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Twelve tips to teach culturally sensitive palliative care

With an increasingly ageing population there will be a rising demand for palliative care, including from older migrants and ethnic minorities. While many (future) physicians are unfamiliar with specific needs of older migrants and ethnic minorities regarding care and communication in palliative care, this may be challenging for them to deal with. Moreover, even many medical teachers also feel unprepared to teach palliative care and culturally sensitive communication to students. In order to support medical teachers, we suggest twelve tips to teach culturally sensitive palliative care to guide the development and implementation of teaching this topic to medical students. Drawn from literature and our own experiences as teachers, these twelve tips provide practical guidance to both teachers and curriculum designers when designing and implementing education about culturally sensitive palliative care.

Retrofitting of urban areas

Age-dependent relationships between children’s motor competence, physical activity, perceived motor competence, physical fitness and weight status

In their developmental model, Stodden et al. (2008) propose age-dependent relations between motor competence, physical activity,perceived motor competence, physical fitness, and weight status thatcan lead to a spiral of (dis)engagement. The goal of this study was toexplore these relations in a large sample of Dutch primary schoolchildren. To our knowledge, this is the first study including all fiveaspects of the model and a large sample of children between four andthirteen years old. Cross-sectional data was collected in 2068 children(ages 4–13), divided over 9 age groups. During physical educationclasses, they completed the 4-Skills Test, a physical activity question-naire, versions of the Self-Perception Profile for Children, Eurofit testand anthropometry measurements. Correlation coefficients per agegroup were calculated (full information maximum likelihood) andtransformed using a Fisher’s r to z transformation, after which thetest-statistic z was calculated. The results show that all five factors arerelated to each other and that a tipping point exists at which relationsemerge or strengthen. Physical fitness is related to motor competenceand physical activity and these relationships strengthen with age. Arelationship between BMI and the other four factors emerges in middlechildhood. Although the model described that physical activity stimu-lates motor competence in early childhood, our data showed that at ayoung age, both motor competence and perceived motor competencehad no relation with physical activity, while they were weakly related toeach other. In middle childhood, both motor competence and perceivedmotor competence were related to physical activity. Our findingsdemonstrate that children in late childhood who have higher perceivedmotor competence are also more physically active, have higher physicalfitness, higher motor competence and lower BMI. Our results indicatethat targeting motor competence at a young age might be a feasible wayto ensure continued participation in physical activities throughoutchildhood and adolescence. Funding source: Netherlands Organization for Scientific Research.

The relationships between children's motor competence, physical activity, perceived motor competence, physical fitness and weight status in relation to age

The goal of this cross-sectional study was to further explore the relationships between motor competence, physical activity, perceived motor competence, physical fitness and weight status in different age categories of Dutch primary school children. Participants were 2068 children aged 4 to 13 years old, divided over 9 age groups. During physical education classes, they completed the 4-Skills Test, a physical activity questionnaire, versions of the Self-Perception Profile for Children, Eurofit test and anthropometry measurements. Results show that all five factors included in the analyses are related to each other and that a tipping point exists at which relations emerge or strengthen. Physical fitness is related to both motor competence and physical activity and these relationships strengthen with age. A relationship between body mass index and the other four factors emerges in middle childhood. Interestingly, at a young age, motor competence and perceived motor competence are weakly related, but neither one of these have a relation with physical activity. In middle childhood, both motor competence and perceived motor competence are related to physical activity. Our findings show that children in late childhood who have higher perceived motor competence are also more physically active, have higher physical fitness, higher motor competence and lower body mass index. Our results indicate that targeting motor competence at a young age might be a feasible way to ensure continued participation in physical activities throughout childhood and adolescence.

The intervention in Libya: "The responsibility to Protect" as a new norm?

In maart 2011 dreigde Muammer Gaddafi van Libya duizenden onschuldige burgers van de stad Benghazi uit hun huizen te halen om hen te vermoorden. De Veiligheidsraad van de Verenigde Naties verwees de situatie door naar het Internationaal Strafhof in Den Haag, dwong een no-flyzone af en gaf de NAVO een mandaat om burgers te beschermen with all necessary means, met de uitzondering van grondtroepen. Deze operatie was snel, robuust en effectief. Het principe van The Responsibility to Protect (R2P) -de verantwoordelijkheid van de internationale gemeenschap om genocide, misdaden tegen de menselijkheid, etnische zuivering en oorlogsmisdaden te voorkomen en te stoppen- werd voor het eerst volledig toegepast. Is R2P daarmee een norm geworden? Dit onderzoek plaatst de casus Libië in het model van de "Norm Life Cycle" (de levenscyclus van een norm) van de Constructivistische theoretici Finnemore en Sikkink (1998). Libië toont aan dat R2P nu een tipping point (omslagpunt) heeft bereikt, en zich van de fase norm emergence (opkomende norm) naar de fase norm cascade heeft verplaatst. Er is echter een spanning ontstaan: de terughoudendheid van de Veiligheidsraad om R2P toe te passen in Syrië (2012) wijst de andere kant uit. Er is dus nog een lange weg te gaan, voordat R2P als een internalised norm (vanzelfsprekende norm) kan worden beschouwd. ABSTRACT In March 2011, Muammar Gaddafi of Libya threatened to pull thousands of civilian protesters in the city of Benghazi out of their homes and kill them. The Security Council of the United Nations referred the crisis to the International Criminal Court, imposed a no-fly zone and provided NATO with a mandate to protect civilians by all necessary means, with the exception of ground troops. This operation was fast, robust and effective. It also marked the first time that the Responsibility to Protect (R2P) principle was fully implemented, being the responsibility of the international community to prevent and respond to genocide, crimes against humanity and war crimes if the state in question is not able or not willing to protect its citizens itself. Has R2P become a new norm? This study situates the case of Libya in the 'Norm Life Cycle' model of Constructivist theorists Finnemore and Sikkink (1998). It suggests that R2P has reached a tipping point and has moved from the stage of norm emergence to the stage of norm cascade. However, a certain tension still exists: the reluctance of the Security Council to implement R2P again in the crisis in Syria (2012)points in the opposite direction. This suggests there is still a long way to go before R2P becomes an internalised norm in the international community.

Restaurant tipping in Europe : a comparative assessment

Tipping is a social norm in many countries and has important functions as a source of income, with significant social welfare effects. Tipping can also represent a form of lost tax revenue, as service workers and restaurants may not declare all cash tips. These interrelationships remain generally insufficiently understood. This paper presents the results of a comparative survey of resident tipping patterns in restaurants in Spain, France, Germany, Switzerland, Sweden, Norway, and the Netherlands. ANOVA and ANCOVA analyses confirm significant variation in tipping norms between countries, for instance with regard to the frequency of tipping and the proportion of tips in relation to bill size. The paper discusses these findings in the context of employment conditions and social welfare effects, comparing the European Union minimum wage model to gratuity-depending income approaches in the USA. Results have importance for the hospitality sector and policymakers concerned with social welfare