Sostenibilitat i modalitats turístiques : una anàlisi de casos a Catalunya

El present article té com a objectiu exposar els resultats obtinguts de l'aplicació d'un sistema d'indicadors de sostenibilitat sociocultural, econòmica i ambiental en diferents municipis turístics de Catalunya (Salou, Naut Aran, Tarragona i Llavorsí). L'interès consisteix a avaluar la influència que exerceixen diferents modalitats turístiques (turisme de sol i platja, turisme de neu, turisme cultural i turisme d'esports d'aventura) en el grau de sostenibilitat turística dels municipis. Es tracta d'una aproximació metodològica a la identificació i quantificació d'impactes del turisme a escala local per valorar comparativament, a partir de l'anàlisi de casos, la sostenibilitat turística associada a cada modalitat.El presente artículo tiene como objetivo exponer los resultados obtenidos de la aplicación de un sistema de indicadores de sostenibilidad sociocultural, económica y ambiental en diferentes municipios turísticos de Cataluña (Salou, Naut Aran, Tarragona y Llavorsí). El interés consiste en evaluar la influencia que tienen diferentes modalidades turísticas (turismo de sol y playa, turismo de nieve, turismo cultural y turismo de deportes de aventura) en el grado de sostenibilidad turística de los municipios. Se trata de una aproximación metodológica a la identificación y cuantificación de impactos del turismo a escala local para valorar comparativamente, a partir del análisis de casos, la sostenibilidad turística asociada a cada modalidad.Cet article vise à présenter les résultats de la mise en place d'un système d'indicateurs de développement durable, sur les axes socioculturel, économique et environnemental, dans différentes communes touristiques de la Catalogne (Salou, Naut Aran, Tarragone et Llavorsí). L'intérêt est d'évaluer l'influence de certaines formes de tourisme (balnéaire, blanc, culturel et actif) sur le degré de durabilité touristique des communes.Il s'agit d'une approche méthodologique pour l'identification et la quantification des impacts du tourisme au niveau local, afin d'évaluer d'une façon comparative à partir des l'analyses de cas, la durabilité associée à chaque forme touristique.The aim of this paper is to present the results for the implementation of a set of indicators of social-cultural, economical and environmental sustainability in different municipalities of Catalonia (Salou, Naut Aran, Tarragona and Llavorsí). The main focus is to evaluate how different tourist modalities (sun and beach tourism, snow tourism, cultural tourism and adventure sport tourism) influence the local tourist sustainability. This is a methodological approach to identify and quantify the tourism impacts at local level to assess comparatively, through case analysis, the level of tourist sustainability associated with each modality

Planificación turística y desarrollo territorial sostenible en el Pirineo catalán. El caso del Valle de Camprodon

XII Coloquio de Geografía del Turismo, Ocio y Recreación de la Asociación de Geógrafos Españoles. Colmenarejo (Madrid), del 17 al 19 de junio de 2010.Este trabajo se inscribe en el Proyecto de investigación CS02008-03315/GEOG, titulado Nuevo turismo y desarrollo territorial sostenible: análisis y evaluación de la intensificación y extensión espacial del turismo en la Cataluña interior, financiado por el Ministerio de Ciencia e Innovación; y en el marco del Grup de Recerca d'Anàlisi Territorial i Desenvolupament Regional (ANTERRIT) (Pla de Recerca de Catalunya, Generalitat de Catalunya)Publicad

Procalcitonin and C-reactive protein to rule out early bacterial coinfection in COVID-19 critically ill patients.

Purpose Although the prevalence of community-acquired respiratory bacterial coinfection upon hospital admission in patients with coronavirus disease 2019 (COVID-19) has been reported to be < 5%, almost three-quarters of patients received antibiotics. We aim to investigate whether procalcitonin (PCT) or C-reactive protein (CRP) upon admission could be helpful biomarkers to identify bacterial coinfection among patients with COVID-19 pneumonia. Methods We carried out a multicentre, observational cohort study including consecutive COVID-19 patients admitted to 55 Spanish intensive care units (ICUs). The primary outcome was to explore whether PCT or CRP serum levels upon hospital admission could predict bacterial coinfection among patients with COVID-19 pneumonia. The secondary outcome was the evaluation of their association with mortality. We also conducted subgroups analyses in higher risk profile populations. Results Between 5 February 2020 and 21 December 2021, 4076 patients were included, 133 (3%) of whom presented bacterial coinfection. PCT and CRP had low area under curve (AUC) scores at the receiver operating characteristic (ROC) curve analysis [0.57 (95% confidence interval (CI) 0.51–0.61) and 0.6 (95% CI, 0.55–0.64), respectively], but high negative predictive values (NPV) [97.5% (95% CI 96.5–98.5) and 98.2% (95% CI 97.5–98.9) for PCT and CRP, respectively]. CRP alone was associated with bacterial coinfection (OR 2, 95% CI 1.25–3.19; p = 0.004). The overall 15, 30 and 90 days mortality had a higher trend in the bacterial coinfection group, but without significant difference. PCT ≥ 0.12 ng/mL was associated with higher 90 days mortality. Conclusion Our study suggests that measurements of PCT and CRP, alone and at a single time point, are not useful for ruling in or out bacterial coinfection in viral pneumonia by COVID-19.post-print1177 K

Thoughts on Spanish urban tourism in a post-pandemic reality: challenges and guidelines for a more balanced future

Purpose – This study aims to identify the challenges faced by urban destinations in Spain in the current transitional stage towards a new reality of tourism, caused by the outbreak of COVID-19 and the ongoing global changes in the tourism industry. Design/methodology/approach – An extensive literature review and an analysis of current debates were conducted to identify the different factors that have influenced the recent tourism phenomenon and the development of destinations on a global, regional-national and local-urban scale. Findings – Four main challenges are identified, including the new mobility patterns of the population; information and communication technologies and the digitalisation process in urban and tourism management; sustainability, as a factor of the competitiveness, stability and viability of urban destinations; and governance in urban destinations. Originality/value – The study’s findings provide valuable insights for urban destination managers to make informed decisions and adapt to the new reality of tourism.This paper has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska Curie grant agreement No 890281; and from the EU’s programme Horizon 2020 under the grant agreement No 870753 Project title: Cities as mobility hubs: tackling social exclusion through “smart” citizen engagement (SMARTDEST)

Gestión sostenible de destinos turísticos: la implementación de un sistema de indicadores de turismo en los destinos de la provincia de Barcelona

El artículo se centra en el diseño e implementación de indicadores de turismo para la gestión sostenible de los destinos, en el marco de un proyecto aplicado en colaboración entre la Universidad de Barcelona y la Diputación de Barcelona. Los objetivos son: a) Explicar las características del Proyecto, y en particular su fundamentación conceptual y metodológica; b) Presentar los resultados del Proyecto, concretamente sobre la aplicación del Índice de Sostenibilidad Turística (ISOST) y el Sistema Europeo de Indicadores de Turismo (SEIT); y c) Aportar un breve balance de los resultados y una reflexión sobre el uso de estos instrumentos

Modulation of phenolic metabolism under stress conditions in a Lotus japonicus mutant lacking plastidic glutamine synthetase

This paper was aimed to investigate the possible implications of the lack of plastidic glutamine synthetase (GS2) in phenolic metabolism during stress responses in the model legume Lotus japonicus. Important changes in the transcriptome were detected in a GS2 mutant called Ljgln2-2, compared to the wild type, in response to two separate stress conditions, such as drought or the result of the impairment of the photorespiratory cycle. Detailed transcriptomic analysis showed that the biosynthesis of phenolic compounds was affected in the mutant plants in these two different types of stress situations. For this reason, the genes and metabolites related to this metabolic route were further investigated using a combined approach of gene expression analysis and metabolite profiling. A high induction of the expression of several genes for the biosynthesis of different branches of the phenolic biosynthetic pathway was detected by qRT-PCR. The extent of induction was always higher in Ljgln2-2, probably reflecting the higher stress levels present in this genotype. This was paralleled by accumulation of several kaempferol and quercetine glycosides, some of them described for the first time in L. japonicus, and of high levels of the isoflavonoid vestitol. The results obtained indicate that the absence of GS2 affects different aspects of phenolic metabolism in L. japonicus plants in response to stress.España FEDER-Ministerio de Economía y Competitividad AGL2014-54413-REspaña Junta de Andalucía,Consejería de Economía, Innovación y Ciencia, P1O-CVI-6368España Junta de Andalucía,Consejería de Economía, Innovación y Ciencia, BIO-16

Primary care provision for young people with ADHD: A multi-perspective qualitative study

Background: Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder. United Kingdom (UK) guidance states primary care has a vital role in effective ADHD management including referral, medication prescribing and monitoring, and providing broader mental health and wellbeing support. However, many general practitioners (GPs) feel unsupported to provide healthcare for young people with ADHD. Inadequate healthcare is associated with rising costs for patients and society. Aim: To investigate the experiences of young people with ADHD accessing primary care in England, from the perspectives of people with lived experience of ADHD (LE), and healthcare professionals (HPs). Design and Setting: Qualitative interviews were conducted with HPs (GPs, practice mangers, and a wellbeing worker), and people with LE (young people aged 16-25, and their supporters) located in Integrated Care Systems, across England. Method: Semi-structured interviews were conducted with participants at five purposively selected general practices (varying by: deprivation, ethnicity, rural-urban setting). Questions focused on experiences of accessing/providing healthcare for ADHD. Reflexive thematic analysis was undertaken within a critical realist framework, to understand how provision works in practice and explore potential improvements. Results: Twenty interviews were completed with 11 HPs and 9 people with LE. Three themes were generated: a system under stress, incompatibility between ADHD and the healthcare system, and strategies for change. Conclusion: Standardisation of ADHD management in primary care, providing better information and support for HPs, and advising on reasonable adjustments for people with LE could help improve access to effective treatments for young people living with ADHD

Support for primary care prescribing for adult ADHD in England: national survey

Background: Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with effective pharmacological treatments that improve symptoms and reduce complications. NICE guidelines recommend primary care practitioners prescribe medication for adult ADHD under shared care agreements with adult mental health services (AMHS). However, provision remains uneven, with some practitioners reporting a lack of support. Aim: This study aimed to describe supportive elements (prescribing, shared care, AMHS availability) of primary care prescribing for adult ADHD medication in England, to inform service improvement and improve access for this underserved population. Design and Setting: Three interlinked cross-sectional surveys asked every integrated care board (ICB) in England (Commissioners), and convenience samples of healthcare professionals (HP) and people with lived experience (LE), about elements supporting pharmacological treatment of ADHD in primary care. Method: Descriptive analyses used percentages and confidence intervals to summarise responses by stakeholder group. Variations in reported provision and practice were explored and displayed visually using mapping software. Results: Data from 782 respondents (42 Commissioners; 331 HP; 409 LE) revealed differences in reported provision by stakeholder group, including for prescribing (94.6% of HP vs 62.6% of LE). Over 40% of respondents reported extended AMHS waiting times of two years or more. There was some variability by NHS region, for example London had highest rates of HP reported prescribing (100%), and lowest reported extended waiting times (25.0%). Conclusion: Elements supporting appropriate shared care prescribing of ADHD medication via primary care are not universally available in England. Co-ordinated approaches are needed to address these gaps

Impact of HLA Mismatching on Early Subclinical Inflammation in Low-Immunological-Risk Kidney Transplant Recipients

The impact of human leukocyte antigen (HLA)-mismatching on the early appearance of subclinical inflammation (SCI) in low-immunological-risk kidney transplant (KT) recipients is undetermined. We aimed to assess whether HLA-mismatching (A-B-C-DR-DQ) is a risk factor for early SCI. As part of a clinical trial (Clinicaltrials.gov, number NCT02284464), a total of 105 low-immunological-risk KT patients underwent a protocol biopsy on the third month post-KT. As a result, 54 presented SCI, showing a greater number of total HLA-mismatches (p = 0.008) and worse allograft function compared with the no inflammation group (48.5 ± 13.6 vs. 60 ± 23.4 mL/min; p = 0.003). Multiple logistic regression showed that the only risk factor associated with SCI was the total HLA-mismatch score (OR 1.32, 95%CI 1.06-1.64, p = 0.013) or class II HLA mismatching (OR 1.51; 95%CI 1.04-2.19, p = 0.032) after adjusting for confounder variables (recipient age, delayed graft function, transfusion prior KT, and tacrolimus levels). The ROC curve illustrated that the HLA mismatching of six antigens was the optimal value in terms of sensitivity and specificity for predicting the SCI. Finally, a significantly higher proportion of SCI was seen in patients with >6 vs. ≤6 HLA-mismatches (62.3 vs. 37.7%; p = 0.008). HLA compatibility is an independent risk factor associated with early SCI. Thus, transplant physicians should perhaps be more aware of HLA mismatching to reduce these early harmful lesions

Clinical Relevance of Corticosteroid Withdrawal on Graft Histological Lesions in Low-Immunological-Risk Kidney Transplant Patients

The impact of corticosteroid withdrawal on medium-term graft histological changes in kidney transplant (KT) recipients under standard immunosuppression is uncertain. As part of an open-label, multicenter, prospective, phase IV, 24-month clinical trial (ClinicalTrials.gov, NCT02284464) in low-immunological-risk KT recipients, 105 patients were randomized, after a protocol-biopsy at 3 months, to corticosteroid continuation (CSC, n = 52) or corticosteroid withdrawal (CSW, n = 53). Both groups received tacrolimus and MMF and had another protocol-biopsy at 24 months. The acute rejection rate, including subclinical inflammation (SCI), was comparable between groups (21.2 vs. 24.5%). No patients developed dnDSA. Inflammatory and chronicity scores increased from 3 to 24 months in patients with, at baseline, no inflammation (NI) or SCI, regardless of treatment. CSW patients with SCI at 3 months had a significantly increased chronicity score at 24 months. HbA1c levels were lower in CSW patients (6.4 +/- 1.2 vs. 5.7 +/- 0.6%; p = 0.013) at 24 months, as was systolic blood pressure (134.2 +/- 14.9 vs. 125.7 +/- 15.3 mmHg; p = 0.016). Allograft function was comparable between groups and no patients died or lost their graft. An increase in chronicity scores at 2-years post-transplantation was observed in low-immunological-risk KT recipients with initial NI or SCI, but CSW may accelerate chronicity changes, especially in patients with early SCI. This strategy did, however, improve the cardiovascular profiles of patients