How do tourists consume a rural wine destination in central Portugal?

Space-time tourist behaviour is influenced by numerous factors related both to tourists and the destination. Yet, however complex it may be, understanding and to some extent managing the way tourists move in space and time is crucial to ensuring the quality of their experience, as well as the effective and sustainable management of destinations and attractions. In the rural wine tourism context, studies on space-time behaviour are rare. The present study uses empirical data collected from tourists staying in hotels of the Bairrada Wine Route territory (N = 116), combining a GPS tracking study with a questionnaire survey. Using a time-geographical analytical approach, the GPS tracking data were mapped for a more detailed analysis of the tourists’ movements in the Bairrada terroir. The findings highlight specificities of tourist consumption in the context of rural wine regions and provide valuable insights for destination planning, service design and marketing of the Bairrada Wine Route.

Using family planning service statistics to inform model-based estimates of modern contraceptive prevalence

The annual assessment of Family Planning (FP) indicators, such as the modern contraceptive prevalence rate (mCPR), is a key component of monitoring and evaluating goals of global FP programs and initiatives. To that end, the Family Planning Estimation Model (FPEM) was developed with the aim of producing survey-informed estimates and projections of mCPR and other key FP indictors over time. With large-scale surveys being carried out on average every 3–5 years, data gaps since the most recent survey often exceed one year. As a result, survey-based estimates for the current year from FPEM are often based on projections that carry a larger uncertainty than data informed estimates. In order to bridge recent data gaps we consider the use of a measure, termed Estimated Modern Use (EMU), which has been derived from routinely collected family planning service statistics. However, EMU data come with known limitations, namely measurement errors which result in biases and additional variation with respect to survey-based estimates of mCPR. Here we present a data model for the incorporation of EMU data into FPEM, which accounts for these limitations. Based on known biases, we assume that only changes in EMU can inform FPEM estimates, while also taking inherent variation into account. The addition of this EMU data model to FPEM allows us to provide a secondary data source for informing and reducing uncertainty in current estimates of mCPR. We present model validations using a survey-only model as a baseline comparison and we illustrate the impact of including the EMU data model in FPEM. Results show that the inclusion of EMU data can change point-estimates of mCPR by up to 6.7 percentage points compared to using surveys only. Observed reductions in uncertainty were modest, with the width of uncertainty intervals being reduced by up to 2.7 percentage points.

Evaluating the Feasibility of the Community Score Card and Subsequent Contraceptive Behavior in Kisumu, Kenya

Background: Women seeking family planning services from public-sector facilities in low- and middle-income countries sometimes face provider-imposed barriers to care. Social accountability is an approach that could address provider-imposed barriers by empowering communities to hold their service providers to account for service quality. Yet little is known about the feasibility and potential impact of such efforts in the context of contraceptive care. We piloted a social accountability intervention - the Community Score Card (CSC) - in three public healthcare facilities in western Kenya and use a mix of quantitative and qualitative methodologies to describe the feasibility and impact on family planning service provision. Methods: We implemented and evaluated the CSC in a convenience sample of three public-sector facility-community dyads in Kisumu County, Kenya. Within each dyad, communities met to identify and prioritize needs, develop corresponding indicators, and used a score card to rate the quality of family planning service provision and monitor improvement. To ensure young, unmarried people had a voice in identifying the unique challenges they face, youth working groups (YWG) led all CSC activities. The feasibility and impact of CSC activities were evaluated using mystery client visits, unannounced visits, focus group discussions with YWG members and providers, repeated assessment of score card indicators, and service delivery statistics. Results: The involvement of community health volunteers and supportive community members – as well as the willingness of some providers to consider changes to their own behaviors - were key score card facilitators. Conversely, community bias against family planning was a barrier to wider participation in score card activities and the intractability of some provider behaviors led to only small shifts in quality improvement. Service statistics did not reveal an increase in the percent of women receiving family planning services. Conclusion: Successful and impactful implementation of the CSC in the Kenyan context requires intensive community and provider sensitization, and pandemic conditions may have muted the impact on contraceptive uptake in this small pilot effort. Further investigation is needed to understand whether the CSC – or other social accountability efforts – can result in improved contraceptive access.

Impact of coronavirus disease 2019 on ENT clinical practice and training: the resident's perspective

Background The arrival of the coronavirus disease 2019 pandemic disrupted life suddenly and forcefully, and healthcare systems around the world are still struggling to come to terms with it. This paper reviews the impact of the pandemic on ENT practice and training. Methods The present manuscript was developed as a narrative review to examine the role of otorhinolaryngologists in the management of the pandemic, and assess its impact on practice and training in the specialty. Results Otorhinolaryngologists handle secretions of organs implicated in disease transmission, leaving them particularly vulnerable even while performing simple procedures. Although the pandemic increased skill expectations, it simultaneously reduced learning opportunities for trainees. In addition, attention to emergencies has been delayed. Further, the suspension of elective procedures has affected patients with malignancies. Conclusion While planning service resumption, provisions need to be made for protective equipment and training; improving teleconsultation services will help provide sustainable care during further waves.

Helping Older Adults to Move Around in Their Community Where, When, and How They Wish: Protocol for Developing a One-Stop Platform Transportation Planning Service Co-Designed by and for Older Adults (Preprint)

BACKGROUND Multiple mobility-related challenges frequently appear with aging. As a result, many older adults have difficulty getting around, to go, for example, to doctors’ appointments or leisure activities. Although various means of transportation are currently available, older adults do not necessarily use them, partly because they do not know which ones are adapted to their needs and preferences. To foster older adults’ autonomy and freedom in their decision-making about transportation, it is crucial to help them make informed decisions about the means that suit them best. OBJECTIVE The aim of this study is to develop MOBILAINÉS, a one-stop platform transportation planning service to help older adults move around in their community where, when, and how they wish. More specifically, the study aims (1) to define older adults’ mobility needs and preferences in order to conceptualize the one-stop platform; (2) to co-create the prototype of the one-stop platform; and (3) to test the prototype with users in a real-life context. METHODS A Living Lab co-design approach is used for this ongoing study. This approach differs from traditional research on aging by facilitating intersectoral knowledge sharing and innovative solutions by and with older adults themselves. A steering committee composed of 8 stakeholders from the public, scientific, and private sectors as well as older citizens meets quarterly throughout the study. The design comprises three phases, each with several iterative subphases. (1) Exploration: through co-design workshops and literature reviews, members of the intersectoral committee define older adults’ mobility needs and preferences to support the conceptualization of the one-stop platform. (2) Experimentation: four personas are produced that reflect the different needs and preferences of typical older adult end-users of the platform. To develop a prototype, scenarios, and mockups (static designs of the web application) are created through co-design sessions with older adults (n=12) embodying these personas. (3) Evaluation: to test the usability of the prototype, changes in mobility, such as the ability to move around and get to activities on time, will be documented by and with older adults (n=30) after using the prototype. The steering committee will identify ways to support the adoption, implementation and scaling up of MOBILAINÉS to ensure that the project is sustainable. Qualitative and quantitative data will be triangulated according to each subphase objective. RESULTS The first phase began in September 2019. The study is scheduled for completion by mid-2023. CONCLUSIONS This innovative one-stop platform transportation planning service will merge existing transportation options in one place. By meeting a wide variety of older adults’ needs and preferences, MOBILAINÉS will help them feel comfortable and safe when moving around, which should increase their participation in meaningful activities and reduce the risk of social isolation.

Law Firms as Tax Planning Service Providers

We provide large sample evidence of law firms facilitating U.S. publicly traded companies' tax planning, investigate when evidence of law firm involvement is strongest, and examine some tax planning mechanisms law firms facilitate. Because companies' tax planning relationships with law firms are not publicly observable, we use litigation filings and SEC comment letters to identify companies' observable law firm relationships. We find a positive association between companies' tax planning and the average tax planning of other companies that have a relationship with the same law firm. This association is stronger for companies that are smaller, younger, R&D intensive, financially constrained, and facing less capital market pressure but does not vary with auditor-provided tax services. We also find evidence consistent with law firms facilitating the use of tax havens, Double Irish structures, and special purpose entities. Our findings deepen our understanding of companies' tax planning ecosystems.

Family planning in Pacific Island Countries and Territories (PICTs): A scoping review

The use of contraceptives for family planning improves women’s lives and may prevent maternal deaths. However, many women in low and middle-income countries, including the Pacific region, still die from pregnancy-related complications. While most health centres offer family planning services with some basic contraceptive methods, many people do not access these services. More than 60% of women who would like to avoid or delay their pregnancies are unable to do so. This scoping review identifies and analyses evidence about family planning service provision in Pacific Island Countries and Territories (PICTs), with the aim of better informing family planning services for improved maternal health outcomes in the Pacific. We used Arksey and O’Malley’s scoping review guidelines, supported by Levac, Colquhoun and O’Brien to identify gaps in family planning service provision. Selected studies included peer-reviewed publications and grey literature that provided information about family planning services from 1994 to 2019. Publication data was charted in MS Excel. Data were thematically analysed and key issues and themes identified. A total of 45 papers (15 peer-reviewed and 30 grey literature publications) were critically reviewed. Five themes were identified: i) family planning services in the Pacific; ii) education, knowledge and attitudes; iii) geographical isolation and access; iv) socio-cultural beliefs, practices and influences; and v) potential enabling factors for improved family planning, such as appropriate family planning awareness by health care providers and services tailored to meet individual needs. While culture and religion were considered as the main barriers to accessing family planning services, evidence showed health services were also responsible for limiting access. Family planning services do not reach everyone. Making relevant and sustainable improvements in service delivery requires generation of local evidence. Further research is needed to understand availability, accessibility and acceptability of current family planning services for different age groups, genders, social and marital status to better inform family planning services in the Pacific.

Free Family Planning Counseling and Services in Labuh Baru Barat Pekanbaru

Indonesia is a country with a relatively high growth rate. The essence of the task of the Family Planning (KB) program is to reduce fertility in order to reduce the burden of development for the realization of happiness and prosperity for the people and nation of Indonesia. As a problem There are people who do not know about contraceptives and have not become family planning acceptors. This activity aims to provide knowledge about contraceptives and provide contraceptives for free. This activity aims to provide knowledge about contraceptives and provide contraceptives for free. The method of service is counseling and coaching residents of West Labuh Baru Village. The service was carried out in Labuh Baru Barat Village, Pekanbaru with 98 participants/samples in the activity. This activity is also in collaboration with midwives in the working area of the Payung Sekaki Health Center, Labuh Baru Barat Village. The tools and materials used in the activity are in the form of contraception as a free family planning service and counseling using the lecture method. The results of community service in Labuh Baru Barat Village are willing to become family planning acceptors according to their needs, and will repeat family planning if the family planning period has ended.