长三角文化旅游资源的整合开发

长三角地区文化旅游资源十分丰富，如能对其进行整合开发和充分挖掘，将能有效增强长三角旅游竞争力，成为市场开拓新的支点和拉动长三角经济的新增长极。整合开发长三角文化旅游资源应采取建立区域文化旅游资源整合开发协调机制，构建长三角文化旅游整体形象，实现小范围的文化旅游资源整合，重点整合开发非物质文化遗产等措施。     

The patient–doctor relationship in the transnational healthcare context

Moving away from paternalism to more equal forms of interaction in the patient–doctor relationship has been seen in positive light by policymakers, patients’ rights advocates and scholars alike. Nonetheless, against the background of commercialisation and consumerism, empirical research showcases how reduced asymmetries bring in tensions and friction between patients and doctors (Greenfield et al. 2012). This paper contributes to the discussion through the examination of the patient–doctor relationship in the niche setting of private transnational healthcare markets which involve patients travelling overseas for care and where commodification, consumerism and care go hand‐in‐hand. It is geographically focused on two large cities in South‐Eastern Europe as settings where health care is provided to foreign patients – Athens and Istanbul – and empirically draws on qualitative interviews with doctors who run small/medium practices. The findings highlight that, despite excessive consumerism, power asymmetries are not mitigated but patient vulnerability shapes the patient–doctor relationship. In the transnational context, the patient faces an additional source of vulnerability: a condition of foreignness. As such, the findings stress that one relationship model (the consumerist) does not, per se, replace an older one (e.g. the Parsonian). Instead, the consumer–provider dimension co‐exists with the client–expert, patient–doctor and, finally, host–guest relation.     

Understanding the complex interplay between tourism, disability and environmental contexts

Purpose. To explore and describe the complex issues and factors related to participation in tourism as perceived by people with disabilities in Hong Kong.

Method. Naturalistic inquiry using key informant interviews and focus groups with 86 people with disabilities. Interviews were transcribed, translated and coded to develop themes and relationships. Triangulation of three investigators from different backgrounds occurred.

Results. The Process of Becoming Travel Active emerged as a six-stage process, intricately related to the personal/disability context and the environmental/travel context. Personal and environmental factors contribute to the six-stage model explaining the complex interplay between tourism, disability and environmental context.

Conclusion. Understanding the complexity provides insight into ways to increase active participation in tourism. Health, tourism and disability sectors have a role to play in the development of accessible tourism.     

Determinants and Drivers of Infectious Disease Threat Events in Europe

Infectious disease threat events (IDTEs) are increasing in frequency worldwide. We analyzed underlying drivers of 116 IDTEs detected in Europe during 2008–2013 by epidemic intelligence at the European Centre of Disease Prevention and Control. Seventeen drivers were identified and categorized into 3 groups: globalization and environment, sociodemographic, and public health systems. A combination of >2 drivers was responsible for most IDTEs. The driver category globalization and environment contributed to 61% of individual IDTEs, and the top 5 individual drivers of all IDTEs were travel and tourism, food and water quality, natural environment, global trade, and climate. Hierarchical cluster analysis of all drivers identified travel and tourism as a distinctly separate driver. Monitoring and modeling such disease drivers can help anticipate future IDTEs and strengthen control measures. More important, intervening directly on these underlying drivers can diminish the likelihood of the occurrence of an IDTE and reduce the associated human and economic costs.     

基于生物多样性保护条件下的旅游资源开发研究--以湖北九宫山自然保护区为例

本文讨论了生物多样性的概念和研究内容,对九宫山自然保护区内的生物多样性观状进行了系统的调查和论述,提出了在生物多样性保护下的自然保护区旅游资源开发战略和功能分区模式。     

Culinary Tourism in Central America: A Cross-Analysis of Government Tourism Websites

Food and beverage are growing tourism niches and have yet to realize their potential in Central America. This study explores how culinary tourism is promoted in official tourism websites of Honduras, Costa Rica, Guatemala, El Salvador, Nicaragua, and Panama. Through a qualitative content analysis, this study examines how the websites introduce and promote traditional and local foods, restaurants, culinary tours, food festivals, recipes, and food safety. This study assesses the culinary tourism marketing strategies, including text and image, and provides practical suggestions for promoting food-related information through these platforms.     

Impacting Health through Cross-Border Pharmaceutical Purchases

ABSTRACT

Annually, retirees known as Winter Texans travel to spend the winter along the Texas/Mexico border and while there, many purchase medicine in Mexico. However, strategies that are used when purchasing Mexican medicine and the health implications of doing so have not been adequately explored. The results of the study we report illustrate that Winter Texans are knowledgeable about their healthcare and act more as choice-making consumers than patients seeking care. Furthermore, the use of Mexican medication did not increase rates of adverse drug events or decrease health-related quality of life scores.     

Navigating the cartographies of trust: how patients and carers establish the credibility of online treatment claims

Digital media offer citizens novel ways of ‘enacting’ health and illness, and treatment and care. However, while digital media may so ‘empower’ citizens, those searching for credible information will be confronted with various, often‐conflicting claims that may have ‘disempowering’ effects. This article uses Gieryn's concept of the ‘cultural cartography’ to explore the criteria that patients and carers employ in establishing the credibility of information on alleged treatments. Drawing on data from interviews with Australian patients and carers who have travelled or considered travelling abroad for unproven commercial stem cell treatments, the article examines how individuals assess rival sources of epistemic authority – science‐based and non‐science‐based – as they search for credible information. As we argue, in a context where conventional treatment options are perceived to be limited or non‐existent – which is likely to be the case with those suffering severe, life‐limiting conditions – and the credibility of sources uncertain, matters of opinion and belief are prone to being interpreted as matters of fact, with potentially far‐reaching implications for citizens’ health. Revealing the mechanisms by which individuals ascribe credibility to health information, we conclude, has become crucial as digital media assume a growing role in health and healthcare and governments encourage citizens to become ‘digitally literate’.     

Ethics of care in medical tourism: Informal caregivers' narratives of responsibility,vulnerability and mutuality

This study examines the experiences of informal caregivers in medical tourism through an ethics of care lens. We conducted semi-structured interviews with 20 Canadians who had accompanied their friends or family members abroad for surgery, asking questions that dealt with their experiences prior to, during and after travel. Thematic analysis revealed three themes central to an ethics of care: responsibility, vulnerability and mutuality. Ethics of care theorists have highlighted how care has been historically devalued. We posit that medical tourism reproduces dominant narratives about care in a novel care landscape. Informal care goes unaccounted for by the industry, as it occurs in largely private spaces at a geographic distance from the home countries of medical tourists.     

Isolation of three distinct carbapenemase-producing Gram-negative bacteria from a Vietnamese medical tourist

Carbapenem-resistant Klebsiella pneumoniae and Escherichia coli, multidrug-resistant Pseudomonas aeruginosa and vancomycin-resistant Enterococcus faecium were isolated from a single patient. The patient came to Japan for advanced medical treatment after having undergone laparoscopic cholecystectomy and hospitalization in Vietnam. Whole-genome sequence analysis revealed that K. pneumoniae harbored bla_OXA-48 that was found on a Col156 -type small plasmid, E. coli harbored bla_NDM-5 and P. aeruginosa harbored both bla_NDM-1 and 16S rRNA methyltransferase (rmtB). To the best of our knowledge, this is the first report of detection of K. pneumoniae harboring bla_OXA-48 on a Col156-type small plasmid in the world and P. aeruginosa coharboring genes encoding NDM-1 and RmtB in Japan.