Bariatric surgery tourism in the COVID-19 era.

Background: Since the start of the Covid-19 pandemic primary and secondary health care services in Northern Ireland have observed an increase in the number of patients who have had bariatric surgery outside of the UK. This study sought to estimate the frequency of bariatric surgery tourism and to audit indications, blood monitoring and medical complications. Methods: All primary care centres within the Western Health Social Care Trust (WHSCT) were invited to document the number of patients undergoing bariatric surgery between January 1, 2017 and December 31, 2022. For one primary care centre, patients who underwent bariatric surgery were assessed against the National Institute of Health and Clinical Excellence (NICE) guideline indications for bariatric surgery. In addition, the blood monitoring of these patients was audited against the British Obesity and Metabolic Surgery Society (BOMSS) guidelines for up to two years following surgery. Medical contacts for surgical complications of bariatric surgery were recorded. Results: Thirty-five of 47 (74.5%) GP surgeries replied to the survey, representing 239,961 patients among 325,126 registrations (73.8%). In the six year study period 463 patients had reported having bariatric surgery to their GP. Women were more likely to have had bariatric surgery than men (85.1% versus 14.9%). There was a marked increase in the number of patients undergoing bariatric surgery with each year of the study (p<0.0001 chi square for trend). Twenty-one of 47 patients (44.7%) evaluated in one primary care centre fulfilled NICE criteria for bariatric surgery. The level of three-month monitoring ranged from 23% (for vitamin D) to 89% (electrolytes), but decreased at two years to 9% (vitamin D) and 64% (electrolytes and liver function tests). Surgical complication prevalence from wound infections was 19% (9 of 44). Antidepressant medications were prescribed for 23 of 47 patients (48.9%). Conclusions: The WHSCT has experienced a growing population of patients availing of bariatric surgery outside of the National Health Service. In view of this and the projected increase in obesity prevalence, a specialist obesity management service is urgently required in Northern Ireland.

Achieving sustainable medical tourism: unpacking privacy concerns through a tripartite game theoretic lens.

Introduction: Medical tourism has grown significantly, raising critical concerns about the privacy of medical tourists. This study investigates privacy issues in medical tourism from a game theoretic perspective, focusing on how stakeholders' strategies impact privacy protection. Methods: We employed an evolutionary game model to explore the interactions between medical institutions, medical tourists, and government departments. The model identifies stable strategies that stakeholders may adopt to protect the privacy of medical tourists. Results: Two primary stable strategies were identified, with E6(1,0,1) emerging as the optimal strategy. This strategy involves active protection measures by medical institutions, the decision by tourists to forgo accountability, and strict supervision by government departments. The evolution of the system's strategy is significantly influenced by the government's penalty intensity, subsidies, incentives, and the compensatory measures of medical institutions. Discussion: The findings suggest that medical institutions are quick to make decisions favoring privacy protection, while medical tourists tend to follow learning and conformity. Government strategy remains consistent, with increased subsidies and penalties encouraging medical institutions towards proactive privacy protection strategies. We recommend policies to enhance privacy protection in medical tourism, contributing to the industry's sustainable growth.

Retinal injury from a laser skin resurfacing device during medical tourism: a public health concern.

BACKGROUND: Laser skin resurfacing is a popular cosmetic procedure for noninvasive skin rejuvenation. Since health insurance plans often do not cover these types of procedures, patients often pay out of pocket. Consequently, there is an incentive to go abroad, where prices are more affordable. However, practitioners in destination countries may lack rigorous training on laser safety, regulatory oversight, or licensing, especially on devices used for "cosmetic" procedures. In certain cases, this can lead to tragic outcomes, especially when underqualified practitioners operate medical-grade laser devices. CASE PRESENTATION: A 29-year-old woman suffered a retinal burn from a handheld Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser pulse device used to perform skin resurfacing treatment at a medical spa in Vietnam. The patient was not adequately informed about the potential risk to her vision and was not provided with any eye protection. A momentary, unintended laser exposure to the patient's right eye led to irreversible vision loss due to a macular burn. This incident caused immediate pain, followed by the sudden appearance of floaters, along with a retinal and vitreous hemorrhage. Despite treatment with off-label bevacizumab for the development of a choroidal neovascular membrane, vision remained at the level of counting fingers because of the presence of the macular scar. CONCLUSION: When utilizing laser-based devices, it is crucial to employ safety measures, such as the wearing of safety goggles or the use of eye shields to protect ocular tissues from potential damage. The growing availability of cosmetic laser devices presents a substantial public health risk, because numerous operators lack adequate training in essential safety standards, or they neglect to follow them. Furthermore, patients seeking services abroad are subject to the regulatory practices of the destination country, which may not always enforce the requisite safety standards. Further research is needed to determine regional and global incidence of laser-related injuries to help direct educational and regulatory efforts.

Smoothness as a quality of care: An STS approach to transnational healthcare mediation.

Medical travel and transnational healthcare involve various difficulties such as the distance and disconnect between patients and healthcare providers, language barriers or logistical challenges of moving ill bodies across space. Medical travel facilitation steps in with some sort of brokerage service that contributes to overcoming or managing these difficulties and, as this paper suggests, acts to create a quality of 'smoothness'. By unpacking three salient facilitation practices, namely connecting, communicating, and coordinating, this paper conceptualises the empirically derived category of 'smoothness'. This as a disposition, outcome, and spatio-temporal manoeuvre of medical travel facilitation. Based on the way in which such practices of mediation act to create smoothness, namely in an attentive, persistent, and collective tinkering manner, this paper suggests that some practices of medical travel facilitation are productively thought not just about setting up the possibility of care transnationally, but that they are key forms of care in itself. Based on these findings, smoothness is considered to be a central but also contested quality of medical travel facilitation and brokerage in a broader sense, but as proposed here, also for care. This conclusion potentially has implications not just for the study of transnational healthcare and mediation activities, but also that of care and transnational mobilities more generally.

Challenges with medical tourism.

PURPOSE OF REVIEW: With the return of international travels to almost prepandemic levels, the number of patients who travel abroad to seek healthcare services is once again growing rapidly. Nevertheless, the expected benefits of medical tourism may be challenged by serious infectious complications. This review summarizes the evolving published evidence on infectious complications related with medical tourism of the last eighteen months. RECENT FINDINGS: There has been an increase of reported infectious complications in patients who had received healthcare abroad. Such complications were frequently associated with serious and prolonged morbidity, repeated treatments and hospitalizations, high healthcare costs, and occasionally fatalities. A devastating outbreak of fungal meningitis occurred among US residents who underwent epidural anesthesia for cosmetic surgery in two clinics in Mexico. Overall, as of July 5, 2023 there were 31 cases with severe cerebrovascular complications and eight deaths. Infections caused by nontuberculum mycobacteria and Candida sp have been also reported the last years. SUMMARY: Considering the expected expansion of medical tourism in the forthcoming years, public health authorities and scientific societies should raise awareness of such infections among physicians and other healthcare professionals and issue recommendations for their management. A system to report complications in patients receiving healthcare abroad is needed.

Social egg freezing and reproductive rights justification: A perspective from China.

Divergences and controversies are inevitable in the discussion of freedoms and rights, especially in the matter of reproduction. The Chinese first social egg freezing lawsuit raises the question: is the freedom to freeze eggs for social reasons justified because it is an instance of reproductive rights? This paper accepts social egg freezing as desirable reproductive freedom, but following Harel's approach and considering two theories of rights, the choice and interest theories of rights, we argue that social egg freezing is not a reproductive right because one cannot justify a right or an instance of rights via merely describing the function of those instances that have been justified as right, that is, the choice theory lacks justifying normativity. Since reserving fertility and a suspension from reproduction do not serve reproductive ends per se, the sufficient reason for demanding social egg freezing as a right should be found in other ends rather than in right-to-reproduce, that is, the interest theory denies the demand as a right-to-reproduce. Permitting it on any grounds without guaranteeing adequate and accessible resources, especially in light of cross-border reproductive care, raises serious questions about reproductive equality and violates the idea of reproductive rights. Therefore, any ground for social egg freezing should be weighed against whether more pressing reproductive needs, specifically those that are justified as rights, have been met. It would be social progress to shoulder these burdens for the vulnerable and then allow social egg freezing-if right-to-reproduce were not the only privilege of the few.

Preparing your patient to travel the globe.

ABSTRACT: Many patients who travel internationally seek medical travel advice from their primary care provider, who may feel unprepared to provide this advice. This article describes online travel medicine resources and a structured approach to a basic pretravel assessment, office evaluation, and destination-specific consultation on travel health and safety.

Medical tourism among Indonesians: a scoping review.

BACKGROUND: International medical travel or medical tourism is not a new phenomenon in many countries, including among Indonesians. Indonesia is reported as a major source of patients from the lower, middle, to upper classes for its neighbouring countries. This scoping review aims to synthesise evidence on supporting factors for Indonesians taking medical tourism and what needs to be improved in Indonesia's health system. METHODS: We conducted a scoping review guided by a framework provided by Arksey and O'Malley. We systematically searched existing literature from 5 databases, including MEDLINE, PubMed, Scopus, ProQuest, and Wiley. Data were extracted based on study details, study design, characteristics of participants and results. Analysis followed the three-stage procedure outlined by Thomas and Harden: (1) coding the text line by line, interpreting the data and identifying concepts or themes; (2) developing descriptive themes by grouping similar concepts in theme and subtheme and (3) generating analytical themes by reviewing preliminary themes and discussing the addition or revision of themes. RESULTS: A total of 25 articles were included in this review. The review highlights a broad range of facilitators for medical tourism among Indonesians: (i) availability of health services, medical specialities, and person-centred care, (ii) region adjacency, transport, and health agency, (iii) affordability of medical treatment, (iv) religious and socio-cultural factors, and (v) reasons patients reported distrust in Indonesian doctors. CONCLUSION: The findings indicate improvements in the Indonesian health system are necessary if the increasing rates of international medical tourism by Indonesian people are to change. Addressing the factors identified in this scoping review through avenues including policy may increase people's satisfaction and trust towards health care and treatment in Indonesia, thereby reducing the number of Indonesian people taking medical tourism.

Cerebral vasospasm due to Fusarium solani meningitis: A complication from medical tourism. Case report and literature review.

OBJECTIVES: Medical tourism is expanding globally, with patients seeking cosmetic procedures abroad. To date, little information is known regarding the risks and outcomes of cosmetic tourism, especially potential stroke complications. Here, we present a case of fungal meningitis in the setting of medical tourism leading to ischemic strokes and vasospasm. MATERIAL AND METHODS: We describe an immunocompetent 29-year-old female patient who initially presented with intractable headaches and an abnormal cerebrospinal fluid (CSF) profile who was eventually diagnosed with Fusarium solani meningitis as a part of a common source outbreak in Matamoros, Mexico. These patients were part of a cohort who underwent cosmetic procedures requiring spinal anesthesia. This report also highlights the unusual clinical course leading to poor outcomes in such conditions. RESULTS: The patient initially presented with headaches, papilledema, elevated opening pressure on the spinal tap, abnormal CSF studies, and eventually developed ischemic strokes and hydrocephalus. CSF showed positive beta D-Glucan with repeated negative CSF fungal cultures. A cerebral angiogram revealed extensive basilar artery vasospasm that led to ischemic strokes. Continued clinical worsening and lack of response to antifungal treatment prompted further imaging that revealed significant non-obstructive hydrocephalus subsequently complicated by spontaneous intracranial hemorrhage. CSF PCR for Fusarium solani species was positive days after her passing. CONCLUSION: This novel case highlights fungal meningitis caused by Fusarium solani complicated by bilateral ischemic strokes stemming from basilar artery vasospasm. Complications from medical tourism impact not only individual patients but also the health systems of both countries. Professional and regulatory entities for cosmetic surgeries must highlight and educate patients on the risks and complications of cosmetic surgeries happening abroad. Physicians should be aware of ongoing outbreaks and possible complications of these procedures.

Managing complications following cosmetic surgery after the COVID pandemic: A study of a year at an NHS plastic surgery unit.

BACKGROUND: The study was an analysis of patients managed by plastic surgery services at Heatherwood and Wexham Park hospitals during the calendar year 2022 for complications following cosmetic surgeries performed both internationally and within the United Kingdom. METHODS: Patients were identified via local databases and encounters and management confirmed with retrospective studies of patient electronic medical records. RESULTS: 23 patients were managed during the year 2022 for complications post cosmetic surgery. 91% (n = 21) of complications were related to breast cosmetic surgery and/or abdominoplasties. 78% (n = 18) of patients presented within the first two months following their procedure. The most common complications identified were wound dehiscence 43% (n = 10), post-operative infection 39% (n = 9) and seromas 30% (n = 7). The most common country selected for surgery by patients was Turkey with 48% (n = 11) of managed patients. 52% (n = 12) of cases were managed conservatively and 48% (n = 11) of cases required invasive procedures including surgery. 87% (n = 20) of patients were discharged with completed treatment. CONCLUSION: Cosmetic surgery and tourism are an in-demand phenomenon and appear here to stay. The stringent regulatory and legal processes in place in the UK may not be applicable abroad to the detriment of patient care. Greater effort is needed to increase public awareness to the risks involved in seeking international options and how to self-screen suitable clinics. Ongoing current national auditing may need to be expanded to understand the true impact on NHS units in dealing with the aftermath of these surgical expeditions.

The Use of Medical Crowdfunding to Mitigate the Personal Costs of Serious Chronic Illness: Scoping Review.

BACKGROUND: Persons diagnosed with serious chronic illnesses and their caretakers experience multiple types of financial costs that strain their income and generate financial distress. Many turn to medical crowdfunding (MCF) to mitigate the harms of these costs on their health and quality of life. OBJECTIVE: This scoping review aims to summarize the research on MCF for persons diagnosed with serious chronic illness regarding study designs and methods; the responsible conduct of research practices; and study foci as they relate to stress, stress appraisals, and the coping processes. METHODS: This review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Eligible studies were conducted in countries designated as high income by the World Bank and focused on beneficiaries diagnosed with serious chronic illness. The findings of the included studies were summarized as they related to the key concepts in a conceptual framework derived from an established stress, appraisal, and coping framework and a conceptual model of financial toxicity in pediatric oncology. RESULTS: Overall, 26 studies were eligible for inclusion in the review. The main findings included a lack of integration of qualitative and quantitative approaches and the inconsistent reporting of the responsible conduct of research practices. The included studies focused on financial stressors that contributed to financial burden, such as out-of-pocket payments of medical bills, basic living expenses, medical travel expenses, and lost income owing to illness-related work disruptions. Few studies addressed stress appraisals as threatening or the adequacy of available financial resources. When mentioned, appraisals related to the global financial struggle during the COVID-19 pandemic or the capacity of social network members to donate funds. The consequences of MCF included the receipt of 3 forms of social support (tangible, informational, and emotional), privacy loss, embarrassment, and the propagation of scientifically unsupported information. Studies found that friends and family tended to manage MCF campaigns. Although most of the studies (21/26, 81%) focused on monetary outcomes, a few (5/26, 19%) concentrated on peoples' experiences with MCF. CONCLUSIONS: The identified methodological gaps highlight the need for more robust and reproducible approaches to using the copious data available on public MCF platforms. The integration of quantitative and qualitative methods will allow for nuanced explorations of the MCF experience. A more consistent elaboration of strategies to promote the responsible conduct of research is warranted to minimize risk to populations that are vulnerable and express concerns regarding the loss of privacy. Finally, an examination of the unanticipated consequences of MCF is critical for the development of future interventions to optimize existing supports while providing needed supports, financial and nonfinancial, that are lacking.

Push and pull factors influencing the choice of a health resort by Polish treatment-seekers.

BACKGROUND: The objective of the study was to indicate social and psychological (inner) motives associated with the desire and needs of travelling to health resorts (push) as well as external motives resulting from destination's attributes, and explaining the choice of the health tourism establishment (pull) by Polish treatment-seekers divided into two social groups: persons in employment and retired persons. The research hypothesis assumed the two groups of people differ very much in terms of preferences motivating them to participate in health resort tourism, destination choices and services offered by health resort establishments. METHODS: Of the 258 health resorts, 154 establishments were selected for research purposes taking into account a proportional distribution of health resorts throughout Poland. An authorial questionnaire was developed and it included three questions with multiple answers, each answer being assessed on a 5-point Likert scale. The research adds new insights by analysing motives associated with health resort tourism in terms of benefits sought by visitors. The main and strongest motive for choosing health resort tourism is concern for health. In addition to old age pensioners, it was legitimate to analyse the group of employed respondents as their stays at a health resort are undertaken to regain not only physical fitness but also work motivation. RESULTS: The present study has demonstrated that motives and age groups have a significant effect on destination choice. Based on the results, it can be concluded that these groups often have diverse needs, expectations and, as a result, motives for choosing this form of tourism and a given health resort. What follows is a possibility of dividing the visitors to health resorts in terms of push and pull motives. CONCLUSIONS: The research hypothesis assuming the two groups varied considerably in terms of preferences motivating them to participate in health resort tourism, destination selection and choice of services offered by the health resort establishment has been confirmed. The ramifications of the study's findings may also be relevant for health resort/spa tourism outside of Poland because healthy lifestyle promotion is a worldwide trend.

Investigating the quality of Iranian hospitals' websites and their association to the Province's share of medical tourism.

BACKGROUND: Nowadays, virtual methods are among the most important and influential marketing instruments in various industries, such as medical tourism. This study aims to investigate the quality of Iranian hospitals' web pages and their association with the province's share of the medical tourism industry in Iran and the ownership type of hospitals. METHODS: In this analytical cross-sectional study, the quality of hospitals' websites was investigated through a 36-item self-administered questionnaire which was validated, and its reliability was verified (Cronbach's alpha = 74%.). The questionnaire was categorized into three sections: hospital services and facilities, hospital's medical tourism-related services, and tourism information of the destination province. The census method was used for data collection. Data analysis was performed using the independent t-test and analysis of variance in SPSS software (version 25), and a P-value < 0.05 was considered statistically significant. RESULTS: A total of, 102 hospitals with an IPD (International Patients Department) were included in the study, and 21.6% did not have an English-language page and were excluded from the study. The mean total score was 47 ± 7.5, indicating low-quality content. Public hospitals had lower quality scores than semi-private and private hospitals. The total quality score, information about the hospital and its services, and the score of information about medical tourism-related services were associated with the province's share of national medical tourism. CONCLUSION: According to the obtained results and the possible role of website quality in increasing provinces' medical tourism development, the IPD page on hospital websites should be revised and regularly updated to make them more informative for prospective medical tourists.