Physical violence in children and adolescents: a retrospective study of injuries to the head and neck region

Aim: This study aimed to investigate the prevalence of physical violence and head and neck injuries among children and adolescents who suffered physical aggression, firearm aggression, and white gun aggression referred to the Legal Medical Department in a southern city in Brazil. Methods: This study was performed at Legal Medical Department in the city of Pelotas, RS, Brazil, from January 2011 to December of 2015. Data were collected from medical reports of children and adolescents (0-19 years old). Demographic information such as sex, age, and skin color was collected. Data were submitted to Chi-square test and multivariate Poisson regression analysis. Results: In this study, 2,716 physical examination reports were analyzed, with a total of 2,171 exams resulting from violence; lesions that had physical aggression as their etiology (1,951) had a higher prevalence. The analysis of the exams revealed that the majority were adolescents (90,05%), white (84.09%), and female (50.21%). The head and neck regions were affected in most cases of violence (57.90%). In the adjusted model, the occurrence of injuries in the head and neck region was higher in males (PR 1.16, CI 95% 1.08 - 1.25), among adolescents (PR 1.28, CI 95% 1.10 - 1.48) and in victims of physical aggression compared to victims of the firearm (2.81, CI 95% 1.79 - 4.40). Conclusion: The results revealed a high prevalence of head and face injuries in victims of violence and that there was a greater prevalence of physical violence among adolescents compared to children and males

Orofacial injuries in children and adolescents (2009-2013): a 5-year study in Porto, Portugal

Abstract The aim of this study was to verify the prevalence of acts of aggression to the head, face and neck towards victims of Physical Violence against Children and Adolescents (PVCA) who were examined at the National Institute of Legal Medicine and Forensic Sciences Delegation North (INMLCF-DN) in Porto, Portugal. A study was carried out on 2,148 complaints of physical aggression against children and adolescents (0 to less than 18 years old) occurred between 2009 and 2013 and which were retrieved from information about violence held on INMLCF-DN data files. Continuous variables were described and the association between them was verified by Chi-square or Fischer's Exact tests with 5% significance level. Within the 5-year timespan, 1,380 cases were identified with clinical relation with physical aggression. Most subjects evaluated were male adolescents and the most affected body region was the face, to which 747 injuries (24.7%) were recorded, with statistically significant association between sex and region (head and face). Victims in 15-17-year-old age group are more susceptible to violence than those in the 0-14-year-old age range. Dentists routinely examine the face, neck and skull, which make them the most appropriate health professionals to identify cases of aggression early.

Resumo O objetivo deste estudo foi verificar a prevalência de atos de agressão à cabeça, face e pescoço em relação às vítimas de Violência Física contra Crianças e Adolescentes (PVCA) que foram examinadas no Instituto Nacional de Medicina Legal e Delegação de Ciências Forenses Norte (INMLCF -DN) no Porto, Portugal. Um estudo foi realizado em 2.148 queixas de agressão física contra crianças e adolescentes [0 a menores de 18 anos] ocorridas entre 2009 e 2013 e que foram recuperadas de informações sobre violência mantidas em arquivos de dados do INMLCF-DN. Variáveis contínuas foram descritas para verificar a suas correlações foram usados os testes do Chi-Quadrado e o Teste Exato de Fisher em um nível de significância de 5%. Nestes 5 anos, foram detectados 1.380 casos que apresentam nexo clínico com agressão física. As vítimas mais acometidas eram adolescentes do sexo masculino, a região do corpo mais atingida foi a face com 747 das lesões (24,7%) registradas. Há significância estatística no teste do qui-quadrado de Pearson na relação de gênero com a cabeça e o rosto. Dentistas rotineiramente examinam o crânio, rosto e pescoço que os torna os profissionais mais adequados para identificar casos de agressão precoce. Os adolescentes são mais suscetíveis à violência do que as crianças menores de 12 anos.

Manejo de las lesiones vasculares en zona I del cuello. Presentación de casos / Handling vascular lesions in the zone I of the neck. Case presentation

RESUMEN Se estima que al menos del 5 al 10 % de todas las lesiones traumáticas del organismo afectan el cuello. En el 30 % de los casos se afecta alguna estructura importante de esta zona del cuerpo humano. Las estructuras vasculares aparecen lesionadas en el 20 % mientras que las estructuras aerodigestivas en un 10%. Las lesiones de la zona I por diversas razones anatómicas y los órganos que incluye son de difícil manejo. Se presentan dos pacientes con lesiones vasculares de la zona I del cuello. Se realizó una revisión del tratamiento de las lesiones traumáticas del cuello con especial énfasis en las de la zona I. Se abordan diferentes tendencias actuales en el manejo de estos pacientes (AU).

ABSTRACT It is appraised that at least 5 to 10 % of all the organism trauma lesions involve the neck. In 30 % of the cases, any main structure of this zone is hurt. Vascular structures are damaged in 20 % while airway-digestive structures are injured in 10 %. The zone I lesions are difficult to handle because of several anatomic reasons and the organs they include. The cases of two patients with vascular lesions in the neck zone I are presented. A review of the treatment of neck trauma lesions was carried out, making special emphasis on the ones in zone I. Several current tendencies in these patients handling are dealt with (AU).

Postura craneocervical como factor de riesgo en la maloclusión / Craniocervical posture as a risk factor for malocclusion

Introducción: los trastornos de la postura craneocervical han sido asociados como factores de riesgo de las enfermedades ortopédicas y, a su vez, son considerados afecciones propias, pero no existen suficientes estudios que los relacionen con la maloclusión dental. Objetivo: determinar si los trastornos de la postura craneocervical constituyen un factor de riesgo en la maloclusión de los pacientes atendidos en la Clínica Victoria de Santa Clara en el período comprendido entre octubre de 2012 y febrero de 2013. Métodos: se realizó un estudio observacional descriptivo de corte transversal donde se formaron 2 grupos, uno con pacientes con maloclusión y otro sin maloclusión, cada uno con 90 pacientes. Para determinar la prevalencia de los trastornos de la postura craneocervical, se emplearon la prueba de convergencia ocular, la prueba de rotación de la cabeza y la alteración del plano biclavicular. Resultados: en el grupo con maloclusión prevalecieron las féminas (55,55 por ciento); los principales factores identificados correspondieron a la herencia (85,55 por ciento), hábitos deformantes (63,33 por ciento), pérdida prematura de dientes (43,33 por ciento) y anormalidades de la musculatura bucal (24,44 por ciento). La prevalencia de los trastornos posturales fue del 97,77 por ciento en el grupo con maloclusión contra el 48,88 por ciento del control; tuvo una relación muy altamente significativa con la maloclusión y un odd ratio de 46,00. Conclusiones: existe un predominio del sexo femenino en el grupo de pacientes con maloclusión y una prevalencia del sexo masculino en el grupo control. Los principales factores de riesgo relacionados con la maloclusión de forma muy altamente significativa son los de mayor prevalencia. Hay predominio de los trastornos de la postura craneocervical en el grupo con maloclusión, presentando una relación muy altamente significativa con esta enfermedad, lo cual constituye un factor de riesgo que incrementa 46 veces más el riesgo de padecer de maloclusión(AU)

Introduction: craniocervical posture disorders have been viewed as risk factors for orthopedic conditions and as separate conditions themselves, but there are not sufficient studies relating them to dental malocclusion. Objective: determine whether craniocervical posture disorders constitute a risk factor for malocclusion in patients cared for at Victoria de Santa Clara clinic from October 2012 to February 2013. Methods: an cross-sectional observational descriptive study was conducted for which two groups were formed: one with patients with malocclusion and the other with patients without malocclusion. Each group was composed of 90 patients. Ocular convergence, head rotation, and biclavicular plane alteration tests were used to determine the prevalence of craniocervical posture disorders. Results: female gender prevailed in the malocclusion group (55.55 percent). The main factors identified were inheritance (85.55 percent), deforming habits (63.33 percent), premature tooth loss (43.33 percent) and oral muscle anomalies (24.44 percent). Prevalence of posture disorders was 97.77 percent in the malocclusion group vs. 48.88 percent in the control group, with a highly significant relationship to malocclusion and an odd ratio of 46.00. Conclusions: female gender prevailed in the malocclusion group, whereas male gender predominated in the control group. The most prevalent risk factors are those related to malocclusion in a highly significant manner. A predominance was found of craniocervical posture disorders in the malocclusion group, with a highly significant relationship to malocclusion, a factor increasing 46 times the risk of suffering from the condition(AU)

Domestic Violence Against Children and Adolescents: Prevalence of Physical Injuries in a Southern Brazilian Metropolis

Violence against children and adolescents is a public health issue worldwide that threatens physical and mental wellbeing and causes irreparable harm. Reports on this violence are an essential way to prevent it and to protect the children and adolescents. Thus, the objective of the present study was to evaluate the prevalence of physical injuries that occur in domestic environments and reported to the Child and Adolescent Protection Network. This retrospective study was conducted at the Epidemiology Center of the Municipality of Curitiba. A total of 10,483 reports for the years 2010 (5,112) and 2011 (5,371) were analyzed and from them were selected reports of physical injuries that occurred in the family environment. The children and adolescents were 0-17 years old, comprising 322 cases of physical abuse within the family in 2010. Out of these, 57.1% were male and 42.9% were female, and 58% (187) presented head and neck injuries. There were 342 reports in 2011, 49% were male and 51% were female; head and neck injuries corresponded to 65% (222) of the reported cases. The prevalence of injuries increased by 6% and head and neck injury increased by 19% between 2010 and 2011. It may be concluded that physical abuse is associated with a high prevalence of head and neck injury, which is easily observed by the health and education professionals. Notification organs should be created in Brazilian hospitals and health centers, which is essential to conduct epidemiological surveillance and appropriate policies.

A violência contra crianças e adolescentes é um grave problema mundial e de saúde pública, que ameaça o bem estar físico e mental, deixando sequelas irreparáveis. A notificação desta violência permite sua prevenção e proteção das crianças e adolescentes. Assim, o objetivo desse estudo foi avaliar a prevalência de lesões na região de cabeça e pescoço contra crianças e adolescentes, bem como caracterizar o tipo das lesões, o agressor e unidades notificadoras. Essa pesquisa retrospectiva foi realizada no Centro de Epidemiologia da Prefeitura Municipal de Curitiba. Um total de 10.483 notificações dos anos de 2010 (5.112) e 2011 (5.371) foi analisado, para compor a amostra das lesões físicas ocorridas no ambiente intrafamiliar, na faixa etária de 0 a 17 anos de idade. Em 2010, a frequência de abuso físico intrafamiliar foi de 322 casos. Destas, 57,1% eram do sexo masculino e 42,9% do sexo feminino, e 58% (187) delas tiveram lesões em cabeça e pescoço. No ano de 2011 foram 342 notificações, sendo que 49% eram do sexo masculino e 51% do sexo feminino e as lesões em cabeça e pescoço corresponderam a 65% (222) dos casos notificados. Houve aumento na prevalência de 6% das lesões físicas e 19% das lesões na região de cabeça e pescoço, do ano de 2010 para 2011. Conclui-se que é alta a prevalência de lesões na região de cabeça e pescoço, áreas facilmente observadas pelo profissional de saúde e da educação. A criação de órgãos notificadores em hospitais e unidades de saúde é fundamental para a vigilância epidemiológica e para definição de políticas adequadas.

Evaluación del módulo de elasticidad de materiales estéticos para la restauración de lesiones cervicales / Assessment of the elasticity module of aesthetic materials for restoration of cervical lesions

La pérdida de tejido en la zona cervical ha sido atribuida principalmente a la erosión y abrasión producidas por el cepillo de dientes. El rol de las fuerzas oclusales es un factor muy importante a tener en cuenta en el desarrollo y avance de estas lesiones cervicales no cariosas. Distinguir las diferentes propiedades mecánicas y sobre todo el módulo de elasticidad de los materiales estéticos utilizados para la restauración de este tipo de lesiones, permitirá una sobrevida mayor de las obturaciones y una gran mejoría en el tratamiento de nuestros pacientes. El objetivo de este trabajo fue evaluar el módulo de elasticidad de 6 materiales restauradores estéticos. Siguiendo la norma ISO 4049 se confeccionaron 10 probetas de cada material experimental. Se empleó el ensayo de flexión de 3 puntos con una INSTRON 4486. De la relación numérica entre los valores de tensión (T) y deformación (D), se obtuvo el módulo de elasticidad o de Young (E), para cada material experimental. El análisis de varianza mostró diferencias significativas (p < 0,0001) entre los diferentes materiales. Los compómeros flow fueron los que presentaron mejores resultados en esta condición experimental, fueron los indicados para la restauracion de lesiones de abfracción(AU)

Te loss of tissue in the cervical zone has been attributed to the erosion and abrasion provoked by toothbrush. The role of occlusal forces is a very important factor to be taken into account in the development and advance of these carious non-cervical lesions. To distinguish the different mechanical properties and mainly the elasticity module of aesthetic material used for repair of this type of lesion, will allows a great survival of the obturations and in large extent in the treatment of our patients. The aim of present paper was to assess the elasticity module of 6 esthetic restoring materials. Following the ISO 4049 rule 10 test tubes of ach experimental material. A flexion assay of 3 points with INSTRON 4486 was used. From the numerical relation among the tension values (T) and deformation (D) we obtained the elasticity or Young (E) elasticity module for each experimental material. The variance analysis showed significant differences (p < 0.0001) among the different materials. The flow compomers were those with better results in this experimental condition, being the more suitable for repair of lesions of abfraction(AU)

Tratamiento quirúrgico de fractura cervical en el Hospital Regional Rancagua: análisis de un periodo de 4 años / Surgical treatment of cervical fracture in the Rancagua Regional Hospital: analysis of a period of 4 years

Introducción: La gravedad, las implicancias neurológicas y el alto costo del tratamiento de la fractura cervical, hacen de esta lesión un tema de suma importancia. Esta injuria provoca graves limitaciones e invalidez a los afectados, en su mayoría en plena actividad laboral, impactando en lo médico, social y económico. Objetivos: Describir los pacientes tratados quirúrgicamente de fractura cervical traumática en el Hospital Regional Rancagua, por el equipo de Neurocirugía dentro de un periodo de 4 años. Materiales y Métodos: Se evaluó - 24 pacientes con antecedente de fractura cervical el mecanismo del trauma, el tiempo transcurrido desde el ingreso hospitalario hasta la cirugía, nivel y compromiso de la lesión medular, tipo de abordaje quirúrgico, complicaciones médicas, quirúrgicas y seguimiento post-operatorio, entre otros. Resultados: 5 mujeres y 19 hombres, edad promedio 39 años (rango de edad 14 a 75 años), principales mecanismos de trauma fueron los accidentes automovilísticos-atropello (58 por ciento). El nivel medular más frecuentemente lesionado fue C4-C5 (25 por ciento). En el 50 por ciento de los pacientes se clasificó de entrada como Frankel A, por lo que un 50 por ciento de todos los pacientes ingresaron tetrapléjicos, y de estos, un 33 por ciento egresó tetraparéticos. Del ingreso a cirugía hubo un tiempo de espera promedio 5 días. Dentro de las complicaciones médicas la causa respiratoria (46 por ciento) fue la más frecuente, necesitando 64 por ciento de estos pacientes ventilación mecánica. Se registró 1 infección de herida operatoria donde el abordaje fue posterior. El Índice de Barthel promedio de 14 pacientes fue de 49 puntos. De 6 pacientes con puntaje Cero, 85 por ciento de estos ingresaron como Frankel A y 50 por ciento egresaron tetrapléjicos. Los pacientes se rehabilitaron en promedio de 2.5 meses. Discusión: Logramos objetivar nuestra realidad. La técnica quirúrgica fue prácticamente uniforme entre los pacientes, sin complicaciones...

Introduction: Gravity, neurological implications and high costs of treating cervical fracture, makes of this injury an issue of most importance. This injury causes severe limitations and disability to those affected, mostly in full working activity, impacting on the medical, social and economic. Objectives: To describe patients surgically treated for traumatic cervical fracture at the Rancagua Regional Hospital, by the team of Neurosurgery Department, within a period of 4 years. Materials and Methods: We evaluated 24 patients with an history of cervical fracture mechanism of trauma, the time from hospital admission to surgery, and commitment level of spinal cord injury, type of surgery, medical and surgical complications and follow-up post -operation, among others. Results: 5 women and 19 men, average age 39 years (ranging age from 14 to 75 years), major trauma mechanisms were motor vehicle accidents (58 percent). The most frequently injured spinal level was C4-C5 (25 percent). 50 percent of patients were classified as Frankel A at the admission, so that 50 percent of all patients admitted were quadriplegics, and of these, 33 percent were discharged as tetraparétic. Admission to the surgery were an average of 5 days. Within cause respiratory medical complications (46 percent) was the most frequent, requiring 64 percent of these patients mechanical ventilation. There was only 1 wound infection where the approach was posterior. The average Barthel Index of 14 patients was 49 points. In 6 patients with zero score, 85 percent were admitted as Frankel A and 50 percent egressed as tetraplejic. Patients were rehabilitated an average of 2.5 months. Conclusions: We were able to objectify our reality. The surgical technique was nearly uniform among patients without severe postoperative surgical complications...

Childhood trauma profile at a tertiary care hospital in India.

Childhood injuries are the leading cause of morbidity and mortality worldwide. We evaluated the type of pediatric injuries encountered in the emergency room amongst 225 children (boys 151, girls 64; age range, 2 mo-12 yr). Data were collected using a structured injury proforma over a period of 12 months. Injuries occurred at home (n=137, 60.8%), street (n=38, 16.8%), and playground (n=37, 16.4%). Most frequent injuries were falls (n=144, 64%) and road traffic injuries (RTI) (n=37, 16.4%). Injuries mostly consisted of fractures (n=72, 32%), bruises (n=39, 17.3%), and lacerations (n=35, 15.5%). Child abuse was recognized in 7 (3.5%) children. There was an average delay of 2 hour 50 minutes to reach the medical facility.

Incidence of typical and atypical hanging among 66 hanging cases.

Present Study conducted prospectively to find out the position of knot in the neck in all hanging cases coming for post mortem examination at Mymensingh Medical College Mortuary in the year 2005. Hanging is a process in which the body is suspended with a ligature around the neck, which causes constriction of air passage preventing exchange of air between atmosphere & alveoli of lungs, leading to asphyxia & death. The constriction force is either the weight of the whole body or the weight of the head alone. A weight of 2Kg is sufficient for death in hanging. According to position of knot hanging is of two types-Typical hanging and Atypical hanging. In typical hanging the knot of the ligature should be at the nape of the neck and the knot of the ligature at any site other than the nape of the neck is Atypical hanging. A total of 557 postmortems were conducted in the year 2005 out of which 66 cases were of hanging. Among these, 66 cases (100%) position of knot on neck were on center of occiput (Typical hanging) in 14 cases (21.21%), on right side in 17 cases (25.75%), on left side in 21 cases (31.81%) and on front of neck in 14 cases (21.21%). Total of 52 cases are of Atypical hanging. This study suggests that Atypical hanging is more common (78.78%) than Typical hanging (21.21%) and more on left side of the neck (31.81%). Study at S.P. Medical College and A.G Hospitals, Bikaner in 2004 shows that out of 390 cases 35 (8.97%) were of hanging. Amongst those 35 cases in 33 cases position of knot on nape of the neck in 5 cases (15.15%), right side of neck 15 cases (45.45%), left side of neck in 11 cases (33.33%) and front of the neck 2 cases (6%). In their study, Typical hanging was found in 15.15% and Atypical hanging was in 84.85%; and Maximum on right side of the neck i.e. 45.45%. In both the studies Atypical hanging was more common but Maximum was on right side in their study and We found maximum on left side.

Abuso e negligência: estudo na delegacia de repressão aos crimes contra a criança e o adolescente / Child abuse and neglect: assessment in a child and adolescent protective police department

A incidência de casos de maus-tratos infantis vem aumentando a cada ano. Este estudo objetivou avaliar os registros de ocorrência realizados durante o primeiro trimestre do ano 2000, na Delegacia de Repressão aos Crimes contra a Criança e o Adolescente (DERCA, Salvador, BA). Uma amostra de 414 ocorrências foi examinada, sendo 377 incluídas. Dados físicos e demográficos foram utilizados. Participaram deste estudo crianças entre 0-18 anos (12,65 ± 4,10), de ambos os sexos (59,9 por cento meninas; 40,1 por cento meninos). Foi utilizado o programa EPI-INFO 6.04 a fim de determinar diferenças significantes (p < 0,05). Todos os tipos de abuso mostraram-se mais freqüentes em meninas e no subgrupo de 11-15 anos. O abuso físico foi o mais encontrado (50,7 por cento), seguido de psicológico (20,2 por cento), sexual (18,0 por cento), abuso físico/psicológico (7,7 por cento) e negligência (3,4 por cento). A maioria dos agressores era do sexo masculino (76,6 por cento). Na faixa etária de 0-10 anos, os pais e vizinhos foram os principais responsáveis por maus-tratos. Do total de lesões, 72,73 por cento envolviam a região de cabeça e pescoço. Foi encontrada uma correlação positiva entre sexo (feminino) e abusos físico e sexual (x² = 12,79, p < 0,05; x² = 42,10, p < 0,05). A violência física contra meninos mostrou-se mais intensa, o que pode ser notado pela maior ocorrência de lesões (x² = 12,54; p < 0,05), inclusive lesões de cabeça e pescoço (x² = 9,25; p < 0,05). Os profissionais de saúde devem habilitar-se para o reconhecimento, documentação e denúncia de maus-tratos contra menores, bem como sensibilizar a comunidade a fim de reduzir a incidência e o impacto da violência contra crianças e adolescentes

Estudio descriptivo sobre ataques y mordeduras de animales en el Município de San Juan, Puerto Rico, 1996-1998 / Descriptive study of animal attacks and bites in the municipality of San Juan, Puerto Rico, 1996-1998

The present study described the frequency of animal bites and attacks in the municipality of San Juan, Puerto Rico between the fiscal years 1996 through 1998. A total of 275 cases were reported to the San Juan Local Office of Environmental Health. The distribution of cases by gender was equal, and persons aged 18 years or older had the highest frequency of animal bites and attacks (52.9 percent). The animal species reported to be involved in the majority of animal bites was the dog (81.1 percent). Upper extremities were involved in 43 percent of these injuries. Animal bites caused by dogs were more often reported among male victims (87.4 percent) (p = 0.031). Approximately 41 percent of dog bites and attacks and 75 percent of bites and attacks caused by other animal species were documented as provoked (p = 0.002). More than 75 percent of the injuries in the head, face or neck involved children < 13 years whereas 65.9 percent of the injuries in the upper extremities involved adults (> 18 years) (p = 0.001). Animal bites and attacks in the upper extremities were more prominent among injuries caused by an animal species different to the dog (71 percent) (p < 0.001). We conclude that animal bites and attacks is a public health concern in light of the increasing pet population. Therefore, educational strategies towards the general population must stress careful supervision of the human-animal interaction as well as the general procedures to follow in case of an injury.

Trauma de Cuello / Neck Trauma

El trauma de esta estructura representa del 5 al 10 por ciento de todos los traumas. La diversidad de lesiones en un área tan pequeña y sus diferentes manejos llevaron a una alta tasa de exploraciones en blanco creando controversia entre el manejo quirúrgico mandatoio y el manejo selectivo. La tendencia actual es que en paciente asintomáticos con heridas en la zona II, el examen físico es seguro para descartar lesiones graves, proponiéndose por esta razón el manejo individualizado. Al colocar en práctica la experiencia militar en la práctica civil se encontraon altos índices de exploraciones en blanco (69-84 por ciento), desarrollándose estudios de manejo selectivo que disminuyeron el número de exploraciones negativas y los costos sin variar la morbimortalidad. La clasificación de Monson y Saletta de las zonas de cuello tiene la importancia clínica de seleccionar a los paicentes según sus posibles lesiones y su estudio. Los mecanismos del trauma se clasifican en penetrante y no penetrante; el primero sucede cuando la lesión atraviesa el plano profundo del músculo cutáneo o platisma del cuello y el segundo mecanismo es producido por procesos de aceleración y desaceleración en accidentes de transito, contusiones, ahorcadura. El manejo del paciente comprende el manejo adecuado de la vía aérea, la inmovilización del cuello y el control por compresión del sangrado buscando disminuir el tiempo de traslado a un centro especializado dentro de los primeros 60 minutos siguientes al trauma; se debe evaluar el mecanismo de lesión, trayecto de la herida, estado general, pérdida de sangre y descartar o confirmar otras lesiones concomitantes realizando una adecuada evaluación de la vía aérea así como del compromiso vascular, neurológico y del tracto digestivo