Recognition of child physical abuse by a group of Brazilian primary care health professionals.

BACKGROUND: Child maltreatment is a complex social and public health problem. AIM: To evaluate the frequency of the recognition by Brazilian health professionals in primary care of child physical abuse (CPA) and associated factors. DESIGN: A representative cross-sectional study was conducted with dentists, nurses, family physicians, and pediatricians who participated in the network of the Family Health Strategy in the city of Belo Horizonte, Brazil. Data collection involved in the administration of a questionnaire validated for use in Brazil. Data were collected from 181 dentists, 235 nurses, 203 family physicians, and 96 pediatricians. RESULTS: Among the 715 health professionals, 499 (69.8%) had some type of postgraduate degree and 414 (57.9%) recognized suspected or proved cases of CPA. The recognition was associated with occupation, as pediatricians recognized 14.11-fold [OR = 14.11 (95% CI: 3.73 to 53.43)] more cases of CPA compared with dentists. The recognition was also associated with a longer period of time working in the city [OR = 2.79 (95% CI: 1.24 to 6.29)]. CONCLUSION: The recognition of cases was positively associated with the longer working time in the municipal network and with pediatricians. The dentist was the category that was least associated with the recognition of CPA.

Frequência de identificação e notificação de abuso físico infantil por profissionais da Estratégia Saúde da Família e relação com fatores socioeconômicos / Identifying and reporting child physical abuse by professionals of the Family Health Strategy and associated factors

Objetivo: Avaliar a frequência de identificação e notificação de abuso físico infantil (AFI) por profissionais da Estratégia Saúde da Família (ESF) e fatores associados em regionais com diferente vulnerabilidade social de Belo Horizonte, Brasil. Métodos: Trata-se de um estudo transversal com amostra de conveniência de pediatras, dentistas, médicos da família e enfermeiros, de dois distritos da ESF de Belo Horizonte, Brasil. Os distritos foram selecionados tomando como referência os índices de vulnerabilidade social. Os profissionais foram convidados a responder um questionário autoaplicável desenvolvido na Universidade de Londres, adaptado para o uso no Brasil. Foram realizadas análises descritivas e analíticas, utilizando o teste qui-quadrado de Pearson (p<0,05). Resultados: Participaram do estudo 144 profissionais: 35 (24,3%) dentistas, 46 (31,9%) enfermeiros, 45 (31,2%) médicos da família e 18 (12,5%) pediatras. Do total, 86 (59,7%) profissionais já identificaram algum caso de AFI na experiência profissional, mas apenas 38 (26,4%) notificaram às autoridades. A identificação e notificação estiveram associadas à categoria profissional (p <0,001) e aos profissionais que realizaram pós-graduação com enfoque na criança (p < 0,001). A vulnerabilidade das regionais não esteve associada à identificação e notificação dos casos de AFI (p = 0,754). Conclusão: A identificação e notificação de casos de AFI associaram-se aos profissionais com formação voltada para o atendimento da criança e com a categoria profissional, sendo o pediatra e o enfermeiro os que mais identificaram e notificaram. A vulnerabilidade social da regional não esteve associada com a identificação e notificação.(AU)

Aim: To evaluate the frequency of identification and report of child physical abuse (CPA) by professionals of the Family Health Strategy (FHS) and associated factors in regional health clinics with different social vulnerabilities in Belo Horizonte, Brazil. Methods: This is a cross-sectional study with a convenience sample of dentists, nurses, family doctors and pediatricians from two districts in Belo Horizonte, Brazil. The districts were selected based on the social vulnerability index (SVI). The professionals were invited to answer a self-administered questionnaire, which was developed at the University of London and adapted for use in Brazil. Descriptive and analytical analyses were performed using Pearson's chi-square test (p <0.05). Results: A total of 144 professionals participated: 35 (24.3%) dentists, 46 (31.9%) nurses, 45 (31.2%) family doctors, and 18 (12.5%) pediatricians. Out of this total, 86 (59.7%) professionals had already identified some case of CPA in their professional experience, but only 38 (26.4%) had reported it to the authorities. The identification and reporting were associated with the professional category (p <0.001) and professionals who had done postgraduate studies focused on children (p <0.001). The vulnerability of regional health clinics was not associated with the identification and notification of the cases from the CPA (p = 0.754). Conclusion: The identification and reporting of CPA were associated with the professionals with training focused on the child care and the professional category, with pediatricians and the nurses representing the professionals who most identified and notified cases. The regional social vulnerability was not associated with identification and reporting.(AU)

Frequência de identificação e notificação de abuso físico infantil por profissionais da Estratégia Saúde da Família e relação com fatores socioeconômicos / Frequency of identification and report of child physical abuse by professionals of the family health strategy and association factors

O presente estudo objetivou avaliar a frequência da identificação e da notificação dos casos de abuso físico infantil pelos profissionais da Estratégia de Saúde da Família (Médicos Generalistas, Enfermeiros, Cirurgiões Dentistas e Médicos Pediatras) vinculados à Secretaria Municipal de Saúde do Município de Belo Horizonte, Minas Gerais. Para fins administrativos e de gestão, o território Municipal é dividido em nove Regionais administrativas: Norte, Pampulha, Venda Nova, Nordeste, Leste, Oeste, Centro-Sul, Barreiro e Noroeste. Neste estudo, apenas os profissionais lotados nas Regionais Venda Nova e Centro-Sul foram avaliados, sendo estes um total de 320 profissionais (103 Médicos Generalistas, 125 Enfermeiros, 61 Cirurgiões Dentistas e 31 Pediatras). Foi realizado cálculo amostral para determinação da amostra por sorteio simples, respeitando-se a proporção de profissionais em cada distrito sanitário, sendo a amostra representativa para estes profissionais constituída por 45 Médicos Generalistas, 46 Enfermeiros, 35 Cirurgiões Dentistas e 18 Pediatras, no total de 144 profissionais. Para a coleta de dados foi utilizado um questionário autoaplicável, desenvolvido na Universidade de Londres (Lazenbatt e Freeman, 2008), o qual foi adaptado transculturalmente e validado para uso no Brasil por Silva-Oliveira et al., (2014). A coleta dos dados foi realizada no período compreendido entre Agosto de 2014 à Setembro de 2015. Os dados levantados foram submetidos à análise estatística, realizada pelo teste Qui-quadrado de Pearson. Do total de participantes, 86 (59,7%) já identificaram algum caso de abuso físico infantil (AFI), entretanto apenas 38 (26,4%) já notificaram algum caso em sua experiência profissional. A identificação e a notificação estiveram associadas a categoria profissional (p< 0,001) e aos profissionais que realizaram pós-graduação com enfoque na criança (p<0,001). A vulnerabilidade das regionais não esteve associada à identificação e notificação de casos de abuso físico infantil (p= 0,754). A identificação e a notificação de casos de abuso físico infantil associaram-se aos profissionais com formação voltada para o atendimento da criança e com a categoria profissional, sendo o pediatra e o enfermeiro os que mais identificaram e notificaram. A vulnerabilidade social da regional não esteve associada com a identificação e notificação.

This study aimed to evaluate the frequency of identification and notification of child physical abuse (CPA) by Primary Health Care professionals (Dentists, Physicians, Nurses and Pediatrics) belonging to Municipal Secretary of Health crowded in 2 lager regions called "North" and "Pampulha" in Belo Horizonte City, Minas Gerais/Brazil. For administrative purposes, Belo Horizonte City has your geographic space divided in nine regions named: Norte, Pampulha, Venda Nova, Nordeste, Leste, Oeste, Centro-sul, Barreiro e Noroeste. In this study, only professionals crowded in regions Venda Nova and Centro-Sul was evaluate, these being a total of 320 professionals (103 Physicians, 125 Nurses, 61 Dentists and 31 Pediatrics). Sample calculation was performed to determine the sample by simple lottery, being proportional to professionals in each regions and this sample was constituted by 45 Physicians, 46 Nurses, 35 Dentists and 18 Pediatrics, in a total of 144 professionals. A questionnaire designed by a team from the University of London (Lazenbatt e Freeman, 2008) adapted by Silva-Oliveira et al., (2014) was used for data collection. The data was collected between August 2014 and September 2015. The frequency distribution and associations between the variables were analyzed using the Chisquare Pearson's Test at a 5% significance level. The analysis of 114 questionnaires filled by health professional participants showed that 86 (59,7%) have identified cases of CPA. However only 38 (26,4%) have reported cases in their professional experience. The identification and reporting were assciated with the professional category (p< 0.001) and professionals who had done postgraduate studies focused on children (p< 0.001). The vulnerability of regional health clinics was not associated with the identification and notification of the cases from the child physical abuse (P= 0.754). The identification and reporting of child physical abuse were associated with the professional category, with training focused on the child care and professional category, with pediatricians and the nurses representing the professionals who most identified and notified cases. The regional social vulnerability was not associated with identification and reporting.

DNA methyltransferase expression in odontogenic cysts and tumours.

Epigenetic silencing of gene expression by promoter CpG island hypermethylation is promoted by the enzymes, DNA methyltransferases (DNMTs). DNMT3a is mainly involved in de novo methylation, whereas DNMT1 acts mainly as a maintenance methyltransferase. The purpose of this study was to investigate the immunoexpression of DNMT1 and DNMT3a in a set of odontogenic cysts and tumours. Formalin-fixed and paraffin-embedded tissue samples of eight radicular cysts, 10 odontogenic keratocysts (OKC), eight adenomatoid odontogenic tumours (AOT), 16 ameloblastomas and eight samples of normal mucosae were included in the study. The DNMT1 and DNMT3a proteins were identified by using a highly sensitive polymer-based system. We found that the normal oral mucosa, OKC, AOT, radicular cyst and ameloblastomas samples showed a widespread nuclear and cytoplasmic immunopositivity for DNMT1. Some radicular cysts, ameloblastomas, AOT and OKC samples presented a positive cytoplasmic reaction for DNMT3a, while negative staining was observed in the normal oral mucosa. Nuclear positivity was found only in the suprabasal cell layers of three OKC samples. Our study shows an increased expression of DNMT3a in odontogenic cysts and tumours, confirming that epigenetic mechanisms are involved in the development of these tumours.