Association of adverse childhood experiences and overweight or obesity in adolescents: A systematic review and network analysis.

This systematic review with meta-analysis assessed the effects of adverse childhood experiences (ACEs) linked to overweight or obesity in adolescents. Twenty-eight studies (cross-sectional, case-control, or cohort) were included, which described individuals with a history of ACE or adverse family experiences, such as physical, emotional, or psychological abuses; neglect; exposure to domestic violence or peer violence; and sexual abuse. Body mass index (BMI) or BMI z score was used by the study to define adolescents with overweight or obesity. Adolescents who reported childhood experiences, mainly physical, sexual, and emotional abuses, were more associated with overweight/obesity, especially those who experienced four or more ACEs. Network meta-analysis indicated that physical, sexual, and neglect were the most common ACEs associated with obesity in adolescents. Due to significant differences and imprecision among the studies, network meta-analysis was inconclusive in determining the impact of other types of ACE on outcomes. However, evidence suggests that exposure to sexual and physical abuse, as well as neglect, is associated with adolescents who are obese or overweight, as well as with the number of ACE experienced. The study presented evidence suggesting that dealing with many ACEs may be a risk factor for overweight and obesity in adolescents.

Deliberate Practice as an Effective Method for Reducing Diagnostic Error in Identifying Burn and Bruise Injuries Suspicious for an Abusive Injury.

OBJECTIVE: To examine the effectiveness of an education intervention for reducing physician diagnostic error in identifying pediatric burn and bruise injuries suspicious for abuse, and to determine case-specific variables associated with an increased risk of diagnostic error. STUDY DESIGN: This was a multicenter, prospective, cross-sectional study. A convenience sample of pediatricians and other front-line physicians who treat acutely injured children in the United States and Canada were eligible for participation. Using a web-based education and assessment platform, physicians deliberately practiced with a spectrum of 300 pediatric burn and bruise injury image-based cases. Participants were asked if there was a suspicion for abuse present or absent, were given corrective feedback after every case, and received summative diagnostic performance overall (accuracy), suspicion for abuse present (sensitivity), and absent (specificity). RESULTS: Of the 93/137 (67.9%) physicians who completed all 300 cases, there was a significant reduction in diagnostic error (initial 16.7%, final 1.6%; delta -15.1%; 95% CI -13.5, -16.7), sensitivity error (initial 11.9%, final 0.7%; delta -11.2%; 95% CI -9.8, -12.5), and specificity error (initial 23.3%, final 6.6%; delta -16.7%; 95% CI -14.8, -18.6). Based on 35 627 case interpretations, variables associated with diagnostic error included patient age, sex, skin color, mechanism of injury, and size and pattern of injury. CONCLUSIONS: The education intervention substantially reduced diagnostic error in differentiating the presence vs absence of a suspicion for abuse in children with burn and bruise injuries. Several case-based variables were associated with diagnostic error, and these data can be used to close specific skill gaps in this clinical domain.

An Observational Study of Sexual Assaults in French Guiana During 2019-2020.

Introduction: Sexual violence is a major public health issue, including in French Guiana. The feeling of insecurity is significant in this part of France. Sexual violence is an important reason for consultation in forensic and emergency medicine. The challenge is to provide care within the first 72 hours, particularly in medicolegal terms and for infectious disease management. The objectives of our study were, firstly, to establish the epidemiology of sexual assaults at Cayenne General Hospital (CGH), and secondly, to evaluate the management of these victims. Materials and Methods: From January 1st, 2019 to December 31st, 2020, we conducted a single-center retrospective descriptive study including patients who were consulted for sexual assaults in the Forensic medicine and the Emergency departments of CGH. Results: Over this period, 400 sexual assault victims were consulted. Most of them, were women (87%) with a median age of 13 years-old [8; 17.5]. The aggressor was mostly male (99%) frequently known by the victim (87%) and from her family (39%). Suspected assaults represented 19% of consultations. The most frequent assault on women was penile-vaginal penetration (82%) and penile-anal penetration (77%) on men. The delay of consultation was superior to 72 hours in 60% of the cases. A psychological follow-up was recommended for 62% of these victims. Conclusion: This work allowed to identify a young and female population at risk, most often assaulted by a male known to her. Most of the patients consulted more than 72 hours after the assault. Our study highlights the need for prevention actions in French Guiana focusing on this population at risk.

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.

Fractura craneal deprimida congénita ("fractura ping-pong") en neonatos como diagnóstico diferencial de maltrato físico / Congenital depressed skull fracture ("ping-pong" fracture) in newborn infants as a differential diagnosis of physical abuse

Las fracturas con hundimiento de cráneo sin una explicación clara sobre su origen orientan al traumatismo con un objeto romo y a la sospecha de maltrato infantil. En el caso de los bebés recién nacidos, su corta edad es un factor de vulnerabilidad y obliga a una exhaustiva evaluación. Ante la sospecha de maltrato infantil, resulta importante evaluar los diagnósticos diferenciales para realizar la intervención más adecuada posible. Es necesario evitar tanto intervenciones excesivas como omitir la intervención que sea necesaria. Las fracturas craneales deprimidas congénitas, descritas como "fracturas pingpong", son raras (0,3 a 2/10 000 partos). Pueden aparecer sin antecedentes traumáticos o en partos instrumentalizados. Se describe en este artículo el caso de un recién nacido con una fractura ping-pong como ejemplo de una fractura no intencional.

Depressed skull fractures without a clear explanation as to their origin point to trauma with a blunt object and suspected child abuse. In the case of newborn infants, their young age is a vulnerability factor and requires an exhaustive assessment. When child abuse is suspected, an assessment of the differential diagnoses is required to make the most appropriate intervention possible. Both an excessive intervention and an omission of a necessary intervention should be avoided. Congenital depressed skull fractures, described as "ping-pong fractures", are rare (0.3 to 2/10 000 births). They may appear without any trauma history or in instrumentalized childbirth. Here we describe the case of a newborn infant with a ping-pong fracture as an example of an accidental fracture.

Conhecimentos e condutas dos cirurgiões-dentistas do estado do Rio Grande do Norte sobre denúncias e notificações de maus-tratos infantis / Knowledge and conduct of dentists of State of Rio Grande do Norte regarding complaints and notifications of child abuse

Os maus-tratos infantis são considerados um problema de saúde a nível mundial. Diante dessa realidade, destaca-se a relevante atuação dos profissionais de saúde na identificação, diagnóstico, notificação e, consequentemente, na redução no número de casos. O Cirurgião-Dentista apresenta-se em uma posição privilegiada no que diz respeito à identificação de casos de violência, visto que a maioria das lesões de ordem física a crianças e adolescentes se apresenta em região de cabeça e pescoço. Dessa forma, objetiva-se identificar as experiências e conduta dos cirurgiões-dentistas do Rio Grande do Norte sobre maus-tratos infantis. Foi realizado um estudo exploratório de caráter quantitativo mediante aplicação de um formulário eletrônico, com questões semiestruturadas, enviado aos dentistas com inscrições ativas no Conselho Regional de Odontologia do Rio Grande do Norte. Foi obtido um total de 100 questionários respondidos. Para análise dos dados, utilizou-se a estatística descritiva e testes de associação. Os resultados revelaram que 14% dos profissionais relataram ter visto caso suspeito de abuso físico, porém nenhum destes realizou notificação no último semestre. Apesar das médias das respostas terem sido superiores a 6 quanto à disposição para detecção, capacidade de diagnóstico e de identificação dos maus-tratos, esses resultados não corroboram com o número de profissionais que considera necessário maior qualificação em diagnóstico ou que desconhecem qualquer meio de notificação. A capacitação técnico-científica para a identificação e diagnóstico diferencial é importante e a responsabilidade pela notificação de casos suspeitos às autoridades é imprescindível para o exercício da profissão em consonância com os valores de cidadania e justiça

Child abuse is considered a global health problem. Given this reality, the relevant role of health professionals in identifying, diagnosing, reporting and, consequently, reducing the number of cases stands out. The dentist is in a privileged position with regard to identifying cases of violence, given that the majority of physical injuries to children and adolescents occur in the head and neck region. Thus, the objective is to identify the experiences and conduct of dentists in Rio Grande do Norte regarding child abuse. An exploratory quantitative study was carried out using an electronic form, with semi-structured questions, sent to dentists with active registrations at the Rio Grande do Norte Regional Dentistry Council. A total of 100 completed questionnaires were obtained. For data analysis, descriptive statistics and association tests were used. The results revealed that 14% of professionals reported having seen a suspected case of physical abuse, but none of them reported it in the last semester. Although the response averages were higher than 6 in terms of willingness to detect, diagnose and identify abuse, these results do not corroborate the number of professionals who consider it necessary to have greater qualifications in diagnosis or who are unaware of any means of reporting. Technical-scientific training for identification and differential diagnosis is important and the responsibility for reporting suspected cases to the authorities is essential for exercising the profession in line with the values of citizenship and justice

Screening for Child Abuse in the Emergency Department of Academic Hospital Paramaribo in Suriname.

Background. Child abuse in Suriname has a prevalence between 58.2% and 68.8%. This prospective observational study evaluates the implementation of screening for child abuse at the Emergency Department (ED) of the Academic Hospital Paramaribo (AZP). Methods. Children (0-16 years) presenting with injury from 01-02-2018 until 31-08-2018 were eligible. Case-record-forms were completed. Multidisciplinary meetings were used to evaluate positive screened and admitted patients. Diagnostic accuracy was calculated and results were compared to retrospective data from 2016. Results. 3253 Children attended the ED. In 1190 (36.6%) children, the screening was completed. The screening was positive in 148 (12%); in 71 (6%) cases child abuse was confirmed. The sensitivity and specificity were 0.88 and 0.92 respectively, PPV 0.43, NPV 0.99. There was a significant increase of detected child abuse cases; 4.4% in 2016 versus 6% in 2018 (P = .04). Conclusion. Implementation of screening at the ED in the AZP increased detection of child abuse. To improve screening's accuracy, more education for healthcare professionals is pivotal.

Childhood Parental Neglect, Abuse and Rejection Among Transgender Women: A Cross-Sectional Study in Rio de Janeiro, Brazil.

We aimed to estimate the proportions of childhood parental neglect, abuse, and rejection and to evaluate the co-occurrence of these experiences among transgender women in Rio de Janeiro, Brazil. This was a cross-sectional study with a convenience sample enrolled between July 2019 and March 2020, using an adapted version of the Childhood Trauma Questionnaire. Proportions and corresponding confidence intervals (CI) were calculated. Kendall correlation with Tau-b estimator was used in the bivariate analyses. We gathered data from 139 participants. The most prevalent types of childhood traumas were emotional abuse (60.43%, 95% CI [51.79, 68.62]), physical abuse (57.55%, 95% CI [48.90, 65.89]) and sexual abuse (44.60%, 95% CI [36.18, 53.27]). Severe to extreme physical and emotional abuse occurred among 40.29% (95% CI [32.06, 48.93]) and 5.75% (95% CI [2.51, 11.02]) of participants, respectively. The proportion of parental rejection (eviction) was 32.37% (95% CI [25.04, 40.69]) and occurred with the other forms of abuse, except sexual abuse. Multiple types of childhood abuse, neglect, and parental rejection were observed among transgender women in our sample. The harmful effects of childhood abuse on the mental and physical health of people in the transgender population are of concern, particularly considering the cumulative effect produced by the co-occurrence of such events and their harmful lifetime effects. It is urgently necessary to debate and formulate public policies to ensure the right to gender expression from childhood.

Sexual violence against children and adolescents in Paraná State: geospatial analysis and main socioeconomic indicators.

OBJECTIVE: Child sexual violence is a multidimensional problem of many contemporary societies, affecting people of all sexes, social stratum and age groups. Offenses involving children and adolescents are more serious, given their total or partial dependence on parents and caregivers. Information on child sexual violence in Brazil is found in raw form and without detail. The objective was to compare the information with social and economic data in the state of Paraná. METHODS: The authors conducted a retrospective study of secondary data from the Notifiable Diseases Information System (SINAN) on cases of sexual violence involving victims aged 0 to 19 years. Results are presented according to notification characteristics. The authors applied exploratory spatial data analysis to assess spatial autocorrelations and investigated relationships by the ordinary least squares regression model. RESULTS: Between 2017 and 2021, there were 13,403 reports of child sexual violence in Paraná State, Brazil. Most victims (82.8%) were female and aged between 10 and 14 years. The majority of sexual violence cases (67.8%) occurred in the home environment. The highest rates on a population basis were observed in the North Central and Greater Curitiba regions, mainly in cities with higher population density and with higher rates of other types of violence. CONCLUSION: The results provide data that can promote a broader understanding of the distribution of sexual violence and the state and associated variations. It is expected to improve the provision of care for victims of child sexual violence and assist in strategic planning to prevent future offenses.

Maternal Emotional and Behavioral Regulation/Dysregulation and Parenting Practices: A Systematic Review.

Emotional and behavioral regulations are crucial for the development of perceptive, responsive, and flexible parenting. Moreover, maternal emotional dysregulation constitutes a risk for maltreatment behaviors. The present study aimed to conduct a systematic review of empirical studies on the associations between mothers' emotional and behavioral regulations and parenting practices with their children or adolescents. A systematic review was conducted, including papers that addressed these variables, analyzing the direct effects, and moderation or mediation effects of maternal emotional and behavioral regulation on parenting practices, targeting child and adolescent samples. We identified 35 studies for analysis. Most of the studies (86%) showed significant associations between maternal emotional and behavioral regulation and parenting practices. Mothers' emotional dysregulation was related to a high risk of maltreatment and negative parenting, such as unsupportive reactions and harsh discipline. High maternal emotional dysregulation and negative parenting, in turn, were associated with children's aggressive behaviors. Conversely, when mothers exhibited high emotional regulation, they engaged in more positive and supportive parenting. Additionally, maternal behavioral regulation with inhibitory control and effortful control led to supportive and warm parenting. Individual and contextual factors, such as maternal victimization history and symptoms of inattention and hyperactivity, had effects on maternal emotional dysregulation, which, in turn, impacted their parenting practices. Consequently, emotional and behavioral regulation played a crucial role in mothers' parenting practices with their children and adolescents. The findings of the current review could contribute to planning parenting interventions, including maternal emotional and behavioral regulation skills, aimed at preventing maltreatment of their children.

Parenting styles and dental caries in Brazilian children and adolescents in foster care.

PURPOSE: This study aimed to analyse parenting styles as a possible factor associated with caries in foster children and adolescents who had been victims of domestic violence. METHODS: The study was carried out in nine foster shelters in Recife, Northeast Brazil, with a sample of 88 participants aged 8 to 17 years old. Data were collected through intraoral examinations to verify deft/DMFT indices, applying the Demandingness and Responsiveness Scales to determine parenting styles. In turn, sociodemographic data were retrieved from records filed at the institutions. Descriptive analysis was performed, with the Mann-Whitney and Kruskal-Wallis tests being used to compare the categories of numerical variables. RESULTS: The mean deft/DMFT was of 3.78 in children (8 and 9 years old) and 1.93 in adolescents (10 years old and older). Overall, the index was of 2.31. Neglect was the main reason for the children's admission to foster care, while neglectful was the most prevalent parenting style. CONCLUSION: Children of indulgent parents had higher caries indices in both deciduous and permanent teeth, while children of authoritative (permanent teeth) and authoritarian parents (deciduous teeth) had the lowest caries indices. However, no significant associations were found between caries and parenting styles.

Reports of Maltreatment in a Children's Hospital: Evaluation of the Epidemiological Profile and Its Relationship with the Outcome in Fractures.

Objective To describe suspected/confirmed cases of child maltreatment related to fractures in a pediatric hospital in southern Brazil. Method Study of the Information System of Notifiable Diseases notifications and the victims' medical records between January/2016 and December/2020. Variables related to the victim, the perpetrator, the type of abuse, the presence of fractures, and their anatomical location and death were evaluated. Logistic regression was performed to identify fracture-related variables, adjusted for sex and age. The results were expressed in odds ratios and their respective 95% confidence intervals. It was considered significant p < 0.05. Results There were 276 cases, 73 infants (26.4%), male predominance (151, 54.7%), with authorship of the mistreatment by relatives (245, 96,0%), 85 (31,5%), they presented fractures, with five deaths (1.9%). Factors related to the presence of fracture: age of the victim (less than two years old; n = 82; or 2.48; 95% CI: 1.45 - 4.25), having more than two aggressors involved ( n = 144; or 2.09; 95% CI: 1.16-3.75), the medium being traffic/automobile accident, ( n = 52; or 2.65; 95% CI: 1.04-6.75), consult an orthopedist ( n = 91; or 6.77 / 95% CI: 3.66-12.51), and the need for surgical intervention ( n = 15; OR 36.72; 95% CI: 8.22-164.03). Conclusions The importance of suspicion, early identification of aggression, and the correct completion of notifications for activating the system of guaranteeing rights and removal of the aggressor was emphasized.

Violência sexual infantojuvenil no Brasil: um panorama de seus determinantes e da maneira como se relacionam / Child and adolescent sexual violence in Brazil: an overview of its determinants and the way they are related

Objetivo: cconstruir um panorama diagnóstico da violência sexual infantojuvenil assistida no sistema de saúde no Brasil. Métodos: estudo transversal, analítico, realizado com dados do Ministério da Saúde a respeito da violência sexual infantojuvenil no Brasil, no período de 2010 a 2021. Foram conduzidas análises de estatística descritiva e multivariadas, por meio das técnicas de Análise de Correspondências Múltiplas e de Clusterização Hierárquica. Resultados: observou-se grande importância associada à presença de vítimas do sexo feminino, solteiras, adolescentes, que têm práticas sexuais apenas com homens, em ambiente residencial, na ausência de ex-cônjuge, patrão, madrasta ou cuidador no momento da ocorrência. Notou-se também, importância associada aos casos de recorrências, à coocorrência de violência física e psicológica, bem como relacionada à participação de pais, namorados e conhecidos como violentadores. Além disso, identificou-se que as ocorrências em via pública parecem estar mais associadas a vítimas de baixa escolaridade. Conclusão: a violência sexual infantojuvenil no Brasil se estabelece, portanto, como um importante problema social, cultural, de segurança e saúde pública. Foi possível explorar os principais parâmetros associados às ocorrências no país, permitindo, assim, a possibilidade de sua aplicação em ferramentas e serviços de assistência.

Objective: build a diagnostic overview of child and adolescent sexual violence assisted in the health system in Brazil. Methods: a cross-sectional, analytical study carried out with data from the Ministry of Health regarding child and adolescent sexual violence in Brazil from 2010 to 2021. Descriptive and multivariate statistical analyses were conducted using Multiple Correspondence Analysis and Hierarchical Clustering. Results: there was great importance associated with the presence of female victims, singles, and teenagers who have sexual practices only with men in a residential environment, in the absence of a former spouse, boss, stepmother, or caregiver at the time of the occurrence. It was also noted the importance associated with cases of recurrence, the co-occurrence of physical and psychological violence, as well as related to the participation of parents, boyfriends, and acquaintances as perpetrators. Furthermore, it was identified that incidents on public roads seem to be more associated with victims with low education. Conclusion: child and adolescent sexual violence in Brazil is, therefore, established as an important social, cultural, safety, and public health problem. It was possible to explore the main parameters associated with occurrences in the country, thus allowing the possibility of its application in assistance tools and services.

Abuso sexual contra crianças no contexto da enfermagem: uma análise de conceito / Child sexual abuse in the context of nursing: a concept analysis

OBJETIVO: Realizar a análise do conceito de abuso sexual em crianças, identificando os possíveis atributos, antecedentes e consequências. MÉTODO: Foi conduzida uma análise de conceito, estruturada por meio de uma scoping review. A busca foi realizada em 6 bases de dados e, após análise, um total de 17 artigos foram incluídos. RESULTADOS: Foram identificados, como antecedentes, crianças com idade acima de 8 anos, do sexo feminino, sendo o agressor frequentemente um parente da vítima ou até mesmo o próprio pai. Quanto aos atributos, foram identificadas alterações psicológicas, doenças sexualmente transmissíveis e gravidez indesejada. As consequências observadas foram predominantemente de natureza psicológica, incluindo depressão e comportamento suicida. CONCLUSÃO: No total, foram agrupados nove antecedentes que estão relacionados aos fatores que levam à vulnerabilidade do abuso. Além disso, foram identificados 11 atributos correspondentes aos sinais característicos que indicam que uma criança é vítima de abuso. Por fim, foram observadas 12 consequências decorrentes da violência sexual infantil.

OBJECTIVE: To conduct a conceptual analysis of child sexual abuse to identify possible attributes, antecedents, and consequences. METHOD: A concept analysis was conducted using a scoping review methodology. Searches were conducted in 6 databases, resulting in 17 articles after analysis. RESULTS: Antecedents included children older than 8 years, female gender, the perpetrator often being a relative of the victim or even the biological father. Psychological changes, sexually transmitted diseases, and unwanted pregnancies were identified. The consequences observed were mainly psychological, including depression and suicidal behavior. CONCLUSIONS: Nine antecedents were grouped as factors contributing to vulnerability to abuse. In addition, 11 attributes correspond to characteristic signs indicating that a child is a victim of maltreatment. Finally, 12 consequences of child sexual violence were observed.

Congenital depressed skull fracture ("ping-pong" fracture) in newborn infants as a differential diagnosis of physical abuse. / Fractura craneal deprimida congénita ("fractura ping-pong") en neonatos como diagnóstico diferencial de maltrato físico.

Depressed skull fractures without a clear explanation as to their origin point to trauma with a blunt object and suspected child abuse. In the case of newborn infants, their young age is a vulnerability factor and requires an exhaustive assessment. When child abuse is suspected, an assessment of the differential diagnoses is required to make the most appropriate intervention possible. Both an excessive intervention and an omission of a necessary intervention should be avoided. Congenital depressed skull fractures, described as "ping-pong fractures", are rare (0.3 to 2/10 000 births). They may appear without any trauma history or in instrumentalized childbirth. Here we describe the case of a newborn infant with a ping-pong fracture as an example of an accidental fracture.

Las fracturas con hundimiento de cráneo sin una explicación clara sobre su origen orientan al traumatismo con un objeto romo y a la sospecha de maltrato infantil. En el caso de los bebés recién nacidos, su corta edad es un factor de vulnerabilidad y obliga a una exhaustiva evaluación. Ante la sospecha de maltrato infantil, resulta importante evaluar los diagnósticos diferenciales para realizar la intervención más adecuada posible. Es necesario evitar tanto intervenciones excesivas como omitir la intervención que sea necesaria. Las fracturas craneales deprimidas congénitas, descritas como "fracturas pingpong", son raras (0,3 a 2/10 000 partos). Pueden aparecer sin antecedentes traumáticos o en partos instrumentalizados. Se describe en este artículo el caso de un recién nacido con una fractura ping-pong como ejemplo de una fractura no intencional.

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

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.

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.

Ethnically distinct populations and coping with violence against children in the COVID-19 pandemic / Poblaciones étnicamente diversas y la lucha contra la violencia infantil en la pandemia de COVID-19 / Populações etnicamente distintas e o enfrentamento da violência contra crianças na pandemia da COVID-19

ABSTRACT Objective: To identify policies and programs adopted by a Brazilian municipality to address violence against children during the COVID-19 pandemic. Method: A qualitative documentary study. The study setting was the municipality of Ananindeua, Pará, Brazil. Data was collected from official websites between November 2021 and February 2022. Thematic content analysis was used with the support of webQDA software. Results: Three empirical categories emerged: a) Impacts of the COVID-19 pandemic on violence against children; b) Action strategies for tackling violence against children in the COVID-19 pandemic; c) Evaluation indicators and targets for action strategies for tackling violence against children. Final considerations: The documents revealed few direct mentions of children, especially traditional populations; they presented superficial and ineffective evaluations of the policies and programs adopted, using exclusively quantitative indicators.

RESUMEN Objetivo: Identificar políticas y programas adoptados por un municipio brasileño para hacer frente a la violencia infantil durante la pandemia de COVID-19. Método: Se trata de un estudio cualitativo documental. El escenario fue el municipio de Ananindeua, Pará, Brasil. Los datos se recogieron de sitios de internet oficiales entre noviembre de 2021 y febrero de 2022. Se utilizó el análisis temático de contenido con el apoyo del software webQDA. Resultados: Surgieron tres categorías empíricas: a) Impactos de la pandemia de COVID-19 en la violencia contra los niños; b) Estrategias de acción para abordar esta violencia; c) Indicadores de evaluación y metas de las estrategias de acción para este afrontamiento. Consideraciones finales: Los documentos revelaron pocas menciones sobre los niños de las poblaciones tradicionales en especial y presentaron evaluaciones superficiales de las políticas y programas adoptados, utilizando exclusivamente indicadores cuantitativos.

RESUMO Objetivo: Identificar políticas e programas adotados por um município brasileiro para o enfrentamento da violência contra crianças durante a pandemia de COVID-19. Método: Estudo qualitativo do tipo documental. O cenário de estudo foi Ananindeua, Pará, Brasil. A coleta de dados foi realizada em sites oficiais, de novembro de 2021 a fevereiro de 2022. Utilizou-se a análise de conteúdo temática apoiada pelo software webQDA. Resultados: Emergiram três categorias empíricas: a) Impactos da pandemia de COVID-19 na violência contra crianças; b) Estratégias de enfrentamento desta violência; c) Indicadores de avaliação e metas das estratégias para este enfrentamento Considerações finais: Há poucas menções diretas às crianças, especialmente às de populações tradicionais; apresentaram avaliações ineficazes das políticas, apenas qualitativamente.

Association between childhood trauma and postpartum depression among Brazilian puerperal women / Asociación entre traumas en la infancia y depresión posparto en puérperas brasileñas / Associação entre trauma na infância e depressão pós-parto em puérperas brasileiras

Objective: to evaluate the association between different forms of childhood trauma and postpartum depression in Brazilian puerperal women. Method: this cross-sectional survey included 253 puerperal women who were evaluated using the Edinburgh Postnatal Depression Scale and the Childhood Trauma Questionnaire. Multivariate logistic regression analyses were performed to verify the association of different types of trauma and the co-occurrence of forms of abuse and neglect with postpartum depression. Results: postpartum depression was identified in 93 women (36.8%; 95% Confidence Interval: 30.8-42.7). All forms of childhood trauma assessed (emotional abuse, emotional neglect, physical abuse, physical neglect and sexual abuse) were independently associated with postpartum depression after adjusting for confounding variables. Emotional abuse remained associated with postpartum depression when the co-occurrence of all forms of childhood trauma was analyzed. Conclusion: the results suggest an association between the different forms of childhood trauma and postpartum depression. In this sense, childhood trauma is an indicator for Nursing professionals to screen for risk factors of postpartum depression during obstetric_follow-up.

Objetivo: evaluar la asociación entre diferentes formas de traumas en la infancia y depresión posparto en puérperas brasileñas. Método: en este estudio transversal se incluyó a 253 puérperas que fueron evaluadas con la Edinburgh Postnatal Depression Scale y el Childhood Trauma Questionnaire . Se realizaron análisis de regresión logística multivariados para verificar la asociación de diferentes tipos de trauma y la coocurrencia de formas de abuso y negligencia con la depresión posparto. Resultados: se identificó depresión posparto en 93 mujeres (36,8%; intervalo de confianza del 95%: 30,8-42,7). Todas las formas de traumas en la infancia que se evaluaron (abuso emocional, negligencia emocional, abuso físico, negligencia física y abuso sexual) estuvieron asociadas de manera independiente con la depresión posparto después de ajustar por variables de confusión. El abuso emocional siguió estando asociado con la depresión posparto cuando se analizó la coocurrencia de todas las formas de traumas en la infancia. Conclusión: los resultados sugieren una asociación entre las diferentes formas de traumas en la infancia y la depresión posparto. En este sentido, los traumas en la infancia son un indicador para que los profesionales de Enfermería detecten factores de riesgo para la depresión posparto en los controles obstétricos.

Objetivo: avaliar a associação entre diferentes formas de trauma na infância e depressão pós-parto em puérperas brasileiras. Método: estudo transversal incluiu 253 puérperas que foram avaliadas pela Edinburgh Postnatal Depression Scale e pelo Childhood Trauma Questionnaire . Análises multivariadas de regressão logística foram realizadas para verificar a associação entre diferentes tipos de trauma e a coocorrência de formas de abuso e negligência com depressão pós-parto. Resultados: a depressão pós-parto foi identificada em 93 mulheres (36,8%; Intervalo de Confiança de 95%: 30,8-42,7). Todas as formas de trauma na infância avaliadas (abuso emocional, negligência emocional, abuso físico, negligência física e abuso sexual) foram independentemente associadas à depressão pós-parto após ajuste para variáveis de confusão. O abuso emocional permaneceu associado à depressão pós-parto quando foi analisada a coocorrência de todas as formas de trauma na infância. Conclusão: os resultados sugerem associação entre as diferentes formas de trauma na infância e depressão pós-parto. Nesse sentido, o trauma na infância é um indicador para os profissionais de Enfermagem rastrearem fatores de risco de depressão pós-parto durante o acompanhamento obstétrico.

Rede social de famílias envolvidas na negligência contra crianças e adolescentes: construindo um olhar multidimensional / Social network of families involved in child neglect: building a multidimensional perspective

Resumo A negligência constitui uma das violências contra crianças e adolescentes mais notificadas, entretanto ainda pouco explorada em estudos nacionais. O objetivo deste estudo foi analisar a rede pessoal social de famílias envolvidas na negligência contra crianças e adolescentes. Estudo qualitativo, ancorado no paradigma da complexidade, realizado junto a 20 familiares envolvidos na negligência contra crianças e adolescentes em município do interior de São Paulo, Brasil. A coleta de dados se deu por mapas mínimos da rede pessoal social e entrevistas semiestruturadas em janeiro de 2021. As redes se apresentaram reduzidas, com pouca ou nenhuma articulação entre os diferentes serviços e setores e predominantemente homogêneas. Por terem muitos vínculos fragilizados, mostrou-se pouco sustentadora, apontando dificuldades no acesso a trabalho, educação e saúde. Pelas características da rede, identificou-se a complexidade do fenômeno da negligência, em que elementos condicionam e perpetuam vivências de ausências e fragilidades. Olhares e ações interprofissionais e intersetoriais são pleiteadas e recomendadas.

Abstract Neglect is one of the most frequently reported forms of violence against children and adolescents, although it has rarely been explored in national studies. In this light, the present study aimed to analyze the personal social network of families involved in negligence against children and adolescents. This work takes a qualitative approach, anchored in the Paradigm of Complexity, conducted with twenty families involved in negligence against children and adolescents in a municipality in the countryside of the state of São Paulo, Brazil. Data collection took place through minimal maps of the personal social network and semi-structured interviews in January 2021. The networks were limited, with little to no interaction among the different services and sectors, and were predominantly homogeneous. Because they have many weakened ties, they are relatively unsupportive, pointing out difficulties in access to work, education, and health. Due to the characteristics of the network, the complexity of the phenomenon of neglect was identified, in which elements condition and perpetuate experiences of absence and fragility. Interprofessional and intersectoral views and actions are requested and recommended.

Knowledge and awareness level of health undergraduate students on child abuse: a cross-sectional study

SUMMARY OBJECTIVE: The aim of the study was to investigate the level of knowledge of symptoms and risks of child abuse among undergraduate health science students according to their socio-demographic characteristics. METHODS: This is a cross-sectional study involving 485 student volunteers. The data collection tools used in the study were the Demographic Data Collection Form and the Scale for Diagnosing Symptoms and Risks of Child Abuse and Neglect. RESULTS: It was found that health students' knowledge of the symptoms and risks of child abuse was moderate. It was also found that knowledge of diagnosing the symptoms and risks of child abuse was higher among women than among men, higher among those who had received education on child abuse, and increased with grade level. CONCLUSION: Child abuse is an important public health issue, and there is a need to raise awareness of this issue among health students.