En 2013 el Grupo se hizo acreedor al Premio Nacional de Calidad, otorgado por la Presidencia de la República. Logró la re-certificación por parte del Consejo de Salubridad General y del College of American Pathologists.Se inauguró la Unidad Académica de la Fundación clínica Média Sur (Médica Sur, 2013).En 2014Médica Sur logró la acreditación por parte de la JointCommission International (JCI), integrándose así a un grupo de élite a nivel mundial en cuanto a la calidad de la atención médica. Ese mismo año obtuvo el premio “EuropeanAwardforBestPractices”, gestionado por la EurpeanSocietyforQualityResearch (Médica Sur, 2014). En 2015 Médica Sur y la Mayo ClinicCare Network inauguraron el Centro de Educación alPaciente (CEAP), con el objetivo de ofrecer la mejor atención médica y contribuir a educar a paciente en lacomprensión de padecimientos (Médica Sur, 2015).
Tourism is an important activity inthe world economy, which implies the displacement from one place to another, and thanks to it, a country is modernizing and developing infrastructure to offer quality tourist services in demand; Mexico is one ofthe main tourist destinations inthe world because you can perform all kinds of tourist activities such as: cultural, sports, religious, eco-tourism, wellness, medical, adventure, gastronomic among others with its international travelers such as international tourists with internment and border tourists, international hikers with border and cruise hikers. The objective of this research is to analyze the impact oftourismin hospitality inMexico through a descriptive methodology through an analytical review ofthe literature with secondary sources. It is concluded that the hotel infrastructure has increased in recent years due to the increase inthe flow of tourists both national and international, which represents the growth in foreign exchange income, jobs and investment for this activity.
In 2015, the municipality of Tlaxco is named Pueblo Mágico, although it is true that it has tourist wealth, according to the Annual Report on the Poverty Situation 60.22% ofthe population is in a state of poverty, therefore, the objective is to make tourism activity the engine of growth ofthe municipality through a planning of products and services that meet the needs ofthe tourist and those ofthe destination, based on a previously made diagnosis ofthe tourist inventory. For this, an instrument was designed whose sample was taken contemplating 118 companies that are directly linked to tourism, 36 surveys being applied. According to the results, 100% of respondents believe that Tlaxco can reach a more visited destination and although 66.7% have a high level of satisfaction residing in Tlaxco, 88.9% believe that although tourism has increased, public services have not improved. However, although 72.2% consider that the influx of tourists has increased, 58.3% consider that the tourist activity ofthe town is limited. Ofthe development plans that have been implemented, 44.5% of respondents have heard those plans but have no total knowledge of them. Therefore, it is essential that the opinion ofthe residents be taken into account, so that new activities and attractions for visitors are implemented in this way.
Inthe last few decades, tourism has become the third most important economic activity inMexico. The increase ofthestrategies for tourism development has led to a diversification ofthe tourist offer ofthe country; for example, in 2001 was created the "Magic Villages Program", linked to the primary and secondary sector primarily, seen as a tool of development of double entry, to serve as a component of improved national and local economy. The paper identifies tourism trends from the characterization ofthe profile ofthe tourist and their demand in four Magical Villages ofthe Northern Sierra of Puebla. To do this, a survey was applied with 50 indicators to a sample of tourists inthe region. The analysis ofthe data suggests that the use of this type of categorization allows the evaluation oftourism demand and the analysis ofthe degree of involvement ofthetourism sector with service providers, from which you can develop an offer of tourist products designed according to the needs ofthe tourist. The results show that most tourists are young, under the age of 30, most of them students, and with a monthly income equal to or less than $4, 000.00, this tourist is looking primarily at the coexistence with nature and enjoy the gastronomy and handicrafts and has an interest highlighted by the rural tourism.
As Cordella (2007:194) remarks, the interaction between doctor and patient is based on unequal power relations, which may even be shown inthe lexical choices made. This is what is reflected in British interactions, where the doctor clearly leads the interaction not only by asking questions and telling the patient what to do, but also through interactional strategies to show affiliation and empathy. In this sense, the data show how affiliation strategies are initiated by the doctor, who usually makes use of jokes, asks personal questions not necessarily related to the health problem and also takes the initiative to offer help at different points ofthe interaction. At the same time, the British patient usually adopts a more passive role by waiting for the doctor to lead and guide him/her inthe interaction. In contrast, Spanish interactions are not so clearly structured and are not always characterized by the doctor leading the interaction. In fact, it is common to find situations where it is the patient who initiates the conversation and the doctor who just accepts the way the interaction is developed or negotiates what is going to be dealt with. It does not mean that there is no negotiation in British interactions; what it implies is, in fact, that there is more room for disagreement in Spanish interactions and therefore, the interactional work done to negotiate may imply more time and effort on the part of both participants. It will be shown that this is the result of more abstract, underlying cultural conceptualizations ofthe three bases of rapport specified by Spencer-Oatey (2000, 2008): face, rights and obligations and interactional goals.
Incidence of inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), seems to be increasing, but data about IBD epidemiology in Latin America remains scarce. This study aimed to determine the incidence of IBD in Uruguay for the period 2007-2011. A retrospective, registry-based study was performed, with data between January 2007 and December 2011 of two medi- cal centers from Uruguay - Montevideo (220,687 members) and Salto (51,235 members). Patients were excluded if the diagnosis occurred outside this period, if it was not confir- med after one year of follow-up or if presenting unclassified IBD. Poisson regression was used to evaluate differences in incidence rates by sex and age at diagnosis. The U Mann Whitney test and Fisher’s exact test were used to compare age at diagnosis and sex distribution between centers and UC vs. CD patients. 67 new IBD cases were identified during
Moreover, we conducted a similar survey, though referred not only to a particular educational level but to all educational strategies -formal and non formal- implemented inthe city of Vancouver, Canada (Pozzo, 2012). The findings show a great variety ofstrategies related to cultural plurality. The varied range of foreign languages at school, study tours, international study groups, and community events to retain the ethnolinguistic vitality of immigrant groups are indicators of pluralist politics. The teaching of English as a second language, literacy programs for immigrants, orientation days for international students and support workshops in English for non- English speaking university students are compensatory strategies aimed at overcoming the cultural deficits of immigrants. On the other hand, research on multiculturalism and related issues also show a policy of cultural pluralism through educational activities which include the rights of minorities and the positive effects of ethnic diversity.
The continuing growth ofmedical costs has been the subject of attention by both government and industry during the last few decades [Carroll, 2002; Oura et al, 2001]. Advances inmedical science have created a continuous flow of new drugs, medical treatment and equipment capable of controlling pathologies that would otherwise be fatal. The increasing availability of successful treatment for diabetes, high blood pressure, many types of cancer, a variety of infectious diseases and AIDS are good examples of this flow. Although the costs of these advances are considerable, those who benefit from
ethnographic field site. The field I identified was not a “site” per se, but, rather, a net- work of people. I began with professional midwives inMexico, a contained and con- nected groupof women, and subsequently gained access to their clientele. I then re- cruited couples, physicians, and obstetric nurses, to my study. Over the course of my fieldwork, I volunteered at two differ- ent transnational NGOs, gaining access to training workshops for indigenous tradi- tional midwives. Having befriended a few indigenous midwives, and while staying as a guest in their homes during repeat visits to their villages, I was able to witness their in- teractions with indigenous women and the “traditional” midwifery care they provide. Finally, I observed medical professionals and maternity patients in both private and public hospital settings and solicited inter- views with physicians and policy makers. This process led me to the Mexican states of Guanajuato, Guerrero, Jalisco, México, San Luís Potosí, Veracruz, Chiapas, Oaxaca, Quintana Roo, Morelia, Querétaro, Puebla, Michoacán, and Nuevo León; additionally, I travelled to California for interviews, and Brazil for participant observation in a “tra- ditional Mexican midwifery” workshop. While the geographic breadth of this “field” is enormous, the specific people I travelled to meet, observe, and interview were very concrete. All the individuals in my study have acquaintances, and often great friends, among the other individuals in my study.
The growth ofthe term cross-cultural is present in 37 reviewed texts, involving concepts such as ethical consumption and sustainability (Yen, Wang, & Yang, 2017). Another text consulted contributes decisively to group decision-making and joint de- cisions in segments that have not been widely researched: intercultural problems in emerging markets, emotions, and consumer misconduct (Cohen, Prayag, & Moital, 2014). Another relevant text suggests a positive relationship between intrinsic re- ligiosity and the belief that questionable consumer activities are not ethical. How- ever, extrinsic religiosity does not affect consumer opinions about the ethics of con- sumer practices (Patwardhan, Keith, & Vitell, 2012). The literature review showed a trend toward purchasing ethical foods (organic foods, fair trade products, and locally grown products), suggesting that this phenomenon can do more harm than good inthe long term, in terms ofthe environment, nutrition, and health (Popa, Draghici, Popa, & Niculita, 2011).
Para la Organización Mundial del Turismo: “Durante décadas, el turismo ha experimentado un continuo crecimiento y una profunda diversificación, hasta convertirse en uno de los sectores económicos que crecen con mayor rapidez en el mundo”. Durante años el mercado en este sector ha permitido el desarrollo de nuevos nichos entre ellos, el llamado Turismo Negro. La definición de dark tourism apareció por primera vez en el año de 1996 con Foley y Lennon.
Medical adherence is defined as the extent to which real medical practices follow the suggestions ofmedical standards. Here the analysis ofthe adherence is used both to verify that the methodology introduced to generate accurate representation ofmedical procedures is correct (SDA-data analysis) and also to validate the SDAs obtained with respect to several predefined standard MAs (SDA-MA analysis). In both cases, the adherence was calculated in terms of type I and type II errors [Doa]. Type I error is related to themedical relevance of not taking the correct medical decision (e.g., forgetting a drug prescription when it is completely necessary) and type II error is related to themedical relevance of taking a wrong medical decision (e.g., ordering a visit to a specialist when it is not necessary). To calculate these errors inthe SDA-data analysis, we register the deviations between the treatment performed in each encounter ofthe EOC database and the treatment pro- posed by the induced SDA diagram. Inthe SDA-MA analysis, for the list of all the possible patient conditions and their probability provided by the health care professionals, we register the deviations between the treatment suggested by the MA and the treatment proposed by the SDA diagram. In both cases, each possible deviation ofthe treatment is given a certain medical relevance provided by a health care professional. The addition of type I and type II errors is called here the total error. The SDA-data analysis was performed to verify the correctness ofthe methodology, that is to say, the level of adjustment ofthe SDA diagrams to the health care procedures within the database. In table 5.3, the columns SDA-Data contain the weighted-mean of type I, type II and total errors when the health care procedures inthe EOC database were compared with those proposed by the SDA diagrams in figures 5.8, 5.9, 5.10 and 5.11. The pruning in tasks 3 and 4 ofthe learning process is the main reason for type I and type II errors. An average 5,1% ofthemedical orders inthe EOC database are not reflected inthe SDA diagrams (type I error), and an average 0,3% ofmedical orders suggested by the SDA diagram do not coincide with the database (type II error).
The Mexican State assumes the rectory of development, therefore the federal executive presents every six years a national development plan, which allows the development of sectoral, special, regional and institutional programs. Tourism is subsumed as a dynamic subsector of vital importance in planning for economic development, derived from its role as a foreign exchange provider and employment generator. The objective of this work is to identify and analyze the regulatory framework oftourism and its importance inthe economic planning ofMexicointhe period 2000-2024. The methodology applied is documentary type with an exploratory- descriptive design that uses secondary sources of information; the presidential reports and national development plans ofthe reference period were consulted. Results and conclusions: the economic development process has required the establishment of conditions that ensure the dynamism ofthe services sector, as well as fully addressing its problems, which has implied a thematic and priority variety in planning, where the economic activity oftourism has become in growth axis. Inthe review ofthe legal framework oftourism, suitable additions are detected that support and guide the design ofthe planning, and envisage actions that were materialized inthe medium term in six- year terms and there is no comprehensive future planning, rather, tourism it is dependent on the trend of urbanization, investment and growth of tourist activities located as a safe offer and other productive activities that generate greater impact on the economy.
is the best way to teach anatomy (El- lis, 2001; Aziz et al., 2002; Cahill, 2002; Rizzolo, 2002; Granger, 2004; Pawlina and Lachman, 2004). Those who feel that the cadaveric dissection is the key to teaching anatomy present a number of reasons why its use must continue. From this point ofview, there are two method proposals for laboratory practice: dissection (Cahill and Dalley, 1990; Jones, 1997; Monkhouse and Farrel, 1999; Marks, 2000; Miller, 2000; Ellis, 2001; Cahill et al., 2002; Granger, 2004) and pro- section (Sinclair, 1965; Nnodim, 1990; Skidmore, 1995; Topp, 2004). There are studies comparing both teaching methods (Alexander, 1970; Nnodim, 1990; Dinsmore et al., 1999) and both of them are used in some universities in Europe (Heylings, 2002) as well as the United States and Canada (Collins et al., 1994).
These examples can also be used to show that the construction of phenotypes can change the way in which results are interpreted. Thus, if we had 30 patients and found from test A that 15 had the wt/*4 genotype and that 10 of these patients had a side effect from taking TAM that was not detected inthe other 20 patients then, depending on which classification we used, we would describe these patients as being IM, PM or EM. Consequently, we would assume from this sample of patients that there was an association between the phenotype and the side effects. In addition, these examples also show that as a larger number of alleles are tested for, the chances of detecting IMs and PMs are increased. For example, a patient with the *3/*5 genotype identified by test B and labelled a PM would not have been detected as a PM by test A, which did not test for these two alleles, and so he or she would have been classified as wt/wt, i.e. EM. Test C may also be unable to identify this patient as a PM, not because ofthe number of alleles tested but
Abstract: Aim: We aimed to receive the opinions ofthe preclinical medical students on medical ethics education, and to present some suggestions for the education program. Methods: Focus group discussions were held with third-grade medical students. The analyses were implemented using Creswell’s six-step qualitative data analysis. Results: During the data analysis, themes with the following titles were identified: necessity ofthe education, content, education methods, assessment, participation, contribution ofthe education, moving to clinical training and suggestions. Discussion: The students stated that the discussions on movies/ books/case-based scenarios are more useful than lectures. Although they believed that student assessment was necessary for themedical ethics education, they had negative attitudes towards Multiple Choice Questions. At the stage of moving to the clinical training, their feelings and thoughts about the learning outcomes they would gain from ethical education were contradictory. Conclusion: Each theme and code obtained from the students’ expressions may contribute to improving medical ethics education for all institutions. Besides student education, it is also necessary the faculty development programs on medical ethics education for clinical teachers. Additionally, further studies can be conducted on the actions that need to be taken to help students internalize the ethical issues and feel the need of learning more.
10 elites, such as the British Medical Association and the Royal Colleges, still play a key role in setting the standards governing medical regulation and training (Bruce, 2007). For example, take the much vaulted medical competence test known as revalidation. As the paper has already noted, this is currently being readied for national implementation in late 2010, and allegedly involves a thorough ‘hands on’ assessment of a doctor’s ‘fitness to practice’ in their chosen medical specialty, which they must pass to stay on themedical register and be able to practice medicine (Donaldson, 2008). NHS management, patients and other health care professionals will all have input into this process. It is therefore no surprise that medical elites use revalidation to argue that they are being responsive to the need to be more open and transparent (i.e. Catto, 2006). However, revalidation will be overseen by the Royal Colleges. Not least of all because it is expected that a mixture of clinical audit, direct observation, simulated tests, knowledge tests and continuing professional development activates, will together ensure a doctor is regarded as competent. Inthe final analysis, the state has to accept that peer review remains the key criteria by which the quality ofmedical work can be judged and the potential for risk inthe application ofmedical expertise minimised (Friedson, 2001). Consequently, and in line with the restratification thesis, the current situation concerning the governance ofmedical expertise inthe United Kingdom is perhaps best summed up by Moran (1999, p. 129-30), who argues that: “…states are more important than ever before, either inthe direct surveillance ofthe profession or in supervising the institutions of surveillance…[this] has not necessarily diminished the power of doctors; but it has profoundly changed the institutional landscape upon which they have to operate”.
Theory says that firms are autonomous to decide whether to increase or decrease its levels of commitment to one or more relationships within a network. Aspects such us speed, intensity, and efficiency ofthe learning process, creating knowledge, and trust building are concepts of intellectual and social capital. In this sense, the sample group proved to have a great deal of strategic alliances with hospitals, universities, insurance companies, etc., abroad. These are great sources of knowledge transfer and a way to learn about how others internationlaize and opperate. All MSOs participated in trade missions, international congresses, and some advertize their services in MT or commercial magazines. Also, reputation was an issue of major concern for the MSO sample in both cities. This is why some of them were very careful when hiring third parties to bring IPs to their organization. I
Disease management require large resources uti- lization, which was intensively established by the fact that 86% of patients required management inthe NICU; 56% of costs comprised components such as lengthy hospitalization (up to 36 days), use of a large number of laboratory and diagnostic exams, and high number of consultations, as well as the need for surfactant treat- ment and MV. The cost predictive model of Zupancic and colleagues 24 reported that the main factors that explain