Relación entre la conciencia de madres y padres sobre el abuso sexual y las habilidades de los niños para decir «no» / The relationship between parental awareness of sexual abuse and children's skills to say «no»

Introducción: El abuso sexual infantil es un problema social global y multidimensional que provoca resultados devastadores y permanentes en las relaciones psicológicas, emocionales, cognitivas, conductuales, físicas, sexuales e interpersonales. Este estudio examina la relación entre la capacidad de decir «no» y la conciencia de madres y padres sobre el abuso sexual en estudiantes de 4.° de primaria. Métodos: El estudio se realizó entre abril de 2022 y junio de 2022 en escuelas primarias de un distrito central provincial en el noreste de Turquía. La muestra del estudio estuvo formada por 310 alumnos de 4.° de primaria y sus madres y padres. Compilamos los datos del estudio con el Formulario de información personal, la Escala de capacidad para decir «no» para niños y la Escala de conciencia de abuso sexual para padres. Resultados: Hubo una correlación positiva débil (p˂0,05) entre las puntuaciones medias de conciencia de las madres sobre el abuso sexual y las puntuaciones medias de rechazo y resistencia de los niños, y una correlación positiva débil (p˂0,05) entre las puntuaciones medias de la conciencia de los padres sobre el abuso sexual y las puntuaciones medias de rechazo de los niños. Conclusión: A medida que aumentó la conciencia de las madres y los padres sobre los mitos y las enseñanzas sobre el abuso sexual y las acciones para combatir el abuso sexual, también aumentó la negativa de los niños. Se encontró que a medida que aumentaba la conciencia de los padres sobre las señales de abuso sexual, aumentaba la negativa de los niños.(AU)

Introduction: Child sexual abuse is a global and multidimensional social problem and causes devastating and permanent psychological, emotional, cognitive, behavioural, physical, sexual and interpersonal sequelae. This study examines the relationship between the ability to say «no» and parental awareness of sexual abuse in 4th grade primary school students. Methods: The study was conducted between April 2022 and June 2022 in primary schools in the central district of a province in north-eastern Turkey. The sample consisted of 310 students enrolled in 4th grade and their parents. We collected the data through a personal information form, the ability to say «no» scale for children and the sexual abuse awareness scale for parents. Results: There was a weak positive correlation between the mean maternal scores of sexual abuse awareness and the mean scores of refusal and resistance in children (P˂.05), as well as a weak positive correlation between the mean paternal scores of sexual abuse awareness and the mean scores of refusal and resistance in children (P˂.05). Conclusion: As mothers’ and fathers’ awareness of sexual abuse myths and of teachings and actions to combat sexual abuse increased, the refusal of children also increased. Also, as fathers’ awareness of the signs of sexual abuse increased, children's refusal increased.(AU)

La violencia como problema de salud / Violence as a health problem

La violencia es un problema de salud pública. Esta, cuando afecta a la infancia, puede generar enfermedad a lo largo de toda la vida del individuo. Aparte de poder producir daños en la esfera física, psíquica y social, supone una vulneración de los derechos de los niños afectados y un elevado consumo de recursos tanto económicos como sociales.Multitud de investigaciones han mejorado la atención a esta violencia. Sin embargo, estos avances no son parejos con el manejo práctico que se realiza a las víctimas tanto en la atención primaria como en la hospitalaria. Existe una significativa área de mejora para la atención pediátrica.A través de este artículo, distintos profesionales de todas las áreas sanitarias pediátricas establecidas desarrollan líneas generales de conocimiento y actuación con respecto a la violencia contra la infancia. Se hace un recorrido a través de la legislación relacionada con la infancia, las distintas tipologías de maltrato que existen, sus efectos, manejo y prevención. Concluye con un epílogo, a través del cual pretendemos mover sensibilidades.En resumen, este es un trabajo que pretende fomentar la formación y sensibilización de todos los profesionales especializados en la salud infantil, para que persigan como objetivo el que sus pacientes alcancen su mayor potencial en la vida y, de esa manera, ayudar a crear una sociedad más sana, con menos enfermedad y más justa.(AU)

Violence is a public health problem, and when it affects childhood, it can cause illness throughout the individual's life. Apart from being able to cause damage in the physical, mental and social spheres, it represents a violation of the rights of the affected children, and a high consumption of resources, both economic and social.A multitude of investigations have improved attention to this violence. However, these advances are not consistent with the practical management of victims, both in Primary and Hospital Care. There is a significant area of improvement for paediatric care.Through this article, different professionals from all established paediatric health care facilities develop general lines of knowledge and action regarding violence against children. An overview is taken of the legislation related to childhood, the different types of abuse that exist, their effects, management and prevention. It concludes with an epilogue, through which we aim to move sensibilities.In summary, this work aims to promote the training and awareness of all professionals specialized in children's health, so that they pursue the goal of achieving their patients’ greatest potential in life, and in this way, to help create a healthier society, with less disease, and more justice.(AU)

A Qualitative Study of Resident Advocacy Work.

BACKGROUND: Advocacy is a critical component of pediatric training and practice. Pediatric resident advocacy experiences include skill development and real-world projects, but little is known about how pediatric residents participate in advocacy. Without this knowledge, educators run the risk of underpreparing residents for the full scope of advocacy work. This study sought to investigate how residents participate in advocacy by characterizing their projects using an evidence-informed conceptual framework and describing the unique lessons were learned by the residents. METHODS: The authors used principles of thematic analysis to interrogate existing documents derived from pediatric residents from 2013 to 2021 at 1 institution. They purposefully sampled and deidentified project proposals and written reflections. Using a constant comparative method, they created codes. Codes, connections between codes, and findings were refined by discussion. RESULTS: Residents demonstrated 4 different types of advocacy: some residents participated in directed agency or activism and others focused on shared agency or activism. Residents reflected on different learning experiences; residents who participated in shared forms of advocacy learned skills such as "Partnering," "Evaluating," and "Planning." Residents who were involved in directed forms of advocacy shared lessons on "Leading," "Presenting," and "Intervening." Advocacy work also changed over time: in later projects (2016-2021) residents took ownership of the role of "advocate"; social and political climate was salient in reflections. CONCLUSIONS: Pediatric residents advocate through shared activism and agency and directed activism and agency. Educators should recognize, support, and supplement the experiences of residents as they participate in different types of advocacy.

Team Functioning and Performance in Child Advocacy Center Multidisciplinary Teams.

The quality of teamwork in Child Advocacy Center (CAC) multidisciplinary teams is likely to affect the extent to which the CAC model improves outcomes for children and families. This study examines associations between team functioning and performance in a statewide sample of CAC teams. Multidisciplinary team members (N = 433) from 21 CACs completed measures of affective, behavioral, and cognitive team functioning. Team performance was assessed with three measures: team member ratings of overall performance, ratings of mental health screening/referral frequency, and caregiver satisfaction surveys. Linear mixed models and regression analyses tested associations between team functioning and performance. Affective team functioning (i.e., liking, trust, and respect; psychological safety) and cognitive team functioning (i.e., clear direction) were significantly associated with team members' ratings of overall performance. Behavioral team functioning (i.e., coordination) and cognitive team functioning were significantly associated with mental health screening/referral frequency. Team functioning was not associated with caregiver satisfaction with CAC services. Aspects of team functioning were associated with team members' perceptions of overall performance and mental health screening/referral frequency, but not caregiver satisfaction. Understanding associations between team functioning and performance in multidisciplinary teams can inform efforts to improve service quality in CACs and other team-based service settings.

Clinical Consultation During a Trauma-Focused Cognitive Behavioral Therapy Community-Based Learning Collaborative: Examination of Consultation Content, Consultative Strategies, and Provider Engagement.

Consultation following evidence-based practice (EBP) training enhances the uptake of EBPs. Yet, little is known about what occurs during consultation, and it is often difficult for providers to engage in consultation. This study examined provider engagement in consultation and the content and strategies used during consultation following training in Trauma-focused Cognitive Behavioral Therapy (TF-CBT) as part of a community-based learning collaborative (CBLC). Minute-to-minute live coding of consultation calls revealed most content was clinically-oriented and the most common strategies used by consultants were didactic in nature. Providers with more years of professional experience and those with greater TF-CBT knowledge attended significantly more consultation calls. Providers with a greater average weekly caseload and providers who were supervisors presented significantly more cases on calls. Providers with greater TF-CBT knowledge spoke significantly more minutes on calls. Consistent with previous work, findings highlight difficulties with provider engagement in consultation and that providers with more baseline expertise are most likely to be engaged. Findings suggest tailoring EBP training efforts to better engage providers at greatest risk for low engagement.

Child Rights during the COVID-19 Pandemic: Learning from Child Health-and-Rights Professionals across the World.

The COVID-19 pandemic underscores the importance of a child rights-based approach to policymaking and crisis management. Anchored in the United Nations Convention on the Rights of the Child, the 3P framework-provision, protection, and participation-forms the foundation for health professionals advocating for children's rights. Expanding it with two additional domains-preparation and power-into a 5P framework has the potential to enhance child rights-based policies in times of crisis and future pandemics. The study aimed to (1) gather perspectives from child health-and-rights specialists on how children's rights were highlighted during the early phase of the pandemic in their respective settings; and (2) evaluate the usefulness of the 5P framework in assessing children's visibility and rights. A qualitative survey was distributed among child health-and-rights professionals; a total of 68 responses were analysed in Atlas.ti 9 from a multi-disciplinary group of policymakers and front-line professionals in eight world regions. As framed by the 5Ps, children's rights were generally not safeguarded in the initial pandemic response and negatively impacted children's health and wellbeing. Further, children lacked meaningful opportunities to raise their concerns to policymakers. The 5P framework holds the potential to shape an ethical child rights-based decision-making framework for future crises, both nationally and globally.

A Pediatric Resident Advocacy in Complex Care Curriculum.

Introduction: Children and youth with special health care needs (CYSHCN) are a special, vulnerable population. Children with medical complexity (CMC) represent a smaller, medically fragile sliver (6%) of the US child population. Several professional pediatric entities direct (or require) pediatric educators to instruct residents in advocacy for all children, explicitly including CYSHCN/CMC populations. While many existing curricula address pediatric advocacy education, a gap remains in curricula specifically designed to aid learners in advocacy of CYSHCN/CMC. Methods: Using Kolb's experiential learning cycle as a framework, we designed and delivered a comprehensive outpatient complex care curriculum, including several didactic video lectures (total: 60:04 minutes, median: 6:25 minutes) and experiential site visits devoted to advocacy topics for CMC, as one portion of a 4-week elective complex care rotation. Residents completed pre- and posttests of knowledge and pre- and postsurveys to self-assess attitudes, comfort, and behavior; viewed didactic video lectures; and engaged in experiential site visits. Reflective statements captured attitudes regarding advocacy for CMC. Results: Between July 2016 and June 2020, 47 trainees completed the rotation; data were available for 30 trainees. Residents demonstrated a statistically significant improvement in knowledge (p < .001), as well as improved attitudes, diversity sensitivity, and comfort in advocating for CMC postrotation. Qualitative comments showed overwhelmingly positive learner reaction. Discussion: This curriculum, which can be offered as a stand-alone resource or a supplement to a comprehensive complex care curriculum, incorporates didactic and experiential teaching methods and addresses a significant competency in advocacy education.

Lineamientos técnicos para la implementación de unidades de puertas abiertas en la atención de neonatos y población pediátrica / Technical guidelines for the implementation of open-door units in neonatal and paediatric care

Para salvaguardar la vida de cada niña y niño es imprescindible la participación de madres, padres, familiares y cuidadores en las unidades de atención neonatal y pediátricas, enfatizando el enfoque de derecho que facilita la transmisión de conocimientos, fomentando una cultura de corresponsabilidad entre el personal de salud y los / as usuarios /as, además promoviendo el empoderamiento de los familiares y cuidadores en el cuidado de niñas o niños durante el periodo de internación. Razón por la cual se han elaborado los presentes lineamientos, que promueven la transformación de las unidades de atención neonatales y pediátricas, a un modelo de puertas abiertas, con calidad, y con calidez, dando un mayor protagonismo y participación activa de las personas que son parte importante de la vida y desarrollo de la niña o niño, asegurando un enfoque práctico que facilite su implementación como parte de los derechos de la niñez, promoviendo la vinculación y participación activa de madres, padres, familiares y cuidadores las 24 horas del día en conjunto con el equipo de salud.

In order to safeguard the lives of each child, the participation of mothers, fathers, relatives and caregivers in neonatal and paediatric care units is essential, emphasizing the legal approach that facilitates the transmission of knowledge, fostering a culture of co-responsibility between health personnel and users//s, and promoting the empowerment of family members and caregivers in the care of children during the period of hospitalization.This is why these guidelines, which promote the transformation of neonatal and pediatric care units, have been developed into an open-door model with quality and warmth, giving greater prominence and active participation to persons who are an important part of the life and development of the child, ensuring a practical approach that facilitates its implementation as part of the rights of the child, promoting the involvement and active participation of mothers, fathers, relatives and caregivers 24 hours a day in conjunction with the health team.

Impressions of child advocacy center leaders: How problematic sexual behavior in children and adolescents is perceived by community professionals.

BACKGROUND: Consistent with the goals of National Children's Alliance, Children's Advocacy Centers (CACs) are optimal for addressing needs related to problematic sexual behavior (PSB) of youth due to their multidisciplinary approach and emphasis on community-level evidence-based interventions (Kelley et al., 2019). To promote child well-being and safety, decisions of the CAC's multidisciplinary team must be based on an accurate understanding of youth with PSB, child sexual development, and best-practice responses. However, misperceptions about youth who have engaged in PSB appear to broadly persist (Hackett, Masson, et al., 2013), leading to obstacles for CACs in addressing PSB. OBJECTIVE: To better understand and address the training and service needs of CACs across the country, the goal of this study was to assess CAC community professionals' (e.g., MDT members) perceptions of children and adolescents with PSB, as reported by CAC leaders. PARTICIPANTS AND SETTING: Participants were 351 CACs from 47 US states, a representative sample based on regional and community distributions. METHOD: A designated point-of-contact (e.g., the Director) for each CAC completed an online survey reflecting on their CAC's professional community's perceptions of youth with PSB. RESULTS: Findings suggested that a number of misperceptions about youth with PSB, particularly adolescents, are commonly reported for CAC professional communities. Prevalent misperceptions surrounded the etiology of PSB, treatment-related needs, and differences between youth with PSB and adults. CONCLUSIONS: Results can be used to inform policy, practice, training, and resource utilization to address youth with PSB in CACs, with specific recommendations provided to enhance an evidence-based approach.

Aggressive and Defensive Behaviour, Normative, and Social Adjustment in the Complex Dynamics of School Bullying / [La conducta agresiva y de defensa, y el ajuste normativo y social en las complejas dinámicas de acoso escolar]

Bullying is a group phenomenon in which schoolchildren take on different roles. Although certain contextual elements play a key role in its evolution, very few longitudinal studies have been carried out to date which investigate how these factors interact. This study aims to explore the different class groupings as regards bullying norms and to examine the effect of the type of norm, social, and normative adjustment and pro-sociality, also of the interaction of group norms with involvement in aggression and victim defence in bullying situations. A total of 3,358 secondary school students (50.71% girls, Mage = 13 years, SD = 1.34) participated in the study. Four groups of norms towards bullying were identified: anti-bullying, anti-bullying but not actively defending, indifference, and pro-bullying. Univariate linear regression models showed that normative adjustment and the type of norms had a direct inverse effect on both types of behaviour, while pro-sociality only had an effect on defence. In groups with pro-bullying norms, a greater effect of normative adjustment was observed for involvement in defence and aggression, and pro-social skills were associated with aggression. These results suggest the need to work on moral, social and emotional elements to improve school climate in schools.(AU)

El acoso escolar es un fenómeno grupal en el que los escolares asumen roles diferentes. Aunque determinadas características contextuales juegan un papel fundamental en su evolución, aún son escasos los estudios longitudinales que exploran cómo interactúan dichos factores. El presente estudio tiene como objetivos explorar los diferentes tipos de agrupamientos de clases según las normas de acoso escolar y examinar el efecto del tipo de norma, el ajuste social y normativo y la prosocialidad, así como la interacción de las normas del grupo con la implicación en la agresión y defensa de la víctima en situaciones de acoso. Un total de 3,358 escolares de secundaria (50.71 % chicas, Medad = 13 años, DT = 1.34) participaron en el estudio. Se identificaron cuatro grupos de normas hacia el acoso: antibullying, en contra del acoso, en contra pero sin defender activamente, neutral y a favor del acoso. Los modelos de regresión lineal univariados mostraron que el ajuste normativo y el tipo de normas tenían un efecto directo inverso en ambas conductas, mientras que la prosocialidad solo tuvo un efecto inverso sobre la conducta de defensa. En los grupos con normas antiacoso se observó un mayor efecto del ajuste normativo en la implicación en la defensa y agresión y que las habilidades prosociales se asociaban con la agresión. Los resultados sugieren que es necesario trabajar los aspectos morales, sociales y emocionales para mejorar el clima escolar.(AU)

Improving teamwork in multidisciplinary cross-sector teams: Adaption and pilot testing of a team training for Child Advocacy Center teams.

Background: Effective teamwork is critical to the mission of Child Advocacy Center (CAC) multidisciplinary teams. Team interventions designed to fit the unique cross-organizational context of CAC teams may improve teamwork in CACs. Methods: A collaborative, community-engaged approach was used to adapt TeamSTEPPS, an evidence-based team training for healthcare, for CAC multidisciplinary teams. The adapted training was piloted with one team and evaluated using mixed methods. Team members completed pre-training (n = 26) and follow-up surveys (n = 22) and participated in qualitative interviews (n = 9). Results: The adaptation process resulted in the creation of TeamTRACS (Team Training in Roles, Awareness, Communication, and Support). Participants rated TeamTRACS as highly acceptable, appropriate, feasible, relevant, and useful for CAC teams. They identified positive and negative aspects of the training, ideas for improvement, and future uses for TeamTRACS. Conclusions: TeamTRACS is a feasible approach to team training in CACs, and team members find the content and skills relevant and useful. Additional research is needed to test the effectiveness of TeamTRACS and identify appropriate implementation strategies to support its use.

Healthcare Use and Case Characteristics of Commercial Sexual Exploitation of Children: Teen Victims Versus High-Risk Teens.

INTRODUCTION: The overall goal of this study was to provide further information about the characteristics of commercial sexual exploitation of children (CSEC) victims by comparing the characteristics of a known victim pool to high-risk patients identified. The specific objectives of this study were to describe patient demographic characteristics, pediatric healthcare use, familial psychosocial characteristics, and child sexual abuse case characteristics present in youth identified as high risk for CSEC victimization compared with a sample of known victims. METHODS: A retrospective chart review was conducted on patients presenting to the emergency department or Child Advocacy Center for a concern of sexual abuse/assault at a midwestern U.S. academic pediatric medical center. Adolescents aged 12-21 years were included in the study. RESULTS: In the current study, multiple CSEC risk factors were noted to increase odds for CSEC victimization: homelessness or life on the streets, runaway behavior, living with mother only, placement in a juvenile detention center, placement in a residential treatment center or group home, and number of living arrangements (four or greater). Multiple elements of high-risk sexual behavior increased odds of CSEC victimization: legally age-inappropriate sex, gonorrhea diagnosis, trichomonas diagnosis, other sexually transmitted infection (STI) diagnoses, number of STIs, and chlamydia diagnosis. DISCUSSION: These findings suggest that age of sexual partners and number and types of STIs are associated with CSEC and should be validated in other groups. In addition, these data suggest that use of cocaine and opiates could serve as an important, yet underrecognized, risk factor.

Caregivers' Perceptions of Child Trauma Symptomatology, Stress, and Child Abuse Disclosures.

Caregivers consider child abuse disclosures stressful life events, but research has not investigated whether this stress affects caregiver ratings of child trauma symptomatology. Secondary data from a Child Advocacy Center in the Midwestern United States between the period of January 1, 2018, and April 31, 2019, stepwise logistic regression models, and change in estimate calculations were used to assess (1) the relationship between child abuse disclosure(s) and caregiver stress and (2) the association between caregiver stress disclosure and clinically significant ratings on the Trauma Symptom Checklist for Young Children (TSCYC). While a child's physical abuse disclosure was associated with caregiver stress and caregiver stress was significantly associated with clinically significant ratings for child depression and anger/aggression TSCYC scales, abuse disclosure did not affect the relationship between caregiver stress and TSCYC scale ratings. Moving forward, caregiver-reported stress should be considered when utilizing caregiver-completed child trauma symptom screens.

Percepciones y sentimientos de niños argentinos pospandemia por COVID-19 / Perceptions and feelings of Argentine children post pandemic COVID-19

La mortalidad y formas graves atribuibles al COVID-19 en población pediátrica han sido bajas en comparación con los adultos. No obstante, los niños, niñas y adolescentes (NNA) constituyen un universo especialmente afectado por la pandemia, en cuanto a restricción y limitación de sus derechos. La Subcomisión de Derechos de la Niñez y Adolescencia y el Comité de Pediatría Social de la Sociedad Argentina de Pediatría entendieron trascendente recolectar sus voces para relevar el impacto que la transición de la situación de pandemia por COVID-19 a la actual "nueva normalidad" ha producido en los sentimientos, emociones y deseos de los NNA en Argentina. Realizamos un estudio cualitativo, descriptivo, basado en encuesta anónima, entre NNA argentinos de 6 a 18 años residentes en Argentina. El análisis incluyó 1537 entrevistas efectivas. Los resultados permitieron sugerir recomendaciones para desarrollar estrategias de afrontamiento, contención y acompañamiento de los NNA en la pospandemia.

The frequency of the severity of the different expressions of SARS-COV-2 disease, and its mortality in the pediatric population have been low unlike in the adult population. However, children and adolescents have been very affected by this virus, through the restriction and limitations of their rights. The Subcommittee on the Rights of the Childhood and Adolescence and the Committee of Social Pediatrics of the Sociedad Argentina de Pediatría understood that it was very important to gather their voices to weigh the impact of the transition from COVID pandemic to this "new normalcy" and the effects on argentine children and adolescents' rights, emotions and desires, especially those related to accessibility to education and health. We carried on a qualitative descriptive narrative transversal phenomenological research, through an open anonymous survey, among children and adolescents between 6 and 18 years old, living in Argentina; 1537 surveys were collected. The research findings allowed elaborate recommendations to develop strategies to face, protect and accompany the children and adolescents during the post-pandemic.

Lineamientos Técnicos para la Implementación del Modelo de Atención Primera Infancia / Technical Guidelines for the Implementation of the Early Childhood Care Model

El presente documento contiene los Lineamientos Técnicos para la Implementación del Modelo de Atención Integral a la Primera Infancia, los cuales deberán ser aplicados por todos los sectores y actores involucrados con la atención de niñas y niños, con el objetivo de asegurar la pertinencia y calidad de las intervenciones desde una visión multidimensional del desarrollo y la responsabilidad compartida de todos los sectores y actores en la provisión de cuidados, estimulación, educación, salud y nutrición, así como en el cumplimiento de sus derechos en entornos protectores que incluyen a las familias y a los actores del territorio nacional

The present document contains the Technical Guidelines for the Implementation of the Model of Comprehensive Care for Early Childhood, which should be applied by all sectors and actors involved in the care of children, with the aim of ensuring the relevance and quality of interventions from a multidimensional vision of development and the shared responsibility of all sectors and actors in the provision of care, stimulation, education, health and nutrition, and the fulfilment of their rights in protective environments that include families and national actors

Climate Change Imperils Pediatric Health: Child Advocacy Through Fossil Fuel Divestment.

Climate change poses an existential threat to children's health. Divestment of ownership stakes in fossil fuel companies is one tool available to pediatricians to address climate change. Pediatricians are trusted messengers regarding children's health and therefore bear a unique responsibility to advocate for climate and health policies that affect children. Among the impacts of climate change on pediatric patients are allergic rhinitis and asthma; heat-related illnesses; premature birth; injuries from severe storms and fires; vector-borne diseases; and mental illnesses. Children are disproportionately affected as well by climate-related displacement of populations, drought, water shortages, and famine. The human-generated burning of fossil fuels emits greenhouse gases (GHG) such as carbon dioxide, which trap heat in the atmosphere and cause global warming. The US healthcare industry is responsible for 8.5% of the nation's entire greenhouse gases and toxic air pollutants. In this perspectives piece we review the principle of divestment as a strategy for improving childhood health. Healthcare professionals can help combat climate change by embracing divestment in their personal investment portfolios and by their universities, healthcare systems, and professional organizations. We encourage this collaborative organizational effort to reduce greenhouse gas emissions.

O plano de parto como mecanismo de proteção do direito à autodeterminação da mulher em contexto obstétrico em Portugal / El pla de part com a mecanisme de protecció el dret a l'autodeterminació de la dona en context obstètric a Portugal / El plan de parto como mecanismo de proteccion el derecho a la autodeterminación de la mujer en contexto obstétrico en Portugal / The birth plan as a safeguard mechanism the right to self-determination of women in obstetric context in Portugal

A violência obstétrica constitui uma das formas de violência contra a mulhere seusdireitosà saúde, segurança, integridade físicaepsíquica, e, nos casos mais extremos, o direito à própria vida. Abordaremosa violência ocorrida no parto, através de insultos, falta de informação, desrespeito pela autonomia e autodeterminação da mulher e da violação do consentimento informado. A prática de procedimentos médicos como a episiotomia, excesso de medicação, privação de movimentos, manobras de Kristeller,entre outras, são potenciadoras de risco para a saúde e vida do próprio feto/criança. Afirmamos que a violência obstétrica é, em muitos casos, não apenas uma violência contra a mulher, mas também contra a criança. Os casos em que a criança venha a nascer com malformações ou doenças resultantes dos maus-tratos que a mãe sofreu no parto, geram responsabilidade médica. Recorremosa obras e a estudos na área do Direito, Bioética e Saúde Reprodutiva assim como, procedemos à análise exaustiva de diplomas legais internacionais e nacionais. Concluímos que a violência exercida contra a mulher no contexto obstétrico atenta frontalmente contra as leges artis medicinaee constitui uma forma de discriminação de género severa que merece censura legal por parte dosEstados e por parte da própria classe médica. Afirmamosque a episiotomia é atualmente qualificada como uma espécie de mutilação genital feminina, criminalmente punível. Defendemos que o direito a acompanhamento no parto e ao cumprimento do plano de parto elaborado pela mulher ou casal são dois mecanismos essenciais a atenuar ou a eliminar a violência obstétrica.(AU)

La violencia obstétrica es una formade violencia contra las mujeres, vulnerando derechoscomo la salud, seguridad, integridad físicaypsicológica, y, en los casos más extremos, el derecho a la vida.Abordaremos la violencia que se produce en el partoa través de insultos, falta de información, falta de respeto a la autonomía y autodeterminación de la mujer y violación del consentimiento informado. La práctica de procedimientos médicos como la episiotomía, medicación excesiva, privación de movimiento, maniobras de Kristeller, entre otros, son factores potenciales de riesgo para la salud y la vida del feto/niño. Afirmamos que la violencia obstétrica es, en muchos casos, no sólo violencia contra la mujer, sino también contra el niño. Los casos en que el niño nace con malformaciones o enfermedades resultantes del maltrato que la madre sufrió en el parto, generan responsabilidad médica. Recurrimos a trabajos en el área del Derecho, la Bioética y la Salud Reproductivay textos jurídicos internacionales y nacionales. Concluimos que este tipo deviolencia contra la mujer atenta directamente contra las leges artis medicinaey constituye una forma de grave discriminación de género que merece la censura jurídica de los Estados y de la propia profesión médica. Afirmamos que la episiotomía está calificada actualmente como un tipo de mutilación genital femenina, sancionable penalmente. Sostenemos que el derecho a estar acompañada durante el parto y a cumplir con el plan de parto elaborado por la mujer o la pareja son dos mecanismos esenciales para mitigar o eliminar la violencia obstétrica.(AU)

Obstetric violence is a form of violence against women, infringingrights such as health, safety, physical and psychological integrity, and, in the most extreme cases, the right to life. We will address violence during childbirth through insults, lack of information, lack of respect for women's autonomy and self-determination, and violation of informed consent. The practice of medical procedures such as episiotomy, excessive medication, deprivation of movement, Kristeller maneuvers, among others, are potential risk factors forthe health and life of the fetus/child. We affirm that obstetric violence is, in many cases, not only violence against the woman, but also against the child. Cases in which the child is born with malformations or diseases resulting from the mistreatment suffered by the mother during childbirth, generate medical responsibility. We refer to works in the area of Law, Bioethics and Reproductive Health and international and national legal texts. We conclude that this type of violence against women is a direct violation of leges artis medicinaeand constitutes a form of serious gender discrimination that deserves legal censure by States and the medical profession itself. We affirm that episiotomy is currently classified as a type of female genital mutilation, punishable under criminal law. We maintain that the rightto be accompanied during childbirth and to comply with the birth plan drawn up by the woman or partner are two essential mechanisms for mitigating or eliminating obstetric violence.(AU)

Factors affecting child welfare and protection workers' intention to quit: a cross-sectional study from Norway.

INTRODUCTION: High turnover rates have been a problem for Norwegian child welfare and protection services for years. The main aim of this study was to identify which factors affect Norwegian child welfare and protection (CWP) workers intention to quit their job and whether there is a difference between experienced (< 3 years) and less experienced workers. METHODS: A cross-sectional survey was performed among 225 Norwegian child welfare and protection workers. Data were collected using a self-report questionnaire. Turnover intention was examined using a variety of job demands and resources as possible predictors. T tests were used to study mean differences in variable scores between experienced and less experienced workers and linear regression analysis was employed determining predictors of intention to quit. RESULTS: For the total sample (N = 225) the most important predictors for intention to quit were workload, burnout, engagement, and views on leadership. Higher emotional exhaustion and cynicism, and low professional efficacy predicted a higher score on the intention to quit scale. High engagement and leadership satisfaction predicted lower scores. The effect of workload was moderated, such that intention to quit among less experienced workers increased more with high workload than it did among more experienced child welfare workers. CONCLUSIONS: The conclusions are that job demands affect experienced and less experienced CWP workers differently and that when designing preventive efforts to reduce turnover this must be considered.

Independent non-legal advocacy in the child protection context: A descriptive review of the literature.

OBJECTIVE: To review the current literature on the use and value of independent non-legal advocacy for parents in the context of child protection. METHOD: A descriptive literature review was undertaken to identify, review, synthesize and unify the available literature on independent non-legal advocacy for parents in a child protection context. A systematic search resulted in 45 publications published between 2008 and 2021 being included in the review. Each publication was then thematically analyzed. OUTCOME: The role and context of different forms of independent non-legal advocacy are described. This is followed by an overview of the three overarching themes identified through thematic analysis - human rights, improving parenting and child protection practice and economic benefits. CONCLUSIONS: The topic of independent non-legal advocacy in child protection settings is an important, under-researched topic. The increasing number of positive outcomes noted in small scale program evaluations suggests the role of independent non-legal advocate may hold significant benefits for families, service systems and governments. Implications for service delivery include enhanced social justice and human rights for parents and children.

Increasing Access to Medical Forensic Care for the Pediatric Patient.

ABSTRACT: Child sexual abuse is a major public health problem. About one in every four girls and one in every 13 boys in the United States experience sexual abuse. In order to best serve these patients and families, the forensic nurse examiner team from a large urban Level 1 trauma center partnered with the local child advocacy center to provide ready access to educated, competent pediatric examiners who provide developmentally appropriate medical forensic care in a child-friendly environment. Consistent with national best practice standards, this occurs as part of a coordinated, colocated, highly functional multidisciplinary team. These services are provided free of charge and regardless of timeline from abuse. This partnership removes several key barriers to this care, including difficulty coordinating with multiple organizations, cost, lack of knowledge regarding available resources, and decreased ability to provide medical forensic care to nonacute patients.