Violencia y maltrato infantil. El aporte del médico radiólogo al abordaje integral multidisciplinario / Child maltreatment and violence. Contributions from radiologists to a comprehensive multidisciplinary approach

El maltrato infantil es definido por la Organización Mundial de la Salud (OMS) como "el abuso y la desatención que sufren los niños menores de 18 años. Incluye todo tipo de maltrato físico y/o emocional […] que resulte en un daño real o potencial para la salud, la supervivencia, el desarrollo o la dignidad del niño". Al examinar los rastros corporales del maltrato físico, siguiendo los mecanismos de lesión más frecuentemente implicados, es posible detectar patrones radiológicos típicos. La evaluación imagenológica del hueso en reparación permite inferir cronologías para correlacionar con los datos obtenidos en la anamnesis. Los profesionales de la salud deben detectar oportunamente lesiones radiológicas sospechosas y activar de forma temprana el resguardo del menor. Nuestro propósito es realizar una revisión sobre las publicaciones recientes referidas al estudio imagenológico en niños de quienes se sospeche que puedan ser víctimas de violencia física.

The World Health Organization (WHO) defines child maltreatment as "the abuse and neglect that occurs to children under 18 years of age. It includes all types of physical and/or emotional ill-treatment [...], which results in actual or potential harm to the child's health, survival, development or dignity." By examining the bodily traces of physical abuse, following the most frequently involved mechanisms of injury, it is possible to identify typical radiological patterns. The imaging studies of the bone under repair allows inferring a timeline that may be correlated to the data obtained during history taking. Health care providers should detect suspicious radiological lesions in a timely manner and promptly activate the safeguarding of the child. Our objective was to review recent publications on the imaging studies of children suspected of being victims of physical violence.

The effect of complex posttraumatic stress and poverty on quality of life among adult survivors of childhood institutional maltreatment: evidence from survivors of the 'Hyeongje Welfare Institution' in South Korea.

Background: Childhood institutional maltreatment (IM) is associated with both complex posttraumatic stress disorder (CTPSD) and poverty in adulthood life, each of which may impact an individual's quality of life (QoL). To find implications for clinical practice and policy making for adult survivors with childhood IM experiences, it is necessary to conduct research examining their current QoL and identifying related factors.Objective: By applying the model of the conservation of resources theory, we focused on how adulthood QoL can be indicated by childhood IM as well as the life outcomes of IM such as additional lifetime trauma, CPTSD, and poverty.Methods: In a cross-sectional study, self-report data were collected from 127 adults who were survivors of the 'Hyeongje' childhood IM in South Korea. We conducted regression analyses of childhood IM experiences, trauma experiences after escape from the institution, current CPTSD symptoms, and current poverty experiences on current QoL.Results: The duration of placement at the 'Hyeongje' (ß = .24, p = .009) was associated with trauma experiences after escape from the institution. Trauma experiences after escape from the institution (ß = .25, p = .007) were associated with CPTSD symptoms. CPTSD symptoms (ß = .26, p = .005) were associated with poverty, and both CPTSD symptoms (ß = -.52, p < .001) and poverty (ß = -.26, p = .003) were negatively associated with current QoL.Conclusions: Prolonged childhood IM brings about loss spirals by increasing an individual's exposure to experiences of further cumulative trauma, CPTSD, and poverty. There is a need for due diligence-based policy making and public support from the government to help create upward spirals for QoL. This may include the imminent detection and rescue of children as well as providing a safe environment, offering multidisciplinary interventions including evidence-based treatment for CPTSD, and considering economic support including collective reparations.

Duration of placement at the 'Hyeongje' institution was associated with additional trauma experience after escaping the institution.Cumulative trauma after escape was associated with CPTSD symptoms; CPTSD symptoms were associated with poverty; and both CPTSD symptoms and poverty were associated with poor current QoL.Multidisciplinary interventions including evidence-based treatment for CPTSD and considering economic resources for childhood IM survivors would be crucial in increasing QoL.

Heightened response to positive facial cues as a potential marker of resilience following childhood adversity.

Background: Childhood maltreatment profoundly influences social and emotional development, increasing psychiatric risk. Alterations in the implicit processing of threat-related cues following early abuse and neglect represent a marker of mental health vulnerability. Less is known about how early adversity influences the perception of positive social cues, despite their central role in establishing and maintaining social interactions and their association with better mental health outcomes.Methods: The sample consisted of 42 children and adolescents with substantiated childhood maltreatment experiences and 32 peers (mean age 13.3), matched on age, pubertal status, gender, socioeconomic status, ethnicity, and cognitive ability. A computerised experimental task assessed the perceived emotional intensity of positive (happy) and negative (fearful) facial expressions. Mental health symptoms were measured via self- and parental reports, and perceived social support was self-reported.Results: The experience of abuse and neglect was associated with heightened perceived intensity of positive facial cues. Cross-sectional post-hoc moderation and mediation analyses, employing a model-building approach, revealed that in maltreatment-exposed participants: (i) their increased response to positive facial cues was associated with lower symptoms; (ii) the presence of social support accounted for their heightened perceived intensity of positive facial cues; (iii) the presence of social support putatively contributed to lower symptoms by increasing the perceived intensity of positive facial cues. No group differences in perceived intensity of negative expressions were observed.Conclusions: These findings provide fresh insight into how positive faces are processed following maltreatment experience in childhood. Maltreatment experience was found to be associated with heightened perceived intensity of happy faces, which in turn was associated with better mental health and greater levels of social support. This suggests that heightened saliency of positive emotions acts protectively in children with maltreatment experience.

The impact of childhood maltreatment on perceiving positive social cues, especially explicit emotional intensity appraisal, is less understood compared to the extensive focus on its role in processing threat-related cues and psychiatric risk.In this study, we found that maltreatment experience was associated with heightened perceived intensity of happy faces, which in turn was associated with better mental health and greater levels of social support.These findings suggest that heightened saliency of positive emotions may act protectively in children with maltreatment experience.

Exposure-based treatments for childhood abuse-related post-traumatic stress disorder in adults: a health-economic evaluation.

Background: Prolonged exposure (PE) is an effective treatment for post-traumatic stress disorder (PTSD).Objective: This study aimed to analyse the cost-effectiveness of three exposure-based treatments in patients with childhood abuse-related PTSD.Method: A net-benefit analysis was conducted alongside a pragmatic randomized controlled trial with participants (N = 149) randomized to three conditions: PE (n = 48), intensified PE (i-PE, n = 51), and phase-based PE [Skills Training in Affective and Interpersonal Regulation (STAIR) + PE, n = 50]. Assessments took place at baseline (T0), post-treatment (T3), 6 month follow-up (T4), and 12 month follow-up (T5). Costs stemming from healthcare utilization and productivity losses were estimated using the Trimbos/iMTA questionnaire for Costs associated with Psychiatric Illness. Quality-adjusted life-years (QALYs) were based on the 5-level EuroQoL 5 Dimensions (EQ-5D-5L) using the Dutch tariff. Missing values of costs and utilities were multiply imputed. To compare i-PE to PE and STAIR + PE to PE, pair-wise unequal-variance t-tests were conducted. Net-benefit analysis was used to relate costs to QALYs and to draw acceptability curves.Results: Intervention costs did not differ across the three treatment conditions. Total medical costs, productivity losses, total societal costs, and EQ-5D-5L-based QALYs did not differ between treatment conditions either (all p > .10). At the relevant €50,000/QALY threshold, the probability of one treatment being more cost-effective than another was 32%, 28%, and 40% for PE, i-PE, and STAIR-PE, respectively.Conclusion: Three equally effective treatments were compared and no differences in cost-effectiveness between treatments were found. Therefore, we advocate the implementation and adoption of any of the treatments and endorse shared decision making.

This is the first study to compare cost-effectiveness of three exposure-based treatments in patients with CA-PTSD alongside a randomized controlled clinical trial (N = 149).The three exposure-based treatments did not differ in terms of outcomes and costs.Findings underline that any of these treatments can be implemented, and we endorse shared decision making to meet patient treatment preference.

Knowledge, attitudes, and experiences of a group of turkish dentists regarding child abuse / Conocimientos, actitudes y experiencias de un grupo de dentistas turcos en relación con el abuso infantil

Child abuse is a universal problem with critical lifelong effects. This study aimed to evaluate knowledge, attitudes, experiences of dentists regarding child abuse and to increase relevant awareness of them. A self-administered questionnaire with 48 questions about dentists' personal and educational information and their level of knowledge, attitudes, experiences on child abuse was implemented. Out of targeted 305 participants, 183 (60.0%) returned completely filled out questionnaires. Majority of participants knew signs and symptoms of child abuse. Of the participants, more than half were well-informed on what to do, however, one quarter had no knowledge about where to report in case of child abuse. In identifying child abuse, 39.3% of the participants found themselves inadequate. The most commonly stated reason for low rate of reporting was hesitancy to identify the case as abuse, and all participants needed more training. Only 12 (6.6%) participants suspected a case of child abuse. Dentists who had children and were long-time experienced and generalist did not have sufficient knowledge about legal obligations, signs and symptoms of child abuse (p<0.05). Arrangements and training programs to increase knowledge, awareness, and responsibility levels of dentists about child abuse appear to be a critically important topic.

El abuso infantil es un problema universal con efectos críticos de por vida. Este estudio tuvo como objetivo evaluar el conocimiento, las actitudes y las experiencias de los dentistas con respecto el abuso infantil y aumentar la conciencia relevante sobre ellos. Se implementó un cuestionario autoadministrado con 48 preguntas sobre información personal y educativa de los odontólogos y su nivel de conocimientos, actitudes, experiencias sobre el abuso infantil. De los 305 participantes seleccionados, 183 (60.0%) devolvieron los cuestionarios completos. La mayoría de los participantes conocían los signos y síntomas del abuso infantil. De los participantes, más de la mitad estaban bien informados sobre qué hacer, sin embargo, una cuarta parte no sabía dónde denunciar en caso de abuso infantil. Al identificar el abuso infantil, el 39.3% de los participantes se encontraron inadecuados. La razón más común para la baja tasa de informes fue la vacilación para identificar el caso como abuso, y todos los participantes necesitaban más capacitación. Solo 12 (6.6%) participantes sospecharon un caso de abuso infantil. Los odontólogos que tenían hijos y eran de larga experiencia y generalistas no tenían suficiente conocimiento sobre las obligaciones legales, signos y síntomas de abuso infantil (p<0,05). Los arreglos y los programas de capacitación para aumentar los niveles de conocimiento, conciencia y responsabilidad de los dentistas sobre el abuso infantil parecen ser un tema de importancia crítica.

Menores víctimas de violencia de género: ¿se les atiende adecuadamente en el ámbito sanitario? / Minors gender violence victims: are they correctly attended in healthcare settings?

Introducción y objetivos: el objetivo fue conocer la opinión de los/as pediatras que atienden a personas menores de edad, que son hijos/as de mujeres víctimas de violencia de género (VG), sobre la formación que reciben y las herramientas con las que cuentan para su abordaje, incluyendo la propia formación y el grado de implicación que asumen en esas situaciones. Material y métodos: se realizó un estudio descriptivo transversal mediante una encuesta validada utilizando Formularios de Google. Se difundió entre sanitarios/as que trabajan con personas menores de edad a través de sociedades científicas, a las que se solicitó colaboración, y de la lista de distribución PEDIAP de RedIris que agrupa a los profesionales mencionados. Resultados: respondieron a la encuesta un total de 407 profesionales. Los profesionales contemplaron la VG entre los problemas sociales de los niños, niñas y adolescentes (NNA) que acuden a sus consultas como poco frecuente: el 71% de las respuestas (el 5,6% lo consideraban frecuente). Respecto a la formación, solo el 19% de los profesionales sanitarios consultados consideran que se les ofrece suficiente formación, y solo el 15% piensan que poseen los conocimientos adecuados en esta materia. Conclusiones: aunque la VG es un problema que debe ser atendido por los profesionales sanitarios, la formación adaptada a ese ámbito, en cuanto a herramientas de detección y de intervención, sigue siendo escasa, lo que puede influir en la infradetección o en un abordaje inadecuado de la misma, así como en una afectación de la salud de los/as hijos/as de las mujeres víctimas de VG (AU)

Background: the aim was to find out the opinion of paediatricians who care for minors who are victims of gender-based violence (GBV), on the training they receive and the tools they have to deal with it, including their own training and the degree of involvement they assume in these situations.Methods: a descriptive cross-sectional study was carried out through a validated survey using Google Forms. It was disseminated among healthcare professionals working with minors through scientific societies that were asked to collaborate and through the PEDIAP distribution list of RedIris, which groups together the aforementioned professionals.Results: a total of 407 professionals responded to the survey. Professionals considered GBV among the social problems of minors attending their offices as infrequent: 71% of responses (compared to 5.6% who considered it frequent). Regarding training, only 19% consider that they are offered sufficient training, and only 15% think that they have adequate knowledge in this area.Conclusions: although GBV is a problem that needs to be addressed by health professionals, training adapted to this field, in terms of detection and intervention tools, remains scarce, which may influence under-detection or an inadequate approach to it, as well as affecting the health of the children of women victims of GBV. (AU)

Síndrome de niño agredido: reporte de caso / Battered child síndrome: case report

La valoración médico legal en los casos de Síndrome de niño agredido debe ser minuciosa, y abarcar todos los aspectos que indican los artículos y guías nacionales e internacionales, para tener una certeza diagnóstica, debe incluir una historia médico legal completa, examen físico detallado y estudios complementarios, así como diagnóstico diferencial. El presente artículo abarca algunos de los aspectos principales a tomar en cuenta ante la sospecha de abuso infantil, mediante la presentación y abordaje de un caso clínico.

The medical legal assessment in the cases of Attacked Child Syndrome must be thorough and cover all the aspects indicated in the articles and national and international guides, to have a diagnostic certainty, it must include a complete legal medical history, detailed physical examination and complementary studies, as well as differential diagnosis. This article covers some of the main aspects to consider when suspected of child abuse, through the presentation and approach of a clinical case.

Predictors and moderators of treatment outcomes in phase-based treatment and trauma-focused treatments in patients with childhood abuse-related post-traumatic stress disorder.

Background: Knowledge of treatment predictors and moderators is important for improving the effectiveness of treatment for PTSD due to childhood abuse.Objective: The first aim of this study was to test the potential predictive value of variables commonly associated with PTSD resulting from a history of repeated childhood abuse, in relation to treatment outcomes. The second aim was to examine if complex PTSD symptoms act as potential moderators between treatment conditions and outcomes.Method: Data were obtained from a randomized controlled trial comparing a phase-based treatment (Skills Training in Affect and Interpersonal Regulation [STAIR] followed by Eye Movement Desensitization and Reprocessing [EMDR] therapy; n = 57) with a direct trauma-focused treatment (EMDR therapy only; n = 64) in people with PTSD due to childhood abuse. The possible predictive effects of the presence of borderline personality disorder, dissociative symptoms, and suicidal and self-injurious behaviours were examined. In addition, it was determined whether symptoms of emotion regulation difficulties, self-esteem, and interpersonal problems moderated the relation between the treatment condition and PTSD post-treatment, corrected for pre-treatment PTSD severity.Results: Pre-treatment PTSD severity proved to be a significant predictor of less profitable PTSD treatment outcomes. The same was true for the severity of dissociative symptoms, but only post-treatment, and not when corrected for false positives. Complex PTSD symptoms did not moderate the relationship between the treatment conditions and PTSD treatment outcomes.Conclusions: The current findings suggest that regardless of the common comorbid symptoms studied, immediate trauma-focused treatment is a safe and effective option for individuals with childhood-related PTSD. However, individuals experiencing severe symptoms of PTSD may benefit from additional treatment sessions or the addition of other evidence-based PTSD treatment approaches. The predictive influence of dissociative sequelae needs further research.The study design was registered in The Dutch trial register (https://www.trialregister.nl/trialreg/admin/rctview.asp?TC = 5991) NTR5991 and was approved by the medical ethics committee of Twente NL 56641.044.16 CCMO.

One of first studies that aimed to identify multiple potential predictors and moderators in patients with PTSD related to childhood abuse.Only severe PTSD predicted worse treatment outcomes.The predictive influence of dissociative sequelae needs further research.

Percepção dos estudantes de odontologia sobre o abuso infantil na cidade de Florianópolis (SC), Brasil / Perception of dental students about child abuse in the city of Florianópolis (SC), Brazil

O abuso infantil é, ainda, um dos grandes problemas de saúde pública no Brasil e no mundo, sendo que em 2020, houve o registro de mais de 75 mil notificações no Brasil. É de suma importância que os profissionais de saúde, sobretudo, cirurgiões-dentistas, estejam capacitados para fazer a identificação e notificação de suspeitas e casos de abuso infantil. Esta pesquisa analisou a percepção dos estudantes de odontologia da Universidade Federal de Santa Catarina (UFSC) sobre o abuso infantil e instrução destes para a realização da notificação compulsória às autoridades na cidade de Florianópolis. Foi aplicado um questionário eletrônico com dezesseis questões abertas e fechadas, previamente estabelecidas pelos autores, tendo como base estudos anteriores sobre o tema. A amostra não-probabilística composta por 69 participantes de todas as fases do curso de graduação em odontologia da UFSC por meio de um estudo transversal. Mais de 97% (n=67) dos entrevistados afirmaram saber o que é abuso infantil, no entanto, aproximadamente 80% (n=54) afirmaram não saber proceder frente a um caso, cerca de 90% (n=62) afirmaram não conhecer a legislação sobre notificação compulsória e 80% (n=57) afirmaram haver interesse em buscar informações sobre o tema. É imprescindível que estudantes de odontologia e cirurgiões-dentistas sejam capazes não só identificar casos de abuso infantil, mas como proceder e mitigar o ciclo de violência no qual esta criança está inserida

Child abuse is still a major public health problem in Brazil and worldwide, with more than 75,000 notifications in Brazil in 2020. It is of utmost importance that health professionals, especially dentists, are trained to identify and report suspected and reported cases of child abuse. This study analyzed the perception of dental students at the Federal University of Santa Catarina (UFSC) about child abuse and their instruction to make the compulsory notification to the authorities in the city of Florianópolis. An electronic questionnaire with sixteen open and closed questions previously established by the authors based on previous studies on the subject was applied to a non-probabilistic sample consisting of 69 participants from all stages of the undergraduate dental course at UFSC. More than 97% (n=67) of the participants said they knew what child abuse was, however, approximately 80% (n=54) said they did not know how to proceed when faced with a case and about 90% (n=62) said they did not know the legislation about compulsory notification and 80% (n=57) said they were interested in seeking information on the subject. It is essential that dental students and dentists are able not only to identify cases of child abuse, but how to proceed and mitigate the cycle of violence in which this child is inserted

Child sexual violence: interpersonal relationship and self-image evaluated by Zulliger R-Optimized Application / Violência sexual infantil: relacionamento interpessoal e autoimagem avaliados pelo Zulliger Aplicação R-Otimizada / Violencia sexual infantil: relaciones interpersonales y autoimagen evaluadas por Zulliger Aplicación R-Optimizada

This study aimed to verify the validity of Zulliger criteria in the evaluation of interpersonal relationships and self-image of children victims of sexual violence. Population: 42 children between 7 and 13 years old participated, divided into three groups: 19 Victims of sexual violence (G1); 10 Cancer patients (G2); 13 Control group (G3). Instruments: Zulliger in the Comprehensive System (ZSC) R-Optimized application; Personality Scale for Children (ETPC, EPQ-J); Social Skills Inventory for Children (SSRS); Intelligence Test (CPM-Raven). G1, when compared to other groups, showed more tendency to problematic or less adaptive understanding of interpersonal interactions [p < 0.05 in PHR, GHR and p (ZSC); Psychosis (ETPC, EPQ-J); EG and F2 (SSRS)], more self-critical and negative self-image [p < 0.05 in MOR (ZSC)] and increased traumatic content [p < 0.05 in Bl (ZSC)]. The ZSC demonstrated preliminary evidence of validity in the evaluation of Interpersonal Relationship and Self-image of victims of child sexual violence. (AU)

Esse estudo objetivou verificar evidências de validade do Zulliger na avaliação de relacionamento interpessoal e autoimagem de crianças vítimas de violência sexual. Participaram 42 crianças entre 7 e 13 anos, divididas em três grupos: 19 vítimas de violência sexual (G1); 10 pacientes com câncer (G2); 13 grupo-controle (G3). Foram utilizados como instrumentos o Zulliger no Sistema Compreensivo (ZSC) aplicação R-Otimizada, Escala de Personalidade para Crianças (ETPC, EPQ-J), Inventário de Habilidades Sociais para Crianças (SSRS), Teste de Inteligência (CPM-Raven). O G1, quando comparado aos outros grupos, mostrou-se com mais tendência a compreensão problemática ou menos adaptativa das interações interpessoais [p < 0,05 em PHR, GHR e p (ZSC); Psicotismo (ETPC, EPQ-J); EG e F2 (SSRS)], mais autocríticas e autoimagem negativas [p < 0,05 em MOR (ZSC)] e aumento de conteúdos traumáticos [p < 0,05 em Bl (ZSC)]. O ZSC demonstrou evidências preliminares de validade na avaliação de Relacionamento Interpessoal e Autoimagem de vítimas de violência sexual infantil. (AU)

Este estudio tuvo como objetivo verificar evidencias de validez de Zulliger en la evaluación de las relaciones interpersonales y la autoimagen de los niños víctimas de violencia sexual. Participaron 42 niños entre 7 y 13 años: 19 Víctimas de violencia sexual (G1); 10 pacientes con cáncer (G2); 13 Grupo de control (G3). Los instrumentos utilizados: Zulliger en el Sistema Comprensivo (ZSC) aplicación R-Optimizada; Escala de personalidad para niños (ETPC, EPQ-J); Inventario de Habilidades Sociales para Niños (SSRS); Test de Inteligencia (CPM-Raven). En comparación con otros grupos, G1 tuvo más probabilidades de una comprensión problemática o menos adaptativa de las interacciones interpersonales [p<0,05 en PHR, GHR y p (ZSC); Psicotismo (ETPC, EPQ-J); EG y F2 (SSRS)], más autocrítica y autoimagen negativa [p<0.05 en MOR (ZSC)] y mayor contenido traumático [p<0.05 en Bl (ZSC)]. El ZSC demostró evidencias preliminares de validez en la evaluación de la Relación Interpersonal y la Autoimagen de las víctimas de violencia sexual infantil. (AU)

Esquemas Iniciais Desadaptativos em Adultos com Histórico de Eventos Estressores Precoces / Early Maladaptive Schemas in Adults with a History of Early Life Stressors / Esquemas Maladaptativos Tempranos en Adultos con Antecedentes de Eventos Estresantes Tempranos

Esse estudo teve como objetivo principal investigar a relação entre os subtipos de Eventos Estressores Precoces e os Esquemas Iniciais Desadaptativos em adultos. Foram utilizados o Questionário sobre Traumas na Infância (Childhood Trauma Questionnaire) e o Questionário de Esquemas de Young - forma reduzida (Young Schema Questionnaire - short form) em uma amostra, não-clínica de 200 pessoas, na qual metade (n=100) apontou a presença de Eventos Estressores Precoces. Os dados foram processados no software IBM SPSS Statistics - versão 22, por meio de estatística descritiva, coeficiente de correlação de Pearson, e comparação de médias através do Teste t de Amostras Independentes. As análises de correlação revelaram que cada subtipo de abuso e negligência se relacionou de diferentes formas com os Esquemas Iniciais Desadaptativos, sugerindo que a influência diferencial de cada tipo deve ser estudada. Dentre todos os subtipos de Eventos Estressores Precoces, o abuso emocional se destacou, apresentando maior prevalência e correlações com mais esquemas.

This study aimed to investigate the relationship between the subtypes of Early Life Stressors and the Early Maladaptive Schemas in adults. The Childhood Trauma Questionnaire and the Young Schema Questionnaire (short form) were used in a non-clinical sample of 200 people in which half (n = 100) had a previous history of Early Life Stressors. The data was processed in the IBM SPSS Statistics - version 22 software, using descriptive statistics, Pearson's correlations coefficients and comparison of means by using the Independent Samples t-Test. Correlation analysis revealed that each type of abuse and neglect was related in different ways to the Early Maladaptive Schemes, which suggests that the differential influence of each type should be studied. Among all the subtypes of Early Stressful Events, the emotional abuse was the one that stood out, showing a higher prevalence and correlations with more schemes than other form of maltreatment, such as physical and sexual abuse.

Este estudio tuvo como objetivo investigar la relación entre los subtipos de Eventos Estresantes Tempranos y los Esquemas Maladaptativos Tempranos en adultos. Se utilizaron el "Cuestionario de Trauma Infantil" (Childhood Trauma Questionnaire) y el "Cuestionario de esquemas - forma reducida" (Young Schema Questionnaire - short form) en una muestra no clínica de 200 personas, en la que la mitad (n = 100) indicó la presencia de EEP. Los datos fueron processados en el software IBM SPSS Statistics, versión 22, utilizando estadística descriptiva, coeficiente de correlación de Pearson y comparación de medias utilizando la Prueba t para Muestras Independientes. Los análisis de correlación revelaron que cada subtipo de abuso y negligencia se relacionó de diferentes formas con los Esquemas Maladaptativos Tempranos, sugiriendo que se debería estudiar la influencia diferencial de cada tipo. Entre todos los subtipos de Eventos Estresantes Tempranos, se destacó el abuso emocional, que tuvo una mayor prevalencia y correlaciones con más esquemas.

Violência familiar na infância, violência no namoro e saúde mental na adolescência / Family violence against children, dating violence and adolescent mental health

O objetivo geral desta tese foi conhecer as magnitudes e os padrões das violências no namoro na adolescência (VNA) e das violências familiares na infância (VFI), as repercussões da VFI nos diferentes padrões de VNA, bem como as relações entre os padrões de VFI e a saúde mental na adolescência. O objetivo geral suscitou três objetivos específicos, cada um explorado em um manuscrito. Os dados usados na tese derivaram da pesquisa "Estupro de vulnerável e outras violências contra adolescentes e jovens do sexo feminino", desenvolvida em 2017 e 2018 que contou com a participação de 721 estudantes de escolas públicas e privadas da IX Região Administrativa (RA) do Rio de Janeiro. Para identificar a VNA, a VFI e estimar a saúde mental, usou-se respectivamente as versões brasileiras do instrumento Conflict in Adolescent Dating Relationships Inventory (CADRI), do Childhood Trauma Questionnaire (CTQ) e do General Health Questionnaire (GHQ-12). As estratégias de análise de dados variaram em função dos diferentes objetivos/manuscritos. O manuscrito 1 estimou as magnitudes de exposição e perpetração das VNA entre os escolares da IX RA do município do Rio de Janeiro. A prevalência de vitimização variou de 16,7% (sexual) a 94,6% (emocional). A prevalência de perpetração variou entre 9,9% (sexual) e 94,6% (emocional). Os adolescentes que relataram serem vítimas de violência na infância, os que vivem em áreas violentas e os que consomem bebidas alcoólicas com maior frequência tiveram maior prevalência de VNA. Os manuscritos 2 e 3 utilizaram análises de classes latentes (ACL) para identificar os padrões de VNA (manuscrito 2) e o padrão de VFI (manuscrito 3) com base na agregação de indivíduos em classes, caracterizadas em função da probabilidade de endosso aos diferentes itens dos instrumentos CADRI e CTQ. Além da identificação destes padrões, buscou-se utilizar as classes estimadas em modelos causais aferindo os efeitos das dimensões de VFI para os padrões de VNA (manuscrito 2) e das classes de VFI para a saúde mental dos adolescentes (manuscrito 3). No manuscrito 2, identificou-se três classes latentes de VNA entre meninas e meninos. O abuso sexual na infância aumentou a chance de pertencer à classe mais grave de vitimização de VNA entre as meninas (OR = 5,72; IC 95% = 2,51-13,06). Os abusos emocionais (OR=5,97; IC 95% = 1,95-18,30) e físicos (OR=3,16; IC 95%=1,07-9,34) aumentaram as chances de classificar os meninos na classe mais grave de perpetração de VNA. A ACL do manuscrito 3 também identificou três classes de violência familiar na infância, tanto em meninas, como em meninos. Apesar de várias semelhanças entre as classes dos dois sexos, as meninas foram mais vítimas de abuso sexual e os meninos de punição corporal (castigo físico). Pertencer à classe mais grave de VFI aumentou os escores do GHQ-12 em 2 a 3 pontos quando comparados às classes mais brandas de violência. A partir destes resultados e com as discussões trazidas pelos três manuscritos, espera-se que esta tese tenha contribuído tanto com as discussões temáticas das violências, como apresentado alguns avanços metodológicos no campo da análise epidemiológica. Com relação aos primeiros aspectos, mais uma vez, evidenciou-se que a violência entre pais e filhos é um problema de saúde pública, por sua alta frequência e relações diretas e especificas com a violência no namoro de adolescentes; ampliou-se também os debates sobre a relação entre as violências e o gênero, na medida em que tanto as prevalências como os padrões de violência diferem entre meninos e meninas desde a infância; identificou-se padrões de violência que mostram que a vivência de diferentes tipos de abuso é a situação mais frequente entre crianças e adolescentes; percebeu-se que as repercussões das violências contra crianças na saúde mental de adolescentes dependem do padrão de coocorrência das diferentes formas de vitimização infantil. Com relação aos avanços metodológicos, a tese é inovadora por propor, pela primeira vez no Brasil, a utilização de ACL para caracterizar as violências contra crianças e em relacionamentos amorosos de adolescentes. Ademais, a tese avança ao articular a identificação de padrões de violência via análise de classes latentes com seus fatores de risco e consequências, ampliando as possibilidades de inferência dos modelos.

The main objective of this thesis was to know the magnitudes and patterns of dating violence in adolescence (DV) and family violence against children (VAC), the repercussions of on different DV patterns, and the relationship of VAC patterns to health mentality in adolescence. The general objective raised three specific goals. Each one was explored in one manuscript. The data used in the thesis were derived from the research "Rape of the vulnerable and other violence against female adolescents and young people", developed in 2017 and 2018, with 721 students from public and private schools in the IX Administrative Region (AR) of Rio de Janeiro. The Brazilian versions of the Conflict in Adolescent Dating Relationships Inventory (CADRI) instrument, the Childhood Trauma Questionnaire (CTQ) and the General Health Questionnaire (GHQ-12) were used to identify DV, VAC and to estimate mental health trends respectively. Data analysis strategies varied according to different objectives/manuscripts. Manuscript 1 estimated the magnitudes of exposure and perpetration of DV among students from the IX AR in Rio de Janeiro. The estimated victimization prevalence ranged from 16.7% (sexual) to 94.6% (emotional). The prevalence of perpetration ranged from 9.9% (sexual) to 94.6% (emotional). Adolescents who reported child abuse, those living in violent areas, and those who consumed alcohol more frequently had a higher prevalence of DV. Manuscripts 2 and 3 used latent classes analysis (LCA) to identify the DV patterns (manuscript 2) and the VAC pattern (manuscript 3) based on the aggregation of individuals into classes, characterized according to the probability of endorsement to the different items from the CADRI and CTQ instruments. In addition to identifying these patterns, we sought to use the estimated classes in causal models, assessing the effects of the VAC dimensions for the DV patterns (manuscript 2) and the VAC classes for adolescents' mental health (manuscript 3). In manuscript 2, three latent classes of DV were identified among girls and boys. Childhood sexual abuse increased the chance of belonging to the most severe class of DV victimization among girls (OR = 5.72; 95% CI = 2.51-13.06). Emotional (OR=5.97; 95% CI = 1.95-18.30) and physical (OR=3.16; 95% CI=1.07-9.34) abuse increased the chances of classifying boys in the most severe class of DV perpetration. The LCA of manuscript 3 also identified three classes of VAC, both in girls and boys. Despite several similarities between the classes of the two sexes, girls suffered more with sexual abuse and boys with corporal punishment (physical punishment). Belonging to the most severe class of VAC increased the GHQ-12 scores by 2 to 3 points compared to the milder classes of violence. Based on these results and with the discussions brought by the three manuscripts, it is expected that this thesis has contributed both to the thematic discussions of violence and presented some methodological advances in the field of epidemiological analysis. Regarding the first aspect, once again, it is evident that violence between parents and children is a public health problem due to its high frequency and direct and specific relationship with violence in adolescents' dating. Debates on the relationship between violence and gender have expanded, as both the prevalence and patterns of violence differ between boys and girls since childhood; patterns of violence were identified that indicate that experiencing different types of abuse is the most frequent situation among children and adolescents, and it was noticed that the repercussions of violence against children on the mental health of adolescents depend on the pattern of co-occurrence of different forms of child victimization. Regarding methodological advances, the thesis is innovative as it proposes the use of LCA to characterize VAC and DV for the first time in Brazil. Furthermore, the thesis advances by articulating the identification of patterns of violence via the analysis of latent classes with their risk factors and consequences, expanding the possibilities of inference from the models.

Notificação de violência infantojuvenil: percepção dos profissionais da Atenção Primária à Saúde / Notification of child and adolescent violence: perception of Primary Health Care professionals / Notificación de violencia infantojuvenil: percepción de los profesionales de la Atención Primaria de Salud

Resumo Diante da magnitude do fenômeno da violência infantojuvenil no Brasil, que representa mais de um terço dos casos notificados por esse agravo no país, o objetivo deste estudo foi analisar a percepção dos profissionais de saúde acerca da identificação e da notificação compulsória dos casos de violência infantojuvenil na Atenção Primária à Saúde. Trata-se de um estudo exploratório, de abordagem qualitativa, realizado com 14 profissionais de duas unidades de Saúde da Família do Recife, Pernambuco, em 2021. Os dados foram coletados em entrevistas guiadas por um roteiro semiestruturado e analisados por meio da análise de Bardin. Os resultados apontam que os profissionais reconhecem a sua responsabilidade ética no processo de notificação de violência infantojuvenil, principalmente pelo contexto familiar e territorial no qual estão inseridos. Entretanto, ainda há muitos desafios que interferem na implicação prática da notificação na Atenção Primária, como o medo da violência e de represálias no território e a falta de capacitação. Investir em estratégias de estímulo à notificação, de modo a garantir respaldo técnico-científico, é imprescindível para a consolidação da prática.

Abstract Given the magnitude of the phenomenon of violence against children and adolescents in Brazil, which represents more than a third of the cases reported for this offense in the country, the objective of this study was to analyze the perception of health professionals about the identification and compulsory notification of cases of violence against children and adolescents in Primary Health Care. This is an exploratory study, with a qualitative approach, carried out with 14 professionals from two Family Health Units in Recife, Pernambuco, Brazil, in 2021. The data was collected in interviews guided by a semi-structured script and analyzed using Bardin's analysis. The results indicate that the professionals recognize their ethical responsibility in the process of reporting violence against children and adolescents, mainly due to the family and territorial context in which they are inserted. However, there are still many challenges that interfere with the practical implications of notification in Primary Care, such as fear of violence and reprisals in the territory and lack of training. Investing in strategies to encourage reporting, in order to ensure technical and scientific support, is essential for the consolidation of the practice.

Resumen Dada la magnitud del fenómeno de la violencia infantojuvenil en Brasil, que representa más de un tercio de los casos notificados por esta condición en el país, el objetivo de este estudio fue analizar la percepción de los profesionales de la salud sobre la identificación y notificación obligatoria de los casos de violencia infantojuvenil en la Atención Primaria de Salud. Se trata de un estudio exploratorio, con abordaje cualitativo, realizado con 14 profesionales de dos Unidades de Salud de la Familia de Recife, Pernambuco, Brasil, en 2021. Los datos fueron recolectados en entrevistas conducidas por un guión semiestructurado y analizados utilizando el análisis de Bardin. Los resultados indican que los profesionales reconocen su responsabilidad ética en el proceso de denuncia de la violencia contra niños y adolescentes, principalmente por el contexto familiar y territorial en el que están insertos. Sin embargo, aún existen muchos desafíos que interfieren en la implicación práctica de la notificación en la Atención Primaria, como el miedo a la violencia y represalias en el territorio y la falta de capacitación. Invertir en estrategias para incentivar la notificación, a fin de garantizar el respaldo técnico-científico, es fundamental para la consolidación de la práctica.

Abuso sexual infantil y adolescente y su relación con trastornos alimentarios / Child and adolescent sexual abuse and its relationship with eating disorders

ANTECEDENTES: El antecedente de abuso sexual (AS) en la infancia o adolescencia en los trastornos alimentarios (TCA) está documentado en la experiencia clínica y en la literatura. Sin embargo, las complejas relaciones entre ambas condiciones no han sido sistematizadas. OBJETIVO: Describir la relación clínica y neurobiológica entre AS y TCA. MÉTODO: Se analizó exhaustivamente la literatura especializada en textos y artículos incluidos en Medline/PubMed, SciELO. Se perfilaron los conceptos centrales y se redactó la información buscando didáctica cohesión incluyendo un caso clínico ilustrativo. RESULTADOS: Aunque el AS es un factor inespecífico para el desarrollo de trastornos mentales, constituye un fenómeno significativo predisponente, desencadenante y perpetuante para la emergencia de un TCA, principalmente bulimia nerviosa. Se describen los factores de riesgo, mediadores, predictores, protectores y de resiliencia. Ambas condiciones poseen correlatos neurobiológicos y clínicos análogos (síntomas nucleares y funciones adaptativas). Existen disfunciones similares en los circuitos de recompensa y regulación emocional, con alteraciones estructurales distintas en áreas prefrontales. CONCLUSIONES: Existe contundente evidencia de la co-existencia de AS en los TCA. No obstante, es necesario continuar desarrollando modelos de investigación que integren realmente los procesos genéticos, hormonales, neurotransmisores, de personalidad y socioculturales de riesgo.

BACKGROUND: A history of childhood sexual abuse (SA) or adolescence in eating disorders (ED) is documented in clinical experience and in the literature. However, the complex relationships between both conditions have not been systematized. OBJECTIVE: To describe the clinical and neurobiological relationship between SA and ED. METHOD: The specialized literature in texts and articles included in Medline/PubMed, SciELO was thoroughly analysed. Central concepts were outlined and information was written seeking didactic cohesion, including an illustrative clinical case. RESULTS: Although SA is a nonspecific factor for the development of mental disorders, it constitutes a significant predisposing, triggering and perpetuating phenomenon for the emergence of ED, mainly bulimia nervosa. Risk, mediator, predictor, protective and resilience factors are described. Both specific conditions show analogous neurobiological and clinical correlates (core symptoms and adaptive functions). Similar dysfunctions exist in reward and emotional regulation circuits, with limited structural disturbances in prefrontal areas. CONCLUSIONS: There is strong evidence of the coexistence of SA in ED. However, it is necessary to develop research models that truly integrate genetic, hormonal, neurotransmitter, personality and sociocultural risk processes.

Perspectivas de estudio sobre el comportamiento suicida en niños y adolescentes: Una revision sistemática de la literatura utilizando la teoría de grafos / Perspectives on the Study of Suicidal Behavior in Children and Adolescents: A Systematic Review of the Literature Using Graph Theory

Resumen En las últimas décadas se ha incrementado el número de investigaciones sobre el comportamiento suicida en la infancia y la adolescencia, sin embargo, no existen trabajos en la actualidad que caractericen la producción científica en perspectivas de estudio. El objetivo de este artículo es realizar una revisión sistemática de las principales perspectivas de estudio sobre el comportamiento suicida en niños y adolescentes, poniendo énfasis en los principales factores de riesgo a nivel biopsicosocial, predictores clínicos y modelos explicativos. La búsqueda bibliográfica se efectuó en la base de datos Web of Science. Para el manejo de la información se emplearon las herramientas Sc12 Tool y Gephi. Se encontraron tres perspectivas dominantes de estudio, enfocadas a: (1) el análisis de los predictores psiquiátricos de la conducta suicida, (2) la relación entre autolesión no suicida y la conducta suicida y (3) el abuso infantil y su relación con la conducta suicida. Se espera que este estudio contribuya a la comprensión de las múltiples aristas investigativas sobre el comportamiento suicida en la infancia y la adolescencia. Al mismo tiempo, la metodología utilizada enriquece el campo de estudio al reflejar con precisión su situación actual a nivel investigativo.

Abstract In the last decades, the number of research on suicidal behavior in childhood and adolescence has increased, however, there are no studies at present that characterize the scientific production in research perspectives. The objective of this article is to perform a systematic review of the main perspectives of study on suicidal behavior in children and adolescents, emphasizing the main risk factors at the biopsychosocial level, clinical predictors, and explanatory models. The bibliographic search was carried out in the Web of Science database. For the management of the information, a citation and clustering analysis was undertaken by means of graph theory. The tools Sc12 Tool and Gephi were used. Three dominant research orientations focused on the analysis of psychiatric predictors of suicidal behavior (i), the relationship between non-suicidal self-injury and suicidal behavior (2), and child abuse and its relationship with suicidal behavior (3). It is hoped that this study will contribute to the understanding of the multiple research questions about suicidal behavior in childhood and adolescence. At the same time, the used methodology enriches the field of study by accurately reflecting its current status at the research level.

Vítimas de maus-tratos, negligência ou abandono em estado do Nordeste Brasileiro / Victims of bad treatment, negligence or abandonment in a Northeast Brazilian state / Víctimas de malos tratos, descuido o abandono en un estado del Noreste del Brasil

Objetivo: descrever a situação epidemiológica de pessoas que foram vítimas de maus-tratos, negligência ou abandono em um estado do nordeste brasileiro. Método: Trata-se de estudo exploratório e descritivo, com abordagem quantitativa e dados retrospectivos, desenvolvido com dados obtidos do Sistema de Informação de Agravos de Notificação. Resultados: A população compreendeu pessoas atendidas e notificadas nos serviços próprios e conveniados ao Sistema Único de Saúde, por causas de maus-tratos, negligência ou abandono, entre 2015 e 2018. Observou-se que a maior parte era do sexo feminino (59,6%), na faixa etária de até 9 anos (56,4%) e residentes da zona urbana (79,1%). Quanto as pessoas que cometeram maus-tratos, negligência ou abandono, a maioria era do sexo feminino, não havia ingerido bebida alcóolica e a violência foi motivada por conflito geracional (20%). Conclusão: Evidenciou-se a necessidade de políticas públicas que proteja as crianças e as pessoas que estão em situação de vulnerabilidade.(AU)

Objective: describes an epidemiological situation of people who have been victims of abuse, neglect or abandonment in a state in northeastern Brazil. Method: This is an exploratory and descriptive study, with a quantitative approach and retrospective data, developed with data obtained from the Notifiable Diseases Information System. Results: The population comprised people attended and notified in the services themselves and under the Unified Health System, due to maltreatment, neglect or abandonment, between 2015 and 2018. It was observed that the majority were female (59, 6%), aged up to 9 years (56.4%) and residents of the urban area (79.1%). As for people who committed abuse, neglect or abandonment, the majority were female, had not drunk alcohol and violence was motivated by generational conflict (20%). Conclusion: The need for public policies to protect children and people who are in a situation of vulnerability was highlighted.(AU)

Objetivo: describe una situación epidemiológica de personas que han sido víctimas de abuso, negligencia o abandono en un estado del noreste de Brasil. Método: Se trata de un estudio exploratorio y descriptivo, con enfoque cuantitativo y datos retrospectivos, desarrollado con datos obtenidos del Sistema de Información de Enfermedades Notificables. Resultados: La población estuvo conformada por personas atendidas y notificadas en los propios servicios y en el Sistema Único de Salud, por maltrato, negligencia o abandono, entre 2015 y 2018. Se observó que la mayoría eran mujeres (59, 6%), de hasta 9 años (56,4%) y residentes del casco urbano (79,1%). En cuanto a las personas que cometieron maltrato, abandono o abandono, la mayoría eran mujeres, no habían bebido alcohol y la violencia estuvo motivada por conflicto generacional (20%). Conclusión: Se destacó la necesidad de políticas públicas para proteger a la niñez y a las personas en situación de vulnerabilidad.(AU)

Depoimento especial a partir de opiniões de psicólogos brasileiros atuantes nessa prática / Views of brazilian psychologists on children's testimony / Testimonio especial a partir de las opiniones de psicólogos brasileños que actúan en esta práctica

O Depoimento Especial (DE) é uma prática de oitiva de crianças e adolescentes no âmbito judiciário, normalmente acompanhado por psicólogos. Objetivou-se conhecer opiniões de psicólogos brasileiros que atuavam no DE sobre essa prática. Foi realizada uma pesquisa qualitativa exploratória transversal on-line, por meio de ferramentas digitais (e.g., Skype, Whatsapp). Dez psicólogos brasileiros, de seis diferentes estados, atuantes no DE, responderam a uma ficha de dados sociodemográficos e a uma entrevista semiestruturada. As entrevistas foram estudadas a partir da análise temática. Evidenciaram-se seis temas, sendo eles: papel profissional, trabalho interdisciplinar, sentimentos, agilidade, proteção e legislação. Tomados em conjunto, esses temas indicam o DE como ágil e protetivo para as crianças e adolescentes vítimas de violência sexual, salientando possíveis desafios à sua efetivação. Os resultados obtidos possibilitam maior conhecimento sobre a prática do DE e podem ser utilizados em futuras revisões dessa prática. (AU)

Special Testimony is a method of judicial hearing of children and adolescents in Brazil, usually accompanied by psychologists. The objective of the present study was to know the opinions of Brazilian psychologists who work with children's testimony about this practice. A cross-sectional exploratory qualitative research was conducted using digital tools such as Skype and Whatsapp. A total of 10 Brazilian psychologists, from six different states, working with Special Testimony completed a socio-demographic questionnaire and a semi-structured interview. The interviews were analyzed according to the Thematic Analysis. Six themes were highlighted: professional role, interdisciplinary work, feelings, swiftness, protection, and legislation. Taken together, these themes indicate that the Special Testimony is swift and protective for children and adolescents victims of sexual violence, highlighting possible challenges to its implementation. The results obtained provided more knowledge about the Special Testimony and can be used in future revisions of this practice. (AU)

El Testimonio Especial (DE) es una práctica de escucha de niños y adolescentes en el ámbito judicial, generalmente, acompañados por psicólogos. La finalidad fue conocer las opiniones de psicólogos brasileños, que trabajan con el Testimonio Especial sobre esta práctica. Se realizó una investigación cualitativa exploratoria transversal en línea utilizando herramientas digitales (e.g., Skype, WhatsApp). Diez psicólogos brasileños actuantes en el DE, provenientes de seis diferentes provincias, respondieron a una ficha de datos sociodemográficos y una entrevista semiestructurada. Las entrevistas se analizaron a partir del análisis temático, destacando seis temas: rol profesional, trabajo interdisciplinario, sentimientos, agilidad, protección y legislación. En conjunto, estos temas apuntaron el DE como ágil y protectivo para los niños y adolescentes víctimas de violencia sexual, evidenciando posibles retos para su implementación. Los resultados obtenidos posibilitan un mayor conocimiento sobre la práctica del Testimonio Especial y pueden ser utilizados en futuras revisiones de esta práctica. (AU)

Childhood maltreatment and social functioning in psychotic disorders: a systematic review protocol.

Background: Childhood maltreatment (CM) is thought to play a key role in the etiology and course of psychotic disorders (PD). In addition, CM is related to neurobiological and clinical characteristics that can lead to poor social functioning. However, the extent to which CM and social functioning are directly associated in individuals with PD, is unclear. Therefore, we aim to systematically review the literature to provide an estimate on the strength of the association between CM and different domains of social functioning in PD and to summarize potential moderators and mediators of this association.Methods and analysis: To identify relevant studies, we will systematically search the following databases: Pubmed (Medline), PsycInfo, Embase, Web of Science (Core Collection), and Pilots (trauma), manually search reference lists and contact experts in the field. Studies will be included if they investigate and report on the association between CM (exposure) and social functioning (outcome) in adults with PD. Two independent reviewers will screen titles, abstracts and full texts according to eligibility criteria, perform data extraction and assess study quality according to a modified version of the Newcastle-Ottawa Scale.Analysis: Effect estimates will be pooled in a meta-analysis. Heterogeneity and publication bias will be assessed and the effects of potential moderators (genetic factors, type of diagnosis, duration of illness, type of CM and age at the time of CM exposure) will be analyzed using meta-regressions. Candidate moderators and mediators (neurocognition, cognitive schemas, comorbidities, stress sensitivity, attachment) will be also examined qualitatively.Ethics and dissemination: Because this review will make use of already published data, ethical approval will not be sought. This work has the potential to inform upcoming investigations on the association between the exposure to CM in PD and social functioning. PROSPERO registration number CRD42020175244.

The first systematic review (and meta-analysis) of the association between CM and different domains of social functioning in individuals with PD.Evidence on both moderators and mediators of the association is summarized.

Trauma Craniano Violento (TCV): Relação entre Conhecimento de Pais, Potencial de Abuso Infantil e Status Socioeconômico Familiar / Abusive Head Trauma (AHT): Relationship between Knowledge of Parents, Child Abuse Potential and Family Socioeconomic Status

Resumo Descreve a relação entre conhecimento sobre Trauma Craniano Violento (TCV), status socioeconômico e potencial de maus-tratos infantis. Dezenove pais e 61 mães responderam aos instrumentos Escala de Atitudes Frente ao Choro do Bebê, Inventário de Potencial de Abuso Infantil e Questionário Socioeconômico. A correlação de Spearman demonstrou resultados significativos entre escolaridade e renda com crenças sobre cuidados com o bebê (r = 0,32, p = 0,004; r = 0,22, p = 0,05, respectivamente), poder aquisitivo e escolaridade com conhecimentos sobre choro infantil (r = -0,40, p<0,001; r = -0,22, p = 0,05, respectivamente), número de filhos com estratégias para lidar com choro (r = -0,29, p = 0,01) e rigidez com consequências de sacudir o bebê e crenças sobre cuidados com o bebê (r = -0,29, p = 0,008; r = -0,359, p = 0,001, respectivamente). Considera importante direcionar intervenções às necessidades de cada população e trabalhar a flexibilidade parental para reduzir o TCV.

Abstract Describes the relationship between knowledge on Abusive Head Trauma, socioeconomic status and child abuse potential. 19 parents and 61 mothers filled out the following instruments: Attitudes Towards Infant Crying Scale, Child Abuse Potential Inventory and Socioeconomic Questionnaire. Spearman's correlation found significant results: schooling and income showed correlation with beliefs about infant care (r = 0,32, p = 0,004; r = 0,22, p = 0,05 respectively), purchasing power and schooling correlated with knowledge on infant crying (r = -0,40, p<0,001; r = -0,22, p = 0,05 respectively), number of children correlated with strategies for coping with baby crying (r = -0,29, p = 0,01) and rigidity with consequences of shaking a baby and beliefs (r = -0,29, p = 0,008; r = -0,36, p = 0,001 respectively). It is important to target interventions to the needs of each population and to work with parental flexibility to reduce the incidence of AHT.

Association between sleep disorders and child violence assessed in Southern Brazil / Associação entre distúrbios do sono e violência infantil avaliada no Sul do Brasil

Aims: identifying sleep disorders (SDs) in children who experienced child maltreatment. Methods: the study evaluated the sleep pattern of 123 children (from 2 to 10 years old), who received assistance with child maltreatment, based on the Children's Sleep Habits Questionnaire (CSHQ) ­ applied in a medical consultation after confirmation of the veracity of the child's report of a violation. The study applied the questionnaire to children seen by doctors in the sector for 11 months. Results: among the children evaluated, 66.7% had SDs. The sample profile was predominantly female (59.3%) and aged between 4 and 7 years old (48.8%). Physical violence was found in 40.7% of the children, in addition to sexual (35.8%), psychological (24.4%), negligence (14.6%) and other types of violence (OTV) (4.5%). SDs are significantly associated with sexual, psychological and OTV (p=0.016). Regarding the subscales, there was a significant difference between the age groups in the bedtime resistance (BR) factor score (p=0.033). The BR characteristic typifies sexual, psychological and OTV. Sleep anxiety (SA) typifies more psychological, sexual and OTV. Night awakenings (NAs) typify psychological, sexual and physical violence. According to the type of violence, significant differences were found in SA (p=0.039), NAs (p=0.026) and BR (p=0.004). Conclusions: the outcomes highlight the association between SDs and child maltreatment. Certain types of violence have a greater negative impact on children's sleep and correlate with specific SD.

Objetivos: identificar distúrbios do sono em crianças que sofreram maus-tratos infantis. Métodos: o estudo avaliou o padrão de sono de 123 crianças (de 2 a 10 anos) atendidas por relatos de maus-tratos, com base no Questionário de Hábitos de Sono Infantil (CSHQ) ­ aplicado em uma consulta médica após confirmação da veracidade do relato de violação da criança. O estudo aplicou o questionário a crianças atendidas no setor durante o período de 11 meses. Resultados: dentre as crianças avaliadas, 66,7% apresentavam distúrbios do sono. O perfil da amostra foi predominantemente feminino (59,3%) e com idade entre quatro e sete anos (48,8%). Violência física foi encontrada em 40,7% das crianças, além de sexual (35,8%), psicológica (24,4%), negligência (14,6%) e outros tipos de violência (4,5%). Os distúrbios do sono estão significativamente associados à violência sexual, psicológica e a outros tipos de violência (OTV) (p=0,016). Em relação às subescalas, houve diferença significativa entre as faixas etárias nos escores de resistência em ir para a cama (p=0,033). A característica resistência em ir para a cama tipifica a violência sexual, psicológica e OTV. Ansiedade do sono tipifica mais a violência psicológica, sexual e OTV. O despertar noturno tipifica a violência psicológica, sexual e física. De acordo com o tipo de violência, foram encontradas diferenças significativas na ansiedade do sono (p=0,039), despertar noturno (p=0,026) e resistência em ir para a cama (p=0,004). Conclusões: os resultados evidenciam a associação entre distúrbios do sono e violência infantil. Certos tipos de violência têm um impacto negativo maior no sono infantil e se correlacionam a distúrbios do sono específicos.