Abuso sexual contra crianças no contexto da Enfermagem: uma análise de conceito / Child sexual abuse in the context of Nursing: a concept analysis

OBJETIVO: Realizar a análise do conceito de abuso sexual em crianças, identificando os possíveis atributos, antecedentes e consequências. MÉTODO: Foi conduzida uma análise de conceito, estruturada por meio de uma scoping review. A busca foi realizada em 6 bases de dados e, após análise, um total de 17 artigos foram incluídos. RESULTADOS: Foram identificados, como antecedentes, crianças com idade acima de 8 anos, do sexo feminino, sendo o agressor frequentemente um parente da vítima ou até mesmo o próprio pai. Quanto aos atributos, foram identificadas alterações psicológicas, doenças sexualmente transmissíveis e gravidez indesejada. As consequências observadas foram predominantemente de natureza psicológica, incluindo depressão e comportamento suicida. CONCLUSÃO: No total, foram agrupados nove antecedentes que estão relacionados aos fatores que levam à vulnerabilidade do abuso. Além disso, foram identificados 11 atributos correspondentes aos sinais característicos que indicam que uma criança é vítima de abuso. Por fim, foram observadas 12 consequências decorrentes da violência sexual infantil.

OBJECTIVE: To conduct a conceptual analysis of child sexual abuse to identify possible attributes, antecedents, and consequences. METHOD: A concept analysis was conducted using a scoping review methodology. Searches were conducted in 6 databases, resulting in 17 articles after analysis. RESULTS: Antecedents included children older than 8 years, female gender, the perpetrator often being a relative of the victim or even the biological father. Psychological changes, sexually transmitted diseases, and unwanted pregnancies were identified. The consequences observed were mainly psychological, including depression and suicidal behavior. CONCLUSIONS: Nine antecedents were grouped as factors contributing to vulnerability to abuse. In addition, 11 attributes correspond to characteristic signs indicating that a child is a victim of maltreatment. Finally, 12 consequences of child sexual violence were observed.

Ethnically distinct populations and coping with violence against children in the COVID-19 pandemic / Poblaciones étnicamente diversas y la lucha contra la violencia infantil en la pandemia de COVID-19 / Populações etnicamente distintas e o enfrentamento da violência contra crianças na pandemia da COVID-19

ABSTRACT Objective: To identify policies and programs adopted by a Brazilian municipality to address violence against children during the COVID-19 pandemic. Method: A qualitative documentary study. The study setting was the municipality of Ananindeua, Pará, Brazil. Data was collected from official websites between November 2021 and February 2022. Thematic content analysis was used with the support of webQDA software. Results: Three empirical categories emerged: a) Impacts of the COVID-19 pandemic on violence against children; b) Action strategies for tackling violence against children in the COVID-19 pandemic; c) Evaluation indicators and targets for action strategies for tackling violence against children. Final considerations: The documents revealed few direct mentions of children, especially traditional populations; they presented superficial and ineffective evaluations of the policies and programs adopted, using exclusively quantitative indicators.

RESUMEN Objetivo: Identificar políticas y programas adoptados por un municipio brasileño para hacer frente a la violencia infantil durante la pandemia de COVID-19. Método: Se trata de un estudio cualitativo documental. El escenario fue el municipio de Ananindeua, Pará, Brasil. Los datos se recogieron de sitios de internet oficiales entre noviembre de 2021 y febrero de 2022. Se utilizó el análisis temático de contenido con el apoyo del software webQDA. Resultados: Surgieron tres categorías empíricas: a) Impactos de la pandemia de COVID-19 en la violencia contra los niños; b) Estrategias de acción para abordar esta violencia; c) Indicadores de evaluación y metas de las estrategias de acción para este afrontamiento. Consideraciones finales: Los documentos revelaron pocas menciones sobre los niños de las poblaciones tradicionales en especial y presentaron evaluaciones superficiales de las políticas y programas adoptados, utilizando exclusivamente indicadores cuantitativos.

RESUMO Objetivo: Identificar políticas e programas adotados por um município brasileiro para o enfrentamento da violência contra crianças durante a pandemia de COVID-19. Método: Estudo qualitativo do tipo documental. O cenário de estudo foi Ananindeua, Pará, Brasil. A coleta de dados foi realizada em sites oficiais, de novembro de 2021 a fevereiro de 2022. Utilizou-se a análise de conteúdo temática apoiada pelo software webQDA. Resultados: Emergiram três categorias empíricas: a) Impactos da pandemia de COVID-19 na violência contra crianças; b) Estratégias de enfrentamento desta violência; c) Indicadores de avaliação e metas das estratégias para este enfrentamento Considerações finais: Há poucas menções diretas às crianças, especialmente às de populações tradicionais; apresentaram avaliações ineficazes das políticas, apenas qualitativamente.

Dentistry Students' Knowledge of Pediatric Patients Who Suffered Violence: A Systematic Review

ABSTRACT Objective: To review the literature unprecedentedly to identify the dentistry students' knowledge of pediatric patients who suffered violence. Material and Methods: A systematic review was conducted using PubMed, Web of Science, LILACS, SciELO, Google Scholar, and OpenGrey electronic databases up to November 2021. The "Grey Literature" was verified through Google Scholar and Open Grey searches to avoid any selection bias. There was no restriction on the date of publication or language. Results: The systematic search yielded 2.756 studies in the first selection phase, but only twenty-two articles were included. All selected articles were published between 1998 and 2021 and used a questionnaire to evaluate the dentistry students' knowledge regarding child maltreatment cases. Brazil was the country that had the most studies included (10 articles). Despite the majority of the students presenting insufficient knowledge about child maltreatment, evidence from this research showed that every form of approach by professionals toward child maltreatment should be considered important. Conclusion: Therefore, there are deficiencies regarding the teaching-learning methodology, reinforcing the need for improvements in Dentistry undergraduate curricula.

Evolución del riesgo y protección en la infancia y la adolescencia

(analítico) Los factores de riesgo y protección pueden ser utilizados para evaluar, prevenir e intervenir en el maltrato infantil. El objetivo de este estudio es analizar longitudinalmente el riesgo en la infancia y la adolescencia, para determinar qué factores pueden ser empleados como indicadores de evolución. Se empleó una muestra de 102 niños, niñas y adolescentes que participaban en el sistema de bienestar infantil español, en tres momentos temporales. Los resultados indicaron que existe una evolución del riesgo, con una tendencia general de disminución de riesgos e incremento de elementos protectores. Nuestros hallazgos identificaron la existencia de factores dinámicos y estáticos. Este estudio pone de manifiesto la relevancia de la atención e intervención continuada y a largo plazo para fortalecer los factores de protección y disminuir los de riesgo en niños, niñas y adolescentes.

(analytical) Risk and protective factors can be used for risk and needs assessments, prevention, and intervention in cases involving mistreatment of children. The aim of this study is to provide a longitudinal analysis of risks and vulnerabilities in childhood and adolescence, with the goal of determining which factors can be used as indicators for progress with cases. A sample of 102 children and adolescents supported by the child welfare system in Spain was used along with measurements based on three different points in time. The study's results indicated that there is a change in risk levels, with a general trend of decreasing risk and increasing protective elements. The study's findings identified the existence of a group of dynamic factors and another group of static factors. This study highlighted the relevance of continuous and long-term care and intervention in order to strengthen protection and decrease risks for children.

(analítico) Os factores de risco e protecção podem ser utilizados para avaliar, prevenir e intervir em casos de maustratos a crianças. O objectivo deste estudo é analisar o risco na infância e adolescência longitudinalmente, a fim de determinar que factores podem ser utilizados como indicadores de evolução. Uma amostra de 102 crianças e adolescentes participantes no sistema espanhol de bem-estar infantil foi utilizada em três pontos no tempo. Os resultados indicaram que existe uma evolução do risco, com uma tendência geral de diminuição do risco e aumento dos elementos protectores. Os nossos resultados identificaram a existência de factores dinâmicos e estáticos. Este estudo destaca a relevância dos cuidados e intervenções contínuos e a longo prazo para reforçar os factores de protecção e diminuir os factores de risco nas crianças.

Prevalência de Violência Sexual com contato e sem contato contra homens brasileiros e fatores associados a sexo forçado / Prevalence of contact and non-contact sexual violence against Brazilian men and factors associated with forced sex

RESUMO Objetivou-se estimar a prevalência da Violência Sexual (VS) contra homens brasileiros e fatores associados. Estudo transversal, que estimou a prevalência de várias formas de VS entre homens brasileiros por meio de questionário virtual. Participaram do estudo 1.241 homens de todos os estados. A maioria era jovem, entre 18 e 39 anos de idade (61,7%), heterossexual (50,2%), do Sudeste (54,4%), das classes socioeconômicas C/D/E (72,1%) e brancos (64,3%). Sobre as prevalências de VS, 70,5% afirmaram ter sofrido VS sem contato, 43,1%, VS com contato, 23,9%, VS com penetração, e 33,1%, sexo forçado. Ser bissexual, ser homossexual e ser divorciado/separado aumentaram as chances de sofrer sexo forçado. Este estudo indica que homens bissexuais e homossexuais têm mais chances de sofrer VS, corroborando outras pesquisas. Entre divorciados/separados, as chances de sofrer VS também se mostraram significativas e precisam ser mais bem exploradas. O estudo oferece a possibilidade de problematização para acolhimento de homens vítimas de VS, pensando majoritariamente na prevenção de efeitos adversos após a violência e na implantação de políticas públicas da área da saúde mais direcionadas para o público-alvo, considerando os principais fatores associados.

ABSTRACT We aimed to estimate the prevalence of sexual violence against Brazilian men and associated factors. A cross-sectional study was conducted, which estimated the prevalence of various forms of sexual violence among Brazilian men by means of a virtual questionnaire. A total of 1241 men from all Brazilian states participated in the study. Most participants were young men between 18 and 39 years (61.7%), heterosexual (50.2%), from the Southeast (54.4%), from socioeconomic classes C/D/E (72.1%), and white (64.3%). Regarding the prevalences of sexual violence, 70.5% reported non-contact sexual violence, 43.1% sexual violence with contact, 23.9% sexual violence with penetration, and 33.1% forced sex. Being bisexual homosexual, and being divorced/separated increased the odds of experiencing forced sex. This study indicates that bisexual and homosexual men are more likely to suffer sexual violence, corroborating other research. Among divorced/separated men the chances of experiencing sexual violence were also significant and need to be further explored. The study offers the possibility of problematization for the care of male victims of sexual violence, focusing mainly on the prevention of adverse effects after violence and the implementation of public policies in health that are more directed to the target audience, considering the main associated factors.

Perfil Neurocognitivo de una cohorte de menores de edad con vivencias de maltrato infantil / Neuropsychological profile of a cohort of children victims of child abuse

El maltrato infantil (MI) es un problema multidimensional. El estrés crónico producido por dicho fenómeno afecta el desarrollo cerebral de niños, niñas y adolescentes (NNA), incidiendo negativamente en la evolución de diversos aspectos del desarrollo, condicionando su vida futura. El objetivo de este estudio es analizar el desempeño sociocognitivo de NNA que han vivenciado MI, mediante el análisis de las funciones del neurodesarrollo, evaluado con subpruebas de la NEPSY II. Se analizan funciones ejecutivas y percepción social, bases del razonamiento y adaptación social. Se estudia el desempeño de 14 de NNA pertenecientes a un Programa de la Fundación Súmate, cuya Misión es la recuperación de la escolaridad NNA que han visto alterado el curso de su desarrollo por MI. Los resultados dan cuenta de alteraciones cerebrales asociadas al MI, las que se evidencian en un deficitario desarrollo funcional de las variables estudiadas. Existe grave descenso en los procesos y subprocesos del funcionamiento ejecutivo. En relación con la percepción social, la muestra estudiada presenta un mejor desarrollo, el que desciende a medida que aumenta la edad. Las funciones estudiadas tienen directa relación con el razonamiento cognitivo y desarrollo socio adaptativo, bases sobre las que se estructura el desarrollo académico. Los hallazgos, refuerzan la urgencia de abordar esta sensible realidad desde la práctica médica en la atención primaria y especializada. Los resultados también son de utilidad para orientar el desarrollo de políticas públicas que efectivamente contribuyan al progreso de nuestro país.

Abstract. Child maltreatment (MI) is a multidimensional problem. The chronic stress produced by this phenomenon affects the brain development of children and adolescents (NNA), negatively affecting the evolution of various aspects of development, conditioning their future life. The objective of this study is to analyze the sociocognitive performance of children and adolescents who have experienced IM, through the analysis of the performance of neurodevelopmental functions, evaluated through subtests of the NEPSY II. Executive functions and social perception, reasoning bases and social adaptation are studied. The performance of 14 NNA belonging to a Fundación Súmate Program is studied, whose mission is the recovery of NNA schooling that has seen the course of their development altered by IM. The results show brain alterations associated with MI, evidenced in a deficient functional development of the variables studied. There is a serious decline in the processes and threads of executive functioning. In relation to social perception, the studied sample presents a better development, which decreases as age increases. The functions studied are directly related to cognitive reasoning and socio-adaptive development, based on which academic development is structured. The findings reinforce the urgency of addressing this sensitive reality from medical practice in primary and specialized care. The results are also useful to guide the development of public policies that effectively contribute to the progress of our country.

VIOLÊNCIA FÍSICA E SEXUAL CONTRA CRIANÇAS MENORES DE CINCO ANOS NO ESTADO DO PIAUÍ / PHYSICAL AND SEXUAL VIOLENCE AGAINST CHILDREN UNDER FIVE YEARS OLD IN THE STATE OF PIAUÍ

Objetivo: analisar o perfil epidemiológico da violência física e sexual contra crianças menores de cinco anos, no Piauí, entre 2014 e 2018. Métodos e Materiais: estudo descritivo, transversal e retrospectivo, que utilizou dados secundários do Sistema de Informação de Agravos de Notificação, no período de 2014 a 2018, extraídos do site do Departamento de Informática do Sistema Único de Saúde (DATASUS). Resultados: foram registrados 406 casos de violência física e 381 de violência sexual. Crianças com idade entre um e quatro anos predominaram entre os casos de violência física (64,29%) e sexual (85,30%). Quanto ao perfil, observou-se predomínio da raça parda (70,78%) e do sexo feminino (69,89%). Os principais agressores foram a mãe, na violência física (50,0%), e amigo/conhecido da família, na violência sexual (40,51%). A residência configurou o local predominante nos casos de violência física (71,92%) e sexual (70,08%). Conclusão: a compreensão sobre a epidemiologia dos tipos de violência em crianças torna-se importante na avaliação dos programas e políticas já estabelecidas.

Objective: to analyze the epidemiological profile of physical and sexual violence against children under five years of age, in Piauí, between 2014 and 2018. Methods and Materials: descriptive, cross-sectional and retrospective study, which used secondary data from the Notifiable Diseases Information System, in the period from 2014 to 2018, extracted from the website of the Department of Informatics of the Unified Health System (DATASUS). Results: 406 cases of physical violence and 381 of sexual violence were registered. Children aged between one and four years predominated among cases of physical (64.29%) and sexual (85.30%) violence. As for the profile, there was a predominance of brown race (70.78%) and females (69.89%). The main aggressors were the mother, in physical violence (50.0%), and a friend/acquaintance of the family, in sexual violence (40.51%). Home was the predominant location in cases of physical (71.92%) and sexual (70.08%) violence. Conclusion: understanding the epidemiology of types of violence against children becomes important in evaluating established programs and policies.

Echoes of early-life stress on suicidal behavior in individuals with substance use disorder / Ecos del estrés en la vida temprana en el comportamiento suicida en personas con trastorno por uso de sustancias

Introduction: Psychoactive substances abuse is considered a problematic social factor due its likelihood to cause harmful, self-destructive behaviors to the subjects and the overall society. Stress in an individual's early life may also be a contributing factor to substance abuse as well as suicide attempts. There is a lack of studies examining these factors in people with substance-use disorder. Aim: to identify the relationship between early-life stress and suicide attempts in drug-dependent adults. Methods: This is a predictive correlational study with a cross-sectional approach. The convenience sample consisted of 105 individuals treated at an outpatient unit for addiction treatment. The participants were assessed using the Mini-international Neuropsychiatric Interview, a Childhood Trauma Questionnaire to measure the severity of the different types of early life stress; the Beck Scale for Suicide Ideation was also used. The data were analyzed using descriptive and inferential statistics through univariate and multivariate logistic regression. Results: The analyzed sample included 33 (31.4%) individuals who attempted suicide and were significantly more likely to suffer from emotional, physical, or sexual abuse than those who had never attempted suicide (p <0,05). Conclusions: Different forms of early-life stress are related to attempted suicide in people with substance-use disorder. Further studies are needed to understand the effects of early-life stress on suicide attempts in drug-dependent people.

Introducción: El abuso de sustancias psicoactivas se considera un factor social problemático cuando se producen conductas autodestructivas perjudiciales para el sujeto y la sociedad. El estrés en la vida temprana de una persona también puede ser un factor que contribuya a las situaciones de abuso de sustancias, así como a los intentos de suicidio. Hay una falta de estudios que examinen estos factores en personas con trastorno por uso de sustancias. Objetivo: Identificar la relación entre estrés en la vida temprana y los intentos de suicidio en personas adultas con trastorno por uso de sustancias. Métodos: Estudio correlacional, predictivo, transversal. La muestra de conveniencia consistió en 105 personas tratadas en una unidad ambulatoria para el tratamiento de adicciones. Las personas se evaluaron por medio de la Mini-Entrevista Neuropsiquiátrica Internacional, el Cuestionario de Trauma Infantil para medir la gravedad de los diferentes tipos de estrés en la vida temprana y la Escala de Beck para Ideación Suicida. Los datos se analizaron mediante estadística descriptiva e inferencial mediante regresión logística univariante y multivariante. Resultados: De la muestra analizada, 33 (31,4%) habían intentado suicidarse y tenían una exposición significativamente mayor al abuso emocional, físico y sexual (p<0,05) en comparación con las personas que nunca habían intentado suicidarse. Conclusiones: Diferentes formas de estrés en la vida temprana están relacionadas con el intento de suicidio en personas con trastorno por consumo de sustancias. Se necesitan más estudios para comprender los efectos del estrés en la vida temprana sobre los intentos de suicidio en una persona con dependencia.

Introdução: O uso abusivo de substâncias psicoativas é considerado um fator social problemático quando ocorrem comportamentos autodestrutivos prejudiciais ao sujeito e à sociedade. O estresse no início da vida de um indivíduo também pode ser um fator que contribui para situações de abuso de substâncias, bem como tentativas de suicídio. Há uma falta de estudos examinando esses fatores em pessoas com transtorno por uso de substâncias. Objetivo: Identificar a relação entre o estresse no início da vida e as tentativas de suicídio em adultos com transtorno de uso de substâncias. Métodos: Estudo correlacional preditivo com abordagem transversal. A amostra por conveniência foi composta por 105 indivíduos atendidos em uma unidade ambulatorial para tratamento de dependências e foi avaliada por meio do Mini-International Neuropsychiatric Interview, do Childhood Trauma Questionnaire para medir a gravidade de diferentes tipos de estresse precoce e da Escala de Beck para Ideação Suicida. Os dados foram analisados por meio de estatística descritiva e inferencial por meio de regressão logística univariada e multivariada. Resultados: Da amostra analisada, 33 (31,4%) já haviam tentado suicídio e tiveram exposição significativamente maior a abusos emocionais, físicos e sexuais (p <0,05) em comparação com os participantes que nunca tentaram suicídio. Conclusões: Diferentes formas de estresse no início da vida estão relacionadas à tentativa de suicídio em indivíduos com transtorno por uso de substâncias . Mais estudos são necessários para compreender os efeitos do estresse precoce nas tentativas de suicídio de uma pessoa com dependência.

30 años de investigación en maltrato infantil: un análisis bibliométrico (1991-2020)

Introducción: el maltrato infantil es un problema global que afecta el desarrollo de los niños y las niñas, pudiendo tener consecuencias a lo largo de su vida. A pesar de la necesidad de investigar para erradicar este fenómeno, no se ha realizado una aproximación bibliométrica de sus avances recientes. Método: este estudio examinó 16 708 artículos sobre maltrato infantil indexados en la Web of Science entre 1991 y 2020 para establecer las tendencias de investigación. Resultados: el maltrato infantil es un campo activo, influenciado principalmente por Estados Unidos, Canadá y Reino Unido, y revistas de la categoría estudios de la familia, especialmente Child Abuse & Neglect. Los artículos más relevantes abordan el tema como parte de las Experiencias Adversas en la Infancia o se centran en su evaluación. Considerando los artículos más relevantes, los temas más estudiados (sujetos, investigación, maltrato y tipos de maltrato, familia y parentalidad, y trastornos) y los principales focos (maltrato, investigación, sexo, reportes y abuso sexual), es posible que el área se esté reestructurando desde la perspectiva del ecobiodesarrollo, con énfasis en el tratamiento y la prevención. Se discuten sus implicaciones teóricas y prácticas. Conclusiones: este estudio actualiza las tendencias de investigación en el campo del maltrato infantil, proporcionando un panorama comprensivo que sugiere una evolución hacia la integración de múltiples disciplinas y enfoques. Los resultados destacan la importancia de seguir investigando este problema global, así como la necesidad de evaluar las intervenciones existentes para reducir su impacto en el desarrollo de los niños y las niñas.

Introduction: Child abuse is a global problem that affects children's development and can have consequences throughout their lives. Despite the need to research to eradicate this phenomenon, there has not been a bibliometric approach to its recent advances. Method: This study examined 16,708 articles on child abuse indexed in the Web of Science between 1991 and 2020 to establish research trends. Results: Child maltreatment is an active field, mainly influenced by the USA, Canada and the UK, and journals in the family studies category, especially Child Abuse & Neglect. The most relevant articles address the topic as part of Adverse Childhood Experiences or focus on its assessment. Considering the most relevant articles, the most studied topics (subjects, research, maltreatment and types of maltreatment, family and parenting, and disorders) and the main foci (maltreatment, research, sex, reporting, and sexual abuse), it is possible that the area is being restructured under the ecobiodevelopmental perspective, with emphasis on treatment and prevention. Its theoretical and practical implications are discussed. Conclusions: This study updates research trends in the field of child maltreatment, providing a comprehensive overview that suggests an evolution toward the integration of multiple disciplines and approaches. The results highlight the importance of further research on this global problem, as well as the need to evaluate existing interventions to reduce its impact on children's development.

Recomendações inter(nacionais) para enfrentamento a violências contra mulheres e meninas na pandemia de COVID-19 / Inter(national) recommendations to face violence against women and girls in COVID-19 pandemic

Resumo Este artigo é parte da pesquisa "As violências no contexto da COVID-19: desafios e vulnerabilidades globais", que propõe uma reflexão crítica acerca das situações de violências de gênero potencializadas pelos protocolos de distanciamento social requeridos pela pandemia de COVID-19. A partir de levantamento bibliográfico do ano de 2020, analisamos recomendações de pesquisadores e instituições de diferentes partes do mundo, com o objetivo de sistematizar e disseminar estratégias para lidar com este cenário. O material está organizado em dois eixos temáticos: políticas de gênero e ações intersetoriais; e estratégias de enfrentamento às violências contra mulheres e crianças no campo da saúde e da assistência social. As recomendações estão centradas no desenvolvimento de ações por Estados/governos, redes de atendimento e sociedade em geral. Parte das recomendações sugere aumentar ou adequar as ações de vigilância já existentes, e parte contribui com propostas criativas, norteando ações promotoras e preventivas em nível individual e coletivo. A adoção de teleatendimento, campanhas midiáticas de conscientização de que a violência é injustificável e desenvolvimento de estratégias de denúncia por meio de sinais e códigos foram reiteradas pela literatura.

Abstract This article is an integral part of the research "Violence in the context of COVID-19: global challenges and vulnerabilities", which proposes a critical reflection on situations of gender-based violence increased by social distancing protocols, required by the COVID-19 pandemic. Based on a 2020 literature survey, we have analyzed recommendations made by researchers and institutions from different countries around the world, with the aim of systematizing and disseminating strategies to deal with this scenario. The material is organized into two thematic areas, namely: gender policies and intersectoral actions; and strategies to face violence against women and children in the health and social work field. The recommendations are focused on the development of actions by States/governments, service networks and society in general. Part of the recommendations suggest increasing or adapting existing surveillance actions and part of them contribute with creative proposals, guiding promotional and preventive actions at an individual and collective level. The adoption of teleassistance, media campaigns raising awareness that violence is unjustifiable and the development of reporting strategies through signs and codes have been reiterated in the literature.

Knowledge, attitudes, and experiences of a group of turkish dentists regarding child abuse / Conocimientos, actitudes y experiencias de un grupo de dentistas turcos en relación con el abuso infantil

Child abuse is a universal problem with critical lifelong effects. This study aimed to evaluate knowledge, attitudes, experiences of dentists regarding child abuse and to increase relevant awareness of them. A self-administered questionnaire with 48 questions about dentists' personal and educational information and their level of knowledge, attitudes, experiences on child abuse was implemented. Out of targeted 305 participants, 183 (60.0%) returned completely filled out questionnaires. Majority of participants knew signs and symptoms of child abuse. Of the participants, more than half were well-informed on what to do, however, one quarter had no knowledge about where to report in case of child abuse. In identifying child abuse, 39.3% of the participants found themselves inadequate. The most commonly stated reason for low rate of reporting was hesitancy to identify the case as abuse, and all participants needed more training. Only 12 (6.6%) participants suspected a case of child abuse. Dentists who had children and were long-time experienced and generalist did not have sufficient knowledge about legal obligations, signs and symptoms of child abuse (p<0.05). Arrangements and training programs to increase knowledge, awareness, and responsibility levels of dentists about child abuse appear to be a critically important topic.

El abuso infantil es un problema universal con efectos críticos de por vida. Este estudio tuvo como objetivo evaluar el conocimiento, las actitudes y las experiencias de los dentistas con respecto el abuso infantil y aumentar la conciencia relevante sobre ellos. Se implementó un cuestionario autoadministrado con 48 preguntas sobre información personal y educativa de los odontólogos y su nivel de conocimientos, actitudes, experiencias sobre el abuso infantil. De los 305 participantes seleccionados, 183 (60.0%) devolvieron los cuestionarios completos. La mayoría de los participantes conocían los signos y síntomas del abuso infantil. De los participantes, más de la mitad estaban bien informados sobre qué hacer, sin embargo, una cuarta parte no sabía dónde denunciar en caso de abuso infantil. Al identificar el abuso infantil, el 39.3% de los participantes se encontraron inadecuados. La razón más común para la baja tasa de informes fue la vacilación para identificar el caso como abuso, y todos los participantes necesitaban más capacitación. Solo 12 (6.6%) participantes sospecharon un caso de abuso infantil. Los odontólogos que tenían hijos y eran de larga experiencia y generalistas no tenían suficiente conocimiento sobre las obligaciones legales, signos y síntomas de abuso infantil (p<0,05). Los arreglos y los programas de capacitación para aumentar los niveles de conocimiento, conciencia y responsabilidad de los dentistas sobre el abuso infantil parecen ser un tema de importancia crítica.

Physical violence against children in Espírito Santo, Brazil: prevalence and associated factors

Abstract Objective: To verify the prevalence of reported cases and the factors associated with physical violence against the child. Methods: Cross-sectional study with data from reported cases of physical violence against children from 2011 to 2018 in the state of Espírito Santo, Brazil. The characteristics of the victim, author and aggression were studied, and the associations were analyzed using Poisson regression. Results: In the period, were notified of 3,127 cases of violence against children. The frequency of physical violence was 23.6% (CI95%: 22.2-25.2), more prevalent in males; for the age group of 6 to 9 years; in rural areas; among aggressors over 20 years of age; outside the residence, and night/dawn shift. Conclusions: Physical violence affects an expressive number of children, mainly committed by adult individuals, probably being the result of an asymmetric relationship of power. Thus, it is important to highlight the need for child protection actions together with cultural and structural changes in our society.

Maternal educational practices and mental health disorders of school-age children

Abstract Objective: To investigate the association between emotional and behavioral difficulties in schoolchildren and maternal educational practices. Methods: Participants and Setting: 631 mother-child pairs were evaluated in a poor urban district in Recife, northeastern Brazil. Cross-sectional study carried out between 2013 and 2014. It integrates a prospective cohort study designed to investigate the consequences of intimate partner violence that occurred during pregnancy, postpartum, and seven years after birth for the physical and mental health of women and their children. Maternal educational practices were assessed using the Parent-Child Conflict Tactics Scale (CTSPC - mother-child version) and the child's behavioral and emotional disorders through the Strengths and Difficulties Questionnaire (SDQ) mother-version. The association was estimated through crude and adjusted prevalence ratios, using Poisson regression considering the 95% confidence interval. Results: The prevalence of violent maternal educational practices was 91.8% (572/631) being 89.7% (566/631) of psychological aggression and 75.6% of physical aggression, subdivided into corporal punishment (73.5%), physical maltreatment (35.8%) and severe physical maltreatment (1.7%). Corporal punishment (Adjusted PR 1.5; CI 95%: 1.1-2.1; p = 0.010) and severe physical maltreatment (Adjusted PR 1.9; CI 95%: 1.3-2.8; p = 0.002) were associated with emotional and behavioral difficulties in schoolchildren. Conclusion: The high prevalence of violent maternal educational practices, especially corporal punishment and severe physical maltreatment is associated with emotional and behavioral disorders in children. Therefore, it is necessary to interventions that promote parental support and effective use of non-violent discipline in conducting the educational process to establish healthier family relationships and to prevent/mitigate the impact of emotional and behavioral problems in children. © 2022 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Síndrome de niño agredido: reporte de caso / Battered child síndrome: case report

La valoración médico legal en los casos de Síndrome de niño agredido debe ser minuciosa, y abarcar todos los aspectos que indican los artículos y guías nacionales e internacionales, para tener una certeza diagnóstica, debe incluir una historia médico legal completa, examen físico detallado y estudios complementarios, así como diagnóstico diferencial. El presente artículo abarca algunos de los aspectos principales a tomar en cuenta ante la sospecha de abuso infantil, mediante la presentación y abordaje de un caso clínico.

The medical legal assessment in the cases of Attacked Child Syndrome must be thorough and cover all the aspects indicated in the articles and national and international guides, to have a diagnostic certainty, it must include a complete legal medical history, detailed physical examination and complementary studies, as well as differential diagnosis. This article covers some of the main aspects to consider when suspected of child abuse, through the presentation and approach of a clinical case.

Perfil epidemiológico dos casos de violência sexual em anápolis - goiás - brasil, nos anos 2017 a 2020 / Epidemiological profile of cases of sexual violence in anápolis - goiás - brazil, in the years 2017 to 2020 / Perfil epidemiológico de los casos de violencia sexual en anápolis - goiás - brasil, en los años 2017 a 2020

RESUMO Objetivo: identificar o perfil epidemiológico das vítimas que sofreram violência sexual, em Anápolis - Goiás - Brasil, entre os anos 2017 a 2020. Métodos: estudo descritivo de natureza quantitativa. Foram utilizados dados da ficha de notificação de violência sexual cadastrada no Departamento de Vigilância Epidemiológica. Utilizado o teste qui-quadrado com nível de significância de 5% (p<0,05). Resultados: foram notificados 850 casos, com o pico em 2020, sendo 82,1% do sexo feminino, entre a faixa etária de dois a 10 anos (42,2%), de cor parda (61,2%) e solteira (37,1%). A principal conduta realizada após violência sexual foi a coleta de sangue (21,6%); os principais agressores foram os pais (20,9%), o tipo de violência sexual principal foi estupro (68,7%) e as vítimas foram encaminhadas, principalmente, para o Conselho tutelar (48,2%). Conclusão: os resultados apontam a necessidade de se fortalecer intervenções no sentido de ampliar a rede de proteção social às crianças e adolescentes.

ABSTRACT Objective: to identify the epidemiological profile of victims who suffered sexual violence, in Anápolis - Goiás - Brazil, between the years 2017 to 2020. Methods: descriptive study of quantitative nature. Data from the notification form of sexual violence registered in the Department of Epidemiological Surveillance were used. Chi-square test was used with a significance level of 5% (p<0.05). Results: 850 cases were notified, with the peak in 2020, 82.1% were female, between the age group of two to 10 years (42.2%), brown (61.2%) and single (37.1%). The main conduct carried out after sexual violence was blood collection (21.6%); the main aggressors were the parents (20.9%), the main type of sexual violence was rape (68.7%) and the victims were mainly referred to the Guardianship Council (48.2%). Conclusion: The results point to the need to strengthen interventions to expand the social protection network for children and adolescents.

RESUMEN Objetivo: identificar el perfil epidemiológico de las víctimas que han sufrido violencia sexual, en Anápolis - Goiás - Brasil, entre los años 2017 a 2020. Método: estudio descriptivo de naturaleza cuantitativa. Se utilizaron datos de la ficha de notificación de violencia sexual registrada en el Departamento de Vigilancia Epidemiológica. Se utilizó la prueba de chi cuadrado con un nivel de significación del 5% (p<0,05). Resultados: Fueron notificados 850 casos, con el pico en 2020, siendo 82,1% mujeres, entre el grupo de edad de dos a 10 años (42,2%), morenas (61,2%) y solteras (37,1%). La principal conducta realizada después de la violencia sexual fue la extracción de sangre (21,6%); los principales agresores fueron los padres (20,9%), el principal tipo de violencia sexual fue la violación (68,7%) y las víctimas fueron encaminadas principalmente al Consejo Tutelar (48,2%). Conclusión: los resultados apuntan a la necesidad de reforzar las intervenciones para ampliar la red de protección social de niños y adolescentes.

Análisis de red del maltrato infantil e ideación suicida en adolescentes peruanos

Introducción: El maltrato infantil es considerado un importante problema de salud pública debido a su impacto perjudicial en la salud física y psicológica de los adolescentes. La exposición a diversos tipos de maltrato puede conducir a otros problemas psicológicos, incluido la ideación suicida y es necesario identificar qué tipo de maltrato evidencia mayor asociación. Objetivo: Analizar la asociación entre el maltrato infantil y la ideación suicida en adolescentes peruanos de población general. Métodos: Estudio transversal cuantitativo. Participaron 1 379 adolescentes peruanos que contestaron instrumentos sobre maltrato infantil e ideación suicida. Se estimó un modelo de red gaussiano y se calcularon sus propiedades globales y locales. Además, para la comparación de grupos, se realizó la invarianza de estructura, fuerza global y aristas. Resultados: El maltrato emocional presentó mayor asociación con la ideación suicida y maltrato físico. Además, la ideación suicida se asoció de manera directa con el maltrato sexual y en menor magnitud con el maltrato físico. La mayor centralidad en la red fue para el maltrato emocional e ideación suicida. Tanto para hombres y mujeres, el maltrato emocional fue el nodo con mayor centralidad, aunque la diferencia surge en las mujeres con la presencia de ideación suicida y en los hombres el maltrato físico. Conclusiones: Los resultados confirman la importancia de evaluar los distintos tipos de maltrato infantil en adolescentes de población general, aunque de manera específica se destaca la valoración del maltrato emocional debido a su fuerte asociación con la ideación suicida, independientemente de si son hombres o mujeres.

Introduction: Child abuse is considered an important public health problem due to its detrimental impact on physical and psychological health in adolescents. Exposure to various types of abuse can lead to other psychological problems, including suicidal ideation, which is necessary to identify which type of maltreatment evidence more association. Objective: To analyze the association between child abuse and suicidal ideation in Peruvian adolescents from general population. Methods: Cross-sectional study with a quantitative approach. A total of 1 379 Peruvian adolescents participated, answered instruments about child abuse and suicidal ideation. A Gaussian network model was estimated, calculating its global and local properties. In addition, for the comparison of groups, structure invariance, global strength and edges were performed. Results: Emotional abuse present stronger partnership with suicidal ideation and physical abuse. In addition, suicidal ideation was directly associated with sexual abuse and to a lesser extent with physical abuse. The greatest centrality in the network was for emotional abuse and suicidal ideation. For both men and women, emotional abuse was the node with the highest centrality, although the difference arises in women with the presence of suicidal ideation and in men with physical abuse. Conclusions: The results confirm the importance of assessing the various types of child abuse in adolescents in general population, although the assessment of emotional abuse is specifically highlighted due to its strong association with suicidal ideation, regardless of whether if they are male or female.

Interrupção legal da gravidez em crianças: o melhor interesse da gestante nas veredas do direito, da medicina e da ética / Legal termination of pregnancy in children in Brazil: the principle of the best interests of the child in the paths of law, medicine, and ethics / Interrupción legal del embarazo en niñas em Brasil: el principio del interés superior del niño en los caminos del derecho, la medicina y la ética

Objetivo: analisar o direito à interrupção legal da gravidez sob o marco teórico do princípio do melhor interesse da criança. Dentre os objetivos específicos, busca-se analisar a postura do Judiciário e do Ministério Público nos casos apresentados, os fundamentos jurídicos para o exercício do direito ao aborto em casos de estupro de vulnerável, os contornos teóricos do princípio do melhor interesse da criança, além de aspectos médicos, tais como a (in)existência de marco temporal para a interrupção da gravidez nos casos permitidos pela legislação, bem como a (im)possibilidade do exercício da objeção de consciência por médicos nesse contexto. Metodologia: adota-se a vertente jurídico-sociológica e a investigação jurídico-propositiva, por meio de raciocínio indutivo. Utiliza-se análise documental e bibliográfica, por meio de revisão bibliográfica qualitativa. Parte-se do marco teórico do princípio do melhor interesse da criança e do adolescente, previsto na Lei nº 8.069/1990, para testar a hipótese de que a interrupção legal da gravidez deve ser compreendida prima facie como o curso de ação que melhor se adequa ao princípio do melhor interesse da criança. Resultados: a gravidez em criança, por si só, já configura a violação de um direito fundamental. A interrupção da gestação nos casos de estupro de vulnerável é direito fundamental, garantido expressamente por lei, sem qualquer condicionante temporal ou qualitativa. Conclusão: confirmou-se a hipótese de que a interrupção legal da gravidez deve ser compreendida prima facie como o curso de ação que melhor se enquadra ao princípio do melhor interesse da criança.

Objective: to analyze the right to legal abortion within the theoretical framework of the principle of the best interests of the child. The specific objectives are to analyze the position of the Judiciary and the Prosecution in two cases, the legal basis of the right to abortion in cases of statutory rape, the theoretical framework of the principle of the best interests of the child, and medical aspects such as the (non-)existence of a time frame for abortion in legally admissible cases and the (im)possibility of the exercise of conscientious objection by physicians in this context. Methods: this paper makes use of the sociological of law and the legal-propositional research directions and follows an inductive thinking approach. Documentary and bibliographic analysis is conducted through a qualitative bibliographical review. This paper starts from the theoretical framework of the principle of the best interests of the child provided by Law No. 8.069/1990 to test the hypothesis that legal abortion is prima facie the procedure that best complies with the principle of the best interests of the child. Results: the pregnancy of a child is in itself a violation of a fundamental right. Abortion in the case of rape of a vulnerable person is a fundamental right explicitly guaranteed by law, without temporal or qualitative constraint.Conclusion: the hypothesis was confirmed, so that legal abortion should be understoodprima facieas the course of action that best corresponds to the principle of the best interests of the child.

Objetivo: analizar el derecho a la interrupción legal del embarazo bajo el marco teórico del principio del interés superior del niño. Entre los objetivos específicos buscamos analizar la posición del Poder |Judicial y del Ministerio Público en los casos presentados, los fundamentos jurídicos para el ejercicio del derecho al aborto en casos de violación de persona vulnerable, los contornos teóricos del principio del interés superior del niño, además de aspectos médicos, como la (in)existencia de un plazo para la interrupción del embarazo en los casos permitidos por la ley, así como la (im)posibilidad de objeción de conciencia por parte de los médicos en este contexto. Metodología: se adopta el aspecto jurídico-sociológico y la investigación jurídico-proposicional, a través del razonamiento inductivo. Se utiliza el análisis documental y bibliográfico, a través de una revisión bibliográfica cualitativa. Parte del marco teórico del principio del interés superior del niño y del adolescente, previsto en la Ley n. 8.069/1990, para contrastar la hipótesis de que la interrupción legal del embarazo debe entenderse prima facie como el curso de acción que mejor se adapta al principio del interés superior del niño. Resultados: el embarazo infantil, por sí solo, ya es una vulneraciónde un derecho fundamental. La interrupción del embarazo en casos de violación de una persona vulnerable es un derecho fundamental, expresamente garantizado por la ley, sin ninguna condición temporal o cualitativa. Conclusión: a partir de los casos presentados, siguiendo la metodología señalada anteriormente, se confirmó la hipótesis de que la interrupción legal del embarazo debe entenderse prima facie como el curso de acción que mejor se ajusta al principio del interés superior del niño.

Interactive effect of childhood abuse and uncertainty stress on depressive symptoms among college students / 中国学校卫生

Objective@#To understand the relationship between childhood abuse and uncertainty stress among college students and their interaction with depressive symptoms, so as to provide evidence for psychological intervention among college students.@*Methods@#A total of 1 830 college students from Xuzhou, Nanjing and Wuhan were selected by multistage stratified cluster random sampling method to conduct a questionnaire survey from March to May 2021 using Adverse Childhood Experience Scale, Uncertainty Stress Scale, and 10-Item Center for Epidemiological Studies Depression Scale.@*Results@#Overall, 361 (19.73%), 507 (27.70%) and 607 (33.17%) college students had childhood abuse experiences, high uncertainty stress and depressive symptoms respectively. After controlling for confounding factors, multivariate Logistic regression analysis showed that the risk of depressive symptoms in college students with childhood abuse experiences was 2.84 times higher than those without childhood abuse experiences ( OR= 2.84 , 95%CI =2.17-3.71). The risk of depressive symptoms among college students with high uncertainty stress was 7.88 times higher than those without high uncertainty stress ( OR=7.88, 95%CI =6.21-9.99). The results of interaction analysis showed that childhood abuse and uncertainty stress had no multiplication interaction but additive interaction on depressive symptoms of college students: RERI (95% CI )=12.73(3.24-22.23), AP (95% CI )=0.57(0.37-0.76), S (95% CI )=2.47(1.53-3.98).@*Conclusion@#High uncertainty stress and childhood abuse have additive interaction on depression symptoms of college students. Eliminating childhood abuse and scientific management of uncertainty stress can reduce the risk of depressive symptoms among college students.

Association between childhood maltreatment and the Big Five personality traits in middle school students / 中国学校卫生

Objective@#The study aimed to explore the relationship between childhood maltreatment (CM) and the Big Five personality traits of middle school students, so as to provide scientific evidence for promoting the healthy development of middle school students personality.@*Methods@#A total of 5 724 middle school students from Xuancheng, Hefei and Huaibei of Anhui Province were selected by using a multi stage stratified cluster sampling method to conduct a questionnaire survey, including demographic characteristics, CM experience and Big Five personality traits. Linear regression analysis and canonical correlation analysis were used to explore the associations between CM and the Big Five personality traits.@*Results@#Physical abuse, emotional abuse, sexual abuse, physical neglect, and emotional neglect of middle school students were significantly associated with conscientiousness ( β = -1.71 --2.55) and neuroticism ( β =1.93-3.87) personality traits( P <0.05). Except physical abuse, all other types of CM were significantly associated with extraversion ( β =-1.04--2.32) and agreeableness ( β =-1.07--1.37) personality traits( P <0.05), and only sexual abuse was associated with openness personality trait( β=-0.70, P <0.05). Except for openness personality trait, the relationship between the number of CM experience and the personality traits of middle school students was statistically significant; there was a dose response relationship between the number of CM experiences and the scores of personality traits each dimension( P < 0.05). In the canonical correlation analysis, the canonical correlation coefficient was -0.375( P <0.05). CM experiences were mainly reflected by emotional abuse, emotional neglect and physical neglect (canonical load coefficient was 0.556-0.951). The Big Five personality traits were mainly reflected by neuroticism, conscientiousness and extraversion (canonical load coefficient was -0.702 -0.639).@*Conclusion@#There is a correlation between CM and the personality traits of middle school students, and prevention of CM is of great significance for promoting the healthy development of middle school students personality.

"A vara da disciplina": discursos de religiosos em defesa de castigos físicos para a educação de crianças e adolescentes / "The rod of discipline": Religious discourses that defend physical punishment in the education of children and adolescents

A Lei Menino Bernardo (LMB) proíbe o uso dos castigos físicos e, desde sua promulgação, tem gerado resistência das alas conservadoras, especialmente religiosas, considerando-a uma intervenção do Estado nos "assuntos de família". Analisamos os discursos pró-castigos físicos disseminados na Internet, identificando seus argumentos e contextos discursivos. Examinamos 43 vídeos, que foram transcritos, e sua codificação interpares foi feita por meio do Atlas.ti, seguida de análise crítica do discurso. Reconhecendo a diversidade do "mundo evangélico" e de suas posturas políticas, identificamos discursos de lideranças conservadoras que enunciam oposição entre a "Família de Deus" e o "Estado do Demônio". O castigo físico é traduzido pelo conceito bíblico de "vara", a ser aplicado pelos pais, que são a autoridade instituída por Deus. A LMB é associada ao caos e à perda de valores cristãos; e é considerada um ato do Estado para enfraquecer a família.(AU)

La Ley Menino Bernardo prohíbe el uso de los castigos físicos y desde su promulgación ha generado resistencia de las alas conservadoras, especialmente religiosas, considerándola una intervención del Estado en los "asuntos de la familia". Analizamos los discursos pro-castigos físicos diseminados en Internet, identificando sus argumentos y contextos discursivos. Examinamos 43 videos, trascritos y su codificación interpares se realizó por medio de Atlas.ti, seguida de análisis crítico del discurso. Reconociendo la diversidad del "mundo evangélico" y de sus posturas políticas, identificamos discursos de liderazgos conservadores que enuncian la oposición entre la "Familia de Dios" x "Estado del Demonio". El castigo físico se traduce por el concepto bíblico de "vara" a ser aplicado por los padres que son la autoridad instituida por Dios. La LMP se asocia al caos, a la pérdida de valores cristianos y al acto del Estado para debilitar la familia.(AU)

The Menino Bernardo Law prohibits the use of physical punishment and, since its enactment, has generated resistance from conservatives, especially religious groups, who consider it an intervention of the State in "family matters". We analyzed pro-physical punishment discourses disseminated on the Internet, identifying their arguments and discursive contexts. Forty-three videos were examined and transcribed, and peer coding was performed using Atlas.ti, followed by critical discourse analysis. Recognizing the diversity of the "evangelical world" and its political positions, we identified conservative discourses about the opposition between the "Family of God" and the "State of the Devil". Physical punishment is translated by the biblical concept of "rod" to be applied by parents, who are the authorities instituted by God. The Menino Bernardo Law is associated with chaos, loss of Christian values, and the State's action to weaken the family.(AU)