RESUMO
OBJECTIVE: Medical tourism is a practice that involves patients intentional travel to privately obtain medical services in another country. Our objective was to consult with diverse lawyers from across Barbados to explore their views on the prospective legal and regulatory implications of the countrys developing medical tourism industry. DESIGN AND METHODS: After recruiting participants through local legal societies and local networks, we held a focus group in February 2014 in Bridgetown with nine lawyers with diverse legal backgrounds. Focus group moderators summarized the study objective and engaged participants in identifying the local implications of medical tourism and the anticipated legal and regulatory concerns. The focus group discussion was transcribed verbatim and analyzed thematically. RESULTS: Five dominant legal and regulatory themes were identified: (1) liability; (2) immigration law; (3) physician licensing; (4) corporate ownership; and (5) reputational protection. Two predominant ethico-legal concerns raised by participants are also heavily reflected in the existing literature: the ability of medical tourists to recover medical malpractice from physicians practicing in Barbados for adverse events; and the effects of medical tourism on local citizens access to health care in the destination country. CONCLUSIONS: Overall this analysis reveals that lawyers in Barbados have an important role to play in the medical tourism sector beyond litigation particularly in transactional and gatekeeper capacities. It remains to be seen whether these findings are specific to Barbados or can be extrapolated to other medical tourism destination countries in the Anglophone Caribbean and beyond.
Assuntos
Viagem , Viagem/legislação & jurisprudência , Cuidados Médicos , BarbadosRESUMO
A pre-operative autologous blood donation programme was started in 1988 and made available to all doctors offering elective surgical procedures. Two hundred and seventy-seven (277) patients presented for autologous donation over a five-year period. Nine point four per cent were rejected because of low haemoglobin ( < 10.5 g/dl). The single biggest user of the programme was the Princess Elizabeth Hospital for handicapped persons. Patients undergoing orthopaedic procedures gave 50% of the donations, and ranged in age from 10 to 73 years. The oldest donor was a 73-year-old man who had an abdominal aortic aneurysm replaced. Gynaecological surgeons in the public and private sectors together provided 43.9% of donors, 3.6% of these underwent elective Caesarean Section, each donating one unit of blood at 36 weeks. Patients undergoing general surgical procedures comprised 10.4% of donors. Autologous donors contributed 1.3% of the total number of donations over this period.
Assuntos
Doadores de Sangue , Transfusão de Sangue Autóloga , Cuidados Pré-Operatórios , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Trinidad e TobagoRESUMO
PIP: This is a summary of 7 papers given at a South American Indian Conference. The papers varied by the training and interests of the authors, but the unifying characteristics were their attention to the quality of data, the concern with placing the Lowland South American Indian societies in historical time, and the focus on the individual in a social context. The trend for tribal societies to abandon traditional practices of birth limitation is worrisome at a time when the balance between population growth and economic resources has deteriorated. Survival risks are high. The traditional societies range over a region stretching from Guyana to Mato Grosso, and have varying degrees of economic and political autonomy. All have been exposed to Western influences. A four-generation account of Barama River Caribs family in Guyana illustrates how marriage choices that appear anomalous were responses to changing demographic pressures. The problems of the definition of a population were revealed in the paper on the Wanano of the Rio Vaupes in Northwest Amazon; the aim was to examine Boas' ideas about the links between language, race, and culture in a region of culturally mixed marriages. High-quality reproductive history data was collected and examined on the Xavante in Pimentel Barbosa in eastern Mato Grosso. The study of household and settlement composition, marriage, fertility, and mortality data among the Bakairi, located west of Shavante, in Mat Grosso, suggests that population increases were kept small due to fertility-inhibiting cultural practices. The combination of detailed examination of cultural practices and statistical analysis provided insights into the demographic behavior of the Canela in central Maranhao, who have had longstanding contact with the West and maintained traditional practices. The difficulties of collecting birth and death records between 1976-86 among the Nambiquara in western Maso Grosso were expressed, and the anomalies of female mortality explained. Statistical analysis of the Shipibo of the Ucayali River Basin in Peru demonstrated that growth was attributed to the abandonment of traditional practices.^ieng
Assuntos
Antropologia Cultural , Etnicidade , Estudos de Avaliação como Assunto , Fertilidade , Indígenas Sul-Americanos , Mudança Social , América , Antropologia , Cultura , Demografia , Países em Desenvolvimento , População , Características da População , Dinâmica Populacional , Ciências Sociais , América do SulRESUMO
PIP: The demographic adaptation of a family of Topside Caribs along the Barama River in Guyana was studied. The family history included two grandfather and granddaughter marriages. Jack Raymond's father, who was born in 1870, left Bottomside after the death of his wife in the 1920s and settled above the falls of the Barama River (Topside in Sawari) with the hope of subsistence living off the rain forest. Information on the grandfather generation was made difficult by name changes, general references to all men in the second generation as grandfathers, and the focus on father's and mother's generation. The typical pattern was for brothers to live close by, and intermarry with a family of sisters. Female children married mother's brothers' sons or father's sisters sons. Their children formed their own cluster settlements. The early history indicated economic hardship, loss of wives, and difficulties in remarrying. The Baird chronicles of the reintroduction of gold mining and the ethnography of Gillin indicated that malaria and round worm were diseases affecting the indigenous population during the 1920s and 1930s. The Topside population was supported by the local gold-mining economy, while the Bottomside population suffered economic hardship and high infant mortality. In the Jack Raymond family, remarriage resulted in children marrying cross cousins. The younger daughter married in the 1940s, when subsistence production of cassava and hunting and gold-mining income provided the family's livelihood. The daughter had 10 surviving children, compared to her adoptive mother's two. For the daughter's generation, the first pregnancy occurred between the ages of 18 and 22 years, and birth spacing was 20-30 months for 25 years. Neither polygyny nor monogamy affected the potential for 12 children. In this Baramita Air Strip population in 1971, there were 62 mothers; reproductive histories were available for 59. The changes in reproductive patterns after 1940 were apparent: for example, a mean of 9.1 surviving children for women aged 40-54 years compared to a mean of 4.3 for women aged 55 years and older. The grandfather-granddaughter marriages were recognized as not the ideal, but were important to survival and society building, and later as part of population stabilization.^ieng
Assuntos
Antropologia Cultural , Etnicidade , Características da Família , Indígenas Sul-Americanos , Casamento , Pesquisa , América , Antropologia , Cultura , Demografia , Países em Desenvolvimento , Guiana , População , Características da População , Ciências Sociais , América do SulRESUMO
Of 1089 healthy blood donors screened for HTLV-1 using ABBOTTS HTLV-1 EIA: 18 (1.7%) were positive; and 16 (1.5%) were confirmed positive using HTLV-1/11 Cambridge Biothec Western Blot method. HTLV-1 antibodies were found amongst the major ethnic groups, viz. Africans, 11 cases (68.75%) and East Indians 4 cases (25%). The mean age of the donors who tested positive for HTLV-1 was 30.75 years; and the male to female ratio was 4.3:1.
Assuntos
Doadores de Sangue , Anticorpos Anti-HTLV-I/sangue , Infecções por HTLV-I/epidemiologia , Adulto , África/etnologia , Fatores Etários , Western Blotting , Feminino , Infecções por HTLV-I/etnologia , Humanos , Técnicas Imunoenzimáticas , Índia/etnologia , Masculino , Prevalência , Estudos Prospectivos , Estudos Retrospectivos , Fatores Sexuais , Trinidad e Tobago/epidemiologiaRESUMO
Of 1089 healthy blood donors screened for HTLV-I using ABBOTTS HTLV-I EIA: 18 (1.7 percent) were positive; and 16 (1.5 percent) were confirmed positive using HTLV-I/11 Cambridge Biothec Western Blot method. HTLV-I antibodies were found amongst the major ethnic groups, viz. Africans, 11 cases (68.75 percent) and East Indians 4 cases (25 percent). The mean age of the donors who tested positive for HTLV-I was 30.75 years; and the male to female ratio was 4.3:1. (AU)
Assuntos
Humanos , Adulto , Masculino , Feminino , Doadores de Sangue , Anticorpos Anti-HTLV-I/sangue , Infecções por HTLV-I/epidemiologia , África/etnologia , Fatores Etários , Western Blotting , Infecções por HTLV-I/etnologia , Técnicas Imunoenzimáticas , Índia/etnologia , Prevalência , Estudos Prospectivos , Estudos Retrospectivos , Fatores Sexuais , Trinidad e Tobago/epidemiologiaRESUMO
We evaluated the immediate causes of death in 54 adults who underwent an autopsy and were diagnosed as having died of the acquired immunodeficiency syndrome between April 1980 and October 1983. The study group included 25 Haitians, 19 homosexual men, five intravenous drug abusers, two hemophiliacs (type A), and three with no known risk. Fourteen died of central nervous system diseases: 11 of Toxoplasma encephalitis, one of progressive multifocal leukoencephalopathy, one of viral encephalitis, and one of intracerebral hemorrhage. Thirty died of respiratory failure; 16 of Pneumocystis carinii pneumonia, ten of cytomegalovirus pneumonia, one of multiple infections, one of interstitial pneumonia, and two of bacterial pneumonia. Two died of overwhelming generalized infections: one of Mycobacterium avium-intracellulare and one of listeriosis. Six died of disseminated Kaposi's sarcoma, while the remaining two persons died of Toxoplasma myocarditis (one) and one of shock resulting from a percutaneous liver biopsy, respectively. There were differences in the immediate causes of death between Haitians and homosexuals as follows: 63% of homosexual men died of either P carinii pneumonia or Kaposi's sarcoma vs 20% of Haitians. In contrast, 72% of Haitians died of other opportunistic infections as compared with 21% of homosexuals. There has not been an increase in the proportion of cases diagnosed premortem since 1982 and overall, only 32 (58%) were diagnosed premortem; the rest were diagnosed only at autopsy. This study provided evidence that 42% died of currently untreatable diseases.