Patient and clinician experiences with cross-border reproductive care: A systematic review

ObjectivesThis review analyzes the experiences of patients and clinicians with regards to international cross-border reproductive care (CBRC) for the purpose of conception.MethodsElectronic databases PubMed, Embase, Web of Science, and Scopus were searched using ‘medical tourism’ AND ‘assisted reproductive technology’ from 1978 to 2020.ResultsPredominant patient motivators for CBRC were cost and legality of assisted reproduction technology (ART) in one's home country, followed by cultural factors like shared language, religion, and cultural familiarity. Clinicians suggested global laws for CBRC would reduce the potential for exploitation of vulnerable populations but believed the enactment of international regulations unlikely and, even if enacted, difficult to enforce.ConclusionsWhile patient and clinician experiences with CBRC varied, patients frequently cited financial and legal reasons for pursuing CBRC, while many providers had concern for the patient’s safety.Clinical practice implicationsThis review recommends clinicians involved in family planning counsel patients seeking treatment abroad by: (i) informing patients of the risks and benefits of treatment abroad, (ii) establishing guidelines and standards for clinicians on resuming patient care post-CBRC, and (iii) creating a directory of reputable CBRC clinicians and experts.     

中医药健康旅游等级划分与评定标准研究思路

本文阐述了中医药健康旅游等级划分与评定标准的研究思路,该标准将中医药健康旅游划分为3个等级,分别为中医健康旅游示范区、中医药健康旅游示范基地、中医药健康旅游示范项目。对中医药健康旅游示范区的评定从基础条件、资源与环境、基础设施与公共服务体系、安全与保障措施等5个方面展开;对中医药健康旅游示范基地的评定从基础条件、资源与环境、基础设施与公共服务体系、中医药健康旅游产品体系安全与保障措施等五个方面展开;对中医药健康旅游示范项目的评定从基础条件、自然与环境、基础设施与公共服务体系、中医药健康旅游特色项目分类、实施方案、安全保障、预期成果等7个方面展开。     

Surge of Dengue Virus Infection and Chikungunya Fever in Bali in 2010: The Burden of Mosquito-Borne Infectious Diseases in a Tourist Destination

Labor flow and travelers are important factors contributing to the spread of Dengue virus infection and chikungunya fever. Bali Province of Indonesia, a popular resort and tourist destination, has these factors and suffers from mosquito-borne infectious diseases. Using area study approach, a series of fieldwork was conducted in Bali to obtain up-to-date primary disease data, to learn more about public health measures, and to interview health officers, hotel personnel, and other resource persons. The national data including information on two other provinces were obtained for comparison. The health ministry reported 5,810 and 11,697 cases of dengue hemorrhagic fever in Bali in 2009 and 2010, respectively. Moreover, two densely populated tourist areas and one district have shown a particularly high incidence and sharp increases in 2010. Cases of chikungunya fever reported in Bali more than doubled in 2010 from the previous year. Our findings suggest that Bali can benefit from a significant reduction in vector populations and dissemination of disease preventive knowledge among both local residents and foreign visitors. This will require a concerted and trans-border approach, which may prove difficult in the province.     

‘The bloke can be a bit hazy about what’s going on’: men and cross-border reproductive treatment

While social science research has begun to demonstrate the significant impact of infertility and involuntary childlessness for men, far fewer studies have specifically explored the male experience of, or men’s involvement in, infertility treatment-seeking and there are few published studies which specifically describe men’s experiences with cross-border reproduction. This paper presents data from the first UK study of transnational treatment-seeking and specifically explores men’s involvement in this process. Data from interviews with 10 men and 34 women who were seeking treatment abroad are organized according to three themes: ‘going along with it’; ‘being a rock’; and ‘doing their bit’. The paper argues that gender is an important aspect of the cross-border treatment experience and that both traditional and emergent gender identities are expressed in the process of treatment-seeking. Healthcare providers need to actively explore men’s perspectives of the treatment process in all locations, to improve quality of care by reducing men’s feelings of marginalization and enhancing their experience of treatment, especially but not exclusively, around the issue of semen collection.There has been little research which has tried to understand more about men’s experiences and involvement in seeking medical help for infertility. There are no published studies which explore the experience of travelling abroad for infertility treatment from the male perspective. In this paper, we present findings from the first UK study of cross-border treatment-seeking and specifically explore men’s involvement in this process. We present findings from interviews with 10 men and 34 women who were seeking treatment in countries outside the UK. These findings are organised according to three themes drawn from the interviews with the men and women: ‘going along with it’; ‘being a rock’; and ‘doing their bit’. This research shows that, as is often the case with treatment-seeking in their home country, men are less likely to get involved in the planning and organization of treatment, but take responsibility for supporting their female partner. Men found some aspects of the treatment process, especially giving a semen sample, particularly difficult. Infertility practitioners in the UK and in other countries need to take account of gender differences and include a consideration of men’s experiences in a more sensitive and proactive way.     

以馆藏资源助力地域文化符号搭建文旅融合底蕴平台

地域文化符号是地方历史文化发展的载体,也是地域文明的象征。图书馆作为地域信息及文献资源的收藏地,在地域文化发展中起着至关重要的作用,在当前经济社会发展的背景下,也是文旅融合发展的重要组成部分。本文以图书馆助力地域文化符号搭建文旅融合底蕴平台为出发点,通过分析找准地域文化符号的意义和方法,探究图书馆在充分利用馆藏资源的基础上,找准文旅融合的契合点,厚积地域文化底蕴的方式和路径,通过进一步融合现代发展元素,打造文化旅游特色品牌项目,使文旅产业成为带动地域经济发展的"动力产业"。     

An analysis of the cost and impact of cosmetic tourism and its associated complications: A multi institutional study

Background and purposeThe increasing cost of cosmetic procedures, long elective waiting times in the public system and affordability of procedures offered abroad has driven the rapid growth of cosmetic tourism. The incidence and cost of patients presenting to the Irish health service with complications related to cosmetic procedures carried out in overseas institutions is largely unknown. This heterogenous group of patients is challenging to identify. Limited data exists for this patient group in the Irish context.We aimed to perform a multicentre audit and cost analysis of patients presenting to Irish health services with complications related to cosmetic procedures performed in overseas institutions over a 2 year period.MethodsPatients presenting to two University Hospitals from March 2019–April 2021 with complications after a cosmetic surgical procedure was performed abroad were studied. The HPO ABF 2020 price list data was used to calculate the inpatient and procedure cost for each subject.Main findings14 (13/92.8% female, mean age 43 ± 11.85 years) patients presented during the study period. Countries of cosmetic operation included: Belgium (6/46.2%), the UK (2/15.4%), Latvia, Turkey, Poland, Lithuania, and Estonia (1 patient/7.7% each country). All required a re-operative procedure. These interventions included: removal of infected implant (n = 1), adjustment or removal of a gastric band (n = 9) and debridement of an infected/necrotic wound (n = 3). Mean length of stay was 9.14 ± 7.48 (range 2–28) days. Five (38.4%) patients required vac dressing. The mean cost of the cohort for the interventional procedure and in-patient stay was €15912.53 (+/? €6388). The sum total of all the costs for the cohort was €231038.60.ConclusionsSignificant costs were associated with prolonged hospital admissions, operative interventions, intravenous antibiotics, VAC dressing application and follow up visits. Complications from procedures performed in overseas institutions account for a significant cost burden to health services in Ireland.     

Human stem-cell research in gastroenterology: Experimental treatment,tourism and biobanking

The growing interest in the possibility of applying stem-cell therapies to gastroenterological diseases is outlined. Some promising results have been reported, but more research is needed in view of the uncertainties and knowledge gaps that still exist. The ethical issues raised by this kind of research are then indicated and classified. Three problematic kinds of situation are outlined: experimental treatments, stem-cell tourism and biobanking. A four-question approach – which is not to be confused with the well-known four-principle approach introduced by Beauchamp and Childress – is described and applied to these three challenging situations. In conclusion, it is pointed out that the analysis of these situations illustrates the interplay between definitions, empirical research and ethics. They are interrelated and need to be integrated.     

黑龙江医疗旅游产业市场细分及价值链整合研究

医疗旅游是近些年发展起来的新型旅游形式,医疗旅游是在经济高度发展的背景下产生的,是人们对健康需求的一种新的尝试,随着我国旅游产业链的升级,以健康为动机的医疗旅游业的发展将成为旅游产业发展的一个重要趋势,由于黑龙江省旅游资源丰富,适合医疗旅游的开发发展,因此对黑龙江医疗旅游价值链的定位整合,是十分重要的和有现实意义的。     

Characterizing surf zone injuries from the five most populated beaches on the Atlantic-fronting Delaware coast

Introduction

Beaches are a popular destination for recreation activities. Surf zone injuries (SZI) can occur resulting from a variety of in-water activities. Little is known regarding the sustained injury types, or demographics of injured persons and activities leading to injuries.

Are patient educational resources effective at deterring stroke survivors from considering experimental stem cell treatments? A randomized controlled trial

ObjectiveTo evaluate whether online resources developed to educate people about the risks associated with experimental stem cell (SC) treatments influence stroke survivors’ attitudes about the safety and effectiveness of these treatments.MethodsAdult stroke survivors who had not previously received SC treatments (N = 112) were recruited from international stroke advocacy/support groups for a prospective, parallel-group randomized controlled trial. Participants indicated whether they were considering SC treatments (yes/no) prior to, immediately following, and 30-days after reading/viewing the International Society for Stem Cell Research booklet or Stem Cell Network video. Participant attitudes regarding the safety, effectiveness, accessibility and affordability of SC treatments were examined on each occasion, and compared to those of a waitlist control group.ResultsSignificantly fewer participants were considering SC treatments immediately after reading the SC research booklet (p =.031), although neither intervention had any impact after 30-days (p >.05). Waitlist and intervention groups reported positive attitudes toward SC treatments at each assessment.ConclusionsStroke survivor attitudes toward SC treatments were initially influenced by the patient booklet, however these changes were not maintained.Practical ImplicationsClinicians are encouraged to initiate discussions about experimental SC treatments during inpatient rehabilitation and to reinforce the risks throughout subsequent care.