SOME CHALLENGES IN CHILD ABUSE PREVENTION IN A MIDDLE INCOME COUNTRY: THE BRAZILIAN PERSPECTIVE.

In this article, we present child abuse and neglect data available in Brazilian public health system platform and in a national childline reporting channel (Dial 100) from 2011-2017. Overall, Brazil has a robust set of laws to protect its children, however, the implementation of public policies is insufficient. The pathway to solve these problems goes through increased governmental funding, intense professional training, and the adoption of an evidence-based perspective to design and implement the policies.

Livro infantil especializado como estratégia de prevenção do abuso sexual / Specialized children's picture book as a strategy of sexual abuse prevention / Cuentos infantiles ilustrados como estrategia para prevenir el abuso sexual

O estudo avaliou se um livro infantil sobre abuso sexual é um meio efetivo para desenvolver habilidades autoprotetivas em 33 crianças de uma escola pública. Os instrumentos utilizados foram: versão adaptada do What If Situation Test (Teste de Situações Condicionais - TSC), que avalia a aquisição de três habilidades autoprotetoras (reconhecer, resistir e relatar); Protocolo de Observação de Atividades Práticas com Familiares e Crianças; e análises qualitativas de verbalizações das crianças filmadas. Em um delineamento experimental, os participantes foram divididos em três grupos: contação de história com livro sobre prevenção do abuso sexual; contação de história com livro não específico sobre abuso sexual e grupo controle (sem contação ou livro). Observou-se que as crianças que participaram da contação com livro sobre abuso sexual obtiveram melhor desempenho em comparação aos outros grupos, apresentando aumento significativo na habilidade de relatar o fato abusivo ocorrido a uma pessoa de confiança.ça.

This study evaluated whether storytelling based on a children's picture book on sexual abuse prevention is an effective way to acquire self-protection skills in 33 children of a Brazilian public school. The instruments included: the adapted Portuguese version of the What If Situation Test (WIST III-R), which was used to assess the acquisition of three self-protective skills (recognize, resist, and report); the Observational Protocol of Practical Activities with Parents and Children; qualitative analysis of children's filmed verbalizations. Participants were divided into three groups in the experimental design: story-telling with a child sexual abuse prevention book, story-telling with a nonsexual abuse prevention book, and a Control Group without intervention. Children who participated in the child sexual abuse book intervention had a statistically significant increase in the ability to report the abuse to a trusted person.

El estudio evaluó si un libro infantil sobre abuso sexual es un medio efectivo para desarrollar habilidades auto protegidas en 33 niños de una escuela pública. Los instrumentos utilizados fueron: una versión adaptada para el portugués de What if Situation Test (TSC), que evalúa la adquisición de tres habilidades auto protectoras (reconocer, resistir y informar), el Protocolo de Observación de Actividades Prácticas con Familiares y Niños; y análisis cualitativos de verbalizaciones de los niños filmadas. En un delineamiento experimental los participantes fueron divididos en 3 grupos siendo: cuenta de historia con libro sobre prevención del abuso sexual; cuenta de historia con libro no específico sobre abuso sexual y Grupo Control sin historia o libro. Se observó que los niños que participaron en la cuenta con el libro de prevención del abuso obtuvieron un aumento significativo en la habilidad de Reportar el hecho abusivo ocurrido a una persona de confianza.

Child Abuse as a Predictor of Alcohol Consumption Among Brazilian University Students.

Alcohol use among university students has received considerate attention in recent years due to its serious consequences. There is insufficient data in terms of the relationship between child abuse history and future use of alcohol in such a group. In addition, little is known about the effects of polyvictimization (lifetime multiple victimization experiences) on the consumption of these young adults. This study has examined whether a history of exposure to intimate partner violence (IPV) and/or child abuse is related to alcohol consumption. Particular attention was given to different forms of victimization (physical, psychological, sexual abuse, and exposure to IPV) occurring over the life of the individual. A questionnaire that underwent a process of adaptation in two pilot studies, incorporating the Alcohol Use Disorders Identification Test (AUDIT) and questions about child abuse history, was used. The questionnaire was applied to 1,452 students in Brazil. Child abuse and polyvictimization were related to higher alcohol intake and binge consumption in the last 3 months. Physical, psychological, and exposure to IPV were polyvictimization forms with the most impact on alcohol consumption. The study points out the need to initiate prevention strategies among Brazilian university students for a decrease of harmful alcohol consumption, as well as prevention of family violence.

A randomized controlled trial of an intervention program to Brazilian mothers who use corporal punishment.

This study evaluated a positive parenting program to Brazilian mothers who used corporal punishment with their children. The intervention was conducted in four agencies serving vulnerable children, and at a home replica laboratory at the University. Mothers who admitted using corporal punishment were randomly assigned between experimental (n=20) and control group (n=20). The program consisted of 12 individual sessions using one unit from Projeto Parceria (Partnership Project), with specific guidelines and materials on positive parenting, followed by observational sessions of mother-child interaction with live coaching and a video feedback session in the lab. The study used an equivalent group experimental design with pre/post-test and follow-up, in randomized controlled trials. Measures involved: Initial Interview; Strengths and Difficulties Questionnaire (SDQ) - parent and child versions; Beck Depression Inventory (BDI); observational sessions with a protocol; and a Program Evaluation by participants. Analysis of mixed models for repeated measures revealed significant positive effects on the BDI and SDQ total scores, as well as less Conduct problems and Hyperactivity in SDQ measures from the experimental group mothers, comparing pre with post-test. Observational data also indicated significant improvement in positive interaction from the experimental group mothers at post-test, in comparison with controls. No significant results were found, however, in children's observational measures. Limitations of the study involved using a restricted sample, among others. Implications for future research are suggested.

Impact of the worst school experiences in students: a retrospective study on trauma / Impacto das piores experiências escolares em estudantes: um estudo retrospectivo sobre trauma / Impacto de las peores experiencias en la escuela en estudiantes: un estudio retrospectivo sobre trauma

The literature indicates damage to students' mental health in cases of school violence. The aim of this retrospective study was to evaluate the psychological impact of school victimization in university students, and to analyze the association between PTSD symptoms and variables related to school victimization. 691 University students responded to the Portuguese version of the Student Alienation and Trauma Survey (SATS). Clinically significant scores in the subscales ranged from 4.7% (somatic symptoms) to 20% (hypervigilance), with frequent symptoms described in the literature resulting from school victimization, such as depression, hopelessness, cognitive difficulties, and traumatic event recollection. Additionally, 7.8% of participants presented PTSD symptoms after suffering their "worst school experience". Associations were found between PTSD symptoms and the level of distress after the experience, as well as the perceived benefits after the event, and duration. The results confirm the potential detrimental effects of school victimization, and may be useful to further investigations on this topic.

A literatura indica a existência de danos para a saúde mental de estudantes em casos de violência no contexto escolar. O objetivo deste estudo retrospectivo foi avaliar o impacto psicológico da vitimização escolar em estudantes universitários e analisar a associação dos sintomas de TEPT com variáveis relacionadas à vitimização. No total, 691 estudantes universitários responderam à Escala sobre Experiências Traumáticas em Estudantes. Escores clinicamente significativos nas subescalas variaram de 4,7% (sintomas somáticos) a 20% (hipervigilância), sendo frequentes sintomas descritos na literatura resultantes de vitimização, como: depressão, desesperança, dificuldades cognitivas e rememoração do evento traumático. Adicionalmente, 7,8% apresentaram sintomas de TEPT após a sua pior experiência escolar. Foram encontradas associações entre os sintomas de TEPT e o incômodo sentido após a experiência, benefícios percebidos após o evento e duração do mesmo. Tais dados indicam o potencial nocivo das experiências de vitimização escolar, podendo contribuir para futuras pesquisas em tal área.

La literatura indica que casos de violencia en el contexto escolar causan daños a la salud mental de los estudiantes. El objetivo de este estudio retrospectivo fue evaluar el impacto psicológico de la victimización escolar en estudiantes universitarios y analizar la asociación de los síntomas de TEPT con variables relacionadas a la victimización. Un total de 691 estudiantes universitarios respondieron a la Escala de Experiencias Traumáticas en los Estudiantes. Puntuaciones clínicamente significativas en las subescalas oscilaron entre el 4,7% (síntomas somáticos) y el 20% (hipervigilancia), y se encontraran síntomas frecuentes descritos en la literatura resultante de victimización, tales como: depresión, desesperanza, problemas cognitivos y recuerda excesiva del evento traumático. Además, el 7,8% tenía síntomas de TEPT un mes después de su peor experiencia escolar. Se encontraran asociaciones con los síntomas de TEPT y el malestar que se siente después de la experiencia; beneficios percibidos después del evento y su duración. Los resultados indican el potencial nocivo de las experiencias de victimización escolar y pueden contribuir a investigaciones futuras.

Impact of the Worst School Experiences in Students: A Retrospective Study on Trauma / Impacto das Piores Experiências Escolares em Estudantes: Um Estudo Retrospectivo Sobre Trauma / Impacto de las Peores Experiencias en la Escuela en Estudiantes: Un Estudio Retrospectivo Sobre Trauma

AbstractThe literature indicates damage to students' mental health in cases of school violence. The aim of this retrospective study was to evaluate the psychological impact of school victimization in university students, and to analyze the association between PTSD symptoms and variables related to school victimization. 691 University students responded to the Portuguese version of the Student Alienation and Trauma Survey (SATS). Clinically significant scores in the subscales ranged from 4.7% (somatic symptoms) to 20% (hypervigilance), with frequent symptoms described in the literature resulting from school victimization, such as depression, hopelessness, cognitive difficulties, and traumatic event recollection. Additionally, 7.8% of participants presented PTSD symptoms after suffering their "worst school experience". Associations were found between PTSD symptoms and the level of distress after the experience, as well as the perceived benefits after the event, and duration. The results confirm the potential detrimental effects of school victimization, and may be useful to further investigations on this topic.(AU)

ResumoA literatura indica a existência de danos para a saúde mental de estudantes em casos de violência no contexto escolar. O objetivo deste estudo retrospectivo foi avaliar o impacto psicológico da vitimização escolar em estudantes universitários e analisar a associação dos sintomas de TEPT com variáveis relacionadas à vitimização. No total, 691 estudantes universitários responderam à Escala sobre Experiências Traumáticas em Estudantes. Escores clinicamente significativos nas subescalas variaram de 4,7% (sintomas somáticos) a 20% (hipervigilância), sendo frequentes sintomas descritos na literatura resultantes de vitimização, como: depressão, desesperança, dificuldades cognitivas e rememoração do evento traumático. Adicionalmente, 7,8% apresentaram sintomas de TEPT após a sua pior experiência escolar. Foram encontradas associações entre os sintomas de TEPT e o incômodo sentido após a experiência, benefícios percebidos após o evento e duração do mesmo. Tais dados indicam o potencial nocivo das experiências de vitimização escolar, podendo contribuir para futuras pesquisas em tal área.(AU)

ResumenLa literatura indica que casos de violencia en el contexto escolar causan daños a la salud mental de los estudiantes. El objetivo de este estudio retrospectivo fue evaluar el impacto psicológico de la victimización escolar en estudiantes universitarios y analizar la asociación de los síntomas de TEPT con variables relacionadas a la victimización. Un total de 691 estudiantes universitarios respondieron a la Escala de Experiencias Traumáticas en los Estudiantes. Puntuaciones clínicamente significativas en las subescalas oscilaron entre el 4,7% (síntomas somáticos) y el 20% (hipervigilancia), y se encontraran síntomas frecuentes descritos en la literatura resultante de victimización, tales como: depresión, desesperanza, problemas cognitivos y recuerda excesiva del evento traumático. Además, el 7,8% tenía síntomas de TEPT un mes después de su peor experiencia escolar. Se encontraran asociaciones con los síntomas de TEPT y el malestar que se siente después de la experiencia; beneficios percibidos después del evento y su duración. Los resultados indican el potencial nocivo de las experiencias de victimización escolar y pueden contribuir a investigaciones futuras.(AU)

Trauma craniano violento pediátrico: uma revisão da literatura / Abusive head trauma in children: a literature review

OBJETIVO: Fornecer uma revisão de literatura científica sobre trauma craniano violento pediátrico enquanto forma de maus-tratos físicos contra bebês e crianças, ressaltando prevalência, sinais e sintomas, consequências, fatores de risco para sua ocorrência e, principalmente, estratégias de prevenção. FONTES DOS DADOS: Revisão nas bases de dados MEDLINE, SciELO, LILACS e Web of Science no período de 2001 a 2012 utilizando os termos "síndrome do bebê sacudido" e "trauma craniano violento" em inglês, espanhol e português. SÍNTESE DOS DADOS: O trauma craniano violento é definido como a lesão ao crânio ou ao conteúdo intracraniano de um bebê ou criança menor de cinco anos devido a um impacto brusco intencional e/ou a uma sacudida violenta. Ocorre principalmente com bebês e crianças menores de um ano de idade, e pode resultar em consequências graves, desde deficiências físicas ou mentais até a morte. Apesar de haver sinais específicos para esta forma de maus-tratos, eles podem se confundir com doenças comuns em crianças ou traumas cranianos acidentais, sendo imprescindível o preparo clínico dos profissionais envolvidos na avaliação dos casos para o diagnóstico correto. As estratégias de prevenção devem incluir tanto a identificação precoce dos casos, como a educação parental sobre o desenvolvimento infantil, especialmente sobre o padrão de choro do bebê. CONCLUSÕES: Considerando a gravidade do trauma craniano violento pediátrico, é fundamental que estratégias de prevenção sejam implementadas e avaliadas no contexto brasileiro. Sugere-se que indicadores de sua incidência sejam pesquisados nacionalmente.

OBJECTIVE: To review the scientific literature on pediatric abusive head trauma as a form of physical abuse against infants and young children, highlighting the prevalence, signs and symptoms, consequences, risk factors for its occurrence, and prevention strategies. DATA SOURCE: The MEDLINE, SciELO, LILACS, and Web of Science databases from 2001 to 2012 were reviewed, using the terms "shaken baby syndrome" and "abusive head trauma" in English, Spanish, and Portuguese. DATA SYNTHESIS: Pediatric abusive head trauma is defined as injury to the skull or intracranial contents of a infant or child younger than 5 years due to intentional abrupt impact and/or violent shaking. It occurs mainly in infants and children under 1 year of age, and may result in severe consequences, from physical or mental disabilities to death. Although there are specific signs for this form of abuse, they can be mistaken for common illnesses in children or accidental head injury; thus, clinical training of professionals involved in the assessment of cases to attain the correct diagnosis is crucial. Prevention strategies should include early identification of cases, as well as parental education on child development, especially on the infant's crying pattern. CONCLUSIONS: Considering the severity of abusive head trauma in children, it is critical that prevention strategies be implemented and evaluated in the Brazilian context. It is suggested that its incidence indicators be assessed at the national level.

International collaboration on prevention of shaken baby syndrome - an ongoing project/intervention.

Caring for young infants can be stressful. Non-accidental brain or head injury (shaken baby syndrome) is a result of parental stress, and a lack of knowledge of how to respond to a crying infant and the dangers of shaking a child. This article demonstrates the value of international collaboration in projects to prevent child maltreatment. It includes reports of prevention of shaken baby syndrome programmes in Australia, Hungary, Greece, Brazil and Turkey.

Abusive head trauma in children: a literature review.

OBJECTIVE: To review the scientific literature on pediatric abusive head trauma as a form of physical abuse against infants and young children, highlighting the prevalence, signs and symptoms, consequences, risk factors for its occurrence, and prevention strategies. DATA SOURCE: The MEDLINE, SciELO, LILACS, and Web of Science databases from 2001 to 2012 were reviewed, using the terms "shaken baby syndrome" and "abusive head trauma" in English, Spanish, and Portuguese. DATA SYNTHESIS: Pediatric abusive head trauma is defined as injury to the skull or intracranial contents of a infant or child younger than 5 years due to intentional abrupt impact and/or violent shaking. It occurs mainly in infants and children under 1 year of age, and may result in severe consequences, from physical or mental disabilities to death. Although there are specific signs for this form of abuse, they can be mistaken for common illnesses in children or accidental head injury; thus, clinical training of professionals involved in the assessment of cases to attain the correct diagnosis is crucial. Prevention strategies should include early identification of cases, as well as parental education on child development, especially on the infant's crying pattern. CONCLUSIONS: Considering the severity of abusive head trauma in children, it is critical that prevention strategies be implemented and evaluated in the Brazilian context. It is suggested that its incidence indicators be assessed at the national level.