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Distribution by Scientific Domains

Medical Sciences	76%
Life Sciences	11%

Selected Abstracts

(634) Reliability and Clinical Utility of an Implanted Intraspinal Catheter Used in the Treatment of Spasticity and Pain

PAIN MEDICINE, Issue 2 2000
Article first published online: 25 DEC 200
Authors: Elliot Krames, Pacific Pain Treatment Center; Iva Chapple, Carolina Pain Center Objectives: To examine the performance and reliability of a redesigned implantable intrathecal catheter. Materials: A total of 212 catheters were implanted in 202 patients in this 22-center, prospective study of an implantable catheter/pump system used to deliver intrathecal drugs for the treatment of pain and spasticity. Along with physician assessments of each use, the rates of common catheter complications (dislodgements, disconnections, fractures, and kinks) experienced during the study were analyzed in relation to implant conditions (catheter entry site, tip position, and anchoring method). Results: A cumulative study of 3112.8 months of patient experience (average: 15.4 months; range: 0 to 30.2 months per catheter) revealed an overall catheter-caused complication rate of 0.3% per patient month. Physician assessments were favorable, with 89% rating this catheter as better than previously used intraspinal catheters. A measure of catheter survival estimates (Kaplan-Meier) at 9 months was 89% including all complications. Comparison of data relating to implant techniques demonstrated a variety of catheter implant techniques (entry, positioning, anchoring) with no correlation between any one technique and the common complications. Conclusions: Performance data and physician assessments indicate that this catheter is an improvement over the previously available catheter. [source]

Critical Therapeutics: Cultural Politics and Clinical Reality in Two Eating Disorder Treatment Centers

MEDICAL ANTHROPOLOGY QUARTERLY, Issue 4 2007
Rebecca J. Lester
Recent studies suggest that eating disorders are increasing in Mexico and that this seems to correspond with Mexico's push to modernization. In this respect, Mexico exemplifies the acculturation hypothesis of eating disorders, namely, that anorexia and bulimia are culture-bound syndromes tied to postindustrial capitalist development and neoliberalist values, and that their appearance elsewhere is indicative of acculturation to those values. Available evidence for this claim, however, is often problematic. On the basis of five years of comparative fieldwork in eating disorder clinics in Mexico City and a small Midwestern city in the United States, I reframe this as an ethnographic question by examining how specific clinical practices at each site entangle global diagnostic categories with local social realities in ways that problematize existing epistemologies about culture and illness. In this regard, debates about acculturation and the global rise of eating disorders foreground issues of central epistemological and practical importance to contemporary medical anthropology more generally. [source]

Combination therapy with ribavirin and interferon in a cohort of children with hepatitis C and haemophilia followed at a pediatric haemophilia treatment center

HAEMOPHILIA, Issue 1 2004
J. Puetz
Summary., Nearly all children with bleeding disorders who received factor concentrates prior to the late 1980s were infected with hepatitis C. Treatment of adults infected with hepatitis C with combination therapy consisting of ribavirin and interferon has shown sustained response rates of 30,60%. Little data is available on the response of children infected with hepatitis C treated with combination therapy, especially those with bleeding disorders. We wish to report a single paediatric haemophilia treatment center's results of treatment of adolescents with haemophilia and hepatitis C infection with combination therapy. All patients followed at the haemophilia treatment center with hepatitis C, who were human immunodeficiency virus (HIV) negative and had a measurable hepatitis C viral load were eligible. Study patients received at least 6 months of 3 MU interferon- , via subcutaneous injection three times per week and 1000 mg day,1 of ribavirin. Eleven patients agreed to participate in the study. Three patients had an un measurable viral load after 6 months of combination therapy. All three completed 12 months of medication and continued to remain free of hepatitis C for 12 months after discontinuation of therapy. Side-effects of combination therapy were significant but tolerable. The sustained response rate in this study is similar to the historical response rate seen in adults but less than the other reported response rates seen in children treated with combination therapy. Given the toxicity of combination therapy, and natural history of hepatitis C infection in children, consideration of a liver biopsy to evaluate disease progression prior to considering antiviral medications is warranted. [source]

Detection of 95 novel mutations in coagulation factor VIII gene F8 responsible for hemophilia A: results from a single institution ,

HUMAN MUTATION, Issue 7 2006
Benoît Guillet
Abstract Hemophilia A (HA) is an X-linked hereditary bleeding disorder defined by a qualitative and/or quantitative factor VIII (FVIII) deficiency. The molecular diagnosis of HA is challenging because of the high number of different causative mutations that are distributed throughout the large F8 gene. The putative role of the novel mutations, especially missense mutations, may be difficult to interpret as causing HA. We identified 95 novel mutations out of 180 different mutations responsible for HA in 515 patients from 406 unrelated families followed up at a single hemophilia treatment center of the Bicêtre university hospital (Assistance Publique-Hôpitaux de Paris [AP-HP], Le Kremlin-Bicêtre). These 95 novel mutations comprised 55 missense mutations, 12 nonsense mutations, 11 splice site mutations, and 17 small insertions/deletions. We therefore developed a mutation analysis based on a body of proof that combines the familial segregation of the mutation, the resulting biological and clinical HA phenotype, and the molecular consequences of the amino acid (AA) substitution. For the latter, we studied the putative biochemical modifications: its conservation status with cross-species FVIII and homologous proteins, its putative location in known FVIII functional regions, and its spatial position in the available FVIII 3D structures. The usefulness of such a strategy in interpreting the causality of novel F8 mutations is emphasized. Hum Mutat 27(7), 676,685, 2006. © 2006 Wiley-Liss, Inc. [source]

The use of herbal remedies by adolescents with eating disorders

INTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 2 2004
Leo Trigazis
Abstract Objective To determine the frequency and type of herbal remedies and the reasons for herbal remedy use by adolescents with eating disorders. Methods Forty-six female adolescent females (age range, 10,17 years; mean age, 15 ± 1.3 years) in a tertiary-care pediatric eating disorder treatment center from May 1998 to July 2000 volunteered for this cross-sectional study. They met the criteria for anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified. Participants completed a 92-item self-administered questionnaire. We summarized information on demographics, use of herbal remedies, knowledge of safety issues of herbal remedies, and trust in the health care system. Results Of these 46 subjects, 17 (37%) used herbal remedies. Of these 17 subjects, 35% (6 of 17) used herbal remedies to decrease their appetites and to induce vomiting, 41% (7 of 17) knew nothing about herbal remedies, despite their use of these products, and 24% (4 of 17) reported that their physicians asked whether they used herbal remedies. The participants did not use herbal remedies because of their dissatisfaction with allopathic medicine. Discussion Adolescents with eating disorders frequently used herbal remedies for both weight control and non,weight control purposes. They did not regularly inform their physicians about their use of herbal remedies and physicians did not regularly inform their patients about this use. The generally high prevalence of herbal remedy use in this population suggests that health care providers need to be knowledgeable and should enquire about patients' use of these products. The perceived benefits, adverse effects, and herb-drug interactions of self-prescribed herbal remedies consumed by adolescents with eating disorders are unknown and further research is needed. © 2004 by Wiley Periodicals, Inc. Int J Eat Disord 35: 223,228, 2004. [source]

Feasibility of Using Interactive Voice Response to Monitor Daily Drinking, Moods, and Relationship Processes on a Daily Basis in Alcoholic Couples

ALCOHOLISM, Issue 3 2010
James A. Cranford
Background:, Daily process research on alcohol involvement has used paper-and-pencil and electronic data collection methods, but no studies have yet tested the feasibility of using Interactive Voice Response (IVR) technology to monitor drinking, affective, and social interactional processes among alcoholic (ALC) couples. This study tested the feasibility of using IVR with n = 54 ALC couples. Methods:, Participants were n = 54 couples (probands who met criteria for a past 1-year alcohol use disorder and their partners) recruited from a substance abuse treatment center and the local community. Probands and their partners reported on their daily drinking, marital interactions, and moods once a day for 14 consecutive days using an IVR system. Probands and partners were on average 43.4 and 43.0 years old, respectively. Results:, Participants completed a total of 1,418 out of a possible 1,512 diary days for an overall compliance rate of 93.8%. ALC probands completed an average of 13.3 (1.0) diary reports, and partners completed an average of 13.2 (1.0) diary reports. On average, daily IVR calls lasted 7.8 (3.0) minutes for ALC probands and 7.6 (3.0) minutes for partners. Compliance was significantly lower on weekend days (Fridays and Saturdays) compared to other weekdays for probands and spouses. Although today's intoxication predicted tomorrow's noncompliance for probands but not spouses, the strongest predictor of proband's compliance was their spouse's compliance. Daily anxiety and marital conflict were associated with daily IVR nonresponse, which triggered automated reminder calls. Conclusions:, Findings supported that IVR is a useful method for collecting daily drinking, mood, and relationship process data from alcoholic couples. Probands' compliance is strongly associated with their partners' compliance, and automated IVR calls may facilitate compliance on high anxiety, high conflict days. [source]

Financial Costs of Alcoholism Treatment Programs: A Longitudinal and Comparative Evaluation Among Four Specialized Centers

ALCOHOLISM, Issue 1 2003
B. Nalpas
Background: Alcoholism is a worldwide problem. Many strategies for alcohol detoxification and relapse prevention exist, but each alcohol treatment center has its own program. The objective of this study was to analyze and compare the financial cost and effectiveness of alcohol treatment programs from inpatient stay to follow-up 1 year later. This was a prospective, open, nonrandomized study of 4 specialized alcohol treatment centers and 267 patients admitted for alcohol detoxification. Methods: We recorded all medical and nonmedical interventions related to the program during patient stay in the hospital and every 3 months after discharge for 1 year and recorded the occurrence of alcohol relapse. Financial evaluation was based on the prices of refund from the French national health insurance service. Results: The mean cost of hospitalization ranged from ,1326 to ,1917 (p= 0.001), a variation mainly due to the difference in the length of hospital stay but also to the cost of the inpatient program, routine medical checkups, and drugs administered. The mean cost of 1 year of follow-up per patient ranged from ,419 to ,1704 (p= 0.001). The efficiency, corresponding to the money spent to prevent the relapse of one patient during 1 month, was approximately ,500/month in three centers and ,658 in the fourth. However, for a similar efficiency, the effectiveness, assessed by the mean time without relapse, was significantly (p= 0.001) different; center 1, which had the highest total cost, had an effectiveness 1.56 times higher than center 3, which had the lowest cost. Conclusions: This work emphasizes the heterogeneity of the costs and effectiveness of alcoholism treatment programs and suggests that research should be conducted to determine which program is the most rational, cost-efficient, and beneficial for patients and the public health office economy. [source]

Automating Standard Alcohol Use Assessment Instruments Via Interactive Voice Response Technology

ALCOHOLISM, Issue 2 2002
James C. Mundt
Background: Interactive voice response (IVR) technology integrates touch-tone telephones with computer-automated data processing. IVR offers a convenient, efficient method for remote collection of self-report data. Methods: Twenty-six subjects recruited from an outpatient alcohol treatment center completed IVR and paper/pencil versions of a demographic and drinking history questionnaire, Stages of Change Readiness and Treatment Eagerness Scale, Drinker Inventory of Consequences, Obsessive-Compulsive Drinking Scale, Alcohol Dependence Scale, and two numerical rating scales of craving and desire to drink during the prior week. Administration of the instruments in both formats was repeated 1 week later. The order of administration method was counterbalanced between subjects and reversed across data collection sessions. Scale and subscale scores from both methods were correlated within sessions. Test-retest correlations were also calculated for each method. A criterion of ,= 0.01 was used to control type I statistical error. Results: Intermethod correlations within each session were significant for all of the instruments administered. Test-retest correlations for both methods were also significant, except for the numerical ratings. Scores on the Alcohol Dependence Scale obtained via IVR were significantly lower than those collected by paper/pencil. Other differences between the data collection methods or across the sessions were inconsistent. The average IVR call length was 34 min and 23 sec. Paper/pencil forms required an average of 18 min and 38 sec to complete and an additional 10 min and 17 sec for data entry. Conclusions: IVR technology provides a convenient alternative to collecting self-report measures of treatment outcomes. Both paper/pencil and IVR assessments provide highly convergent data and demonstrate good test-retest reliability. Alcohol Dependence Scale score differences between methods highlight special considerations for IVR adaptation of existing paper/pencil instruments. Benefits of IVR include procedural standardization, automatic data scoring, direct electronic storage, and remote accessibility from multiple locations. [source]

A Multicenter, 47-Month Study of Safety and Efficacy of Calcium Hydroxylapatite for Soft Tissue Augmentation of Nasolabial Folds and Other Areas of the Face

DERMATOLOGIC SURGERY, Issue 2007
NEIL S. SADICK MD
OBJECTIVES Each soft tissue filler product has its own unique profile in terms of adverse events. In this large-scale study, we investigated the safety profile of Radiesse, an injectable calcium hydroxylapatite (CaHA) implant, in treatment of nasolabial folds and other areas of the face. We also investigated the efficacy in a subset of the larger patient group. METHODS After obtaining informed consent from the subjects, researchers injected CaHA at two treatment centers into 113 patients (100 women and 13 men, ranging in age from 26 to 78 years) for a variety of facial aesthetic applications over a period of 47 months. Seventy-five patients had a single injection session; 38 had multiple sessions. Most patients (102) received 1.0 mL of CaHA per session; 12 received 2.0 mL per session. Typically, CaHA was administered with a 27-gauge 0.5- or 1 1/4-in. needle. RESULTS Safety. Of 113 patients, only 7 reported minor adverse events that were short-term and resolved within 1 month: transient ecchymosis (3), nongranulatomous submucosal nodules of the lip (2), and inflammation and edema (2). Efficacy. Efficacy ratings were performed for a subset of patients (n=41). On a scale of 1 to 5 (1=unsatisfactory; 5=excellent), the mean patient evaluation score for look and feel of the implant was 4.6; the mean physician scores for the look and feel of the implant were 4.5 and 4.6, respectively. During the 6-month follow-up visit, patients' mean ratings of the look and feel of the implant were 4.8 and 4.9, respectively. The physician's mean ratings for the look and feel of the implant were 4.5 and 4.9, respectively. CONCLUSIONS In our study, CaHA performed well, with a favorable safety profile, high patient satisfaction (90% of patients reported very good or excellent results), and good durability. We are especially pleased with the low incidence of adverse events coupled with the favorable responses from the patients themselves due to longevity of correction. [source]

Allodynia in Migraine: Association With Comorbid Pain Conditions

HEADACHE, Issue 9 2009
Gretchen E. Tietjen MD
Background., Cutaneous allodynia (CA) in migraine is a clinical manifestation of central nervous system sensitization. Several chronic pain syndromes and mood disorders are comorbid with migraine. In this study we examine the relationship of migraine-associated CA with these comorbid conditions. We also evaluate the association of CA with factors such as demographic profiles, migraine characteristics, and smoking status that may have an influence on the relationships of CA to pain and mood. Methods., Data are from a cross-sectional multicenter study of comorbid conditions in persons seeking treatment in headache clinics. Diagnosis of migraine was determined by a physician based on the International Classification of Headache Disorders-II criteria. Participants completed a self-administered questionnaire ascertaining sociodemographics, migraine-associated allodynia, physician-diagnosed comorbid medical and psychiatric disorders, headache-related disability, current depression, and anxiety. Results., A total of 1413 migraineurs (mean age = 42 years, 89% women) from 11 different headache treatment centers completed a survey on the prevalence of comorbid conditions. Aura was reported by 38% and chronic headache by 35% of the participants. Sixty percent of the study population reported at least one migraine-related allodynic symptom, 10% reported ,4 symptoms. Symptoms of CA were associated with female gender, body mass index, current smoking, presence of aura, chronic headaches, transformed headaches, severe headache-related disability, and duration of migraine illness from onset. The prevalence of self-reported physician diagnosis of comorbid pain conditions (irritable bowel syndrome, chronic fatigue syndrome, fibromyalgia) and psychiatric conditions (current depression and anxiety) was also associated with symptoms of CA. Adjusted ordinal regression indicated a significant association between number of pain conditions and severity of CA (based on symptom count). Adjusting for sociodemographics, migraine characteristics, and current depression and anxiety, the likelihood of reporting symptoms of severe allodynia was much higher in those with 3 or more pain conditions (odds ratio = 3.03, 95% confidence interval: 1.78-5.17), and 2 pain conditions (odds ratio = 2.67, 95% confidence interval: 1.78-4.01) when compared with those with no comorbid pain condition. Conclusion., Symptoms of CA in migraine were associated with current anxiety, depression, and several chronic pain conditions. A graded relationship was observed between number of allodynic symptoms and the number of pain conditions, even after adjusting for confounding factors. This study also presents the novel association of CA symptoms with younger age of migraine onset, and with cigarette smoking, in addition to confirming several previously reported findings. [source]

Decline in hepatitis B infection observed after 11 years of regional vaccination among Danish drug users

JOURNAL OF MEDICAL VIROLOGY, Issue 10 2010
B.K. Mössner
Abstract The aims of this study were to determine the current prevalence of viral hepatitis and HIV among drug users, and to compare this prevalence with previous findings in the same geographical region. Cross-sectional surveys of drug users attending treatment centers on the island of Funen with approximately 500,000 inhabitants were administered in 1996 and 2007. The 2007 prevalence estimates were: anti-HBc 50.2%, HBsAg 0.9%, anti-HCV 66.8%, HCV-RNA 40%, and anti-HIV 1.1%. The corresponding 1996 prevalence values were: anti-HBc 70% (P,<,0.0001), HBsAg 9.8% (P,<,0.0001), anti-HCV 82.8% (P,<,0.0001), HCV-RNA 56.3% (P,=,0.002), and anti-HIV 1% (P,=,1). The 2007 prevalence of viral hepatitis decreased due to the increasing proportion of non-injectors. Among injectors, the prevalence remained unchanged except for a significant decrease in HBsAg. The 2007 prevalence of ongoing HBV infection among infected (HBsAg/anti-HBc proportion) was the lowest that to our knowledge has been reported among drug-users. Vaccination coverage among susceptible persons tested in 2007 was 24%, compared to 0.7% in 1996. Therefore, despite an unchanged prevalence of anti-HBc among injecting drug users, a highly significant drop in HBsAg prevalence was seen during the last decade. This observation may be linked causally to an increase in hepatitis B vaccination of the susceptible population. Our findings suggest that even incomplete vaccination, without persistent protective anti-HBs levels, may induce an immune memory sufficient to prevent chronic infection upon transmission. J. Med. Virol. 82:1635,1639, 2010. 2010 Wiley-Liss, Inc. [source]

Effect of HIV-1 infection and increasing immunosuppression on menstrual function

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2010
Oliver C. Ezechi
Abstract Aim:, The aim of this study was to determine the prevalence, pattern and determinants of menstrual abnormalities in HIV-positive Nigerian women. Methods:, A cross-sectional study was carried out involving 3473 (2549 HIV-seropositive and 924 seronegative) consecutive and consenting women seen at the HIV treatment centers at the Nigerian Institute of Medical Research, Lagos and the Federal Medical Centre, Markurdi. Results:, The sociodemographic characteristics of the two groups were comparable, except for body mass index (BMI): the HIV-negative women (28.1 ± 8.1) had statistically significantly (P < 0.005) higher BMI compared to the HIV-positive women (21.9 ± 7.5). Menstrual abnormalities were significantly more common in women living with HIV/AIDS (29.1%) compared to the HIV-negative (18.9%) women (P < 0.001). The proportions of women in the two groups with intermenstrual bleeding, menorrhagia, hypermenorrhea, and postcoital bleeding were similar (P > 0.005), however amenorrhea, oligomenorrhea, irregular periods and secondary dysmenorrhea were more common in the HIV-positive women (P < 0.02). Primary dysmenorrhea was less common in HIV-positive women (P < 0.03). Among the HIV-positive women, menstrual dysfunction was more common in women living with HIV/AIDS with opportunistic infections, CD4 count < 200, not undertaking therapy, symptomatic disease and BMI < 20. However, after controlling for cofounders, only CD4 < 200 (odds ratio [OR], 3.65; 95% confidence interval [CI], 1.2,9.7), BMI < 20 (OR, 2.4; 95%CI, 1.3,3.5) and not taking antiretroviral drugs (OR, 2.05; CI, 1.7,6.5) were associated with amenorrhea, oligomenorrhea, irregular periods and secondary dysmenorrhea. Conclusion:, HIV-positive women in this study experienced more menstrual abnormalities of amenorrhea, oligomenorrhea, and irregular periods compared to the HIV-negative controls. HIV-positive women with CD4 count < 200, BMI < 20 and who do not take antiretroviral drugs are at the greatest risk. [source]

Financial Costs of Alcoholism Treatment Programs: A Longitudinal and Comparative Evaluation Among Four Specialized Centers

Financing the Treatment of Chronic Pain: Models for Risk-sharing among Pain Medicine Physicians, Health Care Payers, and Consumers

PAIN MEDICINE, Issue 1 2000
FABPM, Richard L. Stieg MD
Chronic pain patients are among a growing group of medically underserved Americans. Despite increasing public awareness about pain and widespread legislative activity that is focusing on the needs of pain patients, there remain significant roadblocks in bringing the expertise of Pain Medicine specialists to these unfortunate people. This paper explores how the managed care revolution has impacted the practice of Pain Medicine in the United States. The dissolution of many prominent multi-disciplinary pain treatment centers has been paralleled by the evolution of pain management as an area of interest by several competing medical specialty societies. Despite this fragmentation, the American Academy of Pain Medicine continues to grow and to promote the needs of Pain Medicine specialists and their patients. The advantages and disadvantages of various practice patterns for Pain Medicine specialists is explored against a backdrop of discussions about: (1) the problems currently faced by chronic pain patients; (2) the role of organized Pain Medicine in helping patients to access and finance care; and (3) the future of American health care and the new responsibilities that will bring to physicians. Finally, we have some specific recommendations for pain medicine specialists about: (1) sharing risk; (2) exerting individual leadership; and (3) simplifying one's professional life in the new health care environment, that we hope will enable them to continue caring for as many chronic pain patients as possible. It is opined that the development of sophisticated regional specialty networks is the best model to accomplish this task in the future. [source]

National addictions vigilance intervention and prevention program (NAVIPPROÔ): a real-time, product-specific, public health surveillance system for monitoring prescription drug abuse,

PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 12 2008
Stephen F. Butler PhD
Abstract Purpose The National Addictions Vigilance Intervention and Prevention Program (NAVIPPROÔ) is a scientific, comprehensive risk management program for scheduled therapeutics. NAVIPPROÔ provides post-marketing surveillance, signal detection, signal verification and prevention and intervention programs. Here we focus on one component of NAVIPPROÔ surveillance, the Addiction Severity Index-Multimedia Version® (ASI-MV®) Connect, a continuous, real-time, national data stream that assesses pharmaceutical abuse by patients entering substance abuse treatment by collecting product-specific, geographically-detailed information. Methods We evaluate population characteristics for data collected through the ASI-MV® Connect in 2007 and 2008 and assess the representativeness, geographic coverage, and timeliness of report of the data. Analyses based on 41,923 admissions to 265 treatment centers in 29 states were conducted on product-specific opioid abuse rates, source of drug, and route of administration. Results ASI-MV® Connect data revealed that 11.5% of patients reported abuse of at least one opioid analgesic product in the 30 days prior to entering substance abuse treatment; differences were observed among sub-populations of prescription opioid abusers, among products, and also within various geographic locations. Conclusions The ASI-MV® Connect component of NAVIPPROÔ represents a potentially valuable data stream for post-marketing surveillance of prescription drugs. Analyses conducted with data obtained from the ASI-MV® Connect allow for the characterization of product-specific and geospatial differences for drug abuse and can serve as a tool to monitor responses of the abuse population to newly developed "abuse deterrent" drug formulations. Additional data, evaluation, and comparison to other systems are important next steps in establishing NAVIPPROÔ as a comprehensive, post-marketing surveillance system for prescription drugs. Copyright © 2008 John Wiley & Sons, Ltd. [source]

The Role of Interpreters in Psychotherapy With Refugees: An Exploratory Study

AMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 1 2005
Kenneth E. Miller PhD
Findings are presented from a narrative study that examined the use of interpreters in psychotherapy with refugees. Fifteen therapists and 15 interpreters were interviewed at 14 refugee mental health treatment centers in the United States. Core findings concerned the impact of interpreters on the therapeutic alliance, the complex emotional reactions that may arise within the therapy triad, the effects of interpreting on interpreters' own well-being, the multiple roles that interpreters play in addition to translating language, and the training and supervision needs of interpreters and of therapists who work with them. Implications of these findings for agencies that use interpreters in their clinical work with refugees are considered, and specific recommendations are made concerning the hiring, training, and support of interpreting staff. [source]