Prevention of Violence Against Children: A Qualitative Exploration of Colombian Policymakers', Programme Facilitators' and Caregivers' Perceptions.

OBJECTIVE: Violence against children (VAC) is a global public health and human rights issue that can lead to long-lasting negative consequences for individual and societal outcomes. While extensive evidence indicates that parenting programmes might be effective in preventing VAC, there are several unsolved questions on how to ensure interventions are acceptable, feasible, effective and sustainable, particularly in low- and- middle-income countries (LMICs). METHOD: In this study, we report findings from a qualitative examination of policymakers' (N = 10), early childhood and parenting programme facilitators' (N = 20) and parents' and other caregivers' (N = 38) perspectives on VAC prevention to examine the implementation ecosystem of parenting programmes in Colombia, including contextual risk and protection factors, features of existing programmes, and stakeholders' needs. We conducted interviews and focus groups using a semistructured format, along with a thematic approach, to analyse the data from each group of participants (i.e., policymakers, facilitators and caregivers) independently. RESULTS: Overall, the data revealed the critical role of intersecting and interacting factors at the micro (e.g., caregivers' capabilities and beliefs), meso (e.g., programme content and delivery approaches) and macro (e.g., policymakers' vision and existing infrastructure) levels in exacerbating risks/imposing barriers versus protecting/promoting VAC prevention. CONCLUSIONS: These findings provide evidence on the implementation ecosystem of prevention programmes to inform the design of novel strategies and programmes aimed at preventing violence and promoting families' well-being and young children's development.

Proposal of a Knowledge Management Model for Complex Systems: Case of the Supervision and Control Subsystem of the Colombian Health System.

BACKGROUND: Considering regulatory, supervision, and control health policy, an innovative knowledge management model is proposed for the Colombian health system, which is recognized as a complex system. METHODS: A model is constructed through a comparative analysis of various theoretical and conceptual frameworks, and an original methodology is proposed based on an analysis of the macroprocesses of the Supervision and Control System (SSC) of the Colombian General Social Security System in Health (SGSSS). After formulating hypotheses and conceptual references, information errors are determined within the different macroprocesses of the SGSSS, including those of governance and the SSC. RESULTS: The risks of generating duplicate, wrong, hidden, or non-existent information arise when the associated regulations need more specificity to be applied in all cases, thus leading to the risk of different interpretations by some actors. In this way, it is possible to hinder the generation of unified information, as there is no clarity as to who is responsible for the generation or creation of certain data. CONCLUSIONS: The proposed model is characterized by its flexibility and adaptability, integrating several processes that can be executed simultaneously or cyclically (depending on the system's needs) and allowing for the generation and feedback of knowledge at different stages, with some processes simultaneously executed to complement each other.

The acute effects of community violence on young children's regulatory, behavioral, and developmental outcomes in a low-income urban sample in Brazil.

BACKGROUND: Existing research on the impacts of adversity on young children's psychological well-being has largely focused on household-level risk factors using observational methods in high-income countries. This study leverages natural variation in the timing and location of community homicides to estimate their acute effects on the regulatory, behavioral, and developmental outcomes of Brazilian 3-year-olds. METHODS: We compared the outcomes of children who were assessed soon after a recent neighborhood homicide to those of children from the same residential neighborhoods who had not recently experienced community violence. Our sample included 3,241 3-year-olds (Mage = 41.05 months; 53% female; 45% caregiver education less than middle school; 26% receiving a public assistance program) from seven neighborhoods in São Paulo, Brazil. Child outcome measures included parent reports of effortful control and behavior problems as well as direct assessments of children's developmental (cognitive, language, and motor) skills. Community homicides were measured using police records. RESULTS: Recent exposure to community homicides was associated with lower effortful control, higher behavior problems, and lower overall developmental performance for children (d = .05-.20 standard deviations; p = ns - <.001). Effects were consistent across subgroups based on sociodemographic characteristics and environmental supports, but generally largest when community violence exposure was geographically proximal (within 600 m of home) and recent (within 2 weeks prior to assessment). CONCLUSIONS: Results highlight the pervasive effects that community violence can have on young children as well as the need to expand support to mitigate these effects and prevent inequities early in life.

The Apapacho Violence Prevention Parenting Program: Conceptual Foundations and Pathways to Scale.

Violence against children (VAC) is a major global issue with long-lasting negative consequences on individuals and societies. The present study presents a review of the literature on drivers of VAC and the core components of evidence-based violence prevention programs. Moreover, it analyzes the existing services and social infrastructure in Colombia to rigorously inform the design of the Apapacho violence prevention parenting program for families with children younger than five targeted toward Colombia. Findings indicate that (1) VAC in Colombia is a multidimensional issue with roots at the individual, family, community, and society levels, (2) evidence-based violence prevention programs share a common set of content and delivery strategies that could inform the components of the Apapacho program, and (3) there is an urgent need for scalable and flexible violence prevention programs for families with young children in Colombia. Considering existing evidence, the Apapacho violence prevention parenting program will be designed using ecological, developmental, and neuroscience-informed perspectives. This article concludes by presenting the initial components of the theory of change and discussing future directions for the design of the Apapacho program and other violence prevention interventions in LMICs.

Molecular profiling of papillary thyroid carcinomas in healthcare workers exposed to low dose radiation at the workplace.

PURPOSE: Exposure to ionizing radiation, especially during childhood, is a well-established risk factor for thyroid cancer. The vast majority of radiation-induced cancers are papillary carcinomas (PTCs). These tumors typically have gene fusions in contrast to point mutations prevalent in sporadic PTCs. The aim of this study was to investigate the molecular profiles of PTC patients with workplace exposure to ionizing radiation. METHODS: A retrospective review of 543 patients who underwent surgery with diagnosis of PTC was performed. A cohort of nine healthcare specialists previously exposed to radiation sources during their professional practice was selected and analyzed using the ThyroSeq mutation panel for point mutations and gene fusions associated with thyroid cancer. RESULTS: The molecular analysis of surgical samples of PTCs was informative and revealed genetic alterations in five patients. BRAF V600E was found in four (67%) cases whereas RET/PTC1 fusion in one (17%) and one sample (17%) was wild type for point mutations and fusions. One sample completely failed molecular analysis while two others were negative for genes fusions but failed DNA analysis; these three samples were excluded. CONCLUSIONS: In this limited cohort of healthcare workers exposed to low dose of ionizing radiation at the workplace and developed PTC, the molecular profiling determined BRAF V600E point mutation as the most common event, arguing against the role of workplace radiation exposure in the etiology of these tumors.

Maternal knowledge, stimulation, and early childhood development in low-income families in Colombia.

Theoretical models assume that parental knowledge about child development and caregiving motivates parental stimulation, shaping child development. Evidence supporting these models is scarce in low- and middle-income countries (LMICs). This study tests the relations between maternal knowledge, stimulation, and child development in a Colombian sample of 1,277 low-income mothers and their children under the age of five. Mothers showed diverse knowledge about child development and caregiving. Moreover, maternal knowledge when children were 9-26 months old indirectly predicted growth in children's cognitive, receptive language, and gross motor skills at ages 27-46 months, partially through maternal engagement in stimulating activities with the child.

Improving the Measurement of Children's Mental Health Problems in Colombia with Item Response Theory / Cómo mejorar la medición de los problemas de salud mental en los niños colombianos mediante la Teoría de Respuesta al Ítem / Como melhorar a medição dos problemas de saúde mental nas crianças colombianas a partir da Teoria de Resposta ao Item

Abstract The present study examines the psychometric properties of the mental health scale for children used in the 2015 Colombian Mental Health Survey. To do so, a nationally representative sample of 2,727 children is used Mage=8.99; range=7-11, with reports from their main caregivers regarding 26 mental health problem symptoms taken from the Reporting Questionnaire for Children (RQC), Child Behavior Checklist (CBCL), and the Brief Screening and Diagnostic Questionnaire (CBTD). Classical test theory and factor analysis were conducted to analyze the classical location and information of each item, along with the dimensionality, reliability, and convergent validity of the scale. Item Response Theory (IRT) was used in order to estimate theoretically invariant item parameters for location and information. Findings reveal that the mental health scale for children has adequate psychometric properties for its use in Colombia. Furthermore, IRT analyses reveals a set of items that maximize information and that may be used in future administrations when more efficiency is warranted.

Resumen El estudio examina las propiedades psicométricas de la escala de salud mental para niños utilizada en la Encuesta Nacional de Salud Mental Colombia del 2015. Se utilizó una muestra representativa a nivel nacional de 2,727 niños M age =8.99; rango=7-11, con informes proporcionados por sus cuidadores principales respecto de los síntomas de 26 problemas de salud mental tomados del Cuestionario de Reporte para Niños (RQC), el Inventario de Comportamiento de Niños (CBCL) y el Cuestionario Breve de Tamizaje y Diagnóstico (CBTD). Se emplearon la Teoría Clásica de los Tests y el análisis factorial para analizar la localización clásica y la información de cada ítem, así como la dimensionalidad, la confiabilidad y la validez convergente de la escala. Además, se utilizó la Teoría de Respuesta al Ítem (TRI) para calcular los parámetros de ítem teóricamente invariables para localización e información. Los resultados muestran que la escala de salud mental para niños tiene propiedades psicométricas adecuadas para su uso en Colombia. Además, los análisis TRI revelan un conjunto de ítems que maximizan la información y pueden ser usados en administraciones futuras en las que se requiera mayor eficiencia.

Resumo Este estudo analisa as propriedades psicométricas da escala de saúde mental para crianças utilizada na Pesquisa Nacional de Saúde Mental Colombiana de 2015. Foi utilizada uma amostra representativa no âmbito nacional de 2,727 crianças m age =8.99' faixa etária=7-11, com informações fornecidas por seus cuidadores principais a respeito dos sintomas de 26 problemas de saúde mental tomados do Reporting Questionnaire for Children, do Inventário de Comportamentos de Crianças e Adolescentes (Child Behavior Checklist) e do Questionário Breve de Rastreamento e Diagnóstico. Foram utilizadas a Teoria Clássica dos Testes e a análise fatorial para analisar a localização clássica e a informação de cada item, bem como a dimensionalidade, a confiabilidade e a validade convergente da escala. Além disso, a Teoria de Resposta ao Item (TRI) para calcular o padrão de cada item teoricamente invariável para localização e informação. Os resultados indicam que a escala de saúde mental para crianças tem propriedades psicométricas adequadas para seu uso na Colômbia. Ainda, as análises com a TRI revelam um conjunto de itens que maximizam a informação e podem ser usados futuramente com mais eficácia.

Exposure to community violence and Children's mental Health: A quasi-experimental examination.

RATIONALE: Community violence and mental health problems are global health concerns. Yet, assessing the causal links between community violent crime and mental health is challenging due to problems of selection bias. OBJECTIVE: This study examines the link between community violent crime and children's mental health problems, as well as the moderating role of parents' mental health. METHOD: The study employs a representative sample of 404 children (Mage=8.99, range=7-11) from Bogotá, Colombia, as well as longitudinal geocoded data on violent crimes from the national police. To account for problems of selection bias, the empirical strategy exploits naturalistic exogenous variation in the timing and location of an incident of violent crime relative to assessment of children's mental health problems, combined with matching techniques. RESULTS: Findings suggest an incident of violent crime in close proximity to children's homes is associated, on average, with increases in children's mental health problems by 0.28-0.38 SD; having parents with worse mental health exacerbates children's problems. Results from sensitivity checks and falsification tests further support the internal validity of the findings. CONCLUSIONS: Collectively, the results from the present study and those of previous research suggest that community violent crime has the potential to affect local residents negatively beyond direct victims, placing a heavy burden on individuals and society.

Acute exposure to violent neighborhood crime and depressive symptoms among older individuals in Colombia.

To assess the association between acute exposure to neighborhood violent crimes and depression we combined representative, individual-level and geo-coded data for individuals aged 60 years and above living in four major cities in Colombia from the 2010 Demographic and Health Survey (DHS) with objective information on the timing and location of violent crimes. Exploiting spatial and temporal variation in the occurrence of crimes we find that being acutely exposed to a violent crime is positively associated with the number of depressive symptoms.

The Latent Threat of Community Violence: Indirect Exposure to Local Homicides and Adolescents' Mental Health in Colombia.

This study examines the relation between adolescents' indirect exposure to local homicides and mental health disorders and post-traumatic stress disorder (PTSD) symptoms. We employ a sample of 300 adolescents ( Mage=14.52,range=12-17) representative for Bogotá, Colombia, and geocoded data on violent crimes recorded by the national police. Findings show that one SD increment in local homicides is associated with increments by 0.17 SD in the mental health disorder index and a 0.14 SD increase in the PTSD score index, even after accounting for adolescents' direct exposure to violence. The estimated effect for PTSD was larger for adolescents' who were directly exposed to violence and for those living in multidimensionally poor households, whereas no detectable effects were found for adolescents who perceived their residential neighborhood as relatively safe.

Civil conflict, domestic violence, and poverty as predictors of corporal punishment in Colombia.

BACKGROUND: With lingering effects from more than 50 years of war, young children in Colombia are exposed to multiple risk factors such as poverty, civil conflict, and domestic violence. In addition to these environmental stressors, public and legal support for corporal punishment remains high, which is shown by the high prevalence of young children exposed to corporal punishment in Colombia. OBJECTIVE: The purpose of this study is to identify individual, family, and municipality-level predictors of corporal punishment (i.e., hitting with objects and spanking) in Colombia in order to inform prevention and intervention strategies. PARTICIPANTS AND SETTING: We use information gathered in 2015 from a representative sample of 11,759 mothers of children younger than five in Colombia. METHODS: We employed multi-level models to account for the clustering of families in 217 municipalities. RESULTS: Results show that mothers' prior exposure to corporal punishment by their own parents (ß=0.229;p<0.01), attitudes towards domestic violence ß=0.013;p<0.05, municipality homicide rates ß=0.028;p<0.05 and presence of armed groups ß=0.031;p<0.05, household poverty ß=0.030;p<0.01 and poverty of the municipality ß=0.022;p<0.05 predicted mothers' hitting their young children with an object. However, family ß=-0.028;p<0.05 and municipality poverty ß=-0.016;p<0.05 had a negative association with mothers' use of spanking. CONCLUSIONS: These findings suggest that both family and neighborhood level factors have simultaneous associations with parents' use of corporal punishment. Given the accumulating evidence concerning the adverse effects of corporal punishment on child well-being and development, legislative efforts aimed at reducing and ultimately banning corporal punishment are warranted.

Neighborhood crime undermines parenting: Violence in the vicinity of households as a predictor of aggressive discipline.

Child discipline is a central component of parent-child interactions. Evidence suggests corporal discipline impairs children's physical, cognitive, and socioemotional development and compromises their future chances, especially since it is more frequently used against at-risk children. Using geocoded data for 1209 children under the age of five and their mothers, this study analyses the relation between the occurrence of crimes in close proximity to households in four major urban municipalities of Colombia and a particularly violent corporal discipline practice: hitting children with objects. Results indicate that exposure to violent crimes, such as homicides and personal injuries, predicts a higher probability of hitting children with objects, even after controlling for a set of individual, family, and neighborhood characteristics. Sensitivity analyses suggest violent crimes are not related to other discipline methods, and less threatening crimes, such as robbery and drug trafficking, are not associated with hitting children with objects. These findings suggest households' walls are permeable, and outside threats may interfere with families' dynamics and well-being. Future directions and implications are discussed.

Clinical and Epidemiological Characteristics of Suicides Committed in Medellin, Colombia / Características clínicas y epidemiológicas del suicidio consumado en Medellín, Colombia

Background: The purpose of this study was to identify the characteristics of individuals who committed suicide in Medellín between 2008 and 2010, and to identify variables related to the type of events. Methods: A retrospective and descriptive analysis was conducted on data provided by the National Institute of Legal Medicine and Forensic Sciences. In addition, a univariate and bivariate analysis was used to identify the sociodemographic and medical-legal characteristics of the deceased. Multiple correspondence analysis was also used in order to establish typologies. The information was analyzed using STATA 11.0. Results: Of the 389 cases occurring between 2008 and 2010, 84.6% (n = 329) were men. The male to female ratio was 5:1; 64% of the cases occurred in people aged 18-45 years; 6.7% occurred in children under 18, with hanging being the method most chosen by the victims (48.3%). Exploratory analysis was used to identify a possible association between the use of violent methods and events occurring in the housing and social strata 1, 2 and 3. Conclusions: Some factors could be associated with suicide, providing data that could consolidate health intervention strategies in our population.

Antecedentes: El propósito del estudio es identificar las características de los individuos que cometieron suicidio en la ciudad de Medellín entre 2008 y 2010, además de identificar variables relacionadas con la tipología de los eventos. Métodos: Análisis descriptivo retrospectivo de los datos suministrados por el Instituto Nacional de Medicina Legal y Ciencias Forenses. Además, análisis univariable y bivariable para identificar las características sociodemográficas y médico-legales de los fallecidos. Para establecer posibles tipologías, se utilizó el análisis de correspondencias múltiples. La información se analizó utilizando el programa STATA 11.0. Resultados: De los 389 casos ocurridos entre 2008 y 2010, el 84,6% (n = 329) correspondió a varones. La razón varones:mujeres es 5:1. El 64% de los casos ocurrió en personas de 18-45 anños y el 6,7%, en menores de 18 años. El ahorcamiento fue el método más elegido por las víctimas (48,3%). El análisis exploratorio permitió identificar una posible asociación entre el uso de métodos violentos con los eventos que ocurren en la vivienda y los estratos sociales 1, 2 y 3. Conclusiones: Se pudo delinear algunos factores asociados al suicidio consumado, aportando elementos que pueden consolidar estrategias de intervención en la salud de nuestra población.

Clinical and Epidemiological Characteristics of Suicides Committed in Medellin, Colombia.

BACKGROUND: The purpose of this study was to identify the characteristics of individuals who committed suicide in Medellín between 2008 and 2010, and to identify variables related to the type of events. METHODS: A retrospective and descriptive analysis was conducted on data provided by the National Institute of Legal Medicine and Forensic Sciences. In addition, a univariate and bivariate analysis was used to identify the sociodemographic and medical-legal characteristics of the deceased. Multiple correspondence analysis was also used in order to establish typologies. The information was analyzed using STATA 11.0. RESULTS: Of the 389 cases occurring between 2008 and 2010, 84.6% (n=329) were men. The male to female ratio was 5:1; 64% of the cases occurred in people aged 18-45 years; 6.7% occurred in children under 18, with hanging being the method most chosen by the victims (48.3%). Exploratory analysis was used to identify a possible association between the use of violent methods and events occurring in the housing and social strata 1, 2 and 3. CONCLUSIONS: Some factors could be associated with suicide, providing data that could consolidate health intervention strategies in our population.

[Genetics of preeclampsia: an approach to genetic linkage studies]. / Genética de la preeclampsia: una aproximación a los estudios de ligamiento genético.

Due to its high prevalence during pregnancies, preeclampsia is considered an important public health problem. Many investigators agree in that its expression is related to the interaction between genetic and environmental factors. Many studies have searched for genetic factors, attempting to identify chromosomal regions or candidate genes whose variants may be related to high preeclampsia susceptibility. Several studies have associated a number of susceptibility genes to preeclampsia, but the results have not been replicated consistently in all populations. Mapping of genes and chromosomal regions by linkage analysis has located potential markers on chromosomes 2 and 4. Identification of the genes located in these candidate regions will pinpoint the genetic risk factors, will lead to a better understanding of the syndrome, and will provide clues for its prevention and treatment.

Genética de la preeclampsia: una aproximación a los estudios de ligamiento genético / Genetics of preeclampsia: an approach to genetic linkage studies

La preeclampsia es considerada un problema de salud pública debido a su alta prevalencia. Muchas investigaciones coinciden en que su origen se relaciona con la interacción entre factores genéticos y ambientales. Por esta razón, múltiples estudios han explorado tales factores genéticos tratando de identificar regiones cromosómicas y genes candidatos cuyas variantes se relacionen con una mayor susceptibilidad a la enfermedad. Diversos estudios de asociación han identificado algunos genes de susceptibilidad a la preeclampsia, pero los resultados no se han replicado consistentemente en todas las poblaciones, quizá por su complejidad clínica y genética. El levantamiento de mapas de genes y regiones cromosómicas basado en análisis de ligamiento ha mostrado resultados interesantes con algunos marcadores en los cromosomas 2 y 4. En este sentido, hay muchas expectativas con respecto a los genes localizados en tales regiones candidatas, debido a que la identificación de los factores de riesgo genético podría ayudar al entendimiento de esta condición y en proveer claves para su prevención y tratamiento.

Due to its high prevalence during pregnancies, preeclampsia is considered an important public health problem. Many investigators agree in that its expression is related to the interaction between genetic and environmental factors. Many studies have searched for genetic factors, attempting to identify chromosomal regions or candidate genes whose variants may be related to high preeclampsia susceptibility. Several studies have associated a number of susceptibility genes to preeclampsia, but the results have not been replicated consistently in all populations. Mapping of genes and chromosomal regions by linkage analysis has located potential markers on chromosomes 2 and 4. Identification of the genes located in these candidate regions will pinpoint the genetic risk factors, will lead to a better understanding of the syndrome, and will provide clues for its prevention and treatment.