Atuação de enfermeiros na estratégia saúde da família às crianças que sofrem maus-tratos: uma revisão integrativa / The performance of nurses in the family health strategy for children suffering maltreatment: an integrative review / El desempeño de las enfermeras en la estrategia de salud familiar para niños que sufren maltrato: una revisión integrativa

Objetivo: analisar na literatura científica as evidências sobre a assistência de enfermeiros que atuam na estratégia saúde da família às crianças que sofrem maus-tratos. Método: Revisão integrativa realizada nas bases de dados: Web of Science, Embase, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Cumulative Index to Nursing and Allied Health Literature e Medical Literature and Retrivial Sistem online, no período de março a maio de 2021.Resultados: Foram selecionados oito estudos que emergiram as categorias: conhecimento da prática profissional dos enfermeiros em casos de violência infantil; despreparo e desproteção dos enfermeiros com relação à tomada de decisão frente aos casos de violência e dificuldades enfrentadas pelos enfermeiros da atenção primária à saúde mediante o encaminhamento de casos de violência. Conclusão: A falta de preparo assistencial pelos enfermeiros é identificada pela ausência de um protocolo operacional padrão para nortear a assistência a crianças vítima de violência infantil.

Objective: to analyze the evidence in the scientific literature about the assistance provided by nurses who work in the family health strategy to children who suffer abuse. Method: Integrative review carried out in the following databases: Web of Science, Embase, Latin American and Caribbean Literature in Health Sciences, Cumulative Index to Nursing and Allied Health Literature and Medical Literature and Retrivial Online System, from March to May of 2021. Results: Eight studies were selected that emerged in the following categories: knowledge of nurses' professional practice in cases of child violence; nurses' unpreparedness and lack of protection regarding decision-making in cases of violence and difficulties faced by nurses in primary health care through the referral of cases of violence. Conclusion: The nurses' lack of care preparation is identified by the absence of a standard operational protocol to guide the assistance to children who are victims of child violence.

Objetivo: analizar la evidencia en la literatura científica sobre la asistencia brindada por enfermeras que trabajan en la estrategia de salud familiar a los niños que sufren maltrato. Método: Revisión integrativa realizada en las siguientes bases de datos: Web of Science, Embase, Literatura Latinoamericana y Caribeña en Ciencias de la Salud, Índice Acumulativo de Literatura en Enfermería y Afines en Salud y Literatura Médica y Sistema Retrivial Online, de marzo a mayo de 2021. Resultados: Se seleccionaron ocho estudios que surgieron en las siguientes categorías: conocimiento de la práctica profesional del enfermero en casos de violencia infantil; la falta de preparación y desprotección de las enfermeras en la toma de decisiones en casos de violencia y las dificultades que enfrentan las enfermeras en la atención primaria de salud a través de la derivación de casos de violencia. Conclusión: La falta de preparación asistencial de las enfermeras se identifica por la ausencia de un protocolo operativo estándar que oriente la atención a los niños víctimas de violencia infantil.

What happens after the hospital? An analysis of longitudinal care needs in children treated for child physical abuse.

BACKGROUND: Victims of child physical abuse (CPA) undergo stabilization and social evaluation during initial management. Current data guides the initial hospital course, but few studies evaluate post-hospital care. The aim of this study was to evaluate compliance with recommended post-discharge visits. METHODS: A retrospective review of our trauma database at a Level I pediatric trauma center from 2014-2018 was performed. Data included demographics, injuries, and longitudinal outcomes. Descriptive statistics and univariate analyses were performed. RESULTS: There were 401 patients (409 unique presentations). Median age was 7 months. Mortality was 6%. Ninety-five percent (358/377) had recommended appointments with multiple specialty services. Compliance with all recommended visits during the first year after injury was 88%. Patients with complex injuries were as likely to comply with recommended follow-up [72% vs. 67%, p = 0.4]; however, they were more likely to still be receiving care at 1 year (58% vs. 14%, p = 0.0001). Those discharged to CPS custody were more likely to be compliant with their follow-up (90% vs. 82%, p = 0.03). CONCLUSION: Patients significantly injured due to CPA require more post-hospital care over time. CPA management guidelines should include a mechanism to provide resources to these patients and manage multiple coordinating consultants .

Commentary on "What happens after the hospital? An analysis of longitudinal care needs in children treated for child physical abuse".

This is a commentary on the manuscript entitled "What Happens after the Hospital? An Analysis of Longitudinal Care Needs in Children Treated for Child Physical Abuse" by Brittany L. Johnson and colleagues.

[Burns by immersion in children and abuse]. / Brûlures par immersion chez l'enfant et maltraitance.

AIM OF THE STUDY: Ten percent of childhood burns could arise from maltreatment. While describing 6 severe cases of inflicted scalds by immersion in children, we expose our systematic diagnostic approach of abuse and confirm the serious nature of burn when they are inflicted. PATIENTS AND METHOD: The retrospective study concerned children hospitalized for scalds by immersion between 2013 and 2016 and for whom child abuse has been confirmed. Sex, age, burns description, needs of surgery, length of stay at hospital and protection plan set up were collected. RESULTS: Six cases of burns by immersion due to maltreatment were identified (5 boys, 1 girl) with a median age of 12 months. The average total burn surface area was 19%. Burns were of deep second and third degree and always symmetric. Every child underwent surgery at least once. Concern information was transferred for all of them. CONCLUSION: Teams taking care of children with burns must be trained to the difficult diagnostic of abuse or neglect so that early social interventions can be set up in case of maltreatment.

Assistência de enfermagem à criança/adolescente vítima de violência: revisão integrativa / Nursing care for child/adolescent victims of violence: integrative review / Asistencia de enfermería al niño/adolescente víctima de violencia: revisión integrativa

Objetivo: desvelar a produção acerca da assistência de enfermagem prestada às crianças/adolescentes vítimas de violência. Método: trata-se de uma revisão sistematizada realizada com consulta nas bases de dados: LILACS, Scielo e BDENF. Foram selecionados 19 artigos para compor este trabalho. A análise de dados deu-se por meio da proposta de Mendes, Silveira e Galvão. Resultados: os dados foram discutidos através dos tópicos: despreparo dos profissionais frente aos casos de violência infantil; sentimentos dos profissionais envolvidos no cuidado à criança/adolescente vítima de violência; notificação, protocolos e rotinas na assistência à criança/ adolescente vítima de violência; estratégias de assistência à criança/adolescente vítima de violência. Conclusão: os profissionais de enfermagem não se sentem preparados para atuarem frente aos casos de violência infantil. Identificou-se a necessidade de protocolos assistenciais que respaldem a assistência profissional. Ademais, é importante o fortalecimento da rede de atenção intersetorial que garanta a assistência adequada às vítimas e suas famílias

Objective: to explore the literature regarding the nursing care provided to children/adolescents victims of violence. Method: it consists of a systematic review performed on databases such as, LILACS, Scielo and BDENF. 19 articles have been selected to compose this study. The data analysis was developed throughout Mendes, Silveira and Galvão's proposal. Results: the data discussion occurred throughout the following topics: professional unpreparedness to deal with cases of child violence; the feelings of professionals involved on the care provided to a child/adolescent victim of violence; notification, protocols and routines regarding the assistance of children/adolescents victims of violence. Conclusion: nursing professionals do not feel prepared to deal with situations of children violence. It was identified the need of protocols that support the nursing assistance. Furthermore, it is important to enhance the intersectoral attention network in order to ensure the appropriate care to the victims and their families

Objetivo: desvelar la producción acerca de la asistencia de enfermería a los niños/adolescentes víctimas de violencia. Método: se trata de una revisión sistematizada realizada con consulta en las bases de datos: LILACS, Scielo y BDENF. Se seleccionaron 19 artículos para componer este trabajo. El análisis de datos se dio através de la propuesta de Mendes, Silveira y Galvão. Resultados: los datos fueron discutidos através de los tópicos: despreparo de los profesionales frente a los casos de violencia infantil; sentimientos de los profesionales envolvidos en el cuidado al niño/ adolescente víctima de violencia; notificación, protocolos y rutinas en la asistencia al niño/adolescente víctima de violencia; estrategias de asistencia al niño/adolescente víctima de violencia. Conclusión: los profesionales de enfermería no se sienten preparados para actuar frente a los casos de violencia infantil. Se identificó la necesidad de protocolos asistenciales que soporten la asistencia profesional. Además, es importante el fortalecimiento de la red de atención intersectorial que promueva la asistencia adecuada a las víctimas y sus familia

A Retrospective Study of Cervical Spine MRI Findings in Children with Abusive Head Trauma.

BACKGROUND/AIMS: Increasing attention has been given to the possible association of cervical spine (c-spine) injuries with abusive head trauma (AHT). The aims of this study were to describe c-spine MRI findings in hospitalized AHT patients. METHODS: This is a retrospective study of children under the age of 5 years with AHT admitted to hospital in 2004-2013. Those with c-spine MRI were identified, and the images were reviewed. RESULTS: 250 AHT cases were identified, with 34 (14%) undergoing c-spine MRI. Eleven patients (32%) had 25 findings, including hematoma in 2, occiput-C1-C2 edema in 3, prevertebral edema in 6, facet edema in 2, and interspinous and/or muscular edema in 10. No patients had a clinically evident c-spine injury, a clinically unstable c-spine, or required c-spine surgery. CONCLUSIONS: C-spine MRI may identify abnormalities not apparent upon physical examination and the procedure should therefore be considered in cases of suspected AHT.

Teoría de rango medio de enfermería para la adaptación de un menor ante discriminación y violencia familiar / Nursing theory of average range to for the adaptation of a minor to discrimination and family violence

El presente artículo desarrolla el proceso de valoración de enfermería en la práctica comunitaria y el análisis de una situación de enfermería en el proceso de adaptación de un menor ante discriminación y violencia familiar. El análisis se realizó desde la teoría de rango medio (TRM) de Afrontamiento de Roy, y se operacionalizó con el proceso de enfermería mostrando que es autónomo, fundamentado y dinámico, ubicada en una visión de mundo integrativa/interactiva; utilizando, además, los patrones de conocimiento de enfermería: empírico, estético, personal y ético. Se expone unas intervenciones y resultados que buscaron mediar el uso de las taxonomías del lenguaje estandarizados, con la meta desde un planteamiento teórico. Se concluye que es fundamental el uso de una TRM en la práctica tanto clínica como comunitaria, que conduzca y guíe la formación del profesional y la forma como se brinda cuidado. Adicionalmente se logra proponer un proceso de enfermería articulado y coherente con la teoría seleccionada, haciendo del presente análisis una estrategia novedosa de gran utilidad para la comprensión e intervención en la práctica, teniendo en cuenta que se parte de un contexto que involucra escuela, familia, hogar y persona que, al recolectar la información de la mayoría los participantes del proceso, se permite comprender y llevar a cabo las intervenciones.

This article develops the process of nursing assessment in community practice and the analysis of a nursing situation in the process of adaptation of a child in the face of discrimination and family violence. The analysis was made from Roy's Coping Medium Range Theory (TRM), and it was operationalized with the nursing process showing that it is autonomous, grounded and dynamic, located in an integrative / interactive world view; using, in addition, nursing knowledge patterns: empirical, aesthetic, personal and ethical. Some interventions and results are presented that sought to mediate the use of standardized language taxonomies, with the goal from a theoretical approach. It is concluded that the use of a MRS in clinical and community practice is fundamental, that it guides and guides the professional training and the way care is provided. Additionally, a nursing process articulated and coherent with the selected theory is proposed, making the present analysis a novel strategy of great utility for understanding and intervention in practice, taking into account that it starts from a context that involves school, family, home and person who, by collecting the information of the majority of the participants of the process, is allowed to understand and carry out the interventions.

Child Maltreatment Screening and Anticipatory Guidance: A Description of Pediatric Nurse Practitioner Practice Behaviors.

INTRODUCTION: Given the number of children affected by child maltreatment and the dire consequences that can develop, prompt identification of child maltreatment is crucial. The purpose of this study was to describe pediatric nurse practitioner (PNP) practice behaviors related to screening and providing anticipatory guidance for child maltreatment and its psychosocial risk factors. METHOD: The Risk Assessment Survey was developed for this study by 12 PNPs, all of whom were members of NAPNAP's Child Maltreatment Special Interest Group to ensure face validity; all 12 PNPs were content experts in child maltreatment. The content of the survey was derived from key characteristics from the evidence on child maltreatment. The survey was emailed to the more than 8500 NAPNAP members. RESULTS: Two hundred forty-three PNPs responded to the survey, which represents a response rate of 3%. Approximately half of the participants (n = 121; 51%) stated that they never/rarely ask parents questions about domestic violence, more than one-fourth (n = 71; 30%) reported that they never/rarely ask parents questions about discipline, and half of the responding PNPs (n = 120; 50%) reported that they perform an ano-genital exam at well visits. DISCUSSION: This study demonstrates that a significant number of PNPs do not routinely screen for child maltreatment and psychosocial risk factors. This is especially true in regards to sexual abuse screening and anticipatory guidance.

Pediatric abusive head trauma and stroke.

OBJECTIVE Despite established risk factors, abusive head trauma (AHT) continues to plague our communities. Cerebrovascular accident (CVA), depicted as areas of hypodensity on CT scans or diffusion restriction on MR images, is a well-known consequence of AHT, but its etiology remains elusive. The authors hypothesize that a CVA, in isolation or in conjunction with other intracranial injuries, compounds the severity of a child's injury, which in turn leads to greater health care utilization, including surgical services, and an increased risk of death. METHODS The authors conducted a retrospective observational study to evaluate data obtained in all children with AHT who presented to Le Bonheur Children's Hospital (LBCH) from January 2009 through August 2016. Demographic, hospital course, radiological, cost, and readmission information was collected. Children with one or more CVA were compared with those without a CVA. RESULTS The authors identified 282 children with AHT, of whom 79 (28%) had one or more CVA. Compared with individuals without a CVA, children with a stroke were of similar overall age (6 months), sex (61% male), and race (56% African-American) and had similar insurance status (81% public). Just under half of all children with a stroke (38/79, 48%) were between 1-6 months of age. Thirty-five stroke patients (44%) had a Grade II injury, and 44 (56%) had a Grade III injury. The majority of stroke cases were bilateral (78%), multifocal (85%), associated with an overlying subdural hematoma (86%), and were watershed/hypoperfusion in morphology (73%). Thirty-six children (46%) had a hemispheric stroke. There were a total of 48 neurosurgical procedures performed on 28 stroke patients. Overall median hospital length of stay (11 vs 3 days), total hospital charges ($13.8 vs $6.6 million), and mean charges per patient ($174,700 vs $32,500) were significantly higher in the stroke cohort as a whole, as well as by injury grade (II and III). Twenty children in the stroke cohort (25%) died as a direct result of their AHT, whereas only 2 children in the nonstroke cohort died (1%). There was a 30% readmission rate within the first 180-day postinjury period for patients in the stroke cohort, and of these, approximately 50% required additional neurosurgical intervention(s). CONCLUSIONS One or more strokes in a child with AHT indicate a particularly severe injury. These children have longer hospital stays, greater hospital charges, and a greater likelihood of needing a neurosurgical intervention (i.e., bedside procedure or surgery). Stroke is such an important predictor of health care utilization and outcome that it warrants a subcategory for both Grade II and Grade III injuries. It should be noted that the word "stroke" or "CVA" should not automatically imply arterial compromise in this population.

A closer look at non-accidental trauma: Caregiver assault compared to non-caregiver assault.

PURPOSE: The purpose of this study was to examine the outcomes of non-accidental trauma (NAT) patients compared to other trauma (OT) patients across the state of Florida. In addition, NAT and OT patients with a mechanism of injury of assault were further analyzed. METHODS: A statewide database was reviewed from January 2010 to December 2014 for patients aged 0-18years who presented following trauma. Patients were sorted by admitting diagnosis into two groups: rule out NAT and all other diagnoses. Patients with a mechanism of assault were subanalyzed and outcomes were compared. RESULTS: There were 46,557 patients included. NAT patients were younger, had more severe injuries and had a higher mortality rate compared to OT patients. Assault was the mechanism of injury in 95% of NAT patients. NAT assault patients were younger, required more intensive care unit (ICU) resources, and had a higher mortality rate compared to other assault patients. CONCLUSION: Non-accidental trauma patients require more resources and have a higher mortality rate compared to accidental trauma patients, and these differences remain even when controlling for the mechanism of injury. LEVEL OF EVIDENCE: III.

A screening protocol for child abuse at out-of-hours primary care locations: a descriptive study.

BACKGROUND: Child abuse is often unrecognized at out-of-hours primary care (OOH-PC) services. The aim of our study was to evaluate the clinical outcome of the screening instrument SPUTOVAMO-R2 for child abuse (checklist), followed by a structured approach (reporting code), at OOH-PC services. The reporting code with five steps should ensure consistent action in case of a suspicion. METHODS: All children attending one of the five participating OOH-PC services in the region of Utrecht, the Netherlands, in a year time, were included. The checklist is an obligatory field in the electronic patient file and was filled in for all children. In case of a positive checklist, the steps in the reporting code were followed. Additionally, the case was evaluated in a multidisciplinary team to determine the probability of child abuse. RESULTS: The checklist was filled in for 50671 children; 108 (0.2 %) were positive. The multidisciplinary team diagnosed child abuse in 24 (22 %) of the 108 positive checklists, and no child abuse in 36 (33 %). Emotional neglect was the most frequent type of abuse diagnosed. For all abused children, care was implemented according to the protocol. The most frequent care given was a referral to the hospital (N = 7) or contact with child's own general practitioner (N = 6). CONCLUSION: A checklist followed by a reporting code guarantees consistent actions and care for children with a suspicion of child abuse. The percentage of positive checklists is lower than expected. Validity of the checklist should be assessed in a diagnostic study.

An investigation of child maltreatment and epigenetic mechanisms of mental and physical health risk.

In the present investigation, differential methylation analyses of the whole genome were conducted among a sample of 548 school-aged low-income children (47.8% female, 67.7% Black, M age = 9.40 years), 54.4% of whom had a history of child maltreatment. In the context of a summer research camp, DNA samples via saliva were obtained. Using GenomeStudio, Methylation Module, and the Illumina Custom Model, differential methylation analyses revealed a pattern of greater methylation at low methylation sites (n = 197 sites) and medium methylation sites (n = 730 sites) and less methylation at high methylation sites (n = 907 sites) among maltreated children. The mean difference in methylation between the maltreated and nonmaltreated children was 6.2%. The relative risk of maltreatment with known disease biomarkers was also investigated using GenoGo MetaCore Software. A large number of network objects previously associated with mental health, cancer, cardiovascular systems, and immune functioning were identified evidencing differential methylation among maltreated and nonmaltreated children. Site-specific analyses were also conducted for aldehyde dehydrogenase 2 (ALDH2), ankyrin repeat and kinase domain containing 1 (ANKK1), and nuclear receptor subfamily 3, group C, member 1 (NR3C1) genes, and the results highlight the importance of considering gender and the developmental timing of maltreatment. For ALDH2, the results indicated that maltreated girls evidenced significantly lower methylation compared to nonmaltreated girls, and maltreated boys evidenced significantly higher methylation compared to nonmaltreated boys. Moreover, early onset-not recently maltreated boys evidenced significantly higher methylation at ALDH2 compared to nonmaltreated boys. Similarly, children with early onset-nonrecent maltreatment evidenced significantly higher methylation compared to nonmaltreated children at ANKK1. The site-specific results were not altered by controlling for genotypic variation of respective genes. The findings demonstrate increased risk for adverse physical and mental health outcomes associated with differences in methylation in maltreated children and indicate differences among maltreated children related to developmental timing of maltreatment and gender in genes involved in mental health functioning.

Development of a systematic protocol to identify victims of non-accidental trauma.

PURPOSE: Each year, nearly 1 million children in the USA are victims of non-accidental trauma (NAT). Missed diagnosis or poor case management often leads to repeat/escalation injury. Victims of recurrent NAT are at higher risk for severe morbidity and mortality resulting from abuse. The objective of this review is to describe the evolution and implementation of this tool and evaluate our institutional response to NAT prior to implementation. METHODS: A systematic guideline for the evaluation of pediatric patients in which NAT is suspected or confirmed was developed and implemented at a level II pediatric trauma hospital. To understand the state of our institution prior to implementation of the guideline, a review of 117 confirmed NAT cases at our hospital over the prior 4 years was conducted. RESULTS: In the absence of a systematic management guideline, important and relevant social and family history red flags were often missing in the initial evaluation. Patients with perineal bruising experienced significantly higher mortality than patients without perineal bruising (27.3 vs. 5.7%; p = 0.03) and were significantly more likely to require surgery (45.5 vs. 14.2%; p = 0.02). CONCLUSION: Development and implementation of a standardized tool for the differentiation and diagnosis of NAT and creation of a structured electronic medical record note should improve the description and documentation of child abuse cases in a community hospital setting. A retrospective analysis demonstrated that in the absence of such a tool, management of NAT may be inconsistent or incomplete. Perineal injury is an especially ominous red flag finding.

[Recurrent voluntary ingestion of metallic objects in prison by a female patient]. / Ingestion volontaire d'objets métalliques à répétition chez une patiente en milieu carcéral.

INTRODUCTION: Recurrent and intentional ingestion of metallic objects is a rare but important phenomenon. It has attracted great interest among mental health professionals over the last decades. However, this issue is rarely reported in the literature. A deep exploration of its clinical and specific psychopathological aspects remains limited. CASE REPORT: We report the case of a 32-year-old female patient, who was sentenced to 20 years in prison for homicide against her cousin, the daughter of an uncle who had raped her when she was 14. This affair was hushed by the patient's family and the patient was submitted to several acts of abuse by her family. Following her incarceration, she repeatedly ingested metallic objects requiring repeated admissions in a department of surgery for endoscopic extractions or surgical interventions. She impulsively ingested more than 30 times various metallic objects such as wire, razor blades, spoons, etc., under the pressure of impulsiveness and massive anxiety. Voluntary metal ingestions, associated with iterative self-mutilation behaviors, took place within the framework of a borderline personality disorder, the incarceration and the conditions of imprisonment playing a role in initiating and retaining the behavior. CONCLUSION: Through this case report, we examine the specific psychiatric aspects of intentional ingestion of metallic objects in order to better understand this behavior.

[Trauma history and posttraumatic stress symptoms among children and adolescents attending a mental health service]. / Traumaanamnese und posttraumatische Stresssymptomatik in einer kinder- und jugendpsychiatrischen Inanspruchnahmepopulation.

OBJECTIVE: Systematic exploration of potentially traumatic events and posttraumatic stress symptoms of patients attending a hospital for child and adolescent psychiatry and psychotherapy. METHODS: The UCLA PTSD Reaction Index for DSM-IV was filled in by 413 children and adolescents and 403 caregivers at their first attendance at the clinic. RESULTS: At least one traumatic event was reported by 46.9% of the children and adolescents and/or caregivers. Clinically relevant post-traumatic stress symptoms were reported in 22.9%. CONCLUSION: In the investigated sample routinely performed screening assessments can identify clinically relevant post-traumatic stress symptoms in almost one of four patients of child mental health services.

Significado do cuidado às crianças vítimas de violência na ótica dos profissionais de saúde / The meaning of care for child victims of violence from the perspective of health professionals / Significado del cuidado de los niños víctimas de la violencia desde la perspectiva de los profesionales de salud

Objetivou-se descrever os significados do cuidado atribuídos por profissionais na atenção a crianças vítimas de maus tratos. Trata-se de pesquisa descritiva de natureza qualitativa, realizada com 14 profissionais em uma emergência pediátrica de hospital de Fortaleza, no período de março a junho de 2010, por meio de entrevista semiestruturada. Nos resultados, identificaram-se duas categorias: "sentimentos e sofrimento do profissional de saúde" e "limitações à prática profissional no cuidar de crianças violentadas". Dentre os sentimentos expressos, estava a compaixão em relação às crianças maltratadas, sendo esta um motivador profissional. Aqueles considerados negativos foram indignação e ira contra o agressor. Concluiu-se que o cuidar de crianças vítimas de violência constitui um desafio para os profissionais de saúde dos serviços de emergência, por envolver aspectos biopsicossociais que ultrapassam a lesão corporal propriamente dita e o universo hospitalar.

The aim of this study was to describe the significance of the care attributed by professionals in attending child victims of abuse. This descriptive study, using a qualitative approach, was developed with 14 professionals in the pediatric emergency unit of a hospital in Fortaleza, in the period between March and June of 2010, by means of semi-structured interviews. The results identified two categories: 'Feelings and suffering of the health professional' and 'Limitations of the professional practice in the care of abused children'. The emotions expressed included compassion towards abused children, which was a motivation for professionals. Negative feelings included rage and anger against the aggressor. In conclusion, the care of child victims of violence is a challenge for health professionals from emergency services, as it involves biopsychosocial aspects that go beyond the injury itself and the hospital universe.

Descripción de los significados atribuidos por profesionales de la salud en su práctica profesional con niños maltratados. Estudio descriptivo y cualitativo realizado con 14 profesionales de la salud de una sala de emergencia pediátrica en un hospital de Fortaleza, Brasil, entre marzo y junio de 2010, a través de una entrevista semiestructurada. Los resultados identificaron dos categorías: Los sentimientos y sufrimientos de los profesionales de la salud y las limitaciones a la práctica profesional en el cuidado de los niños maltratados. Entre los sentimientos expresados tomó la palabra sobre la compasión hacia los niños abusados, al ser un motivador profesional. Aquellos considerados negativos fueron rabia e ira contra el agresor. El tratamiento de niños maltratados es un desafío para los profesionales de la salud en los servicios de emergencia, ya que involucra aspectos biopsicosociales que van mucho más allá de las lesiones físicas y del entorno hospitalario.

Caracterización del maltrato psicológico infantil en el área de salud del Policlínico Reynold García de Versalles / Infantile psychological maltreatment characterization in a health area of the Versalles Reynold García polyclinic

Se realizó una investigación descriptiva transversal con el objetivo de caracterizar el maltrato psicológico infantil en niños atendidos en consultas de Psicología del área de salud de Versalles, Matanzas, en el período comprendido entre el 1ro. de enero y el 31 de marzo del año 2012. El universo estuvo constituido por los 50 niños comprendidos en las edades de 7 y 11 años, 31 varones y 19 hembras que fueron atendidos en dicho periodo. Una vez obtenido el consentimiento informado del familiar para participar voluntariamente en el estudio y a fin de recopilar la información necesaria, se aplicó el cuestionario de maltrato psicológico Infantil, de Joaquín de Paúl Ochotorena, instrumento ya validado y que se ajustaba a los objetivos del trabajo. Se identificó maltrato psicológico en el 100 por ciento de los casos, habiendo prevalecido las manifestaciones de rechazo (86 por ciento), aislamiento (72 por ciento) y amenazas (68 por ciento). Se advirtió que el sexo masculino obtuvo valores superiores al femenino en todas las categorías. Se concluye que el maltrato psicológico infantil es un factor común para los niños con trastornos emocionales tratados en consulta de psicología, independientemente de su sexo y edad. Se recomienda desarrollar intervención educativa sobre maltrato infantil a padres de niños comprendidos en las edades de 7-11 años del área de salud y promover prácticas de trabajo en los profesionales que se ocupan de la salud mental infantil en la Atención Primaria de Salud, para la prevención, identificación y tratamiento de este fenómeno.

A cross-sectional descriptive research was carried out with the objective of characterizing the infantile psychological maltreatment in children attending the consultation of Psychology of Versalles health area, Matanzas, in the period covering form January 1st to March 31st 2012. The universe was made up by 50 children aged 7-11 years, 31 male and 19 female, who were attended in that period. Once the informed consent was obtained for the family members to voluntarily participate in the study and to collect the necessary information, we applied the infantile psychological maltreatment questionnaire of Joaquin de Paúl Ochotorena, an already validated instrument, adjusted to the work aims. The psychological maltreatment was identified in 100 percent of the cases, prevailing manifestations of rejection (86 percent), isolation (72 percent) and menacing (68 percent). We noticed that male gender showed higher values in all the categories. We concluded that infantile psychological maltreatment is a common factor for children with emotional disorders treated in psychology consultations, in spite of their gender and age. We recommend developing an educative intervention on infantile maltreatment in parents of the health area children aged 7-11 years and promoting working practices among professionals dealing with the infantile mental health in the Primary Health Care level, for preventing, identifying and treating this phenomenon.

Maltrato infantil en la primera infancia: una revisión panorámica sobre prevención, detección y tratamiento / Maltreatment in early childhood: a scoping review of prevention, detection and treatment

Objetivo: identificar y sintetizar la evidencia disponible sobre la efectividad de las intervenciones destinadas a la prevención universal, detección y tratamiento en situaciones de maltrato sufridas por infantes (0-4 años). Diseño: revisión panorámica (Scoping Review). Fuentes de Datos: MEDLINE, LILACS, PsycINFO, Psyclist, SciELO, ISI Web of Knowledge, Science Direct, EBSCO, EMBASE, Cochrane Library, DARE, Google Scholar y Base de la UNICEF. Métodos de la revisión: se utilizaron diversas palabras claves para identificar estudios cuantitativos experimentales y observacionales, que dieran cuenta de estrategias de detección, prevención y terapéuticas de las diversas situaciones de maltrato infantil. Se excluyó el abuso sexual. La cobertura temporal fue desde 2002 hasta 2012, en idioma inglés y español. Resultados: de 105 artículos seleccionados, 36 cumplieron con los criterios de selección. En el ámbito de la prevención del maltrato infantil las estrategias mejor evaluadas fueron los programas de habilidades de crianzas grupales, de enfoque cognitivo o cognitivo-conductual, con aprendizaje interactivo. Respecto de la detección se identificaron sólo dos instrumentos con especificidad y valor predictivo positivo óptimos. En el ámbito del tratamiento se identificaron diversas estrategias terapéuticas con efectos positivos en indicadores conductuales, funcionales y psicoafectivos. No queda clara la relevancia poblacional de las intervenciones, así como tampoco la efectividad diferencial entre las distintas aproximaciones terapéuticas. Conclusiones: a la fecha existen numerosas estrategias preventivas de maltrato infantil a nivel individual y familiar. Los instrumentos utilizados para la detección carecen de confiabilidad para ser usados a nivel colectivo. A nivel terapéutico no se cuenta con evidencia científica suficiente en calidad y cantidad como para privilegiar una intervención por sobre otra...

Purpose. To identify and synthesize the best available evidence on the effectiveness of interventions for universal prevention, detection and treatment of early childhood maltreatment (0-4 years). Design. Scoping Review. Data sources. MEDLINE, LILACS, PsycINFO, Psyclist, SciELO, ISI Web of Knowledge, Science Direct, EBSCO, EMBASE, Cochrane Library, DARE, Google Scholar and UNICEF Base. Methods. A variety of keywords were used to identify quantitative experimental and observational studies on detection, prevention and treatment strategies in different situations of child maltreatment. Sexual abuse was excluded. The search spanned from 2002 to 2012, in English and Spanish. Results. Of 105 articles, 36 met the selection criteria. In prevention, the best evaluated strategies were parenting programs based on cognitive or cognitive-behavioral approach and interactive learning strategies. In detection, only two instruments were identified with optimum specificity and positive predictive value. In treatment, a variety of treatment strategies were identified with favorable effects on behavioral, functional and psycho affective indicators. The population relevance of these interventions is unclear, as the differential effectiveness of these therapeutic approaches. Conclusions. There are many child maltreatment prevention strategies at the individual and family level. The instruments used for detection are not reliable for use at the collective level. Insofar as therapy, not enough evidence was found both in quality and quantity to favor one intervention over another. It is recommended to understand the problem from the public health perspective and to generate multisectoral and interdisciplinary approaches.