Resumen. La relevancia del sector vitivinícola en España y su conexión con el desarrollo del entorno rural, así como la preocupación de la población por los aspectos medioambientales y sociales, justifican el creciente interés por incorporar prácticas verdes y sostenibles en el turismo del vino. Además, dentro de los enoturistas existe un segmento cada vez más creciente que demanda servicios y destinos turísticos responsables con el medio ambiente y la sociedad, en general.Teniendo en consideración esta demanda creciente, las bodegas deberían atender este segmento de consumidores que reclaman un turismo de vino sostenible. Para poder llevar a cabo una sólida iniciativa enoturista sostenible, este trabajo propone un marco teórico basado en un enfoque multinivel, que incluye además de las tradicionales perspectivas multi-stakeholders y multi-motivacional, una perspectiva multidimensional que recoge los aspectos claves del concepto de sostenibilidad, es decir, el económico, el social y el medioambiental. IntroducciónEl sector del vino en España tiene una gran importancia, debido a su valor económico, social, cultural y ambiental. De hecho, según datos de la Organización Internacional de la Viña y el Vino (OIV), en 2016 la superficie de viñedos en España, con 975 mil hectáreas, era la mayor en el mundo (concretamente representaba un 14% de la superficie de viñedos mundial y un 30% de la europea). Por otra parte, España, con 39,4 millones de hectolitros, era el tercer país productor de vino en el mundo. En cuanto al consumo, en 2016, España ocupaba el séptimo lugar en el ranking mundial, con 9,9 millones de hectolitros consumidos. Otro dato relevante es que España fue el mayor exportador de vino, con 22,9 millones de hectolitros en términos de volumen y 28.900 millones de euros en términos de valor, lo que representó una cuota de mercado global del 22%.No obstante, la importancia del sector del vino no se refleja únicamente en términos de su producción, sino también en el peso que supone el enoturismo o turismo del vino como destino de calidad. El sector vitivinícola crea a su alrededor todo un ecosistema de actividades que deberían estar alineadas con la sostenibilidad ambiental y cultural, el desarrollo económico del medio rural y la desestacionalización de la demanda turística.Los datos aportados por el noveno informe anual de la Asociación Española de Ciudades del Vino (ACEVIN) ponen de manifiesto que 2016 fue un excelente año para el enoturismo y las cifras de visitantes reflejan la consolidación del turismo del vino dentro de la oferta turística española. El creciente interés mostrado por los turistas del vino ha impulsado la proliferación de eventos de vino y el crecimiento del negocio del enoturismo.En líneas generales, el enoturismo se relaciona con un turismo gastronómico, cultural y de naturaleza. El turismo del vino puede ser definido como todas aquellas visitas a viñedos, bodegas, festivales del vino, catas de vino y/o experiencias respecto a todos los atributos de la uva y del vino de cualquier zona vit...
La encefalopatía de Wernicke es una emergencia neurológica caracterizada por la tríada clínica clásica de oftalmoplejia, ataxia y alteración del estado mental, que conlleva alta morbimortalidad. Se debe a un déficit de la vitamina B1 (tiamina), que en su forma activa desempeña un papel esencial en el metabolismo de neuronas de áreas específicas del cerebro. Aunque el alcoholismo es la causa más frecuente de este déficit, se han descrito numerosos agentes que pueden alterar la biodisponibilidad o el metabolismo de la tiamina (1), entre las que cabe destacar la cirugía del tracto gastrointestinal, sobre todo tras cirugía bariátrica. Por lo general el cuadro se produce entre las semanas cuatro y doce tras la resección, pero excepcionalmente se han descrito casos que ocurren de forma tardía (años). Presentamos el caso de un paciente intervenido de gastrectomía por un adenocarcinoma antropilórico que desarrolló una encefalopatía de Wernicke a los ocho años de la resección quirúrgica.
BACKGROUND Teledermatology (TD) is a branch of telemedicine focused on the evaluation of cutaneous lesions by dermatologists remotely, in order to avoid unnecessary in-person consults that could be otherwise resolved by this method, and to shorten the time required for prompt evaluation of cutaneous diseases. OBJECTIVE This study aimed to create and validate a questionnaire to evaluate satisfaction with the use of TD among primary care pediatricians (PCPs) and to test the questionnaire in our health area before performing an intervention for the optimization of TD. METHODS We first created a questionnaire based on previous publications. Then, an expert consultation was made before drafting the final version of the questionnaire. We tested it twice among pediatricians of different health areas, with a 1-month gap between both evaluations. Internal consistency, reproducibility, and validity of the questionnaire were evaluated. Finally, the validated questionnaire was tested among the PCPs of our health area, to analyze their responses. RESULTS We registered 38 questionnaire responses. In all, 30 (78.9%) PCPs actively used TD several times within a month or a year; none of them used TD daily. Technical and health care quality of TD was mostly considered as good or very good. TD was regarded as similar or even better than face-to-face evaluation for most PCPs, whereas 7.9% (3/38) of PCPs thought TD was worse than conventional consults. Most PCPs considered TD as an effective, self-learning, and trustable tool, and 10.5% (4/38) of them identified that pictures captured by mobile phones were a barrier for its use, as it affects patient privacy. Technical problems, absence of exclusive devices for image taking, and delayed answers are some other barriers for TD that need to be overcome. Nonetheless, all PCPs were satisfied with TD, and all of them reported they would continue or start to use this tool. CONCLUSIONS TD has demonstrated to be an efficient tool, as it reduces waiting time and costs for dermatology evaluation, and it increases satisfaction among professionals. With our proposed questionnaire, we validated that quality, usability, efficacy, and satisfaction related to TD in our health area had a positive consideration among PCPs in general, but there still are barriers to overcome.
Background Teledermatology (TD) is a branch of telemedicine focused on the evaluation of cutaneous lesions by dermatologists remotely, in order to avoid unnecessary in-person consults that could be otherwise resolved by this method, and to shorten the time required for prompt evaluation of cutaneous diseases. Objective This study aimed to create and validate a questionnaire to evaluate satisfaction with the use of TD among primary care pediatricians (PCPs) and to test the questionnaire in our health area before performing an intervention for the optimization of TD. Methods We first created a questionnaire based on previous publications. Then, an expert consultation was made before drafting the final version of the questionnaire. We tested it twice among pediatricians of different health areas, with a 1-month gap between both evaluations. Internal consistency, reproducibility, and validity of the questionnaire were evaluated. Finally, the validated questionnaire was tested among the PCPs of our health area, to analyze their responses. Results We registered 38 questionnaire responses. In all, 30 (78.9%) PCPs actively used TD several times within a month or a year; none of them used TD daily. Technical and health care quality of TD was mostly considered as good or very good. TD was regarded as similar or even better than face-to-face evaluation for most PCPs, whereas 7.9% (3/38) of PCPs thought TD was worse than conventional consults. Most PCPs considered TD as an effective, self-learning, and trustable tool, and 10.5% (4/38) of them identified that pictures captured by mobile phones were a barrier for its use, as it affects patient privacy. Technical problems, absence of exclusive devices for image taking, and delayed answers are some other barriers for TD that need to be overcome. Nonetheless, all PCPs were satisfied with TD, and all of them reported they would continue or start to use this tool. Conclusions TD has demonstrated to be an efficient tool, as it reduces waiting time and costs for dermatology evaluation, and it increases satisfaction among professionals. With our proposed questionnaire, we validated that quality, usability, efficacy, and satisfaction related to TD in our health area had a positive consideration among PCPs in general, but there still are barriers to overcome. Conflict of Interest None declared.
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