Unravelling Vaccine Scepticism in South Tyrol, Italy: A Qualitative Analysis of Personal, Relational, and Structural Factors Influencing Vaccination Decisions.

Low vaccine uptake in South Tyrol, particularly for non-coronavirus and SARS-CoV-2 vaccines, poses a significant public health challenge in the northernmost province of Italy. This qualitative study conducted in-depth interviews with a purposive sample of vaccine-sceptical parents to examine the factors that contribute to their vaccination decisions. The ten participants' children had varied vaccination statuses, ranging from unvaccinated to partially vaccinated or vaccinated as late as possible. Only one adult participant received the SARS-CoV-2 vaccine. Using Grounded Theory analysis, the emergent meta-category of 'self-relatedness' was identified, highlighting the importance of individual experiences and the social context. The study found that participants' social circles consisted of individuals with similar vaccination attitudes, often characterized by a shared affinity for nature. Although they accepted individuals with different views, they remained uninfluenced. Participants perceived healthcare professionals as one-sided and uncritical, expressing distrust toward state orders. They believed that parents should be responsible for their children's well-being rather than the state. Distrust in the state and healthcare system, exacerbated by the SARS-CoV-2 pandemic, was rooted in negative experiences. In contrast, the participants had positive experiences with natural healing, homeopathy, and trusting the natural course of events. They perceived themselves as tolerant, non-radical, curious, health-conscious, yet critical and questioning. Participants resisted coercion, fear-mongering, and state sanctions and sought alternatives to mandatory vaccination. To address the complex social and behavioural factors underlying vaccination refusal, this study suggests that vaccination advocates, policymakers, and information providers should engage in appreciative, personal, and well-founded information exchanges with vaccine-hesitant individuals. Broad and comprehensible information dissemination, flexibility, and freedom of decision are essential for increasing informed decision making. Further research is required to better understand the epistemic basis of vaccine hesitancy.

Broad support for regulating the clinical implementation of future reproductive techniques.

STUDY QUESTION: Do gynaecologists, infertile patients and the general public, consider that regulation of the clinical implementation of stem cell-based fertility treatments is required? SUMMARY ANSWER: There is broad support from gynaecologists, patients and the general public for regulating the clinical implementation of future stem cell-based fertility treatments. WHAT IS KNOWN ALREADY: There is debate on the need to regulate the clinical implementation of novel techniques. Regulation may hinder their swift adoption and delay benefits for patients, but may prevent the implementation of ineffective or harmful techniques. Stem cell-based fertility treatments, which involve creating oocytes or spermatozoa by manipulating stem cells, are likely to be implemented in clinical practice in the near future and will probably impact future generations as well as the current one. STUDY DESIGN, SIZE, DURATION: A cross-sectional survey was conducted among gynaecologists working in fertility clinics (n = 179), patients with severe infertility (n = 348) and a representative sample of the general public (n = 1250). The questionnaire was disseminated in the Netherlands in the winter of 2015-2016. PARTICIPANTS/MATERIALS, SETTING, METHODS: The newly developed questionnaire was reviewed by experts and tested among the general public. The questionnaire assessed whether participants wanted each of nine potential negative consequences of the clinical implementation of stem cell-based fertility treatments to be regulated. In addition, the importance of all negative and positive potential consequences, the appropriate regulatory body and its need to consult with advisors from various backgrounds was questioned. MAIN RESULTS AND THE ROLE OF CHANCE: In total, 958 respondents completed the questionnaire (response rate: 54%). A large majority of each participant group (>85%) wanted regulation, for at least one potential negative consequence of the clinical implementation of stem cell-based fertility treatments. The majority of all participant groups wanted regulation for serious health risks for intended parents, serious health risks for children and the disposal of human embryos. Regulation for out-of-pocket costs and the burden of treatment received little support. The majority of gynaecologists and the general public, but not the patients, requested regulation for the risk of minor congenital abnormalities, the success rates and the naturalness of treatments. Nevertheless, the majority of patients did consider the former two potential negative consequences important. The majority of all groups preferred a national bioethics committee as the regulatory body. This committee should consult with advisors from various backgrounds and should consider the broader context of potential consequences of the stem cell-based fertility treatments. LIMITATIONS, REASONS FOR CAUTION: This empirical study focuses on only three stakeholder groups. This study reports on the perspective of the majority and this is not per definition the morally right perspective. The transferability of our findings to other cultures and other techniques remains unclear. WIDER IMPLICATIONS OF THE FINDINGS: A national bioethics committee, consulting with advisors from various backgrounds, should regulate the clinical implementation of future stem cell-based fertility treatments. Whether this broad support for regulation applies to novel techniques from other fields of medicine should be examined. STUDY FUNDING/COMPETING INTEREST(S): The Young Academy of the Royal Netherlands Academy of Arts and Sciences. None of the authors has any conflict of interest to declare. TRIAL REGISTRATION NUMBER: Not applicable.

Perspectiva bioética intercultural e direitos humanos / Perspective of intercultural bioethics and human rights / Perspectiva bioética intercultural y los derechos humanos

Este artigo tem como objetivo contribuir para o aprofundamento da reflexão acerca dos conflitos culturais na esfera bioética e problematizar o emprego dos direitos humanos como referencial teórico-normativo, mediador dos conflitos em bioética que apresentem elementos de interculturalidade. Os passos metodológicos adotados neste estudo foram: análise do conceito de perspectiva bioética intercultural e de conflito cultural em bioética, a partir da acepção desenvolvida pelo Colectivo Amani; exame dos direitos humanos como instrumentos da cultura da humanidade, com base na teoria de Bauman; investigação acerca dos instrumentos que os direitos humanos fornecem para a solução de conflitos culturais em bioética. Concluiu-se que a perspectiva bioética intercultural deve incorporar às suas dimensões prescritivas e descritivas os instrumentos dos direitos humanos, que concorrem para a solução de conflitos culturais, bem como as normas e instituições de direitos humanos, que asseguram a participação e integração social dos sujeitos integrantes de comunidades culturais em conflito.

The aim of this study was to contribute to a deeper understanding of intercultural conflicts within the field of bioethics, and to identify problems associated with using human rights as a theoretical normative that mediator of bioethical conflicts characterized by interculturalism. The methodological steps adopted in this study were: an analysis of the concept of intercultural conflict in bioethics, from the perception of the Colectivo Amani; a study of human rights as tools of human culture based on Bauman’s theory; and an investigation of the tools human rights offer for the solving of intercultural conflicts in bioethics. It was concluded that intercultural bioethics must apply the norms and institutions of human rights to its prescriptive and descriptive dimensions so as to ensure the participation and social integration of individuals from communities in cultural conflict. Such measures will act as tools for the solution of intercultural conflicts.

Este artículo tiene como objetivo contribuir a la profundización de la reflexión sobre los conflictos culturales en la esfera bioética y discutir el uso de los derechos humanos como un referente teórico y normativo, mediador de conflictos en materia de bioética que presentan elementos interculturales. El proceso metodológico utilizado en este estudio fueron: análisis del concepto de perspectiva intercultural bioética y del conflito cultural en bioética desde el sentido desarrollado por el Colectivo Amani; examen de los derechos humanos como instrumentos de la cultura de la humanidad, basado en la teoría de Bauman; investigación sobre los instrumentos de derechos humanos que plantean soluciones para los conflictos culturales en bioética. Se concluyó que la perspectiva intercultural bioética debe incorporar en sus dimensiones prescriptivas y descriptivas los instrumentos de los derechos humanos que buscan la solución de los conflictos culturales, y también las normas e instituciones de derechos humanos, con vistas a garantizar la participación y la integración social de los sujetos de las comunidades culturales en conflicto.

A produção do cuidado na atenção domiciliar: relações de poder e estratégias de resistência / The production of care in the domiciliary attention: relations of power and strategies of resistance

A transição demográfica e epidemiológica constitui um desafio para o campo da saúde, pois demanda a produção do cuidado contínuo, intensivo, integral e humanizado. Diversas estratégias para atender a este novo perfil vêm sendo construídas e, dentre estas, destacam-se os Serviços de Atenção Domiciliar (SAD). Entende-se que a produção do cuidado na AD é permeada por relações de poder e propõe-se neste estudo a sua investigação. O objetivo é analisar as relações de poder que se estabelecem nas práticas da Atenção Domiciliar, considerando as estratégias utilizadas nesse processo. Trata-se de estudo de natureza qualitativa. Os dados foram obtidos por meio de 109 visitas com duas equipes, em Minas Gerais. Durante as visitas, foram realizadas observações sobre a produção do cuidado no momento da alta hospitalar e admissão no SAD, assistência no domicílio, reinternação, readmissão e visitas pós-óbito. Essas visitas possibilitaram o acompanhamento de 14 casos de pacientes. De forma complementar, foram realizadas entrevistas com cinco pacientes/cuidadores e dez profissionais. Os dados foram analisados na perspectiva da análise de discurso orientado pelo referencial de Michel Foucault. Os resultados indicam a presença majoritária de um cuidador com o vínculo parental e do sexo feminino. As relações que atravessam a produção do cuidado no domicilio se caracterizam por envolvimento, empatia, vínculos e acolhimentos, mas também revelam a disciplinarização, o controle e a normatização que afetam o cuidado na atenção domiciliar. Os profissionais atuam de forma integrada, na perspectiva de atender às necessidades de saúde dos pacientes e cuidadores. São atenciosos e procuram orientar as ações de acordo com o contexto de vida das famílias. Contudo, suas práticas representam o poder do discurso técnico-cientifico e normativo-organizacional, próprios do modo de operar as ações no sistema de saúde. Os usuários e cuidadores, por sua vez, também disputam a produção do cuidado...

The demographic and epidemiological transition pose challenges to the field of health, as they demand the production of continuous, intensive, integral and humanized care. Several strategies to meet this new profile has been built and, among these, we highlight the Home Care services (SAD). It is understood that the production of care in AD is permeated by power relations and proposes to this study to investigate them. The goal is to analyze power relations that are established practices in Home Care, comprising the operation of the strategies used in this process. This is qualitative study, data were obtained in carrying out 109 visits to two teams of home care in the city of Contagem, Minas Gerais. During the visits were carried out observations on the production of care at the time of hospital admission and at SAD, in home care, readmission and readmission and post-obito visits. These visits enabled the monitoring of 14 cases of patients. Complementarily interviews were conducted with 5 patients / carers and 10 professionals. Data were analyzed from the perspective of discourse analysis directed by Michel Foucault's framework. The results indicate the majority presence of a caregiver with parental bond and female. These relations involved in the production of care in the home are characterized by involvement, empathy, bonds and acolhimentos but also reveal the disciplining, control and regulation affecting care in home care. The professionals work in an integrated manner with a view to meet the health needs of patients and caregivers. They are attentive and seek to guide the actions according to the context of life of families. However, their practices represent the power of technical-scientific and normative-organizational discourse own mode of operating actions in the public health system. Users and carers...

La ideología en la planificación normativa y la modernización neoliberal: contextos y dispositivos de poder / Ideology in normative planning and neoliberal modernization: contexts and power devices

Las reestructuraciones productivas de los hospitales públicos en América Latina pretenden realizar cambios en las formas como se produce la atención y el cuidado. La actual reestructuración productiva se asegura ideológicamente mediante el desplazamiento de los discursos hegemónicos en el sector, de la planificación normativa hacia los discursos de la modernización neoliberal. En el presente artículo, la metodología utilizada fue cualitativa, a través del análisis crítico del discurso. Se analizaron las principales características de ambos paradigmas hegemónicos, la relación entre sus principales tecnologías con los contextos económicos, sociales y culturales en que emergieron y su articulación con los dispositivos de poder.

The productive restructuration of public hospitals in Latin America pretends to make changes in the ways in which attention and care occurs. Current productive restructuration is ideologically ensured by the displacement of the hegemonic discourses in the sector, from Normative Planning to the discourses of neoliberal modernization. In this article, the methodology was qualitative, through Critical Discourse Analysis. The analysis approached to the main features of both hegemonic paradigms, the relationship between its core technologies with economic, social and cultural contexts in which they emerged and how it relates to power devices.

Bioética na América Latina: desafio ao poder hegemônico / Bioética en Latinoamérica: desafío al poder hegemónico / Bioethics in Latin America: challenge to hegemonic power

Este trabalho propõe a discussão sobre pontos relevantes para a consolidação da bioética nos países em desenvolvimento, considerando, especificamente, as bioéticas latino-americanas. Busca estimular o debate acerca da construção de alternativa aos impasses decorrentes da ampliação do âmbito e foco da disciplina à dimensão social. Para isso, traça de modo sucinto o panorama da bioética nesses países, iniciando pela caracterização desse campo de estudo e sintetizando, em breve histórico, seu processo de construção. Em linhas gerais, descreve as principais conquistas das bioéticas desenvolvidas no contexto brasileiro e latino-americano, enfatizando, especialmente, sua aproximação aos direitos humanos, tomados como marcos regulatórios dos padrões éticos nas relações sociais. Apresenta, ao final, considerações críticas sobre o paradoxo implicado na adoção dos direitos humanos, buscando incentivar a reflexão acerca da bioética como ferramenta de luta contra as desigualdades que ainda marcam nosso continente...

Este trabajo propone a discusión acerca de puntos relevantes para la consolidación de la bioética en los países en desarrollo, considerando, específicamente, las bioéticas Latinoamericanas. Busca estimular el debate acerca de la construcción de una alternativa al callejón sin salida que resulta de la expansión del alcance y enfoque de la asignatura a la dimensión social. Para ello, describe de manera sucinta el panorama de la bioética en estos países, a partir de la caracterización de este campo de estudio y que resume, en un breve historial, su proceso de construcción. En líneas generales describe los principales logros de las bioéticas desarrolladas en el contexto brasileño y latinoamericano, destacando, sobretodo, su acercamiento a los Derechos Humanos, considerados hitos regulatorios de los estándares éticos en las relaciones sociales. Presenta, al final, las consideraciones críticas acerca de la paradoja implicada en la adopción de los Derechos Humanos, tratando de fomentar la reflexión acerca de la bioética como herramienta de lucha contra las desigualdades que aún marcan nuestro continente...

This paper proposes a discussion on relevant issues for the consolidation of Bioethics in developing countries, specifically considering the Latin American Bioethics. It seeks to encourage the debate on the construction of an alternative to the impasses resulting from the expansion of the subject scope and focus to the social dimension. For this, it succinctly outlines the viewpoint of Bioethics in these countries, starting from the characterization of this field of study and summarizing briefly its construction process. In broad terms, it outlines the main achievements of Bioethics developed in the Brazilian and Latin American context, especially emphasizing their approach to human rights, taken as regulatory milestones of ethical standards in social relations. It presents, in the end, critical considerations about the paradox implied in adopting Human Rights, seeking to encourage reflection about Bioethics as a tool to fight against the inequalities that still feature our continent...

Desarrollo de un Modelo de Interlocución para el Sistema de Salud basado en el Caso de la Guajira Colombiana / Developing an interlocution model for the health system based on studying the Colombian Guajira

Objetivos: Este artículo busca mostrar el desarrollo de un Modelo de Interlocución sobre el desempeño local del sistema de salud en La Guajira, entre 2005 y 2007, con el fin de generar condiciones para la participación social y el mejor desempeño del sistema conforme a las condiciones, necesidades y expectativas locales. Métodos: El desarrollo del Modelo se hizo mediante técnicas etnográficas, en la primera y segunda fase de la investigación, y técnicas participativas, en la tercera. La metodología buscaba recoger la información que permitiera escoger las estrategias de intervención para mejorar las habilidades y capacidades para la participación de los usuarios y que sugiriera la creación de espacios de confianza para la interlocución entre los actores y la negociación de acciones de mejoramiento para el sistema. Con base en la etnografía del sistema y del usuario, se diseñaron estrategias de intervención que incluyen materiales impresos pedagógicos y tres módulos en forma de talleres participativos. Se probó el Modelo en cuatro localidades de La Guajira, en donde al final se crearon Mesas de Trabajo en Salud con participación de usuarios y decisores institucionales. Resultados: Se constató que se puede lograr que los usuarios participen como ciudadanos informados y consumidores críticos, fortaleciendo sus habilidades de interlocución, ampliando sus conocimientos, generando léxicos y significados compartidos con los actores institucionales, y utilizando los dispositivos locales y redes sociales de participación. Conclusión: Es indispensable encontrar estrategias efectivas para motivar una mayor participación de las instituciones, especialmente de las Entidades Promotoras de Salud y Aseguradoras del Régimen Subsidiado.

Objectives: This article shows the development of an interlocution model regarding the health system's local performance in La Guajira from 2005 to 2007. It was aimed at producing conditions for social participation and improving the system's performance according to local conditions, needs and expectations. Methods: Such model was developed by using ethnographic techniques during the investigation's first and second phases and participative techniques during its third phase. The methodology sought to collect information leading to choosing intervention strategies for improving user-participation ability and capacity and creating spaces of trust for interlocution between the actors and negotiating action for improving the system. Intervention-strategies were based on system and user ethnography, including printed pedagogical material and three modules in the form of participative workshops. The model was tested in four localities in the Guajira, leading to working tables for health being created, encouraging participation by users and institutional decision-makers. Results: It was noted that users could participate as informed citizens and critical consumers, strengthening their interlocution abilities, broadening their knowledge, producing vocabulary and meaning shared with the institutional actors and using local mechanisms and social participation networks. Conclusion: Effective strategies must be found for motivating greater participation by institutions, especially health promoting entities and subsidised regime insurers.

Pedagogia crítica da educação física no jogo das relações de poder / Critical pedagogy of physical education in the power-relations game / Pedagogía crítica de la educación física en el juego de las relaciones de poder

Este artigo insere-se em uma pesquisa sobre os fundamentos da pedagogia crítica da educação física. Elege como interlocutor da análise os escritos do filósofo Michel Foucault, investigando a reordenação efetuada pelo autor em sua discussão sobre a noção de (relações de) poder e sujeito no último domínio de sua obra. Busca compreender os corolários desse deslocamento nos impulsos emancipadores e libertadores da pedagogia crítica em nossa área. Aponta a premência de seguir problematizando, autocriticamente, sua própria atualidade discursiva no presente

This article is part of a research on the foundations of the critical pedagogy of Physical Education. It chooses for the dialogue the philosopher Michel Foucault's writings, to investigate the self realignment in his discussion about the notion of (relation of) power and subject in the last domain of his work. It tries to understand the corollary of this displacement in the emancipators liberators pulses and of Critical Pedagogy in Physical Education. It points the urgency of permanent self-critical analysis of its discursive actuality

Este texto es parte de una investigación sobre los fundamentos de la Pedagogía Crítica de la Educación Física. Elige como interlocutor los escritos del filósofo Michel Foucault, preguntando por la reordenación que hace en su discusión sobre la noción de (relaciones de) poder y sujeto en el último dominio de su obra. Busca comprender los corolarios de este desplazamiento en los impulses emancipadores y libertadores de la pedagogía crítica en nuestra área. Apunta para la urgencia de seguir reflexionando de manera autocrítica sobre su propia actividad discursiva