for diverse populations.

Medical Spanish education aims to reduce linguistic barriers in healthcare and has historically been led by Hispanic/Latinx students and faculty, often without formal training or institutional support. We surveyed 158 US medical schools about their medical Spanish programs. We then examined national trends in Underrepresented in Medicine and Hispanic/Latinx faculty and students as factors associated with meeting medical Spanish basic standards for curricula, educators, assessment, and course credit. We received responses from 125 schools (79%), of which 98 (78%) reported offering some form of medical Spanish. Schools with greater racial/ethnic diversity were more likely to have medical Spanish required courses (P-values

In the valuable orchid genus

Latinx individuals represent a linguistically and racially diverse, growing US patient population. Raciolinguistics considers intersections of language and race, prioritizes lived experiences of non-English speakers, and can help clinicians more deftly conceptualize heterogeneity and complexity in Latinx health experiences. This article discusses how raciolinguistic hierarchies (ie, practices of attaching social value to some languages but not others) can undermine the quality of Latinx patients' health experiences. This article also offers language-appropriate clinical and educational strategies for promoting health equity.Las personas latinx representan una creciente población estadounidense diversa de pacientes desde el punto de vista lingüístico y racial. La raciolingüística considera las interrelaciones del idioma y la raza, prioriza las experiencias vividas de personas que no hablan inglés y puede ayudar a los médicos a conceptualizar de manera más hábil la heterogeneidad y la complejidad en las experiencias de salud de latinx. Este artículo analiza cómo las jerarquías raciolingüísticas (es decir, las prácticas de otorgar valor social a algunos idiomas, pero no a otros) pueden socavar la calidad de la experiencia sanitaria de los pacientes latinx. Este artículo también ofrece estrategias clínicas y educativas adecuadas al lenguaje para promover la equidad sanitaria.

Resumen El carcinoma epidermoide sarcomatoide es una entidad rara en la fosa nasal. Presentamos el caso de un varon de 50 anos con una masa polipoide en la cavidad nasal izquierda. En el estudio anatomopatologico, se observa una histologia bifasica de nidos escamosos no queratinizantes y un estroma sarcomatoide con positividad para AE1-AE3. El paciente presento metastasis cervicales ipsilaterales, tratandose con vaciamiento cervical, radioterapia y cisplatino adyuvante. Dos anos despues se encuentra libre de enfermedad.

An alternative for sustainable urban development is to revegetate cities with the construction of planters as well as to recover degraded sites. The objective of this work was to characterize urban waste materials produced in Mexico City and to evaluate their potential for constructing Technosols for plant growth, as an alternative to use in revegetating the city without affecting natural landscapes. Construction and demolition waste materials amended with different application rates of compost made out of gardening wastes from Mexico City green areas were tested. Nine mixtures were prepared; three based on concrete, three based on demolition waste and three based on excavation waste. Changes on physical, chemical and physicochemical properties of these mixtures, namely nutrient contents, water retention and aeration capacity, were monitored in a twelve-month experiment. The mineralogy and the risk regarding the release of heavy metals and trace elements were also evaluated in the soluble fraction. The constructed Technosols were appropriate, to a greater or lesser extent, for tomato plant growth. Soil pH and soil electrical conductivity (EC) were the main factors defining their suitability; both parameters changed over time due to the washing of salts. The particle size of the mineral materials as well as the application rates of compost used in the construction of the Technosols resulted in adequate water holding capacity and soil aeration for plant growth. The type of parental materials defined the majority of the Technosol characteristics as well as their ability to function as a plant support. The concentrations of readily available heavy and trace metals were not a limitation for plant growth. However, potential co-transport of these elements with soluble organic matter should be considered in further research.

Purpose On March 16, 2020, the Spanish government declared a state of alarm due to the rapid spread of coronavirus disease 2019 (COVID-19). Patients with chronic obstructive pulmonary disease (COPD) were restricted to remain confined at home, and medical visits were cancelled for 3 months. The impact of this lockdown on the manifestations of COPD and the quality-of-life of these patients has not been explored. Patients and methods One hundred patients with COPD were interviewed by telephone from May 2-18, 2020. The interviews included questions about the lockdown, missed medical appointments, fears of the disease, possible COVID-19 infection, and exacerbations of COPD suffered during this period and their management. In addition, the COPD Assessment Test, the Hospital Anxiety and Depression, and the 5-Dimension Euro Quality-of-Life questionnaires were administered. Results Sixty-four (64%) patients claimed to have strictly complied with the lockdown, and only 42 (42%) stated they had left home at least once during lockdown. Only one patient (1%) was hospitalized due to COVID-19, and 13 (13%) patients presented an exacerbation of COPD self-managed at home with no admissions due to exacerbation of COPD during this period. A medical consultation or complementary test was cancelled in 90% of the patients, but 61% had a medical telephone visit with a high degree of satisfaction (mean 9.3/10). Most patients declared that their feeling regarding lung disease and general health was similar or even better during lockdown (82% and 81%, respectively). Conclusion Our results indicate that in general lockdown had a low impact on COPD patients. Only one patient was affected by COVID-19, but moderate exacerbations of COPD were not infrequent. Although many medical visits and test were cancelled, patients were very satisfied with the medical telephone visits.

Medical communication across languages is gaining attention as the multilingual character of local, regional, and national populations across the world continues to grow. Effectively communicating with patients involves not only learning medical terminology, but also understanding the community’s linguistic practices, and gaining the ability to explain health concepts in patient-centered language. Language concordance between physicians and patients improves patient outcomes, but methods to teach communication skills for physicians are usually limited to the majority or official language. For example, in U.S. medical schools increased demand for physician skills in other languages, such as Spanish, has resulted in renewed academic discourse about best practices in teaching practical communication skills for physicians. In language education, translanguaging is an approach that integrates and validates multilingual individuals’ real use of language, which often includes non-standard words, regionalisms, and mixed influences from multiple languages, such as Spanglish or Chinglish. Efforts to improve medical language concordance by teaching a second language to medical students would benefit from an understanding of patient-centered communication strategies, such as is supported by translanguaging. Teaching effective communication skills to physicians should evolve and engage with the fluid linguistic attributes of culturally and linguistically diverse patient populations. In this eye opener, we first introduce the translanguaging perspective as an approach that can increase attention to patient-centered communication, which often includes spontaneous practices that transcend the traditional boundaries of named languages, and then present examples of how translanguaging can be implemented in medical education in order to sustainably enhance equity-minded patient-accessible medical communication.

Medical Spanish (MS) education is in growing demand from U.S. medical students, providers, and health systems, but there are no standard recommendations for how to structure the curricula, evaluate programs, or assess provider performance or linguistic competence. This gap in medical education and assessment jeopardizes health care communication with Hispanic/Latino patients and poses significant quality and safety risks. The National Hispanic Health Foundation and University of Illinois College of Medicine convened a multidisciplinary expert panel in March 2018 to define national standards for the teaching and application of MS skills in patient-physician communication, establish curricular and competency guidelines for MS courses in medical schools, propose best practices for MS skill assessment and certification, and identify next steps needed for the implementation of the proposed national standards. Experts agreed on the following consensus recommendations: (1) create a Medical Spanish Taskforce to, among other things, define educational standards; (2) integrate MS educational initiatives with government-funded research and training efforts as a strategy to improve Hispanic/Latino health; (3) standardize core MS learner competencies; (4) propose a consensus core curricular structure for MS courses in medical schools; (5) assess MS learner skills through standardized patient encounters and develop a national certification exam; and (6) develop standardized evaluation and data collection processes for MS programs. MS education and assessment should be standardized and evaluated with a robust interinstitutional medical education research strategy that includes collaboration with multidisciplinary stakeholders to ensure linguistically appropriate care for the growing Spanish-speaking U.S. population.

Introduction: Meditation has been a practice studied from different perspectives, especially from health, but little from qualitative methodologies that account for the subjective processes of change in everyday life. Objective: The following study pretends to get to know the meaning that a group of students attributes to the use of meditation in their daily life. Method: From a qualitative methodology, there is an investigation in the experience of university students who participated in a general training course in which ten meditation meetings were held. The recollection of data was done from semi-structured interviews to the participants, with the review of personal binnacles in which they reported their experience in every meditation. Results: The meditation practice had implications in the personal, relational and societal areas, emphasizing the well-being that the meditation generates in the short and medium-term, contributing to self-care, to self-knowledge and the change of the perspective on themselves, on others and the social reality, favoring the transforming actions in these areas. Conclusion: The meditation generates a rupture in the subject’s daily life, experience that would have favored their critical thinking regarding their reality, which is complemented with other strategies from occupational therapy could contribute to the intervention processes, assuming a facilitating role for the transformation of individual life and social reality.

El turismo comunitario en el Ecuador es una actividad reconocida y regulada legalmente. Estas regulaciones también establecen las actividades y el tipo de capacitación con las que deben contar las comunidades indígenas o rurales que han tenido la iniciativa por emprender en este sector para garantizar la calidad de los servicios turísticos ofertados. El requisito de capacitación y formación se vuelve problemático para los miembros de los emprendimientos comunitarios por diferentes razones, por ejemplo: capacitadores con conocimientos limitados de la comunidad, capacitadores que no poseen las herramientas pedagógicas y metodológicas necesarias para motivar una participación activa de las personas asistentes a las capacitaciones y contenidos de aprendizaje que sean pertinentes con el contexto de la comunidad. Por este motivo se propone un modelo de co-capacitación de los miembros de la comunidad en el que con el soporte de un facilitador, y utilizando una metodología didáctica basada en problemas (PBL) sean los mismos miembros de la comunidad que compartan sus conocimientos para lograr un aprendizaje común con el objetivo de lograr que sus emprendimientos de turismo comunitario sean rentables y se mantengan en el tiempo. Palabras clave: turismo comunitario; sostenibilidad; capacitación; pedagogía; metodología.

Introduction: Language concordance between patients and physicians is an important factor in providing safe and effective health care, with Spanish as the predominant and fastest growing non-English language in the United Sates. However, despite increasing demand for medical Spanish education, valid concerns about inadvertently increasing provider use of limited Spanish with patients, lack of knowledge of best practice in education and assessment, and lack of institutional support still present barriers to medical Spanish education in medical schools. Methods: The authors conducted a narrative review of existing literature that evaluates the link between medical Spanish education of physicians and language concordance. Results: Medical Spanish educational efforts, although increasing, are not consistently linked to learner assessment. The literature to date supports that for medical Spanish education to improve patient outcomes, it should be linked to assessment methodology that demonstrates improvement in language concordance with Spanish-speaking patients, and should include safety measures to prevent inadvertent communication errors. The authors review data for published medical Spanish postcourse language assessment strategies and provide recommendations to ensure responsible and competent use of medical Spanish skills. Conclusion: The authors propose three structural elements that should be considered when incorporating or enhancing medical Spanish education in medical schools: institutional endorsement of the role of medical Spanish education within a national health disparities context; precourse proficiency testing to establish student starting level; and learner postcourse communications skills and limitations assessment to provide individualized recommendations and assure patient safety.

Background: Hurricanes have a strong influence on the ecological dynamics and structure of tropical forests. Orchid populations are especially vulnerable to these perturbations due to their canopy exposure and lack of underground storage organs and seed banks. Aims: We evaluated the effects of Hurricane Ivan on the population of the endemic epiphytic orchid Encyclia bocourtii to propose a management strategy. Methods: Using a pre- and post-hurricane dataset (2003–2013), we assessed the population asymptotic and transient dynamics. We also identified the individual size-stages that maximise population inertia and E. bocourtii’s spatial arrangement relative to phorophytes and other epiphytes. Results: Hurricane Ivan severely affected the survival and growth of individuals of E. bocourtii, and caused an immediate decline of the population growth rate from λ = 1.05 to λ = 0.32, which was buffered by a population reactivity of ρ1 = 1.42. Our stochastic model predicted an annual population decrease of 14%. We found an aggregated spatial pattern between E. bocourtii and its host trees, and a random pattern relative to other epiphytes. Conclusion: Our findings suggest that E. bocourtii is not safe from local extinction. We propose the propagation and reintroduction of reproductive specimens, the relocation of surviving individuals, and the establishment of new plantations of phorophytes. This work was supported by the Inter-ministerial Commission for Science and Technology under Grant [CICYT-Spain, Project CGL2015-69985-R]; and the Havana Project of the University of Alicante.

Neurologic clinical care requires that clinicians gather and synthesize complex information, including a thorough, precise history and a detailed physical examination that maximizes the patient's cooperation. Yet, for patients who do not speak the dominant language in the country or region where they live, effective communication with their clinician may not always occur. In this article, we discuss the impact of language on neurologic care, focusing on access to care and on the diagnosis and treatment of two common and potentially life-threatening conditions: stroke and epilepsy. We then review implications for clinical neurologic care as well as medical education and present evidence-based recommendations for improving neurologic health equity for linguistically diverse populations. Strategies should integrate professional medical interpreters (for oral communication) and translators (for written materials) into the neurologic team, account for families and caregivers in a culturally humble manner, and teach learners to apply clinical neurologic skills in both language-concordant and discordant situations.

BackgroundCoinfections in COVID19 appear to worsen hospitalized patients prognosis.ObjectiveTo describe the characteristics of bacterial and fungal coinfections in patients admitted for COVID19 and to identify the risk factors associated with its occurrence.Patients and MethodsSingle-center retrospective study reviewing medical records of patients with COVID19 diagnosed with bacterial or fungal infection during hospital admission.Results333 patients were analyzed during March 15-May 15, 2020. 16.82% had some coinfection during admission. Coinfections were more frequent in patients with comorbidities (80.36% vs 19.64% p7500 and increased procalcitonin on admission as well as lymphopeniaEnterococci, Candida spp, Enterobacteriaceae and Pseudomonas spp. 74% of patients received ceftriaxone: 17.34% of those treated had a coinfection compared to 15.48% not treated (p 0.694).ConclusionsOccurrence of coinfections is frequent and prolongs hospital stay without influencing mortality. The presence of comorbidities and ICU stay were identified as the main risk factor for coinfection, while increased neutrophils and procalcitonin at admission and lymphopenia during evolution were the main biological predictors. Enterococcus was the most frequent pathogen. Ceftriaxone use does not protect against appearance of bacterial infections. C. albicans was the most frequently isolated fungus and was associated with prolonged ICU stay.