As diversas faces da morte de crianças na perspectiva de médicos e enfermeiros / The diverse faces of child death from the perspective of doctors and nurses

Introdução: Adoecimento e morte de crianças são eventos pouco aceitos na sociedade. Objetivo: Analisar a percepção de médicos e enfermeiros de terapia intensiva sobre a morte de crianças. Métodos: Estudo de aborda-gem qualitativa, com médicos e enfermeiros de três Unidades de Terapia Intensiva (UTI Pediátrica, UTI Neonatal e UTI Cardiológica) de um hospital de ensino. Foram realizadas entrevistas semiestruturadas gravadas, transcritas e analisadas segundo análise de conteúdo na modalidade temática. Resultados: Foram entrevistados 14 profis-sionais, com idade entre 28-53 anos, que possuíam tempo mínimo de dois anos de atuação em terapia intensiva e média de 43 horas semanais de trabalho. Os sentimentos e atitudes diante da morte emergiram da análise das falas e foram categorizados nos seguintes temas: percepção da morte na infância, obstinação terapêutica e so-frimento no encontro com as famílias. Os profissionais reconheceram lacunas na formação durante a graduação e pós-graduação para lidar com a morte de crianças. Sofrimento, ansiedade, culpa, frustração e impotência foram relatados, demonstrando a complexidade que envolve situações de morte de criança. A condição clínica e a capaci-dade de interação da criança influenciaram nas atitudes e na própria maneira do profissional lidar com a morte. A espiritualidade foi um importante mecanismo de enfrentamento. Conclusão: A morte de crianças em UTI provoca sentimentos ambivalentes em médicos e enfermeiros responsáveis pelo seu cuidado. Os profissionais sofrem pela morte de alguém que ainda não desfrutou da vida, porém a aceitam quando pensam no fim de uma vida marcada por sofrimentos e limitações impostos pela doença. O contato com o tema morte durante a formação profissional e nas discussões regulares dos serviços podem auxiliar na forma de lidar com esse evento. A espiritualidade foi um importante recurso de enfrentamento. (AU)

ntroduction: Sickness and death of children are little accepted events in society. Objective: To analyze the perception of intensive care doctors and nurses about the death of children. Methods: Qualitative approach study, with doctors and nurses from three Intensive Care Units (Pediatric ICU, Neonatal ICU and Cardiological ICU) of a teaching hospital. Recorded semi-structured interviews were carried out, transcribed and analyzed according to content analysis in the thematic modality. Results: 14 professionals were interviewed, aged 28-53 years, with a minimum of 2 years of intensive care experience time and an average of 43 hours of work per week. The feelings and attitudes towards death emerged from the speech analysis and were categorized in the following themes: per-ception of death in childhood, therapeutic obstinacy and suffering in meeting with families. Professionals recognized gaps in training during undergraduate and graduate studies to deal with the death of children. Suffering, anxiety, guilt, frustration, impotence and guilt were reported, demonstrating the complexity of child death situations. The clinical condition and the child's ability to interact influenced the attitudes and the professional's way of dealing with death. Spirituality was an important mechanism of confrontation. Conclusion: The death of children in ICU causes ambivalent feelings in doctors and nurses responsible for their care. Professionals suffer for the death of someone who has not yet enjoyed life, but accept it when they think about the end of a life marked by suffering and limitations imposed by the disease. Contact with the subject of death during professional training and in the regular discussions of services can help in the way to deal with this event. Spirituality was an important resource of coping. (AU)

Psychological distress and mother-child relationship: influence of life context on a population sample (BRISA) through the use of directed acyclic graphs (DAG)

This study aimed to investigate the association between maternal psychological distress and impairment in mother-child relationship in a sample from a Northeast capital city in Brazil with a low Human Development Index, using directed acyclic graphs (DAG). A total of 3,215 women were evaluated for the presence of psychological distress through the Self Reporting Questionnaire instrument and for the mother-child relationship by the first factor of Postpartum Bonding Questionnaire, considered the most appropriate in the literature. Demographic and socioeconomic variables were used to construct a theoretical model and, after this, multivariate logistic regression was performed using variables suggested by Directed Acyclic Graphs (DAG). Psychological distress was present in 22.7% of the women and 12.6% of them presented impaired mother-child relationships. After adjustment, the variable 'maternal mental distress' remained associated with impaired mother-child relationship (RR=3.03), and among the explanatory variables only 'primary school level' (RR=1.48) was associated as a risk factor to this outcome. The results indicated that, in this population, women with psychological distress and lower schooling are more likely to present impaired mother-child relationships.

Determinants of the introduction of early complementary feeding before and after the third month of life: a multinomial analysis

The introduction of early complementary feeding (ECF) is determined by different factors depending on when it occurs. The objective of this study was to analyze factors associated with the introduction of ECF in two different moments of the infant's life: from zero to three and from four to five months of age. A cohort with 3,306 dyads studied in the BRISA survey in São Luis/MA in 2010 was used. Questionnaires were applied at birth and at follow-up when the infants were 15 to 36 months of age of women with more than 20 weeks of gestational age, residing in this municipality. A multivariate model of multinomial logistic regression was used to verify associations between independent variables and ECF at 0 to 3 months and at 4 to 5 months of age. A hierarchical analysis model was used to select variables for confounding adjustment. Variables with a P-value <0.05 were considered significant. For ECF introduced between 0-3 months, the variables "use of pacifier", "maternal paid activity", "smoking", and "postpartum pregnancy" were identified as risk factors. The variables "use of pacifier" and "maternal paid activity" remained associated as a risk for ECF introduced from 4-5 months. The variable 'mother without partner' (RR=1.26 and P=0.04) represented a risk factor for ECF only for the 4-5 months period. Although each period presented specific risk factors, the use of pacifier and maternal professional activity were associated in the two periods studied, indicating their importance for the introduction of ECF.