Assessing the consequences of recent climate change on World Heritage sites in South Greenland.

In the Arctic region, microbial degradation poses a significant threat to the preservation of archaeological deposits, actively consuming irreplaceable cultural and environmental records. In this study we assess the potential effects of the last 40 years of climate change on organic archaeological deposits within the UNESCO World Heritage area Kujataa in South Greenland. We use the dynamic process-oriented model, CoupModel to simulate soil temperatures and soil moisture contents at four archaeological sites in the area. The results show that the organic deposits have experienced a substantial warming the last 40 years, which combined with decreasing soil moisture contents creates a dangerous combination that can accelerate the degradation of organic materials. Currently, there are 583 archaeological sites registered within the area. Our findings highlight that the current climatic conditions are not conducive to organic preservation. The greatest risk of degradation lies within the relatively dry continental inland areas of the study region, where all Norse Viking Age settlements are situated. However, even at the "cold" and "wet" outer coast, the combined effects of rising summer temperatures and declining soil moisture levels may already be exerting a noticeable impact.

Ancient DNA provides insights into 4,000 years of resource economy across Greenland.

The success and failure of past cultures across the Arctic was tightly coupled to the ability of past peoples to exploit the full range of resources available to them. There is substantial evidence for the hunting of birds, caribou and seals in prehistoric Greenland. However, the extent to which these communities relied on fish and cetaceans is understudied because of taphonomic processes that affect how these taxa are presented in the archaeological record. To address this, we analyse DNA from bulk bone samples from 12 archaeological middens across Greenland covering the Palaeo-Inuit, Norse and Neo-Inuit culture. We identify an assemblage of 42 species, including nine fish species and five whale species, of which the bowhead whale (Balaena mysticetus) was the most commonly detected. Furthermore, we identify a new haplotype in caribou (Rangifer tarandus), suggesting the presence of a distinct lineage of (now extinct) dwarfed caribou in Greenland 3,000 years ago.

Footprints from the past: The influence of past human activities on vegetation and soil across five archaeological sites in Greenland.

Climate change has irrevocable consequences for the otherwise well-preserved archaeological deposits in the Arctic. Vegetation changes are expected to impact archaeological sites, but currently the effects are poorly understood. In this article we investigate five archaeological sites and the surrounding natural areas along a climate gradient in Southwest Greenland in terms of vegetation types, above- and below-ground biomass, soil geochemistry and spectral properties. The investigations are based on data from site-sampling and optical remote sensing from an unmanned aerial vehicle (UAV) and satellites. Results show that the archaeological sites are dominated by graminoids with approximately two times more above- and below-ground biomass than the surrounding areas, where the vegetation is more heterogeneous. This difference is associated with a 2-6 times higher content of plant available phosphorus and water extractable nitrate and ammonium in the archaeological deposits compared to the surrounding soil. Furthermore, the vegetation at archaeological sites is less affected by the regional climate variations than the surrounding natural areas. This suggests that soil-vegetation interactions at archaeological sites are markedly different from the natural environment. Thus, the long-term vulnerability of buried archaeological remains cannot be assessed based on existing projections of Arctic vegetation change. Finally, the study demonstrates that vegetation within archaeological sites has distinct spectral properties, and there is a great potential for using satellite imagery for large scale vegetation monitoring of archaeological sites and for archaeological prospection in the Arctic.

"Ne diyor?" (What does she say?): informal interpreting in general practice.

OBJECTIVE: The aim of this study was to offer a comparative analysis of informal interpreters during medical consultations with both good and poor mutual understanding between general practitioners (GPs) and patients. METHODS: Sixteen video-registered medical interviews of Turkish immigrant patients were analysed. Stretches of discourse of eight interviews with good mutual understanding between patient and doctor were compared to eight interviews with poor mutual understanding. The discourse analysis focused on: (1) miscommunication and its causes; (2) changes in the translation; (3) side-talk activities. RESULTS: In the cases of 'poor mutual understanding', the instances of miscommunication far exceeded those in the 'good mutual understanding' group. Style of self-presentation, content omissions and side-talk activities seemed to hinder good mutual understanding. CONCLUSION: Alongside the evidence about problems with informal interpreting, sometimes the use of family interpreters can facilitate medical communication. PRACTICE IMPLICATIONS: Recommendations are given in order to increase physicians' awareness of the complex process of interpreting, as well as to empower informal interpreters and patients to effectively deal with this communicative triad.

GPs' interactional styles in consultations with Dutch and ethnic minority patients.

The aim of this study was to examine interactional styles of general practitioners (GPs) in consultations with Dutch patients as compared to ethnic minority patients, from the perspective of level of mutual understanding between patient and GP. Data of 103 transcripts of video-registered medical interviews were analyzed to assess GPs' communication styles in terms of involvement, detachment, shared decision-making and patient-centeredness. Surveys were used to collect data on patients' characteristics and mutual understanding. Results show that overall, GPs communicate less adequately with ethnic minority patients than with Dutch patients; they involve them less in decision-making and check their understanding of what has been discussed less often. Intercultural consultations are thus markedly distinguishable from intracultural consultations by a lack of adequate communicative behavior by GPs. As every patient has a moral and legal right to make informed decisions, it is concluded that GPs should check more often whether their ethnic minority patients have understood what has been said during the medical consultation.

Cultural diversity in patient participation: the influence of patients' characteristics and doctors' communicative behaviour.

OBJECTIVE: The primary goal of this study was to examine the extent to which patient participation during medical visits is influenced by patients' ethnic background, patients' culture-related characteristics (e.g. acculturation, locus of control, cultural views) and features of doctors' communicative behaviour. Furthermore, the mutual influence between patients' participatory behaviour and doctors' communicative behaviour was investigated. An additional goal was to identify the independent contribution of these variables to the degree of patient satisfaction and mutual understanding between GP and patient. METHODS: Communicative behaviour of patients (n=103) and GPs (n=29) was analysed with Roter's Interaction Analysis System, frequency of patient questions and patients' assertive utterances (e.g. making requests, suggesting alternative treatment options). Additional data were gathered using GP and patient questionnaires after the consultations. RESULTS: Results show that non-Western ethnic minority patients display less participatory behaviour during medical consultations than Dutch patients. GPs' affective verbal behaviour had most effect on degree of patient participation and patient satisfaction. Regression analyses indicate a significant mutual influence between patients' verbal behaviour and GPs' verbal behaviour. CONCLUSION: Overall, results of this study show some important differences between Dutch and non-Western ethnic minority patients in degree of patient participation. Furthermore, our results indicate that patient participation encompasses several aspects that are not necessarily interrelated. PRACTICE IMPLICATIONS: The necessity for continued education of GPs' communicative skills, particularly when dealing with non-Western ethnic minority patients, is reflected in the strong influence of GP's affective verbal behaviour on both patient participation and their satisfaction with the medical encounter.

The impact of an intervention in intercultural communication on doctor-patient interaction in The Netherlands.

OBJECTIVE: Findings of scarcely available studies indicate that there are substantial gaps in intercultural doctor-patient communication. In order to improve intercultural communication in medical practice in The Netherlands, an educational intervention was developed. The aim of the present study was to examine the effects of this intervention on doctor-patient communication. METHODS: Participants (general practitioners: n=38; patients: n=124) were assigned at random to an intervention or a control group. GPs in the intervention group received 2.5 days training on intercultural communication. Patients in the intervention group were exposed to a videotaped instruction in the waiting room, right before the consultation. Data were collected through videotapes of visits of ethnic minority patients to their GP and home interviews with the patients after their medical visit. Communication behaviour was assessed using the Roter interaction analysis system (RIAS). Interview length was assessed as well. RESULTS: The length of the medical encounter increased significantly after having received the intervention. Total number of GP utterances increased significantly too. When comparing relative frequencies on affective and instrumental verbal behaviour of both patients and doctors, no significant changes could be detected. CONCLUSION: It is concluded that there seems to be some change in doctor-patient interaction, but RIAS may not be suitable to detect subtle changes in the medical communication process. It is recommended to use other analysis methods to assess cultural differences in medical communication. PRACTICE IMPLICATIONS: Knowledge about possible antecedents of gaps in intercultural medical communication should be increased in order to be able to design effective interventions for intercultural doctor-patient communication.

The effect of educational intervention on intercultural communication: results of a randomised controlled trial.

BACKGROUND: Due to worldwide migration to Western countries, physicians are increasingly encountering patients with different ethnic backgrounds. Communication problems can arise as a result of differences in cultural backgrounds and poor language proficiency. AIMS: To assess the effectiveness of an educational intervention on intercultural communication aimed to decrease inequalities in care provided between Western and non-Western patients. DESIGN OF STUDY: A randomised controlled trial with randomisation at the GP level and outcome measurements at the patient level. SETTING: General practice in Rotterdam. METHOD: Thirty-eight Dutch GPs in the Rotterdam region, with at least 25% of inhabitants of non-Western origin, and 2407 visiting patients were invited to participate in the study. A total of 986 consultations were finally included. The GPs were educated about cultural differences and trained in intercultural communication. Patients received a videotaped instruction focusing on how to communicate with their GP in a direct way. The primary outcome measure was mutual understanding and the secondary outcomes were patient's satisfaction and perceived quality of care. The intervention effect was assessed for all patients together, for the 'Western' and 'non-Western' patients, and for patients with different cultural backgrounds separately. RESULTS: An intervention effect was seen 6 months after the intervention, as improvement in mutual understanding (and some improvement in perceived quality of care) in consultations with 'non-Western' patients. CONCLUSIONS: A double intervention on intercultural communication given to both physician and patient decreases the gap in quality of care between 'Western' and 'non-Western' patients.

When cultures meet in general practice: intercultural differences between GPs and parents of child patients.

Although health care professionals in The Netherlands are increasingly confronted with diverse immigrant groups, medical counselling and treatment of these groups has not been the subject of extensive research yet. From other studies it is well known that intercultural differences can have serious consequences for health care, e.g. in terms of risk of incorrect diagnoses or non-compliance. Eighty-seven autochthonous Dutch and immigrant (mainly from Turkey and Surinam) parents of child patients and their general practitioners (GPs) were recruited to investigate the influence of cultural differences on mutual understanding and patient compliance. Analyses of questionnaires and home interviews revealed that there is a relation between the cultural background of the patient and effectiveness of communication. Communication in consultations between GPs and persons from ethnic minorities is less effective than in consultations with Dutch persons: there is more misunderstanding, and also more non-compliance. In general, mutual understanding between GP and patient proves to be a strong predictor for patient compliance. These findings hold especially true for patients living in two worlds, i.e. a mixture of traditional and western cultures. The results are discussed in terms of methodological issues and practical implications for the health care providers.