Implementation of National Leprosy Eradication Programme during COVID-19 era: A qualitative research

Introduction: The COVID-19 pandemic imposed new challenge to the implementation of the National Leprosy Eradication Programme. According to national data, after lockdown due to COVID-19, there was a 29% reduction in total leprosy cases reported in the first quarter (April-June) of 2020 in comparison to 2019. Objectives: To explore the difficulties faced by different stakeholders of the National Leprosy Eradication Programme like policy makers, doctors, grass root level health workers as well as leprosy patients during COVID-19 pandemic with respect to programme implementation and access to leprosy care. Materials and Methods: Qualitative research was undertaken including two focus-group-discussions held among six leprosy patients diagnosed after lockdown and nine ASHA workers as well as six in-depth interviews of doctors, leprologists, and programme managers. Ethics committee approval was sought and informed consent was obtained from all participants. All focus-group-discussions were electronically recorded and the in-depth interviews telephonically recorded, transcribed and translated from Bengali-to-English. Transcripts were separately coded by researchers and thematically analysed with the help of Visual-Anthropac software version 1.0. Results: Solitary focus on COVID-19 control, capacity building and information, education and communication, leprosy case search & surveillance, co-infection among health workers, transportation issues were the themes explored from focus-group-discussions of health workers and ASHA workers. Similarly, the present study identified six themes from in-depth interviews of programme manager, leprologists, programme manager as diagnostic difficulty, operational issues, rehabilitation issues, capacity building & information education and communication activities and way forward. Limitations: The research reveals the perceptions of rural population of Eastern India with high leprosy prevalence, which might not be applicable for urban areas or low prevalent districts Conclusion: The solitary focus of the administration towards COVID and shifting the infrastructure and human resource only towards the management of COVID can lead to resurgence of the leprosy. Having an organised framework of operations, catering to the need of the front-line workers in rendering services, utilizing the digital platform and social media, and focusing on rehabilitation would be needed to overcome the crisis

Development of an integrated telerehabilitation model in children with cerebral visual impairment in South India during the COVID-19 pandemic – A pilot study

Purpose: Coronavirus disease 2019 (COVID?19) pandemic affected the in?person rehabilitation/habilitation services in families with children with cerebral visual impairment (CVI) in India. This study aimed to develop a structured and family?centered telerehabilitation model alongside conventional in?person intervention in children with CVI to observe its feasibility in the Indian population. Methods: This pilot study included 22 participants with a median age of 2.5 years (range: 1–6) who underwent a detailed comprehensive eye examination followed by functional vision assessment. The visual function classification system (VFCS) was administered to the children and the structured clinical question inventory (SCQI) to the parents. Every participant underwent 3 months of telerehabilitation including planning, training, and monitoring by experts. At 1 month, the parental care and ability (PCA) rubric was administered to the parents. After 3 months, in an in?person follow?up, all the measures were reassessed for 15 children. Results: After 3 months of Tele?rehabilitation there were significant improvements noted in PCA rubric scores (P<0.05). Also, statistically significant improvements were noted in functional vision measured using SCQI and VFCS scores (P<0.05) compared to baseline. Conclusion: The outcomes of the study provide the first steps towards understanding the use of a novel tele?rehabilitation model in childhood CVI along?side conventional face?to?face intervention. The added role of parental involvement in such a model is highly essential.

Parental perception of facilitators and barriers to activity and participation in an integrated tele-rehabilitation model for children with cerebral visual impairment in South India – A virtual focus group discussion study

Purpose: This study utilized virtual focus group discussions to document the facilitators and barriers reported by the parents as part of the tele?rehabilitation service delivery model in India. Methods: This study included 17 participants who were enrolled into the Tele?rehabilitation program (16 mothers, 1 father) and the virtual focus group discussion (V?FGD) were conducted through a WhatsApp video call. Three V?FGDs were conducted involving two moderators and a note taker. The V?FGD, focused at extracting the perceptions of parents pertaining to facilitators, barriers and coping mechanisms to barriers related to the tele?rehabilitation model. Results: Thematic analysis resulted in four themes for barriers that included: family and support, time, parent and care taker, child and place of living related; facilitators reported included: continuous monitoring, accessibility to professional services, provision of resource materials and parental empowerment. Themes “family and support” and “child” were most reported by parents with children >3 years and ?3 years respectively. Finally, the barriers and facilitators were aligned with the chapters and codes of International Classification of Functioning, children and youth version (ICF?CY) environment and personal factors. Conclusion: This V?FGD highlights the importance of parental?centred and structured Tele?rehabilitation among children with CVI in India. The outcome of this study opens avenues for creating effective intervention.

Perspectives On Health Care Cost-Consciousness among Medical Students and Physicians

Introduction: Health care costs consciousness refers to care that aims to assess the benefits, harms and costs of interventions by the physicians. Rising health care costs have created an urgent need to improve physicians� knowledge on health care costs for providing cost conscious care. Objectives: This study was done to assess and compare the knowledge and attitude towards health care cost consciousness of the undergraduate medical students and interns. Methodology: A Mixed Method study was done using a standardized questionnaire among 388 medical students and a Qualitative approach using In-depth interviews with 15 practicing physicians and a Focus group discussion to understand their perceptions on cost-conscious care and their opinions on introducing Cost-conscious curriculum for the medical students. Data analysed using a framework analytical approach and NVivo12. Results: 84% of the students agreed that all health personnel should be familiar with health care costs, 84.5% agreed that inclusion of the health care cost consciousness in medical curriculum is important for their carrier. The themes emerged identified the various perceptions, determinants on health care costs, cost-conscious decision making and their responsibility as a physician. Conclusion: The physicians and interns strongly suggested including a structured learning on Cost-Conscious Care as a part of medical education to educate and train the future physicians.

Male attitudes towards family planning in the Limpopo province of South Africa

Women often do not receive support from their partners with regards to familyplanning (FP), which can lead to hesitancy and inconsistent use. This study sought tounderstand the male attitudes that contribute to this.Methods: A qualitative descriptive study was conducted in 2019 using focus group discussions (FGDs) with purposively selected men aged ≥ 25 years and in a relationship with a woman of childbearing age. An open-ended question guide was used to explore men's perceptions regarding FP. The discussions were recorded, translated and transcribed verbatim, whereafter transcripts were coded and analysed thematically. Results: Three major themes were identified, namely: (1) the advantages of FP, including financial benefits and the prevention of sexually transmitted infections and unwanted pregnancy; (2) the disadvantages of FP, including perceived adverse effects on men and women, as well as marital difficulties; and (3) the exclusion of men from FP by health workersand their partners. Conclusion: Men felt ambivalent towards FP. They were aware of the benefits thereof, but were hesitant to allow their female partners to use contraceptives, because of several misconceptions about the adverse effects. This underscores the need to involve men in FP programmes.

Knowledge and consumption practices on probiotics in selected low to middle-income class Filipino mothers in an Urban City

Objective@#Mothers are exposed to various functional food components, including probiotics, which have a direct effect on the quality of their breast milk. Probiotics enhance the microbial composition of breast milk, making it more beneficial for the infant’s gut health. This study aimed to explore the extent of knowledge and dietary practices on probiotics among low- to middle-income healthy Filipino mothers in an urban area. @*Methods@#Data was gathered using three focus group discussions (FGD) participated in by low- to middle-income healthy Filipino mothers residing in Barangays West Rembo and Rizal in Makati City, Philippines. Prior to the FGD, preliminary interviews of selected participants and market surveys were done to determine the food items to be included in the FGD questionnaire. @*Results@#A total of 19 mothers participated in the FGDs. The most common probiotic sources identified were yogurt, fermented milk product (Yakult), miso and tausi. The most consumed probiotic source was fermented milk product (94.7% of participants), at least once a month; followed by powdered milk (78.9%), consumed daily. The most commonly reported influence for consumption of these food items was advertisements from television (89.5%). About 53% of the participants related probiotics to better digestion and increased immunity as heard from advertisements and through counselling by physicians. When asked to elaborate on how probiotics influence digestion and immunity, almost all participants had difficulty explaining the benefits.@*Conclusion@#Although majority of the participants consumed food sources of probiotics, they had limited knowledge on its other non-food sources and benefits. In addition, the consumed food source was confined to the food item that was most advertised on television. Thus, there is a need for health and nutrition experts to exert a stronger influence in the community by disseminating information regarding probiotics.

Perception and knowledge regarding under-nutrition in children among anganwadi workers: a qualitative study in Berhampur of Ganjam district, Odisha

Background: Anganwadi centres (AWCs) remain hub for promoting nutrition in children. For an effective functioning of programs, Anganwadi workers (AWWs) need to have a sound knowledge and perception regarding under-nutrition. A qualitative study (Focus Group Discussion) was conducted with aim to assess perceptions and knowledge of AWWs regarding under-nutrition in 6 domains like about term under-nutrition in children, its causes, identification of it, its community management, advices to be given to parents and knowledge of program related to under-nutrition in their locality.Methods: 2 Focus group discussions (each consisted of 12 members and took around 40-45 minutes) were conducted in December 2018 among AWWs of Berhampur through purposive sampling. One author played role of facilitator who carried out discussions, another acted as recorder who took notes and sociograms were recorded by another author. Audio-visual recordings were done. Data were analysed and a report was created based on grounded theory.Results: Participants had fair knowledge of term under-nutrition. They had good knowledge of causes of under-nutrition in children and knew how to identify. But none of them had proper knowledge of community management of malnutrition (CMAM) in children. Though most of them have knowledge of screening of malnourished children and referral to Nutritional rehabilitation centre, they were unaware of other key components of CMAM. Many AWWs didn’t know much about programs for combating malnutrition; however they were well acquainted with ICDS and VHND.Conclusions: Quality training programs and more sensitisation should be done for Anganwadi workers. Specific training on CMAM should be carried out for them.

Family Involvement by Japanese Family Physicians in Their Clinics: The Second Report of a Focus Group Discussion / 日本プライマリ・ケア連合学会誌

Objective: To clarify the involvement of Japanese family physicians with patients and their families in their daily practice.Methods: Participants were Japanese family physicians with over one year of experience of full-time work in their clinics, and who were able to join the focus group discussions (FGD) and member checks. The study employed a qualitative research design with semi-structured FGD. Two analysts examined video recordings of the FGD, and the results were verified through member checks and external checks.Results: Eight physicians participated at first, but five of them dropped out because of job commitments or death. The involvement by Japanese family physicians consisted of three stages. The first stage was "the approach of repeated hypothesis testing and normalizing" as safety interventions. The second stage was "reevaluation of the family" utilizing family genograms, family conferences, and others. After exhausting all other efforts, they engaged in "accepting the one who comes to them" in collaboration with the patient and families. The outcomes included awareness of patients, their smiles due to feeling accepted, and their expressed emotions. They did not explicitly boast that they were able to engage with family members. In addition, they also needed case studies of instances of "failure." Conclusion: Japanese family physicians engaged in three-stage involvement with families.

Nutrition labelling: an exploratory study on personal factors that influence the practice of reading nutrition labels among adolescents

@# Introduction: The consumption of processed food is increasing in developing countries. Nutrition labels on food packaging are important for the education of consumers, particularly adolescents, to help them make healthier food choices. However, there is evidence to suggest that adolescents generally do not use nutrition labels. This study aims to explore the personal factors that influence the practice of Malaysian adolescents in reading nutrition labels. Methods: The participants were adolescents, aged 13-16 years, from five public schools in Negeri Sembilan. Five semi-structured focus group discussions (FGDs) were conducted. The participants discussed their personal views, knowledge and perceptions regarding the use of nutrition labels and food selection. Data gathered from the FGDs were coded through thematic analysis using the NVivo software. Results: While the participants were familiar with nutrition labels, their usage was relatively low during food selection due to the lack of interest in nutrition information, past experiences, hunger and cravings, time constraints and the taste of the food. The main reasons for using nutrition labels were health consciousness and their curiosity about specific nutrition information provided on the labels. The majority of participants believed that information provided on the labels was accurate because it was provided by reliable institutions. There was also misperception among some participants, mixing up nutrition labels with list of ingredients and the expiry dates. A few participants were unconvinced by the labels and stated that the labels provided misleading information. Conclusion: Personal factors such as knowledge, misperception, awareness and trust significantly impact how adolescents read nutrition labels.

Factors and issues on treatment adherence among Filipino patients with epilepsy and their caregivers

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Non-adherence to treatment in epilepsy is considered as a worldwide problem ranging from 30-50% of patients. Despite its striking magnitude, only a few studies tried to explain the factors affecting it. Moreover, a standard method to measure adherence to treatment among patients is still lacking. An in-depth analysis on adherence to treatment of patients with epilepsy, taking into factor their values, beliefs, and culture, is deemed necessary.</p><p style="text-align: justify;"><strong>OBJECTIVES:</strong> The purpose of this qualitative study is to investigate the contributory factors and issues on treatment adherence faced by Filipino patients with epilepsy and their caregivers. This study also aimed to serve as a catalyst to further stimulate local researches on treatment adherence in epilepsy.</p><p style="text-align: justify;"><strong>METHODS:?</strong>Four focus group discussions were conducted with patients and caregivers who voluntarily agreed to participate and share their experiences on dealing with epilepsy. A total of 39 participants were included. The focus group discussions, facilitated by skilled moderators, were composed of an ice breaker and a discussion on the experiences and issues faced by the participants. The discussions were transcribed and analyzed using thematic coding.</p><p style="text-align: justify;"><strong>RESULTS:</strong> Three main content categories were identified from the focus group discussions, namely, 1) accepting a life with epilepsy, 2) dealing with the disease, and 3) ensuring freedom from seizure attacks, which were further sub-categorized. From these, a number of factors affecting treatment adherence were identified and a conceptual framework was developed by the investigators.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> This study was able to demonstrate that conducting a focus group discussion was an effective means of eliciting the experiences and issues in patients and their caregivers. Several factors affecting treatment adherence such as patient-doctor relationship, financial resources, government support, adverse medication effects, religious belief, trigger avoidance, frequent reminders, and safety precautions were elucidated in this study.</p>

How and When Do Japanese Family Physicians Assess Family in Their Clinics?: A Preliminary Initial Report from a Focus Group Discussion / 日本プライマリ・ケア連合学会誌

Objective: To clarify how and when Japanese family physicians assess families in their daily practice.Methods: Participants were Japanese family physicians with over one year of experience of full-time work in their clinics, and who were able to join the focus group discussions (FGD) and member checking. The study employed a qualitative research design with semi-structured FGD. Two analysts examined video recordings of the FGD, and the results were verified through member checking and the checking by external members.Results: Physicians assessed families naturally while examining patients for common cold, during vaccination, and during registration in the Japanese care insurance system.Additionally, the physicians assessed the families when they observed or suspected something strange regarding the patient and/or the family.Families were assessed based on how they spent their time during special Japanese events that the family members attended together (e.g., Bon festival or Japanese style New Year holidays), the patient's illness behavior in non-reserved outpatient clinics, and their communication patterns. Furthermore, the family photograph technique for family therapy was also used for assessment.Conclusion: Participants utilized skills of family therapy such as communication patterns and family photographs. They also employed unique skills such as assessment of the families' sharing time during traditional events, assessment of the patient's illness behavior, and general assessments regarding the Japanese care insurance system.

Current Status of Public-Private Partnership in Mongolian Health Sector / Шинэ санаа Шинэ нээлт

State that the private sector partnership is a general concept that encompasses formal legal relationships between government entities and the private sector to use private sector resources and expertise to ensure delivery of public services and property. This is because public services to improve the capacity for sustainable use of private sector skills and modernization of technology andfinancial resources, capacity building and increased capacity necessary to wait for the budget cost ofthe current economic situation of our country. Public-private partnership noted that the assessment made by international organizations to take place very effectively in our country. Therefore, the evaluation of the current public-private partnership in the health sector in order toimprove these conditions and to improve the quality and accessibility of care and identify ways of involvement in the implementation of a basis for the work of the study. The purpose of the study is to assess the state of public-private partnership conditions in the Mongolian health sector.We conducted overall 20 focus group interviews with 180 participants, including doctors and health care professionals. 17 out of 20 were from Ulaanbaatar and 3 were out of 20. From them, six interviews in the Aimag’s and district’s Complex Hospital represented for the secondary health care organizations, 8 interviews in the Family Clinic represented for primary health care organizations.3 interviews in the third health care organizations. Also 3 interviews in the private health care organizations.Is not known the advantages of public and private medical practitioners and medical specialists partners and do not have experience in working partner. But running has partnered with medical doctors, specialists increased support service types currently provided as a partnership between the hospital and doctor finds that your experience is improving and increasing the quality of service.For flip side is that partners can expand partnership working poor accountability. Future doctors and medical experts believe is necessary to strengthen the increasing awareness of the Partnership through the provision of secondary education, advocacy and policy.Doctors and medical experts believe that public-private partnerships Mongolian international health industry groups have developed expanding significantly. It believes that the lack of knowledge about the partnership, due to be implemented in a realistic policy document.

Health Group and Disease Group's Perceptions of Health and Health-related Quality of Life: a Focus Group Study and In-depth Interviews

BACKGROUND: This study aimed to understand and explore perception of healthy adults and chronically ill adults on health and health-related quality of life (HRQoL). METHODS: Data were collected by open questions using a focus group discussion for healthy adults (N=6) and in-depth interviews for chronically ill adults (N=6). Previously developed 34 HRQoL items also were offered and participants were asked to select the five most important HRQoL items among them. RESULTS: Findings were elicited along the following themes: health, HRQoL, health maintenance strategies, and elements affecting health. The definition on "being healthy" by healthy participants had a variety of standards and required several conditions to be fulfilled. Whereas chronically ill adults have more flexible perception about the coexistence of health and disease. Health dimensions were thought to affect each other, and physical and mental health dimension were selected as the most important items. As for the five most important HRQoL items, both group participants selected mental health dimension than physical or social health dimensions. Health maintenance strategies were similar in both groups except more healthcare service use in chronically ill adults. CONCLUSIONS: This study shows the difference of perception on health and HRQoL between health group and disease group in Korea. It can be used for developing the HRQoL assessment tool reflecting the perception of Korean people.

An experience of focus groups fieldwork among novice nurses in the Eastern Visayas Region, Philippines

@#<p style="text-align: justify;">Focus group (FG) as a method of research is becoming popular in nursing. However, limited practical examples on the processes and skills required for the implementation in the Philippines to address the implementation in the Philippines to address the complexity of this methods may prevent novice nurses to pursue more FG-based researches. For nurses and other health researches who intend to use the FG, facilitation and note taking in FG discussions as well as transcribing and translating are important skills to master. Ways to enhance he quality of data should also be devised to improve trustworthiness of findings such as pre-testing of tools, conduct of dis briefing sessions and, validation of translations and other data sources. Through appropriate methodological processes and examples, FG research is valuable in exploring and understanding nursing and health-related issues. This article showcases the experience of nine novice Philippine nurse researches in their aim to achieve high quality FG study on access to maternal health services conducted in the Eastern Visayas region of the Philippines.</p>

A study to evaluate adolescent health problems using focus group discussion.

Background: Adolescent health needs, behaviors and expectations are unique and routine health care services are not well geared to provide these services. The purpose of this study was to explore the perceived reproductive health problems in group of adolescents in Jammu district of J&K state in India. Methods: This qualitative study was conducted in an urban setting in Jammu. A convenient sample of 32 adolescents between 17-19 years of age participated in four focus group discussions. Participants were selected from four educational institutions selected by simple random technique. A pre-tested focus group guide was used for data collection. Male and female facilitators conducted discussions separately with young males and females. Results: Psychological distresses due to various reasons and problems regarding menstrual cycle and were reported as the commonest health problems. Conclusions: Adolescent health services are inadequate and a vailable services are not being delivered in an acceptable manner. Proper training of health care providers on youth friendly service provision is essential. A national level integrated health care program is needed for the adolescents.

Needs assessment on training programs and materials in the field of international nutrition according to one’s career stage / 国際保健医療

<B>Introduction</B><BR>This study was undertaken to identify needs of training and educational materials on international nutrition by career stage.<BR><B>Methods</B><BR>Focus Group Discussions (FGD) and a questionnaire survey were conducted in September and October 2008. In FGD, the participants were divided into three groups; undergraduate students who can potentially be involved in future nutrition activity for international cooperation (“students”), graduate students in international health or young workers involved in international cooperation through researches or programs on nutrition (“young”), and the experts who have worked for international nutrition cooperation (“experienced”). The results of FGD and questionnaire survey were categorized using the modified KJ methods.<BR><B>Results</B><BR>The numbers of FGD participants were two for “students”, four for “young” and seven for “experienced”. The questionnaires were completed by 119 undergraduate students. The specific issues they expected to learn in the field of international health and nutrition were the current situation in developing countries for the “students” and the process to identify the specific problems for the “young” and “experienced” The skills they would like to acquire were English proficiency for the “students” and “young” and understanding of the working fields as well as communication skills for the “young” and “experienced”. As for the necessary experience to get a job of international cooperation, working experience as a dietitian in Japan was stated by all groups. Additionally, the “young” mentioned overseas experience and the “experienced” suggested adaptability to different cultures as well as interpersonal skills.<BR><B>Conclusions</B><BR>This study identified communication skills as the needs common to all groups, while different needs were also identified by one›s career stage; especially educational needs among the “students” and training needs among the “young” and “experienced”. It is urgently required to develop training and educational materials on international nutrition that would meet the needs of each career stage.

Evaluation on implementation of preventive activities of non-communicable diseases / Монголын Анагаах Ухаан

Background: Mongolia is one of the most influenced countries by non-communicable diseases among developing countries. Non-communicable diseases, including cardiovascular diseases, cancers, respiratory diseases, diabetes, and injuries have become the major causes of morbidity and mortality in Mongolia.Goal: To assess impact of preventive intervention activities of non-communicable diseases in framework of the Millennium challenge account (MCA) health projectMethods: We conducted 17 focus group discussions (FGD) from March to April 2013 in primary and secondary health care settings, of which six in urban and eleven in rural areas.We identified themes concerning the current situation of NCD related health services from the perspective of health professionals, and insights into institutional and professional experiences related to management, implementation and coordination of the newly implemented MCA-Mongolia NCD prevention and control project.Results: As a result of the health project, NCD related knowledge and skills of health professionals have improved through progressive training, and development of guidelines and manuals. During the project, availability of equipment supplies has improved. Accordingly, medical equipment and laboratory reagents needed for early detection of NCDs were provided to primary and secondary health care settings, despite some challenges in the implementation of the project. As result of theproject implementation, increased public awareness on NCDs, and attitude change were considered as the biggest changes.Conclusion: The health project was considered as successful to provide knowledge on the best practice in NCD prevention.

Food Restrictions during Pregnancy among Indigenous Temiar Women in Peninsular Malaysia

Introduction: A qualitative comparative case study was conducted to compare and contrast food taboos and avoidance practices during pregnancy among Orang Asli or indigenous Temiar women in four distinct locations that represent different lifestyle experiences and cultural practices. Methods: Through snowballing sampling, a total of 38 participants took part in five focus groups: one group each in Pos Simpor and Pos Tohoi in Kelantan state, one group in Batu 12, Gombak in Selangor state, and two groups in a regroupment scheme (RPSOA) in Kuala Betis, Kelantan. All the transcripts were coded, categorised and ‘thematised’ using the software package for handling qualitative data, NVivo 8. Results: Variant food prohibitions were recorded among the Temiar women residing in different locations, which differ in food sources and ways of obtaining food. Consumption of seventeen types of food items was prohibited for a pregnant Temiar woman and her husband during the prenatal period. Fear of difficulties during labour and delivery, convulsions or sawan, harming the baby (such as foetal malformation), and twin pregnancy seemed to trigger many food proscriptions for the pregnant Temiar women, most of which have been passed on from generation to generation. Conclusion: The findings of this study confirm that beliefs about food restrictions are strong among those Temiar living a traditional lifestyle. However, those who have adopted a more modern lifestyle also preserve them to some extent.

Risk of Ad hoc Interpreters on the Medical Care Services for Brazilian Residents in Japan / 国際保健医療

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.<BR>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.<BR>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.

Problems and difficulties of early warning and response system for public health emergencies in China / 中国血吸虫病防治杂志

Objective To study current situation and existed problems in the public health emergency alert and response system so as to formulate more advices to consummate it and help to establish a more reasonable system adapting to our country. Methods A qualitative study was carried out among CDC working staff including two focus group discussions(FGD). Results Although government had put more emphasis on public health,increasing its devotion and strengthening the alert and response capability after SARS outbreak, some problems still existed, such as ① absence of correlative laws and rules; ② lack of government devotion; ③ insufficient utilization of surveillance information; ④ lack of the canonical response guidance. Conclusions With regard to the building up of the public health emergency alert and response system, the following proposals are put forward: increasing payout on public health; consummating the construction of disease surveillance network; affording more education and training to correlative staff engaged in the disease control to improve their abilities.