Early childhood maltreatment experience and later sexual behavior in Brazilian adults undergoing treatment for substance dependence

Objective: To investigate the prevalence of early childhood maltreatment and associations with later sexual behavior among adult substance users. Methods: A cross-sectional study enrolled 134 substance dependents who sought outpatient care in São Paulo, Brazil. Childhood trauma prevalence was assessed using the Childhood Trauma Questionnaire (CTQ). The Sexual Addiction Screening Test (SAST), drug of choice (DOC), and sexual behavior were also investigated. Results: The sample was composed predominantly of single adult males (76.1%), with alcohol as the DOC (73.9%). Experiences of emotional neglect (88.1%), emotional abuse (80.6%), physical neglect (78.4%), physical abuse (64.2%), and sexual abuse (31.3%) were prevalent. Women were more likely to have been sexually abused (OR 2.9, 95%CI 1.15-7.61) and physically abused (OR 3.7, 95%CI 1.31-10.6) in childhood. Those who were sexually abused in adulthood were more likely to have suffered physical abuse in childhood (OR 6.9, 95%CI 1.45-11.8). The odds of having been sexually abused in childhood were higher among subjects who reported to have exchanged sexual favors for drugs (OR 5.7, 95%CI 1.35-9.64) and to have been sexually abused in adulthood (OR 6.1, 95%CI 5.2-12.36). Conclusion: Physical and sexual abuse in childhood are highly prevalent in substance-dependent adults, and are associated with sexual revictimization and high-risk sexual behavior in adulthood.

Telomere length and childhood trauma in Colombians with depressive symptoms

Objective: Childhood trauma and telomere length (TL) are important risk factors for major depressive disorder. We examined whether there was an association between childhood trauma and TL in a sample of Colombians who were assessed for depressive symptoms. Methods: We applied the Center for Epidemiologic Studies Depression scale, the Patient Health Questionnaire-9, the Hospital Anxiety and Depression scale and the Childhood Trauma Questionnaire to 92 Colombian subjects (mean age = 21). TL was measured with quantitative PCR. Spearman's correlation coefficient (rs) was used to analyze the relationship between childhood trauma scores and TL. Results: We found a significant correlation between TL and sexual abuse scores (rs = 0.428, p = 0.002) in individuals with higher depressive symptom scores. Conclusion: This is the first report of a significant association between TL and sexual abuse in a Latin American sample and provides additional evidence about the role of childhood trauma and TL in neuropsychiatric disorders.

Maus-tratos infantis: um olhar sobre a omissão de pais na atenção à saúde bucal dos seus filhos / Child abuse: a look at parent’s omission in attention to the oral health care of their children

Os maus-tratos geralmente acontecem com indivíduos que estejam em condição de autonomia limitada ou que essa autonomia ainda não esteja totalmente estabelecida, como as crianças. Esse tipo de violência pode ser classificada como física, à saúde, privação de alimentação ou de cuidados necessários, trabalho excessivo ou meios disciplinares abusivos. Objetivo: O presente estudo teve como objetivo analisar a omissão de cuidados dos pais/responsáveis como forma de maus-tratos infantis. Relato de Caso: Três crianças foram examinadas clinicamente pela equipe de saúde bucal de uma Unidade Básica de Saúde e, durante a avaliação odontológica, foi observado que as criançasapresentavam quadro álgico, múltiplas lesões de cáries e placa generalizada. Quando questionados,todos os responsáveis negaram o fato de que a condição de saúde bucal de suas crianças foinegligenciada e desconheciam as sanções legais que poderiam sofrer devido à situação de maus-tratosque foi configurada. Conclusão: O quadro de maus-tratos com relação à negligência da saúde bucal estádiretamente relacionado à importância atribuída à primeira dentição da criança. Para evitar esse tipo deocorrência, é necessário que haja a conscientização de pais e responsáveis quanto à relevância da saúdee higiene oral para a prevenção de doenças bucais. Além disso, é fundamental que os responsáveissejam informados das penalidades que lhes podem ser aplicadas caso se configure, por meio deevidências, o quadro de maus-tratos.

Abuse usually happens to individuals who are on limited autonomy status or that this autonomyis not yet fully established, such as children. This type of violence can be classified as physical,related to health, food or necessary care deprivation, overwork or abusive disciplinarymeasures. This study aimed to analyze the omission of care of parents / guardians as a form ofchild abuse. Case Report: Three children were clinically examined by the oral health team of a Basic Health Unit and, during the dental evaluation, it was observed that children had painsymptoms, multiple cavities and general board and generalized plaque. When questioned, allparents / guardians denied the fact that the condition of oral health of their children had beenneglected and lacked knowledge of any legal sanction that could suffer due to the abuseconfigured. Conclusion: The mistreatment regarding oral health negligence is directly related tothe importance attached to child's first teeth. To avoid this type of occurrence, parents /guardians need to be aware of the importance of health and oral hygiene to prevent oraldiseases. Moreover, they must be informed of the penalties that may be applied to them if,through evidence, the condition of child abuse is set.

Characteristics of abuse in children: a prospective medico-legal study in Menoufia university hospital during the year 2009

Child abuse is a serious worldwide problem and can be difficult to detect. This work aimed at screening and evaluating the medico-legal aspects of child physical and sexual abuse cases received at Menoufia University Hospital asking for medico-legal report during one year [2009]. The present study was carried out on child abuse cases that came with one of their care taker to issue a medicolegal report in claim for others. Claims were for physical or sex abuse. Physical abuse [130 cases] was represented by 73.1% for males and 26.9% for females. Most of the cases [73.1%] wee in the age group >12-<18 years old, while 22.3% were between 6-12 years old and 4.6% were below 6 years old. Bruises represented the highest percent 26.2% while stab wound was the least [1.5%]. More statistical evaluation of the data showed that there were no significant differences between females and males regarding different age groups, type and site of injury and instrument used. Mean while females were significantly highly exposed to head and neck injuries in age group < 12 years than in females > 12 years old. At the same time females were significantly submitted to head and neck injuries than males in the age group < 12 years and to mixed sites injuries in the age group >12 years. Assailants were mainly one of the parents [70.8%] then relatives [16.9%] and stranger [12.3%]. Sexually abused children [5 cases] were mainly < 6 years [80%] and those of the age group > 6-12 were 20%. Males were 40% of the cases while females were 60%. General examination was negative in 60% of cases, while abrasions and scratches were equally represented with 20% for each. Local examination was negative in 40% of cases, while 40% showed dilatation of the anal sphincter in one male and in one female. One female case [20%] showed severe tear in the perineum and posterior commissure. Offenders of the sex abuse children were mainly relatives [80%] and only 20% a stranger [nonrelatives] that could be known to the child. The study throws light on the magnitude of the child abuse problem in the society and the importance of multi disciplinary study by different specialties. More evaluation is needed and pediatricians, orthopedists and family physicians should be oriented of the possible mimics of the child lesions that raise the suspicions for child abuse and reporting for them. Media and teaching programs should stress on the problem and its deleterious results onto the child health and futures and for the community on the instant and on the long run

Maltrato Infantil: una realidad muy cercana, ¿cómo debemos actuar los odontólogos? / Child Abuse: a reality so close, how do we proceed dentists?

El maltrato y el abandono de los niños y adolescentes es un problema social en aumento que no se limita a las profesiones legales o de servicio social, sino también a la odontología. El objetivo de la presente revisión es brindar la información actual sobre maltrato infantil y al mismo tiempo orientar al odontólogo a detectar, documentar, informar y ayudar a tratar a niños, adolescentes y sus familias que presenten este problema y poder prevenir episodios de maltrato.

Child abuse and neglect of children and adolescent is a growing social problem not limited to the legal prefession or social service, but also dentistry. The objective of this review is to provide current informaction on child abuse and at the same time guide the dentist to identify, document, report and help treat children and adolescents and their families that are experiencing this problem and to prevent episodes of abuse.

Violência contra crianças na cidade de Ribeirão Preto, São Paulo, Brasil: a prevalência dos maus-tratos calculada com base em informações do setor educacional / Violence against children in the city of Ribeirão Preto, São Paulo State, Brazil: child abuse prevalence estimated from school system data

Os números oficiais dos maus-tratos infantis não correspondem à realidade, pois muitos casos não são notificados. No presente estudo, buscou-se estimar a prevalência em crianças de 0 a 10 anos matriculadas em estabelecimentos educacionais da rede pública e particular da cidade, com base em informações obtidas junto aos educadores/professores, partindo do pressuposto de que eles estão bem posicionados para identificá-los, e comparar essa prevalência com a oficial. O instrumento utilizado foi a Cartilha Epidemiológica e a amostra, aleatória e representativa, composta por 305 professores, responsáveis por 6.907 crianças. A prevalência obtida, de 5,7 por cento, contra 0,3 por cento calculada com os dados dos Conselhos Tutelares, corroborou a hipótese de que a oficial representa tão somente a ponta do iceberg. As modalidades mais freqüentemente identificadas, tanto nos estabelecimentos públicos quanto nos particulares, foram as negligências e os abusos psicológicos, às quais geralmente se dá menor importância, por serem consideradas menos graves. Denotou-se, contudo, um agravamento das problemáticas ao longo das idades, indicando a importância de um trabalho em rede, para a detecção, notificação e intervenção precoce nessas situações, na lógica da prevenção secundária.

The official statistics on child abuse fail to reflect reality, since many cases are not reported. The current study aimed to estimate the real prevalence of child abuse in children 0 to 10 years of age enrolled in public and private daycare centers and schools in the city, using information obtained from teachers and staff, based on the premise that they are well-positioned to identify cases, and then to compare this estimated prevalence to the official rate. The instrument used was the Epidemiological Manual, and the random, representative sample consisted of 305 teachers, responsible for 6,907 children. The resulting prevalence was 5.7 percent, compared to 0.3 percent as calculated by data from the Tutorial Councils, thus corroborating the hypothesis that the official rate merely represents the tip of the iceberg. The most frequent forms of abuse identified by both the public and private schools were neglect and psychological abuse, generally considered less important, since they are viewed as less serious. The problems were also shown to become worse as the children grew older, indicating the importance of network collaboration for detection, notification, and early intervention in such situations, under the logic of secondary prevention.

Análise de fraturas diafisárias do fêmur em crianças menores de 3 anos de idade / Femoral shaft fractures: an assessment in children younger than 3 years old

Este estudo consiste na reavaliação ortopédica e psicossocial de crianças que sofreram fratura do fêmur até a idade dos três anos e objetiva a análise de suas causas prováveis e detecção de indícios de ocorrência de Síndrome de Maus Tratos. Trinta e cinco crianças menores de três anos de idade sofreram fratura diafisária de fêmur e foram atendidas no Pronto Socorro do Serviço de Ortopedia e Traumatologia da Santa Casa de São Paulo, no período de janeiro de 1996 a agosto de 2002, sendo que 18 compareceram para reavaliação. Como causa relatada das fraturas observamos: queda em 13 (72,2 por cento) casos, queda de objetos sobre o membro em três (16,7 por cento) e fratura no parto em dois (11,1 por cento). Constatamos suspeita de Síndrome dos Maus Tratos em nove (maus tratos físicos em seis [33,3 por cento] e negligência em três [16,7 por cento]) casos, fratura patológica em quatro (22,2 por cento), causa acidental em três (16,7 por cento), e outras causas em dois (11,1 por cento) casos. Maus tratos constituem uma importante causa a ser investigada nos casos de fratura do fêmur em crianças com menos de três anos de idade, sendo o provável mecanismo responsável por metade das fraturas aqui estudadas.

This study consists of an orthopaedic and psychosocial re-evaluation of children who experienced femur fractures as young as 3 years old and aims to analyze potential causes and detect Child Abuse rates. Thirty-five children under the age of three years who experienced femoral shaft fractures received care at the Emergency Department of the Orthopaedics and Traumatology Service of Santa Casa de São Paulo within the period ranging from January, 1996 to August, 2002. Eighteen patients returned to the hospital for re-evaluation. The reported causes for fractures were: fall in 13 cases (72.2 percent), object fall on the limb in 2 cases (11.1 percent). Child abuse was suspected in 9 cases (physical abuse in 6 cases (33.3 percent), negligence in 3 cases (16.7 percent), pathological fracture in 4 cases (22.2 percent), accidental causes in 3 cases (16.7 percent), and other causes in 2 cases (11.1 percent). Child abuse constitutes an important cause that needs to be investigated in cases of femur fracture in children under the age of three years and this has possibly been the mechanism responsible for half of the fractures investigated in the current study.

Generación de ingresos / Generation of income

El documento aporta información valiosa para prevenir el reclutamiento de niños, niñas y adolescentes explotados sexualmente, asi como la protección y restitución de derechos a las víctimas en la Triple Frontera y otras partes del mundo

Síndrome del bebé sacudido (SBS) / Syndrome of drinks shaken

El Síndrome del Bebé Sacudido (SBS) es una patología que plantea dificultades para su diagnóstico correcto y seguro. El subdiagnóstico y el subregistro son habituales. Presentamos dos casos de SBS en su forma clínica clásica que tuvieron los signos característicos: lactantes sanos hasta el momento de la consulta, que bruscamente presentaron un cuadro neurológico agudo, severo y polimorfo asociado a hemorragias intracraneales e intraoculares. Se recomiendan los procedimientos y estudios para arribar al diagnóstico en forma concluyente y aplicar un tratamiento adecuado

Diagnosis and evaluation of child maltreatment

This study was done to evaluate the child maltreatment [abuse]problem in Sammalot and to identify the underlying high risk factors. It was carried out on 80 subjects all of them were victims of child abuse from Sammalot General Hospital. They were diagnosed to be abused from the detailed history and medical examination. It was found that, the high risk age group for family victimization was those below the age of 5 years. The most common type of child abuse was the physical and there was no significant difference between the number of male and female victims. The high risk factors studied showed that, non living with the parents, non educated families, poverty and substance abuse were time strongest predictors for injury from child abuse. This study concluded that child abuse is a world wide phenomenon that interfere with the child's normal social, cogmitiveand spiritual development and elimination of its risk factors help in facing this problem in our society

Papel del odontólogo en la detección y prevención del maltrato infantil / Dentistïs role in detecting and preventing child abuse

En este artículo se presenta una revisión de la literatura con respecto al tema del maltrato infantil, abordado desde un punto de vista general y odontológico, en el cual se resalta el papel del odontólogo en la detección del maltrato en la consulta clínica. Primero se hace una reseña histórica, destacando los aspectos culturales del maltrato; luego se encuentra la definición y clasificación del maltrato infantil, haciendo énfasis en el maltrato físico y la forma como el odontólogo es una ficha clave en la detección de las lesiones, se retoman datos de la epidemiología del maltrato, y por último se recalca el papel del odontólogo forense en los casos donde se sospeche maltrato en un menor. Este artículo pretende sensibilizar a los odontólogos para que estén alerta a cualquier signo que presente sospecha de síndrome de maltrato infantil

Normas y procedimientos para la atención de la violencia intrafamiliar / Norms and procedures for the attention of violence intrafamiliar

El documento "Normas y Procedimientos para la Atención de la Violencia Intrafamiliar" es una herramienta básica que propociona el Ministerio de Salud a los trabajadores de la salud que trabajan en la Atencion de las personas afectadas por la violencia Intrafamiliar, dichas normas son una guía indespensable, para que el personal de salud disponga de los elementos necesarios para la detectar con destreza la detección, prevención, atención y rehabilitación de las victimas de la violencia

Maltrato infantil / Child abuse

El maltrato infantil (MI) es un hecho conocido desde la antiguedad, sin embargo sólo en los últimos años se ha tomado real conciencia de éste como una patología de la infancia. En 1962 el tópico de maltrato infantil (MI) ganó la atención médica debido a la publicación del "Síndrome del niño golpeado" de Henry Kempe y cols. cuando por primera vez se conoció como una patología con todos sus aspectos físicos, radiológicos e implicancias legales. Chile, por su parte, se adscribe a los derechos del niño y, por ende, cualquier violación a estos derechos es considerado un maltrato. Desde ese momento se establece la obligación de proteger al niño. El pediatra a través de su labor tanto ambulatoria como hospitalaria tiene la posibilidad y el deber de proteger a los niños. Hacer el diagnóstico de MI es tan crucial como el de cualquier otra patología ya que una intervención oportuna puede prevenir catastróficas consecuencias

Maltrato al menor: una urgencia médica y social que requiere atención multidisciplinaria / Child abuse: a medico-social emergency

El fenómeno de maltrato infantil, en cualquiera de sus formas clínicas, habitualmente es considerado como una urgencia cuando la vida del menor está en inminente peligro o cuando ha sucedido una agresión sexual muy escandalosa. Sin embargo, existen claros ejemplos de que la urgencia también radica en el hecho de considerar rápidamente la certeza del diagnóstico, las complicaciones médico-quirúrgicas que la agresión inflingida puede generar, la situación de estrés permanente que estos niños y algunos de sus familiares viven, la condición legal del menor y del agresor así como el conocer a la brevedad ciertos aspectos sociales que giran alrededor de cada paciente para poder establecer fehacientemente un diagnóstico de certeza. El objetivo de este ensayo es señalar algunos aspectos médicos, sociales y jurídicos que permiten considerar cada caso de maltrato infantil como una verdadera urgencia médico-social

El maltrato infantil: un problema mundial / Child abuse: A worldwide problem

Al abordar el maltrato infantil se presentan diversos problemas: desconocimiento de la verdadera proporción de dicha problemática; raíces culturales e históricas profundas; diversidad de opiniones en cuanto a su definición y clasificación; dificultades en la investigación y, finalmente, una diversidad de consideraciones sobre sus repercusiones y su manejo terapéutico. En el presente artículo se estudia el maltrato infantil desde sus antecedentes históricos, así como sus clasificaciones, sus definiciones y su epidemiología. Asimismo, se revisan las repercusiones y se plantean las alternativas de tratamiento que en la bibliografía existente se han manejado como fundamentales para enfrentar este fenómeno cada vez más alarmante. Queda subrayada la necesidad de unificar criterios en cuanto a la definición y clasificación de información científica en torno a datos demográficos que, finalmente, hablarán de la realidad del problema, de los avances relacionados con sus causas, su diagnóstico, sus medidas preventivas y su tratamiento. Es fundamental utilizar medidas tendientes a prevenir el maltrato, pues una gran parte de los problemas en el niño se ven reflejados en la vida adulta. Se comparan las distintas clasificaciones en torno al tema, así como las características tanto del agredido como del agresor en los distintos tipos de maltrato

Síndrome da criança negligenciada: considerações gerais e apresentação de caso / Neglected child's syndrome: general considerations and case report

O autor apresenta uma revisão da patologia traumática forense da criança, aqui abordada sob a denominação de síndrome da criança agradida, englobando seis formas distintas de agressão imposta à criança, pelos pais ou tutores. No tocante à síndrome da criança negligenciada, apresenta uma caso e discute seus principais aspectos.

Nino Maltratado / Child abuse

Se presentan 200 ninos maltratados que acuden al Hospital Pediatrico Docente "Juan Manuel Marquez" en el periodo comprendido de diciembre de 1990 a enero de 1992; estos fueron seleccionados teniendo en cuenta los criterios de maltrato, y era el objetivo fundamental del estudio conocer como se comporta en nuestro medio. En los resultados se muestra que la forma mas frecuente fue el tipo no intencional; la ingestion de toxicos fue la forma de negligencia fisica mas frecuente dentro del maltrato no intencional, esta es mas usual en los ninos menores de 5 anos; los trastornos psiquiatricos y el alcoholismo son favorecedores del maltrato intencional, la madre es la que mas maltrata; la mortalidad por esta causa no fue elevada (5 fallecidos) y los criterios de riesgo de maltrato tienen utilidad para su identificacion

Atención integral de salud al menor de 5 años / Comprehensive care of health in minors of five years: educative module

El objetivo general del presente módulo es el de contribuir al desarrollo del Programa de atención al menor de cinco años, proporcionando al personal de salud, un marco referencial de los diferentes componenetes del programa que le permitan y motiven a brindar una atención integral a este grupo etáreo