Las políticas del agua en España: bases para un desarrollo turístico equilibrado, en el contexto de la desglobalización

Economic activities related to tourism need, at different scales, a policy related to water, in our case in Spain. The main objective of the present investigation is to show the guidelines that mark, or should indicate, the path for the use of a scarce resource such as water, so that the tourist activities can be developed in a balanced way, marking and favoring the growth of the different tourist destinations, contributing to the achievement of more equanimous living conditions. Thus, when analyzing the Water policy in detail, it is determined as in Spain, since the appearance in the current democratic era, of the Water Law of 1985, until approximately the presentation of the Royal Decree that approves the regulation of Hydrological Planning, it has been denoting a progressive development in terms of the issues that have had to face the different water policies. Along these lines, the legal guidelines related to water resources have been adapting to the demands of the circumstances, mainly to the community trends embodied in the renowned Directive 2000/60/EC, which essentially required that rational water availability be guaranteed, so that the various social activities were revitalized.  Las actividades económicas relacionadas con el turismo necesitan, a diferentes escalas, de una política relacionada con el agua, en nuestro caso en España. El objetivo principal de la presente investigación es mostrar las directrices que marcan, o debieran señalar, el camino para la utilización de un recurso escaso como es el agua, para que las actividades turísticas puedan desarrollarse de forma equilibrada, marcando y favoreciendo el crecimiento de los diferentes destinos turísticos, coadyuvando al logro de unas condiciones de vida más ecuánimes. De esta forma, al analizar la política de Aguas con detenimiento, se determina como en España, desde la aparición en la época democrática actual, de la Ley de Aguas de 1985, hasta aproximadamente la presentación del Real Decreto que aprueba el reglamento de la Planificación Hidrológica, se ha ido denotando un progresivo desarrollo en cuanto a los asuntos que han tenido que ir afrontando las diferentes políticas hídricas. En esta línea, las directrices legales relativas al recurso hídrico, han ido amoldándose a las exigencias de las circunstancias, principalmente a las tendencias comunitarias encarnadas en la renombrada Directiva 2000/60/CE, que exigía esencialmente, que se garantizase una disponibilidad de aguas racional, de tal forma que se revitalizase las diversas actividades sociales

Métodos y técnicas de monitoreo y predicción temprana en los escenarios de riesgos socionaturales

Esta obra concentra los métodos y las técnicas fundamentales para el seguimiento y monitoreo de las dinámicas de los escenarios de riesgos socionaturales (geológicos e hidrometeorológicos) y tiene como objetivo general orientar, apoyar y acompañar a los directivos y operativos de protección civil en aterrizar las acciones y políticas públicas enfocadas a la gestión del riesgo local de desastre

Water policies in Spain: bases for a balanced tourism development, in the context of de deglobalization

Las actividades económicas relacionadas con el turismo necesitan, a diferentes escalas, de una política relacionada con el agua, en nuestro caso en España. El objetivo principal de la presente investigación es mostrar las directrices que marcan, o debieran señalar, el camino para la utilización de un recurso escaso como es el agua, para que las actividades turísticas puedan desarrollarse de forma equilibrada, marcando y favoreciendo el crecimiento de los diferentes destinos turísticos, coadyuvando al logro de unas condiciones de vida más ecuá-nimes. De esta forma, al analizar la política de Aguas con detenimiento, se determina como en España, desde la aparición en la época democrática actual, de la Ley de Aguas de 1985, hasta aproximadamente la presentación del Real Decreto que aprueba el reglamento de la Planificación Hidrológica, se ha ido denotando un progresivo desarrollo en cuanto a los asuntos que han tenido que ir afrontando las diferentes políticas hídricas. En esta línea, las circunstancias, principalmente a las tendencias comunitarias encarnadas en la renombrada Directiva 2000/60/CE, que exigía esencialmente, que se garantizase una disponibilidad de aguas racional, de tal forma que se revitalizase las diversas actividades sociales.ABSTRACT: Economic activities related to tourism need, at different scales, a policy related to water, in our case in Spain. The main objective of the present investigation is to show the guidelines that mark, or should indicate, the path for the use of a scarce resource such as water, so that the tourist activities can be developed in a balanced way, marking and favoring the growth of the different tourist destinations, contributing to the achievement of more equanimous living conditions. Thus, when analyzing the Water policy in detail, it is determined as in Spain, since the appearance in the current democratic era, of the Water Law of 1985, until approxi-mately the presentation of the Royal Decree that approves the regulation of Hydrological Planning, it has been denoting a progressive development in terms of the issues that have had to face the different water policies. Along these lines, the legal guidelines related to water resources have been adapting to the demands of the circumstances, mainly to the community trends embodied in the renowned Directive 2000/60/EC, which essentially required that rational water availability be guaranteed, so that the various social activities were revitalized

Patients with Crohn's disease have longer post-operative in-hospital stay than patients with colon cancer but no difference in complications' rate

BACKGROUNDRight hemicolectomy or ileocecal resection are used to treat benign conditions like Crohn's disease (CD) and malignant ones like colon cancer (CC).AIMTo investigate differences in pre- and peri-operative factors and their impact on post-operative outcome in patients with CC and CD.METHODSThis is a sub-group analysis of the European Society of Coloproctology's prospective, multi-centre snapshot audit. Adult patients with CC and CD undergoing right hemicolectomy or ileocecal resection were included. Primary outcome measure was 30-d post-operative complications. Secondary outcome measures were post-operative length of stay (LOS) at and readmission.RESULTSThree hundred and seventy-five patients with CD and 2,515 patients with CC were included. Patients with CD were younger (median = 37 years for CD and 71 years for CC (P < 0.01), had lower American Society of Anesthesiology score (ASA) grade (P < 0.01) and less comorbidity (P < 0.01), but were more likely to be current smokers (P < 0.01). Patients with CD were more frequently operated on by colorectal surgeons (P < 0.01) and frequently underwent ileocecal resection (P < 0.01) with higher rate of de-functioning/primary stoma construction (P < 0.01). Thirty-day post-operative mortality occurred exclusively in the CC group (66/2515, 2.3%). In multivariate analyses, the risk of post-operative complications was similar in the two groups (OR 0.80, 95%CI: 0.54-1.17; P = 0.25). Patients with CD had a significantly longer LOS (Geometric mean 0.87, 95%CI: 0.79-0.95; P < 0.01). There was no difference in re-admission rates. The audit did not collect data on post-operative enhanced recovery protocols that are implemented in the different participating centers.CONCLUSIONPatients with CD were younger, with lower ASA grade, less comorbidity, operated on by experienced surgeons and underwent less radical resection but had a longer LOS than patients with CC although complication's rate was not different between the two groups

The impact of stapling technique and surgeon specialism on anastomotic failure after right?sided colorectal resection: an international multicentre, prospective audit

Aim There is little evidence to support choice of technique and configuration for stapled anastomoses after right hemicolectomy and ileocaecal resection. This study aimed to determine the relationship between stapling technique and anastomotic failure. Method Any unit performing gastrointestinal surgery was invited to contribute data on consecutive adult patients undergoing right hemicolectomy or ileocolic resection to this prospective, observational, international, multicentre study. Patients undergoing stapled, side?to?side ileocolic anastomoses were identified and multilevel, multivariable logistic regression analyses were performed to explore factors associated with anastomotic leak. Results One thousand three hundred and forty?seven patients were included from 200 centres in 32 countries. The overall anastomotic leak rate was 8.3%. Upon multivariate analysis there was no difference in leak rate with use of a cutting stapler for apical closure compared with a noncutting stapler (8.4% vs 8.0%, OR 0.91, 95% CI 0.54–1.53, P = 0.72). Oversewing of the apical staple line, whether in the cutting group (7.9% vs 9.7%, OR 0.87, 95% CI 0.52–1.46, P = 0.60) or noncutting group (8.9% vs 5.7%, OR 1.40, 95% CI 0.46–4.23, P = 0.55) also conferred no benefit in terms of reducing leak rates. Surgeons reporting to be general surgeons had a significantly higher leak rate than those reporting to be colorectal surgeons (12.1% vs 7.3%, OR 1.65, 95% CI 1.04–2.64, P = 0.04). Conclusion This study did not identify any difference in anastomotic leak rates according to the type of stapling device used to close the apical aspect. In addition, oversewing of the anastomotic staple lines appears to confer no benefit in terms of reducing leak rates. Although general surgeons operated on patients with more high?risk characteristics than colorectal surgeons, a higher leak rate for general surgeons which remained after risk adjustment needs further exploration

Relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit

Aim: The anastomosis technique used following right-sided colonic resection is widely variable and may affect patient outcome. This study aimed to assess the association between leak and anastomosis technique (stapled vs handsewn). Method: This was a prospective, multicentre, international audit including patients undergoing elective or emergency right hemicolectomy or ileo-caecal resection operations over a 2-month period in early 2015. The primary outcome measure was the presence of anastomotic leak within 30\ua0days of surgery, determined using a prespecified definition. Mixed effects logistic regression models were used to assess the association between leak and anastomosis method, adjusting for patient, disease and operative cofactors, with centre included as a random-effect variable. Results: This study included 3208 patients, of whom 78.4% (n\ua0=\ua02515) underwent surgery for malignancy and 11.7% (n\ua0=\ua0375) underwent surgery for Crohn's disease. An anastomosis was performed in 94.8% (n\ua0=\ua03041) of patients, which was handsewn in 38.9% (n\ua0=\ua01183) and stapled in 61.1% (n\ua0=\ua01858). Patients undergoing handsewn anastomosis were more likely to be emergency admissions (20.5% handsewn vs 12.9% stapled) and to undergo open surgery (54.7% handsewn vs 36.6% stapled). The overall anastomotic leak rate was 8.1% (245/3041), which was similar following handsewn (7.4%) and stapled (8.5%) techniques (P\ua0=\ua00.3). After adjustment for cofactors, the odds of a leak were higher for stapled anastomosis (adjusted OR\ua0=\ua01.43; 95% CI: 1.04\u20131.95; P\ua0=\ua00.03). Conclusion: Despite being used in lower-risk patients, stapled anastomosis was associated with an increased anastomotic leak rate in this observational study. Further research is needed to define patient groups in whom a stapled anastomosis is safe

The relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit.

BACKGROUND: Anastomosis technique following right sided colonic resection is widely variable and may affect patient outcomes. This study aimed to assess the association between leak and anastomosis technique (stapled versus handsewn) METHODS: This was a prospective, multicentre, international audit including patients undergoing elective or emergency right hemicolectomy or ileo-caecal resection operations over a two-month period in early 2015. The primary outcome measure was the presence of anastomotic leak within 30 days of surgery, using a pre-specified definition. Mixed effects logistic regression models were used to assess the association between leak and anastomosis method, adjusting for patient, disease and operative cofactors, with centre included as a random effect variable. RESULTS: This study included 3208 patients, of whom 78.4% (n=2515) underwent surgery for malignancy and 11.7% (n=375) for Crohn's disease. An anastomosis was performed in 94.8% (n=3041) of patients, which was handsewn in 38.9% (n=1183) and stapled in 61.1% (n=1858) cases. Patients undergoing handsewn anastomosis were more likely to be emergency admissions (20.5% handsewn versus 12.9% stapled) and to undergo open surgery (54.7% versus 36.6%). The overall anastomotic leak rate was 8.1% (245/3041), which was similar following handsewn (7.4%) and stapled (8.5%) techniques (p=0.3). After adjustment for cofactors, the odds of a leak were higher for stapled anastomosis (adjusted odds ratio 1.43, 95% confidence interval 1.04-1.95, p=0.03). DISCUSSION: Despite being used in lower risk patients, stapled anastomosis was associated with an increased anastomotic leak rate in this observational study. Further research is needed to define patient groups in whom a stapled anastomosis is safe. This article is protected by copyright. All rights reserve