Sistema de indicadores para evaluar la calidad de los servicios generales de la Clínica Central Cira García / System of indicators to evaluate the quality of general services of Cira García Central Clinic

Introducción: En Cuba el sistema nacional de salud con acceso universal y cuidado de los individuos, la familia y la comunidad es una fortaleza reconocida internacionalmente. La Clínica Central Cira García es un centro de atención médica especializada de referencia internacional en la atención a pacientes extranjeros. Su calidad ha sido certificada por distintas organizaciones, no obstante, trabaja intencionadamente por elevar los estándares alcanzados. Objetivo: Proponer un sistema de indicadores para evaluar la calidad del subproceso servicios generales de la Clínica Central Cira García. Métodos: Se aplicaron métodos teóricos y empíricos, a través del análisis y la síntesis, el método sistémico-estructural-funcional y el análisis de contenido, se analizó la documentación existente relativa a la gestión de la calidad de la institución y en particular de servicios generales, se sistematizaron los resultados y se propuso el sistema de indicadores de calidad a evaluar. Se utilizaron la observación y la entrevista en la caracterización del funcionamiento de las distintas esferas de trabajo que comprende el subproceso servicios generales con lo que se obtuvieron criterios del público interno. Se aplicó una encuesta de satisfacción a pacientes no hispanohablantes de países desarrollados. Se trianguló la información y se detectaron las brechas de mejora. Resultados: Se propuso un sistema de cuatro dimensiones, 14 variables y 54 criterios para evaluar la gestión de calidad del subproceso servicios generales el cual prácticamente no era tomado en cuenta en los indicadores de calidad utilizados hasta el momento. En las encuestas de satisfacción la mayoría de los criterios establecidos recibieron niveles satisfactorios por al menos el 90 por ciento de los encuestados. El tiempo de espera para recibir la habitación y el dominio de idiomas fueron los criterios que mostraron mayor insatisfacción. Conclusiones: Para garantizar un turismo de salud competitivo que cumpla con las expectativas de pacientes que seleccionen con este fin el destino Cuba, se necesita contar con un sistema de indicadores para evaluar la calidad de los procesos no clínicos que apoyan el desarrollo de los procesos clave que puedan generalizarse a las instituciones que desarrollan turismo de salud(AU)

Introduction: In Cuba, the national health system with universal access and care for individuals, the family and the community is an internationally recognized strength. Cira García Central Clinic is a specialized medical care center of international reference in the care of foreign patients. Its quality has been certified by different organizations, however, it intentionally works to raise the standards achieved. Objective: Propose a system of indicators to evaluate the quality of the sub-process called general services in Cira García Central Clinic. Methods: Theoretical and empirical methods were applied, through analysis and synthesis, the systemic-structural-functional method and content analysis, the existing documentation related to the quality management of the institution and in particular of general services was analyzed, the results were systematized and the system of quality indicators to be evaluated was proposed. Observation and interview were used in the characterization of the functioning of the different areas of work comprising sub-process called General Services, thus obtaining criteria from the internal public. A satisfaction survey was applied to non-Spanish-speaking patients from developed countries. Information was triangulated and improvement gaps were detected. Results: A system of four dimensions, 14 variables and 54 criteria was proposed to evaluate the quality management of the sub-process general services which was practically not taken into account in the quality indicators used so far. In the satisfaction surveys, most of the established criteria received satisfactory levels by at least 90percent of the respondents. The waiting time to receive the room and the mastery of languages were the criteria that showed the biggest dissatisfaction. Conclusions: To guarantee a competitive health tourism that meets the expectations of patients who select Cuba destination for this purpose, it is necessary to have a system of indicators to evaluate the quality of non-clinical processes that support the development of key processes that can be generalized to the institutions that develop health tourism(AU)

Emprendimiento médico y turismo de salud en Bucaramanga (Colombia) / Medical Enterprise and Health Tourism in Bucaramanga (Colombia) / Empreendedorismo em medicina e turismo de saúde em Bucaramanga (Colômbia)

Introducción. Los indicadores económicos y las perspectivas comerciales han promovido al turismo de salud sin considerar las perspectivas de desarrollo, mejora e internacionalización del sistema de salud por los médicos-empresarios de Bucaramanga. Objetivo. Identificar las perspectivas médico-empresariales de las instituciones hospitalarias de Bucaramanga que promueven el turismo de salud y bienestar como segmento de desarrollo empresarial y crecimiento socioeconómico. Método. Interpretación deductiva de los textos seleccionados a partir de la técnica de contraste documental, presentando un estado general del turismo de salud hasta precisar la experiencia en turismo médico de Bucaramanga. Temas tratados. En las perspectivas sectoriales se identifican las principales tipologías turísticas asociadas con la salud; en las perspectivas médicas se reafirman las tendencias históricas de atención en salud en las zonas francas de Bucaramanga. Conclusiones. El turismo de salud y bienestar antes que un producto estratégico de clase mundial es una alternativa de desarrollo para los profesionales de la salud, internacionalización de sus centros hospitalarios, adopción de estándares y protocolos estrictos para atender pacientes extranjeros y, oferta de innovaciones o servicios para el mejoramiento del sistema de salud pública de Colombia. Cómo citar: Pérez-Pinzón LR. Emprendimiento médico y turismo de salud en Bucaramanga (Colombia). MedUNAB. 2020;23(2): 307-315. doi: 10.29375/01237047.3499

Introduction: Economic indicators and commercial perspectives have promoted health tourism without considering the local health care system's development, improvement and internationalization perspectives of Bucaramanga's doctor-entrepreneurs. Objective: To identify the medical-entrepreneurial perspectives of Bucaramanga's hospitals that promote well-being and health tourism as a business development and socioeconomic growth segment. Methodology: This is a deductive interpretation of the selected texts based on the documentary comparison technique, showing the general state of health tourism until Bucaramanga's medical tourism experience is specified. Topics Discussed: The main types of tourism associated with health are identified in sectorial perspectives. The historical health care trends in Bucaramanga's free trade zones are reaffirmed through medical perspectives. Conclusions: Well-being and health tourism, apart from being a world-class strategic product, it is an alternative for health care professionals' development, their hospitals' internationalization, adopting strict standards and protocols to attend foreign patients and offering innovations or services to improve Colombia's public health care system. Cómo citar: Pérez-Pinzón LR. Emprendimiento médico y turismo de salud en Bucaramanga (Colombia). MedUNAB. 2020;23(2): 307-315. doi: 10.29375/01237047.3499

Introdução. Os indicadores econômicos e as perspectivas comerciais promoveram o turismo de saúde sem considerar as perspectivas de desenvolvimento, melhoria e internacionalização do sistema de saúde pelos médicos-empresários de Bucaramanga. Objetivo. Identificar as perspectivas da medicina empresarial nas instituições hospitalares de Bucaramanga que promovem o turismo de saúde e bem-estar como um segmento de desenvolvimento empresarial e crescimento socioeconômico. Métodos. Interpretação dedutiva dos textos selecionados a partir da técnica de análise documental, apresentando um estado geral de turismo de saúde até explicitar a experiência em turismo de saúde de Bucaramanga. Tópicos discutidos. Nas perspectivas setoriais foram identificadas as principais tipologias turísticas associadas à saúde; nas perspectivas da medicina foram reafirmadas as tendências históricas de atenção em saúde nas áreas francas de Bucaramanga. Conclusão. O turismo de saúde e bem-estar, além de ser um produto estratégico de classe mundial, é uma alternativa de desenvolvimento para os profissionais de saúde, para a internacionalização de seus centros hospitalares, a adopção de padrões e protocolos rígidos de atendimento a pacientes estrangeiros e para a oferta de inovações ou serviços para o melhoramento do sistema de saúde pública da Colômbia. Cómo citar: Pérez-Pinzón LR. Emprendimiento médico y turismo de salud en Bucaramanga (Colombia). MedUNAB. 2020;23(2): 307-315. doi: 10.29375/01237047.3499

Evaluación del nivel de inglés en los programas de enfermería en Colombia: 2011-2016 / Evaluation of the English level in Colombian nursing programs: 2011-2016

Objetivo: evaluar si se cumplió la meta del Gobierno de Colombia para el 2014 de que el 20 % de los graduandos de programas de enfermería de las instituciones colombianas de educación superior se clasifiquen en nivel intermedio o superior en inglés. Metodología: se emplearon los resultados del módulo de inglés de la base de datos de las pruebas Saber Pro del Instituto Colombiano para la Evaluación de la Educación (2011-2016). Los niveles de calificación de este módulo son adaptados del Marco Común Europeo de Referencia. Para inferir respecto al logro de la meta de la política se realizaron pruebas de proporciones paramétricas y no paramétricas. Adicionalmente, se hicieron ajustes sobre el valor p. Resultados: ningún programa cumplió estadísticamente con la meta. Sin embargo, cuando solo se realizó la prueba de comparación de proporciones paramétrica y no paramétrica (sin corrección por hacer múltiples comparaciones), el programa de la Universidad del Valle, sede Cali, sí la cumplió. Conclusión: la meta propuesta por el Programa de Fortalecimiento al Desarrollo de Competencias en Lenguas Extranjeras para el 2014 no se cumplió en el caso de los estudiantes de enfermería evaluados; solo el 2,36 % alcanzó el nivel B+ ese año. Además, se encuentran rezagados respecto a los programas de medicina, economía y administración de empresas

Objective: To determine if universities' nursing programs reached the goal established in 2014 by the Colombian government of having 20% of higher education graduates reaching an intermediate or superior level in English. Methods: The research used a descriptive and statistical approach (parametric and non-parametric tests) using the data of nursing students in Higher Education Institutions who took Saber Pro test (2011 -2016). The grades of this module are adapted to the Common European Framework of Reference for Languages. In order to make inferences in respect to the achievement of the government's goal, parametric and non-parametric proportionality tests were carried out. Additionally, adjustments were made to the p-value to avoid the bias that results from generating a joint conclusion from joining results of an individual test. Results: No nursery program met the statis-tical goal. However, Universidad del Valle's nursing program met the goal if only the parametric and non-parametric proportion comparison tests (without correction for multiple comparisons) are considered. Conclusion: Overall, the goal of the Program for the Strengthening of the Development of Competency in Foreign Languages by 2014 was not met by nursing students: just 2.36% of them achieved an intermediate or higher level of English in 2014. In addition, nursing students fall behind student in medicine, economics and business administration programs

Turismo de salud: revalorización de la medicina tradicional Kallawaya en el municipio de Charazani / Health tourism: revaluation of Kallawaya traditional medicine in the municipality of Charazani

El turismo es una actividad socio económica que ha permitido que los pueblos del mundo puedan revalorizar sus culturas y así poder reencontrarse en ellas, descubriendo nuevas formas de interculturalidad, como un puente hacia sus raíces, su historia, su identidad, sus tradiciones, usos y costumbres. Si bien todos los tipos de turismo pueden ser una opción económica que mejore la calidad de vida de los habitantes de los destinos turísticos, también debemos recapacitar sobre la salud de los habitantes del lugar y los beneficios de relajamiento y bienestar que ofrecen los espacios naturales para los turistas, aspiramos con este proyecto profundizarnos a lo que es el turismo de salud y la revalorización de la medicina tradicional Kallawaya. Ya que los integrantes de los pueblos originarios, campesinos y autoridades del Municipio no se preocupan en mostrar la diversidad de los bienes naturales que rodean su medio ambiente, es necesario demostrar que con las riquezas naturales y saberes ancestrales que poseen se puede realizar proyectos, en este caso de Turismo de Salud: Revalorización de la Medicina Tradicional Kallawaya, declarados Patrimonio Oral e Intangible de la Humanidad declarado por la UNESCO. Estamos seguros que los médicos Kallawayas, tanto colliris, jampiris y herbolarios, guardan conocimientos genuinos desde sus antepasados, que pasan de generación en generación. Se sabe que muchos de estos médicos curanderos recuperaron a personas con enfermedades crónicas y pacientes dados de baja en la medicina occidental, como ser: epilepsia, diabetes, neumonía obstructiva y diversas patologías físico/mentales, utilizando diversas clases de hierbas y la asistencia espiritual de estos chamanes. Además vemos la necesidad y compromiso de integrar a todo esto, recurriendo a espacios naturales como las aguas termales y cascadas de agua fría, que juntas, existen en el mismo Municipio de Charazani, integrando con un spa adaptado al lugar para beneficencia tanto de turistas como de los mismos habitantes del lugar. (AU)

Revisión de estrategias de turismo de salud e identificación de aportes para Santander, Colombia / Review of Health Tourism Strategies and Identification of Contributions to Santander, Colombia / Revisão das estratégias de turismo de saúde e identificação de contribuições para Santander, Colômbia

Introducción: Colombia se presenta como uno de los países con mayor potencial para exportar servicios en los próximos años, en cuanto a turismo de salud se refiere. La imagen de sus médicos en diferentes especialidades ha venido aumentando, gracias a su preparación, calidad y relativo bajo costo con respecto a los países de la región. Santander, concretamente con las zonas francas en salud, ha venido alcanzando reconocimiento a nivel latinoamericano. El potencial que tiene este turismo se argumenta en los logros del sector salud y los efectos en cuanto al turismo internacional y en el desarrollo socio-económico de algunas regiones. Objetivo: Identificar las estrategias exitosas, fortalezas y debilidades del turismo médico en el ámbito nacional e internacional que permitan recomendar acciones estratégicas para generar ventajas competitivas al sector de salud en Santander y lo lleven al liderazgo. Metodología: Revisión de tema, con búsqueda sistemática de información bibliográfica, se utilizaron los descriptores DeCS: "Comercialización de Servicios de Salud", "Turismo Médico", "Economía de la Salud", "Servicios de Salud", "Comercio", "Economía Hospitalaria", en las bases de datos Scielo, Google Scholar, PubMed, además de realizar entrevistas con expertos de las entidades. Resultados: Se encontró que Colombia cuenta con una buena posición a nivel mundial y latinoamericano en términos de turismo en salud destacándose por la oferta de servicios en cardiología, cirugía estética y ortopedia; España cuenta con uno de los mejores sistemas de salud y tiene el séptimo puesto en la comercialización de servicios hospitalarios; India, Israel y Singapur lideran los temas de investigación e innovación posicionándolos también como potencias en el turismo médico. Conclusiones: Comparando a Bucaramanga y Área Metropolitana con otras ciudades y países, aún se requiere mayor reconocimiento como región y aunque se cuenta con entidades certificadas internacionalmente, es necesario trabajar en equipo con otras entidades prestadoras, el gobierno, agremiaciones y formar recursos humanos para atender el mercado internacional. [Vargas-Mantilla MM. Revisión de estrategias de turismo de salud e identificación de aportes para Santander, Colombia. MedUNAB 2017-2018; 20(3): 349-361].

Introduction: Colombia is one of the countries with the greatest potential to export services in the next years, in terms of health tourism. The image of its doctors in different specialties has been increasing, thanks to their preparation, quality and relative low cost with respect to the countries of the region. Santander, specifically with the free trade zones in health, has been achieving recognition in Latin America. The potential of this tourism is argued in the achievements of the health area and the effects in terms of international tourism and the socio-economic development of some regions. Objective: To identify the successful strategies, strengths and weaknesses of medical tourism in the national and international scope that allow recommending strategic actions to create competitive advantages to the health sector in Santander and guide it to leadership. Methodology:Atopic review with a systematic search of bibliographic information, in which DeCS descriptors were used such as Marketing of Health Services, medical tourism, Health economics, Health services, trading and Hospital economy in the databases Scielo, Google Scholar and Pubmed; in addition, interviews were conducted with experts from the entities. Results: It was found that Colombia has a good position in the world and Latin America in terms of health tourism, standing out for the offer of services in cardiology, aesthetic surgery and orthopedics; Spain has one of the best health systems and has the seventh position in the marketing of hospital services. India, Israel and Singapore lead the research and innovation issues, positioning them also as powers in medical tourism. Conclusions: Comparing Bucaramanga and Metropolitan Area with other cities and countries, it needs even more recognition as a region and although there are internationally certified entities, it is necessary to work as a team with other health providers, the government, associations and train staff to serve the international market. [Vargas-Mantilla MM. Review of Health Tourism Strategies and Identification of Contributions to Santander, Colombia. MedUNAB 2017- 2018; 20(3): 349-361].

Introdução: A Colômbia é um dos países com maior potencial para exportar serviços nos próximos anos, em termos de turismo de saúde. A imagem de seus médicos em diferentes especialidades tem aumentado, graças à sua preparação, qualidade e baixo custo relativo em relação aos países da região. O estado de Santander, especificamente com as zonas francas em saúde, vem conquistando reconhecimento na América Latina. O potencial deste turismo é reconhecido nas conquistas do setor de saúde e os efeitos são discutidos em turismo internacional e desenvolvimento socioeconômico de algumas regiões. Objetivo: Identificar as estratégias, pontos fortes e fracos de sucesso do turismo médico no âmbito nacional e internacional que permitem recomendar ações estratégicas para gerar vantagens competitivas para o setor de saúde em Santander e levá-lo à liderança. Metodologia: Revisão do tema, com busca sistemática de informações bibliográficas, foram utilizados os descritores DeCS: "Marketing de Serviços de Saúde", "Turismo Médico", "Economia da Saúde", "Serviços de Saúde", "Comércio", "Economia hospitalar ", nos bancos de dados Scielo, Google Scholar, PubMed, além de realizar entrevistas com especialistas das entidades. Resultados: A Colômbia encontrou uma boa posição no mundo e na América Latina em termos de turismo em saúde, destacando-se pela oferta de serviços em cardiologia, cirurgia estética e ortopedia; A Espanha tem um dos melhores sistemas de saúde e tem o sétimo lugar na comercialização de serviços hospitalares; Índia, Israel e Cingapura lideram as questões de pesquisa e inovação, posicionando-as também como fortalezas no turismo médico. Conclusões: Comparando Bucaramanga e a Área Metropolitana com outras cidades e países, ainda é necessário mais reconhecimento como região e, embora existam entidades certificadas internacionalmente, é necessário trabalhar em equipe com outras entidades de crédito, o governo, associações e capacitar recursos humanos para participar mercado internacional. [Vargas-Mantilla MM. Revisão das estratégias de turismo de saúde e identificação de contribuições para Santander, Colômbia. MedUNAB 2017-2018; 20(3): 349-361].

Russian Inpatients' Nursing Service Expectations, Satisfaction and Intention to Revisit Hospital / 기본간호학회지

PURPOSE: The aim of this study was to identify Russian inpatients' expectation and satisfaction with nursing service, and further, to analyze the relationship between these variables. METHODS: A structured questionnaire was used to survey for 81 Russian inpatients. The survey was conducted from January to June, 2014. RESULTS: Empathy and assurance significantly influenced nursing service expectation and satisfaction. Nursing service expectation was statistically significant for the number of visit to Korea, and nursing service satisfaction was statistically significant for gender, monthly income and primary care giver during hospitalization. Revisit intention was significantly different according to religion, medical department and primary care giver during hospitalization. There were positive correlations between nursing service expectation and satisfaction, and between nursing service satisfaction and intention to revisit the hospital. CONCLUSION: The results of this study show that the level satisfaction with nursing service influences Russian inpatients' intention continue using the hospital. Therefore, in order to increase the intention to revisit the hospital Korea hospital employees, especially nurses, need to develop nursing service strategies according to general characteristics, culture and nationality of foreign patients.

Netnografia e análise bioética de blogs de turismo terapêutico com células-tronco / Netnography and the bioethical analysis of therapeutic tourism blogs for stem cells

Resumo O turismo terapêutico é um fenômeno sanitário recente e tem repercutido entre as pessoas com deficiência. As redes sociais virtuais têm permitido que pessoas se organizassem para descobrir rotas e meios de buscar tratamentos não convencionais na China. Nesse contexto, empresas estrangeiras de biotecnologia têm ofertado terapias celulares experimentais. Neste trabalho realizou-se netnografia de 58 blogs de pessoas que organizaram campanhas para realizar tratamento na China. Na análise verificou-se que a principal motivação para a mobilização de recursos e pessoas a fim de submeter um filho com deficiência a um tratamento com células-tronco sem comprovação científica é a retórica de esperança aportada por tais empresas. Concluímos que, pelas implicações éticas, legais e sanitárias deve-se ampliar o debate sobre o tema a fim de proteger os sujeitos vulnerados de uma exposição inadvertida a riscos de saúde por tratamentos sem controle ou rigor.

Abstract Therapeutic tourism is a recent phenomenon in public health and has had repercussions among people with disabilities. Virtual social networks have enabled people to organize themselves to discover ways and means of seeking unconventional treatments in China. In this context, foreign biotech companies have offered experimental cell treatment therapies. In this work, netnography (conducting ethnographic research online) was conducted on the blogs of 58 people who organized campaigns to carry out treatment in China. In the analysis it was found that the main motivation for mobilization of resources and people in order to submit a disabled child to a treatment with stem cells without scientific proof is the rhetoric of hope promoted by stem cell laboratories. The conclusion drawn is that due to the ethical, legal and health implications, debate on the subject should be broadened in order to protect vulnerable individuals against inadvertent exposure to health risks due to treatments without proven control or rigor.

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.

Factors Influencing Intention of Vietnamese to Use Korean Medical Tourism / 간호행정학회지

PURPOSE: The purpose of this study was to identify factors related to Vietnamese customers who use Korean medical and tourism services. The study was based on the Anderson Models METHODS: Participants were 173 Vietnamese who were living in Ho Chi Minh and Hanoi in Vietnam. Data were analyzed using descriptive statistics, χ², t-test and Multiple Logistic Regression. RESULTS: Research necessary factors had the most significant effect among the preceding factors, possible factors and necessary factors. Human service and outstanding natural beauty of necessary factors had significant influence on customer intention to use. According to the result of the stepwise logistic regression analysis, the most important item in medical services was human service OR=1.89 (p=.014), and for tour services, outstanding natural beauty OR=4.30 (p=.033). The explained variance for customer intention to use was 91.9%. CONCLUSION: These results suggest the need to improve the human service and outstanding natural beauty to retain customers' intention to use.

Review on the current reformation of the physician surcharge in Korea

The reform of the physician surcharge system in Korea, which was applied beginning August 1, 2014, reduced the financial burden from three major non-covered services. However, hospital financial balances, already negatively affected by the longstanding impact of lower reimbursement from the social insurance system, are likely to decline further. Now is the time for the Korean government to introduce policies that can solve the fundamental problems, caused by low contributions and a limited benefit design, that have distorted health care system. Tertiary care hospitals cannot expect significant revenue from increasing the numbers of beds and expensive equipment, as in the past. Tertiary care hospitals are members of the public health system and are social enterprises intended to contribute to the development of society. Policies should reinforce the traditional hospital model, with a focus on high quality of care, educational training, research, and public health leadership, but also on development of new business models, such as official development assistance and medical tourism. Above all, the government should accept that, in contrast to economy market rules in many other contexts, medical services are not determined according to supply and demand. The government must seek amendment of the relevant laws and regulations, including sustainable benefit plans, in order to provide high quality of care. For the successful implementation of government reform, the government should not ignore procedural justice in the allocation of resources.

Factors Influencing Chinese Customers' Loyalty to Korean Medical and Tourism Services / 간호행정학회지

PURPOSE: The purpose of this study was to identify factors related to the loyalty of Chinese customers who use Korean medical and tourism services. METHODS: Participants were 158 Chinese who visited plastic surgery clinics in Korea. Data were analyzed using descriptive statistics, One-way ANOVA, Scheffe? test, Pearson Correlation and Hierachical Multiple Regression. RESULTS: Medical service quality, tourism service quality and medical and service satisfaction were positively correlated with customer loyalty. Medical service quality and medical and tourism service satisfaction had significant influence on customer loyalty. The explained variance for customer loyalty was 84.9%. CONCLUSION: These results suggest the need to improve the tourism service and medical and tourism service satisfaction to retain loyal customers.

Review of Medical Services for Inbound Muslim Patients Associated with Global Healthcare Industry Activation: Focus on Nutrition Service

This article aimed to investigate problems relating to medical tourism based on a review of medical tourism reports and statistics in the global healthcare industry. To be a leading nation in the global healthcare industry, the needs and culture of many peoples, including Muslims, should be considered. Qualified medical services by JCI certification, including nutrition services, will provide opportunities to participate in the international and Asia medical tourism markets. In this article, the definitions of medical tourism, medical service, Halal and Haram, nutrition service for inbound Muslim patients, and Halal food supply in Korea were examined for medical service improvement. Mutual assistance between the government and private enterprise, sharing of medical service information, and construction of a cooperative network system are needed and should be supported by the government.

[Impact of the human activities on the eco-tourism sites: a case study Ajloun Forest Reserve forests and its vicinity - Jordan]

Ajloun Reserve is considered one of the most important reserves established in the Hashemite Kingdom of Jordan, in order to promote development, tourism and the environment on one hand and to preserve the natural and environmental components in the other hand. This research deals with the impact of human activities on the touristic environment of the Ajloun reserve and its vicinity. This research aiming at identifying the environmental changes that have occurred in Ajloun preserve by touristic human activities within the preserve and its vicinity. As well as to develop an integrated management and implementation plan based on the balance between the preserve layout and its vicinity to prevent exploitation and environmental degradation, and awareness of the negative environmental change witnessed in the preserve. This research indicated that human activity for residents in the reserve and its vicinity areas is the primary theme for maintaining the environmental and natural components of the reserve through participation in the planning and oversight of the process and the implementation of any projects related to the preserve. To integrate this activity with the other sectors in the region such as agriculture, industry and tourism for the benefit of residents in these areas. Accordingly, the researcher has followed a methodology based on field visits to the reserve and personal contact inside the reserve, and the local population in neighboring villages to collect information and data from which to describe and analyze human activities in the preserve and its vicinity and the use of desktop tools and internet and field observations. The researcher has come up with a set of findings and recommendations, as the need to put restrictions on human activities within the presewe and its vicinity through the goals of these activities and its positive and negative environmental and natural impacts. Through the invitation of planners and stakeholders on preserve to the adoption of new entries in the preserve layout administratively and environmentally based on a balance between human activities undertaken within the preserve and the activities that take place in its vicinity

Addressing Practical Issues Related Tto Nursing Care For International Visitors To Hiroshima / Problemas Práticos Relacionados Aos Cuidados De Enfermagem Para Visitantes Internacionais A Hiroshima / Cuestiones Prácticas Relacionadas Con La Atención De Enfermería Para Visitantes Internacionales A Hiroshima

When nine million foreigners visited Japan in 2013, the federal government set a goal to attract an additional two and a half million visitors including medical tourists by 2020. This research investigates the attitudes and concerns of Japanese nurses when they are in a situation dealing with foreign patients. The data were collected from March through September 2010, from 114 nurses at three hospitals, in close proximity to popular tourist destinations in Hiroshima. A questionnaire was developed for this research, named Mari Meter, which included a section to write answers to an open question for the nurses to express their opinions. These responses were examined statistically and by word analysis using Text Mining Studio. Japanese nurses expressed greatest concern about payment options, foreign language skills, and issues of informed consent, when dealing with foreigners. The results confirm that, in order to provide a high quality of patient care, extra preparation and a greater knowledge of international workers and visitors are required by nursing professionals in Japan.
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Quando nove milhões de estrangeiros visitaram o Japão em 2013, o governo federal estabeleceu uma meta de atrair outros dois milhões e meio de visitantes, incluindo o turismo médico, em 2020. Esta pesquisa investiga atitudes e preocupações de enfermeiras japonesas ao lidar com pacientes estrangeiros. Os dados foram coletados no período de março a setembro de 2010, com 114 enfermeiros de três hospitais próximos a destinos turísticos populares em Hiroshima. Um questionário denominado Mari Meter foi desenvolvido especificamente para esse fim, incluindo uma seção de respostas a uma questão aberta para que os enfermeiros expressem suas opiniões. As respostas foram submetidas a procedimentos estatísticos e de análise de discurso, usando o software Text Mining Studio . As enfermeiras japonesas expressaram maior preocupação quanto a opções de pagamento, conhecimentos de línguas estrangeiras e questões de consentimento informado, ao prestar cuidados a pacientes estrangeiros. Os resultados confirmam que, a fim de proporcionar um atendimento de qualidade ao paciente, é necessário preparação extra e maior conhecimento sobre trabalhadores e visitantes internacionais por parte de profissionais de enfermagem no Japão.

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Cuando nueve millones de extranjeros visitaron Japón en el año 2013, el gobierno federal estableció la meta de atraer al año 2020 a más de dos millones y medio de visitantes, incluyendo el turismo médico. Esta investigación analiza las actitudes y preocupaciones de enfermeras japonesas en el cuidado pacientes extranjeros. Los datos fueron recolectados entre marzo y septiembre del año 2010, por medio de entrevistas a 114 profesionales de enfermería de tres hospitales cercanos a zonas turísticas populares en Hiroshima. Se desarrolló específicamente para este fin un cuestionario llamado Mari Meter, con una sección con una pregunta abierta, para que las enfermeras expresan sus opiniones. Las respuestas fueron sometidas a procedimientos estadísticos y de análisis de discurso, utilizando el software Text Mining Studio. Las enfermeras japonesas expresaron su preocupación con respecto a las formas de pago, conocimientos de idiomas y tópicos del consentimiento informado mientras brindaban cuidados de enfermería a pacientes extranjeros. Los resultados confirman que para proporcionar una atención de calidad al paciente, los profesionales de enfermería en Japón necesitan de una preparación adicional y de un mayor conocimiento acerca de los trabajadores y visitantes internacionales.

Indianidades: repertórios mobilizados pela ioga transnacionalizada nos fluxos turísticos Brasil-Índia / Indianness: repertories mobilized through transnationalized yoga in tourist flux Brazil-India / Indianidades: repertorios movilizados por el yoga transnacionalizado en los flujos turísticos Brasil-India

Pouco ainda se sabe sobre as paisagens da Índia negociadas no mercado turístico brasileiro. Viagens direcionadas às pessoas interessadas em ioga constituem um dos fluxos mais estáveis de turismo Brasil-Índia, as Yoga Journeys. Recorrendo à noção de repertórios interpretativos (Potter & Wetherell, 1987; Spink, 2003, 2010), este trabalho discute as maneiras de falar e de ver imageticamente a Índia que circulam no turismo brasileiro, fazendo-o por meio do estudo dos materiais de divulgação veiculados por agências nacionais de viagens que vendem pacotes turísticos à Índia voltados à prática da ioga. A essas maneiras de falar e ver a Índia nomeou-se indianidades, termo que busca escapar a essencializações fundadas em identidades nacionais. O corpus foi composto por materiais de divulgação utilizados por duas agências de viagens nos quais analisamos os informativos e páginas eletrônicas, sendo estudados os textos escritos, os roteiros de viagem e as imagens. Foram identificados três principais repertórios: exotismo, espiritualidade e bem-estar. Os primeiros se remetem à atemporalidade da Índia como país isolado e diferente do resto do mundo, e o último, ao movimento de aproximação entre as práticas antes consideradas espirituais e os serviços de saúde e lazer.

Little is known about the prospect of India trade in Brazilian tourism market. Using the notion of repertoires (Potter & Wetherell, 1987; Spink, 2003, 2010), this article aim to study the Indianness conveyed in India-Brazil tourism. The corpus was composed of two travel agencies, which we analyzed newsletters and web pages. In analyzed materials repertoires identified on India released in packages specialized tour. Tours directed peoples' interest in yoga as one of the most stable fluxes of tourism between Brazil and India, Yoga Journeys. We identified three main repertoires: exoticism, spirituality and wellness. The presence of those repertoires indicate that in the opposite direction of increasing modernization shows that the country is on the right track (Pinheiro, 2010), repertories associated with timelessness and spirituality resist and give space to fissures and ambivalences which mark the contemporary India.

Sabemos poco todavía sobre los paisajes de la India comercializados en el mercado turístico brasileño. Los viajes dirigidos a las personas interesadas en el yoga constituyen uno de los flujos más estables del turismo Brasil-India, los Yoga Journeys. Recurriendo a la noción de repertorios interpretativos (Potter & Wetherell, 1987; Spink, 2003, 2010), este trabajo tiene como objetivo estudiar las diversas maneras de hablar y de ver la manera imaginaria de la India que circula en el turismo brasileño a través del estudio de materiales de divulgación vehiculados por agencias nacionales de viajes que venden paquetes turísticos a la India dirigidos a la práctica del yoga. A esas maneras de hablar y de ver la India las llamaremos indianidades, término que intenta huir de las esencializaciones fundadas en las identidades nacionales. El corpus fue compuesto por materiales de divulgación utilizados por dos agencias de viajes en los que analizamos los informativos y páginas electrónicas, estudiando los textos escritos, los recorridos de los viajes y las imágenes. Se identificaron tres principales repertorios: exotismo, espiritualidad y bien estar. Los dos primeros remiten a la atemporalidad de la India como país aislado y diferente del resto del mundo, y el último, al movimiento de aproximación entre las prácticas anteriormente consideradas espirituales y los servicios de salud y ocio.

Binational utilization and barriers to care among Mexican American border residents with diabetes / Utilización binacional y barreras a la atención en las personas con diabetes que residen en la frontera mexicano-estadounidense

OBJECTIVE: To assess whether U.S.-Mexico border residents with diabetes 1) experience greater barriers to medical care in the United States of America versus Mexico and 2) are more likely to seek care and medication in Mexico compared to border residents without diabetes. METHODS: A stratified two-stage randomized cross-sectional health survey was conducted in 2009 - 2010 among 1 002 Mexican American households. RESULTS: Diabetes rates were high (15.4%). Of those that had diabetes, most (86%) reported comorbidities. Compared to participants without diabetes, participants with diabetes had slightly greater difficulty paying US$ 25 (P = 0.002) or US$ 100 (P = 0.016) for medical care, and experienced greater transportation and language barriers (P = 0.011 and 0.014 respectively) to care in the United States, but were more likely to have a person/place to go for medical care and receive screenings. About one quarter of participants sought care or medications in Mexico. Younger age and having lived in Mexico were associated with seeking care in Mexico, but having diabetes was not. Multiple financial barriers were independently associated with approximately threefold-increased odds of going to Mexico for medical care or medication. Language barriers were associated with seeking care in Mexico. Being confused about arrangements for medical care and the perception of not always being treated with respect by medical care providers in the United States were both associated with seeking care and medication in Mexico (odds ratios ranging from 1.70 - 2.76). CONCLUSIONS: Reporting modifiable barriers to medical care was common among all participants and slightly more common among 1) those with diabetes and 2) those who sought care in Mexico. However, these are statistically independent phenomena; persons with diabetes were not more likely to use services in Mexico. Each set of issues (barriers facing those with diabetes, barriers related to use of services in Mexico) may occur side by side, and both present opportunities for improving access to care and disease management.

OBJETIVO: Evaluar si las personas con diabetes que residen en la frontera mexicano-estadounidense 1) encuentran mayores barreras para obtener atención médica en los Estados Unidos de América que en México; y 2) acuden a México en busca de atención y medicación con mayor probabilidad que las personas no diabéticas que residen en la frontera. MÉTODOS: Durante el 2009 y el 2010, en una muestra de 1 002 hogares mexicano-estadounidenses, se llevó a cabo una encuesta transversal de salud en dos etapas, estratificada y aleatorizada. RESULTADOS: Las tasas de diabetes eran elevadas (15,4%). La mayor parte de las personas con diabetes (86%) notificaron comorbilidades. En comparación con los participantes no diabéticos, los afectados de diabetes experimentaban dificultades algo mayores para pagar US$ 25 (P = 0,002) o US$ 100 (P = 0,016) por recibir atención médica, y encontraban mayores barreras en materia de transporte e idioma (P = 0,011 y 0,014, respectivamente) para ser atendidos en los Estados Unidos, aunque era más probable que contaran con una persona o lugar adonde acudir en busca de atención médica y para ser sometidos a tamizaje. Una cuarta parte de los participantes acudían a México en busca de atención o medicamentos. Una edad menor y el haber vivido en México se asociaban con la búsqueda de atención en México, pero no el padecer diabetes. La presencia de múltiples barreras financieras se asociaba independientemente con una probabilidad aproximadamente tres veces mayor de acudir a México en busca de atención médica o medicación. Las barreras idiomáticas se asociaban con la búsqueda de atención en México. La confusión acerca de los trámites para recibir atención médica y la percepción de no recibir siempre un trato respetuoso por parte de los proveedores de atención médica en los Estados Unidos se asociaban con la búsqueda de atención y medicación en México (odds ratio, 1,70 - 2,76). CONCLUSIONES: La notificación de barreras modificables a la atención médica fue frecuente entre los participantes y algo más frecuente entre 1) las personas con diabetes; y 2) los que buscaban se atendidos en México. Sin embargo, estos fenómenos son estadísticamente independientes; no era más probable que las personas con diabetes utilizaran servicios en México. Ambos conjuntos de problemas (las barreras que deben afrontar las personas con diabetes, las barreras relacionadas con el uso de servicios en México) pueden coexistir, y proporcionan oportunidades para mejorar el acceso a la atención y el tratamiento de las enfermedades.

Turismo con células madre y requisitos para su uso clínico: desafíos bioéticos más allá del embrión / Bioethical challenges of stem cell tourism

Stem cells have drawn extraordinary attention from scientists and the general public due to their potential to generate effective therapies for incurable diseases. At the same time, the production of embryonic stem cells involves a serious ethical issue concerning the destruction of human embryos. Although adult stem cells and induced pluripotential cells do not pose this ethical objection, there are other bioethical challenges common to all types of stem cells related particularly to the clinical use of stem cells. Their clinical use should be based on clinical trials, and in special situations, medical innovation, both of which have particular ethical dimensions. The media has raised unfounded expectations in patients and the public about the real clinical benefits of stem cells. At the same time, the number of unregulated clinics is increasing around the world, making direct offers through Internet of unproven stem cell therapies that attract desperate patients that have not found solutions in standard medicine. This is what is called stem cells tourism. This article reviews this situation, its consequences and the need for international cooperation to establish effective regulations to prevent the exploitation of patients and to endanger the prestige of legitimate stem cell research.

Medical tourism in the caribbean region: a call to consider environmental health equity / Turismo médico en la región del Caribe: una llamada a considerar la equidad en salud ambiental

Medical tourism, which is the intentional travel by privatepaying patients across international borders for medical treatment, is a sector that has been targeted for growth in many Caribbean countries. The international development of this industry has raised a core set of proposed health equity benefits and drawbacks for host countries. These benefits centre on the potential investment in health infrastructure and opportunities for health labour force development while drawbacks focus on the potential for reduced access to healthcare for locals and inefficient use of limited public resources to support the growth of the medical tourism industry. The development of the medical tourism sector in Caribbean countries raises additional health equity questions that have received little attention in existing international debates, specifically in regard to environmental health equity. In this viewpoint, we introduce questions of environmental health equity that clearly emerge in relation to the developing Caribbean medical tourism sector. These questions acknowledge that the growth of this sector will have impacts on the social and physical environments, resources, and waste management infrastructure in countries. We contend that in addition to addressing the wider health equity concerns that have been consistently raised in existing debates surrounding the growth of medical tourism, planning for growth in this sector in the Caribbean must take environmental health equity into account in order to ensure that local populations, environments, and ecosystems are not harmed by facilities catering to international patients.

El turismo médico - el viaje intencional pagado por pacientes privados para atravesar las fronteras internacionales en busca de tratamiento médico - es un sector escogido como objeto de crecimiento en muchos países del Caribe. El desarrollo internacional de esta industria ha planteado a los países anfitriones, un conjunto básico de ventajas y desventajas con respecto a propuestas para la equidad en la salud. Estos beneficios se centran en la inversión potencial en infraestructura de salud y las oportunidades de desarrollo de fuerza laboral en el área de la salud, mientras que las desventajas giran en torno a una potencial reducción de acceso a los cuidados de salud para la población local, así como en torno al uso ineficiente de los limitados recursos públicos para apoyar el crecimiento de la industria del turismo médico. El desarrollo del sector del turismo médico en los países del Caribe, plantea problemas adicionales en materia de equidad de la salud, que han recibido poca atención en los debates internacionales existentes, específicamente con respecto a la equidad en salud ambiental. Desde este punto de vista, introducimos cuestiones de equidad en salud ambiental que se suscitan claramente tan pronto se trata de desarrollar el sector del Turismo Médico en el Caribe. Estas cuestiones reconocen que el crecimiento de este sector tendrá impactos en los entornos físicos y sociales, recursos, y la infraestructura de la gestión de residuos en los países. Sostenemos que - además de abordar las amplias preocupaciones en torno a la equidad de salud, que se han venido planteado constantemente como parte de los debates en torno al crecimiento del turismo médico - la planificación del crecimiento de este sector en el Caribe debe considerar la equidad en salud ambiental, con el fin de asegurar que los ecosistemas, el medio ambiente, y las poblaciones locales no sufran daño por parte de las instalaciones creadas para ofrecer servicios a los pacientes internacionales.