Medical tourism in the Caribbean

Although travel for medical reasons has a long history, it has more recently evolved from a cottage industry to a worldwide enterprise. A number of countries are positioning themselves to attract visitors who are willing to travel to obtain health services that are more accessible, less expensive, or more available than in their countries of origin. This has in turn given rise to medical packages that combine tourism with health. Several Caribbean nations - including Cuba, Barbados, Jamaica, and Puerto Rico - hope to expand their revenues in this new market. Each country has selected specific service niches and promotes its services accordingly. While Cuba has been promoting its services to other countries for several decades, medical tourism is just beginning in the other islands. Ultimately, these nations' economic success will hinge on their comparative advantage vis-à-vis other options, while their success in terms of improving their own health care depends on the extent to which the services for tourists are also available to the islands' populations.     

Externalities,Prospect Theory,and Social Construction: When Will Government Act,What Will Government Do?*

Objectives. Political theories of agenda setting and policy choice are still limited in predicting when an issue will become salient and, once it has, what policy option will be used to address it. This article illustrates that for a large class of externality problems, perspectives from three other social science disciplines can refine those predictions. Methods. A synthesis of implications from economics on assignment of property rights, loss aversion from prospect theory, and image of the policy target from social construction is used to determine the conditions under which issues gain attention and the likely policy solutions. Results. Assignment of property rights establishes a baseline used to assess any further government actions, with losses from that base more likely to generate political attention. The assignment of rights also determines if a problem is defined as a negative or positive externality, which restricts the type of policies used to address the problem. This initial allocation of rights is in turn affected both by the political power and social construction of the groups involved. Conclusions. The result is a bias in policy attention and outcomes strongly influenced by the norms used in assignment of property rights, which typically favor those generating the negative externality.     

The Melanoma Patient Exchange: Insights from a Supportive Group Intervention for Melanoma Patients and their Caregivers

Melanoma is one of the fastest growing cancers worldwide, and the psychosocial impact of its diagnosis and treatment can be substantial. The authors implemented a support group for melanoma patients and caregivers to address a gap in support services. The authors describe insights from the first year of the program, including group format and dynamics, participant feedback, and satisfaction. Feedback was collected using the Group Session Rating Scale and two open-ended questions. Sixty-six members participated and responses demonstrated high satisfaction with the group (Mean = 38.7/40.0). Similar organizations may utilize these strategies to provide a support group option for their population of interest.     

Body Movement Is Associated With Orgasm During Vaginal Intercourse in Women

Very few studies have investigated the relationship between women’s ability to experience an orgasm during vaginal intercourse and specific stimulation techniques. We examined two common techniques during vaginal intercourse both with and without simultaneous external clitoral stimulation: (1) body movement, in particular back-and-forth swinging movements of the pelvis and trunk; and (2) precise rubbing of the clitoris with an immobilized body. Structural equation modeling was used to compare the effects of the two stimulation techniques on women’s orgasm frequency (N = 1,239). As hypothesized, the frequency of orgasm during vaginal intercourse with simultaneous clitoral stimulation was positively associated with a preference for body movement during arousal. Body movement, as opposed to body immobilization, was also associated with a higher frequency of orgasm during vaginal intercourse without simultaneous clitoral stimulation. We conclude that body movement is associated with more orgasms during vaginal intercourse, whereas precise rubbing of the clitoris with an immobilized body is not associated with more orgasms. Teaching women to move their pelvis and trunk in a swinging back-and-forth movement during vaginal intercourse might therefore facilitate reaching an orgasm, whereas encouraging them to self-stimulate the clitoris might be less helpful if done with an immobilized body.     

A meso-level conceptualization of CEO celebrity effectiveness

The concept of celebrity has the potential to expand traditional views of leadership by suggesting that, with the aid of the media, firms and CEOs can surpass their peers and develop marketable personas of their own. However, the research, to date, has focused on the emergence of CEO celebrity, rather than the critical question of how CEOs translate their celebrity into personal and firm-related success. The present paper addresses this issue by articulating a meso-level conceptualization focused on the role of CEO political skill in the conversion of celebrity to reputation and performance at the individual and firm levels of analysis. Implications of the proposed conceptualization and directions for future research are discussed.     

Reanalysis of Dose-Response Data from the Iraqi Methylmercury Poisoning Episode

Applying a hockey stick parametric dose-response model to data on late or retarded development in Iraqi children exposed in utero to methylmercury, with mercury (Hg) exposure characterized by the peak Hg concentration in mothers'hair during pregnancy, Cox et al. calculated the "best statistical estimate" of the threshold for health effects as 10 ppm Hg in hair with a 95% range of uncertainty of between 0 and 13.6 ppm.⁽¹⁾A new application of the hockey stick model to the Iraqi data shows, however, that the statistical upper limit of the threshold based on the hockey stick model could be as high as 255 ppm. Furthermore, the maximum likelihood estimate of the threshold using a different parametric model is virtually zero. These and other analyses demonstrate that threshold estimates based on parametric models exhibit high statistical variability and model dependency, and are highly sensitive to the precise definition of an abnormal response. Consequently, they are not a reliable basis for setting a reference dose (RfD) for methylmercury. Benchmark analyses and statistical analyses useful for deriving NOAELs are also presented. We believe these latter analyses—particularly the benchmark analyses—generally form a sounder basis for determining RfDs than the type of hockey stick analysis presented by Cox et al. However, the acute nature of the exposures, as well as other limitations in the Iraqi data suggest that other data may be more appropriate for determining acceptable human exposures to methylmercury.     

Correlation Between Carcinogenic Potency of Chemicals in Animals and Humans

Twenty-three chemicals were selected for comparison of the carcinogenic potencies estimated from epidemiological data to those estimated from animal carcinogenesis bioassays. The chemicals were all those for which reasonably strong evidence of carcinogenicity could be found in humans or animals and for which suitable data could be obtained for quantifying carcinogenic potencies in both humans and animals. Many alternative methods of analyzing the bioassay data were investigated. Almost all of the methods yielded potency estimates that were highly correlated with potencies estimated from epidemiological data; correlations were highly statistically significant (p less than 0.001), with the corresponding correlation coefficients ranging as high as 0.9. These findings provide support for the general use of animal data to evaluate carcinogenic potential in humans and also for the use of animal data to quantify human risk.     

Mediterranean Back and Other Stereotypes: A Review of the Australian Literature Dealing with Industrial Back Injuries

This paper analyses the attitudes to migrants evident in much of the Australian literature dealing with industrial back injuries. Both medical and lay writers believe that migrants, especially those from Southern Europe, are over-represented among patients complaining of occupationally induced back pain. It is also widely believed that migrants are more prone than Australian born workers to malingering and psychosomatic complications of back injury. However no firm statistical evidence for this viewpoint was discovered. Three small studies which tend to refute it are discussed.