Risk of infection with leptospirae during farmwork was estimated using information from past leptospirosis outbreaks in both Miyagi Prefecture, Japan (around 1960) and northeastern Thailand (around 2000). Outbreaks of leptospirosis in Miyagi Prefecture were concentrated in October, while it occurred throughout the rainy season, showing a tendency to decentralize, in northeastern Thailand. In 1959, a large leptospirosis outbreak occurred in Miyagi Prefecture. The risk (1,600/100,000) of leptospira infection in the high-risk area during that outbreak was 3.4 times as high as that (470/100,000) in the middle-risk area. The risk in this year was 5.7 (high-risk area), 2.8 (middle-risk area) and 2.0 (low-risk area) times higher than that in the same area from 1960 to 1964 which could be considered as the average risk in the past time. In northeastern Thailand, the risk (50/100,000) of leptospira infection was 30 percent compared with that (170/100,000) in the middle-risk areas in Miyagi Prefecture from 1960 to 1964. Based on the risk, number of leptospirae invading into human body through skin during farmwork was estimated with the dose-response model. In Miyagi Prefecture and northeastern Thailand, the estimated numbers were 65-1,200 and 3.5-42 leptospirae per 100,000 exposures which means frequency of the daily farmwork, respectively. On the other hand, the calculation under possible environmental conditions (e.g. density of rats carrying leptospirae, water depth in paddy field) demonstrated that farmers had been in contact with 4,300 leptospirae only in an hour of their work. The result showing only a small part of leptospirae in contact invaded into human body primarily attributes to the strong structure of unwounded skin composed of stratified squamous epithelium and dermis. And also the result can be explained by a hydraulics theory. Although leptospirae being nearby skin surface can attach to skin since the water flow does not occur there, the spirochetes a little away from skin surface are easily transported with the flow and would be unable to invade into human body.
Objectives The objective of this study is to find the easily measurable associated factor for hypothermic neonatal mortality in a regional Moroccan hospital. Methods A retrospective study was carried out in PAGNON hospital. 52 patients admitted to PAGNON hospital neonatal unit for hypothermia between October 1st, 2005, and June 30, 2007, were included in this study. Clinical features including gestational age, body weight at hospitalization, rectal temperature, the day after birth, place of delivery were recorded at the time of hospitalization. Hypothermia was classified as per WHO classification. Results In 52 hypothermic neonates, 36 patients (69.3%) survived and 16 patients (30.7%) died. There was a significant statistical difference between survival group and no survival group regarding rectal temperature (31.1±2.7°Cvs. 28.7±2.3°C; mean±SD, p=0.003). All patients who died during hospitalization had below 33°C of rectal temperature at hospitalization. As for WHO classification, the severe hypothermic group had higher mortality rate than the moderate hypothermic group (45.2% vs. 9.5%, p=0.006). There was no significant statistical difference for body weight at hospitalization, the day after birth and gestational age in two groups. The severe hypothermic group was higher in the ratio of delivery at the domicile than those of moderate hypothermic group (22.6% vs. 0%, p=0.020). In multiple logistic regression analysis accounting for rectal temperature, the day after birth and body weight at hospitalization, only rectal temperature was significantly associated with survival rate (odds ratio 1.408, 95% confidence interval 1.088−1.821, p=0.009). Conclusion Between the moderate hypothermic neonates and the severe hypothermic neonates classified WHO classification, there was a significant difference between the mortality rate. It is important to keep the rectal temperature more than 32°C. The rectal temperature is an associated factor for hypothermic neonatal mortality which is easily measured at hospitalization in rural hospital in morocco.
The purpose of this study is to describe issues in use of interpreters when Brazilian residents have an access to the medical care services in Japan. Focus groups were undertaken with three groups of eighteen Brazilian residents in Shizuoka prefecture. Data analysis drew upon the principles of summarizing content analysis. The participants' proficiency in Japanese language varied; six were intermediate level, eight were basic level, and four were unable to communicate in Japanese. Ten of them used interpreters at medical care services. Those interpreters were usually ad hoc, untrained individual such as members of the family, friends, or outsourced personnel. Summarizing content analysis revealed three themes as follows: When using ad hoc interpreter; The interpreter may omit, add, or substitute some words/phrases therefore the interpretation may be inaccurate. The interpreter may not understand the medical terms because those terms are not used daily. Absence of trained medical interpreters at medical facilities; It is tedious to find an interpreter. The patient cannot provide sufficient information to a physician, nor can he/she understand what a physician explain, nor know the effect/side effect of the medicine. Measures to improve the communication between Brazilian patients and physicians; The presence of a hospital interpreter would be essential. Written notes are highly appreciated. Communication barriers between a physician and a patient can be seen regardless of the presence of an interpreter. It is important to tell the interpreter to interpret a word/phrase uttered by both a patient and a physician accurately and to explain to him/her of the importance of privacy protection in advance. It is also suggested that a physician needs to avoid to use the technical terms, explain in words which could easily be understood by a patient or give notes to a patient so that there will be a better communication between a physician and a patient.
Objective The number of foreign students coming to Japan continues to increase year by year. The majority of those students are from China. Besides social problems and insurance difficulties, cultural differences are an underlying cause of their health problem. The aim of our research is to evaluate the health behavior and health status of students from China who are living in Japan with the objective of providing recommendations for improvement of health care. Method A survey of students was conducted using questionnaires. The target for this study is Chinese students compared with domestic students at the same university in Japan. The contents of the questionnaire are related to; attribute attitude toward health and sickness, belief in health, mental and physical health status, social support, health behavior, and fitness activity. Results The rate of collected questionnaires was 35.7% (107/300) from Chinese students and 47.7% (143/300) from Japanese students. The average age of Chinese students was 24.5 years old and average duration of their stay was three years. Chinese students had high consciousness about maintaining good health. They obtained social support from friends, parents, acquaintances, family members other than parents and not much was obtained from school related people. As for health habit, female students were more likely to practice good health habits than males. Conclusions 1. Chinese students had high consciousness about maintaining good health. 2. Chinese students living in a foreign culture are highly aware and concerned about their health status but they are not in a position to obtain sufficient social support from university. It is vital for them to secure imminent social supports from now on. 3. Differences in responses by gender were evident in the group related to health habits.
Introduction Recently, an increasing number of registered foreigners get married and bear children in Japan. At the same time, a variety of needs for maternal and child health (MCH) impose burden for medical practitioners. A questionnaire survey was conducted to clarify the situation of MCH service for foreign residents. Method Self-report questionnaires developed by “The study group for MCH in a multiethnic and multicultural society” were sent by mail to the pediatricians registered in the Gunma medical association or Gunma pediatric association. In total, target number was 299. The survey period was between 2003/10/6-11/3. Result The number of valid response was 167. Out of 167, 155 doctors replied to have experience of caring foreigners. 75% of them had the experience of trouble in communication. For the question of the need of translator, 76.8% of doctors answered “absolutely necessary” or “necessary if the quality of translation is high enough”. Desired competencies for translators were “Accurate translation of diagnosis, hands on of treatment strategy” or “To help taking detailed patient's history”. For the experience of using MCH handbook in foreign languages, 52.9% of doctors answered “Never used it”. Discussion We found that the majority of doctors had difficulty in communicating with foreigners. To meet the doctors' requirement for the competency of translator, two strategies should be considered. One is to develop professional medical translator through education of basic medical knowledge or Japan's health care system. The other is to train foreigners already engaging in translation. For communication tools development, user friendly concept should be reflected including 1) adscript of foreign and Japanese languages, 2) illustration usage and 3) eye-friendly materials for elderly. Contents should have explanations including 1) diagnosis and treatment policy for common disease, 2) ways of coping with common symptoms, and 3) the information of a variety of Japan's welfare services.