Usefulness of screening for Candida auris colonisation in international patients admitted to a large university hospital.

INTRODUCTION: Candida auris is an emerging pathogen in health care-associated infections. In contrast to many other countries with rising numbers of C. auris, only seven cases have been reported in Germany from 2015 to 2017, mostly from patients who received prior medical treatment abroad. We therefore established a mandatory screening for C. auris colonisation at our tertiary care centre for all patients who were admitted as international patients or previously hospitalised in a foreign country within the past 6 months. METHODS: Colonisation of patients was assessed using a previously established screening protocol for multidrug resistant bacteria. Since 2017, all screening samples were additionally analysed for C. auris using CHROMagar Candida (CHROMagar, Paris, France). Yeast isolates were identified using matrix-assisted laser ionisation time-of-flight (MALDI TOF), except for C. albicans (identified by the typical green colour on chromogenic agar). Data were analysed retrospectively. RESULTS: Our study cohort included 655 patients and an overall number of 1399 samples. Fifty-three patients were colonised with Candida species (C. albicans, n = 37; C. glabrata, n = 14; others n = 9). No case of C. auris was detected. Candida spp. were mainly detected from respiratory samples (5.4% positive) and gastrointestinal specimen (5.2%). Laboratory costs were 14,689 € and analyses resulted in 98.7 h of additional technician's work. CONCLUSION: No colonisation with C. auris was detected among patients with previous hospitalisation abroad. Universal C. auris screening of patients with any contact to foreign health care does not seem to be cost-effective in our setting and more targeted screening strategies have to be developed.

Frequency and type of alterations during medical interpretation by trained healthcare interpreters / 国際保健医療

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.

Challenges and the potential of promoting remote medical interpreting during COVID-19.

Language barriers negatively affect patient outcomes, and linguistic assistance is essential for adequate healthcare. The adoption of face-to-face medical interpretating is believed to have been rendered more challenging by the implementation of hospital admission restrictions following the outbreak of novel coronavirus disease (COVID-19). On the other hand, remote interpretating can be implemented using merely equipment, enabling it to be introduced without being impacted by the transmission of illness, and its use may have spread globally. To comprehend how COVID-19 has impacted remote interpreting utilization and what issues have arisen, we conducted a systematic review of two databases, PubMed and Ichushi-web (Japanese medical literature) with "remote interpreting" and "COVID-19" as keywords in June, 2022. Five references were included in the review. The research supported an increase in remote interpreting during COVID-19 to limit the risk of infection. This change in the trend of medical interpreting has the potential of promoting remote medical interpreting for places lacking sufficient linguistically skilled human resources, regardless of the pandemic status. There have also been accounts of novel methods of remote medical interpretation in which neither the healthcare professional nor the interpreter was face-to-face with the patient, and difficulty was acknowledged by both the healthcare professional and the patient with remote interpreting. To fully take advantage of the possibilities of remote interpreting, additional training and support would be required. Further studies are also required to determine the best way to employ this technology.

Preliminary Examination of an Appropriate Price Calculation Method and Medical Treatment Costs for Foreign Visitors in Japan.

This study proposes a method for calculating the appropriate medical treatment price level for foreign visitors (FVs) in Japan. Hospital management costs and foreign prices were analyzed from a market principles perspective to determine the medical treatment price. The study involved two stages: a preliminary survey and an extended survey, supplemented by an international survey. Relatively frequent diseases were selected, and the costs incurred by hospitals for the treatment of FVs were analyzed though data from three hospitals, covering 24 outpatients and 4 inpatients. Payments made by three insurance companies for overseas medical institution services for Japanese tourists with pharyngitis were analyzed. This study shows that the appropriate medical treatment prices for FVs, considering profits, were 1.22-4.26 times higher compared with prices under Japan's public health insurance plans. Furthermore, these prices were 1.31-4.26 times higher for outpatients with pharyngitis and external injury and 1.22-3.66 times higher for inpatients with appendicitis and femoral fractures. The price of pharyngitis treatment in 12 countries was USD 20.32-158.75 per patient for Japanese tourists, whereas FVs paid 60.24 dollars (1.13 times higher than Japan's public healthcare price) in Japan. This study shows it was appropriate to set the ideal price level for FVs higher than that for Japanese patients.

Resident foreign patients receive adequate dialysis but fewer preemptive transplantations: data from the Italian pediatric dialysis registry.

BACKGROUND: Sociocultural issues play a key role in children needing kidney replacement therapy (KRT). METHODS: Data of incident patients < 18 years treated with chronic dialysis or preemptive kidney transplantation (pTx) between 2007 and 2016 were retrospectively collected from the Italian Pediatric Dialysis Registry; KRT modality and outcome were compared between patients with at least one non-Italian parent ("resident foreign patients," RFPs) and those from native parents ("domestic patients," DPs) and between the quinquennium 2007-2011 (period 1) and 2012-2016 (period 2). RESULTS: We included 448 children (26.8% RFPs). The percentage of RFPs increased from 23 to 30.3% (p = 0.08) from periods 1 to 2. They were younger (6.7 vs. 9.4 years, p = 0.025) and less often treated with pTx (3.3 vs. 13.4%, p = 0.009) than DPs. The percentage of pTx increased from period 1 to 2 in RFPs only (8.4-18.6%, p = 0.006). Independent predictors of a lower probability of pTx were lower age, belonging to RFPs group, starting KRT in period 1 and focal segmental glomerulosclerosis or glomerulopathy as primary kidney disease. Peritoneal dialysis was the preferred dialysis modality in both groups. Age, primary kidney disease, and center size were independently associated with dialysis modality choice. Patient survival, waiting time to Tx, and dialysis modality survival were not different between the two groups. CONCLUSIONS: The proportion of patients receiving KRT born from immigrant families increased in recent years in Italy. They were younger and less often treated with pTx than domestic patients. In case of dialysis, the outcome was not different between the two groups. Graphical abstract.

Factors related to difficulty in caring for foreign patients among nurses in Japanese hospitals / 国際保健医療

AbstractObjectives  To explore factors related to difficulty in caring for foreign patients among Japanese nurses.Methods  A self-administered online survey was conducted with nurses working in a university hospital and a general hospital in Tokyo using Google Forms. The survey involved participants’ demographics, including language ability and international experiences, and 16 questions on difficulty in caring for foreign patients.Results  A total of 138 nurses completed the survey (response rate of 11.3%). The average nursing experience was 14.1 (±10.6) years, and 50% of the participants had a bachelor’s degree. The higher-difficulty items were predominantly related to communication, followed by insurance or payment. The most difficult item was “communication in a language other than English,” but no factor was associated with it. The path analysis showed that “being able to speak a foreign language” was directly and significantly associated with a lower total difficulty score (β＝−0.313, p＝0.011). Higher educational degree was associated with higher “self-evaluated English level” (β＝0.282, p<0.001), which was associated with “being able to speak a foreign language” (β＝0.396, p<0.001). Higher educational degree was also associated with “international experiences (study)” (β＝0.161, p＝0.044), which was associated with both “self-evaluated English level” (β＝0.256, p<0.001) and “being able to speak a foreign language” (β＝0.286, p<0.001). Lower educational degree was associated with more nursing experience (β＝−0.454, p<0.001), which was associated with a higher “number of foreign patients cared for” (β＝0.291, p<0.001) but not with lower difficulty. Although “international experiences (sightseeing)” was highly correlated with “international experiences (study)” (β＝0.338, p<0.001), sightseeing was not significantly related to higher “self-evaluated English level” or lower difficulty. Conclusion  Learning foreign languages, including English, and international study experiences could reduce difficulty in caring for foreign patients. An intervention study that evaluates the effect of training that includes a language aspect on caring for foreign patients may be necessary.

Presence of a translator in the operating theater for awake mapping in foreign patients with low-grade glioma: a surgical experience based on 18 different native languages.

OBJECTIVE: Intraoperative brain mapping with neurocognitive monitoring during awake surgery is currently the standard pattern of care for patients with diffuse low-grade glioma (DLGG), allowing a maximization of the extent of resection (EOR) while preserving quality of life. This study evaluated the feasibility of DLGG resections performed with intraoperative cognitive monitoring via the assistance of a translator for patients speaking foreign languages, and compared the surgical functional and oncological outcomes according to the possibility of direct communication with the surgical team. METHODS: Foreign patients who underwent awake surgery with intraoperative electrical mapping with the assistance of a translator for the resection of a DLGG in the authors' institution between January 2010 and December 2020 were included. Patients whose native language included one of the three languages spoken by the surgical team (i.e., French, English, or Spanish) were excluded. The patients were classified into two groups. Group 1 was composed of patients able to communicate in at least one of these three languages in addition to their own native language. Group 2 was composed of patients who spoke none of these languages, and therefore were unable to communicate directly with the operating staff. The primary outcome was the patients' ability to return to work 3 months after surgery. RESULTS: Eighty-four patients were included, of whom 63 were classified in group 1 and 21 in group 2. Eighteen different native languages were tested in the operating theater. Awake mapping was successful, with elicitation of transitory disturbances in all patients. There was no significant difference in the 3-month return-to-work status between the two groups (95% in group 1 [n = 58/61] vs 88% in group 2 [n = 15/17]; p = 0.298). Similarly, no significant difference between the two groups was found regarding the intraoperative tasks performed, the mean duration of the surgery, and the rate of permanent postoperative deficit. A significantly greater EOR was observed in group 1 patients in comparison to group 2 patients (90.4% ± 10.6% vs 87.7% ± 6.1%; p = 0.029). CONCLUSIONS: Real-time translation by an interpreter during awake resection of glioma is feasible and safe in foreign patients. Nonetheless, when no direct verbal communication is possible between the surgical team and the patient, the EOR is less.

[The particular aspects of development of medical and health promoting tourism].

The expansion of types of medical care and the development of tourism activities in medical services market in Russia actively gains momentum. The certain successes were achieved in this sector of economy. Medical and health tourism is more than complex and complicated category as compared to classical types of tourism and requires additional investigation related to improving efficiency of market business activities of related services and implementation of optimal state policy related to regulation and support of development of this segment of tourism industry. The article analyzes current state of market of medical services provided to foreign citizens and considers trends of further development of market of medical and health tourism. The topic of development of medical and health tourism in context of need is to ensure sustainable development of national economy and integration cooperation in the field of recreation and tourism.

Knowledge, attitudes and prejudices of nursing students about the provision of transcultural nursing care to refugees: A comparative descriptive study.

OBJECTIVES: The aim of this study was to determine the knowledge, attitudes, and prejudices of nursing students regarding the provision of transcultural nursing care to refugees. METHODS: The sample of this comparative descriptive study was composed of 317 volunteering nursing students living in Ankara, Turkey. Descriptive statistics were presented as number, percentage, and mean ± standard deviation. The relationships among dependent and independent variables were analyzed with Pearson chi-square test. p ≤ 0.05 was accepted as statistically significant. RESULTS: The mean age of the students was 21.19 ± 1.66 years; 88.6% were female. Only 30.0% (n = 95) of students (predominantly seniors) were educated on transcultural nursing. Statistically significant differences were found among grades of nursing students on the answers to the items, "Refugees are under coverage of general medical insurance system," "The concept of 'Health' differs from culture to culture," "Cultural features of the patient are important for caring nurse," "In order to provide care to only refugees and foreign patients, nurses from other cultures should be employed in hospitals," "Interpreters should be employed in hospitals 24 hours for services for refugees," and "According to my observations, refugees and their relatives admitted to the hospital are not respecting the healthcare workers and hospital rules." In addition, there was a statistically significant difference in students' comfort level with nursing care activities between those students who were literate in a foreign language and those who were not literate in a foreign language. CONCLUSIONS: Our findings show that attending lectures on transcultural nursing in a curriculum of seniors and being literate in a foreign language had a positive impact on the attitudes of students in terms of the provision of medical care to refugees. It is recommended that nursing programs integrate lectures on transcultural nursing into the curricula of all four grades of nursing education and encourage students in language learning to better serve our disadvantageous guests.

Needs and motivation of hospital nurses regarding training on how to care for foreign patients in Japan / 国際保健医療

Objectives  The objective of this study was to investigate the needs and motivation of nurses regarding training on how to take care of foreign patients at hospitals and to explore related demographic factors.Methods  A questionnaire was distributed to all nurses working at two hospitals in Tokyo, one university and one general, using Google form. The needs and contents of training they would like to participate were summarized using descriptive statistics. Fisher’s exact test, t test, Mann-Whitney U test and Spearman’s correlation coefficients were used to analyze related factors. Results  Responses of 138 nurses were analyzed (98 university and 40 general) with a response rate of 11.3%. More nurses in the university hospital held a bachelor’s degree and higher subjective English ability than the general hospital. In both hospitals, 59.7% answered that they “strongly feel” or “feel” stress/anxiety in dealing with foreign patients and 77.5% answered that training is necessary.   “Language training” was felt most necessary, followed by training regarding “different cultures and religions.” In regard to language training, “daily conversation” was most necessary, followed by “technical terms”; English being most necessary, followed by Chinese. Approximately one-fourth of participants (24.6%) answered in the affirmative for attending such training by adjusting their private schedules and 59.4% answered they only wanted to attend if it fits into their schedule.   Nurses who answered, “unable to speak English”, had a higher desire to improve their ability to take care of foreign patients; also, those who had higher stress/anxiety felt it was necessary to attend the training. Participants who had been studying a foreign language showed higher motivation.Conclusion  Daily conversation in English was felt most necessary regarding training to care for foreign patients. Training during work hours rather than on private time was preferred.

Research on international medical service model of large comprehensive Class A tertiary hospitals / 中华医学教育探索杂志

International medical service is becoming much more popular at present with the increased exchanges between countries around the world.This paper mainly analyzes the characteristics and practical measures taken by the international department of some large comprehensive class A tertiary hospitals in regard to customer orientation,service features,facility and environment building,talent team building and foreign communications,management and credentials,and insurance cooperation.It is found out that thecustomers are ambassadors,counselors,foreign workers and their family members,foreigners for business visits or foreign tourists;appointment service,one-stop service and other special service are provided;separate clinical area or room of international elements are installed;they continually enhance foreign exchanges and improve language skills and foreign culture cognitions of team members;they have particular management modes and operate with international standards;they cooperate with international insurance companies.The mode of international medical service is thus concluded on the analysis.

[The need for medical interpreters: a questionnaire survey of municipal hospitals in Japan].

Objectives　This study aimed to investigate the need for medical interpreters, in relation to hospital size, the number of foreign patients accepting, and risk management in municipal hospitals in Japan.Methods　In 2016, we conducted a questionnaire survey at 894 municipal hospitals in Japan. The questionnaire included hospital characteristics, the number of foreign patients, the need for medical interpreters, and the respondents' background. We used the incident classification of the Safety Management Council of National University Hospitals (0-5 levels and others). We applied pairwise analysis to hospital size: small hospitals (20-99 beds), medium hospitals (100-399 beds), and large hospitals (400 or more beds).Results　The response rates of the small, medium, and large hospital were 30.1%, 32.5%, and 32.8%, respectively. The percentage of hospitals that had accepted foreign patients over the previous year ranged from 84.9% to 97.6%, a higher with larger hospitals. Larger hospitals attended to emergencies, hospitalization, and surgical patients more frequently than the smaller hospitals. Hospital staff who communicated with non-Japanese-speaking foreign patients via ad-hoc interpreters accompanying the patients ranged from 84.3% to 86.7% in larger hospitals. Of the staff at small, medium, and large hospitals, 66.7%, 58.5%, and 44.7%, respectively, considered the interpretations of the ad-hoc interpreters accompanying the patient to be accurate. Of the small, medium, and large hospitals, 31.6%, 76.5% and 92.3% claimed that they would use interpreting services if the interpretation costs were covered by the National Health Insurance System (P<0.001). When foreign patients are accepted, 75.7%, 84.7% and 94.6% of small, medium and large hospitals require trained medical interpreters, respectively (P=0.014). Hospital staff reporting that the most common reason for using an interpreter was to reduce medical risks ranged from 81.1% to 94.3%. Of the 274 hospital staff surveyed, 4.7% had experiences of incidents due to the language barriers when dealing with foreign patients. The incident classification was as follows: 3 cases with Impact Level 0, including MRI withdrawal; 9 cases with Level 1, including unauthorized discharge and self-extraction of an in-travenous drip; 1 case of precipitate labor; 1 case of Level 5 death; and 3 other cases. Small hospitals have not been reporting incidents, but larger hospitals, despite the small number of foreign patients, have been reporting incidents.Conclusion　Large or medium-sized hospitals need medical interpreters more than smaller hospitals because of the greater number of foreign patients being attended to, and diversity and complexity of reasons for seeking hospital services. Our results suggest that language barriers when dealing with foreign patients are a threat to patient safety. The majority of the responding Japanese municipal hospitals believe that they require trained language interpreters to improve risk management.

Facts and cautions regarding international medical ventures

The "Act on Overseas Medical Expansion and Foreign Patient Attraction Support"(legislation no. 13599), due to be enacted by the National Assembly during the general meeting on June 23, 2016, will give institutionalized support and fully recognize the efforts for medical tourism-that is, the overseas expansion of medicine and ingress of foreign patients. However, before jumping into medical tourism, the failures of previous ventures in this field must be analyzed. The absence of specific goals and strategies, insufficient planning and analysis of feasibility, the lack of international experience, and glocalization and marketing failures of previous projects are all areas in which improvement is advised. Further, overseas medical expansion is only possible when various considerations are examined, such as the influence on the domestic medical market, as well as plans for securing the management capacity to ensure economic feasibility and risk management of medical institutions.

The Sociodemographic and Clinical Characteristics of Patients in the Multi-Cultural Mental Health Clinic / 신경정신의학

OBJECTIVES: This study investigated changes in the clinical characteristics of foreign patients receiving psychiatric treatment in a public mental hospital in Seoul over the last nine years. METHODS: We compared the sociodemographic and clinical characteristics of a multi-cultural mental health (MCMH) clinic group of 49 foreign psychiatric patients, who had attended the newly opened special clinic for foreigners during the period August 2009-2010, with those of a general group of 71 foreign psychiatric patients, who had been treated in conventional ways during the period 2002-July 2009. RESULTS: The MCMH clinic group was characterized by voluntary attendances with the assistance of family, friends or supporting organizations. The patients were more likely to have resided longer in Korea, to have Korean citizenship, to be young married immigrant women and to have children. They were also more able to communicate by themselves or with the support of bilingual interpreters and were more likely to receive outpatient-based treatment and to experience longer periods of treatment. In contrast, the general group was characterized by involuntary hospital attendances supported by the police or the embassies of their home countries, and patients received inpatient services. They were also discharged sooner to be sent back to their home countries. Depressive disorder, anxiety disorder, and adjustment disorder were more common in the MCMH clinic group, while schizophrenia, bipolar disorder and a past history of psychiatric disorders were more common in general group. In the MCMH clinic group, those patients with Korean citizenship or permanent residency seemed to maintain consistent and stable treatment with a good prognosis. CONCLUSION: The findings from the specialized multi-cultural mental health clinic suggest that specialized setting for foreigners is more efficient in helping them, particularly for married immigrant women. This means that specialized systematic evaluation and treatment approach needs to be developed to provide culturally relevant mental health services for foreigners living in Korea.

An Epidemiologic and Histopathologic Study of Skin Diseases in Foreign Patients Visiting through International Health Services / 대한피부과학회지

BACKGROUND: Recently, foreigners among outpatients in dermatologic clinics are increasing as foreigners staying in Korea are increasing. OBJECTIVE: The purpose of this study was to investigate the epidemiologic and histopathologic characteristics of skin diseases in foreign patients. METHODS: Total 277 foreign patients had undergone skin biopsies among patients visiting through international health services, Samsung medical center during 7-year period between January, 1996 and December, 2002. Their clinical data and histopathologic findings were reviewed. RESULTS: The number of skin biopsies taken from foreign patients was 429(4.6%) among total 8779 skin biopsies during 7 years. It showed a tendency to increase with time. The mean age of patients was 42.3 years and the ratio of men to women was about 2: 1. Distribution of nationality showed most of the patients came from North America(47.7%) and Europe (22.0%). Patients from USA were most common(41.5%). The distributions of dermatoses were common melanocytic nevi(24.2%), seborrheic keratoses (11.4%), actinic keratoses(8.4%), dysplastic nevi(6.8%), and epidermal or pilar cysts(5.1%). Total 266 cases(62%) were the dermatoses which could be clinically manifested as pigmented lesions. The numbers of cutaneous premalignant lesions and malignant tumors were 20(4.7%) and 68(15.9%), respectively. CONCLUSION: This study showed epidemiologic and histopathologic characteristics of the skin diseases of foreign patients staying in Korea. In comparison with Korean patients, it seems that foreign patients concern themselves much more about skin cancers and want their pigmented skin lesions to be examined. Dermatologists should consider performing skin biopsies in foreign patients who presented pigmented skin lesions.

An Epidemiologic and Histopathologic Study of Skin Diseases in Foreign Patients Visiting through International Health Services / 대한피부과학회지

BACKGROUND: Recently, foreigners among outpatients in dermatologic clinics are increasing as foreigners staying in Korea are increasing. OBJECTIVE: The purpose of this study was to investigate the epidemiologic and histopathologic characteristics of skin diseases in foreign patients. METHODS: Total 277 foreign patients had undergone skin biopsies among patients visiting through international health services, Samsung medical center during 7-year period between January, 1996 and December, 2002. Their clinical data and histopathologic findings were reviewed. RESULTS: The number of skin biopsies taken from foreign patients was 429(4.6%) among total 8779 skin biopsies during 7 years. It showed a tendency to increase with time. The mean age of patients was 42.3 years and the ratio of men to women was about 2: 1. Distribution of nationality showed most of the patients came from North America(47.7%) and Europe (22.0%). Patients from USA were most common(41.5%). The distributions of dermatoses were common melanocytic nevi(24.2%), seborrheic keratoses (11.4%), actinic keratoses(8.4%), dysplastic nevi(6.8%), and epidermal or pilar cysts(5.1%). Total 266 cases(62%) were the dermatoses which could be clinically manifested as pigmented lesions. The numbers of cutaneous premalignant lesions and malignant tumors were 20(4.7%) and 68(15.9%), respectively. CONCLUSION: This study showed epidemiologic and histopathologic characteristics of the skin diseases of foreign patients staying in Korea. In comparison with Korean patients, it seems that foreign patients concern themselves much more about skin cancers and want their pigmented skin lesions to be examined. Dermatologists should consider performing skin biopsies in foreign patients who presented pigmented skin lesions.

A Study on the Comparison of Disease Status between Foreign Patients and Korean Patients / 한국역학회지

The objective of this study is to identify any differences in disease status between foreign patients staying in Korea and Korean patients. The study results are : First, more foreign stayers than Korean in their 20's and 30's seek medical services but those after age of 60 show the opposite pattern. This difference seems to feflect cultural difference in the concept of medical services and health seeking behavior. Second, foreign pateints were much more frequently(almost threee times) diagnosed as having an acute disease, and the fact that the most common diseases were "diseases of the respiratory system" can suggest the seriousness of air pollution problem in Korea. And, the fact that foreign stayers, especially those from developed countries, tend to take more periodic general physical examina-tion indicated that their health maintenance efforts place emphasis on prevention. Foreign patients seek more medical services during the spring and summer time when compared to Korean patients, and Korean patients visited the clinic more frequently during the autum time. Also, the review of the number of outpatients seeking medical services and the average duration of outpatient follow-up mainten-ance after discharge suggest that foreigners suffer less severe diseases than Koreans do. Finally, in contrast to the usual practice of Koreans of coming to the center without prior calling for reservation, most foreign patients tend to make reservations before coming(usually a day before) in general. This is also reflective of cultural difference related to the way of utilizing medical services.