Social inequities in the food retail patterns around schools in Recife, Brazil / Desigualdades sociais no padrão do varejo de alimentos no entorno de escolas em Recife, Brasil

Abstract This study aimed to describe the community food environment surrounding schools and its association with territorial socio-environmental vulnerability in the city with the highest intraurban social inequity index in Brazil. Methods: this ecological observational study includes data on the presence and type of food retail in a 400 m buffer surrounding public and private schools in Recife. We have also described the Health Vulnerability Index (HVI) of census tracts and conducted multivariate analyses. Results: through factor analysis, we observed two grouping patterns of food retail. The "diverse food outlets" pattern was positively associated with middle HVI (β 0.14, 95% confidence interval [CI] - 0.11; 0.16) and higher HVI areas (β 0.15, 95%CI - 0.11; 0.17), while "the large food retail chains" pattern was inversely associated with middle HVI (β -0.42, 95% CI - 0.53; -0.30) and high HVI areas (β -0.32, 95%CI - 0.45; -0.18) and positively associated with private schools (β 0.15, 95%CI - 0.030; 0.27). Conclusion: the greatest variety in food retail is in high HVI areas, and large food retail chains prevail around private schools, especially in low HVI areas.

Resumo Este trabalho objetivou descrever o ambiente alimentar comunitário no entorno das escolas e sua associação com a vulnerabilidade socioambiental territorial na cidade com maior índice de desigualdade social intraurbana do Brasil. Métodos: estudo ecológico observacional, inclui dados sobre a presença e o tipo de varejo de alimentos em uma área de 400 m no entorno de escolas públicas e privadas de Recife. Descrevemos o Índice de Vulnerabilidade à Saúde (IVS) dos setores censitários e realizamos análises multivariadas. Resultados: por meio da análise fatorial, observamos dois padrões de agrupamento de estabelecimentos. O padrão "Diversos pontos de venda de alimentos" foi associado positivamente com IVS médio (β 0,14; intervalo de confiança [IC] 95% - 0,11; 0,16) e áreas de IVS mais alto (β 0,15; IC95% - 0,11; 0,17), enquanto o padrão "Grandes redes varejistas de alimentos" foi inversamente associado às áreas de IVS médio (β -0,42; IC95% - 0,53; -0,30) e alto IVS (β -0,32; IC95% - 0,45; -0,18) e positivamente associado com escolas particulares (β 0,15; IC95% - 0,030; 0,27). Conclusão: a maior variedade de estabelecimentos está em áreas de alto IVS, e grandes redes varejistas de alimentos predominam no entorno de escolas particulares, especialmente em áreas de baixo IVS.

Pattern of Psychiatric Emergencies in Children and Adolescents at a Tertiary Care Centre After Onset of COVID-19 Pandemic

Objective: To assess changes in profile of psychiatric emergencies in children and adolescents (aged <19 year) during the coronavirus disease 2019 (COVID-19) pandemic compared to pre-pandemic period. Methods: The psychiatric emergency records were analyzed for the period of April, 2019 – September, 2021 to assess the pattern and profile of mental health emergencies in children and adolescents in the period before and after the onset of the pandemic lockdown (i.e., 23 March, 2020). Results: 379 consecutive child and adolescent psychiatric emergencies were identified, of which 219 were seen after the onset of pandemic. Commonest reason for referral in the pandemic group was attempted self-harm (44.3%). The ICD-10 neurotic, stress-related and somatoform disorders constituted the commonest diagnostic category, similar to pre-pandemic period. A significantly higher proportion (44% vs 28%) of children was prescribed benzodiazepines in the pandemic period, compared to the pre-pandemic period. Conclusion: The average monthly psychiatric emergencies in children and adolescents showed no increase during the pandemic period. Self-harm was the commonest cause of psychiatric referral in emergency services mental health crisis in the younger population.

Ações de enfrentamento ao trabalho infantil em natal/rn no campo do esporte e lazer / Actions to combat child labor in natal/rn in the fild of sport and leisure

O presente artigo traz a análise da trajetória e legitimação das leis de proteção à criança e o adolescente no Brasil; o panorama do trabalho infantil no Estado do Rio Grande do Norte, conforme a Pesquisa Nacional por Amostra de Domicílios 2016-2019; os programas, projetos e ações de prevenção e enfrentamento a problemática do trabalho infantil no município de Natal/RN; aproximações no campo do esporte e lazer, infância e direito ao lúdico e as políticas públicas de esporte e lazer em Natal/RN. Com o objetivo de ressaltar a importância das políticas públicas de esporte e lazer na perspectiva intersetorial como ferramenta de prevenção e enfrentamento ao trabalho infantil. A conclusão a que se chega é a imprescindibilidade da articulação intersetorial entre a rede de proteção social e as políticas públicas de esporte e lazer. Para alcançar os objetivos propostos, foram realizadas pesquisas bibliográfica e documental.

This article trae an analysis of the trajectory and legitimization of child and adolescent protection laws in Brazil; the panorama of child labor in the State of Rio Grande do Norte, according to the National Household Sample Survey 2016-2019; programs, projects and actions to prevent and combat the problem of child labor in the city of Natal/RN; approaches in the field of sport and leisure, childhood and the right to play and public sport and leisure policies in Natal/RN. With the aim of highlighting the importance of public sports and leisure policies from an intersectoral perspective as a tool for preventing and combating child labor. The conclusion reached is the indispensability of intersectoral articulation between the social protection network and public sports and leisure policies. To achieve the proposed objectives, bibliographic and documentary research was carried out.

Associations of sugar-sweetened beverages intake frequency with physical growth and glucolipid metabolism among children and adolescents / 环境与职业医学

Background Children and adolescents drink sugar-sweetened beverages (SSBs) frequently. Research has confirmed that SSBs associate with weight gain and overweight or obesity. However, it is unclear whether high SSBs intake associates with abnormal changes in physical growth and glucolipid metabolism before causing adverse health outcomes such as overweight and obesity. Early identification of associated health risks of overconsumption of SSBs have important public health implications. Objective To investigate the differences in physical growth and glucolipid metabolism between different SSBs intake frequency groups in normal weight children and adolescents aged 6-17 years, and to evaluate the early effects of SSBs intake on physical growth and glycolipid metabolism before causing overweight and obesity, aiming to provide a scientific basis for the prevention and control of childhood overweight and obesity and related chronic diseases, and for the formulation of policies on the control of SSBs consumption. Methods Data were from the Shanghai Diet and Health Survey (SDHS) among primary and secondary school students. The participants were normal weight children and adolescents aged 6-17 years. Propensity scores were calculated according to energy intake and physical activity factors, after stratifying by age and gender. Participants were 1:1 matched with the closest propensity scores in the high-frequency (≥1 time·d−1) and the low-frequency (≤1 time·week−1) SSBs intake groups. The outcome indicators were physical measurements such as height, weight, percent of body fat, and waist circumference, and metabolic indicators such as fasting blood glucose, total triglycerides, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol. Body mass index (BMI) was calculated. Food frequency questionnaire was used to collect SSBs consumption in the past three months through face-to-face interview. A paired t-test was used to compare the differences in physical and glycolipid metabolic indicators between the high-frequency intake group and the low-frequency intake group of SSBs. Results A total of 431 pairs were obtained. For children and adolescents in grades 6-9, overall height (difference=2.92 cm, P=0.002), weight (difference=2.53 kg, P=0.003), and waist circumference (difference=1.34 cm, P=0.035) were higher in those who consumed SSBs ≥1 time·d−1 than in those who consumed ≤1 time·week−1. For children and adolescents in grades 10-12, overall weight (difference=2.27 kg, P=0.041) was higher in those who consumed SSBs ≥1 time·d−1 than in those who consumed ≤1 time·week−1. Over 95% of the study subjects reported blood glucose and lipid test results within the normal range; but girls in grades 1-5 who consumed SSBs ≥1 time·d−1 had a higher total cholesterol (difference=0.20 mmol·L−1, P=0.027) and low-density lipoprotein cholesterol (difference=0.19 mmol·L−1, P=0.010) than those who consumed ≤1 time·week−1; boys in grades 6-9 who consumed SSBs ≥1 time·d−1 had a lower high-density lipoprotein cholesterol (difference=-0.10 mmol·L−1, P=0.039) than those who consumed ≤1 time·week−1. Conclusion High-frequency intake of SSBs may be associated with higher total cholesterol and low-density lipoprotein cholesterol in normal weight children and adolescents in grades 1-5, and higher weight in normal weight children and adolescents in grades 6-12. There is an urgent need to educate children and adolescents about nutritional health, enhance their ability to make healthy food and beverage choices, and take early interventions to control the intake of SSBs in children.

Evaluation of health warning labels for commercial locations vending sugar-sweetened beverages / 环境与职业医学

Background Long-term excessive consuming sugar-sweetened beverages have a negative impact on health. In order to decrease the consumption of sugar-sweetened beverages and create a healthy food environment, the Health Commission of Shenzhen Municipality pioneered to enforce health warning labels presented in commercial locations vending sugar-sweetened beverages based on relevant provisions of the Health Regulations of Shenzhen Special Economic Zone，but its effect has not yet been evaluated. Objective To evaluate the impact of presenting health warning labels in commercial locations vending sugar-sweetened beverages in Shenzhen. Methods A multi-stage stratified sampling method was used to randomly select one street in each of the 10 districts (excluding the Shenzhen Shantou Special Cooperation Zone) of Shenzhen followed by a convenience sampling to select sampling sites to conduct an undercover investigation on the presentation of health warning labels for sugar-sweetened beverages in six different types of venues (n=232) such as shopping malls, ordinary supermarkets/convenience stores, self-service vending machines, catering service places, medical institutions, and venues serving minors' education and activities. At the same time, 238 site managers, 1002 adult consumers, and 7396 child and adolescent consumers were interviewed. Results Among 213 commercial locations vending sugar-sweetened beverages, the rate of health warning label installation was 26.3%, with the highest installation rate in shopping malls (55.0%). Among site managers, 47.8% were aware that commercial locations were required to install health warning labels, and 50.0% were aware of the standards for setting up health warning labels. The higher the awareness of relevant regulations, the higher the rate of installation of health warning labels. More than half of site managers (55.3%) believed that after installing health warning labels, the sales of sugar-sweetened beverages and sugar-sweetened beverages in large-volume packages had decreased compared to the same period in previous years. Most of the interviewed consumers indicated that if they saw the health warning labels for sugar-sweetened beverages, they would buy less, give up purchasing, or choose low-sugar or sugar-free beverages, and also discourage their family members or friends from drinking such beverages. Compared with participants without awareness of the health warning labels, both adult and child and adolescent consumers with awareness of the health warning labels believed that the installation is beneficial to their good eating habits and reported a higher proportion of discouraging family members or friends from drinking such beverages, with a lower frequency of consuming sugar-sweetened beverages. Conclusion Health warning labels for sugar-sweetened beverages have a significant effect on promoting behavior changes, and both site managers and citizens have a high level of support for them. However, in view of the low voluntary compliance rate of commercial locations and the installation rate of health warning labels, the publicity and enforcement of the Health Regulations of Shenzhen Special Economic Zone should be enhanced.

Diagnóstico da situação das crianças e dos adolescentes e de sua captura por uma agenda neoliberal / Diagnosis of the situation of children and teenegers and their capture by a neoliberal politics

Resumo: O artigo apresenta a situação das crianças e dos adolescentes da classe trabalhadora brasileira no contexto do capitalismo neoliberal e do Estatuto da Criança e do Adolescente (ECA). Para tal, analisa os dados de diferentes institutos de pesquisas sobre temas como trabalho, violência e educação. Constata o agravamento da vida do segmento, mesmo com o avanço das garantias jurídicas, e que o ECA se configura como a modernização do status jurídico necessário à restruturação do capital.

Abstract: The article presents the situation of children and teenagers from the Brazilian working class in the context of neoliberal capitalism and the Statute of Children and Adolescents (ECA). To this end, it analyzes data from different research institutes on topics such as work, violence and education. It notes the worsening of the life of the segment, even with the advancement of legal guarantees, and that the ECA is configured as the modernization of the legal status necessary for the restructuring of capital.

A gestão do sofrimento psíquico infantojuvenil: Uma pesquisa com a Rede de Atenção Psicossocial do município do Rio de Janeiro / The management of child and adolescent psychological suffering: A study with the Psychosocial Care Network of the municipality of Rio de Janeiro

Nesta tese investigamos a noção de sofrimento psíquico, cotejando esse conceito com os de sofrimento social e transtorno mental, na rede de atenção psicossocial infantojuvenil do município do Rio de Janeiro. Consideramos como ponto de partida a construção do sentimento de infância e sua penetração no Brasil por meio do discurso higienista, resultando na tardia inserção da criança na agenda da atenção psicossocial brasileira. Em seguida, apontamos a polifonia discursiva contida na noção de sofrimento e abordamos o tema teoricamente a partir do método genealógico foucaultiano, identificando nessa polifonia os discursos: antropológico, biomédico e psicanalítico. A partir daí, exploramos os distintos níveis do governo da infância, tendo como guias os conceitos de biopoder, biopolítica, governamentalidade e medicalização. Para avançar na investigação, aplicamos metodologia qualitativa com a técnica de coleta de dados por meio de grupo focal, realizado a partir do relato de um caso traçador, eleito por cada equipe de quatro CAPSi da rede de atenção psicossocial infantojuvenil do município do Rio de Janeiro. Os achados da pesquisa nos mostram, por ora, que a noção de transtorno mental, representante do discurso biomédico, mantém-se presente nas práticas da saúde mental em paralelo às noções de sofrimento psíquico e sofrimento social. Há, no entanto, um certo mascaramento do sofrimento motivado pelo social em favor do sofrimento psíquico que, para ser reconhecido, precisa ser nomeado como transtorno. Esse achado nos parece se justificar pela própria condição psíquica da criança e mesmo do adolescente, ainda apresentados (falados) pelo outro. Em nossa interpretação, essa condição se radicaliza quando a história social da criança não lhe oferece marcas do infantil que favoreceriam que o sentimento de infância se fizesse representar nas histórias dessas crianças e adolescentes. (AU)

In this thesis, we investigate the notion of psychological suffering, comparing this concept with those of social suffering and mental disorder, in the child and adolescent psychosocial care network of the municipality of Rio de Janeiro. We consider as a starting point the construction of the feeling of childhood and its penetration in Brazil through the hygienist discourse, resulting in the late insertion of the child in the Brazilian psychosocial care agenda. Next, we point out the discursive polyphony contained in the notion of suffering and approach the subject theoretically from the Foucauldian genealogical method, identifying in this polyphony the discourses: anthropological, biomedical and psychoanalytic. From there, we explore the different levels of childhood government, guided by the concepts of biopower, biopolitics, governmentality and medicalization. To advance in the investigation, we applied a qualitative methodology with data collection technique through focus group, carried out from the report of a tracer case, elected by each team of four CAPSi from the child and adolescent psychosocial care network of the municipality of Rio de Janeiro. The research findings show us, for now, that the notion of mental disorder, representative of the biomedical discourse, remains present in mental health practices in parallel with the notions of psychic suffering and social suffering. However, there is a certain masking of suffering motivated by the social in favor of psychic suffering which, to be recognized, needs to be named as a disorder. This finding seems to be justified by the very psychic condition of the child and even of the adolescent, still presented (spoken) by the other. In our interpretation, this condition is radicalized when the child's social history does not offer him marks of the infantile that would favor the feeling of childhood to be represented in the stories of these children and adolescents. (AU)

Estudo retrospectivo de caracterização epidemiológica de queixa, diagnóstico e população pouco explorados num serviço de urgência de psiquiatria da infância e adolescência / Retrospective study of the epidemiological characterization of little explored complaints, diagnoses and population in a child and adolescent psychiatry emergency service

Introdução: A prevalência de transtornos mentais na população pediátrica é presumida em 13,4%. Porém, apenas um em cada seis recebe tratamento apropriado, evidenciando a lacuna entre necessidade e acesso à assistência. Isso resulta em maior risco para situações de crise psicossocial, especialmente entre aqueles em situações de vulnerabilidade com acesso limitado a recursos de tratamento. Diante da diversidade de temas no cenário de urgência em psiquiatria da infância e adolescência (PIA), nosso estudo escolhe tópicos menos explorados, visando compreender fatores sociodemográficos que levam essa população ao serviço de urgência de PIA. Objetivos: Caracterização epidemiológica de queixa (irritabilidade e uso de substâncias), diagnóstico (Autismo) e população (adolescentes em medidas socioeducativas) pouco explorados num serviço de urgência de PIA. Métodos: Estudo transversal retrospectivo realizado pela análise de prontuários dos pacientes, de até 18 anos, atendidos no período de 01 de junho de 2017 a 31 de maio de 2018 na urgência de PIA de um serviço de Belo Horizonte. Resultados: Agressividade, agitação e irritabilidade foram as queixas mais comuns no atendimento de urgência. A irritabilidade esteve associada ao diagnóstico de transtorno de humor sem especificação no atendimento de urgência. Transtorno do Espectro Autista foi o único diagnóstico associado à busca de atendimento por irritabilidade, com taxa de primodiagnóstico de 23% e em idade tardia. O uso de maconha, cocaína e álcool foi comum entre os pacientes atendidos na urgência, e a depressão foi o diagnóstico mais relacionado ao uso de substâncias (SPA). 24,8% dos atendimentos com relato de uso de SPA envolviam adolescentes em medidas socioeducativas (SE). Estes, frequentemente relataram vivências traumáticas e maior chance de quadros de transtornos relacionados ao estresse, de conduta e por uso de SPA. Conclusões: Os achados reforçam a hipótese de que as unidades de urgência podem servir como ponto inicial de diagnóstico e acesso de crianças e adolescentes com transtornos mentais, destacando possíveis lacunas na atenção básica. As unidades de SE parecem precisar aprimorar a abordagem de questões ligadas ao uso de SPA. Compreender as características da população que frequenta a urgência de PIA permite debater estratégias para prevenção e tratamento de transtornos com impacto na rede de cuidados da infância e adolescência.

Introduction: The prevalence of mental disorders in the pediatric population is estimated at 13.4%. However, only one in every six individuals receives adequate treatment, highlighting the gap between necessity and access to care. This disparity results in an elevated risk for psychosocial crisis situations, particularly among those in vulnerable circumstances with limited access to treatment resources. Given the diversity of issues in the context of child and adolescent psychiatry (CAP) emergencies, our study focuses on less explored topics, aiming to comprehend the sociodemographic factors that lead this population to seek urgent care in CAP settings. Objectives: Epidemiological characterization of underexplored complaints (Irritability and Substance Use), diagnosis (Autism) and population (Adolescents imprisoned) in a CAP emergency service. Methods: Retrospective cross-sectional study conducted through the analysis of medical records of patients, up to 18 years, attended at the CAP emergency department of a facility in Belo Horizonte, during the period from June 1, 2017, to May 31, 2018. Results: Aggressiveness, agitation and irritability were the most frequent complaints in emergency care. Irritability was associated with the diagnosis of unspecified mood disorder in the clinical setting. Autism Spectrum Disorder was the only pre-existing diagnosis associated with seeking care due to irritability, with a first-diagnosis rate of 23%, occurring later in age. The use of marijuana, cocaine, and alcohol was prevalent among patients attending the emergency department, with depression being the diagnosis most closely linked to the substance use (SU). Among cases involving reported of SU, 24.8% involved adolescents within socio-educational measures (SE), who often reported traumatic experiences. This group also exhibited higher likelihood of stress-related disorders, conduct disorders, and SU-related conditions. Conclusions: The findings reinforce the hypothesis that emergency units can serve as an initial point of contact for children and adolescents with mental disorders, highlighting potential gaps in primary care. SE units demonstrated a need for improvement in addressing issues related to SU. By comprehending the population frequenting the CAP emergency department, it becomes possible to discuss strategies for the prevention and treatment of disorders with impacts on the childhood and adolescence care network.

Consultas por sospecha de abuso sexual infantojuvenil en la sección de Ginecología de un hospital pediátrico: variaciones prepandemia e intrapandemia de COVID-19 / Consultations due to suspected child and adolescent sexual abuse at the Department of Gynecology of a children's hospital: pre- and intra-COVID-19 pandemic

Introducción. Se ha postulado que el aislamiento social debido a la pandemia de la enfermedad por el coronavirus 2019 (COVID-19, por su sigla en inglés) aumentaría la incidencia de abuso sexual infantojuvenil (ASIJ). Objetivo. Comparar la incidencia y las características de las consultas realizadas en Ginecología en relación con ASIJ antes y durante la pandemia de COVID-19. Materiales y métodos. Se realizó un estudio descriptivo, observacional y comparativo entre las situaciones de sospecha de ASIJ ocurridas durante la pandemia de COVID-19 en relación con las del mismo período del año previo en un hospital pediátrico de alta complejidad. Resultados. Se consignaron 122 consultas por sospecha de ASIJ, 78 en el período previo a la pandemia y 44 en la pandemia. El motivo de consulta al hospital más frecuente, en ambos grupos, fue el relato de ASIJ y, al Servicio de Ginecología en particular, la evaluación de genitales externos. La mayor parte presentó un examen físico normal. Se observó una mayor prevalencia de infecciones de transmisión sexual (ITS) en el grupo de pandemia. Se realizaron más internaciones y denuncias para protección de víctimas en dicho grupo. Se registró que el agresor era conocido de la víctima en casi el 90 % de las víctimas de ambos grupos. Conclusiones. Durante la pandemia se evidenció una disminución en el número total de consultas a Ginecología, de modo que aquellas por sospecha de ASIJ representaron un mayor porcentaje. Sin embargo, las características en relación con la presencia de lesiones graves, infecciones de transmisión sexual o embarazo no se vieron modificadas

Introduction. It has been suggested that the social isolation due to the coronavirus disease 2019 (COVID-19) may increase the incidence of child and adolescent sexual abuse (CASA). Objective. To compare the incidence and characteristics of medical consultations made to the Department of Gynecology due to CASA before and during the COVID-19 pandemic. Materials and methods. Descriptive, observational, and comparative study about suspected CASA events occurred during the COVID-19 pandemic compared to those occurred in the previous year at a tertiary care children's hospital. Results. One hundred and twenty-two medical consultations due to suspected CASA were recorded; 78 before and 44 during the pandemic. In both groups, the most common reason for consultation at the hospital was an account of CASA and, at the Department of Gynecology in particular, the external genitalia examination. Most subjects had a normal physical examination. There was a higher prevalence of STI in the pandemic group. In addition, there were also more hospitalizations and police reports for victims protection in this group. The abuser was known to the victim in almost 90% of cases in both groups. Conclusions. During the pandemic, the total number of medical consultations to the Department of Gynecology decreased so the percentage of those due to suspected CASA was higher. However, the presence of severe lesions, STIs or pregnancy did not change

Vigilância em Saúde do Trabalhador e articulações intersetoriais no enfrentamento do trabalho infantil em Diadema, SP, Brasil / Surveillance in Occupational Health and intersectorial articulations in the fight against child labour in Diadema, SP, Brazil

Este artigo visa apresentar uma intervenção desenvolvida no âmbito de atuação do Centro de Referência em Saúde do Trabalhador de Diadema, SP. Os objetivos foram analisar os acidentes de trabalho com adolescentes notificados pela rede municipal de saúde de 2009 a 2019 e relatar as estratégias intersetoriais e as ações de vigilância e prevenção implementadas. Foram analisados os dados do Sistema de Informação de Agravos de Notificação, relatórios técnicos das vigilâncias e registros de reuniões e eventos da equipe. Dos 5.179 acidentes de trabalho graves notificados, 7,5% atingiram jovens entre 14 e 17 anos, sendo 72% do sexo masculino e 28% do feminino. A compreensão do fenômeno de modo ampliado foi favorecida pela discussão intersetorial e pelo matriciamento na saúde. Foram constatadas as dificuldades dos profissionais de saúde em identificar o acidente de trabalho e a negação dos pais sobre as condições adversas de trabalho. Espera-se superar a invisibilidade e subnotificação das situações de trabalho infantil e contribuir para aplicação dos princípios da precaução e da prevenção para construir paradigmas protetivos sobre as crianças e suas famílias no enfrentamento do trabalho infantil

This study aims to show an intervention developed within the scope of the Worker's Health Reference Centre in Diadema. We analysed municipal health network reports of occupational accidents with adolescents from 2009 to 2019 to assess intersectoral strategies and the implemented surveillance and prevention actions. Notifiable Diseases Information System, technical reports from surveillance, and records of our team's meetings and events of were analyzed. Of the 5,179 reported serious work accidents, 7.5% affected young people aged between 14 and 17 years, 72% of which were boys and 28%, girls. Intersectoral discussion and a matrix health support favoured a broader understanding of the phenomenon. We found difficulties of healthcare providers in identifying work accidents and parents' denial about adverse working conditions. We expect to overcome the invisibility and underreporting of child labour and contribute to the application of principles of precaution and prevention to build protective paradigms for children and their working families to combat child labour

Analysis of students' learning behavior in the teaching practice of the presentation-assimilation-discussion class based on Xuexitong platform / 中华医学教育探索杂志

Objective:To analyze students' learning behavior in the teaching practice of the presentation-assimilation-discussion (PAD) class based on Xuexitong platform.Methods:The PAD class based on Xuexitong platform was applied to the course of child and adolescent health in the specialty of preventive medicine. And the data were collected from the platform to analyze students' learning behavior, including the number of visits and its rules, the completion rate and duration of homework submission, the completion rate of task points, and the number of students participating in discussions. Questionnaires were used to investigate students' evaluation of the learning effect. SPSS 17.0 was used for Mann-Whitney U test, Kruskal Wallis H, and Chi-square test. Results:A total of 99 students visited the platform 40 322 times over 84 days, with a peak on the day of the discussion class, with the highest number of visits from 16:00 to 20:00, and 29.3% (29/99) of them visited the platform for less than 40 days. The completion rate of homework submission was 98.0% (582/594), with 31.1% (181/582) of the person-times less than 6 hours of homework submission duration. The completion rate of task points was 99.0% (3 919/3 960), and the number of students participating in discussions was 3 (2,7). In total, 86.9% to 90.9% of the students thought that the five aspects of learning effect were partly or basically achieved.Conclusion:Students' learning behavior is good on the whole, but their participation in discussion is few, and some of them learn passively, which needs to be further improved.

Health policy and systems research capacity development to support maternal, newborn, child and adolescent health in West and Central Africa

Objectives: To examine how and why a South-South capacity development and networking program for leadership, research, practice and advocacy on maternal new-born, child and adolescent health and health policy and systems strengthening in West Africa and Cameroon worked and identify lessons for low- and middle-income countries. Design: Single qualitative case study drawing on data from document review, observations, key informant interviews and a deliberative workshop. Ethics approval for primary data collection was obtained from the Ghana Health Service Ethical Review Committee (GHS-ERC 012/10/18). Setting: West Africa and Cameroon Participants: Researchers, policy and programme managers and frontline health workers Interventions: Networking and capacity development Results: The programme made good progress in implementing many but not all planned capacity development and networking activities. The opportunity to network with other organisations and individuals and across countries, disciplines, and languages as well as to learn, to develop skills, and obtain mentorship support, were considered valuable benefits of the partnership. Human and financial resource constraints meant that not all planned interventions could be implemented. Conclusions: Lessons for health policy and systems research capacity building in LMIC include the potential of South-South partnerships, the need for dedicated resources, the potential of Sub-regional health organizations to support capacity building and recognition that each effort builds on preceding efforts of others, and that it is important to explore and understand where the energy and momentum for change lies.

Trinta anos do Estatuto da Criança e do Adolescente no Brasil: práticas de garantia de direitos a partir de um marco regulatório neoliberal / Thirty years of the Statue of Children and Adolescents in Brazil: practices to guarantee rights based on a neoliberal regulatory framework / Treinta Años del Estatuto de la Niñez y Adolescentes en Brasil: prácticas para garantizar derechos basadas en un marco regulatorio neoliberal

O artigo objetiva colocar em análise as referências sócio-políticas presentes na emergência do Estatuto da Criança e do Adolescente e seus efeitos nas práticas de garantia de direitos, a partir de uma experiência de participação em uma rede de serviços ao infantojuvenil. Para tanto se destaca o percurso histórico e político da formulação da lei, dando ênfase à presença do pensamento neoliberal, como organizado pelo UNICEF com seu trabalho de articulação dos movimentos e das propostas que compõem o ECA. Tendo como referência análises sobre o direito como mecanismo liberal de governo, as ideias são fundamentadas em autores clássicos como Marx e Foucault, bem como em uma literatura contemporânea brasileira que acompanha os 30 anos de execução da lei. Aponta-se para o paradoxo trazido pela execução da política de garantia de direitos sustentada em parcerias público-privadas, sob a lógica e os princípios das múltiplas faces do privado.(AU)

This article aims at analyzing the social and political references of the emergency of the Child and Adolescent Statue (CAS), as well as its effects in the guaranty of rights practices, parting from an experience of participation in a service net for infants and adolescents. We highlight the historical and political processes of the law's formulation, emphasizing the presence of the neoliberal thought, as organized by UNICEF, while it articulated the movements and proposals that compose the CAS. Understanding the right as a liberal mechanism of government, we found our ideas on classical authors as Marx and Foucault, as well as on a contemporary Brazilian literature that follows the 30 years of execution of the law. We point out to the paradox brought by the execution of a policy of rights guaranty sustained in public-private agreements, under the logic and the principles of the multiple faces of the private sense.(AU)

El artículo tiene como objetivo analizar los referentes sociopolíticos presentes en el surgimiento del Estatuto de la Niñez y la Adolescencia y sus efectos en las prácticas de garantía de derechos, a partir de una experiencia de participación en una red de servicios para la niñez y la adolescencia. Para ello, se destaca la trayectoria histórica y política de la formulación de la ley, destacando la presencia del pensamiento neoliberal, como lo organiza UNICEF con su labor de articulación de los movimientos y propuestas que integran la ECA. Basadas en análisis del derecho como mecanismo liberal de gobierno, las ideas se basan en autores clásicos como Marx y Foucault, así como en la literatura brasileña contemporánea que sigue a los 30 años de aplicación de la ley. Señala la paradoja que genera la ejecución de la política de garantía de derechos sustentada en alianzas público-privadas, bajo la lógica y los principios de las múltiples caras de lo privado.(AU)

A cross sectional study of psychiatric morbidity in children of alcohol dependent fathers

Background: Children of Alcoholics (COAs) form a large but heterogeneous group. Along with genetic predisposition to develop dependence, COAs may inherit other comorbid mental disorders, that the alcohol dependence syndrome often presents with. Prevalence of psychiatric morbidity in children in general have been reported to be around 6.46 % in Indian studies. Studies done with COAs have shown mixed findings, reporting both internalizing, externalizing and other behaviour problems. With dearth of Indian studies assessing psychiatric morbidity in COAs, a study was conducted to assess same. Methodology: A cross sectional study was conducted in private de-addiction centre in South India. Sixty- five children in age group of 6 to 18 years, whose fathers were admitted for alcohol dependence syndrome, were assessed along with their primary care giver using a semi-structured socio-demographic proforma and Kiddie-Schedule for Affective Disorder and Schizophrenia-Present and Lifetime version. Chi square and independent samples t test were used as appropriate. Results: 55.4% of the children had some lifetime psychiatric diagnosis. Around 21.5% of children had more than one lifetime diagnoses. Most common disorders found were anxiety disorders followed by mood disorders. Comparison of socio-demographic variables with respect to presence or absence of any lifetime psychiatric diagnosis, anxiety disorders, mood disorders and multiple diagnoses did not reveal any significant differences. Conclusion: Psychiatric morbidity in COAs was higher than in children in general population as reported in other studies. Having alcohol dependent males in de-addiction centres provides an avenue for early detection and treatment of psychiatric morbidity in their children.

Exclusão sociodigital e desproteção de crianças, adolescentes e famílias em tempos de crise / Sociodigital exclusion and deprotection of children, adolescents and families in times of crisis / Exclusión sociodigital y desprotección de niños, adolescentes y familias en tiempos de crisis

Este artigo tem como objetivo realizar uma análise psicossociológica das atuações da rede de proteção a crianças, adolescentes e suas famílias em contexto de desproteção social, vulnerabilidade relacional e exclusão sociodigital em tempos de covid-19. Para tanto, realizou-se uma revisão de literatura buscando verificar aspectos de desproteção e estratégias de atuação da rede neste momento de crise. Apresentamos, ainda, um relato de experiência de encontros on-line de redes sociais do Distrito Federal para discutir sobre atendimento e oferta de serviço nos territórios. Assim, diante dos processos excludentes, ampliados pela crise sanitária, social, política e econômica, com vistas a atuações protetivas e de garantia de direitos, a inclusão sociodigital deve ser pauta incluída nas discussões sobre proteção social, em que se devem intensificar ações de resistência e de construções colaborativas entre atores da rede intersetorial e comunitária.

This article aims to perform a psychosociological analysis of the performance of the protection network for children, adolescents and their families in the context of social deprotection, relational vulnerability and sociodigital exclusion in Covid-19 times. To this end, a literature review was carried out seeking to verify aspects of the network's unprotection and performance strategies in this moment of crisis. We also present an account of the experience of online social networking meetings in the Distrito Federal to discuss care and service provision in the territories. Thus, given the exclusionary processes, amplified by the sanitary, social, political and economic crisis, with a view to protective actions and the guarantee of rights, socio-digital inclusion should be included in the discussions on social protection, in which resistance actions should be intensified and collaborative constructions between actors in the intersectoral and community network.

Este artículo tiene como objetivo realizar un análisis psicosociológico de las acciones de la red de protección de los niños, adolescentes y sus familias en el contexto de la desprotección social, la vulnerabilidad relacional y la exclusión sociodigital en tiempos de Covid-19. Para ello, se realizó una revisión de la literatura que buscaba verificar los aspectos no protegidos y las estrategias de actuación de la red en este momento de crisis. También presentamos un informe sobre la experiencia de las reuniones online de las redes sociales del Distrito Federal para discutir la asistencia y la oferta de servicios en los territorios. Así, ante los procesos de exclusión, amplificados por la crisis sanitaria, social, política y económica, con miras a las acciones de protección y garantía de derechos, se debe incluir la inclusión sociodigital en los debates sobre la protección social, en los que se deben intensificar las acciones de resistencia y las construcciones colaborativas entre los actores de las redes intersectoriales y comunitarias.

A conquista da formação integrada na SBPSP / The achievement of integrated training in SBPSP / La consecución de una formación integrada en SBPSP / La réalisation de la formation intégrée au SBPSP

Este artigo tem por objetivo descrever o processo que levou à implantação da formação integrada na SBPSP. Para tanto, relata brevemente a história da formação em psicanálise de crianças e adolescentes na instituição, bem como o processo que levou à concepção do modelo aprovado a ser implantado. Um breve relato dos fatores que nortearam a formação integrada no Cocap também está incluído, assim como algumas concepções acerca da integração e o programa de formação. Esperamos que sua leitura esclareça e motive o membro filiado a incluir em suas escolhas seminários concernentes à psicanálise de crianças e adolescentes, uma vez que o estudo da infância e da adolescência faz parte da formação psicanalítica, ampliando a escuta do infantil no adulto, ainda que não se trabalhe diretamente com essa faixa etária.

This article aims to describe the process that led to the implementation of integrated training in SBPSP. To this end, it briefly reports the history of the training in psychoanalysis of children and adolescents in the institution, as well as the process that led to the conception of the approved model. A brief report of the factors that guided integrated training in Cocap is also included, as well as some conceptions about integration and the training program. We hope that this reading will clarify and motivate one to include in one's choices the seminars that concern the psychoanalysis of children and adolescents, since the study of childhood and adolescence is part of the analytical training - and amplifies the psychoanalytical listening to the infantile - even if one does not work directly with this age group.

Este artículo tiene como objetivo describir el proceso que condujo a la implementación de la capacitación integrada en SBPSP. Para ello, se informa brevemente la trayectoria de la formación en psicoanálisis de la niñez y la adolescencia en la institución, así como el proceso que condujo a la concepción del modelo aprobado a implementar. También se incluye un breve informe de los factores que orientaron la formación integrada en Cocap, así como algunas concepciones sobre la integración y el programa formativo. Esperamos que su lectura aclare y motive al candidato a incluir seminarios sobre el psicoanálisis de niños y adolescentes en sus elecciones, ya que el estudio de la niñez y adolescencia es parte de la formación psicoanalítica, aunque no trabajemos directamente con este grupo, ampliando la escucha del infantil en el adulto.

Cet article vise à décrire le processus qui a conduit à la mise en œuvre de la formation intégrée au SBPSP. A cet effet, il rend brièvement compte de l'histoire de la formation en psychanalyse des enfants et adolescents en institution, ainsi que du processus qui a conduit à la conception du modèle approuvé à mettre en œuvre. Un bref compte rendu des facteurs qui ont guidé la formation intégrée au Cocap est également inclus, ainsi que quelques conceptions sur l'intégration et le programme de formation. Nous espérons que votre lecture clarifiera et motivera les candidats à inclure dans ses choix des séminaires concernant la psychanalyse des enfants et des adolescents, puisque l'étude de l'enfance et de l'adolescence fait partie de l'éducation psychanalytique, même si nous ne travaillons pas directement avec ce groupe, élargissant l'écoute de l'infans chez le adulte.

ECA 30 ANOS E O DIREITO DAS CRIANÇAS E ADOLESCENTES AOS MUSEUS E À DIVULGAÇÃO CIENTÍFICA / ECA 30 YEARS OLD AND THE RIGHT OF CHILDREN AND ADOLESCENTS TO MUSEUMS AND SCIENCE COMMUNICATION / ECA 30 AÑOS Y EL DERECHO DE LOS NIÑOS Y ADOLESCENTES A MUSEOS Y DIVULGACIÓN CIENTÍFICA

A presente pesquisa, de caráter exploratório associada à pesquisa bibliográfica, discute o acesso e a participação de crianças e adolescentes a museus, espaços científicos-culturais e ações de divulgação científica, tendo em vista seus direitos à educação, à cultura e ao lazer previstos no Estatuto da Criança e do Adolescente de 1990. Apesar de alguns progressos alcançados nos 30 anos da Lei, desigualdades persistem e são retratadas no texto. Iniciamos com uma reflexão pautada em leituras sobre a importância desses espaços no desenvolvimento da criança e do adolescente, seguida pela apresentação de dados da exclusão aos direitos fundamentais dessa faixa etária no Brasil. Posteriormente, trazemos resultados de pesquisas com vistas a construir argumentos que evidenciem as potencialidades, desafios e recomendações para o acesso e a participação de crianças e adolescentes nos museus, espaços científico-culturais e ações de divulgação científica, que fazem parte fundamental do seu desenvolvimento psicológico e intelectual.

This research, of an exploratory nature associated with bibliographic research, discusses the access and participation of children and adolescents to museums, scientific-cultural places and science communication actions, taking into consideration their rights to education, culture and leisure guaranteed in the Brazilian Statute of the Child and Adolescent 1990. Despite some progress achieved in the 30 years of the Law, inequalities persist and are portrayed in the text. We started with a reflection based on readings on the importance of these places in the development of children and adolescents, followed by the presentation of data on the exclusion of fundamental rights of this age group in Brazil. Subsequently, we bring research results in order to build arguments that show the potential, challenges and recommendations for the access and participation of children and adolescents in museums, scientific-cultural places and science communication actions, which are a fundamental part of their psychological and intellectual development.

Esta investigación, de naturaleza exploratoria asociada con la investigación bibliográfica, discute el acceso y la participación de niños y adolescentes a museos, espacios científico-culturales y acciones de divulgación científica, en vista de sus derechos a la educación, cultura y ocio previstos en el Estatuto del Niño y el Adolescente de 1990. A pesar de algunos avances logrados en los 30 años de la Ley, las desigualdades persisten y están describen en el texto. Comenzamos con una reflexión basada en lecturas sobre la importancia de estos espacios en el desarrollo de niños y adolescentes, seguida de la presentación de datos sobre la exclusión de los derechos fundamentales de este grupo en Brasil. Posteriormente, traemos resultados de investigación para construir argumentos que muestren el potencial, los desafíos y las recomendaciones para el acceso y la participación de niños y adolescentes en museos, espacios científico-culturales y acciones de divulgación científica, que son una parte fundamental de su desarrollo psicológico e intelectual.

Depoimento especial a partir de opiniões de psicólogos brasileiros atuantes nessa prática / Views of brazilian psychologists on children's testimony / Testimonio especial a partir de las opiniones de psicólogos brasileños que actúan en esta práctica

O Depoimento Especial (DE) é uma prática de oitiva de crianças e adolescentes no âmbito judiciário, normalmente acompanhado por psicólogos. Objetivou-se conhecer opiniões de psicólogos brasileiros que atuavam no DE sobre essa prática. Foi realizada uma pesquisa qualitativa exploratória transversal on-line, por meio de ferramentas digitais (e.g., Skype, Whatsapp). Dez psicólogos brasileiros, de seis diferentes estados, atuantes no DE, responderam a uma ficha de dados sociodemográficos e a uma entrevista semiestruturada. As entrevistas foram estudadas a partir da análise temática. Evidenciaram-se seis temas, sendo eles: papel profissional, trabalho interdisciplinar, sentimentos, agilidade, proteção e legislação. Tomados em conjunto, esses temas indicam o DE como ágil e protetivo para as crianças e adolescentes vítimas de violência sexual, salientando possíveis desafios à sua efetivação. Os resultados obtidos possibilitam maior conhecimento sobre a prática do DE e podem ser utilizados em futuras revisões dessa prática. (AU)

Special Testimony is a method of judicial hearing of children and adolescents in Brazil, usually accompanied by psychologists. The objective of the present study was to know the opinions of Brazilian psychologists who work with children's testimony about this practice. A cross-sectional exploratory qualitative research was conducted using digital tools such as Skype and Whatsapp. A total of 10 Brazilian psychologists, from six different states, working with Special Testimony completed a socio-demographic questionnaire and a semi-structured interview. The interviews were analyzed according to the Thematic Analysis. Six themes were highlighted: professional role, interdisciplinary work, feelings, swiftness, protection, and legislation. Taken together, these themes indicate that the Special Testimony is swift and protective for children and adolescents victims of sexual violence, highlighting possible challenges to its implementation. The results obtained provided more knowledge about the Special Testimony and can be used in future revisions of this practice. (AU)

El Testimonio Especial (DE) es una práctica de escucha de niños y adolescentes en el ámbito judicial, generalmente, acompañados por psicólogos. La finalidad fue conocer las opiniones de psicólogos brasileños, que trabajan con el Testimonio Especial sobre esta práctica. Se realizó una investigación cualitativa exploratoria transversal en línea utilizando herramientas digitales (e.g., Skype, WhatsApp). Diez psicólogos brasileños actuantes en el DE, provenientes de seis diferentes provincias, respondieron a una ficha de datos sociodemográficos y una entrevista semiestructurada. Las entrevistas se analizaron a partir del análisis temático, destacando seis temas: rol profesional, trabajo interdisciplinario, sentimientos, agilidad, protección y legislación. En conjunto, estos temas apuntaron el DE como ágil y protectivo para los niños y adolescentes víctimas de violencia sexual, evidenciando posibles retos para su implementación. Los resultados obtenidos posibilitan un mayor conocimiento sobre la práctica del Testimonio Especial y pueden ser utilizados en futuras revisiones de esta práctica. (AU)

Rede de proteção a crianças e adolescentes em situação de violência na visão dos profissionais / Red de seguridad para niños y adolescentes en situación de violencia a juicio de profesionales / Safety net for children and adolescents under situation of violence through the view of professionals

Objetivo analisar o conhecimento dos profissionais da rede de proteção sobre crianças e adolescentes em situação de violência e a funcionalidade, desdobramentos e desfechos dessa rede. Método estudo descritivo, de abordagem qualitativa, realizado com 16 profissionais dos serviços que compõem a rede de proteção. A coleta dos dados deu-se por entrevista semiestruturada, realizada no período de dezembro de 2018 a janeiro de 2019; os dados foram analisados com base no conceito temático de rede. Resultados os profissionais têm conhecimento sobre a violência contra a criança e o adolescente e também a alguns aspectos da rede de proteção no que concerne aos serviços ofertados, conceitos e desfechos; entretanto, desconhecem os protocolos de fluxos dos serviços existentes dentro da própria rede de proteção. Considerações finais observa-se a necessidade de maior conhecimento por parte dos profissionais sobre o funcionamento da rede de proteção, para uma atuação mais efetiva no combate à violência.

Objetivo analizar el conocimiento de los profesionales de la red de protección sobre niños y adolescentes en situaciones de violencia y la funcionalidad, consecuencias y resultados de esta red. Método estudio descriptivo con un enfoque cualitativo realizado con 16 profesionales de los servicios que componen la red de protección. Los datos se recopilaron mediante entrevista semiestructurada, realizada de diciembre de 2018 a enero de 2019; datos fueron analizados sobre la base del concepto temático de red. Resultados los profesionales tienen conocimientos sobre la violencia contra los niños y adolescentes y también algunos aspectos de la red de protección con respecto a los servicios ofrecidos, conceptos y resultados; sin embargo, desconocen los protocolos de flujos de servicios existentes dentro de la propia red de protección. Consideraciones finales se observa la necesidad de un mayor conocimiento por parte de los profesionales sobre el funcionamiento de la red de protección, para una acción más eficaz en la lucha contra la violencia.

Objective analyzing the knowledge of the professionals of the protection network about children and adolescents under situation of violence and the functionality, consequences and outcomes of this network. Method a descriptive study with a qualitative approach carried out with 16 professionals from the services that make up the protection network. Data were collected by semi-structured interview, conducted from December 2018 to January 2019; data were analyzed based on the thematic concept of network. Results professionals have knowledge about violence against children and adolescents and some aspects of the protection network about the services offered, concepts and outcomes; however, they are unaware of the protocols of flows of existing services within the protection network itself. Final considerations it is observed the need for greater knowledge on the part of professionals about the functioning of the protection network, for a more effective action in combating violence.

A proposição de articulação em rede para atenção pública a crianças e adolescentes / The proposition of the network articulation to public attention to children and adolescents / La conexión en red como proposición de una atención pública para niños y adolescentes

Objetivou-se investigar se e de que modo uma articulação em rede pode auxiliar e garantir a participação social na elaboração de uma agenda de políticas sociais pautada na garantia dos direitos de crianças, adolescentes e jovens. Por meio de observação participante e entrevistas, em uma experiência local, concluiu-se que, apesar de ter fomentado o debate sobre direitos e possibilitado a participação dos profissionais, a forma de organização para ser efetivamente democrática precisa ser revista, a fim de propiciar a participação de todos os atores sociais envolvidos, inclusive crianças, adolescentes e jovens.

This study attempt to investigate if and how a network articulation can help and guarantee social participation in the elaboration of an agenda of social policies based on the guarantee of the rights of children, adolescents and young people. Through the method of participant observation and interviews, in a local experience, we concluded that despite the fact we have fomented the debate on rights and made possible the participation of professionals, the form of organization to be effectively democratic needs to be revised in order to facilitate the participation of all social actors involved, including children, adolescents and young people.

El objetivo fue investigar si y cómo una red puede asistir y garantizar la participación social en el desarrollo de una agenda de políticas sociales basado en la garantía de los derechos de los niños, adolescentes y jóvenes. A través de la observación participante y entrevistas, en un experimento local encontró que, a pesar de haber fomentado el debate sobre los derechos y hecho posible la participación de profesionales; la forma de organización efectivamente democrática necesita revisarse, con el fin de propiciar la participación de todos los actores sociales involucrados, incluyendo niños, adolescentes y jóvenes.