Relationship between Illness Perception and the need for Professional Medical Interpretation for International Patients in Japan.

This study aimed to conduct a cross-sectional questionnaire survey of foreign patients to analyze the impact of patients' illness perceptions on their need for professional medical interpreters. From February 2022 to May 2023, an online questionnaire was distributed to 4,962 individuals aged 18 years or older who were non-native speakers of Japanese. These individuals were enrolled in organizations such as international exchange associations and Japanese language support classes and had utilized medical institutions in Japan due to their own illness or injury or that of their children. Among the 312 valid responses, international patients with a high score for illness perception were more likely to want to utilize professional medical interpreters than those with a low score for illness perception (odds ratio, 1.968; 95% confidence interval, 1.044-3.709; P = 0.036). Our findings suggest that hospitals should be better prepared to meet the potential language needs of international patients with a higher illness perception.

Evaluating a conceptual framework for quality assessment of medical interpretation.

OBJECTIVE: We aimed to evaluate a proposed conceptual framework for quality assessment of medical interpretation using actual data from clinical settings. METHODS: A mixed methods approach was used. Routine outpatient encounters involving Portuguese-speaking Brazilian patients, Japanese physicians, and hospital-provided and ad hoc interpreters were digitally recorded and transcribed. A questionnaire survey examining participants' satisfaction was conducted; 111 and 13 encounters by hospital-provided and ad hoc interpreters, respectively, were recorded. Segments of consecutively interpreted utterances were coded as "altered," whereby the interpreter changed the meaning of the source utterance, or "unaltered (accurate)." Frequency and type of alteration were analyzed. The effect of positive interpretation alterations on physician-patient interactions was qualitatively described. RESULTS: Interpretation accuracy was significantly higher for hospital-provided interpreters, but was not associated with overall patient satisfaction. Overall physician satisfaction was associated with accurate interpretation, clinically negative altered interpretations, and positive voluntary interventions (p < 0.05). Positive alterations promoted patient, physician, and interpreter interactions, which helped to achieve clinical outcomes. CONCLUSION: A new conceptual framework for quality assessment of medical interpretation was developed for clinical settings. Healthcare provider satisfaction can provide a measure of interpretation alterations. PRACTICE IMPLICATIONS: Healthcare providers can effectively use the conceptual framework to improve medical interpretation and collaboration with healthcare interpreters.

Relationship Between Patient-Provider Language Discordance and the Need for Professional Medical Interpretation for International Patients in Japan.

BACKGROUND: Language barriers between patients and healthcare providers pose significant challenges in medical care in Japanese hospitals. Inadequate patient understanding of discussions with healthcare providers because of patient-provider language discordance has been reported in previous studies. There are growing expectations of professional medical interpreters to address these challenges. A previous study reported that patients with patient-provider language discordance were more likely to need interpreter assistance compared with patients with patient-provider language concordance. OBJECTIVE: We conducted a cross-sectional study utilizing a questionnaire survey of foreign patients to analyze the impact of the degree of patient-provider language discordance on the degree of patient comprehension of patient-provider communication, as well as patients' need for professional medical interpreters in Japanese hospitals. METHOD: From February 2022 to May 2023, an online questionnaire was distributed to 4,962 individuals aged 18 years or older who were non-native speakers of Japanese and who had attended medical institutions in Japan because of illness or injury experienced by themselves or by their children. A chi-square test and residual analysis were used to analyze the relationship between patient-provider language discordance and patient comprehension of patient-provider language concordance. Logistic regression analysis was performed to analyze the relationship between patient-provider language discordance and the necessity of professional medical interpretation. RESULTS: Among 4,962 study subjects who received the online survey, the total number of responses was 363 (7.3%). The rate of low-level patient comprehension was significantly higher in the patient-provider language discordance group compared with other groups. In a logistic regression model that accounted for sociodemographic factors, both the partial and complete patient-provider language discordance groups were more likely to want to use professional medical interpreters compared with the patient-provider language concordance group (OR: 4.16; 95% CI, 1.55-11.16; P=0.005; OR: 4.73; 95% CI, 1.70-13.18; P=0.003, respectively). CONCLUSION: The current findings suggest that hospitals should be better prepared to meet the potential language needs of international patients with no or limited use of Japanese in daily conversation.

Illness Perception Accorded by Language Assistance in Non-Japanese-Speaking Patients.

Background and objective While over half of foreign residents in Japan need language assistance during medical consultations, no extant studies have clarified illness perception accorded by language assistance in non-Japanese-speaking patients. This cross-sectional study conducted an online questionnaire survey to investigate the illness perception of non-Japanese-speaking patients and analyze the factors related to illness perception. Methodology The survey was conducted twice, from February to May 2022 and from February to April 2023, targeting non-Japanese-speaking individuals. In total, 293 valid responses were obtained. The Brief Illness Perception Questionnaire (Brief IPQ) scores were compared between the groups receiving language assistance and those without assistance, and a logistic regression analysis was performed to examine the factors related to illness perception accorded by the status of the language assistance group. Results The total score for illness perception was significantly lower in the language assistance group than in the non-assistance group (P = 0.04). Moreover, in the language assistance group, age (odds ratio [OR] = 0.91, 95% confidence interval [CI] = 0.84-0.99) and comprehension of medical consultations (OR = 0.31, 95% CI = 0.11-0.83) were significantly associated with low illness perception among participants. However, these associations were not observed in the non-assistance group. Conclusions These findings underscore the crucial role of ensuring effective communication and promoting a better understanding of illness perception during medical consultations.

Patterns of alcohol and alcohol-flavoured non-alcoholic beverage advertisements over Japanese free-to-air television networks.

BACKGROUND: Alcohol use is a serious public health challenge worldwide. Japan has no government regulations or legal penalties against advertising alcoholic beverages on television (TV). Instead, advertisements depend on the Japanese alcohol industry's self-regulation on airtime (no advertisements from 5 am to 6 pm) and the content of alcoholic beverages, which must not tempt minors. However, many adolescents (10 to 19 years old) watch TV from 6 pm to 11 pm. The aim of this study was to describe the pattern in the advertising of alcoholic beverages and alcohol-flavoured non-alcoholic beverages (AFNAB) in Japan during the popular TV viewing time for adolescents. METHODS: A secondary analysis of advertising airtime data from five free-to-air Japanese TV networks in the Greater Tokyo area that aired between 12 August and 3 November 2019, was performed. RESULTS: During the study period, 5215 advertisements for alcoholic beverages and AFNABs aired (1451.75 min). In total, 2303 advertisements (44.2%) were beer, low-malt beer, or beer-taste beverages, 277 (5.3%) were whisky, 2334 (44.8%) were local alcoholic beverages (shochu and seishu), and 301 (5.8%) were AFNAB. On average, more advertisements aired on weekends (67.6 advertisements) than on weekdays (59.3 advertisements) per day. Approximately 30% of advertisements for AFNABs were aired during the time restricted for alcohol advertising, although AFNABs are considered alcohol according to industry guidelines. During the popular television viewing time for young adolescents, about two to three times more advertisements were aired per hour than during the rest of the day, on both weekdays and weekends (p < 0.001). CONCLUSION: The number of alcohol advertisements aired at times when adolescents often watch TV is 2 to 3.2 times higher than that at other times of the day. Furthermore, despite the industry's self-imposed regulations, some alcoholic beverages are still advertised. Therefore, other methods to protect children and adolescents from exposure to advertisements for alcoholic beverages should be investigated and implemented.

Effects of suvorexant on sleep apnea in patients with heart failure: A protocol of crossover pilot trial.

BACKGROUND: Suvorexant, an orexin receptor antagonist, is known as a safe and effective sleep medication. Many patients with heart failure (HF) have sleep-disordered breathing (SDB) and are short sleepers, and it is unknown whether suvorexant is effective in HF patients and can improve insomnia safely. The aim of this study is to examine the effect of suvorexant on SDB in patients with HF. METHODS: The Heart Failure with Insomnia and Suvorexant trial of Juntendo University Hospital and Juntendo Shizuoka Hospital (J-FLAVOR trial) is a multicenter trial with a randomized double crossover design. We will enroll a total of 30 HF patients treated in the Juntendo University Hospital and Juntendo Shizuoka Hospital. Eligible patients will undergo portable sleep monitoring twice with or without oral administration of suvorexant in a randomly assigned order. Before the study night, patients in the suvorexant first group will receive suvorexant for 4 consecutive days. There are at least 3 wash-out days between the study nights with and without suvorexant. Primary outcome measures of the non-inferiority trial of suvorexant include the apnea-hypopnea index and the severity of SDB, and the results will be compared between the study nights with and without suvorexant. CONCLUSION: The present study can determine whether suvorexant can be used in HF patients without affecting their SDB. This is a pilot study to primarily assess whether suvorexant affects the severity of SDB in patients with HF. Therefore, further study is warranted to investigate whether suvorexant alters short- and long-term clinical outcomes by providing longer and better sleep in patients with HF.

Thermodynamics of protein denaturation at temperatures over 100 °C: CutA1 mutant proteins substituted with hydrophobic and charged residues.

Although the thermodynamics of protein denaturation at temperatures over 100 °C is essential for the rational design of highly stable proteins, it is not understood well because of the associated technical difficulties. We designed certain hydrophobic mutant proteins of CutA1 from Escherichia coli, which have denaturation temperatures (Td) ranging from 101 to 113 °C and show a reversible heat denaturation. Using a hydrophobic mutant as a template, we successfully designed a hyperthermostable mutant protein (Td = 137 °C) by substituting six residues with charged ones. Thermodynamic analyses of these mutant proteins indicated that the hydrophobic mutants were stabilized by the accumulation of denaturation enthalpy (ΔH) with no entropic gain from hydrophobic solvation around 100 °C, and that the stabilization due to salt bridges resulted from both the increase in ΔH from ion-ion interactions and the entropic effect of the electrostatic solvation over 113 °C. This is the first experimental evidence that has successfully overcome the typical technical difficulties.

Correction of hyperphosphatemia suppresses cardiac remodeling in uremic rats.

BACKGROUND: Hyperphosphatemia is associated with cardiovascular disease in patients with chronic kidney disease. To examine the effects of correction of hyperphosphatemia, we investigated the association between phosphate metabolism and cardiac remodeling in uremic rats. METHODS: Four groups were studied for 8 weeks: (1) control (sham), (2) 5/6 nephrectomized (Nx) rats fed a normal phosphate regular diet (Nx + NP), (3) Nx rats fed a high phosphate (1.2 %) diet (Nx + HP), and (4) Nx rats fed a high phosphate diet containing 2 % lanthanum carbonate (Nx + HP + La). The relationship between phosphate metabolism and cardiac remodeling was analyzed. RESULTS: Nx + HP rats showed a significant increase in serum phosphate and PTH compared with Nx + NP rats, while Nx + HP + La rats showed slight decreases in these levels. Both Nx + HP and Nx + HP + La rats showed a significant increase in fibroblast growth factor-23 (FGF23) compared with Nx + NP rats. Urinary phosphate excretion showed a similar trend to that of FGF23. Nx + HP rats showed a significant increase in LV weight and matrix deposition compared with Nx + NP rats, and this increase was also significantly suppressed in Nx + HP + La rats. Serum phosphate levels and PTH were significantly correlated with LV weight and matrix deposition, but FGF23 levels did not show the correlation. FGF23 had a high correlation with urinary phosphate excretion. CONCLUSIONS: These results suggest that correction of hyperphosphatemia by lanthanum carbonate could suppress cardiac remodeling independently of changes in FGF23.

Development and pilot testing of a novel education method for training medical interpreters.

OBJECTIVE: The goal of this study was to determine core competencies by means of a systematic literature review and to design and test an interpreter training program. METHODS: Core competencies in medical interpreting were searched using a systematic literature review. An intervention program was developed to improve core competencies. Pretests and posttests were conducted to pilot-test knowledge and interpreting skills in participants aged 22-62 years (n=43). Results of the tests were compared. RESULTS: Results of the systematic review indicated five core competencies: (a) maintaining accuracy and completeness; (b) medical terminology and understanding the human body; (c) behaving ethically and making ethical decisions; (d) nonverbal communication skills; and (e) cross-cultural communication skills. Statistical analysis showed a significant improvement in knowledge and interpreting skills in the intervention program compared with the control program. CONCLUSION: Posttest assessment showed that the developed training system can be useful in improving knowledge and quality in medical interpreting. PRACTICE IMPLICATIONS: A 3-day training program for medical interpreters could bridge the gap between medical professionals and patients with limited English proficiency while being amenable to integration into clinical flow.

Vitamin D receptor activators inhibit vascular smooth muscle cell mineralization induced by phosphate and TNF-α.

BACKGROUND: Vascular calcification is a highly regulated process. Tumor necrosis factor-α (TNF-α) has been shown to accelerate the highly regulated osteogenic process in vascular smooth muscle cells (VSMCs). Vitamin D receptor activators (VDRAs) have been associated with beneficial cardiovascular outcomes in patients with chronic kidney disease. We examined whether maxacalcitol, a vitamin D(3) analog, exhibits a suppressive effect on VSMC mineralization induced by phosphate and TNF-α. METHODS: Human VSMCs were treated with either vehicle, maxacalcitol (10(-9) to 10(-7) M), or calcitriol (10(-9) to 10(-7) M) in 2.5 mM of phosphate media with TNF-α (1 ng/mL) for 9 days. VSMC mineralization was determined and expression of genes associated with the osteogenic process was examined by real-time reverse transcription-polymerase chain reaction. Expression of matrix metalloproteinase-2 (MMP-2) messenger RNA (mRNA) in VSMCs and MMP-2 protein in media was also analyzed. RESULTS: Vehicle-treated VSMCs exhibited massive mineralization, which was inhibited by maxacalcitol in a concentration-dependent manner. Calcitriol also inhibited the mineralization. While vehicle-treated VSMCs exhibited increased mRNA expression of genes associated with the osteogenic process (Cbfa1/Runx2 and osteocalcin) compared with VSMCs grown in normal media without TNF-α (control), maxacalcitol and calcitriol suppressed the increase in mRNA species. Furthermore, vehicle-treated VSMCs exhibited increased MMP-2 mRNA and protein in the media that were suppressed notably by maxacalcitol. CONCLUSIONS: Both the VDRAs abrogated the acceleration of the osteogenic process induced by phosphate and TNF-α in VSMCs, which was linked to inhibition of mineralization in VSMCs. MMP-2 blockade by VDRAs may contribute to an inhibitory effect on vascular calcification.

Effect of dibutyryl cyclic adenosine monophosphate on the gene expression of plasminogen activator inhibitor-1 and tissue factor in adipocytes.

INTRODUCTION: Hypertrophic adipocytes in obese states express the elevated levels of plasminogen activator inhibitor-1 (PAI-1) and tissue factor (TF). An increase in the intracellular concentration of cyclic adenosine monophosphate (cAMP) promotes triglyceride hydrolysis and may improve dysregulation of adipocyte metabolism. Here, we investigate the effect of dibutyryl-cAMP (a phosphodiesterase-resistant analog of cAMP) on the gene expression of PAI-1 and TF in adipocytes. MATERIALS AND METHODS: Differentiated 3T3-L1 adipocytes were treated with dibutyryl-cAMP and agents that would be expected to elevate intracellular cAMP, including cilostazol (a phosphodiesterase inhibitor with anti-platelet and vasodilatory properties), isoproterenol (a beta adrenergic agonist) and forskolin (an adenylyl cyclase activator). The levels of PAI-1 and TF mRNAs were measured using real-time quantitative reverse transcription-PCR. RESULTS AND CONCLUSIONS: The treatment of adipocytes with dibutyryl-cAMP resulted in the inhibition of both lipid accumulation and TF gene expression. However, PAI-1 gene expression was slightly but significantly increased by dibutyryl-cAMP. On the other hand, cilostazol inhibited the expression of PAI-1 without affecting lipid accumulation. When the adipocytes were treated with cilostazol in combination with isoproterenol or forskolin, the inhibitory effect of cilostazol on PAI-1 gene expression was counteracted, thus suggesting that inhibition by cilostazol may not be the result of intracellular cAMP accumulation by phosphodiesterase inhibition. These results suggest the implication of cAMP in regulation of the gene expression of TF and PAI-1 in adipocytes. Our findings will serve as a useful basis for further research in therapy for obesity-associated thrombosis.

High-throughput crystallization-to-structure pipeline at RIKEN SPring-8 Center.

A high-throughput crystallization-to-structure pipeline for structural genomics was recently developed at the Advanced Protein Crystallography Research Group of the RIKEN SPring-8 Center in Japan. The structure determination pipeline includes three newly developed technologies for automating X-ray protein crystallography: the automated crystallization and observation robot system "TERA", the SPring-8 Precise Automatic Cryosample Exchanger "SPACE" for automated data collection, and the Package of Expert Researcher's Operation Network "PERON" for automated crystallographic computation from phasing to model checking. During the 5 years following April, 2002, this pipeline was used by seven researchers to determine 138 independent crystal structures (resulting from 437 purified proteins, 234 cryoloop-mountable crystals, and 175 diffraction data sets). The protocols used in the high-throughput pipeline are described in this paper.