Medical tourism is a relatively recent global economic and political phenomenon which has assumed increasing importance for developing countries, particularly in Asia. It has been slower to develop within the context of the tourism industry in English-speaking Caribbean countries but there is evidence that the tourism policy makers in the region perceive medical tourism as a potentially lucrative niche market. However, while the potential of medical tourism has seemingly been embraced by the region's political directorate, there has been limited discussion of the extent to which this market niche can realistically provide competitive advantage for the region. The argument of this conceptual paper is that the English-speaking Caribbean cannot hope to compete successfully in the global medical tourism market with many developing world destinations in Asia, or even with other Caribbean countries such as Cuba, on factors such as low cost, staff expertise, medical technological capability, investment in healthcare facilities or even in terms of the natural resources of sun, sea and sand. Rather, in order to achieve competitive advantage the countries of the region should, on the one hand, identify and develop their unique resources and competences as they relate to medical tourism, while, on the other hand, they should exploit the demand of the postmodern tourist for authentic experiences. Both these supply and demand side issues, it is argued, can be addressed through the development of a medical tourism product that utilises the region's indigenous herbal remedies. [PUBLICATION ABSTRACT]; Medical tourism is a relatively recent global economic and political phenomenon which has assumed increasing importance for developing countries, particularly in Asia. It has been slower to develop within the context of the tourism industry in English-speaking Caribbean countries but there is evidence that the tourism policy makers in the region perceive medical tourism as a potentially lucrative niche market. However, while the potential of medical tourism has seemingly been embraced by the region's political directorate, there has been limited discussion of the extent to which this market niche can realistically provide competitive advantage for the region. The argument of this conceptual paper is that the English-speaking Caribbean cannot hope to compete successfully in the global medical tourism market with many developing world destinations in Asia, or even with other Caribbean countries such as Cuba, on factors such as low cost, staff expertise, medical technological capability, investment in healthcare facilities or even in terms of the natural resources of sun, sea and sand. Rather, in order to achieve competitive advantage the countries of the region should, on the one hand, identify and develop their unique resources and competences as they relate to medical tourism, while, on the other hand, they should exploit the demand of the postmodern tourist for authentic experiences. Both these supply and demand side issues, it is argued, can be addressed through the development of a medical tourism product that utilises the region's indigenous herbal remedies. Reprinted by permission of Carfax Publishing, Taylor & Francis Ltd.

This study aimed to understand subjective cognitive decline (SCD) and functional difficulties in older age cohorts with depressive symptoms, using one scoping review and two empirical studies. We implemented the six steps of Arksey and O'Malley's procedure for the scoping review. We used the population, concept, and context (PCC) inclusion and exclusion criteria in the literature search across MEDLINE via Ebscohost, PubMed, and PsycINFO for articles published on ADL/IADL indicators of SCD in older adults with depressive symptoms and that published in English language journals from January 2011 to November 2021. The two empirical studies used the 2019 wave of the Behavioral Risk Factor Surveillance Survey dataset of older adults aged 65 and ≥ 80 from the Centers for Disease Control and Prevention. We used multiple regression and the bias-corrected percentile bootstrap with 5000 samples using standard path-analytic approaches for the moderated mediation for the two empirical studies. Findings supported that instrumental activities of daily living (IADLs) presented more difficulties for older adults with SCD than the basic activities of daily living (B-ADLs), given that IADLs require more cognitive capabilities than B-ADLs. Environmental factors like healthcare access and subjective functional difficulties predicted SCD by mentally unhealthy day (MUD) mediation and age cohort moderation. The middle age cohort (70–74) had the most pronounced effects of the MUDs mediation in the relationship between healthcare access and IADLs in older adults with SCD. The younger-old (65–69) showed more substantial MUD mediation effects in the relationship between subjective functional difficulties and SCD. Worse SCD was associated with being Asians, female older adults, and at lower education years and income levels. Findings profiled SCD indicators in daily living activities across age cohorts and the mentally unhealthy days presentation. We extend the chronic stress theory predictions on accentuated emotional vulnerability from increased functional difficulties, compounding SCD.

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During the last several decades, many people, fleeing from disasters or political threats, have applied for asylum in the European countries. Council Directive 2003/9/EC, laying down minimum standards for the reception of asylum-seekers, as well as several other directives, have been developed in the EU in order to ensure fair treatment of the asylum-seekers in all the European countries. However, there are huge differences in the national asylum laws of countries and consequently, the way they treat the asylum-seekers. In this research, the national asylum laws of Germany and the Netherlands are studied and compared, showing that though following the Council Directive, fair or equal treatment of asylum-seekers cannot be guaranteed. In the Netherlands asylum-seekers are granted with a great extent of benefits while in Germany, they are greatly discriminated against. Based on the Social Determinants of Health Model, developed by Dahlgren and Whitehead in 1991, the hypothesis is that the asylum seekers in the Netherlands enjoy better health status than the ones in Germany, because based on the Dutch asylum laws, they have better living and working conditions. In order to confirm or negate this hypothesis, a meta-study of available literature on the health status of asylum-seekers has been done. However, the hypothesis could not be confirmed/ negated due to extreme lack of availability of data in this area. By discussing the relationship between life conditions and health of individuals, reviewing current legal instruments regulating asylum in the EU and analyzing the available data on the health status of asylum-seekers, this paper draws the attention to the importance of data and research on these topics and the need for development of practices for collection of such information. Availability of such information can affect future decision and policy makings regarding asylum-seekers and their health and might result in comprehensive reformations in the current national or international legal instruments.

Made available in DSpace on 2016-04-29T14:16:46Z (GMT). No. of bitstreams: 1 Nathalie Jacinta Rodrigues de Oliveira Py.pdf: 1071074 bytes, checksum: 13862fca79bbb6cfa67df01abeb5b819 (MD5) Previous issue date: 2015-12-02 / Goals: The goal of the study is an analyze of the implantation of health care public polities for mammography access in the Oiapoque river frontier between France and Brazil where there is several social inequalities in health care. Justifications: The interest to this subject has two influences: The work realized at the coordination of the Regional Cancer Network of French Guiana in collaboration with health care professionals, a social worker and a psychologist in the support to patients and their dose relatives. The knowledge of the frontier zone with the richness of the population and the challenges they take up in the everyday life by living far away from the main cities. Hypotheses: Two questions will be analyzed to answer the main problematic: Are the social determinants on health care for the frontier population regarded for the implantation of polities for breast cancer detection access? Which are the strategies of the public powers, institutional actors and the professionals to facilitate the access to mammography for the frontier population? Teorico-metodological aspects: The analyze of the social inequalities on health care influence will be based on the economist Amartya Sen theory on the link between social inequalities and individual freedom. A documental research and interviews of professionals working on the frontier had been realized to understand the specific context of the region, the brazilian and french health care system, the organization of the breast cancer detection for the frontier population. Results: We can conclude that the territorial inequalities has most impact on the access of mammographyfor the women living on frontier. The inequalities needs a coordination of the public action to realized the structural modifications, and also local actions promoting more interaction between professionals and population / Objetivos: Este trabalho tem como objetivo analisar a implementação das políticas publicas de saúde para o acesso à mamografia na região da fronteira fluvial do rio Oiapoque entre a França e o Brasil que apresenta varias situações de desigualdades sociais de saúde. Justificativa: O interesse por essa problemática teve duas influências: O trabalho realizado na coordenação da Rede regional do câncer da Guiana Francesa, em colaboração com os profissionais de saúde, uma assistente social e uma psicóloga no atendimento aos pacientes e familiares. O conhecimento de uma região de fronteira rica pela diversidade de sua população e dos desafios que enfrentam no seu quotidiano pelo distanciamento com as cidades principais. Duas questões foram contempladas para responder à problemática principal: Os determinantes sociais de saúde da população da região fronteiriça estão sendo contemplados na implementação das políticas de acesso à detecção do câncer de mama? Quais são as estratégias propostas pelos poderes públicos, os atores institucionais, os profissionais para facilitar o acesso à mamografia para a população da fronteira? Aspectos teórico-metodológicos: A análise da influência das desigualdades sociais de saúde no acesso a mamografia foi realizada com base na teoria do economista Amartya Sen sobre a relação entre as desigualdades sociais e a liberdade dos indivíduos. Uma pesquisa documental e entrevistas com profissionais da fronteira foram realizadas para entender o contexto específico da região, os sistemas de saúde brasileiros e francês e a organização da detecção do câncer de mama para a população fronteiriça. Resultados obtidos: Pudemos concluir que as desigualdades territoriais são maior impacto na falta de participação ao exame de as que tem detecção do câncer de mama das mulheres de vivem na fronteira. Essas desigualdades requerem uma ação pública coordenada para realizar mudanças estruturais "e de organização dos serviços públicos, mais também ações localizadas, promovendo maior interação entre os profissionais e a população

Black women in the United States have a high prevalence of hypertension and suffer the most complications of cardiovascular disease. Black women, though aware of the dangers associated with hypertension, have limited opportunity to access health care and or change their lifestyles. The purpose of this quantitative cross-sectional study was to test if there was a significant difference in hypertension awareness, health care access/use, and lifestyle modifications in Black women prior to and post implementation of The Patient Protection and Affordable Care Act, as compared to women of other races. The behavior modification theory guided this study. Secondary data from the National Health Interview Survey for the years 2009 to 2013 for women ages 20 - 65 were analyzed using logistic regression analysis. According to the study results, there was no association (p values > 0.05) among variables age, education, income, length of employment, and hypertension awareness, health care access/use, and life style modification among Black women in the United States, as compared to women of other races. The findings from this study may allow researchers and policy makers to develop more culturally significant health services for Black women. These findings could create positive social change by targeting programs that promote hypertension awareness leading to effective lifestyle changes in Black women.

There is a growing population worldwide who are not able to receive dental care. The numbers and trend are increasing and the availability of providers and resources are dwindling in comparison. The dissertation starts off with an example of how the current dental healthcare system has allowed some tragic outcomes. This paper will discuss the barriers of obtaining dental care for this growing population, challenges in dental education and offer some future solutions. Using the example of a dental tragedy, we hope to be inspired as a call to action to avert further fatalities and improve the dental healthcare system. The paper reviews the issue from: 1. A Long term perspective with the current and projected statistics for special needs population nationwide and California. 2. An Expanding population perspective that focuses on patients with autism spectrum disorder. 3. A Complex needs perspective of an example of the increasing necessity of hospital dentistry care.

The need for health in general and oral health in particular is a basic and fundamental element for a quality life. Not everyone in America has access to basic oral health services. California, in particular, has greater challenges than other areas of the country in providing basic oral health services to everyone. This paper will discuss the problems of accessing oral health care, the importance of achieving oral health care, the necessity of maintaining oral health, the factors influencing oral health care access, and the response of the dental profession to the problems of access to oral health care. These problems will be examined from the following three perspectives: (1) Statewide Perspective, (2) Locality Perspective, (3) Individual Perspective. Potential solutions for vulnerable populations in accessing oral health care will be developed using data from quantitative and qualitative methodologies.