The "moral career" of perinatally HIV-infected children: revisiting Goffman's concept.

HIV-infected children usually live in vulnerable situations, experiencing discrimination and stigma commonly felt by other people living with HIV/AIDS. The present study aims to analyse primary socialisation of HIV-infected children and adolescents recruited from a public health service in Rio de Janeiro (Brazil) as a social process that shapes a new generation of stigmatised and vulnerable persons. Research was informed by an interactionist perspective, focusing on key aspects of HIV-infected children and adolescents life histories under the conceptual frame of Erving Goffman's theories regarding "moral careers". Goffman defines the making of a moral career as the process through which a person learns that she/he possesses a particular attribute, which may lead her/him to be discredited by members of the surrounding society. We have identified aspects of life histories of HIV-vertically infected children and adolescents for each aspect of "moral career" as described by Goffman, relating them to as family structure, the experience of living HIV within the family, and the position and family role of a given subject. The patterns of "moral career" proposed by Goffman in 1963 were useful in identifying components of HIV-related stigma among children and adolescents. These include gender and social disadvantages, difficulty in coping with a child with a potentially severe disease, orphanhood, abandonment, adoption and disclosure of one's HIV serostatus. Primary socialisation of HIV-infected children and adolescents is a key piece of the complex HIV/AIDS-labelling process that could be targeted by interventions aiming to decrease stigma and marginalisation. Health care workers and stakeholders should be committed to ensuring education and guaranteeing the legal rights of this specific population, including the continuous provision of quality health care, full access to school and support to full disclosure of HIV diagnosis.

Children and Adolescents with Perinatal HIV-1 Infection: Factors Associated with Adherence to Treatment in the Brazilian Context.

Challenges to the adherence to combination antiretroviral therapy among the pediatric population should be understood in the context of the trajectories of families, their interaction with healthcare services, and their access to material and symbolic goods. The present study analyzed individual, institutional and social factors that might be associated with the caregivers' role in the treatment adherence of children and adolescents living with HIV (CALHIV). Based on semi-structured interviews and questionnaires applied to 69 caregivers seen at pediatric AIDS services of five Brazilian macro-regions, we observed that adherent caregivers had better acceptance of diagnosis and treatment, were less likely to face discrimination and social isolation secondary to AIDS-related stigma and tended to believe in the efficacy of treatment, and to be more optimistic about life perspectives of CALHIV. Interventions aiming to improve adherence and to promote the health of CALHIV should take in consideration the interplay of such different factors.

O pediatra e sua função apostólica: percepções de médicos residentes sobre suas práticas / The pediatrician and his apostolic function: perceptions of resident physicians about their practices / El pediatra y su función apostólica: percepciones de médicos residentes acerca de su práctica

Este estudo é o resultado de um trabalho pedagógico, realizado com médicos residentes em pediatria em um hospital público no Rio de Janeiro. Durante um mês os residentes se encontraram diariamente com um supervisor para uma conversa sobre as suas consultas ambulatoriais. Os sentimentos que esses atendimentos despertavam nos médicos eram trazidos para os encontros. O foco da consulta era a relação médico-paciente e os padrões defensivos dos médicos. O estudo buscou apreender as estratégias subjetivas, utilizadas pelos médicos pediatras em formação para enfrentar a sua prática clínica cotidiana. Oito residentes do primeiro ano de pediatria foram entrevistados com foco nas questões relacionadas à puericultura. Seguiu-se o Método de Explicitação do Discurso Subjacente (MEDS) no campo da pesquisa qualitativa em que as entrevistas são realizadas com uma mescla de perguntas abertas e outras específicas. Observou-se que o zelo apostólico, ou seja, os padrões defensivos dos profissionais, tal como formulado por Michael Balint, se manifesta como uma exigência acentuada sobre as mães, como uma dificuldade de conhecer a dinâmica da família. É possível que esses comportamentos estejam relacionados à excessiva idealização da mãe e da criança, como demonstrou a análise das narrativas. O trabalho direcionado para os conceitos idealizados sobre as mães e as crianças pode ajudar no arrefecimento do zelo apostólico nos profissionais em formação.

This study is the result of a pedagogical work with medical residents in pediatrics at a public hospital in Rio de Janeiro. The doctors met every day during a month with a supervisor to report about their daily practice. During these meetings they talked about the feelings that arouse in the doctors while they were with their patients. The focus of the consultation was directed on the doctor-patient ́s relationship and the defensive patterns doctors may have. The study seeks to learn how subjective strategies used by pediatricians in training are applied in their everyday clinical practice. Eight residents of the first year of Pediatrics were interviewed focusing on issues related to childcare. These interviews were conducted following the Underlying Discourse Unveiling Method (UDUM) in the Field of Qualitative Research in which there are both opens another specific question.It was observed that the apostolic zeal, ie,defensive patterns of professionals, as it was defined by Michael Balint, manifests itself as a strong demand on the mothers, as well as a difficulty in knowing family dynamics. It is possible that these behaviors are related to an excessive idealization of the mother and the child as demonstrated by the analysis of the narratives. The work directed towards the idealized concepts of mothers and infants may be usefin mitigating the apostolic zeal in professionals in training.

Este estudio es el resultado de un trabajo pedagógico con los médicos residentes en pediatría en un hospital público en Rio de Janeiro. Durante un mes los médicos se reunieron todos los días con un supervisor para comentar lo que había surgido en las consultas ambulatorias. En estas reuniones el tema se centró sobre los sentimientos que se despertaban en los ellos durante las mismas. El foco de la consulta estaba dirigido a la relación médico-paciente y los patrones defensivos de los médicos.El estudio examina las estrategias subjetivas utilizadas por los pediatras en formación para poder cumplir con su práctica clínica diaria. Ocho residentes del primer año de pediatría fueron entrevistados centrándose en cuestiones relacionadas con el cuidado de niños. Se ha seguido el Método de Explicación del Discurso Subyacente (MEDS) en el Campo de la Investigación Cualitativa en el cual las entrevistas se llevan a cabo con una mezcla de preguntas abiertas y otras específicas. Se observó que el celo apostólico, es decir, los patrones defensivos de los profesionales, tal como fue formulado por Michael Balint, se manifiesta como una fuerte exigencia con las madres y como una dificultad de conocer la dinámica de la familia. Es posible que estos comportamientos estén relacionados con la idealización excesiva de la madre y del niño, como lo demuestra el análisis de las narrativas. El trabajo dirigido hacia los conceptos idealizados de las madres y de los niños puede ayudar a reducir el celo apostólico en los profesionales en formación.

Broncocospia flexivel de fibra-otica em Pediatria / Bronchoscopy fexible of optic fibers in Pediatrics

O autor analisa as indicacoes, diagnosticos encontrados ecomplicacoes de 170 broncoscopias em criancas, realizadas com aparelho flexivelde fibra-otica, no Hospital dos Servidores do Estado, Rio de Janeiro. O exame alcancou uma positividade diagnostica de 83% nos pacientes com doenca respiratoria alta, sendo menor nos pacientes com doenca respiratoria baixa. A incidencia de complicacoes foi de 8,2%, porem, nenhuma delas foi grave, mesmo tendo-se examinados pacientes de ate 920 gramas. A Broncofibroscopia otica e um exame seguro, queaprimora enormemente a investigacao diagnostica em Pneumonia pediatrica .

Fatores associados ao prognostico da pneumonia com derrame pleural / Factors associated at the prognosis of the pneumonia with pleural effusion

Trabalhos recentes tem dado enfase ao tratamento cirurgico precoce nos pacientes com empiema. Entretanto fatores preditivos de ma evolucao ainda nao estao definidos. Os autores revisaram 87 casos de pneumonia com derrame pleural internados no Servico de Pediatria do Hospital dos Servidores do Estado, Rio de Janeiro, nos ultimos 5 anos, no intuito de detectar parametros que se correlacionassem com um pior prognostico. A presenca de pneumotorax ou pneumatocele no inicio da doenca, o aspecto purulento do derrame pleural foram preditivos de uma evolucao mais lenta e de maior morbidade .