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  This study aimed to identify the types, frequency, and clinical significance of altered interpreta-tion in clinical settings.Methods  Routine outpatient encounters involving Portuguese-speaking Brazilian patients, Japanese doctors, and hospital-provided interpreters were digitally recorded and transcribed. Segments of consecutively interpreted utterances were coded as “altered,” in which the interpreter changed the meaning of the source utterance, or “unaltered (accurate),” and the types and frequency of occurrence were analyzed. Altered interpretations were categorized as clinically negative or positive and classified into four categories: omission, addition, substitution, or voluntary intervention. Incidents resulting from alterations were investigated. Reliability was assessed by examining the correlation between random independently coded samples.Results  In total, 111 encounters were analyzed. The mean segments per encounter was 67.9 (range 14-186), and the mean frequency (standard deviation) of altered interpretations per 100 segments was 46.7 (14.3) for accurate interpretations; 46.1 (17.9) for negative or not significant alterations, including 27.2 (10.3) for omissions, 6.0 (5.0) for additions, 10.4 (6.9) for substitutions, and 2.5 (2.7) for voluntary interventions; 0.0 (0.2) for alterations potentially leading to an incident; and 26.2 (11.9) for positive alterations, including 1.8 (2.6) for positive omissions, 7.7 (4.7) for positive additions, 7.8 (6.3) for positive substitutions, and 8.8 (5.2) for positive voluntary interventions. The frequency of negative alterations was weakly negatively correlated with number of segments per minute (r＝−0.339). Conclusion  Trained healthcare interpreters with fewer clinically significant altered interpretations were effective. Professional medical providers should recognize the importance of positive alterations by healthcare interpreters and collaborate with them to provide safe medical care for foreign patients. To facilitate the provision of appropriate medical care to a growing foreign population with diverse cultural and linguistic needs, undergraduate medical education should teach aspiring medical professionals how to collaborate with healthcare interpreters and foreign patients.

Objective：To assess the effects of increased financial incentives in medical fee revisions on acute rehabilitation quality by elucidating the changes in the timing and quantity of rehabilitation services provided after total knee arthroplasty.Methods：The analysis was conducted using nationwide Diagnosis Procedure Combination data from 2010 to 2017. Hospitals were divided into two groups (≥1,000 cases and＜1,000 cases), and the differences in basic characteristics, clinical findings/course, and rehabilitation practices were analyzed according to medical fee revision years. Multiple linear regression analyses were performed with the following dependent variables：duration before postoperative rehabilitation initiation and the number of rehabilitation therapy units provided. Independent variables included medical fee revision years and case volume.Results：Throughout the 8-year study period, there were reductions of 0.4 days (hospitals with ≥1,000 cases) and 1.3 days (hospitals with＜1,000 cases) before rehabilitation initiation. There were also significant increases in rehabilitation therapy units provided in the first 2two weeks after surgery. Earlier rehabilitation initiation was associated with case volume and medical revision year. Similarly, increases in rehabilitation therapy units were associated with case volume, medical revision year, and comprehensive rehabilitation plan evaluation fees.Conclusion：Higher reimbursements to hospitals, especially hospitals with＜1,000 cases, were associated with earlier rehabilitation interventions, and increased rehabilitation services provided within a short duration. These medical fee revisions appeared effective in raising the quality of acute rehabilitation therapy.

Objective：To assess the effects of increased financial incentives in medical fee revisions on acute rehabilitation quality by elucidating the changes in the timing and quantity of rehabilitation services provided after total knee arthroplasty.Methods：The analysis was conducted using nationwide Diagnosis Procedure Combination data from 2010 to 2017. Hospitals were divided into two groups (≥1,000 cases and＜1,000 cases), and the differences in basic characteristics, clinical findings/course, and rehabilitation practices were analyzed according to medical fee revision years. Multiple linear regression analyses were performed with the following dependent variables：duration before postoperative rehabilitation initiation and the number of rehabilitation therapy units provided. Independent variables included medical fee revision years and case volume.Results：Throughout the 8-year study period, there were reductions of 0.4 days (hospitals with ≥1,000 cases) and 1.3 days (hospitals with＜1,000 cases) before rehabilitation initiation. There were also significant increases in rehabilitation therapy units provided in the first 2two weeks after surgery. Earlier rehabilitation initiation was associated with case volume and medical revision year. Similarly, increases in rehabilitation therapy units were associated with case volume, medical revision year, and comprehensive rehabilitation plan evaluation fees.Conclusion：Higher reimbursements to hospitals, especially hospitals with＜1,000 cases, were associated with earlier rehabilitation interventions, and increased rehabilitation services provided within a short duration. These medical fee revisions appeared effective in raising the quality of acute rehabilitation therapy.

No abstract available.
Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Amino Acid Sequence ; Calreticulin/*genetics ; Child ; DNA/chemistry/genetics/metabolism ; Exons ; Female ; Humans ; Janus Kinase 2/*genetics ; Male ; Middle Aged ; Molecular Sequence Data ; Polymorphism, Single Nucleotide ; Receptors, Thrombopoietin/genetics ; Sequence Analysis, DNA ; Sex Factors ; Thrombocythemia, Essential/*diagnosis/genetics ; Young Adult

BACKGROUND: It is important to achieve herd immunity by vaccinating as many people as possible to end the COVID-19 pandemic. We investigated the relationship between willingness to receive vaccination and sources of health information among those who did not want to be vaccinated against COVID-19. METHODS: This prospective cohort study collected data using a self-administered questionnaire survey. The baseline survey was conducted during December 22-25, 2020, and the follow-up survey during February 18-19, 2021. Participants were aged 20-65 years and worked at the time of the baseline survey (N = 33,087). After excluding 6,051 invalid responses, we included responses from 27,036 participants at baseline. In total, 19,941 people responded to the follow-up survey (74% follow-up rate). We excluded 7,415 participants who answered "yes" to the question "If a COVID-19 vaccine becomes available, would you like to get it?" in the baseline survey. We finally analyzed 12,526 participants. RESULTS: The odds ratio for change in willingness to be vaccinated from "no" to "yes" differed by source of health information. Compared with workers that used TV as a source of information, significantly fewer people who reported getting information from the Internet and friends/colleagues were willing to get the vaccine. CONCLUSIONS: It is important to approach workers who do not watch TV when implementing workplace vaccination programs. It is likely that willingness to be vaccinated can be increased through an active company policy whereby the top management recommend vaccination, coupled with an individual approach by occupational health professionals. TRIAL REGISTRATION Not applicable.
Adult ; Aged ; COVID-19/prevention & control* ; COVID-19 Vaccines ; Cohort Studies ; Cross-Sectional Studies ; Humans ; Influenza Vaccines ; Japan ; Middle Aged ; Pandemics ; Prospective Studies ; Young Adult

BACKGROUND: To combat coronavirus disease 2019 (COVID-19), many countries have used contact tracing apps, including Japan's voluntary-use contact-confirming application (COCOA). The current study aimed to identify industry and workplace characteristics associated with the downloading of this COVID-19 contact tracing app. METHODS: This cross-sectional study of full-time workers used an online survey. Multiple logistic regression analysis was used to evaluate the associations of industry and workplace characteristics with contact tracing app use. RESULTS: Of the 27,036 participants, 25.1% had downloaded the COCOA. Workers in the public service (adjusted odds ratio [aOR] = 1.29, 95% confidence interval [CI] 1.14-1.45) and information technology (aOR = 1.38, 95% CI 1.20-1.58) industries were more likely to use the app than were those in the manufacturing industry. In contrast, app usage was less common among workers in the retail and wholesale (aOR = 0.87, 95% CI 0.76-0.99) and food/beverage (aOR = 0.81, 95% CI 0.70-0.94) industries, but further adjustment for company size attenuated these associations. Workers at larger companies were more likely to use the app. Compared with permanent employees, the odds of using the app were higher for managers and civil servants but lower for those who were self-employed. CONCLUSIONS Downloading of COCOA among Japanese workers was insufficient; thus, the mitigating effect of COCOA on the COVID-19 pandemic is considered to be limited. One possible reason for the under-implementation of the contact tracing app in the retail and wholesale and food/beverage industries is small company size, as suggested by the fully adjusted model results. An awareness campaign should be conducted to promote the widespread use of the contact tracing app in these industries.
Adult ; COVID-19/prevention & control* ; Contact Tracing/methods* ; Cross-Sectional Studies ; Female ; Humans ; Industry/classification* ; Japan/epidemiology* ; Male ; Middle Aged ; Mobile Applications/statistics & numerical data* ; SARS-CoV-2 ; Smartphone ; Workplace/statistics & numerical data*