Association between suicidal behavior and symptoms of other mental health problems in Mexican adolescents.

BACKGROUND: Suicidal behavior in adolescents is a growing public health problem. Knowing its risk factors is key for reducing it. OBJECTIVE: To identify the relationship between two suicidal behaviors (ideation and attempt) and eight mental health problems (MHPs) in Mexican adolescents. MATERIAL AND METHODS: Through an online survey of adolescent students from 20 states, the following information was screened: symptomatology of six MHPs (affective problems/depression, behavioral problems, somatic problems, inattention and hyperactivity problems, oppositional defiant problems and anxiety problems) and suicidal behavior (suicidal ideation and suicide attempts). MHP and suicidal behavior frequencies and percentages were analyzed, and associations were sought using binary logistic regression. RESULTS: Six-thousand seven hundred sixty-six adolescents completed the survey, out of whom 61.02% were females, with ages ranging between 11 and 19 years (16.38 ± 1.33); 10% reported suicidal behavior, and between 3 and 5%, MHPs. The predictors (χ2(8) = 387.13, p < 0.001) of suicidal behavior were affective problems/depression, behavioral problems, somatic problems, oppositional defiant problems and anxiety problems. CONCLUSION: Five mental health problems increased the risk of reporting suicidal behaviors.

ANTECEDENTES: Las conductas suicidas en adolescentes son un problema de salud pública que va en aumento. Conocer sus factores de riesgo es clave para reducirlas. OBJETIVO: Identificar la relación entre dos conductas suicidas (ideación e intento) y ocho problemas de salud mental (PSM) en adolescentes mexicanos. MATERIAL Y MÉTODOS: Mediante una encuesta en línea a adolescentes escolarizados de 20 estados, se tamizó la siguiente información: sintomatología de seis PSM (problemas afectivos/depresión, problemas conductuales, problemas somáticos, problemas de inatención e hiperactividad, problemas oposicionistas desafianes y problemas de ansiedad) y conducta suicida (ideación e intentos de suicidio). Se analizaron frecuencias y porcentajes y se indagó asociación mediante regresión logística binaria. RESULTADOS: Completaron la encuesta 6766 adolescentes entre 11 y 19 años (16.38 ± 1.33), 61.02 % del sexo femenino. El 10 % reportó conducta suicida y entre 3 y 5 %, PSM. Los factores predictivos (χ2(8) = 387.13, p < 0.001) de la conducta suicida fueron problemas afectivos/depresión, problemas conductuales, problemas somáticos, problemas oposicionistas desafiantes y problemas de ansiedad. CONCLUSIÓN: Cinco problemas de salud mental incrementaron el riesgo de reportar conductas suicidas.

Victimization and factors related to polyvictimization in adolescents of Mexico City.

INTRODUCTION: Experiencing or being exposed to violence is called victimization; living it can generate repercussions on health, quality of life and life expectancy. OBJECTIVES: To describe victimization and identify factors related to polyvictimization (≥ 4 victimization incidents) in adolescents. METHODS: After informed consent and assent were obtained, the ICAST-C and Youth Self-Report validated self-report questionnaires were applied in nine public secondary schools, by means of which demographic data, six forms of victimization and symptoms related to eight mental health problems were investigated. Frequencies of the forms of victimization and polyvictimization were obtained and an ordinal regression was carried out to identify variables related to polyvictimization. RESULTS: The answers of 638 participants were included; 49.37% reported victimization throughout life, 53.37% before previous year and 68.86% during previous year; 47.65% reported polyvictimization, 21.75% before previous year and 17.53% during previous year. The factors related to polyvictimization were depression-introversion, attention deficit, rule-breaking behaviors, bullying and parental separation/divorce. CONCLUSIONS: Victimization and polyvictimization were frequent in this sample of adolescents; the factors that were related to polyvictimization included symptoms of mental health problems, bullying and parental divorce/separation.

INTRODUCCIÓN: Experimentar o exponerse a la violencia se denomina victimización; vivirla puede repercutir en la salud, calidad y esperanza de vida. OBJETIVOS: Describir la victimización e identificar los factores relacionados con la polivictimización (≥ 4 incidentes) en adolescentes. MÉTODOS: Se aplicaron los cuestionarios validados de autorreporte ICAST-C y Youth Self Report en nueve escuelas secundarias públicas, previo consentimiento y asentimiento informados, con los que se investigaron datos demográficos, seis formas de victimización y sintomatología relacionada con ocho problemas de salud mental. Se obtuvieron frecuencias de las formas de victimización y polivictimización y se realizó regresión ordinal para identificar variables relacionadas con la polivictimización. RESULTADOS: Se incluyeron las respuestas de 638 participantes, 49.37 % indicó victimización a lo largo de la vida, 53.37 % antes del año anterior y 68.86 % durante el año anterior; 47.65 % reportó polivictimización, 21.75 % antes del año anterior y 17.53 % durante el año anterior. Los factores relacionados con la polivictimización fueron depresión-introversión, déficit de atención, conductas para romper las reglas, bullying realizado y separación/divorcio de los padres. CONCLUSIONES: La victimización y polivictimización fueron frecuentes en los adolescentes estudiados; la sintomatología de problemas de salud mental, bullying realizado y divorcio/separación de los padres se relacionaron con polivictimización.

Adverse childhood experiences. Knowledge and use by pediatrics residents.

INTRODUCTION: Adverse childhood experiences (ACEs) have been associated with the acquisition of risk behaviors and development of chronic and mental diseases since adolescence and in adult life. OBJECTIVE: To identify the knowledge and the frequency pediatrics residents ask about ACEs with. METHODS: Through an online survey sent to all resident physicians of the 2017-2018 academic year of a tertiary care children's hospital, demographic variables, knowledge, use, training and barriers to interrogate and search for ACEs were collected. RESULTS: 21% of residents answered the survey; the majority were women (70 %), less than 5 % of participants were familiar with ACEs, 31 % enquired about them in parents and their children, and 71 % considered having some barrier to interrogate about them. CONCLUSIONS: Participants in this study showed limited knowledge about ACEs, which had an impact on the frequency they enquired about them with in their patients and their parents; at least half had the perception that it is beyond the reach of the pediatrician to identify them.

INTRODUCCIÓN: Las experiencias adversas en la infancia (EAI) se han relacionado con la adquisición de conductas de riesgo y el desarrollo de enfermedades crónicas y mentales, desde la adolescencia y en la vida adulta. OBJETIVO: Identificar el conocimiento y la frecuencia con la que médicos residentes de pediatría interrogan sobre las EAI. MÉTODOS: Mediante una encuesta en línea enviada a todos los médicos residentes del año académico 2017-2018 de un hospital pediátrico de tercer nivel, se recabaron variables demográficas, del conocimiento, uso, entrenamiento y barreras para interrogar sobre EAI. RESULTADOS: 21 % de los residentes respondió la encuesta, la mayoría fue del sexo femenino (70 %), menos de 5 % de los participantes estaba familiarizado con las EAI, 31 % interrogaba sobre ellas a los padres e hijos y 71 % consideró que tiene alguna barrera para interrogarlas. CONCLUSIONES: Los participantes de este estudio mostraron un conocimiento limitado sobre las EAI, lo que repercutió en la frecuencia con la que preguntaban al respecto a sus pacientes y padres; al menos la mitad tuvo la percepción que identificarlas está fuera del alcance del pediatra.

Maltrato infantil: aspectos jurídicos en México.

In Mexico, the complexity of the comprehensive care of a girl, boy or adolescent who is the victim of any form of child abuse requires the necessary legal knowledge for comprehensive management. Physicians probably lack sufficient knowledge of the laws to understand and correctly address the legal aspects immersed in the comprehensive care of this population group. Considering that child abuse has been characterized as a world-wide medical-social-legal problem, it is necessary to know the essential legal mechanisms to protect minors who are victims of it and understand the legal status of their families and of the probable aggressor. The purpose of this article is to present the existing legal framework in Mexico and the actions of world organizations in this area. It is necessary for the Political Constitution of the United Mexican States to be the basis on which legal behaviors related to child abuse, crime investigation and administration of justice are founded, as well as for international agreements on the subject, which have been signed by the government of Mexico, to be adhered to.

En México, la complejidad de la atención integral de una niña, niño o adolescente víctima de cualquier modalidad de maltrato infantil requiere el conocimiento jurídico indispensable para su manejo integral. Los médicos probablemente no tienen un conocimiento suficiente de las leyes para entender y atender correctamente los aspectos legales involucrados en la atención integral a este grupo de la población. Considerando que el maltrato infantil ha sido catalogado como un problema médico-social-legal de alcance mundial, se hace necesario el conocimiento de los mecanismos jurídicos indispensables para proteger a los menores que son víctimas y entender la condición legal de su familia y del probable agresor. El objetivo de este artículo es presentar el marco jurídico existente en México y las acciones en este rubro de las organizaciones mundiales. Se precisa que la Constitución Política de los Estados Unidos Mexicanos sea la base en la que se fundamenten las conductas legales vinculadas con el maltrato infantil, la investigación de delitos y la administración de justicia, así como los convenios internacionales sobre el tema, los cuales han sido suscritos por el gobierno de México.

[Trauma craneal no accidental en niños: costo económico directo de la atención médica en un hospital de tercer nivel].

INTRODUCTION: Abusive head trauma (AHT) is an extreme form of physical abuse that is produced by abruptly shaking an infant or toddler. OBJECTIVE: To describe the direct economic cost of care during hospitalization of 14 children with confirmed diagnosis of AHT in a pediatric hospital. METHOD: Analysis of the cost of disease in patients with AHT attended to between 2001 and 2010. Partial direct economic cost of medical care (days of hospital stay, laboratory tests and imaging studies, surgical procedures and subspecialist consultations) was calculated adjusting for inflation, with year 2001 taken as base year. Patients were classified in three groups (moderate, severe and fatal AHT). Descriptive and sensitivity analysis was carried out. RESULTS: Patients with severe AHT generated higher medical care costs ($105,794.88 ± 33,201.91) in comparison with the group of moderate ($37,012.95, ± 7,154.87) and fatal AHT ($18,595.04 ± 6424.47) (p <0.05). Total cost was $665,467.98 Mexican pesos ($71,249.25 international dollars). CONCLUSIONS: Total cost for the 14 patients was an elevated figure, as in other parts of the world. The direct economic cost is closely related to the severity of the clinical presentation.

INTRODUCCIÓN: El trauma craneal no accidental (TCNA) es una forma extrema de abuso físico que se produce por la sacudida brusca de un lactante o preescolar. OBJETIVO: Describir el costo económico directo de la atención durante la hospitalización de 14 niños con diagnóstico confirmado de TCNA en un hospital pediátrico. MÉTODO: Análisis del costo de la enfermedad en pacientes con TCNA, atendidos entre 2001 y 2010. Se realizó análisis descriptivo y de sensibilidad. Se calculó costo económico directo parcial de la atención médica (días de estancia hospitalaria, exámenes de laboratorio y gabinete, procedimientos quirúrgicos y consultas por subespecialista), ajustado por la inflación, se tomó como año base 2001. Los pacientes se clasificaron en tres grupos: TCNA moderado, severo y fatal. RESULTADOS: Los pacientes con TCNA severo generaron mayor costo en la atención médica ($105 794.88 ± 33 201.91), en comparación con el grupo con TCNA moderado ($37 012.95 ± 7154.87) y fatal ($18 595.04 ± 6424.47) (p < 0.05). El costo total fue de 665 467.98 pesos mexicanos (71 249.25 dólares internacionales). CONCLUSIONES: El costo total de los 14 pacientes fue una cifra elevada como en otras partes del mundo. El costo económico directo se relaciona estrechamente con la gravedad del cuadro clínico.

ISPCAN Child Abuse Screening Tool for Children (ICAST-C): Translation and adaptation to Mexican Spanish, and psychometric properties tested in Mexico City adolescents.

BACKGROUND: Research using the IPSCAN Child Abuse Screening Tool for Children (ICAST-C), has provided ample evidence of the magnitude of violence against children. Knowledge about its psychometric characteristics and validity is limited. Hence, our objective was to translate and culturally adapt the ICAST-C in adolescents from Mexico City and determine its psychometric properties. PARTICIPANTS AND SETTING: To determine the psychometric properties of the instrument 723 adolescents between 11 and 18 years of age from 9 public secondary schools in Mexico City participated. METHODS: The study was carried out in two phases: 1) translation and adaptation of the instrument (in 5 steps) and 2) pilot evaluation of the psychometric properties. Total and factor reliabilities were determined, Pearson correlation was used for temporal stability while construct validity was determined by Confirmatory Factor Analysis (CFA), and final adequacy of the items eliminated by the CFA. RESULTS: We developed the culturally relevant Mexican Spanish version of the ICAST-C. The CFA confirmed the six-factor structure hypothesis. To improve the original model we eliminated ten items, the final model showed good global fit indices (χ2(1310) = 2207.68, p < .01, χ2/df = 1.68; CFI =0.95; RMSEA = 0.02 [CI95% 0.02-0.03]; SRMR = 0.08). Total and factor reliabilities were adequate (Alpha = 0.79-0.92, r = 0.52-0.75), except for the non-violent discipline factor (Alpha = 0.59, r = 0.38). CONCLUSIONS: While these data suggest that this version of the ICAST-C is valid and reliable for adolescents in Mexico City public secondary schools, further research should evaluate the psychometric properties in a national sample.

Pediatric Abusive Head Trauma: Multicentric Experience in Mexico.

Abusive head trauma (AHT) is one of the most severe forms of child abuse due to its morbidity and mortality. However, AHT is still misdiagnosed in developing countries because of its nonspecific clinical picture and limited knowledge of it on the part of physicians. The aim of this study was to describe some characteristics of children with AHT, their families, and caregivers, as well as the clinical data that could serve as signs for its suspicion and the medical-legal resolution of the cases. Children suspect with AHT in emergency rooms in three Mexican hospitals were included after obtaining informed consent from the parents. All information was obtained from the parents by means of a questionnaire and from different clinical and radiological evaluations of the clinical records of the patients. 15 children, with a median age of 5 months and predominantly males (73.33%), were included in the study. 66% reported a history of irritability periods, and most of the patients (73.33%) had more than one habitual caregiver. The diagnosis of AHT was suspected in only 33.33% on admission in the Emergency Services. Acute symptomatology was present in 53.33%, while less severe symptoms were reported in the rest. Special attention should be paid on babies with history of irritable periods. When a child who is previously healthy and suddenly presents with a seizure or cardiorespiratory dysfunction or brought to the hospital dead, the diagnosis of AHT should be considered as a priority.

Munchausen syndrome by proxy in Mexican children: medical, social, psychological and legal aspects.

INTRODUCTION: The Munchausen Syndrome by Proxy (MSP), is considered as an unusual less frequent variety of child abuse (CA). In this type of abuse the perpetrators purposely provide factitious information, tamper with specimens or actually induce an illness in a child. Nowadays, it is a clinical entity described in pediatrics as more frequently than before. Despite the fact of its presence worldwide, there are still problems in order to get an appropriate diagnostic. It is also difficult to handle both the clinical and legal aspects in various countries. OBJECTIVE: Make our academic fellows aware of various pediatric, psychological, social and legal aspects of a series of cases attended at the Clínica de Atención Integral al Niño Maltratado from Instituto Nacional de Pediatría (CAINM-INP), Mexico [Integral Clinic of Attention for Abused Children, at National Institute of Pediatrics, Mexico]. MATERIAL AND METHODS: From a series of 25 cases, 18 minors of age were considered with this syndrome since we found that they shared medical, psychological, social and legal characteristics. RESULTS: 18 minors of age belonged to 14 families. 4 of those families had two affected children each one. These affected children were girls 13/18, predominant in children under six years in 10/18. Syndrome expression was distributed as follows: fever from a non determined origin, seizures, chronic diarrhea, hematuria, and probable sexual abuse. 14 children were hospitalized. In all cases, the aggressor was the mother. The psychological evaluation of six perpetrators revealed psychotic, histrionic, and compulsive-obsessive traits. The socio-economic condition was low in 50% of the cases. A legal demand was posed for seven patients in which all the children remained under the custody of the mother. CONCLUSIONS: In Mexico, reports of CA have increased within the last years according to experience. Some complex forms as MSP require the participation of an interdisciplinary team for both diagnosis and integral attention.

[Nutritional status in children victims of physical and sexual abuse]. / Estado de nutrición en niños víctimas de abuso físico y de abuso sexual.

OBJECTIVE: To assess and relate the nutritional status by type of abuse in a pediatric population diagnosed with physical abuse (PA) and sexual abuse (SA). MATERIAL AND METHODS: It's a retrospective, cross-sectional, descriptive study of 178 clinical records of children aged less than 12 years, attended at the Clinic for the Integral Care of the Abused Child of the Instituto Nacional de Pediatría and the Universidad Nacional Autónoma de México (CAINM-INP-UNAM), during the period 1994 to 2005. The relationship of nutritional status with the type of abuse was analyzed in two age ranges (3 months to less than five years, and five to 11 years) and gender with Student t and chi-square tests. RESULTS: We identified that, in girls PA was associated with stunting (PA: 48% vs. SA: 12%, p < 0.005 and PA: 21% vs. SA: 0%, p < 0.002) and wasting (PA: 21% vs. SA: 0%, p < 0.01 and PA: 21% vs. SA: 0%, p < 0.002). Whereas in girls SA was associated with overweight and obesity in age range five to 11 years (PA: 0% vs. SA: 31%; p < 0.01). CONCLUSIONS: This study identified acute and chronic under nutrition in girls with PA, and overweight and obesity in girls with SA. These findings enrich the knowledge for the suspicion of maltreatment child syndrome during the search of the aetiology of the clinical expression studied.

Asociación entre conducta suicida y síntomas de otros problemas de salud mental en adolescentes mexicanos / Association between suicidal behavior and symptoms of other mental health problems in Mexican adolescents

Resumen Antecedentes: Las conductas suicidas en adolescentes son un problema de salud pública que va en aumento. Conocer sus factores de riesgo es clave para reducirlas. Objetivo: Identificar la relación entre dos conductas suicidas (ideación e intento) y ocho problemas de salud mental (PSM) en adolescentes mexicanos. Material y métodos: Mediante una encuesta en línea a adolescentes escolarizados de 20 estados, se tamizó la siguiente información: sintomatología de seis PSM (problemas afectivos/depresión, problemas conductuales, problemas somáticos, problemas de inatención e hiperactividad, problemas oposicionistas desafianes y problemas de ansiedad) y conducta suicida (ideación e intentos de suicidio). Se analizaron frecuencias y porcentajes y se indagó asociación mediante regresión logística binaria. Resultados: Completaron la encuesta 6766 adolescentes entre 11 y 19 años (16.38 ± 1.33), 61.02 % del sexo femenino. El 10 % reportó conducta suicida y entre 3 y 5 %, PSM. Los factores predictivos (χ2(8) =387.13, p < 0.001) de la conducta suicida fueron problemas afectivos/depresión, problemas conductuales, problemas somáticos, problemas oposicionistas desafiantes y problemas de ansiedad. Conclusión: Cinco problemas de salud mental incrementaron el riesgo de reportar conductas suicidas.

Abstract Background: Suicidal behavior in adolescents is a growing public health problem. Knowing its risk factors is key for reducing it. Objective: To identify the relationship between two suicidal behaviors (ideation and attempt) and eight mental health problems (MHPs) in Mexican adolescents. Material and methods: Through an online survey of adolescent students from 20 states, the following information was screened: symptomatology of six MHPs (affective problems/depression, behavioral problems, somatic problems, inattention and hyperactivity problems, oppositional defiant problems and anxiety problems) and suicidal behavior (suicidal ideation and suicide attempts). MHP and suicidal behavior frequencies and percentages were analyzed, and associations were sought using binary logistic regression. Results: Six-thousand seven hundred sixty-six adolescents completed the survey, out of whom 61.02% were females, with ages ranging between 11 and 19 years (16.38 ± 1.33); 10% reported suicidal behavior, and between 3 and 5%, MHPs. The predictors (χ2(8) = 387.13, p < 0.001) of suicidal behavior were affective problems/depression, behavioral problems, somatic problems, oppositional defiant problems and anxiety problems. Conclusions: Five mental health problems increased the risk of reporting suicidal behaviors.

[Adolescent pregnancy: its causes and repercussions in the dyad]. / Embarazo adolescente: sus causas y repercusiones en la diada.

Teen pregnancy (TP) is a global public health problem that affects the physical and emotional health, educational and economic status of prospective parents and often also affects the product of gestation. In most cases, the TP is an unplanned event, and often difficult to accept by the couple. But it is more complicated for the future mother who suddenly finds herself without the protection of the couple, her family and her school companions. The risks to which the young mothers are exposed are diverse, but include: submitting to a clandestine abortion, falling into drug addiction, prostitution and crime; Also, it should be noted that with so many adversities, she can develop child maltreatment and frequently, she may be attacked at home, at school or in society giving rise to the twin phenomena of child abuse. To address this problem, it is necessary to develop preventive strategies aimed at risk of early pregnancy or acquiring sexually transmitted diseases by implementing educational programs for personal, family or schools for this age group range. It stresses the need for these programs to be consistent and persistent, as a basic strategy to reduce the consequent risks to unplanned or accepted sex life.

El embarazo en adolescentes (EA) es un problema de salud pública mundial que altera la salud física, emocional, la condición educativa y económica de los futuros padres; asimismo, frecuentemente se afecta también al producto de la gestación. El EA habitualmente no es un evento planeado o deseado y, frecuentemente, difícil de aceptar por la pareja, aunque quizá sea más marcado en la futura madre, quien bruscamente se puede encontrar sin protección. Ello se agrava cuando su condición económica no le permite atender sus propias necesidades y las de su hijo. Los riesgos a los que se expone la joven son diversos, pero destacan: someterse a un aborto clandestino, caer en adicciones, prostitución y delincuencia. Para hacer frente a este problema es necesario desarrollar estrategias preventivas orientadas al riesgo de embarazo temprano o la adquisición de enfermedades por transmisión sexual, mediante la implementación de programas educativos de alcance personal, familiar o escolar para este grupo etario. Se insiste en la necesidad de que dichos programas sean constantes y persistentes, como una estrategia básica que permita disminuir los riesgos consecuentes a una vida sexual no planeada o aceptada.

Victimización y factores relacionados con polivictimización en adolescentes de la Ciudad de México / Victimization and factors related to polyvictimization in adolescents of Mexico City

Resumen Introducción: Experimentar o exponerse a la violencia se denomina victimización; vivirla puede repercutir en la salud, calidad y esperanza de vida. Objetivos: Describir la victimización e identificar los factores relacionados con la polivictimización (≥ 4 incidentes) en adolescentes. Métodos: Se aplicaron los cuestionarios validados de autorreporte ICAST-C y Youth Self Report en nueve escuelas secundarias públicas, previo consentimiento y asentimiento informados, con los que se investigaron datos demográficos, seis formas de victimización y sintomatología relacionada con ocho problemas de salud mental. Se obtuvieron frecuencias de las formas de victimización y polivictimización y se realizó regresión ordinal para identificar variables relacionadas con la polivictimización. Resultados: Se incluyeron las respuestas de 638 participantes, 49.37 % indicó victimización a lo largo de la vida, 53.37 % antes del año anterior y 68.86 % durante el año anterior; 47.65 % reportó polivictimización, 21.75 % antes del año anterior y 17.53 % durante el año anterior. Los factores relacionados con la polivictimización fueron depresión-introversión, déficit de atención, conductas para romper las reglas, bullying realizado y separación/divorcio de los padres. Conclusiones: La victimización y polivictimización fueron frecuentes en los adolescentes estudiados; la sintomatología de problemas de salud mental, bullying realizado y divorcio/separación de los padres se relacionaron con polivictimización.

Abstract Introduction: Experiencing or being exposed to violence is called victimization; living it can generate repercussions on health, quality of life and life expectancy. Objectives: To describe victimization and identify factors related to polyvictimization (≥ 4 victimization incidents) in adolescents. Methods: After informed consent and assent were obtained, the ICAST-C and Youth Self-Report validated self-report questionnaires were applied in nine public secondary schools, by means of which demographic data, six forms of victimization and symptoms related to eight mental health problems were investigated. Frequencies of the forms of victimization and polyvictimization were obtained and an ordinal regression was carried out to identify variables related to polyvictimization. Results: The answers of 638 participants were included; 49.37% reported victimization throughout life, 53.37% before previous year and 68.86% during previous year; 47.65% reported polyvictimization, 21.75% before previous year and 17.53% during previous year. The factors related to polyvictimization were depression-introversion, attention deficit, rule-breaking behaviors, bullying and parental separation/divorce. Conclusions: Victimization and polyvictimization were frequent in this sample of adolescents; the factors that were related to polyvictimization included symptoms of mental health problems, bullying and parental divorce/separation.

[Child abuse: its knowledge, attention and diffusion in three pediatric hospitals in Mexico]. / Maltrato infantil: su conocimiento, atención y difusión en tres hospitales pediátricos de México.

Child abuse (CA) was observed in Mexico since the early 60's through isolated publications from clinical cases and where manifestations of physical injury or sexual abuse predominated. Since the 90's, the Clinic for Integral Care of the Abused Child was established at the National Institute of Pediatrics (CAINM-INP, for its Spanish acronym), which actions were addressed to the care, teaching and research on this topic. This approach was replicated in two hospital centers in the country: the Clinic for Integral Care of the Abused Children at Children's Specialty Care Hospital of Chihuahua and the Pediatric Service of the General Hospital of Mexicali. The main objective of this work was to present to the medical community, paramedics, and other professionals who interact with the pediatric population and society, the efforts that have been made in Mexico to address this legal, medical, and social pathology in a logical manner, and always aimed at protecting victims and their families.

Experiencias adversas en la infancia. Conocimiento y uso por médicos residentes de pediatría / Adverse childhood experiences. Knowledge and use by pediatrics residents

Resumen Introducción: Las experiencias adversas en la infancia (EAI) se han relacionado con la adquisición de conductas de riesgo y el desarrollo de enfermedades crónicas y mentales, desde la adolescencia y en la vida adulta. Objetivo: Identificar el conocimiento y la frecuencia con la que médicos residentes de pediatría interrogan sobre las EAI. Métodos: Mediante una encuesta en línea enviada a todos los médicos residentes del año académico 2017-2018 de un hospital pediátrico de tercer nivel, se recabaron variables demográficas, del conocimiento, uso, entrenamiento y barreras para interrogar sobre EAI. Resultados: 21 % de los residentes respondió la encuesta, la mayoría fue del sexo femenino (70 %), menos de 5 % de los participantes estaba familiarizado con las EAI, 31 % interrogaba sobre ellas a los padres e hijos y 71 % consideró que tiene alguna barrera para interrogarlas. Conclusiones: Los participantes de este estudio mostraron un conocimiento limitado sobre las EAI, lo que repercutió en la frecuencia con la que preguntaban al respecto a sus pacientes y padres; al menos la mitad tuvo la percepción que identificarlas está fuera del alcance del pediatra.

Abstract Introduction: Adverse childhood experiences (ACEs) have been associated with the acquisition of risk behaviors and development of chronic and mental diseases since adolescence and in adult life. Objective: To identify the knowledge and the frequency pediatrics residents ask about ACEs with. Methods: Through an online survey sent to all resident physicians of the 2017-2018 academic year of a tertiary care children’s hospital, demographic variables, knowledge, use, training and barriers to interrogate and search for ACEs were collected. Results: 21% of residents answered the survey; the majority were women (70 %), less than 5 % of participants were familiar with ACEs, 31 % enquired about them in parents and their children, and 71 % considered having some barrier to interrogate about them. Conclusions: Participants in this study showed limited knowledge about ACEs, which had an impact on the frequency they enquired about them with in their patients and their parents; at least half had the perception that it is beyond the reach of the pediatrician to identify them.

[Sleep alterations in childhood victims of sexual and physical abuse]. / Alteraciones del sueño en niños víctimas de abuso físico o sexual.

INTRODUCTION: The abused child syndrome is related to a variety of emotional disorders, among which are the "post-traumatic stress syndrome" and the phenomena "re-experience," which is related to disturbances of the normal sleep-wake cycle. OBJECTIVE: To determine the polysomnographic characteristics of the abused child syndrome and compare them with paired healthy children. MATERIAL AND METHODS: After two-night habituation, all-night video-digital polygraphic recordings following recommendations of the International Federation of Clinical Neurophysiology were performed in 15 abused child syndrome and 15 healthy controls. RESULTS: In the abused child syndrome patients, the main sleep changes were decreased sleep efficiency, decreased sleep onset sleep latency, increased wakefulness, decreased REM sleep and total sleep time. CONCLUSIONS: The abused child syndrome have abnormal sleep patterns, independent of the type of abuse, age or sex. Sleep alterations are a new characteristic of the abused child syndrome, not previously described.

Anti-cardiolipin, anti-cardiolipin plus bovine, or human beta(2)glycoprotein-I and anti-human beta(2)glycoprotein-I antibodies in a healthy infant population.

BACKGROUND: Pathogenic antiphospholipid antibodies studies are usually conducted on populations of adults. Studies involving normal children are scant. METHODS: Antibody reactivity against CL alone (true aCL), CL-complexed to bovine beta(2)GP-I (aCL-bovine beta(2)GP-I), or human (aCL-human beta(2)GP-I) beta(2)GP-I, or to phospholipid-free human beta(2)GP-I (anti-human beta(2)GP-I) was determined by ELISA in serum samples from 360 Mexican children ranging from 1 month through 8 years of age. RESULTS: Statistical analysis of variance and rankings of Kruskal-Wallis demonstrated no significant difference in all tested antibody activities between ages and genders of the study population. Values are presented as a percentile distribution included between 5 and 99, corresponding to the percentages of the studied population. Normal arbitrary units (AU) for IgG, IgA, and IgM true aCL that correspond to the 95 and 99 percentiles are as follows: 2.15 and 3.5; 2.35 and 5.0, and 3.15 and 4.5, respectively. IgG, IgA, and IgM aCL-bovine beta(2)GP-I activities are 2.6 and 5.0, 3.0 and 5.0, and 2.7 and 6.0 AU, respectively, while IgG activities of aCL-bovine and human beta(2)GP-I are 1.45 and 1.80, respectively. Normal values for IgG anti-human beta(2)GP-I are 1.85 AU. CONCLUSIONS: While elevated serum levels of antibodies to CL and/or beta(2)GP-I have been associated with thrombotic and hematologic manifestations, the majority of reports deal with adult populations. We report the cut-off values (in AU, international PL units, and international units for beta(2)GP-I) of the specific serologic response of true aCL, aCL-bovine beta(2)GP-I, aCL-human beta(2)GP-I, and anti-human beta(2)GP-I in healthy Mexican children.

[Adverse effects of marijuana in children: Could its knowledge limit the legalization of drugs in Mexico?] / Efectos adversos de la marihuana en la edad pediátrica: su conocimiento ¿podría limitar la legalización de la droga en México?

A reflection on whether to expose, determine and clarify the effects of marijuana on pregnant adolescents and their fetus is a determining factor to consider more judiciously the tendency to legalize marijuana in Mexico. We emphasize alterations in the central nervous system, immune system and some genetic aspects of the fetus and its potential expressions at different stages of a child's life. Should pediatricians and parents allow, in addition to the difficulties that their patients and children face today, the risk that is the affordability of marijuana? That is the challenge to overcome.

Maltrato infantil: su conocimiento, atención y difusión en tres hospitales pediátricos de México / Child abuse: its knowledge, attention and diffusion in three pediatric hospitals in Mexico

Resumen: El maltrato infantil (MI) se ha visualizado en México desde la década de los 60 a través de publicaciones aisladas de casos clínicos donde predominaban las manifestaciones de daño físico o abuso sexual. A partir de la década de los 90, se estableció la Clínica de Atención Integral al Niño Maltrato en el Instituto Nacional de Pediatría (CAINM-INP), cuyo accionar se orientó a la asistencia, docencia e investigación del tema. Este enfoque fue imitado en dos centros hospitalarios del país: en la Clínica para la Atención Integral del Menor Maltratado del Hospital Infantil de Especialidades de Chihuahua y en el Servicio de Pediatría del Hospital General de Mexicali. El objetivo básico de este trabajo fue presentar a la comunidad médica y paramédica, a otros profesionales que interactúan con la población pediátrica y a la sociedad civil los esfuerzos que se han realizado en México para enfrentar esta situación médica-social y legal de una manera lógica, siempre orientada a proteger a las víctimas y a sus familias.

Abstract: Child abuse (CA) was observed in Mexico since the early 60's through isolated publications from clinical cases and where manifestations of physical injury or sexual abuse predominated. Since the 90's, the Clinic for Integral Care of the Abused Child was established at the National Institute of Pediatrics (CAINM-INP, for its Spanish acronym), which actions were addressed to the care, teaching and research on this topic. This approach was replicated in two hospital centers in the country: the Clinic for Integral Care of the Abused Children at Children's Specialty Care Hospital of Chihuahua and the Pediatric Service of the General Hospital of Mexicali. The main objective of this work was to present to the medical community, paramedics, and other professionals who interact with the pediatric population and society, the efforts that have been made in Mexico to address this legal, medical, and social pathology in a logical manner, and always aimed at protecting victims and their families.

Abusive head trauma at a tertiary care children's hospital in Mexico City. A preliminary study.

OBJECTIVES: Determine the prevalence, clinical signs and symptoms, and demographic and family characteristics of children attending a tertiary care hospital in Mexico City, Mexico, to illustrate the characteristics of abusive head trauma among this population. METHODS: This is a cross-sectional descriptive study of infants and children under 5, who suffered head trauma and were admitted to the National Pediatrics Institute in Mexico City, a tertiary care referral center. We reviewed medical records and extracted data on clinical and neurological signs and symptoms, fundus, radiological (long bones, thorax, CAT scan), and laboratory tests. We administered a standardized questionnaire assessing child abuse and neglect to the parents of the children included in the study. RESULTS: One hundred and twenty children, under 5 presenting with head trauma, were recruited, 13 (11%) were considered abusive head trauma (AbHT) and 107 (89%) were diagnosed as accidental head injury (AcHI). The AbHT group comprised younger infants (mean age 8 months) and the AcHI group included toddlers about an average of 25 months. To account for this significant age difference, we performed a comparison of age matched cases. The children in the AbHT were more likely to be female, the result of the first unintended pregnancy and the children of younger mothers (17-19). Mothers in this group had attended fewer than 5 prenatal care visits and fathers had a history of alcohol abuse. Five (38%) of the 13 AbHT children did not survive their injuries and overall showed greater neurological and respiratory compromise, increased prothrombin time (PT), and lower hematocrit values. The most common intracranial injuries suffered by children in the AbHT group were subdural/epidural hematoma and parenchymal/subarachnoid hemorrhage. Retinal hemorrhage was the most frequent ocular injury. CONCLUSIONS: In a tertiary care children's hospital, 11% of the children presenting with head trauma, were considered of abusive origin. Unintended pregnancy among teen mothers and substance abuse in the father were associated with abusive head trauma in this descriptive study.