Uso de internet e de jogos eletrônicos entre adolescentes em situação de vulnerabilidade social / El uso de internet y electrónicos juegos por los adolescentes en alto riesgo social

O domínio de ferramentas digitais pode ser importante via de inclusão social. O presente estudo visou investigar o uso que 60 adolescentes em situação de vulnerabilidade social, participantes das atividades do Projeto Quixote, fazem da internet e de jogos eletrônicos. Procurou-se caracterizar tipo de atividade, frequência, duração, companhia, local, finalidade do uso de internet e de jogos eletrônicos, incluindo dificuldades encontradas no manejo da rede. A maioria dos adolescentes entrevistados está na escola, usa internet e jogos eletrônicos, interagindo com amigos e familiares, principalmente para comunicação e entretenimento. Os participantes relataram que aprenderam a usar sozinhos e que sabem de riscos associados a essas práticas. Entretanto, os resultados mostram que eles se expõem a condutas de risco. Diferenças de gênero foram observadas. Discute-se a necessidade de capacitar pais e educadores para estimular uso que desenvolva competências visando inclusão social assim como a importância de acompanhar o uso para prevenir prática inadequada ou excessiva.(AU)

Manejo de herramientas digitales puede ser importante medio de inclusión social. El objetivo de este estudio fue investigar el uso de Internet y de los juegos electrónicos por 60 adolescentes en alto riesgo social, participantes en las actividades llevadas a cabo por el Projeto Quixote. Hemos tratado de caracterizar el tipo de actividad, la frecuencia, la duración, la compañía, la ubicación y la finalidad del uso de internet y juegos electrónicos, así como las dificultades encontradas en la gestión de la web. La mayoría de los adolescentes entrevistados estaban matriculados en la escuela, utilizan internet y juegos electrónicos para interactuar con amigos y familiares, sobre todo para la comunicación y el entretenimiento. Los adolescentes informaron que aprendieron a utilizar estos dispositivos por sí mismos y que conocían los riesgos asociados con estas prácticas. Sin embargo, los resultados muestran que se habían expuesto a diversos riesgos. Diferencias de género fueran observadas. Se discute la importancia de empoderar a los padres y educadores a desarrollar habilidades orientadas a la inclusión social así como de hacer el seguimiento del uso para prevenir la práctica inadecuada o excesiva.(AU)

Uso de internet e de jogos eletrônicos entre adolescentes em situação de vulnerabilidade social / El uso de internet y electrónicos juegos por los adolescentes en alto riesgo social / Use of internet and electronic games by adolescents at high social risk

O domínio de ferramentas digitais pode ser importante via de inclusão social. O presente estudo visou investigar o uso que 60 adolescentes em situação de vulnerabilidade social, participantes das atividades do Projeto Quixote, fazem da internet e de jogos eletrônicos. Procurou-se caracterizar tipo de atividade, frequência, duração, companhia, local, finalidade do uso de internet e de jogos eletrônicos, incluindo dificuldades encontradas no manejo da rede. A maioria dos adolescentes entrevistados está na escola, usa internet e jogos eletrônicos, interagindo com amigos e familiares, principalmente para comunicação e entretenimento. Os participantes relataram que aprenderam a usar sozinhos e que sabem de riscos associados a essas práticas. Entretanto, os resultados mostram que eles se expõem a condutas de risco. Diferenças de gênero foram observadas. Discute-se a necessidade de capacitar pais e educadores para estimular uso que desenvolva competências visando inclusão social assim como a importância de acompanhar o uso para prevenir prática inadequada ou excessiva.

Manejo de herramientas digitales puede ser importante medio de inclusión social. El objetivo de este estudio fue investigar el uso de Internet y de los juegos electrónicos por 60 adolescentes en alto riesgo social, participantes en las actividades llevadas a cabo por el Projeto Quixote. Hemos tratado de caracterizar el tipo de actividad, la frecuencia, la duración, la compañía, la ubicación y la finalidad del uso de internet y juegos electrónicos, así como las dificultades encontradas en la gestión de la web. La mayoría de los adolescentes entrevistados estaban matriculados en la escuela, utilizan internet y juegos electrónicos para interactuar con amigos y familiares, sobre todo para la comunicación y el entretenimiento. Los adolescentes informaron que aprendieron a utilizar estos dispositivos por sí mismos y que conocían los riesgos asociados con estas prácticas. Sin embargo, los resultados muestran que se habían expuesto a diversos riesgos. Diferencias de género fueran observadas. Se discute la importancia de empoderar a los padres y educadores a desarrollar habilidades orientadas a la inclusión social así como de hacer el seguimiento del uso para prevenir la práctica inadecuada o excesiva.

Handling digital tools can be an important means of social inclusion. The aim of this study was to investigate Internet use and electronic gaming in 60 teenagers at high social risk, participants in Projeto Quixote. We sought to characterize type of activity, frequency, duration, company, location, and purpose of Internet use and electronic gaming, as well difficulties managing the web. Most of the interviewed teenagers were enrolled in school, and used Internet and electronic games to interact with friends and family, especially for communication and entertainment. The adolescents reported that they learned to use these devices by themselves and that they knew the risks associated with these practices. However, the results show that they had exposed themselves to several risks. Gender differences were observed. The urge of empowering parents and educators to develop skills to promote social inclusion is discussed, as well as the importance of monitoring use, in order to prevent inappropriate or excessive use.

A visão dos profissionais de saúde em relação à violência doméstica contra crianças e adolescentes: um estudo qualitativo / Health professionals' views about domestic violence against children and teenagers: a qualitative study

A violência doméstica é um dos temas mais difíceis de serem tratados pelos profissionais de saúde. Buscou-se compreender, na pesquisa realizada, a experiência dos profissionais de saúde sobre a violência doméstica contra crianças e adolescentes, descrevendo a identificação dos casos e a assistência prestada às vítimas em Unidades Básicas de Saúde. As técnicas utilizadas foram observação participante, entrevistas semi-estruturadas e grupos focais conduzidos em duas Unidades Básicas de Saúde de Embu/SP, considerada uma das regiões mais violentas do país. Dentre os resultados obtidos, os profissionais ressaltaram inúmeras dificuldades para lidar com a questão da violência, como o medo de se envolver com pessoas criminosas, a falta de resguardo nas unidades de saúde e a falta de comprometimento dos familiares. Um dos motivos da dificuldade de denúncia seria a reprodução de padrões culturais da população em que se aceita a punição física como uma prática educativa. Além disso, não se sentiam responsáveis ou capacitados para lidar com o problema. Os profissionais do Embu, de certa forma, acabam por reproduzir os mesmos valores e atitudes da comunidade em relação à violência, mantendo-se coniventes com o silêncio das famílias, evitando o comprometimento com os casos e desacreditando nas instituições responsáveis pela proteção ao menor. Ficou evidente que o problema da violência doméstica contra crianças e adolescentes não é de fácil manejo. A assistência oferecida às vítimas é restrita, principalmente pelas dificuldades dos profissionais em lidar com as características socioculturais da população atendida e pelo pouco diálogo com as instituições responsáveis pelo encaminhamento dos casos. A abordagem, o encaminhamento e o tratamento de crianças e adolescentes vítimas de violência física podem adquirir maior eficácia quando se estabelece essa aproximação dos serviços de saúde com o cotidiano vivido pela população.

Domestic violence is one of the most difficult topics to be dealt with by health professionals. We aimed, in this research, to understand the experience of health professionals concerning domestic violence against children and teenagers, describing the identification of the cases and the aid offered to the victims in the Unidades Básicas de Saúde (UBS - Primary Health Care Units). The techniques were participant observation, focus groups and semi-structured interviews conducted at two UBSs in the city of Embu, one of the most violent regions of Brazil, located in the Metropolitan Region of São Paulo. According to the results, the professionals said they have several difficulties in tackling the question of violence, such as fear of getting involved with criminal people, lack of protection in the UBSs and the relatives' lack of commitment. The fear of assuming legal obligations makes it difficult for the professionals to have attitudes in order to assist the victims. One of the reasons for their denunciation difficulty would be the reproduction of cultural standards in which physical punishment is accepted as an educational practice. Besides, they seem not to feel responsible or qualified to deal with the problem. The professionals of Embu, in a certain way, reproduce the same values and attitudes of the community in relation to violence, conniving at the silence of the families, avoiding commitment to the cases and not believing in the institutions that are responsible for children's protection. It was clear that the problem of domestic violence against children and teenagers is not easy to deal with. The assistance offered to the victims is restricted, mainly due to the professionals' difficulties in handling the social-cultural characteristics of the population and to the lack of dialogue with the institutions that are responsible for referring the cases...

Environmental factors associated with adolescent antisocial behavior in a poor urban community in Brazil.

BACKGROUND: Investigating risk factors for anti-social behavior (ASB) is particularly relevant in a poor urban and violent community of a developing country where homicide is the primary cause of death among 15-24-year olds. OBJECTIVES: To identify individual and environmental factors associated with ASB in adolescents from an urban poor community in the outskirts of São Paulo City, Brazil. METHOD: This cross-sectional study was based on a probabilistic sample of clusters that included all eligible households (women aged 15-49 years with a son or daughter <18 years of age). One mother-child pair was randomly selected per household (n = 813; response rate: 82.4%). This study is focused on the age group 11-17 years (n = 248). ASB was identified by externalizing scores in the clinical range on the Child Behavior Checklist and/or the Youth Self Report. Potential correlates included individual, maternal, paternal, and familial characteristics. Backward logistic regression analysis identified independent correlates and significant interactions. FINDINGS: Youths with high ASB scores were more likely to be victims of severe physical punishment and have an absent father/substitute. Maternal anxiety/depression was a risk factor only among older adolescents (15-17 years), while the presence of internalizing problems was a risk factor only among younger adolescents (11-14 years). Having a non-working mother increased the risk for ASB only among low-income adolescents. CONCLUSION: The recognition that certain environmental factors may have harmful effects on adolescents' mental health, and the identification of more vulnerable groups can contribute to the development of effective strategies for prevention and treatment of ASB.

Severe physical punishment: risk of mental health problems for poor urban children in Brazil.

OBJECTIVE: To examine the relationship between specific types of child mental health problems and severe physical punishment, in combination with other important known risk factors. METHODS: We conducted a cross-sectional study in Embu, São Paulo, Brazil, as the Brazilian component of a multicountry survey on abuse in the family environment. From a probabilistic sample of clusters that included all eligible households (women aged 15-49 years with a son or daughter < 18 years of age), we randomly selected one mother-child pair per household (n = 813; attrition rate: 17.6%). This study focused on children aged 6-17 years (n = 480). Child Behaviour Checklist CBCL/6-18 was used to identify children with internalizing problems only, externalizing problems only, and both internalizing and externalizing problems (comorbidity). Severe physical punishment was defined as being hit with an object, being kicked, choked, smothered, burnt, scalded, branded, beaten or threatened with a weapon. We examined other potential correlates from four domains: child (gender, age, ever witnessing marital violence); mother (education, unemployment, anxiety or depression, marital violence); father (absence, drunkenness); and family (socioeconomic status). The WHO Self-Reporting Questionnaire (SRQ-20) was used to identify maternal anxiety or depression (score > 7). Backward logistic regression analysis identified independent correlates and significant interactions. FINDINGS: Multivariate modelling showed that severe punishment was an independent correlate of comorbid internalizing and externalizing problems but was not associated with internalizing problems only. It increased the risk of externalizing problems alone only for children and adolescents not exposed to maternal anxiety or depression. Maternal anxiety or depression increased the risk only for children or adolescents not exposed to severe punishment. CONCLUSION: Severe punishment may be related to child mental health problems, with the mechanism depending on the type of problem. Its influence persists in the presence of family stressors such as the father's absence and maternal anxiety or depression.

Primary care and children's mental health in Brazil.

OBJECTIVE: Primary care offers opportunities to expand children's access to mental health (MH) services, but a given practice's community context and staff attitudes may influence which integration models are feasible. The aim of this study was to explore the possibility of using community-based primary care to increase access to MH services in low-income communities in Brazil. METHODS: A qualitative study was undertaken using focus groups with adolescents aged 11 to 16 (n = 46), parents (n = 40), and primary care clinicians and staff (n = 52) from public-sector health centers in 6 low-income Brazilian communities chosen for their geographic diversity. RESULTS: Parents felt they had little support in parenting and attributed much of their children's behavior and mood problems to life in violent, poor communities. Parents thought that primary care could potentially be a source of MH care, but that clinicians often seemed rushed or uninterested. Clinicians classified many child problems as issues with parenting rather than MH. Nonprofessional staff was more likely to be a source of support to parents, except at one center that had a truly integrated MH service. Adolescents reported little need for MH services. CONCLUSIONS: Expanding the role of primary care in child MH may require close attention to how parents, adolescents, and clinicians define their problems and on the causes to which they attribute them. These factors interact with differences in how centers organize MH care, and the extent to which they take advantage of patient interactions with nonprofessional staff.

Severe physical punishment and mental health problems in an economically disadvantaged population of children and adolescents

OBJECTIVE: To estimate the prevalence of severe physical punishment of children/adolescents in a low-income community, and to examine child mental health problems as a potential correlate. METHOD: This study is a Brazilian cross-sectional pilot study of the World Studies of Abuse in Family Environments. A probabilistic sample of clusters including all eligible households (women aged 15-49 years, son/daughter < 18 years) was evaluated. One mother-child pair was randomly selected per household (n = 89; attrition = 11 percent). Outcome (severe physical punishment of children/adolescents by mother/father) was defined as shaking (if age < 2 years), kicking, choking, smothering, burning/scalding/branding, beating, or threatening with weapon. Three groups of potential correlates were examined: child/adolescent (age, gender, physical/mental health); mother (education, unemployment, physical/mental health, harsh physical punishment in childhood, marital violence); father (unemployment, drunkenness). Severe marital violence was defined as kicking, hitting, beating or use of /threat to use a weapon. The following standardized questionnaires were applied by trained interviewers: World Studies of Abuse in Family Environments Core Questionnaire, Child Behavior Checklist, Self-Report Questionnaire. RESULTS: Outcome prevalence was 10.1 percent. Final logistic regression models identified two correlates: maternal harsh physical punishment in childhood (total sample, OR = 5.3, p = 0.047), and child/adolescent mental health problems (sub-sample aged 4-17 years, n = 67, OR = 9.1, p = 0.017). CONCLUSIONS: Severe physical punishment of children/adolescents is frequent in the studied community. The victims have a higher probability of becoming future perpetrators. When intrafamilial violence occurs, child/adolescent mental health may be compromised.

OBJETIVO: Estimar a prevalência de punição física grave de crianças/adolescentes em comunidade de baixa renda e examinar problemas de saúde mental nas crianças/adolescentes como um potencial fator associado. MÉTODO: Este trabalho é um estudo piloto brasileiro de corte transversal do World Studies of Abuse in Family Environments. Foi avaliada uma amostra probabilística de conglomerados, incluindo todos os domicílios elegíveis (mulheres de 15-49 anos, filho/filha < 18 anos). Uma dupla mãe-filho foi aleatoriamente selecionada por domicílio (n = 89; perda amostral = 11 por cento). O desfecho clínico (punição física grave de crianças/adolescentes por mãe/pai) foi definido como sacudir/chacoalhar (se < 2 anos), chutar, esganar, sufocar, queimar, espancar ou ameaçar com arma. Três grupos de potenciais fatores associados foram examinados: criança/adolescente (idade, sexo, problemas de saúde física/mental); Mãe (escolaridade, desemprego, problemas de saúde física/mental, punição severa na infância, violência conjugal); Pai (desemprego, embriaguez). Violência conjugal grave foi definida como chute, soco, espancamento ou uso/ameaça de uso de arma. Os seguintes questionários padronizados foram aplicados por entrevistadores treinados: World Studies of Abuse in Family Environments Core Questionnaire, Child Behavior Checklist, Self-Report Questionnaire. RESULTADOS: Prevalência do desfecho clínico foi de 10,1 por cento. Modelos finais de regressão logística identificaram dois fatores associados: experiência materna de punição severa na infância (amostra total, OR = 5,3, p = 0,047) e problemas de saúde mental na criança/adolescente (sub-amostra de 4-17 anos, n = 67, OR = 9,1, p = 0,017). CONCLUSÕES: A punição física grave de crianças/adolescentes é freqüente na comunidade estudada, sendo que as vítimas têm probabilidade aumentada de se tornarem futuros agressores. Quando ocorre violência intrafamiliar, a saúde mental das crianças e adolescentes pode estar comprometida.

Severe physical punishment and mental health problems in an economically disadvantaged population of children and adolescents.

OBJECTIVE: To estimate the prevalence of severe physical punishment of children/adolescents in a low-income community, and to examine child mental health problems as a potential correlate. METHOD: This study is a Brazilian cross-sectional pilot study of the World Studies of Abuse in Family Environments. A probabilistic sample of clusters including all eligible households (women aged 15-49 years, son/daughter < 18 years) was evaluated. One mother-child pair was randomly selected per household (n = 89; attrition = 11%). Outcome (severe physical punishment of children/adolescents by mother/father) was defined as shaking (if age