Views, Attitudes and Challenges When Supporting a Family Member in Their Decision to Travel to Switzerland to Receive Aid-In-Dying.

Objectives: Exploring the experiences, perceptions and meanings of family members and close friends of Israeli individuals who sought aid-in-dying outside Israel. Methods: Using the phenomenological-interpretive approach, a qualitative research design was employed, based on ten in-depth semi-structured interviews with Israelis who had provided support for a relative who embarked on suicide tourism. Results: The following five themes emerged from interviews: (1) facilitators for supporting an individual requesting suicide tourism; (2) choosing death and actively making the decision to die; (3) the meaning of traveling to die; (4) offering support throughout the process; and (5) facilitating procedures after death. Conclusion: The participants spoke of the active role that they played in their relative's suicide-tourism journey. They conveyed conflicting emotions and values regarding the decision at hand, the ability to say goodbye thanks to their pre-planned death, helping to reduce their suffering and burden, and dealing with the challenge of disclosing the deceased's plans, before and after the act, as well as their own involvement in the process. Relatives of suicide-tourism patients should receive professional support during and following this difficult process.

Factors influencing the cruisers in recommending onshore excursions in Gran Canaria.

This paper investigates which elements are the ones that most influence the cruise passenger to recommend the onshore excursions, offering relevant information that could help all stakeholders (cruise firms, local operators, politicians, etc.) to better design/adapt shore excursions to the expectations of the cruise passengers, increasing the positive impact of this activity in the destination. The latter is essential for the existence of a good harmony between the cruise ships visiting a destination and the population living there. To this aim, an ordered logit model was estimated using a sample of 1,059 questionnaires obtained during the period 2018-2020. The results have shown that cruise passengers are more likely to recommend the onshore excursions if their expectations regarding the excursion have been covered, they have perceived a good quality/price ratio and have had a satisfactory tour guide service. Moreover, the fact that the cruisers aged between 45 and 55 are less likely to recommend excursions could suggest that the design of existing excursions could be improved by being tailored by demographic characteristics (i.e., aged-oriented) or even by offering different alternatives for each group during the shore excursion when possible. The results could be useful to all stakeholders when designing excursions to increase the positive impact of this activity on the destination.

Research on rural tourism environment perception based on grounded theory A case study of Beishan Village, Zhuhai City, Guangdong Province, China.

Drawing upon its regional culture, natural landscapes, and architectural features, Beishan Village in Zhuhai City, Guangdong Province, has forged a distinctive rural development model that combines an industrial park with tourism. While this approach has catalyzed rural progress, it also encounters numerous complex practical challenges. Utilizing the grounded theory method, this study employs participatory observation, in-depth interviews, and network data analysis to investigate the perspectives of three key stakeholder groups: villagers, tourists, and resident merchants. A model is constructed to capture their environmental perceptions of rural tourism. Based on an analysis of network and interview textual data, as well as the influencing factors identified through the theoretical model, this study proposes several optimization strategies. These include enhancing infrastructure development, cultivating a regional brand culture, strengthening the institutional management framework, establishing a rural sharing economy platform, and introducing digital tours. These strategies are designed to refine and enhance Beishan Village's development model, offering insights for similar villages and advancing the integration of beautiful China initiatives with urban and rural development efforts.

Negotiating Hegemonic Masculinities and Mutual Exoticization within Grindr Tourism Interactions: "Everyone in Tel Aviv is a Muscle God".

Dating apps are spaces where masculinities are communicated digitally, affecting inequalities around gender expressions. This study aims to identify the masculinities communicated within Grindr tourism interactions in Tel Aviv and analyze how masculinities shape relations among international tourists and locals. Methods consist of interviews and audio diaries with nineteen tourist, local, and immigrant Grindr users in Tel Aviv. Theories of affordances, hegemonic masculinities, and relational sociology are used to analyze the data. In discussion of the results, the concept of mutual exoticization is put forth to interpret the social dynamics valued within Grindr tourism interactions, thereby revealing oppositional fantasies tied to nationalities and masculinities. The study also explores ethnicity's association with social and erotic capital in digital circulations of a localized Mizrahi masculinity. Findings reveal that while hegemonic masculinities are circulated on Grindr, resistance is also a part of Grindr tourism relations around masculinities. This research concludes by shedding light on masculinity inequalities within digital spaces where different nationalities co-congregate, revealing everyday negotiations of gender regimes. Grindr is the site of both reproduction of and resistance to social inequalities around masculinities.

Assessing the reactions of tourist markets to reinstated travel restrictions in the destination during the post-COVID-19 phase.

This study, leveraging search engine data, investigates the dynamics of China's domestic tourism markets in response to the August 2022 epidemic outbreak in Xinjiang. It focuses on understanding the reaction mechanisms of tourist-origin markets during destination crises in the post-pandemic phase. Notably, the research identifies a continuous rise in the potential tourism demand from tourist origin cities, despite the challenges posed by the epidemic. Further analysis uncovers a regional disparity in the growth of tourism demand, primarily influenced by the economic stratification of origin markets. Additionally, the study examines key tourism attractions such as Duku Road, highlighting its resilient competitive system, which consists of distinctive tourism experiences, economically robust tourist origins, diverse tourist markets, and spatial pattern stability driven by economic factors in source cities, illustrating an adaptive response to external challenges such as crises. The findings provide new insights into the dynamics of tourism demand, offering a foundation for developing strategies to bolster destination resilience and competitiveness in times of health crises.

Perspectives of nature-based tourism-dependent communities on climate change in the Okavango Delta, Botswana.

The intensity and frequency of climate extremes such as heat waves, droughts and extreme rainfall events are projected to rise. This will increase the severity of their impacts across socio-ecological systems. Economic sectors such as nature-based tourism become more vulnerable because of their reliance on climate and natural capital as key resources. While attempts have been made to understand how climate change may impact tourists and the industry itself, little is known about the same on tourism-dependent communities. This paper determines the extent to which tourism-dependent communities are vulnerable to climate change in the Okavango Delta, Botswana, to enhance their wider livelihood the development of strategies for improving adaptive capacity, resilience, and reduced exposure sensitivities. A household survey of 172 households was conducted in three purposively selected villages of Mababe, Sankuyo and Khwai, actively involved in community-based tourism for their socio-economic development. Information sourced related to livelihood options, peoples' resilience, local risks, and hazards. The data was analysed using descriptive statistics and thematic analysis. The results indicate that respondents have observed climatic changes over the years such as increased temperatures, decreased rainfall, and increased frequencies of extreme events. The respondents attributed changes in natural capital to these observed climatic conditions in the form of desiccation, dwindling populations of some wildlife species, decreased fish stocks and reduced vegetation cover. This renders the tourism-dependent communities vulnerable as their livelihood is threatened. The paper thus concludes that climate change adaptation is an urgent priority for local communities who are already exposed to existing climatic and non-climatic stresses.

Does medial tourism promote growth in healthcare sector?

The purpose of this study is to investigate the effect of medical tourism revenues on the growth of healthcare sector across 49 emerging and developed economies from 2008 to 2022. Using panel GMM and PMG/ARDL estimation methods, the results show that higher levels of medical tourism revenues promote growth in the healthcare sector. This finding remains robust across different sample periods, alternative measure of healthcare sector performance, and model specifications.

Cross-border healthcare-seeking and utilization behaviours among ethnic minorities: exploring the nexus of the perceived better option and public health concerns.

BACKGROUND: Many ethnic minorities in Hong Kong seek medical tourism after encountering inequalities in access to local healthcare because of language barriers and cultural-religious differences. The present study explored the ethnic minorities' lived experiences of medical tourism and issues arising from cross-border health-seeking relevant to this specific population. METHODS: Qualitative in-depth interviews with 25 ethnic minority informants from five South Asian countries in 2019. RESULTS: The 19 informants out of the 25 have sought assistance from their international networks for home remedies, medical advice and treatments of traditional/Western medicines, for they are more costly or unavailable in Hong Kong and for issues related to racial discrimination, language barriers, transnationalism engagement, cultural insensitivity, and dissatisfaction with healthcare services in Hong Kong. DISCUSSION: Medical tourism can relieve the host country's caring responsibilities from healthcare services, so the government might no longer be hard-pressed to fix the failing healthcare system. Consequently, it could cause public health concerns, such as having patients bear the risks of exposure to new pathogens, the extra cost from postoperative complications, gaps in medical documentation and continuum of care, etc. It also triggers global inequities in health care, exacerbating unequal distribution of resources among the affordable and non-affordable groups. CONCLUSION: Ethnic minorities in Hong Kong sought cross-border healthcare because of structural and cultural-religious issues. The surge of medical tourism from rich and developed countries to poor and developing countries may infringe upon the rights of residents in destination countries. To mitigate such negative impacts, policymakers of host countries should improve hospital infrastructure, as well as train and recruit more culturally sensitive healthcare workers to promote universal health coverage. Healthcare professionals should also strive to enhance their cultural competence to foster effective intercultural communication for ethnic minority groups.

Food tourism to revitalize the Basque Country.

The research examines the impacts of sensory experiences, taste, and destination food imagery on tourists' attitude. This study changes risks into positive attributes like safety and security, which significantly shape tourist decision-making processes. It underscores the significance of emotional well-being and safety concerns impacting tourists' visiting intentions. Employing Partial Least Squares Structural Equation Modelling, the study focuses on exploring the relationships among food tourism motivators, destination food image, safety perceptions, and the pandemic's impact on tourists' behavioural intentions within the Basque region. With a sample of 601 participants, this research emphasizes the importance of integrating risk mitigation actions and managing emotional states to design strategies for the sustained growth of the tourism industry.

The implications of industry 4.0 for the tourism sector: A systematic literature review.

The tourism sector is presently facing new challenges resulting from the increasing digitalization of society. Boosted by industry 4.0, new tourism dynamics are emerging. Nonetheless, the real significance of this revolutionary trend and its implications still lack further development. Aiming to assess the state-of-the-art about the digital transformation on the tourism sector, triggered by the 4.0 paradigm, the present study followed a systematic literature review approach, adopting the PRISMA protocol guidelines. A total of 44 manuscripts were considered relevant for analysis. The findings illustrate that the 4.0 paradigm is being embraced from three main perspectives: the visitor-technology interaction and its influence on decision-making, the digital competencies in tourism students, and the technology penetration in different sub-sectors of the supply chain. However, studies conceptualizing the 4.0 paradigm in the tourism sector are lacking, beyond empirical research on areas such as digital skills, pros and cons of industry 4.0 technologies, and spatial consequences.

Place perception and restorative experience of recreationists in the natural environment of rural tourism.

Introduction: In contemporary society, people spend long periods under high stress, and tourism activities have gradually been internalized as a new means of stress release and self-recovery. Studies have found that the high-quality natural environment of rural tourism destinations has a higher restorative effect than other places, and the rural natural environment can provide psychological recovery to visitors on top of offering visual beauty and other experiences. Methods: This paper starts with the relationship between rural place perception and restorative experience evaluation. Based on theories such as the restorative environments theory, we investigates whether rural natural environmental factors have a restorative effect on recreationists through collecting 300 questionnaires and using SPSS 26.0 structural equation modeling for analysis. Results: The study found that there is a positive correlation between rural natural perception, place dependence, and restorative experience, forming a positive feedback loop dynamic system. The analysis suggests that enhancing the perception of the rural natural environment and place attachment can improve the restorative experience of recreationists in rural settings. Discussion: This research establishes a systematic research framework for the relationship between rural natural perception, place attachment, and restorative experience, to deeply understand the dynamic interaction between them. It reveals the relationship between rural natural perception and restorative experience, suggesting that enriching the perceptual elements in rural natural spaces can meet the diverse needs of recreationists, enhance the sense of dependence and identification with rural spaces, and thus promote the psychological well-being and restorative experience of recreationists. The study also finds that place dependence plays a mediating role between rural natural perception and restorative experience. Place attachment and place identity, as mediating variables, act as bridges and catalysts in the process of rural natural perception affecting restorative experience.

Rivers of plastic: A socio-economic and topographic approach to modeling plastic transport from catchment to sea.

Marine litter caused by discharge of mismanaged plastic waste is considered to be one of the major environmental challenges by the international society. With the annual increase of plastic production, a growing number of plastic products are being used in people's daily lives. A large number of these plastics end up as waste emitted into rivers and subsequently into oceans through the effects of downpours or wind, posing a threat to the marine ecosystem. In this study, we developed a riverine plastic transport model based on catchment topography and social-economic factors. By applying reasonable compromise on the complexity of the model, this compromised simplified process-based model has the innovative capability to estimate plastic emissions effectively under the current conditions of limited data availability for model inputs. Compared to existing models, this novel model can also resolve challenges related to the contributions of various land use types and transport stages to plastic emissions into the oceans. To further explore the applicability of our results on a global scale, certain input parameter such as the proportion of mismanaged waste is crucial for users to acquire. Here, taking the S river catchment as our study area, the tourism-driven seasonal variation of land-based plastic emissions was quantified. According to our estimation, the emission flux in S river catchment in 2020 was 68 to 280 tons. 62.4% of riverine plastics reached the ocean. Although urban areas are the predominant contributors to the total emission flux, the contributions from other land use types such as forests and cultivated areas are also unignorable. For instance, forests and cultivated areas contribute 25.7% and 6.3%, respectively, even surpassing the contributions from high tourist activity (5.8%). Stricter waste collection legislations are imperatively needed particularly in these regions.

Bottom sediments as an indicator of the restoration potential of lakes-a case study of a small, shallow lake under significant tourism pressure.

The study covered a small, shallow lake, intensively used for recreation (sailing, tourist services and port infrastructure). This study aimed to determine the spatial differentiation of bottom sediments and the potential for phosphorus release in five zones, differing mainly in the type of recreation, depth, direct catchment management, shoreline management and macrophyte presence. The results were used to propose protective and restoration measures to improve the water quality of the studied lake. The innovation in the study was the detailed analysis of bottom sediments, which can be a significant source of pollution besides the external load from the catchment and tourist pressure, in the planned management of this ecosystem. Examination of the physicochemical properties of the bottom sediments showed a clear variation in both composition and potential for internal phosphorus loading. The sediments from the profundal zone, where the most boating activity was observed, together with the sediments from the shallow zone where the boats dock (mooring zone), had the highest potential to supply phosphorus to the bottom waters. This fact was demonstrated by the highest total phosphorus (TP) concentrations in sediments (up to 1.32 mgPg-1 DW) and the content of the most mobile fractions (up to 33%). The other zones associated with the marina, fuel zone, tributary and canal were not significant sources of phosphorus to the ecosystem. Based on the above results, a restoration method involving the removal of bottom sediments from the bottom zone was proposed, supported, of course, by protective measures in the catchment (maintaining a buffer zone around the lake and limiting the inflow of pollutants with tributary waters). The proposed measures with sustainable tourist pressure should improve water quality and thus contribute to protecting this valuable natural landscape.

Welfare and stress assessment of tourism carriage horses under real working conditions in Sicily.

Animal welfare has become an increasingly important concern regarding equids working as carriage animals. In the present study, the changes in the markers of stress and inflammatory responses as a result of the work performed by tourism carriage horses under real working conditions in Sicily (Italy) were investigated. Twenty-two Standardbreds performed a normal working day in the carriage tourism business during the months of May, June and July 2022, consisting of one day of work for each month. Blood samples were collected in the stables at rest before the tour route (Pre; 07.00 AM) and within 10 min after the end of the workday (Post; 05.00 PM). Haematological parameters, serum concentration of cortisol, total proteins together with the globulin fractions were investigated before and after the carriage work. Environmental temperature, relative humidity and temperature humidity index (THI) were also assessed. The direct erythrocyte indices increased after work compared to rest condition (P < 0.05). The values of cortisol, total proteins and globulins were not affected by carriage work (P > 0.05), while, higher cortisol, total proteins, α1- and α2-globulins values were observed in July compared to May and June (P < 0.05). These changes are probably due to the increase in THI values which showed mild stress in June and high stress in July. This study suggests that the tourism carriage horses herein investigated have adapted to their work activity, however, avoiding working horses during the hottest hours of the day in the summer months is advocated.

Coupling and interaction mechanism between green urbanization and tourism competitiveness based an empirical study in the Yellow River Basin of China.

Exploring the spatial coupling relationship and interaction mechanism between green urbanization (GU) and tourism competitiveness (TC) is of great significance for promoting urban sustainable development. However, the lack of research on the interaction mechanism between GU and TC limits the formulation of effective environmental management policy and urban planning. Taking 734 counties in the Yellow River Basin (YRB) as the study area, this paper analyzes the spatial coupling relationship between GU and TC on the basis of comprehensive evaluation of GU and TC. Then, the interactive mechanism between GU and TC is systematically discussed, and the synergistic development strategy of the two is proposed. The results show that the GU level presents a multicore circle structure, with provincial capitals, prefecture-level urban districts and economically developed counties in east-central regions as high-value centers. The TC at county scale presents a multi-center spatial structure. Additionally, there is a significant positive spatial coupling between GU and TC in the YRB. The analysis further reveals that green urbanization level, social progress, population development, infrastructure construction, economic development quality, and eco-environmental protection has a observably influence on TC. Tourism competitiveness, service competitiveness, location competitiveness, resource competitiveness, market competitiveness, environmental influence, and talent competitiveness has a observably influence on GU. TC can promote GU, and the improvement of green urbanization level can support the development of tourism competitiveness. According to the spatial zoning method, 734 counties are divided into 6 categories, and the coordinated development strategy of GU and TC for each type of district is proposed.

Destination Restaurants' Practices and the Production of Locality: The Case of Michelin Restaurants in China.

Dining plays a pivotal role in the travel experience, with numerous studies identifying the significant impacts of restaurant attributes on tourists' destination experiences and their sense of place. The identified attributes include the origin of food produce, menu design, the physical and social servicescape, and restaurant reputation, all of which have the potential to enhance customers' sense of place. Therefore, based on theories of the production of locality, this study explores how destination restaurants "put place on the plate" and identifies how destination restaurants promote place. Semi-structured interviews were conducted with the representatives of seventeen Michelin (one star, two stars, three stars, and Bib Gourmand)-awarded restaurants across Mainland China. The results reveal three primary strategies employed by destination restaurants in promoting place: forging partnerships with the local community to produce, present, and reproduce localities; leveraging local knowledge embedded in the local produce, recipes, cooking techniques, and local culture; and practicing translocality to introduce a regional cuisine to diverse and cosmopolitan consumers. This research provides a comprehensive understanding of the way in which notions of locality and place are used by destination restaurants and the way in which this may promote not only restaurants but also regional culinary cultures and destination attractiveness.

A study on the spatial differences between the tourism network attention and tourism flow in Shanghai, China.

The tourism network attention as a reflection of tourism demand is closely related to the tourism flow, the differences between the two has become an important criterion for judging the efficiency of destination tourism demand conversion, as well as a manifestation of the balance and coordination of destination tourism industry. Against the background of insufficient release of tourism demand in China, research on the development differences between tourism network attention and tourism flow can provide a basis for demand-side management and high-quality development. Based on the theory of spatial mismatch, this research analyzes the spatial development difference between the tourism network attention and the tourism flow in Shanghai from 2012 to 2021 using methods such as center of gravity model, spatial mismatch index, and two-dimensional combination matrix. The results show: (1) According to the analysis of the center of gravity model, there was a shift of the center of gravity of tourism network attention with the direction of "south-north", while the tourism flow shifted "west-east"; the center of gravity between tourism network attention and tourism flow began to diverge from 2012 to 2016, gradually converged from 2016 to 2019, and then gradually deviated again after 2020. (2) According to the spatial mismatch index, the spatial mismatch types between tourism network attention and tourism flow in various Districts of Shanghai are mainly negative and low mismatch, with high mismatch areas mainly distributed in the eastern and southwestern parts of Shanghai. (3) Combining the two-dimensional combination matrix, it can be observed that the spatial development difference between tourism network attention and tourism flow in Shanghai show a characteristic of "enlarging-shrinking-enlarging". From 2012 to 2016, the spatial development difference between tourism network attention and tourism flow in Shanghai continuously expanded; from 2017 to 2019, the spatial development difference continuously shrank; and from 2020 to 2021, the spatial differences expanded again. (4) The analysis results of the panel data model show that the development of tourism resources and the level of tourism services have a positive promoting effect on the evolution of spatial mismatch, while the social basic development environment has a negative effect. The research results not only meet the needs of evaluating the high-quality development of the tourism industry in the current economic restructuring, providing direction for the high-quality development of the regional tourism industry, but also enrich the research content of network attention as a tourism element participating in the evaluation of tourism industry development quality, and deepen the relationship research between network attention and tourism flow.

Evaluation model of urban tourism competitiveness in the context of sustainable development.

In the contemporary context marked by globalization and the growing prominence of sustainable development, assessing urban tourism competitiveness has emerged as a crucial research domain. This paper aims to develop a comprehensive model for evaluating city tourism competitiveness, grounded in the principles of sustainable development. The model incorporates factors such as city tourism resources, environmental considerations, economic aspects, and societal factors. This holistic approach seeks to offer valuable insights for the city tourism industry. The study conducts a thorough analysis of current research both domestically and internationally, highlighting gaps and articulating the objectives and significance of the research. Employing a machine learning-based empowerment method, the paper determines the significance of evaluation indices and utilizes the Topsis method for assessing urban tourism competitiveness. Distinguishing itself from traditional evaluation methods, this model integrates the principles of sustainable development throughout the evaluation process, with environmental, social, and economic sustainability serving as pivotal evaluation indicators. Empirical analysis involves the evaluation of tourism competitiveness for select cities, facilitating inter-city comparisons. Results from empirical studies demonstrate the model's effectiveness in evaluating urban tourism competitiveness, providing targeted developmental recommendations for urban tourism.

A study of the evolutionary game of carbon offset involving tourism stakeholders under incentive and constraint mechanisms.

Tourism carbon offsetting is a crucial pathway to achieving peak carbon and carbon neutrality in the tourism industry. Accurately grasping the collaborative evolutionary mechanisms among local governments, tourism enterprises, and tourists is key to promoting the implementation of tourism carbon offsetting. By constructing an evolutionary game model involving local governments, tourism enterprises, and tourists in carbon offsetting, this study uses MATLAB to simulate the evolutionary stable strategies under various conditions. Additionally, it dynamically simulates the collaborative strategies of the three parties under the influence of local government incentive and constraint mechanisms. The results indicate that under strong governmental constraint mechanisms, there is a promotion of active participation in carbon offsetting by local governments, tourism enterprises, and tourists. Incentive policies at certain levels also play a positive guiding role. As incentives increase, local subsidies and intervention costs also rise, leading to an evolution towards less enthusiastic participation among the three parties. Appropriately balanced government incentives and penalties are beneficial in achieving an equilibrium of benefits among multiple stakeholders involved in carbon offsetting, thus helping to attain carbon neutrality goals.