Crowding en de toeristische belevingswaarde in een stedelijke omgeving: een structural equation modeling benadering

Draagkracht is een multidimensionaal concept, onlosmakelijk verbonden met de noties van duurzame ontwikkeling. Terwijl een overvloed van studies zich reeds concentreerde op ecologische en economische draagkracht, heeft de socio-demografische component tot nog toe slechts beperkte aandacht gekregen. Deze paper tracht een lacune op te vullen door de impact te bestuderen van andere toeristen op de toeristische belevingswaarde en dit in een urbane omgeving. De impact van het gebruiksniveau op de beleving wordt over het algemeen geoperationaliseerd door gebruik van het concept ‘crowding’, daarbij impliciet veronderstellend dat dit woord een negatieve connotatie inhoudt. Crowding wordt dan gezien als de schending van een persoonlijke norm, automatisch leidend tot negatieve gevoelens. Deze paper toont echter aan dat crowding niet noodzakelijk verbonden is met een afnemende toeristische belevingswaarde. Allereerst wordt het concept door middel van structural equation modeling gerelateerd aan een set variabelen waarvan wordt verondersteld dat ze de perceptie van het gebruiksniveau beïnvloeden. Dit leidt tot de ontwikkeling van een verbeterd crowding model. De resultaten bevestigen de grotendeels psychologische constructie van de perceptie van crowding. Het effect van het gedrag van andere toeristen, de attitude ten overstaan van andere culturen, de reisreden en de eerdere reiservaring blijken een veel grotere uitwerking op het gepercipieerde gebruiksniveau te hebben dan de situationele karakteristieken van de bestemming. De invloed van deze laatste eigenschappen kan hooguit marginaal genoemd worden. Het aantal bezoekers ter plaatse vertoont zelfs geen significante impact, wat de conclusie bevestigt dat kwaliteit, veel meer dan kwantiteit, bepalend is in de beoordeling van een bepaald gebruiksniveau. De relatie tussen crowding en belevingswaarde tenslotte blijkt significant negatief te zijn, waarbij de beleefde situatie minder positief wordt ervaren wanneer een hoger crowding niveau wordt gepercipieerd. Deze correlatie kan echter voornamelijk toegeschreven worden aan het verschil tussen het geprefereerde en gepercipieerde gebruiksniveau.status: publishe

Management practices for postdural puncture headache in obstetrics: a prospective, international, cohort study

Peer reviewe

Acute dietary protein intake restriction is associated with changes in myostatin expression after a single bout of resistance exercise in healthy young men.

Skeletal muscle satellite cells (SCs) play an important role in the myogenic adaptive response to exercise. It remains to be established whether nutrition plays a role in SC activation in response to exercise. In the present study, we assessed whether dietary protein alters the SC response to a single bout of resistance exercise. Twenty healthy young (aged 21 +/- 2 y) males were randomly assigned to consume a 4-d controlled diet that provided either 1.2 g protein kg body weight-1 d-1 [normal protein diet (NPD)] or 0.1 g protein kg body weight-1 d-1 [low protein diet (LPD)]. On the second day of the controlled diet, participants performed a single bout of resistance exercise. Muscle biopsies from the vastus lateralis were collected before and after 12, 24, 48, and 72 h of post-exercise recovery. SC content and activation status were determined using immunohistochemistry. Protein and mRNA expression were determined using Western blotting and reverse transcription polymerase chain reaction. The number of myostatin + SCs decreased significantly at 12, 24, and 48 h (range, -14 to -49%; P < 0.05) after exercise cessation, with no differences between groups. Although the number of myostatin + SCs returned to baseline in the type II fibers on the NPD after 72 h of recovery, the number remained low on the LPD. At the 48 and 72 h time points, myostatin protein expression was elevated (86 +/- 26% and 88 +/- 29%, respectively) on the NPD (P < 0.05), whereas it was reduced at 72 h (-36 +/- 12% compared with baseline) in the LPD group (P < 0.05). This study demonstrates that dietary protein intake does not modulate the post-exercise increase in SC content but modifies myostatin expression in skeletal muscle tissue. This trial was registered at clinicaltrials.gov as NCT01220037

Management practices for postdural puncture headache in obstetrics: a prospective, international, cohort study

Background: Accidental dural puncture is an uncommon complication of epidural analgesia and can cause postdural puncture headache (PDPH). We aimed to describe management practices and outcomes after PDPH treated by epidural blood patch (EBP) or no EBP. Methods: Following ethics committee approval, patients who developed PDPH after accidental dural puncture were recruited from participating countries and divided into two groups, those receiving EBP or no EBP. Data registered included patient and procedure characteristics, headache symptoms and intensity, management practices, and complications. Follow-up was at 3 months. Results: A total of 1001 patients from 24 countries were included, of which 647 (64.6%) received an EBP and 354 (35.4%) did not receive an EBP (no-EBP). Higher initial headache intensity was associated with greater use of EBP, odds ratio 1.29 (95% confidence interval 1.19–1.41) per pain intensity unit increase. Headache intensity declined sharply at 4 h after EBP and 127 (19.3%) patients received a second EBP. On average, no or mild headache (numeric rating score≤3) was observed 7 days after diagnosis. Intracranial bleeding was diagnosed in three patients (0.46%), and backache, headache, and analgesic use were more common at 3 months in the EBP group. Conclusions: Management practices vary between countries, but EBP was more often used in patients with greater initial headache intensity. EBP reduced headache intensity quickly, but about 20% of patients needed a second EBP. After 7 days, most patients had no or mild headache. Backache, headache, and analgesic use were more common at 3 months in patients receiving an EBP

Management practices for postdural puncture headache in obstetrics: a prospective, international, cohort study

© 2020 British Journal of AnaesthesiaBackground: Accidental dural puncture is an uncommon complication of epidural analgesia and can cause postdural puncture headache (PDPH). We aimed to describe management practices and outcomes after PDPH treated by epidural blood patch (EBP) or no EBP. Methods: Following ethics committee approval, patients who developed PDPH after accidental dural puncture were recruited from participating countries and divided into two groups, those receiving EBP or no EBP. Data registered included patient and procedure characteristics, headache symptoms and intensity, management practices, and complications. Follow-up was at 3 months. Results: A total of 1001 patients from 24 countries were included, of which 647 (64.6%) received an EBP and 354 (35.4%) did not receive an EBP (no-EBP). Higher initial headache intensity was associated with greater use of EBP, odds ratio 1.29 (95% confidence interval 1.19–1.41) per pain intensity unit increase. Headache intensity declined sharply at 4 h after EBP and 127 (19.3%) patients received a second EBP. On average, no or mild headache (numeric rating score≤3) was observed 7 days after diagnosis. Intracranial bleeding was diagnosed in three patients (0.46%), and backache, headache, and analgesic use were more common at 3 months in the EBP group. Conclusions: Management practices vary between countries, but EBP was more often used in patients with greater initial headache intensity. EBP reduced headache intensity quickly, but about 20% of patients needed a second EBP. After 7 days, most patients had no or mild headache. Backache, headache, and analgesic use were more common at 3 months in patients receiving an EBP

Management practices for postdural puncture headache in obstetrics : a prospective, international, cohort study

Background: Accidental dural puncture is an uncommon complication of epidural analgesia and can cause postdural puncture headache (PDPH). We aimed to describe management practices and outcomes after PDPH treated by epidural blood patch (EBP) or no EBP. Methods: Following ethics committee approval, patients who developed PDPH after accidental dural puncture were recruited from participating countries and divided into two groups, those receiving EBP or no EBP. Data registered included patient and procedure characteristics, headache symptoms and intensity, management practices, and complications. Follow-up was at 3 months. Results: A total of 1001 patients from 24 countries were included, of which 647 (64.6%) received an EBP and 354 (35.4%) did not receive an EBP (no-EBP). Higher initial headache intensity was associated with greater use of EBP, odds ratio 1.29 (95% confidence interval 1.19-1.41) per pain intensity unit increase. Headache intensity declined sharply at 4 h after EBP and 127 (19.3%) patients received a second EBP. On average, no or mild headache (numeric rating score <= 3) was observed 7 days after diagnosis. Intracranial bleeding was diagnosed in three patients (0.46%), and backache, headache, and analgesic use were more common at 3 months in the EBP group. Conclusions: Management practices vary between countries, but EBP was more often used in patients with greater initial headache intensity. EBP reduced headache intensity quickly, but about 20% of patients needed a second EBP. After 7 days, most patients had no or mild headache. Backache, headache, and analgesic use were more common at 3 months in patients receiving an EBP