ABSTRACT
The new habits of tourist consumption favor the rise of cultural tourism, either as the primary or complementary offer of a destination. Therefore, it is necessary to deepen the study of the behavior of cultural tourism demand. This research aims to develop a structural model that allows measuring the main variables that affect the satisfaction and loyalty of the internal demand of the cultural tourist to a heritage destination. The results are helpful for the design of tourism management. The hypotheses posited have been tested using non-linear structural equations (SEM), estimated with data from the National Statistics Institute on internal demand for cultural tourism in Spain (n = 18,024). The results confirm the importance of socio-cultural variables and the tourist’s experience on fidelity to the visited destination. Furthermore, the negative relationship between the repetition of the visit and satisfaction is striking.
ABSTRACT
The prone position is a non-invasive technique resulting from the mobilization of the patient, where the person is lying horizontally face down. This technique has been used since the 1970s, but it has gained great relevance in the last year owing to the COVID-19 pandemic with the use of invasive mechanical ventilation. Objectives: To evaluate the effectiveness of the prone position in patients with acute respiratory distress syndrome as a consequence of the COVID-19 disease who are mechanically ventilated and admitted to the intensive care unit. To demonstrate the nursing care carried out and to identify the respiratory benefits of the prone position in this type of patient. Data sources, study eligibility criteria: The search for articles was carried out from January 2018 to June 2021, in five databases (Pubmed, Google Scholar, Scielo, Dialnet, and WOS), based on the clinical question, using the keywords derived from the DeCS and MeSH thesauri, combined with the Boolean operators “AND”, “NOT”, and “OR”. The search was limited to publications from the last 6 years, in English. Results: After applying the selection criteria and evaluating the quality of the methodology, 12.14% (n = 21) of the 173 results were included with filters: 3 bibliographic reviews, 1 narrative review, 2 systematic review, 7 descriptive (4 series of cases and 3 of cross section), and 8 analytical (6 of cohorts and 2 of cases and controls). Conclusions and implications of key findings: The prone position in adults with acute respiratory distress syndrome improves oxygenation, in conjunction with invasive mechanical ventilation, from the second cycle and in prolonged pronation episodes. This technique improves oxygenation by increasing alveolar recruitment and inspiratory capacity in the dorsal pulmonary areas.
ABSTRACT
BACKGROUND AND OBJECTIVE: SARS-CoV-2 infection has bimodal distribution in Europe with a first wave in March to June 2020 and a second in September 2020 to February 2021. We compared the frequency, clinical characteristics and outcomes of adults with acute lymphoblastic leukemia (ALL) and infection in the first vs. second pandemic waves in Spain. PATIENTS AND METHODS: In this prospective study the characteristics of ALL and COVID-19 infection, comorbidities, treatment and outcome in the two periods were compared. The study ended when vaccination against SARS-CoV-2 was implemented in Spain. RESULTS: Twenty eight patients were collected in the first wave and 24 in the second. The median age was 46.5 years (range 20-83). Patients from the first wave had a trend to more severe ALL (higher frequency of patients under induction or submitted to transplantation or under immunosuppressive therapy). No significant differences were observed in need for oxygen support, intensive care unit (ICU) requirement, days in ICU and time to COVID-19 infection recovery. Seventeen patients (33%) died, with death attributed to COVID infection in 15 (29%), without significant differences in the 100 day overall survival (OS) probabilities in the two waves (68% ± 17% vs. 56% ± 30%). The only prognostic factor for OS identified by was the presence of comorbidities at COVID-19 infection (HR: 5.358 [95% CI: 1.875- 15.313]). CONCLUSION: The frequency and mortality of COVID-19 infection were high in adults with ALL, without changes over time, providing evidence in favor of vaccination priority for these patients.