Percepción de miedo o exageración que transmiten los medios de comunicación en la población peruana durante la pandemia de la COVID-19 / Perception of exaggeration or fear propagated by the media among the Peruvian population during the COVID-19 pandemic

Introducción: En crisis sanitarias mundiales los medios de comunicación son importantes para informar sobre los temas relevantes a la población. Objetivo: Caracterizar y encontrar asociaciones de la percepción de miedo o exageración que transmiten los medios de comunicación en la pandemia del COVID-19 en ciudades del Perú. Métodos: Estudio transversal analítico y multicéntrico. Se realizó una encuesta virtual a 4009 personas, en 17 ciudades del Perú, del 15-20 de marzo del 2020. El instrumento, previamente validado, evaluó tres factores: la exageración de los medios; el miedo generado y la comunicación que provenía del personal de salud, familiares y amigos. Los coeficientes de relación y los valores p fueron calculados a través del uso de modelos lineales generalizados, con familia Gaussian y función de enlace identity. Se consideraron a los valores de p <0,05 como estadísticamente significativos. Resultados: Los participantes percibieron que las redes sociales (64 por ciento) y la televisión (57 por ciento) exageraban la información; también, los participantes manifestaron que la televisión (43 por ciento) y las redes sociales (41 por ciento) aumentaron la percepción del miedo. En cuanto a su familia/amigos, percibían que exageraban la situación (39 por ciento) y generaban miedo (25 por ciento). Al análisis multivariado, las mujeres (p<0,001), las que tuvieron secundaria completa (p=0,023), las universitarias (p=0,037) y con postgrado (p=0,002) tuvieron un menor puntaje total de miedo y percepción de exageración. Conclusiones: La percepción de exageración y generación de miedo en la población fueron en mayor medida ocasionados por la televisión y las redes sociales(AU)

Introduction: In global health crises the media is important for reporting on important issues to the population. Objective: To characterize and find associations of perceived fear or exaggeration conveyed by the media in the COVID-19 pandemic. Methods: Analytical and multicenter cross-sectional study. A virtual survey was conducted among 4009 people, in 17 cities of Peru, from March 15-20, 2020. The instrument, previously validated, evaluated three factors: the exaggeration of the media; the fear generated and the communication coming from health personnel, family members and friends. Relationship coefficients and p-values were calculated through the use of generalized linear models, with Gaussian family and identity linkage function. Values of p <0.05 were considered statistically significant. Results: Social networks (64 percent) and television (57 percent) were perceived by all participants as exaggerating information; also, television (43 percent) and social networks (41 percent) increased the perception of fear. As for their family/friends, they perceived that they exaggerated the situation (39 percent) and generated fear (25 percent). In the multivariate analysis, women (p<0.001), those who had completed high school (p=0.023), were university students (p=0.037) and those with a postgraduate degree (p=0.002) had a lower total score of fear and perception of exaggeration. Conclusions: The perception of exaggeration and fear generation in the population were mostly caused by television and social networks(AU)

Fear of Life, Fear of Death, and Fear of Causing Death: How Legislative Changes on Assisted Dying Are Doomed to Fail.

Fear of life, fear of death, and fear of causing death form a combination that prevents reasoned changes in laws concerning end-of-life situations. This is shown systematically in this article using the methods of conceptual analysis. Prevalent fears are explicated and interpreted to see how their meanings differ depending on the chosen normative stance. When the meanings have been clarified, the impact of the fears on the motivations and justifications of potential legislative reforms are assessed. Two main normative stances are evoked. The first makes an appeal to individual self-determination, or autonomy, and the second to the traditional professional ethics of physicians. These views partly share qualifying elements, including incurability and irreversibility of the patient's medical condition, proximity of death, the unbearable nature of suffering, and issues of voluntariness further shade the matter. The conclusion is that although many motives to change end-of-life laws are admirable, they are partly contradictory, as are calls for autonomy and appeals to professional ethics; to a degree that good, principled legislative solutions remain improbable in the foreseeable future.

La vía negativa de acceso a la dignidad y la expresión "muerte digna" / The negative approach to dignity and the expression "death with dignity"

Se justifica un enfoque negativo de la noción de dignidad como alternativa posible a las concepciones escéptica y metafísica. Tal enfoque consiste en comprender la dignidad como un límite de lo moralmente admisible cuyo contenido sería esencialmente negativo: no recibir un trato cruel, inhumano, degradante, discriminatorio o humillante. Desde este enfoque se analiza la expresión «muerte digna» en los casos límite en que es imposible apelar al principio de autonomía personal

The negative approach can be justified as an alternative to Skeptical and metaphysical conceptions of dignity. This approach conceives dignity as a boundary of what is morally admissible and it’s essentially negative content consists in not being treated in a cruel, inhuman, discriminative degrading or humiliating way. From that starting point, we proceed to study the expression «death with dignity» in the borderline cases when it´s impossible to appeal to the principle of personal autonomy

Global trends on fears and concerns of genetic discrimination: a systematic literature review.

Since the 1990s, developments in the field of genetics have led to many questions on the use and possible misuse of genetic information. 'Genetic discrimination' has been defined as the differential treatment of asymptomatic individuals or their relatives on the basis of their real or assumed genetic characteristics. Despite the public policy attention around genetic discrimination, there is currently still much confusion surrounding this phenomenon. On the one hand, there is little evidence of the occurrence of genetic discrimination. On the other hand, it appears that people remain concerned about this theme, and this fear influences their health and life choices. This article makes use of a systematic literature review to investigate what is already known about the nature, extent and background of these fears and concerns. The 42 included studies have found considerable levels of concerns about genetic discrimination. Concerns dominate in insurance contexts and within personal interactions. The extent of concerns appears to vary depending on the type of genetic illness. Furthermore, installed laws prohibiting genetic discrimination do not seem to alleviate existing fears. This raises important questions as to the origins of these fears. Based on the findings, recommendations for future research are made. First, research on the background of fears is needed. Second, future research needs to assess more fully all different forms (for example, direct and indirect) of genetic discrimination. Thirdly, it has to be studied whether genetic discrimination is a form of discrimination that is distinguishable from discrimination based on an illness or disability. Finally, a last element that should be addressed in future research is the most recent developments in research on genomics, such as next-generation sequencing or genome-wide association studies.

Fall experiences of persons with fibromyalgia over 6 months.

AIMS: To describe circumstances and consequences of falls occurring among persons with fibromyalgia who had recent falls. BACKGROUND: Fibromyalgia is a common widespread pain condition that has been linked to increased fall-risk. No published research described experiences of falling in persons with fibromyalgia. Prior to development of fall-risk reduction interventions, it is essential to understand the context of falls and fall experiences in persons with fibromyalgia. DESIGN: Descriptive longitudinal study. METHODS: The study took place during 2009; data were collected via fall diaries and interviews in 18 US women ages 21-69 years. RESULTS: Over 6 months, 17 of 18 participants fell or had a near-fall. For the 15 women with 6-month fall-prevalence data, median number of falls was 2, with 3 near-falls. Most fall experiences contained intrinsic and extrinsic contributory factors. Participants reported engaging in various activities prior to falls/near-falls. A substantial minority (32-48%) experienced severe symptoms (pain, fatigue, stiffness) at the time. Most falls/near-falls occurred in homes during the day; one resulted in injury. Themes that were identified included the following: always being careful or generally cautious; fear of losing control of one's body, especially related to balance; desire to continue activities counterbalanced with frustration at not being able to because of fear of falling; perception of having become clumsy. CONCLUSIONS: Nurses caring for persons with fibromyalgia should assess for potential fall-risk factors and offer plans for individualized fall-prevention strategies.

Estratégias de enfrentamento dos dilemas bioéticos gerados pela violência na escola / Coping strategies to bioethical dilemmas generated by school violence

A violência na escola é um problema social que perpassa o âmbito da educação e da saúde pública, envolve aspectos bioéticos e requer mecanismos de enfrentamento, a partir da educação em saúde. Este estudo objetiva discutir estratégias fundamentadoras da educação em saúde, sobre aspectos bioéticos no domínio da violência escolar. Consiste em uma revisão bibliográfica crítico-reflexiva por meio do acesso a banco de dados da Biblioteca Virtual de Saúde (BVS), utilizando os descritores "violência and bioética" e "violência na escola", considerando os estudos publicados no período de 2004 a 2009. Realizamos também levantamento das obras de Paulo Freire e Pedro Demo, teóricos da Educação Libertadora. A leitura do material conduziu-nos a definição e discussão de três eixos temáticos: 1) bioética como instrumento reflexivo para a retomada dos valores morais na sociedade; 2) escola como formadora ética e de exercício de cidadania; 3) educação em saúde como instrumento para o enfrentamento da violência na escola. Acreditamos que a violência escolar envolve questões bioéticas que devem ser alvo de intervenções educativas na perspectiva libertadora, no intuito de gerar reflexões sobre o caráter negativo da violência escolar, tanto para o ensino-aprendizagem, como para o adoecimento dos atores envolvidos nessa problemática. Os profissionais da saúde poderão estabelecer a intersetorialidade com a educação e contribuir na prevenção da violência na escola, por meio de ações educativas em saúde, mobilizando cidadãos para uma sociedade comprometida em promover a vida; e que os profissionais da educação sejam receptivos e coparticipantes do processo intersetorial de educação e saúde.

School violence is a social problem that pervades the educational and public health context, involving bioethical issues and requires coping mechanisms from health education. This study aims to discuss strategies that underlie health education, on bioethical issues in the school violence field. It consists of a critical-reflexive literature review by accessing the Virtual Health Library (VHL) database, using the keywords: "violence and bioethics", and "violence at school", considering the studies published from 2004 to 2009. We also surveyed Paulo Freire's and Pedro Demo's works, theorists of Libertarian Education, which led us define and discuss three thematic areas: 1) bioethics as a reflective instrument for the moral values resumption in the society, 2) school as an ethics and citizenship practice creator, 3) health education as a contributor to coping with violence at school. We believe that school violence involves bioethical issues that should be the target of educational interventions in the liberating perspective, in order to generate reflections on the negative character of school violence, both for teaching and learning, as to the sickening of the actors involved in this issue. Health professionals may establish the intersectoriality with the education and contribute in preventing violence at school, through health education actions, mobilizing citizens for a society committed to promoting life. And the education professionals must be receptive and co-participants in the education and health intersectorial process.

Nurses' ethical reflections on caring for people with malodorous exuding ulcers.

The aim of this study was to illuminate nurses' reflections on obstacles to and possibilities for providing care as desired by people with malodorous exuding ulcers. Six nurses who took part in a previous study were interviewed. The participants were shown an illustration with findings from a study that elucidated the meaning of living with malodorous exuding ulcers. They were asked to reflect on the obstacles to and possibilities of providing the care desired by the patients. Twelve audio-recorded transcribed interviews were analysed using qualitative content analysis. Our interpretations of participants' reflections on the obstacles and possibilities while caring for such patients revealed one theme: striving to 'do good' and 'be good'. The obstacles were formulated as subthemes: experiencing clinical competence constraints, experiencing organizational constraints, experiencing ineffective communication, fearing failure, and experiencing powerlessness. The possibilities were formulated by the subthemes: spreading knowledge about ulcer treatments, considering wholeness, and creating clear channels of communication. A multiprofessional team could overcome the identified obstacles and provide structure, competencies, commitment and support to 'do good' for patients and 'be good' nurses.

Bioconservatism, bioliberalism, and the wisdom of reflecting on repugnance.

We consider the current debate between bioconservatives and their chief opponents--whom we dub bioliberals--about the moral acceptability of human enhancement and the policy implications of moral debates about enhancement. We argue that this debate has reached an impasse, largely because bioconservatives hold that we should honour intuitions about the special value of being human, even if we cannot identify reasons to ground those intuitions. We argue that although intuitions are often a reliable guide to belief and action, there are circumstances in which they are not reliable. Intuitions--including intuitions about enhancement--are subject to various cognitive biases rendering them unreliable in some circumstances. We argue that many bioconservative intuitions about enhancement are examples of such unreliable intuitions. Given this, it is unrealistic of bioconservatives to expect others to rely on their unexamined intuitions. Furthermore, refusing to engage in debates about the reasons and values that underpin their intuitions about enhancement will have the effect of making bioconservative voices less relevant in policy debates about enhancement than they would otherwise be.

Miedo y deshumanización: una visión crítica sobre la realidad cotidiana en el laboratorio de anatomía humana / Fear and deshumanization: a critical view on the daily routine of the human anatomy laboratory

La anatomía humana tiene como importante fuente de estudio al cuerpo humano. Ella utiliza cuerpos no reclamados, usualmente de indigentes, cuerpos entregados como un beneficio a la sociedad sin nada pedir nada a cambio, siendo dignos de pleno respeto. Sin embargo, preocupa que la muerte no es mirada socialmente como algo natural a la vida, llevando la convivencia en el laboratorio de anatomía humana a un estado de miedo, angustia y repulsión. Con eso se produce un mecanismo de negación, que puede generar deshumanización hacia la pieza anatómica. Ser confrontado con la muerte de otro, es lo mismo que confrontarse con nuestra propia muerte. En este contexto, los profesores y técnicos tienen una gran responsabilidad en discutir y reflejar la cuestión, de modo que puedan promover la idea que el cadáver es la expresión de vida y respeto, pues tal concepto será de gran importancia para la futura vida profesional de los estudiantes. Con este artículo, nuestro objetivo es reflexionar sobre la realidad de la muerte y el respeto en el laboratorio de anatomía humana.

Human anatomy has the human body as an important source of studies. It uses non-claimed, usually pauper, bodies delivered as a benefit to society without a counterpart, thus deserving full respect. However, within current society, death is not faced as something proper to life, what results in a state of fear, agony and loath within the human anatomy laboratory. Therefore, negation mechanisms which may generate dehumanization are produced. To be confronted with someone else's death is the same as to be confronted with our own death. Within this context, Professors and technicians have great responsibility on having the students aware that the cadaver is the expression of life and respect, as such concepts will be very important for the students' future professional life. With this article we aim at reflecting on the reality of death and respect inside the human anatomy laboratory.

Transparency in nursing leadership: a chosen ethic.

The concept of transparency has been viewed as an essential leadership attribute or element in healthcare organizational structures and processes. While viewed as something that is desired and valued, there is a lack of nursing disciplinary literature that defines the concept and its possible meanings. This column provides a beginning definition of transparency from the humanbecoming nursing theoretical perspective and launches a discussion with potential ethical implications for leadership in nursing practice and education.

Mechanisms underlying an ability to behave ethically.

Cognitive neuroscientists have anticipated the union of neural and behavioral science with ethics (Gazzaniga 2005). The identification of an ethical rule--the dictum that we should treat others in the manner in which we would like to be treated--apparently widespread among human societies suggests a dependence on fundamental human brain mechanisms. Now, studies of neural and molecular mechanisms that underlie the feeling of fear suggest how this form of ethical behavior is produced. Counterintuitively, a new theory presented here states that it is actually a loss of social information that leads to sharing others' fears with our own, thus allowing us to treat others as we would like to be treated. Adding to that hypothetical mechanism is the well-studied predilection toward affiliative behaviors. Thus, even as Chomsky hypothesizes that humans are predisposed to utter grammatical sentences, we propose that humans are 'wired for reciprocity'. However, these two neural forces supporting ethical behavior do not explain individual or collective violence. At any given moment, the ability to produce behavior that obeys this ethical rule is proposed to depend on a balance between mechanisms for prosocial and antisocial behaviors. That balance results not only from genetic influences on temperament but also from environmental effects particularly during critical neonatal and pubertal periods.

Relatives in end-of-life care--part 2: a theory for enabling safety.

AIM: To develop a goal-oriented praxis theory for enabling safety for relatives when an adult or older patient is close to end-of-life. BACKGROUND: This is the second part of a project focusing on the situation and needs of relatives in end-of-life care. Our interpretation of the existing corpus of knowledge pertaining to the needs of close relatives in this situation showed the significance of relatives' need for safety. METHOD: The theory was developed step-by-step, through triangulation of critical review of empirical research in the field, our own clinical experiences from end-of-life care, renewed literature searches and theoretical reasoning. THEORY: The foundation for the theory is taken from the ethical intention of the philosopher Paul Ricoeur. From this, the theory focuses on relatives in the context of end-of-life care with the goal of enabling safety. This is proposed by four aphorisms functioning as safety enablers and these are directed towards the professional's approach and attitude, the relative's concern for the patient, the specific situation for the relative and the patient's end-of-life period as a period in the life of the relative. RELEVANCE TO CLINICAL PRACTICE: Implications for end-of-life practice are considered and include aspects for promotion of just institutions in end-of-life care, the significance of negotiated partnership in end-of-life care, enabling safety for relatives living in existential and practical uncertainty in connection with end-of-life care and diversity of relatives' preferences as they live through this particular period.

What should HIV/AIDS be called in Malawi?

HIV/AIDS is the leading cause of morbidity and mortality in the southern African country of Malawi. At the largest referral health facility in Blantyre, the Queen Elizabeth Central Hospital, the majority of patients hospitalized in medical wards and up to a third of those in the maternity unit are infected with HIV. Many patients in the surgical wards also have HIV/AIDS. Health professionals in Blantyre, however, often choose not to write down the diagnosis of HIV or AIDS; rather, they prefer to use 'SGOT', 'ELISA' and 'spot test' to represent the HIV test, while 'immunosuppression', '\CD4 disease' and 'ARC' are preferred instead of 'AIDS'. It is possible that health professionals' belief that mentioning HIV and/or AIDS will harm patients is encouraging them to use these euphemisms. The use of less than exact terms to label HIV and AIDS may not be without cost. For instance, future attempts to conduct retrospective case study research may be hampered by this practice, which is not in accordance with the international classification of diseases. It is suggested that, although stigmatization and discrimination could be important driving factors in the use of cryptic language, it may be more worthy to fight discrimination and stigmatization head-on, rather than create avenues where these reactions may be perpetuated.

Faculty encounters with uncivil nursing students: an overview.

The critical incident technique (CIT) was used to explore faculty experiences with uncivil nursing students. Twenty-one nursing faculty with various years of experience in teaching were interviewed to ascertain what they considered critical incidents of uncivil encounters with nursing students and what effect those encounters had on them. Thirty-six encounters were described by the faculty. Of the 36 encounters, 33 occurred with individual students and 3 occurred with groups of students. Twenty-three encounters occurred in the context of poor student performance requiring constructive criticism or resulting in course failure. A battlefield metaphor is used to describe the incidents, their antecedents, and their consequences. The encounters were precipitated by a period of escalating tensions and effort by the faculty to diffuse the situation. The faculty were surprised and caught off guard by the encounters, which ranged in severity from mild to highly aggressive. The faculty often perceived significant threats to well-being of self, loved ones, job security, and/or possessions. The aftermath of the encounters included physical and emotional tolls on faculty, decreased self-esteem and loss of confidence in teaching ability, significant time expenditures, and negative consequences to the educational process. Three of the faculty left teaching in part due to encounters with students.