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It is often asked what are the dominant and major players in the provision of medical and hospital services in the “medical tourism” industry to provide these services to “medical tourists”.

The major players in this market and the effective marketing of offshore medical services are Argentina , Brazil , Costa Rica , India or course , Malaysia , Mexico ( proximity to the United States and major markets , with a fair amount of seniors present - states such as Texas, Nevada , Arizona and California) , Panama , the Philippines ( especially to Asian medical consumers such as Japan and S. Korea) , South Africa , Thailand and Turkey.

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After suffering through decades of bra-cup envy, those with diminutive décolletages in their late teens and early 20s may enjoy a lower risk of developing type 2 diabetes later in life than their fuller-chested counterparts  or at least, that’s what a new study suggests.

But many doctors caution that the conclusions of this new research may have more to do with obesity  therefore bigger breasts  than they do with breast size alone.

Researchers at Harvard University and the University of Toronto surveyed 92,106 women who participated in the Nurses’ Health Study, asking each of the participants to recall her bra size at the age of 20. The average age of the women participating in the study was 38.

Results showed that, compared with women who recalled having an A cup or smaller at the age of 20, women who recalled having a D cup or larger had about three times higher risk for developing type 2 diabetes.

The results also showed that women who reported wearing B cup and C cup bras experienced a higher risk for the development of diabetes than women who wore an A cup  even after figuring in age, body mass index (BMI), waist circumference, eating habits, family history of diabetes, physical activity level and pregnancies.

The findings were published Monday in the Canadian Medical Association Journal.

Although researchers involved with the study said it’s still unclear how breast size could be tied to diabetes risk, lead study investigator Dr. Joel Ray, an assistant professor and clinician scientist in the division of endocrinology and metabolism at the University of Toronto, believes the correlation has something to do with how breasts develop during puberty.

“Breast development is a hallmark of puberty, and we know the onset of puberty occurs earlier in obese girls,” Ray explained. “But in addition to puberty and breast development beginning earlier [in obese girls], we believe the overall effect of it may be more pronounced as well, in the sense that overall net production of breast is greater.”

Supporting this idea is the fact that puberty, in addition to being a time for breast development, is also a period marked by raised insulin resistance, which corresponds with the infamous middle school growth spurt.

Ray said that just as breast development is both accelerated and more pronounced in obese girls, so may be their levels of insulin resistance  a cornerstone for the development of type 2 diabetes.

However, many experts remain unconvinced of the study’s findings and question why they should be asked to abandon the tried-and-true methods of evaluating patients’ type 2 diabetes risk simply by calculating their BMIs and evaluating their lifestyles.

“In reality, obesity is a major determinant of risk for diabetes,” said Dr. Lewis Kuller, professor and chair in the department of epidemiology at the University of Pittsburgh. “Breast size, generally, is highly correlated with body size and body fatness, since what you’re storing in the breast is mainly fat tissue.”

And in light of this, Kuller said, breast size may simply tell us something we already know about diabetes risk.

“It’s not like we don’t already have a measure for how fat someone is,” he added. “You can tell just by looking in the mirror. You’re not gaining some new knowledge from evaluating your breast size 20 years ago that you couldn’t already predict just by looking in the mirror.”

Other diabetes researchers agreed. Body fat “is strongly associated with diabetes. If breast size is simply measuring fatness, this finding is not particularly interesting,” said Dr. Roberta Ness, chair of the department of epidemiology at the University of Pittsburgh.

Predictor… or Punch Line?

“My first impression is that this [study] is silly and likely to become a punch line on the Tonight Show,” said Dr. David Nathan, director of the diabetes center and general clinical research center at Massachusetts General Hospital. “However, after more serious consideration, I would note that there are likely… other factors that may explain the association [between breast size and diabetes risk].”

The first problem identified by Nathan was the fact that although researchers attempted to control for the body mass and waist size of the participants, most experts believe these risk factors are so central to predicting diabetes risk that no amount of statistical adjusting could account for their impact.

Dr. Charles Clark, director of the diabetes collaborating center for continuing health professional education at Indiana University in Indianapolis, Ill., said that in comparison to BMI and waist circumference  two of the most important risk factors for diabetes, according to the American Diabetes Association (ADA)  breast size as a factor in diabetes risk is “not very important.”

“Factors to consider that are much more predictive [of diabetes risk] can be found at the ADA web page,” said Clark.

Nathan also said that responses of study participants in recalling their bra sizes from decades ago and in estimating their body fat at the ages of five and 10 were bound to be “soft and not very reliable.”

Even Ray echoed Nathan’s concerns about how data was collected and interpreted in the study.

“Some of these risk factors, like BMI and waist circumference, we made adjustments for, but does that really mean that breast size is an independent predictor of diabetes risk? I think we can still be challenged on that even though we showed it in these models,” Ray said.

Not Ready for Practice

Because breast size is also determined by many factors unrelated to diet and metabolic rate  such as genetic and environmental factors  some doctors believe that examining bra size is a clinical waste of time.

“Breast size is determined by a number of genetic and environmental factors,” Clark said. “Because it is related to age at [first menstruation] and pre-pubertal growth rates that are also important determinates of obesity, breast size is probably a surrogate for the presence of obesity or the predilection to become obese.”

However, lead study author Karin Michels, co-director of the obstetrics and gynecology epidemiology center at Brigham and Women’s Hospital in Boston, Ma., said that because they controlled for the participants’ BMI levels as accurately as possible, their results reveal an “additional marker over and above obesity to predict risk for diabetes.”

But Michels stopped short of recommending that doctors begin to examine a young woman’s breast size as a possible indicator of future diabetes risk.

“Whether this may translate into a practical or clinical measure, I would be cautious in making that conclusion,” Michels said.

Moreover, Ray expressed concern that female patients might get unnecessarily worked up about the study’s findings.

“I’m concerned about overemphasis of this study or a physician applying it in practice,” Ray said.

“Women might get very worked up about the relation of their breast size to diabetes risk when we don’t have a substantial body of evidence to show that link.”

http://abcnews.go.com/print?id=4204203

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Costa Rica has been a popular destination for dental and cosmetic surgery since as far back as the early 1980’s . Now a number of locally well known hospitals are seeking to develop their medical tourism volumes and capitalize on these market with both products , services and marketing.

Two hospitals in particular, Clinica Biblica and CIMA Hospital are among the forerunners in developing this market. Indeed the Clinic Biblica Hospital complex are working towards a plan for setting aside an entire hospital wing for medical tourism.

While the countries pristine beaches may be the overall biggest draw for the overall tourist traffic. Among the main draws of Costa Rica in terms of its tourist marketing strengths are Costa Rica’s closeness to North America and its relatively inexpensive cost of care and medical industry labor costs.

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The economic dynamo and prosperity that has become South Korea has propelled the images of Korean beauty as well.

To that point foreign medical tourists are viewing South Korea as a prime Cosmetic surgery center of excellence and renown. The popularity of anything Korean as become known as the “Korean Wave” which is sweeping across Asia. What has sown the movement and the image are the images of South Korean pop culture being spread via satellite , tv , dvd and computer games. All include a good measure of the flawlessly chiseled features of the characters of well known and distributed South Korean “Soap Operas”.

South Korea with its dynamic industrial economy as well as exceptional marketing expertise will certainly grow and thrive in this industry. The culture as well integrates well with cosmetic surgery. South Koreans do not seem averse to either the pain involved or fear of adverse reactions to cosmetic surgery and its ordeals. There are approximately 1500 plastic surgeons in Seoul ( the capital of South Korea) alone.

Many foreign tourists are planning to come to South Korea as a result of South Korea’s reputation of high quality plastic surgery practice and plastic surgery technology.

The “Korean Wave” have been instrumental in spreading the image of Korean beauty, which in turn stimulated the boom in aesthetic medical tourism.

Interestingly enough a flow of patients from China and Southeast Asia who request operations to make them look similar to well known South Korean actresses.

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Physicians are also noting an increase of travel to areas of higher risks which require more and more as well as more immunization and immunizations schedules. For example not only is pleasure travel increasing to more exotic areas but also groups such as NGO’s and the Peace Corps are increasingly traveling to these far flung areas. What is interesting is that the health threats and the protections necessary are entirely different than for travelers to such areas as Asia or South America.

The most common travel immunizations generally required are for typhoid and hepatitis A. The commercial product Twinrix is generally recommended in such situations. It affords both coverage of Hepatitis A and Hep B. On the cautious side diseases can well change their yearly schedules and / or geographic locations covered so that it never hurts to remain on the cautious side as well as a constant monitoring of changing conditions as well as incidence. It is recommended to always stay current on the latest medical geographic news, reports and trends.

In addition it is always wise to check the status of your coverage for the more basic diseases afforded coverage by shots - dipththeria , mumps, measles and rubella. Travellers should research their destinations and as well inquire of their physicians as well at least 6 - 8 weeks before leaving on their travels. It may even be a worse case scenario of getting immunized even after arriving back , if new threats have developed in the interim. Some coverage may be afforded this way as well.

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Taking care ,goes a long way as well when you are on a vacation - or indeed or on a medically related trip - vacation or not , medical tourism is after all a trip - and perhaps even a vacation in itself. Some useful tips and practices that indeed may go a long way for guarding against negative forces and mishaps along the way. Heavy , overpacked baggage can be one of the biggest contributors to shoulder , neck as well as back injuries. You should only pack what you need for your medical tourism tourist trip. After all health and maintenance of good health , as well as posture are the reasons that you are traveling in the first place. It is best practice always to avoid twisting your body. In the case of hand luggage , a back pack can be tried to distribute weight evenly over both shoulders as well as freeing up your hands. Another good tactic and practice is to push rather than pull luggage. Wheels on baggage can also save and prevent a fair amount of difficulties and problems as well. Back pain can be the result of sitting for long periods of time in improper ergonomic situations/ Stretches can be done , either preventedly or on the spot. Airplane trips are the best widely known and appreciated of such situations. However long auto trips as well as train rides can do the same. Cervical pillows and lumbar belts can be useful adjuncts in this manner. Treatments and stretch exercises can be done along the journey or at the end destination. A good regime for treating an effected area is alternating ten minutes of ice and heat. Combine this as well with light stretching. In addition fatigue itself can result in such injuries . Since of course travel cam be a high stress time of sleeplessness and muscle tension. All in all . plan ahead , plan a simple route , and plan ahead.

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Often patients get very frustrated waiting in medical treatment queues. Who needs this they say. On top of this the mental turmoil of waiting in the medical treatment queue can cause needless mental turmoil and much worse patient treatment outcomes.

However in some cases the medical insurance administration will refuse to pay costs for overseas or out of country medical treatment - deeming that such treatment is “unnecessary” , “not essential” or even a vacation by the patient.

I t can often be said that medical insurance administraters see them themselves not as providing essential levels of medical care but rather as parcelers out or controllers and allocaters of limited resources. On top of that as the resources become less and less even more medical administration is needed , not less , ” to dole out the limited resources”.

However a U.K. woman has won a three year legal battle with her local medical insurance agency to force the local NHS Health Trust to pay for her medical treatment abroad- an enforced reversal of their stated judgement.

This decision and judgment can well form the basis of precedents of further claims for medical tourism treatment costs , especially in daunting potential life threatening illnesses - such as cancer - where time is of the greatest essence.

In this case the patient was told that the time frame for a simple scan of her back would be approximately one year.

T he patient picked up and had the relatively simple procedure done at a private clinic in another E.U. country. Attempting reimbursement for the approximately $ 700 scan - the claim was refused , resulting in a three to four year legal battle.

In the end the NHS Health Care Trust relented and agreed to pay both legal and medical costs.

Thus a precedent has been set in both medical , legal and medical tourism venues.

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The question is often asked - should I purchase extra travel insurance if my charge card offers travel insurance - often at no cost.

It never hurts to be careful and cautious. The costs of travel for medical care are not small. Often you we will be traveling to non tourist spots at off peak - but high travel costs.

It is not as if you can pick your time of illness or treatment. During peak tourist seasons a traveller can often pick up deals on charter flights and lodgings. Not so in many cases of medical tourism. On top of that your return may be delayed due to complications or delays in treatment. That charter flight with its deal price is not going to sit on the runway for you , or your loved one who is seeking medical treatment abroad.

Often your air tickets may be non refundable as well. Cancellation and interruption travel insurance may be more than a good idea. Does you charge card insurance cover it . Do a thorough job of research. It is best to do the original insurance contract . This may be available online freely or you may have to ask the credit card company for it - this can be done by a toll free number or mail. Best to stay away from the glossy brochures that you will find at your financial institution - they may not comprehensive or legally binding. For valid legal reasons it is always best to go to the actual contract .

One last point. Often travel insurance does not cover ” preexisting conditions”. For example if you or your loved one is travelling for cardiac treatment and you run into problems or delays due to treatment for the cardiac conditon, then under these clauses the insurance company can deem the illness as preexisting and therefore not have to pay you for the claim to reimburse the extra airfare you incur.

It is always best to ask beforehand . As well receive all answers in writing . Retain these documents in a safe place for ready access.

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The primary concern in medical tourism is usually the patient and their health concerns. One should remember that other members of the traveling party or family may fall ill on the travels. As well the initial patient themselves may acquire other health concerns and problems on their travels along with the medical tourist.

Believe it or not the first concern is overpacking. It is not only a question of size that is within airport and airline regulations but also the physical weight of the baggage. I am sure you have seen many husbands trying valiantly to carry their wife’s baggage in the airport settings. It is best to pack only what you will need - and then cut out 25 to 30 %. When lifting the bags - do not shy from using porters where possible and as well either purchase luggage with built in wheels or purchase a foldable trolley. One of mankind’s major inventions were the wheel and the fulcrum. Why not use to your ease and advantage - in addition to preventing further health problems.

If you do have to pick up and carry bags and luggage - try to avoid twisting and rotating motions to your body.

I f you do have hand luggage - then a backpack will work wonders not only to free your hands bu also to distribute the weight of the hand luggage across your back. Lastly if you can push rather than pull your luggage and bags that is preferable.

The patient should always hand carry at least a week supply of their medication and medications in their hand luggage - not checked into baggage. The medication that is essential to maintain your stabilized level of health may be brand or dose specific at your destination or along the way. The same medication from the same manufacturer , even if available , may have an entirely different name and then different strengths and even color presentation than what you are used to. Even if you have an extra prescription from your doctor, the local pharmacy and medical laws from the local colleges and enforcement bodies may not allow your prescription to be filled with your medication. Your weeks worth of pills, in your hand luggage , on hand will tide you over until your lost baggage is found or another source of medication is determined and available to you.

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