Many health care professionals in Japan may face growing communication difficulties due to the governmental growth strategy released in 2010 aiming to increase the capacity to care for non-Japanese speaking patients. This article describes what is currently known about the language barriers in health care so that health care stakeholders can improve their cross-linguistic and cultural services. Three areas will be discussed in terms of how they affect health care: 1) language barriers, 2) health care interpretation, and 3) the cultural competence of health care providers. Specific research recommendations are also discussed in each area.
We have held an annual diabetic summer camp since 1982 for children with type 1 diabetes mellitus (T1D). The dietary style in the previous camp had generally been a fixed diet, however, a free-choosing diet was introduced to the camp in 2008. We studied the significance of the free-choosing diet for nutritional management in children with T1D. Nineteen children with T1D, 10 males and 9 females aged 9.9 ± 3.1 years, participated in the camp in 2008 and were involved in the study. Despite the fact that they chose components of foods as they liked during the camp, none of the children showed over-intake of foods or any imbalance in the components of foods while on the free-choosing diet. This good outcome could be due to nutritional advice provided by a special pediatric dietician at the outpatient clinic. On the other hand, some children did not consume enough vegetables, which should be resolved by further education of the children. It appears that the free-choosing diet could promote flexibility in the nutritional management of diabetes and a diabetic summer camp might be good opportunity to learn skills regarding how to select adequate foods for children with T1D.
Recently, metabolic syndrome (MetS), which has been linked to abdominal adiposity and insulin resistance, has been regarded as an important contributor to cardiovascular disease worldwide. However, this has been rarely reported in the etiological studies of MetS in children. The aim of this study was to investigate the causes of MetS in children. The subjects were 225 students who participated in the school health consultation after screening for the lifestyle related diseases in S ward in the Tokyo Metropolitan Area. We examined the relationship between the parental and grandparental history of diabetes mellitus and the constituent variables of MetS, and decreased physical activity in the students, according to the responses to questionnaires by their parents. The results are as follows: Students who had a family history of diabetes mellitus had significantly greater waist circumference, waist / height ratio and serum ALT levels compared to those who did not have a history of diabetes mellitus, and also the former group showed higher serum TG levels than the latter, but this did not reach statistical significance. It was observed that the numbers of constituent variables of MetS increased as the waist circumference grew larger. Moreover, the waist circumference correlated inversely with the duration of exercise outdoors on holidays. It was suggested that the family history of diabetes mellitus and decreased physical activity might be important risk factors of MetS in children.
Vascular Endothelial Growth Factor (VEGF) is a protein associated with angiogenesis and a potent vascular permeability factor. This study was undertaken to assess the neurological and histological roles of VEGF after TBI (Traumatic Brain Injury) in a rat model of cerebral contusion. We examined the time course of VEGF expression, BBB (Blood Brain Barrier) disruption, and brain edema after traumatic brain injury. The necrosis volume and motor performance were measured to determine tissue repair and functional recovery after the brain injury. The contusion necrosis volume was aggravated at 21 days after the injury (115.0 ± 14.3 mm³ vs. 137.3 ± 21.1 mm³, p < 0.05) and motor performance, which was evaluated at 1, 3, 7, 14, 21 days after the injury by Rota rod test, recovered less in the bevacizumab (VEGF antibody) treated group (78.4 ± 9.8% vs. 103.6 ± 7.7%, p < 0.05). We conclude that VEGF may have therapeutic potential for tissue repair and functional recovery after the injury, via angiogenesis.
A 65-year-old woman was referred to our hospital because of ECG abnormalities that were observed during a health check up. Physical examination revealed a systolic murmur and fixed splitting of the second heart sound at the left sternal border in the second intercostal space. ECG revealed sinus rhythm and complete right bundle branch block. Chest X-ray revealed no cardiomegaly and no dilatation of the pulmonary arteries. Transthoracic echocardiography (TTE) showed no apparent abnormalities except for mild pulmonary stenosis. Transesophageal echocardiography (TEE) revealed an oval ostium secundum type of atrial septal defect (ASD) with a diameter of approximately 3 cm and minor LA → RA shunt. Cardiac catheterization data have supported this finding. Minor pulmonary stenosis and an oval morphology of atrial septal defect may have resulted in some specific hemodynamics in this case.
Matrix-producing carcinoma (MPC) of the breast is rare, and preoperative diagnosis is difficult. We report a case of MPC of the breast. A 56-year-old female complained of a palpable mass, 2 cm in diameter, located in the upper outer quadrant of the right breast. Ultrasonography demonstrated an irregular hypoechoic lesion. MRI showed a breast mass about 2.5 cm in size and dynamic study revealed early contrast enhancement. The tumor was irregular in shape. Axillary lymph node did not exhibit swelling. We chose excisional biopsy as the first step and diagnosed the mass as invasive ductal carcinoma. Finally, we performed endoscopic breast conserving surgery with sentinel lymph node biopsy. The specimen contained a white solid tumor. The histpathological finding was invasive ductal carcinoma with a direct transition cartilaginous matrix. ER and PgR, HER2 were negative. We performed radiation therapy and chemotherapy after the operation. Fourteen months after the operation, the patient is alive and free of recurrence.
A 93-year-old man was admitted to our hospital due to dyspnea and cough caused by right spontaneous pneumothorax. Chest CT showed right lung collapse and bullas in the right upper, middle, and lower lobes. A chest tube thoracotomy was placed immediately. Nevertheless, chest drainage did not improve the pneumothorax, and the air leak persisted for 2 weeks. We conducted thoracographic studies and bubbles showed from a bulla in the upper lobe. Considering his age, condition, respiratory function, and performance status, we carried out ligation of the bulla on the upper lobe by video-assisted thoracic surgery under local and epidural anesthesia. The postoperative course was good and the patient was discharged from the hospital after the third postoperative day.
The patient was a 22-year-old man who was admitted to our hospital because of an abnormal shadow detected by chest radiograph and the symptom of bloody sputum. Chest computed tomography showed a slightly lobulated cystic mass and a surrounding halo of ground-glass opacity in the left upper lobe. The patient underwent surgery because of the tendency for growth in the lesion area and the symptom of persistent, frequent bloody sputum. During the operation, we found that the patient lacked a left superior division of the bronchus by bronchoscopy and diagnosed congenital bronchial atresia. The patient underwent a left upper division segmentectomy. Microscopic findings of the resected cystic mass demonstrated the expanding bronchus and the distal lung area with emphysematous changes. The postoperative course was uneventful, and the patient was discharged from the hospital on the seventh postoperative day.