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Aims: identifying sleep disorders (SDs) in children who experienced child maltreatment. Methods: the study evaluated the sleep pattern of 123 children (from 2 to 10 years old), who received assistance with child maltreatment, based on the Children's Sleep Habits Questionnaire (CSHQ) ­ applied in a medical consultation after confirmation of the veracity of the child's report of a violation. The study applied the questionnaire to children seen by doctors in the sector for 11 months. Results: among the children evaluated, 66.7% had SDs. The sample profile was predominantly female (59.3%) and aged between 4 and 7 years old (48.8%). Physical violence was found in 40.7% of the children, in addition to sexual (35.8%), psychological (24.4%), negligence (14.6%) and other types of violence (OTV) (4.5%). SDs are significantly associated with sexual, psychological and OTV (p=0.016). Regarding the subscales, there was a significant difference between the age groups in the bedtime resistance (BR) factor score (p=0.033). The BR characteristic typifies sexual, psychological and OTV. Sleep anxiety (SA) typifies more psychological, sexual and OTV. Night awakenings (NAs) typify psychological, sexual and physical violence. According to the type of violence, significant differences were found in SA (p=0.039), NAs (p=0.026) and BR (p=0.004). Conclusions: the outcomes highlight the association between SDs and child maltreatment. Certain types of violence have a greater negative impact on children's sleep and correlate with specific SD.

Objetivos: identificar distúrbios do sono em crianças que sofreram maus-tratos infantis. Métodos: o estudo avaliou o padrão de sono de 123 crianças (de 2 a 10 anos) atendidas por relatos de maus-tratos, com base no Questionário de Hábitos de Sono Infantil (CSHQ) ­ aplicado em uma consulta médica após confirmação da veracidade do relato de violação da criança. O estudo aplicou o questionário a crianças atendidas no setor durante o período de 11 meses. Resultados: dentre as crianças avaliadas, 66,7% apresentavam distúrbios do sono. O perfil da amostra foi predominantemente feminino (59,3%) e com idade entre quatro e sete anos (48,8%). Violência física foi encontrada em 40,7% das crianças, além de sexual (35,8%), psicológica (24,4%), negligência (14,6%) e outros tipos de violência (4,5%). Os distúrbios do sono estão significativamente associados à violência sexual, psicológica e a outros tipos de violência (OTV) (p=0,016). Em relação às subescalas, houve diferença significativa entre as faixas etárias nos escores de resistência em ir para a cama (p=0,033). A característica resistência em ir para a cama tipifica a violência sexual, psicológica e OTV. Ansiedade do sono tipifica mais a violência psicológica, sexual e OTV. O despertar noturno tipifica a violência psicológica, sexual e física. De acordo com o tipo de violência, foram encontradas diferenças significativas na ansiedade do sono (p=0,039), despertar noturno (p=0,026) e resistência em ir para a cama (p=0,004). Conclusões: os resultados evidenciam a associação entre distúrbios do sono e violência infantil. Certos tipos de violência têm um impacto negativo maior no sono infantil e se correlacionam a distúrbios do sono específicos.

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OBJECTIVE: To evaluate the perceptions of physicians, nurses and nursing technicians of their participation in the decision-making process surrounding life support limitation in terminally ill pediatric patients, with comparisons by professional category. METHODS: A cross-sectional study was conducted in the pediatric intensive care unit of a tertiary public university hospital with the participation of physicians, nurses and nursing technicians. The MacArthur Admission Experience Survey Voice Scale was used to assess and quantify the perceptions of professionals who assisted 17 pediatric patients with life support limitation within 24 hours after the outcome of each patient was determined. All professionals working in the unit (n = 117) who were potentially eligible for the study received a free and informed consent form prior to the occurrence of the cases studied. RESULTS: Study participants included 25/40 (62.5%) physicians, 10/17 (58.8%) nurses and 41/60 (68.3%) nursing technicians, representing 65% of the eligible professionals identified. The questionnaire return rate was higher for physicians than technicians (p = 0.0258). A perceived lack of voice was reported in all three professional categories at varying rates that were lower for physicians than for nurses and nursing technicians (p < 0.00001); there was no difference between the latter (p = 0.7016). In the three professional categories studied, three subscale items were reported. For two of the three statements, there were significant differences between physicians and nurses (p = 0.004) and between physicians and nursing technicians (p = 0.001). For one of the statements, there was no difference among the three professional categories. CONCLUSION: Respondents perceived a lack of voice in the decision-making process at varying rates across the three categories of studied professionals who assisted terminally ill pediatric patients with life support limitation, with physicians expressing lowered rates of perceived coercion.

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RESUMO Objetivo: Avaliar as percepções de médicos, enfermeiros e técnicos de enfermagem sobre sua participação no processo de tomada de decisão de limitação de suporte de vida, em pacientes pediátricos terminais, comparando por categoria profissional. Métodos: Estudo transversal realizado em unidade de terapia intensiva pediátrica de hospital público universitário, terciário, com a participação de médicos, enfermeiros e técnicos de enfermagem. Foi usada a Escala de Voz da MacArthur Admission Experience Survey para avaliar e quantificar a percepção dos profissionais que assistiram 17 pacientes pediátricos em limitação de suporte de vida, nas primeiras 24 horas após o desfecho de cada paciente. Todos os profissionais que atuavam na unidade (n=117), potencialmente elegíveis para a pesquisa, receberam o Termo de Consentimento Livre e Esclarecido previamente à ocorrência dos casos. Resultados: Participaram 25/40 (62,5%) médicos, 10/17 (58,8%) enfermeiros e 41/60 (68,3%) técnicos de enfermagem, representando 65% dos profissionais elegíveis. A taxa de devolução dos questionários pelos médicos foi maior que a dos técnicos (p = 0,0258). Houve registro de percepção de falta de voz nas três categorias profissionais, em taxas variáveis, porém menos percebida pelos médicos do que pelos enfermeiros e técnicos (p < 0,00001); entre estes últimos, não houve diferença (p = 0,7016). Nas três categorias profissionais, foram assinalados os três itens que compõem a subescala. Em duas das três afirmativas, houve diferença significativa entre médicos e enfermeiros (p = 0,004), e entre médicos e técnicos (p = 0,001). Em uma das afirmativas, não houve diferença entre as três categorias profissionais. Conclusão: Houve percepção de falta de voz no processo de tomada de decisão, em taxas variáveis, nas três categorias de profissionais que assistiram pacientes pediátricos terminais em limitação de suporte de vida, sendo os médicos os que expressaram menor percepção de coerção.

ABSTRACT Objective: To evaluate the perceptions of physicians, nurses and nursing technicians of their participation in the decision-making process surrounding life support limitation in terminally ill pediatric patients, with comparisons by professional category. Methods: A cross-sectional study was conducted in the pediatric intensive care unit of a tertiary public university hospital with the participation of physicians, nurses and nursing technicians. The MacArthur Admission Experience Survey Voice Scale was used to assess and quantify the perceptions of professionals who assisted 17 pediatric patients with life support limitation within 24 hours after the outcome of each patient was determined. All professionals working in the unit (n = 117) who were potentially eligible for the study received a free and informed consent form prior to the occurrence of the cases studied. Results: Study participants included 25/40 (62.5%) physicians, 10/17 (58.8%) nurses and 41/60 (68.3%) nursing technicians, representing 65% of the eligible professionals identified. The questionnaire return rate was higher for physicians than technicians (p = 0.0258). A perceived lack of voice was reported in all three professional categories at varying rates that were lower for physicians than for nurses and nursing technicians (p < 0.00001); there was no difference between the latter (p = 0.7016). In the three professional categories studied, three subscale items were reported. For two of the three statements, there were significant differences between physicians and nurses (p = 0.004) and between physicians and nursing technicians (p = 0.001). For one of the statements, there was no difference among the three professional categories. Conclusion: Respondents perceived a lack of voice in the decision-making process at varying rates across the three categories of studied professionals who assisted terminally ill pediatric patients with life support limitation, with physicians expressing lowered rates of perceived coercion.

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OBJECTIVE: To identify the presence of ventricular diastolic dysfunction by tissue Doppler in fetuses of diabetic mothers, with or without septal hypertrophy, in comparison to fetuses of nondiabetic mothers. METHODS: A contemporary transverse study in fetuses with a gestational age between 25 weeks to term, studying diastolic function by assessment using tissue Doppler and pulsed wave Doppler of the atrioventricular diastolic flow. The mothers of the fetuses all had previous or gestational diabetes, and were referred to the Fetal Cardiology Unit of the Institute of Cardiology in Porto Alegre, Brazil. We analysed variance with the Student-Neumann-Keuls post hoc test. An alfa of 0.05 was considered significant for statistical analysis. RESULTS: The mean myocardial velocities of the E'and A' waves at the mural mitral annulus, in fetuses of diabetic mothers with myocardial hypertrophy, were, respectively, 7.00 plus or minus 1.6 centimetres per second, and 10.24 plus or minus 3.3 centimetres per second. In the fetuses of diabetic mothers group without myocardial hypertrophy, the comparable values were 7.19 plus or minus 2.4 centimetres per second and 10.77 plus or minus 3.77 centimetres per second, respectively. In the control group, they were 4.81 plus or minus 0.85 centimetres per second and 8.01 plus or minus 2.2 centimetres per second. The difference between the velocities in fetuses of diabetic mothers and in fetal normal mothers was statistically significant (p less than 0.05). Statistically significant differences were also observed in E' and A' diastolic waves at the aortic mitral annulus, as well as for the tricuspid annulus when tissue Doppler assessment was carried out in the same sample. The mean ratio between the E and E' of mitral and tricuspid waves in the control fetuses of normal mothers was significantly higher than in fetuses of diabetic mothers. CONCLUSION: Pulsed tissue Doppler, when used in fetuses of diabetic mothers and compared with fetuses of nondiabetic mothers, shows evidence of impaired diastolic function, independently of the presence of myocardial hypertrophy.

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Introdução: O forame oval (FO) tem extrema importância na circulação fetal, pois conduz o sangue oxigenado proveniente da placenta diretamente ao átrio esquerdo. Frequentemente fetos de mães diabéticas(FMD) apresentam hipertrofia miocárdica(HM), com alterações na função diastólica ventricular esquerda, podendo acarretar modificações do fluxo pelo FO, com reflexo no índice de pulsatilidade. Objetivo: Testar a hipótese de que o fluxo pelo FO apresenta índice de pulsatilidade maior em FMD com HM do que em fetos sem HM de mães com ou sem diabetes. Métodos: Trata-se de um estudo transversal controlado comparando FMD com HM com FMD sem hipertrofia e fetos controles normais. Pacientes: 16 FMD com HM(grupo I), 36 FMD sem HM(grupo II) e 39 fetos controles normais(grupo III), A ecocardiografia fetal com Doppler foi realizada para obter o índice de pulsatilidade do forame oval(IPFO), através da razão velocidade sistólica-velocidade pré-sistólica/velocidade média. Foram utilizados ANOVA e teste das diferenças mínimas significativas, com alfa crítico de 0,05. Resultados: O IPFO médio foi de 4,07 mais ou menos 1,33 no grupo I, 2,28 mais ou menos 0,58 no grupo II e 2,78 mais ou menos 0,55 no grupo III. Houve diferença estatisticamente significante entre os grupos (p menor 0,001); os valores de IPFO do grupo I foram significativamente maiores dos que o do grupo II e III (p menor 0,001). Os valores do IPFO do grupo II não foram significativamente diferentes em relação ao grupo III (p igual 0,604). Conclusão: Fetos de mães diabéticas com hipertrofia miocárdica têm o índice de pulsatilidade do fluxo do forame oval maior do que os fetos sem hipertrofia miocárdica e fetos controles normais. Sugere-se que sua diferença ocorra por uma complacência diminuída do ventriculo esquerdo secundária à hipertrofia do septo interventricular.

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