Autonomy in an ascribed relationship: the case of adult children and elderly parents

Abstract Demographic and cultural changes have given rise to the question of whether adult children will continue to provide support to their elderly parents. In a qualitative study among selected respondents from a large representative sample, we investigated the motivations of adult children to provide support to their elderly parents. Five major themes emerged: Individual choice, obligation, reciprocity, quality of the relationship and genetic relatedness. Respondents rejected general norms of filial obligations, were reluctant to impose behavioral rules on others, but nevertheless expressed strong personal obligations to care. Individualization is often equated with withdrawing from providing care. Our findings suggest otherwise. Filial obligations tend to be strong, but personalized. Social prescriptions have given way to personal motives to provide care

SARS-CoV-2 susceptibility and COVID-19 disease severity are associated with genetic variants affecting gene expression in a variety of tissues

Variability in SARS-CoV-2 susceptibility and COVID-19 disease severity between individuals is partly due to genetic factors. Here, we identify 4 genomic loci with suggestive associations for SARS-CoV-2 susceptibility and 19 for COVID-19 disease severity. Four of these 23 loci likely have an ethnicity-specific component. Genome-wide association study (GWAS) signals in 11 loci colocalize with expression quantitative trait loci (eQTLs) associated with the expression of 20 genes in 62 tissues/cell types (range: 1:43 tissues/gene), including lung, brain, heart, muscle, and skin as well as the digestive system and immune system. We perform genetic fine mapping to compute 99% credible SNP sets, which identify 10 GWAS loci that have eight or fewer SNPs in the credible set, including three loci with one single likely causal SNP. Our study suggests that the diverse symptoms and disease severity of COVID-19 observed between individuals is associated with variants across the genome, affecting gene expression levels in a wide variety of tissue types

A first update on mapping the human genetic architecture of COVID-19

peer reviewe

Addressing healthcare for migrants and ethnic minorities in Europe: A review of training programmes

Background: The global phenomenon of migration has dramatically changed the social context in which healthcare professionals operate. European states are facing a growing need to effectively train healthcare professionals to understand and respond appropriately to the diverse needs of migrants and ethnic minorities. While many European Union (EU) countries have adopted specific initiatives, there is considerable variation in these activities and few examples of evaluation of the quality of these training courses. Aims: This article describes findings from a review conducted as a part of the ‘Training packages for health professionals to improve access and quality of health services for migrants and ethnic minorities, including the Roma (MEM-TP)’ project, which sought to identify and assess training programmes for health professionals delivered in Europe between 2004 and 2013. Methods: The review and analysis of training materials comprised three components: (1) a review of the published and unpublished literature, (2) a survey addressing national contact persons, and representatives of international organisations and non-governmental organisations and (3) an assessment of the quality of the training programmes identified. Results: The review showed that training programmes tend to be characterised by low levels of participant involvement in training development, delivery and evaluation. Training programmes often lacked an explicit pedagogical approach, did not systematically focus on outcomes in training design, implementation and evaluation, and were poorly linked to key organisational and policy support. Finally, while cultural competence continues to be the broad conceptual approach used in training programmes, alternate approaches such as intersectionality, equity and person-centred care are emergent. Conclusion: Training programmes in Europe can be further improved in order to ensure an effective response to the diverse needs of patients, carers, health professionals and the community

Defining a framework for medical teachers' competencies to teach ethnic and cultural diversity : results of a European Delphi study

Medical students need to be trained in delivering diversity-responsive health care but unknown is what competencies teachers need. The aim of this study was to devise a framework of competencies for diversity teaching. An open-ended questionnaire about essential diversity teaching competencies was sent to a panel. This resulted in a list of 74 teaching competencies, which was sent in a second round to the panel for rating. The final framework of competencies was approved by the panel. Thirty-four experts participated. The final framework consisted of 10 competencies that were seen as essential for all medical teachers: (1) ability to critically reflect on own values and beliefs; (2) ability to communicate about individuals in a nondiscriminatory, nonstereotyping way; (3) empathy for patients regardless of ethnicity, race or nationality; (4) awareness of intersectionality; (5) awareness of own ethnic and cultural background; (6) knowledge of ethnic and social determinants of physical and mental health of migrants; (7) ability to reflect with students on the social or cultural context of the patient relevant to the medical encounter; (8) awareness that teachers are role models in the way they talk about patients from different ethnic, cultural and social backgrounds; (9) empathy for students of diverse ethnic, cultural and social background; (10) ability to engage, motivate and let all students participate. This framework of teaching competencies can be used in faculty development programs to adequately train all medical teacher

Culturally competent in medical education – european medical teachers’ self-reported preparedness and training needs to teach cultural competence topics and to teach a diverse class

Background: Health inequalities related to culture and ethnicity may be reduced by training future health care providers. Medical teachers therefore also need to be culturally competent. The aim of this study was to assess medical teachers’ preparedness and their training needs to teach cultural competence topics and to teach a diverse class. Methods:A link to an online survey was sent to medical teachers of eleven European institutions. Results were analysed through descriptive analysis and answers to open-ended questions were analysed using qualitative analysis. Results:968 respondents were included. The majority of respondents felt it was important that cultural competence topics should be incorporated into the medical curriculum. Assessment of skills in cultural competence was found important as well

Twelve tips to teach culturally sensitive palliative care

Gepubliceerd in Medical Teacher, 17-10-2020, Taylor & Francis Online https://www.tandfonline.com/toc/imte20/current?gclid=EAIaIQobChMI4bTGiZrs7wIVSBV7Ch3GzAAbEAAYASAAEgKAMfD_BwE CC-BY-NC-ND 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