Foro: Intervención de representantes del grupo Acuerdos Fundamentales / Forum: Intervention by representatives of the Fundamental Agreements group

En la Academia Nacional de Medicina, el viernes 3 de febrero de 2023 se dieron cita los representantes del grupo Acuerdos Fundamentales, conformado por 14 organizaciones académicas, científicas y gremiales de la salud con la ministra de Salud y Protección Social, Dra. Carolina Corcho Mejía, con el fin de conocer la propuesta del gobierno nacional sobre la reforma al sistema de salud, y a su vez dar respuesta a las inquietudes sobre diferentes temas, para lo cual cada organización tuvo la oportunidad de intervenir.

Contextual predictive factors of child sexual abuse: the role of parent-child interaction.

OBJECTIVES: To determine the prevalence of child sexual abuse in the Colombian coasts, as well as to assess the role of parent-child interactions on its occurrence and to identify factors from different environmental levels that predict it. METHODS: This cross-sectional study explores the results of 1,089 household interviews responded by mothers. Descriptive analyses and multivariate logistic regressions were conducted, with child sexual abuse regressed on parent-child interactions, children's characteristics, maternal characteristics, family characteristics, and community characteristics. RESULTS: 1.2% of the mothers reported that their children had been sexually abused. Families that communicated with their children were less likely to report child sexual abuse, each additional standard deviation of communication reduced child sexual abuse 3.5 times. Affection and negative treatment to the children were not associated with child sexual abuse. Families who experienced intimate partner violence and violent communities were more likely to experience child sexual abuse. CONCLUSIONS: Interventions are needed to address the problem of child sexual abuse.

ISPCAN Child Abuse Screening Tools Retrospective version (ICAST-R): Delphi study and field testing in seven countries.

OBJECTIVES: To gain consensus among an ethnically and linguistically diverse group of international child protection experts on the structure and content of a new survey tool for retrospective measurement of child abuse, and to determine the performance of the instrument through an international field trial with young adults. METHODS: The questionnaire was developed through focus group discussions with international experts, and then subjected to a Delphi study in two waves to determine the perceived importance and translatability of items. The resultant questionnaire was translated into six languages and field tested in seven countries with convenient samples of young adults aged 18-26 years (N=842). RESULTS: Child maltreatment experts from 28 countries provided input to questionnaire development. Satisfactory agreement on draft item inclusion and exclusion and the translatability of items was gained. The tool includes 15 primary questions about potentially abusive physical, sexual and emotional events, with follow-up questions about perpetrator characteristics, frequency of acts and periods in childhood when the recalled abuse occurred. The field test revealed lifetime prevalence per item usually exceeded 10% (11/15 items; range 2.1-49.5%). Internal consistency (Cronbach's alpha) was moderate to high for each of three item sub-sets (between .61 and .82) and the rates of missing data were low (less than 1.5% for 14 of 15 items). The great majority of respondents nominated either peer and/or adult perpetrators (between 82.3% and 98.2% depending upon the item), and among these, child/adolescent peers and non-family adults (including teachers for emotional and physical acts) were nominated often. CONCLUSIONS: The ICAST-R is based on consensus from international experts, translates clearly and has satisfactory properties for adoption as a survey tool to estimate prevalence and describe perpetrators and other contextual aspects of child abuse. PRACTICE IMPLICATIONS: This tool can be utilized in a broad range of cultures and languages and may contribute to improved research practice. Although the core items are limited to just 15 acts of maltreatment, if these behaviorally specific questions are adopted as key indicators and incorporated into comprehensive local, national or regional surveys, eventually there should be greater comparability in survey estimates.

The development and piloting of the ISPCAN Child Abuse Screening Tool-Parent version (ICAST-P).

OBJECTIVE: Child maltreatment is a problem that has longer recognition in the northern hemisphere and in high-income countries. Recent work has highlighted the nearly universal nature of the problem in other countries but demonstrated the lack of comparability of studies because of the variations in definitions and measures used. The International Society for the Prevention of Child Abuse and Neglect has developed instrumentation that may be used with cross-cultural and cross-national benchmarking by local investigators. DESIGN AND SAMPLING: The instrument design began with a team of expert in Brisbane in 2004. A large bank of questions were subjected to two rounds of Delphi review to develop the fielded version of the instrument. Convenience samples included approximately 120 parent respondents with children under the age of 18 in each of six countries (697 total). RESULTS: This paper presents an instrument that measures parental behaviors directed at children and reports data from pilot work in 6 countries and 7 languages. Patterns of response revealed few missing values and distributions of responses that generally were similar in the six countries. Subscales performed well in terms of internal consistency with Cronbach's alpha in very good range (0.77-0.88) with the exception of the neglect and sex abuse subscales. Results varied by child age and gender in expected directions but with large variations among the samples. About 15% of children were shaken, 24% hit on the buttocks with an object, and 37% were spanked. Reports of choking and smothering were made by 2% of parents. CONCLUSION: These pilot data demonstrate that the instrument is well tolerated and captures variations in, and potentially harmful forms of child discipline. PRACTICE IMPLICATIONS: The ISPCAN Child Abuse Screening Tool - Parent Version (ICAST-P) has been developed as a survey instrument to be administered to parents for the assessment of child maltreatment in a multi-national and multi-cultural context. It was developed with broad input from international experts and subjected to Dephi review, translation, and pilot testing in six countries. The results of the Delphi study and pilot testing are presented. This study demonstrates that a single instrument can be used in a broad range of cultures and languages with low rates of missing data and moderate to high internal consistency.

ISPCAN Child Abuse Screening Tool Children's Version (ICAST-C): Instrument development and multi-national pilot testing.

OBJECTIVE: To develop a child victimization survey among a diverse group of child protection experts and examine the performance of the instrument through a set of international pilot studies. METHODS: The initial draft of the instrument was developed after input from scientists and practitioners representing 40 countries. Volunteers from the larger group of scientists participating in the Delphi review of the ICAST P and R reviewed the ICAST C by email in 2 rounds resulting in a final instrument. The ICAST C was then translated and back translated into six languages and field tested in four countries using a convenience sample of 571 children 12-17 years of age selected from schools and classrooms to which the investigators had easy access. RESULTS: The final ICAST C Home has 38 items and the ICAST C Institution has 44 items. These items serve as screeners and positive endorsements are followed by queries for frequency and perpetrator. Half of respondents were boys (49%). Endorsement for various forms of victimization ranged from 0 to 51%. Many children report violence exposure (51%), physical victimization (55%), psychological victimization (66%), sexual victimization (18%), and neglect in their homes (37%) in the last year. High rates of physical victimization (57%), psychological victimization (59%), and sexual victimization (22%) were also reported in schools in the last year. Internal consistency was moderate to high (alpha between .685 and .855) and missing data low (less than 1.5% for all but one item). CONCLUSIONS: In pilot testing, the ICAST C identifies high rates of child victimization in all domains. Rates of missing data are low, and internal consistency is moderate to high. Pilot testing demonstrated the feasibility of using child self-report as one strategy to assess child victimization. PRACTICE IMPLICATIONS: The ICAST C is a multi-national, multi-lingual, consensus-based survey instrument. It is available in six languages for international research to estimate child victimization. Assessing the prevalence of child victimization is critical in understanding the scope of the problem, setting national and local priorities, and garnering support for program and policy development aimed at child protection.

A cuarenta años de la propuesta de atención médica familiar en el Instituto Mexicano del Seguro Social / Fourty years after the proposal of family medicine attention in the Instituto Mexicano del Seguro Social

El presente estudio es una investigación histórica que tuvo como propósito identificar los factores políticos, laborales y económicos que precipitaron en el año de 1953, la propuesta de un Sistema Médico Familiar en el Instituto Mexicano del Seguro Social. Es reproducida una fracción de la célebre ponencia "Médico de familia" expuesta en la ciudad de Panamá en enero de 1954, en el Seminario de Seguridad Social auspiciado por la CISS y la OIT. Se concluye que en los años cincuenta, México fue escenario de un intenso debate sobre la calidad de la atención médica y la racionalización de recursos financieros en las instituciones de seguridad social; lográndose por medio de esas reflexiones, el surgimiento de un Sistema Médico Familiar, que con diversas modificaciones a través de 40 años, continúa vigente

A cuarenta años de la propuesta de atención médica familiar en el Instituto Mexicano del Seguro Social / Fourty years after the proposal of family medicine attention in the Instituto Mexicano del Seguro Social

El presente estudio es una investigación histórica que tuvo como propósito identificar los factores políticos, laborales y económicos que precipitaron en el año de 1953, la propuesta de un Sistema Médico Familiar en el Instituto Mexicano del Seguro Social. Es reproducida una fracción de la célebre ponencia "Médico de familia" expuesta en la ciudad de Panamá en enero de 1954, en el Seminario de Seguridad Social auspiciado por la CISS y la OIT. Se concluye que en los años cincuenta, México fue escenario de un intenso debate sobre la calidad de la atención médica y la racionalización de recursos financieros en las instituciones de seguridad social; lográndose por medio de esas reflexiones, el surgimiento de un Sistema Médico Familiar, que con diversas modificaciones a través de 40 años, continúa vigente(AU)