Abstract Objective: The aim of this study was to identify the characteristics of services in Brazil that compound the Brazilian Pediatric Palliative Care (PPC) Network. Methods: An online survey was conducted among representatives from PPC services. A total of 90 services from Brazil completed the online survey and answered a questionnaire about the service’s characterization, health professionals working in PPC, access to opioid prescription and education, and research in PPC. Results: In total, 80 services (88.9%) were created after 2010, 52 (57.9%) were in the southeast region, 56 (62.2%) were in public hospitals, 63 (70%) had up to 100 beds, and 57 (63.3%) were at the tertiary level. Notably, 88 (97.8%) had a physician in the team and 68 (75.5%) dedicated part-time to PPC. Also, 33 (36.7%) revealed concern with the care of health professionals and 36 (40%) reported difficulty or no access to opioid prescription. Research studies were reported to be conducted in 29 (32.2%) services. Conclusions: This mapping points out to a concentration of PPC services in the southeast region, with part-time professional dedication, and the need to improve professionals’ care. Difficulty in opioid access was reported. It is necessary to extend PPC participation to other Brazilian regions, increase time dedicated to PPC, improve professionals’ care and improve access to opioid prescription.

RESUMO Objetivo: Identificar as características dos serviços que compõem a Rede Brasileira de Cuidados Paliativos Pediátricos (CPP). Métodos: Estudo do tipo survey online entre representantes de serviços de CPP. O total de 90 serviços do Brasil participaram da pesquisa e responderam a um questionário sobre a caracterização do serviço, os profissionais de saúde que nele atuam, o acesso à prescrição de opioides e a educação e pesquisa em CPP. Resultados: Oitenta serviços (88,9) foram criados após 2010, 52 (57,9%) estão na Região Sudeste, 56 (62,2%) em hospitais públicos, 63 (70%) têm até cem leitos e 57 (63,3%) estão no nível terciário. Oitenta e oito serviços (97,8%) tinham um médico na equipe e, em 68 (75,5%), os profissionais dedicavam parte de seu tempo aos CPP. Trinta e três serviços (36,7%) revelaram preocupação com o atendimento aos profissionais de saúde. Trinta e seis (40%) relataram dificuldade ou nenhum acesso à prescrição de opioides. Foi reportada a realização de pesquisas em 29 (32,2%). Conclusões: Este mapeamento aponta para a concentração dos serviços de CPP na Região Sudeste, com dedicação parcial dos profissionais, e para a necessidade de cuidar deles. Foi relatada dificuldade no acesso aos opioides. É necessário estender a participação na rede de CPP para outras regiões do Brasil, aumentar o tempo dedicado aos CPP pelos profissionais e cuidar destes, além de melhorar o acesso à prescrição de opioides.

ABSTRACT Objectives: to present a theoretical model for the interactional context of health professionals and families of children and adolescents under palliative care. Methods: qualitative study based on the theoretical frameworks of Grounded Theory and Symbolic Interactionism. Ten palliative care professionals took part in this study through semi-structured interviews employing snowball technique from 2020 to 2021. Results: the comparative data analysis resulted in the theoretical model “Searching for human connection to transcend symbolisms in pediatric palliative care”. It reveals symbolic elements that substantiate the construction of a collaborative context integrating two phenomena: “Overcoming boundaries and intertwining paths” and “Embracing suffering to weave meaningful experiences”. Symbolisms in palliative care guide the behavior of families and professionals, which makes them the key factor to be managed. Final Considerations: symbolisms and suffering continually integrate the interactional experience of professionals. Empathy and compassion are fundamental elements to enable their connection with families.

RESUMEN Objetivos: presentar un modelo teórico sobre el contexto interaccional entre los profesionales de la salud y las familias de niños y adolescentes en cuidados paliativos. Métodos: estudio cualitativo bajo la Teoría Fundamentada en los Datos y el Interaccionismo Simbólico. Participaron diez profesionales activos en cuidados paliativos, a través de entrevistas semiestructuradas, con base en la técnica de “bola de nieve”, entre los años 2020 y 2021. Resultados: el análisis comparativo de los datos resultó en el modelo teórico ‘Buscando la conexión humana para trascender simbolismos de los cuidados paliativos pediátricos’. Evidencia los elementos simbólicos que apoyan la construcción del contexto colaborativo integrando dos fenómenos: ‘Rompiendo fronteras y entrelazando caminos’ y ‘Acogiendo el sufrimiento para tejer experiencias de vida significativas’. Los simbolismos de los cuidados paliativos guían los comportamientos de las familias y los profesionales, constituyendo el principal factor a ser manejado. Consideraciones Finales: el simbolismo y el sufrimiento son continuamente parte de la experiencia de interacción del profesional. La empatía y la compasión son elementos fundamentales para su conexión con las familias.

RESUMO Objetivos: apresentar um modelo teórico sobre o contexto interacional entre profissionais de saúde e famílias de crianças e adolescentes em cuidados paliativos. Métodos: estudo qualitativo sob os referenciais da Teoria Fundamentada nos Dados e Interacionismo Simbólico. Participaram dez profissionais atuantes em cuidado paliativo, por meio de entrevista semiestruturada, a partir da técnica “bola de neve”, entre os anos 2020 e 2021. Resultados: a análise comparativa dos dados resultou no modelo teórico ‘Buscando por conexão humana para transcender simbolismos do cuidado paliativo pediátrico’. Evidencia elementos simbólicos que sustentam a construção do contexto colaborativo integrando dois fenômenos: ‘Rompendo fronteiras e entrelaçando caminhos’ e ‘Acolhendo o sofrimento para tecer experiências de vida significativas’. Simbolismos dos cuidados paliativos orientam comportamentos das famílias e profissionais, constituindo-se no principal interveniente a ser manejado. Considerações Finais: simbolismos e sofrimento integram continuamente a experiência interacional do profissional. Empatia e compaixão são elementos fundamentais para sua conexão com as famílias.

SUMMARY OBJECTIVE: To identify what structure represents life style in medical students, in a public university, with the application of the Fantastic Lifestyle Questionnaire. METHODS: This is a cross-sectional exploratory study. The Fantastic Lifestyle Questionnaire was applied online to medical students. Factorial analysis was realized and factors were extracted by principal components method. Rotation was conducted by Varimax method. RESULTS: Sixty-one questionnaires were analyzed. Students were male in 45.9%, single in 88.5%. The model was composed of three factors that explained 63.5% of all observed variance. The factors related to sleep perception, nutrition and stress, followed by relationships and entertainment and then, activity. Cronbach's alpha was 0.81, which was considered good. CONCLUSION: The model composed by the three factors observed in this group of students represented the construct quality of life, evaluated by the Fantastic Lifestyle Questionnaire. This result may provide substrate to actions that aim to improve quality of life and well-being in medical students from this university.

Resumo Este estudo analisou a autopercepção de estudantes de uma faculdade de medicina em relação a sua aptidão para comunicar más notícias e identificar fatores associados. Mediante questionário autoaplicável, 44,1% do total de 214 participantes se consideraram aptos para a abordagem. Foram associados à maior autopercepção de aptidão para a comunicação de más notícias: mais tempo de curso ( p <0,001); achar que a graduação ofereceu os recursos necessários à aquisição da habilidade de comunicar más notícias ( p <0,001); conhecer algum protocolo validado ( p =0,015); e ter tido necessidade de comunicar má notícia na graduação ( p <0,001). Concluiu-se que a maioria dos estudantes não se sentia apta a comunicar más notícias. Conhecer um protocolo e ter tido necessidade de comunicar más notícias na graduação foram importantes para a aptidão. Sugere-se que o tema seja abordado de forma diferente, com mais atividades práticas.

Abstract This study analyzed medical students’ self-perception regarding their aptitude to communicate bad news and identify associated factors. Using a self-administered questionnaire, 44.1% of 214 participants considered themselves suitable for the approach. The following were associated with greater self-perception of aptitude for breaking bad news: more time in the course ( p <0.001); believing that the undergraduate course offered the necessary resources to acquire the skill to communicate bad news ( p <0.001); knowing a validated protocol ( p =0.015); having needed to communicate bad news during the undergraduate course ( p <0.001). In conclusion, most students felt unable to communicate bad news. Knowing a protocol and having the need to communicate bad news during the undergraduate course were essential for aptitude. As a suggestion, the topic should be approached differently, with more practical activities.

Resumen Este estudio analizó la autopercepción de los estudiantes de una facultad de medicina en relación con su aptitud para comunicar malas noticias e identificar factores asociados. A través de un cuestionario autoaplicable, el 44,1 % del total de 214 participantes se consideraron aptos para el enfoque. Se asociaron con una mayor autopercepción de aptitud para la comunicación de malas noticias: más tiempo de curso ( p <0,001); pensar que el pregrado ofreció los recursos necesarios para adquirir la habilidad de comunicar malas noticias ( p <0,001); conocer algún protocolo validado ( p =0,015); y haber tenido necesidad de comunicar malas noticias en el pregrado ( p <0,001). Se concluyó que la mayoría de los estudiantes no se sentían aptos para comunicar malas noticias. Conocer un protocolo y haber tenido la necesidad de comunicar malas noticias en el pregrado fue importante para la aptitud. Se sugiere que el tema sea abordado de forma diferente, con más actividades prácticas.

SUMMARY OBJECTIVE: The aim of this study was to estimate self-perception of anguish and low quality of life among health care professionals who cared for the dying patients during the COVID-19 pandemic and to determine the characteristics of health care professionals and patients and end-of-life care. METHODS: An online survey that included health care professionals who cared for the dying patient from July 1 to October 31, 2020 was conducted. Low quality of life, anguish, characteristics of patients and health care professionals, and end-of-life care were recorded. Poisson regression was performed to assess the predictors of anguish and low quality of life. RESULTS: A total of 102 health care professionals, including 14 males (13.7%), with a median age of 37 years, composed of 41 physicians (40.2%), 36 physiotherapists (35.3%), and 25 nurses (24.5%) were included in this study. Self-perception of anguish occurred in 69.6% and was associated with physicians and disagreement with end-of-life care offered. Low quality of life was reported in 64.7% and was associated with not having time to talk to patients’ relatives. The agreement that medical care was enough reduced self-perception of low quality of life. CONCLUSION: Self-reported anguish was more frequent in physicians and when the disagreement about end-of-life care occurred. Low quality of life was more frequent when health care professionals did not have time to talk to patients’ relatives and was less frequent when health care professionals agreed that medical care was enough. Strategies should be done by health services to reduce the impact of the pandemic on health care professionals.

RESUMO JUSTIFICATIVA E OBJETIVOS: As experiências dolorosas as quais o recém-nascido é submetido podem ter relação com reações futuras e que existem diferenças no comportamento de resposta à dor nos recém-nascidos oriundos de diferentes vias de parto. O estudo teve como objetivo avaliar a resposta à dor em bebês nascidos por cesariana e parto vaginal. MÉTODOS: Estudo coorte prospectivo que incluiu recém-nascidos nascidos a termo, de cesariana e parto vaginal. Utilizou-se, como estímulo doloroso agudo, a injeção intramuscular de vitamina K rotineira ao nascimento. Os recém-nascidos foram avaliados quanto à dor pela escala unidimensional Neonatal Facial Coding System e pela multidimensional COMFORT Behavior Scale (Comfort b), além da frequência cardíaca nos momentos antes, imediatamente após e 10 minutos após o estímulo. Foi utilizado teste t de Student para a análise estatística com significância de 5%. RESULTADOS: Foram avaliadas 83 crianças. A intensidade da dor avaliada por ambas as escalas antes do estímulo doloroso foi maior no grupo de recém-nascidos de cesariana, porém não foi estatisticamente significativa. Os valores da frequência cardíaca após o estímulo mostraram diferença estatisticamente significativa (p<0,05) maiores no grupo cesariana que no parto vaginal. CONCLUSÃO: Os dados obtidos não evidenciaram diferenças na percepção da dor entre recém-nascidos de parto vaginal e cesariana.

ABSTRACT BACKGROUND AND OBJECTIVES: It is already known that the painful experiences to which the newborn is subjected may be related to future reactions and differences in the behavioral response to pain in newborns from different birth routes. This study aimed to evaluate the response to pain in infants born by cesarean section and vaginal delivery routes. METHODS: This is a prospective cohort study. Newborns born at full term were allocated into two groups: cesarean section and vaginal delivery. The intramuscular vitamin K injection was performed as an acute pain stimulus because it is a routine injection at birth. The newborns were evaluated for pain on two scales, a one-dimensional, the Neonatal Facial Coding System, and a multidimensional, the COMFORT Behavior Scale (Comfort b), in addition to heart rate counting, moments before, immediately after and 10 minutes after the stimuli. Students t-test was used for statistical analyzes, and the level of significance was 5%. RESULTS: Eighty-three children were evaluated. The pain intensity assessed by both scales before the pain stimulus was higher in the cesarean section group, but not statistically significant. Heart rate values after the stimulus showed a statistically significant difference (p<0.05), higher in the cesarean section group than in the vaginal delivery. CONCLUSION: The results did not suggest that there are differences in the perception of pain among newborns born vaginally and cesarean section.

A importância da saúde mental nas práticas em saúde fez surgir nas escolas médicas a demanda por uma capacitação aprimorada dos graduandos nessa área. Este artigo tem como principal objetivo descrever a experiência da Liga Acadêmica de Saúde Mental (LISM) da Faculdade de Medicina de Botucatu - Unesp como atividade de ensino extracurricular. Relatam-se sua formação, objetivos, dificuldades iniciais, composição, modo de funcionamento e principais atividades desenvolvidas desde 2004. Acredita-se que a LISM tem tido êxito em complementar a formação médica nessa área, pois atua na prevenção e promoção da saúde, incluindo atividades voltadas à saúde mental dos estudantes. Discute-se também criticamente a atuação das Ligas de Saúde Mental nas escolas médicas, incluindo alguns riscos, como o de favorecer a especialização precoce em Psiquiatria, de aumentar a falsa dicotomia entre saúde física e mental ou simplesmente reproduzir atividades acadêmicas oficiais. Tais atividades extracurriculares não devem desmobilizar a comunidade acadêmica na luta pela valorização, integração e inserção sistemática e longitudinal de temas de saúde mental no currículo oficial dos cursos de graduação, indispensáveis à adequada formação dos médicos generalistas.

Considering the importance of mental health for general health practice, there has been an increasing demand by medical students for better training in this area. The main aim of the present article is to describe the experience of the Students' League on Mental Health (LISM) at the Botucatu Medical School, São Paulo State University (UNESP), in teaching mental health contents as extracurricular activities. The article describes the initial difficulties in the league's organization, as well as its structure and functioning and the main activities developed by the students since it was founded in 2004. The LISM has been successful in complementing medical training in this area, since it encompasses preventive and health promotion activities, including those targeting the students' own mental health. Some concerns regarding the role of students' leagues in mental health in medical schools are also discussed, including the risks of favoring early specialization in psychiatry, fueling the false dichotomy between physical and mental health, and simply reproducing regular curricular activities. These leagues should not discourage the academic community from struggling to value, integrate, and systematically include mental health themes in the official curriculum, which are indispensable to proper training of general practitioners.