Medical tourism: A conceptual framework for an innovation in global healthcare provision

© 2015, IGI Global. The purpose of this chapter is to establish a conceptual model that can potentially fill research gaps in the literature about medical tourism as an innovative concept in global healthcare provision by developing emerging economies as they are providing low cost alternatives in medical treatment at internationally accredited medical facilities to treat patients from developed countries. Major databases such as Ebscohost and Emerald have been used to search relevant literature. The literature on medical tourism is reviewed so as to understand the key drivers of medical tourism as well as research gaps in the existing literature. Three major drivers of medical tourism have been identified, namely cost, waiting time, and perceived quality. Further empirical research is needed to test the conceptual model in order to better understand what drives a decision to engage in medical tourism. This chapter makes three major contributions; firstly, the identification of the medical tourism literature from the service marketing and management perspectives; secondly, to propose a conceptual model representing innovation in medical tourism for global healthcare by developing emerging economies; thirdly, the identification of research gaps in the medical tourism literature through which future research can further the knowledge of why people travel to developing countries for medical treatment.

A discrete choice experiment to examine the preferences of patients with cancer and their willingness to pay for different types of health care appointments

BACKGROUND: This study sought to understand the preferences of patients with cancer and the trade-offs between appointment attributes using discrete choice experiment (DCE). METHODS AND STUDY DESIGN: Patients with cancer at 3 hospitals completed a self-administered DCE. Each scenario described 6 attributes: expertise of health care professionals (HCPs), familiarity of doctors with patients' medical history, waiting time, accompaniment by family/friends, travel time, and out-of-pocket costs. Patient preferences were estimated using logistic regression. Willingness to pay (WTP) estimates were derived from regression coefficients. RESULTS: Of 512 patients contacted, 185 returned the questionnaire. The mean age was 61 years, and 60% of respondents were female. The mean time since cancer diagnosis was 34 months, 90% had received treatment; and 61% had early-stage disease. The most important attributes were expertise and familiarity of doctors with patients' medical history; distance traveled was least likely to influence patient preferences. The WTP analysis estimated that patients were willing to pay $680 (95% CI, 470-891) for an appointment with a specialist, $571 (95% CI, 388-754) for doctors familiar with their history, $422 (95% CI, 262-582) for shorter waiting times, $399 (95% CI, 249-549) to be accompanied by family/friends, and $301 (95% CI, 162-441) for shorter traveling times. Male patients had a stronger preference for accompaniment by family/friends. The expertise of HCP was the most important attribute for patients regardless of geographic remoteness. CONCLUSIONS: Our study can assist the development of patient-centered health care models that improve patient access to experienced HCPs, support the role of primary care providers during the cancer journey, and educate patients about the roles of non-oncology HCPs to cope with increasing demand for cancer care.

Audiência única e a duração razoável do processo nos juizados especiais cíveis

Esta dissertação pretende demonstrar que os Juizados Especiais Cíveis Estaduais, regulados pela Lei n° 9.099/95, orientados pelos princípios da oralidade, simplicidade, informalidade, economia processual e celeridade, que foram criados em decorrência da necessidade de viabilizar um maior acesso à justiça, principalmente da população mais carente, com redução de custos e simplificação de procedimentos que possibilitassem os julgamentos dentro de um prazo razoável, na realidade da práxis forense, estão sendo desvirtuado dos seus objetivos. Neste sentido, o estudo apresenta números comprovando que os Juizados Especiais cumpriram seu desiderato de proporcionar o acesso ao judiciário, mas que passaram a padecer do mesmo problema da justiça comum: a morosidade na entrega da prestação jurisdicional. Além da incompatibilidade de estrutura com a atual demanda que obviamente vai ensejar lentidão nos Juizados, o estudo apresenta como motivo para esse quadro a conduta dos juizes, responsáveis pela administração do processo, que reproduzem nos Juizados o fomlalismo e a burocracia inerente ao processo civil comum, ao instituir, em evidente descompasso com a lei e seus princípios, um procedimento com duas audiências, sendo uma para conciliação e outra, nos casos em que não é obtido acordo, para instrução e julgamento, em dias distintos, aumentando o tempo de duração dos processos. O estudo conclui que a utilização de audiência única, além de ser uma detenninação legal e estar em sintonia com seus princípios, proporciona celeridade nos julgamentos. diminuindo o custo e o tempo de espera dos litigantes, obstáculos do acesso à justiça que a Lei n° 9.099/95 procurou remover.

Análise da efetividade do transplante renal na qualidade de vida dos receptores no estado do Rio Grande do Norte

This study was developed with the aim of analyzing the effectiveness of renal transplantation on quality of life of kidney recipients in the Rio Grande do Norte State. This is a descriptive study with longitudinal design, panel type with quantitative approach to data analysis. The Quality of Life (QoL) of chronic disease kidney patients before and after kidney transplantation was assessed by the WHOQOL-bref, The population consisted of patients in pre and post-renal transplantation, the sample had 63 patients older than 18 years. The study was conducted after approval by the Research Ethics Committee of the Onofre Lopes University Hospital, Federal University of Rio Grande do Norte, No. CAAE 0008.0.294.000-10. Data collection was performed at a referral center for renal transplantation in Rio Grande do Norte, from May 2010 to May 2013. Data were analyzed using descriptive statistics and presented in tables and graphs. For statistical analyzes, Microsoft Excel XP and SPSS 15.0 software were used. The tests used were simple variance (ANOVA), t-test, Mann-Whitney and Wilcoxon test to compare means, and Spearman correlations. P values <0.05 were considered significant. The demographic data showed a predominance of people between 18 and 45 years (68.2%) with a mean age of 39.9 years (SD 12.2), male (63.5%), married (58.7%), with children (51.0%). Regarding the education level was observed that 49.2% of participants had completed primary school, and most did not engage in any work activity (90.4%) during the study period. Hemodialysis was the predominant renal replacement therapy (96.8%) and the average waiting time for execution of transplantation was 1.9 years (SD 1.9). Comparison of QoL before and after transplantation showed significant differences in all areas analyzed, demonstrating that kidney transplantation had a positive impact on QoL in chronic renal patients undergoing kidney transplantation. Sociodemographic factors did not influence the quality of life in this group of patients, indicating that transplantation was the main factor to explain the improvement in quality of life. Thus, the alternative hypothesis of the study was accept, that there is a significant difference in quality of life before and after kidney transplant. It is expected that the results of this study may contribute to the development of strategies to encourage organ donation and kidney transplantation process

Satisfação do paciente com a fisioterapia :tradução, adequação cultura e validação de um instrumento de medida

The measurement of patient satisfaction can provide information about the success of the care provider in reaching the values and meeting the expectations of the patient. The purpose of this study was to translate into the Portuguese language and to culturally customize to the Brazilian population the instrument to measure patient satisfaction with physical therapy elaborated by Goldstein et al. The study sample was made up of 279 patients who were undergoing physical therapy treatment at 39 different private clinics in a middle-sized town in northeastern Brazil. For the translation of the survey instrument, the back-translation technique was employed, in association with the bilingual method. The reliability and validity of the Brazilian version of the instrument were both assessed. Reliability analysis, carried out with the computation of Cronbach alpha coefficients, showed that the measures obtained with the instrument have a high degree of internal consistency. The aspects dealing with the patient therapist relationship are the most important predictors of satisfaction, followed by those dealing with courtesy, privacy, and practical aspects such as efficiency of the facility in the patient admissions process, setting up of appointments, and waiting time in waiting room. Items dealing with aspects such as location of the facility and availability of parking facilities may underestimate the reliability of the instrument. This study translated, culturally customized, and validated an instrument to measure patient satisfaction with physical therapy originally developed in English. By so doing, this study has made this instrument available to the Brazilian society, and it has rendered it a useful parameter that can be utilized in our country in the field of physical therapy

Acompanhando o crescimento e o desenvolvimento da criança : uma intervenção integrada entre enfermagem e família

The accompanying the growth and development of the child is the guiding line of basic health measures directed at this public, acting within the scope of health monitoring and inferring positively in the rate of infant morbidity and mortality, which are still a preoccupation worldwide and in Brazil. However, mostly, this practice is based on the biomedical model of care, individualized, with emphasis on the medicalization and complaints, favoring the passivity of users. Given this issue, aim to develop accompanying the growth and development of the child in a Basic Unit Family Health, through a collective approach of medical care next to a health team, especially nurses and caregivers. This is a qualitative study, with the research-action method. Involved the four nurses and twenty-six of children's caregivers of the area of Basic Unit Family Health of Cidade Nova, in Natal, in the period from February to July 2010. The results were analyzed following the direction of the thematic analysis of Freire. In the situation analysis of the current reality of the accompanying the growth and development the children in the Basic Unit Family Health, through participant observation and applying a questionnaire to the nurses, we realize that despite these professionals have a knowledge tied to the paradigm of health promotion, in practice the monitoring of child is done through individual consultations in outpatient room, based on complaints brought by caregivers, with little solvability in actions employed. Given the need for change in medical care model, we decided jointly, in the focal group, for the collective monitoring of children's the growth and development, featuring then this proposal to the multidisciplinary team, discussing the participation of professional categories and planned collectively the actions. In the implementation stage of collective action, we contemplate the execution by the caregivers of anamnesis and physical examination, recording data in the Child Health Handbook and discussion of clinical findings, under the supervision of nurses and facilitators. In the evaluation, we found that this collective accompanying strategy allowed to caregivers learn new knowledge, exchange experiences, assistance in home care, beyond reduce the waiting time for medical care and creating opportunity of more time for debate about the children‟s health situation, differing of ambulatory care. As difficulties, we face with a high rate of defaulters (53.8%), lack of motivation and passivity of the users, little participation of other health professionals and nurses' involvement in other activities, technical and bureaucratic in the moment of care. Thus, we note also a strong rooting of individual clinical model on the way of thinking and acting of nurses and caregivers

Enhanced stabilization of aerosol-OT surfactant monolayer upon interaction with small amounts of bovine serum albumin at the air-water interface

An investigation is made of the influence from small amounts of the protein bovine serum albumin (BSA) on the lateral organization of low molecular weight surfactant sodium bis-2-ethylhexyl sulfosuccinate (AOT) at the air-water interface. Surface pressure (pi - A), surface potential (DeltaV - A) and Brewster angle microscopy (BAM) experiments were carried out, with particular emphasis on the monolayer stability under successive compression-expansion cycles. AOT monolayer is not stable at the air-water interface, which means that the majority of AOT molecules go into the aqueous subphase as monomers and/or normal micelles. When a waiting time elapses between spreading and compression, the surfactant monolayer tends to reorganize partially at the air-water interface, with a monolayer expansion being observed for waiting times as large as 12 h. The incorporation of very small amount of BSA (10(-9) M) at the interface, also inferred from BAM, increases the monolayer stability as revealed by pi - A and DeltaV - A results. For a waiting time of circa 3 h, the mixed monolayer reaches its maximum stability. This must be related to protein (and/or protein-surfactant complexes) adsorbed onto the AOT monolayer, thus altering the BSA conformation to accommodate its hydrophobic/hydrophilic residues. Furthermore, the effects from such small amounts of BSA in the monolayer formation and stabilization mean that the AOT monolayer responds cooperatively to BSA. (C) 2004 Elsevier B.V. All rights reserved.

Processos difusivos generalizados

We investigate several diffusion equations which extend the usual one by considering the presence of nonlinear terms or a memory effect on the diffusive term. We also considered a spatial time dependent diffusion coefficient. For these equations we have obtained a new classes of solutions and studied the connection of them with the anomalous diffusion process. We start by considering a nonlinear diffusion equation with a spatial time dependent diffusion coefficient. The solutions obtained for this case generalize the usual one and can be expressed in terms of the q-exponential and q-logarithm functions present in the generalized thermostatistics context (Tsallis formalism). After, a nonlinear external force is considered. For this case the solutions can be also expressed in terms of the q-exponential and q-logarithm functions. However, by a suitable choice of the nonlinear external force, we may have an exponential behavior, suggesting a connection with standard thermostatistics. This fact reveals that these solutions may present an anomalous relaxation process and then, reach an equilibrium state of the kind Boltzmann- Gibbs. Next, we investigate a nonmarkovian linear diffusion equation that presents a kernel leading to the anomalous diffusive process. Particularly, our first choice leads to both a the usual behavior and anomalous behavior obtained through a fractionalderivative equation. The results obtained, within this context, correspond to a change in the waiting-time distribution for jumps in the formalism of random walks. These modifications had direct influence in the solutions, that turned out to be expressed in terms of the Mittag-Leffler or H of Fox functions. In this way, the second moment associated to these distributions led to an anomalous spread of the distribution, in contrast to the usual situation where one finds a linear increase with time

Identificação de indivíduos vulneráveis no entorno de um hospital universitário: conectando vulnerabilidade, solidariedade e saúde

No entorno de um hospital universitário do interior do estado de São Paulo há pessoas dormindo, se alimentando ou descansando nos gramados e arredores, permanecendo nestes locais durante horas. Este estudo objetivou identificar e caracterizar indivíduos vulneráveis em área externa deste hospital, oferecendo ajuda. A coleta dos dados foi realizada no período de novembro de 2007 a outubro de 2008, semanalmente, em dias e horários sorteados. Identificaram-se pessoas que permaneciam nesses locais, sendo entrevistados 52 sujeitos. Esses indivíduos são, predominantemente, do sexo feminino (67,3%), brancos (51,9%), casados (59,6%), com escolaridade de até quatro anos de estudo (44,2%) e sem profissão definida (84,6%). A maioria aguardava o horário do ônibus da prefeitura de seu município de origem; o tempo médio de espera foi de aproximadamente 90 minutos e grande parte dos sujeitos apresentou necessidades durante os períodos de espera. Foi oferecida ajuda a 15 pessoas que referiram necessidades no momento da entrevista. Concluiu-se que esses indivíduos se encontram em situação de vulnerabilidade individual, social e programática, destacando-se a vulnerabilidade sócio-econômica, apresentam capacidade de autodeterminação reduzida, submetendo-se a condições desfavoráveis por dependerem dos serviços públicos.

Método titrimétrico para determinar fosfito em amostras agroindustriais

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Oriented growth of Bi3.25La0.75Ti3O12 thin films on RuO2/SiO2/Si substrates by using the polymeric precursor method: Structural, microstructural and electrical properties

c-axis oriented Bi3.25La0.75Ti3O12 (BLT) thin films were grown on a RuO2 top electrode deposited on a (100) SiO2/Si substrate by the polymeric precursor method. X-ray diffraction and atomic force microscope investigations indicate that the films exhibit a dense, well crystallized microstructure having random orientations with a rather smooth surface morphology. The electrical properties of preferred oriented Bi3.25La0.75Ti3O12 (BLT) thin films deposited on RuO2 bottom electrode leaded to a large remnant polarization (P-r ) of 17.2 mu C/cm(2) and (V-c ) of 1.8 V, fatigue free characteristics up to 10(10) switching cycles and a current density of 2.2 mu A/cm(2) at 5 V. We found that the polarization loss is insignificant with nine write/read voltages at a waiting time of 10,000 s. Independently of the applied electric field the retained switchable polarization approached a nearly steady-state value after a retention time of 10 s.

Retention characteristics in Bi3.25La0.75Ti3O12 thin films prepared by the polymeric precursor method

Ferroelectric Bi3.25La0.75Ti3O12 (BLT) thin films were deposited on Pt/Ti/SiO2/Si substrates by the polymeric precursor method. The films present c-axis preferred orientation after annealing at 700 degrees C for 2 h in conventional furnace. All the capacitors showed good polarization fatigue characteristics at least up to 1x10(10) bipolar pulse cycles and excellent retention properties up to 1x10(4) s. We found that the polarization loss is insignificant with five write/read voltages at a waiting time of 10 000 S. Independently of the applied electric field the retained switchable polarization approached a nearly steady-state value after a retention time of 10 s. (C) 2005 American Institute of Physics.

Experimental study of a methodology for Fission-track Dating without neutron irradiation

To carry out the dating by the Fission Track Method (FTM) the international community that works with this method employs methodologies in which the mineral to be dated must be irradiated with neutrons. Such irradiation, performed in a nuclear reactor, demand a relatively long waiting time so that the activity of the sample attain a proper level for handling. The present work aims to establish a methodology that makes possible the dating by FTM using a mass spectrometer instead of a nuclear reactor. This methodology was applied to apatite samples from Durango, Mexico. © 2009 Elsevier Ltd. All rights reserved.

Análise da penetração de material resinoso ao esmalte dental em função de agente clareador e tempo

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Trade facilitation and Central American integration: Customs modernization

The development of trade facilitation and regional integration is closely linked to the efficiency of public services and the competitiveness of the companies that support export activity. The importance of trade facilitation measures has been emphasized in various issues of the FAL Bulletin. On this occasion the subject is be discussed from the point of view of regional integration, and a case in Central America is considered of particular interest. El Salvador and Guatemala, by integrating their electronic systems for obtaining export licenses, have been able to reduce waiting times significantly. In Guatemala, in December 2000, there was a waiting time of 24 hours, whereas in November 2004 the procedure took 1.5 minutes via the Internet. This issue of the Bulletin is based on research into electronic government initiatives related to foreign trade, which is being conducted by the International Trade and Integration Division.