Search Results (126)

Medical tourism is among the fastest-growing segments of the global travel industry, and Taiwan’s internationally recognised healthcare system positions it well to compete in this market. Yet the companies best placed to lead this development have traditionally been identified through online word-of-mouth or personal recommendation rather than objective evidence, and performance criteria are rarely weighted to reflect both subjective opinion and objective data. This study addresses both gaps with a hybrid framework that uses main path analysis to identify, objectively, the companies most active in medical aesthetic technology, and integrates the Best–Worst Method (BWM), Entropy, Game Theory, and Grey-based TOPSIS to weight a four-dimensional, seventeen-criterion framework and rank company performance in medical tourism. An empirical application to seven Taiwanese companies engaged in medical aesthetics alongside medical tourism, drawing on industry expert assessments, shows that Service and Healthcare Resources is the most influential dimension, and that cloud-based customisation, multilingual personnel, and professional in-trip medical care are the most important criteria. Sensitivity analysis across nine weighting scenarios and comparison against four alternative ranking methods confirm the robustness of the ranking. The framework offers a replicable, objective template for evaluating medical tourism performance and provides managerial guidance for companies and policymakers seeking to strengthen Taiwan’s position in this market. Full article

‘Wellness-at-sea’ is an integral part of the cruise holiday service bundle. Marketed within an image of experiential diversity within a safe, controlled environment, it features medical centers, spa facilities and restoration-focused itineraries. Nevertheless, epidemiologically speaking, cruise ships rank amongst the riskiest transmission environments in tourism. This perspective paper proposes a typology of wellness cruising along two axes (i.e., offer scope: themed voyages versus onboard amenities and promotion focus: borrowed credibility versus narrative ‘storyscaping’) and uses it to develop the ‘wellness-risk paradox’, a boundary case for health-tourism literature. Three testable propositions emerge: reputational risk exposure increases with the offer’s wellness centrality; narrative-based promotion is more susceptible than credibility-based promotion and a quadrant-adjusted health-assurance scheme is more effective than current inspection standards. The argument draws on the 2026 Andes hantavirus outbreak aboard the MV Hondius (three deaths among thirteen cases), the 2020 Diamond Princess outbreak, and a decade of official outbreak surveillance, reporting an increase in gastrointestinal outbreaks from 0.34 to 0.62 per million passengers between 2019 and 2025 (rate ratio 1.84, 95% CI 0.87–3.86), which reverses the pre-pandemic downward trend although annual counts remain too small for the change to reach conventional statistical significance. Sanitation-inspection compliance cannot reliably predict outbreaks, nor does it facilitate trust. Four domains of action are proposed: continuous air-quality monitoring, wastewater surveillance, behavioral risk modeling and jurisdictional coordination. Full article

Background/Objectives: Croatia is among the European countries with moderately high antibiotic consumption and correspondingly elevated antimicrobial resistance (AMR) rates. National-level surveillance, however, masks substantial county-level heterogeneity that is relevant for targeted stewardship. This study aimed to (i) quantify and statistically test temporal changes in total antibacterial consumption (J01), beta-lactam antibiotics (J01C), and macrolides/lincosamides/streptogramins (J01F) across all 21 Croatian counties between 2017 and 2024, spanning the pre-pandemic, pandemic, and post-pandemic periods, and (ii) characterize geographic disparities that could inform region-specific stewardship interventions. J01C and J01F were selected because they are, respectively, the most heavily consumed and the most steadily rising antibiotic subgroups in Croatia, and both carry direct relevance to the WHO Access, Watch, Reserve (AWaRe) stewardship framework. Methods: A retrospective, registry-based analysis of antibiotic consumption in all 21 Croatian counties was conducted using annual distribution data from the Croatian Agency for Medicinal Products and Medical Devices (HALMED), covering 1 January 2017 to 31 December 2024. Consumption was expressed as defined daily doses per 1000 inhabitants per day (DDD/TID). County-level values for 2017, 2020, 2021, and 2024 were compared using paired Student’s t-tests (confirmed with Wilcoxon signed-rank tests) and a Friedman test across all four time points; national annual means (2017–2024) were compared descriptively against European Union/European Economic Area (EU/EEA) surveillance benchmarks. Results: National J01 consumption declined from 21.16 to 16.96 DDD/TID between 2017 and 2021 (−19.8%) and rebounded to 22.75 DDD/TID by 2024 (+34.1%); the county-level decline and rebound were both statistically significant (paired t-tests, p < 0.001 for each comparison; Friedman χ² = 57.97, p < 0.001). J01C followed the same U-shaped pattern, temporally coincident with the COVID-19 pandemic period (12.59 → 5.13 → 9.05 DDD/TID; all comparisons p < 0.001), whereas J01F rose continuously throughout the study period, without a corresponding dip during that period (2.81 → 3.49 → 4.43 DDD/TID; p < 0.001 for every interval). Croatia’s 2024 mean county-level J01 consumption was significantly above the 2024 EU/EEA population-weighted mean of 18.8 DDD/TID (one-sample t-test, p = 0.016). The sharpest pandemic-era declines and post-pandemic rebounds were concentrated in Adriatic coastal counties (Primorje-Gorski Kotar, Zadar, Šibenik-Knin, and Istria). Conclusions: Total and beta-lactam antibiotic consumption in Croatia followed a U-shaped trajectory temporally coincident with the COVID-19 pandemic period, while macrolide, lincosamide, and streptogramin use rose steadily throughout 2017–2024, a pattern of stewardship concern given that this subgroup is predominantly classified as “Watch” under the WHO AWaRe framework. Coastal counties displayed disproportionate fluctuations, plausibly reflecting seasonal population dynamics not captured by resident-population denominators. AWaRe-stratified, tourism-adjusted, county-level surveillance is recommended to guide targeted stewardship. Full article

Health tourism represents a dynamic sector operating at the intersection of medical services, international patient mobility, and tourism development. Despite its growing prominence, the academic literature frequently conflates health tourism with medical and wellness tourism—a conceptual ambiguity that complicates the establishment of robust, sustainable legal frameworks. Addressing this gap, the present paper conceptualizes health tourism as an overarching framework that encompasses recovery, wellness, and medical sub-sectors. Within this comprehensive paradigm, we explore the contemporary landscape of health tourism in Northern Cyprus through a stakeholder-driven qualitative lens. Utilizing a qualitative case study design, data were gathered via semi-structured interviews with 40 key respondents representing healthcare, travel, public administration, academia, and related professional domains, and subsequently subjected to thematic analysis using NVivo 15 software. The findings reveal that the sector in Northern Cyprus is heavily skewed toward medical tourism, with a concentrated focus on in vitro fertilization (IVF), cosmetic surgery, dental care, and bariatric procedures. Conversely, wellness and rehabilitation tourism remain largely untapped strategic niches. The analysis further indicates that sectoral growth is constrained by structural bottlenecks, including fragmented governance, limited international recognition, transport and accessibility barriers, inadequate accreditation systems, lack of stakeholder synergy, and ethical concerns regarding advertising and patient safety. Moving beyond standard environmental sustainability, this research underscores that long-term destination resilience requires ethical governance, clinical quality controls, patient-rights advocacy, transparent legal frameworks, and community-level economic integration. Ultimately, this study proposes an integrated, stakeholder-centric paradigm tailored to the unique socio-political and structural realities of Northern Cyprus, offering actionable policy recommendations that enrich the discourse on sustainable medical tourism from a small-island perspective. Full article

China’s low-altitude economy (LAE) is moving from policy experimentation to coordinated industrial deployment, yet existing assessments often treat the LAE as a homogeneous sector or equate aircraft capability with deployment readiness. This study develops a scenario-gated sustainability readiness framework for six representative LAE and urban air mobility (UAM) scenarios in China: emergency medical logistics and disaster response, infrastructure inspection and public-service monitoring, urban instant logistics, airport shuttle and intermodal passenger transfer, urban air taxi, and low-altitude tourism. The proposed framework consists of a scenario layer, an eight-dimensional readiness layer, and a decision layer integrating 0–4 ordinal scoring, evidence-confidence tagging, non-compensatory gate conditions, and readiness classification. The eight dimensions cover mission and demand fit; airspace and traffic controllability; infrastructure and site readiness; digital communication, navigation, surveillance, and data security; vehicle, energy, and environmental performance; weather and route-environment robustness; workforce and organizational readiness; and social acceptance and legal legitimacy. The illustrative application indicates that infrastructure inspection is the only routine scaling candidate; emergency medical logistics and urban instant logistics are suitable for bounded routine operation; airport shuttle and tourism should remain controlled pilot candidates; and open-network urban air taxi is still at the pre-pilot stage. The study contributes a scenario-based deployment logic for sustainable aviation and UAM governance. Full article

Changsha’s historic district, a key part of China’s Historic and Cultural Cities, faces the challenge of balancing spatial constraints and historical preservation while optimizing its existing infrastructure. The public service facilities in Changsha’s historic district are the subject of this study. The study goes beyond traditional facility classification techniques and divides these facilities into four categories: medical and welfare, cultural and historical, education and sports, and environmental sanitation. It is based on field research and multi-source geospatial data and considers a variety of factors, including the distribution of cultural resources, traditional living zones, historic street networks, and cultural and tourism functions of the historic district. Based on this foundation, we propose a configuration evaluation framework that encompasses three dimensions—“spatiality, accessibility, and relatedness”—to systematically analyze the spatial distribution of facilities, walkability, and the community network structure by integrating kernel density, accessibility, and modularity algorithms. The results offer methodological guidance and practical support for facility planning research in the context of historic and cultural city preservation, as well as a scientific foundation for the focused optimization and renovation of public service facilities in historic districts. Full article

Thermal groundwater resources constitute valuable health-oriented georesources, particularly when integrated into regional strategies for wellness, balneotherapy, and therapeutic tourism. This study presents the first comprehensive and integrated hydrochemical, geospatial, and balneological characterization of thermal groundwater systems in Uruguay, enabling their classification from a medical hydrology perspective and supporting the assessment of their potential use in balneotherapy. Seven thermal groundwater sources located in northwestern Uruguay were investigated, mainly associated with the Guaraní Aquifer System (GAS), together with the singular Almirón spring, which represents a distinct hydrogeological setting. Field measurements and laboratory analyses were conducted to determine physicochemical parameters, major ions, and gases. Hydrogeochemical facies were identified using Piper and Gibbs diagrams, while multivariate statistical techniques, including Principal Component Analysis (PCA) and hierarchical clustering, were applied to discriminate water types and support their balneological classification. The results indicate that most thermal waters associated with the GAS are characterized by sodium–bicarbonate facies, weak to medium mineralization. Dry residue to 180 °C, (311–734 mg/L), and mesothermal to hyperthermal temperatures (36.3–44.5 °C), reflecting deep confined circulation and prolonged water–rock interaction. By comparison, the Almirón spring exhibits a chloride–sodium facies with strong mineralization. Dry residue to 180 °C, (6590 mg/L) and hypothermal (32 °C), consistent with a distinct hydrogeological origin involving crystalline basement and Devonian sedimentary units and reflecting more evolved geochemical conditions. Based on the obtained results, and by analogy with comparable international hydrothermal profiles, the main balneological indications of these waters include musculoskeletal and rheumatic disorders, dermatological disorders, and other emerging indications such as stress, sleep disorders, obesity, and Long COVID. In conclusion, this study reveals the hydrochemical diversity of Uruguay’s thermal groundwater and its possible use in balneology. Future research should focus on controlled clinical and balneological studies to validate specific therapeutic effects. Full article

Tourism and destination healthcare systems are increasingly interdependent, yet this relationship remains weakly conceptualised within tourism and hospitality research. Expanding travel flows introduce transient populations, seasonal demand volatility, and distinctive risk profiles that reshape local healthcare demand, while healthcare capacity and governance have become critical enabling conditions for destination resilience and competitiveness. This conceptual paper synthesises contemporary research and practice-based evidence to develop an integrated framework explaining how tourism development and healthcare systems co-evolve. Using a narrative review and conceptual synthesis approach, the framework is informed by two contrasting destination contexts: Phuket, Thailand, a high-volume international and medical tourism hub, and Australia’s Northern Territory, a low-density remote tourism region reliant on aeromedical retrieval and public health services. The proposed framework identifies three interlinked pillars—tourism pressure pathways, health system response capacities, and opportunity leverage mechanisms—positioning healthcare systems as core tourism infrastructure and health system resilience as a central dimension of sustainable destination governance. The framework offers a transferable analytical tool to support tourism planning, health policy integration, and cross-sectoral governance across diverse destination settings. Full article

Objective: Although Las Vegas is a major tourist hub, it is not among the counties that are under CDC surveillance for Clostridioides difficile infection (CDI), a major nosocomial infection. To determine the distribution of C. difficile ribotypes in the Las Vegas area, we collected stool samples from CDI-positive patients at the University Medical Center (UMC). Methods: We included adult patients diagnosed with CDI and provided informed consent. C. difficile was isolated from the stool samples and ribotyped. Demographic information was also obtained and analyzed. All information was compared to the surveillance data from the CDC. Results: We identified more frequently in male patients than in the CDC data. Less than half of the patients used antibiotics prior to the infection. We observed several comorbidities in our patient sample pool, with cardiovascular disease and diabetes being the most prevalent comorbidities. Hypervirulent C. difficile strain 027 was the most prevalent ribotype. Except for two samples of ribotype 076, all other samples represented unique singlet ribotypes. Four of these ribotypes (160, 302, 363, and 813) have not been explicitly reported in humans. Conclusions: Due to the unique environment created by the tourism industry in Las Vegas, this population is exposed to national and international visitors. This study shows the pre-COVID landscape of C. difficile ribotypes in Las Vegas and offers valuable insights into the varieties of C. difficile that are currently infecting this community. Full article

This Perspective presents a framework for US hospitals treating foreign patients to reconceptualize international healthcare trade by leveraging all four modes of trade in health services under the General Agreement on Trade in Services (GATS), which include information exchange (Mode 1), patient travel/medical tourism (Mode 2), commercial presence (Mode 3), and temporary movement of healthcare personnel (Mode 4). This framework illustrates how hospitals could adopt multi-modal approaches and describes the strategic implications for hospitals and their international patient programs. Historically, US hospitals have focused primarily on international patient travel (Mode 2), but this narrow approach creates vulnerability to disruption. Mode 2 exports by US hospitals have not recovered to pre-pandemic levels, making expansion into other modes essential for maintaining competitive advantages while mitigating systemic risks. Diversification into other modes, such as digital health and telemedicine (Mode 1), co-branding and managing facilities (Mode 3) and visiting professorships (Mode 4) are single-mode approaches for diversification. Multi-country clinical trials are an example of cross-border trade that addresses all four modes of GATS. Overall, this perspective provides a new framework for US providers engaged in or considering entry into international markets that does not solely rely on Mode 2 medical tourism but instead adopts a multi-modal, cross-border health service paradigm. Full article

Background/Objectives: Unpaid medical expenses incurred by foreign nationals represent a growing concern for healthcare systems amid increasing international mobility. Japan, which lacks mandatory public insurance coverage for non-resident visitors, faces particular vulnerability in terms of uncompensated hospital care. This study aims to identify factors contributing to unpaid medical charges among uninsured, non-resident foreign patients hospitalized at a tertiary care facility in Tokyo. Methods: This retrospective observational analysis was conducted using medical and administrative data from patients admitted between January 2023 and February 2025. Patients who received elective medical tourism care were excluded. Data on demographics, length of hospital stay, care intensity, payment status, and third-party financial assistance were analyzed. Logistic regression models were applied to assess predictors of nonpayment. Results: Among 153 eligible cases, 9 patients (5.9%) had outstanding hospital bills upon discharge. Compared with those with completed payments, the unpaid group experienced longer admissions, more intensive care utilization, and higher total charges. Notably, the absence of third-party financial support (primarily travel insurance) was significantly associated with unpaid charges. Multivariate analysis identified this factor as the main independent predictor (adjusted odds ratio [OR]: 0.12; 95% confidence interval [CI]: 0.02–0.915; p = 0.040). Total amount of billing was also statistically significant (adjusted odds ratio [OR]: 1.01; 95% confidence interval [CI]: 1.00–1.01; p = 0.039). Conclusions: These findings highlight the importance of private insurance in mitigating financial risk in hospitals. Implementing policy measures to promote or require insurance enrollment, along with streamlined reimbursement systems, may contribute to sustainable care delivery for international patients. Full article

Approximately 27.6% of Italian beaches are currently affected by erosion, despite the widespread implementation of coastal defence structures. Around 10,500 installations—mainly groins and detached breakwaters—occupy nearly 24.6% of the national shoreline. Although primarily designed to protect tourist beaches, these hard-engineered structures often degrade coastal landscapes, alter nearshore circulation, and pose risks to swimmers. Nevertheless, beaches remain a fundamental asset for the “3S” (Sun, Sea, Sand) tourism sector, which contributes approximately 2.2% to Italy’s GDP, accounting for over 175 million tourists’ overnight stays in 2024, frequently concentrated near protected coastal zones. In this study, drowning incidents along the Italian coastline were analyzed using press reports complemented by official statistics. Between 2016 and 2021, an average of 145 fatalities occurred per bathing season. Sudden drownings following medical emergencies accounted for 41% of cases, non-swimmers for 18%, accidental falls into the water for 3%, and water sports activities for an additional 3%. Rip currents on natural beaches were responsible for 22% of drownings, whereas those generated by coastal defence structures accounted for 12%. A further 12% of non-swimmer fatalities are suspected to have resulted from falls into depressions or channels formed in proximity to these structures. Evidence from previous studies and seabed morphology analyses indicates that coastal defence structures can generate rip currents through two main mechanisms: (1) hydraulic pressure exerted against groins, which drives offshore flow, and (2) water outflow between pairs of breakwaters resulting from wave setup behind them. Both processes, though often less intense, are also observed near submerged structures. The erosional channels formed by these currents may persist well beyond storm events, maintaining dangerous conditions for bathers. As Italy continues to rely predominantly on hard coastal protection measures, improving the understanding of drowning dynamics associated with these structures is crucial. This should be accompanied by regulatory updates requiring designers and coastal managers to systematically assess related hazards and to propose effective mitigation and safety strategies. Full article

Assisted reproduction is a rapidly expanding pillar of medical tourism. Greece combines a liberal legal framework, internationally accredited clinics, and comparatively competitive costs, attracting cross-border patients seeking ART services. Following the 2022 amendment (Law 4958/2022) which amends the original law n.3305/2005, treatment is permitted up to age 54 under specific authorization, while court-approved surrogacy, anonymous gamete donation, and the adoption of decision-support technologies (e.g., AI-assisted embryo assessment, PGT-A) underpin the sector’s growth. This review synthesizes legal, medical, economic, and social dimensions, drawing on Q1 literature and official datasets (WHO, OECD, ESHRE/ICMART), and compares Greece with Spain, the USA, the Czech Republic, and Ukraine. Quantitative indicators include age-stratified success rates and indicative treatment costs. We discuss benefits and risks for patients and the health system, highlighting policy options for sustainable, ethically robust reproductive tourism in Greece. Full article

Sectoral vulnerability to distinct crisis types in small, open, and geopolitically exposed markets—such as Jordan—remains insufficiently quantified, constraining targeted policy design and portfolio allocation. This study’s primary purpose is to establish a transparent, comparable metric of sector-level market resilience that reveals how crisis typology reorders vulnerabilities and shapes recovery speed. Applying this framework, we assess Jordan’s equity market across three archetypal episodes—the Global Financial Crisis, the Arab Spring, and COVID-19—to clarify how shock channels reconfigure sectoral risk. Using daily Amman Stock Exchange sector indices (2001–2025), we estimate $GARCH\left(\mathrm{1,1}\right)$ models for each sector–crisis window and summarize volatility dynamics by persistence $(\alpha +\beta )$, interpreted as an inverse proxy for resilience; complementary diagnostics include maximum drawdown and days-to-recovery, with nonparametric (Kruskal–Wallis) and rank-based (Spearman, Friedman) tests to evaluate within-crisis differences and cross-crisis reordering. Results show pronounced heterogeneity in every crisis and shifting sectoral rankings: financials—especially banking—display the highest persistence during the GFC; tourism and transportation dominate during COVID-19; and tourism/electric-related industries are most persistent around the Arab Spring. Meanwhile, food & beverages, pharmaceuticals/medical, and education recurrently exhibit lower persistence. Higher persistence aligns with slower post-shock normalization. We conclude that resilience is sector-specific and contingent on crisis characteristics, implying targeted policy and portfolio responses; regulators should prioritize liquidity backstops, timely disclosure, and contingency planning for fragile sectors, while investors can mitigate crisis risk via dynamic sector allocation and volatility-aware risk management in emerging markets. Full article

We propose an edge-enhanced federated learning framework for real-time itinerary optimization in elderly oriented adventure tourism, addressing the critical need for adaptive scheduling that balances activity intensity with health constraints. The system integrates lightweight convolutional neural networks with a priority-based scheduling algorithm, processing participant profiles and real-time biometric data through a decentralized computation model to enable dynamic adjustments. A modified Hungarian algorithm incorporates physical exertion scores, temporal proximity weights, and health risk factors, then optimizes activity assignments while respecting physiological recovery requirements. The federated learning architecture operates across distributed edge nodes, preserving data privacy through localized model training and periodic global aggregation. Furthermore, the framework interfaces with transportation systems and medical monitoring infrastructure, automatically triggering itinerary modifications when vital sign anomalies exceed adaptive thresholds. Implemented on NVIDIA Jetson AGX Orin modules, the system achieves 300 ms end-to-end latency for real-time schedule updates, meeting stringent safety requirements for elderly participants. The proposed method demonstrates significant improvements over conventional itinerary planners through its edge computing efficiency and personalized adaptation capabilities, particularly in handling the latency-sensitive demands of intensive tourism scenarios. Experimental results show robust performance across diverse participant profiles and activity types, confirming the system’s practical viability for real-world deployment in elderly adventure tourism operations. Full article