Holidays in the Danger Zone: Entanglements of War and Tourism

A timely, and uniquely historical, look at how war turns soldiers, and all of us, into tourists. Holidays in the Danger Zone exposes the mundane and everyday entanglements between two seemingly opposed worlds—warfare and tourism. Debbie Lisle shows how a tourist sensibility shapes the behavior of soldiers in warespecially the experiences of Western military forces in “exotic” settings. This includes not only R&R but also how battlefields themselves become landscapes of leisure and tourism. It further explores how a military sensibility shapes the development of tourism in the postwar context, from “Dark Tourism” (engaging with displays of conflict and atrocity) to exhibitions of conflict in museums and at memorial sites, as well as in advertising, film, journals, guidebooks, blogs, and photography. Focused on how war and tourism reinforce prevailing modes of domination, Holidays in the Danger Zone critically examines the long historical arc of the war-tourism nexus from nineteenth-century imperialism to World War I and World War II, from the Cold War to globalization and the War on Terror.

Initiating advance care planning on end-of-life issues in dementia: Ambiguity among UK and Dutch physicians

Background
In dementia, advance care planning (ACP) of end-of-life issues may start as early as possible in view of the patient’s decreasing ability to participate in decision making. We aimed to assess whether practicing physicians in the Netherlands and the United Kingdom who provide most of the end-of-life care, differ in finding that ACP in dementia should start at diagnosis.

Methods
In a cross-sectional study, we surveyed 188 Dutch elderly care physicians who are on the staff of nursing homes and 133 general practitioners from Northern Ireland. We compared difference by country in the outcome (perception of ACP timing), rated on a 1–5 agreement scale. Regression analyses examined whether a country difference can be explained by contrasts in demographics, presence, exposure and role perceptions.

Results
There was wide variability in agreement with the initiation of ACP at dementia diagnosis, in particular in the UK but also in the Netherlands (60.8% agreed, 25.3% disagreed and 14.0% neither agreed, nor disagreed). Large differences in physician characteristics (Dutch physicians being more present, exposed and adopting a stronger role perception) hardly explained the modest country difference. The perception that the physician should take the initiative was independently associated with agreeing with ACP at diagnosis.

Conclusions
There is considerable ambiguity about initiating ACP in dementia at diagnosis among physicians practicing in two different European health care systems and caring for different patient populations. ACP strategies should accommodate not only variations in readiness to engage in ACP early among patient and families, but also among physicians.