Triage hospitalario para las enfermeras: Entre la incertidumbre, la sobrecarga y los desacuerdos / Hospital triage for nurses: Between uncertainty, overload, and disagreements

Resumen Estudio cualitativo, las participantes fueron enfermeras que realizaban triage hospitalario en la ciudad de Medellín Colombia. Objetivo Describir las dificultades que las enfermeras tienen al realizar el triage y cómo las afrontan. Metodología Estudio etnográfico en el que se realizaron siete entrevistas con las cuales se logró la saturación de las categorías y llevó diario de campo; la ética fue parte integral del proceso. Resultados Las dificultades en el triage son la incertidumbre, la sobrecarga y los desacuerdos con las escalas, los médicos, los pacientes y los familiares y están mediadas por la interacción con el paciente, la familia y la institución; las enfermeras para afrontar las dificultades se "resetean", liberan cargas, toman las decisiones que consideran adecuadas, hablan con sus colegas y oran. Conclusiones Las enfermeras reciben presiones que las hace sentirse vulnerables ante la sobrecarga, los problemas de interacción y la incertidumbre llevándola a que tenga que realizar diferentes sistemas de afrontamiento.

Summary Qualitative study, the participants were nurses who performed hospital triage in the city of Medellín Colombia. Objective To describe the difficulties facing by nurses when performing triage and how they deal with them. Methodology An Ethnographic design was conducted, data saturation was achieved after seven interviews, field notes were taken; ethics was part of the research process. Results The difficulties in triage are uncertainty, overload and disagreements with scales, doctors, patients and relatives and are mediated by interaction with the patient, family and institution; nurses to cope with difficulties need to "reset" themselves, release burdens, make the decisions they deem appropriate, talk to their colleagues and pray. Conclusions Nurses receive pressures that make them feel vulnerable to overload, interaction problems and uncertainty leading them to have to perform different coping systems.

El quehacer cotidiano de la enfermera significa soportar la carga / O trabalho cotidiano da enfermeira significa suportar a carga / The daily work of nurse means bear the burden

Introducción: Las enfermeras le dan significados a su quehacer cotidiano y la comprensión de estos favorece el diseño de propuestas orientadas a promover la calidad, humanización y gestión de los servicios. El objetivo fue comprender el significado que las enfermeras le dan a su quehacer cotidiano. Materiales y Métodos: Se utilizó la investigación cualitativa con enfoque etnográfico, se realizaron entrevistas grupales y se llevó diario de campo. Resultados: Las enfermeras deben apropiarse del servicio, lo que significa realizar cuidado integral y cargar el servicio. Esta carga del servicio es entendida como soportar la carga de la culpa, los problemas, las interacciones, los indicadores y protocolos sin suficiente tiempo. Discusión: El cuidado genera motivación la cual es una emoción capaz de provocar, mantener y dirigir la conducta hacia un objetivo, la carga laboral ha obligado a las enfermeras a dedicar menos tiempo al cuidado lo cual las lleva a sentimientos de culpa, agotamiento y estrés. Conclusiones: El quehacer de enfermería significa una carga cuando sienten que deben encargarse de tareas que no son de su competencia profesional o que son impuestas limitando su autonomía. Tener que soportarla lleva a las enfermeras a la desmotivación.

Introdução: As enfermeiras dão significados ao seu quefazer cotidiano e a compreensão destes favorece o desenho de propostas orientadas a promover a qualidade, humanização e gestão dos serviços. O objetivo foi compreender o significado que as enfermeiras lhe dão ao seu quefazer cotidiano. Materiais e Métodos: Se utilizou a investigação qualitativa com enfoque etnográfico, se realizaram entrevistas grupais e se fez diário de campo. Resultados: As enfermeiras devem apropriar-se do serviço, o que significa realizar cuidado integral e carregar o serviço. Esta carga do serviço é entendida como suportar a carga da culpa, os problemas, as interações, os indicadores e protocolos sem suficiente tempo. Discussão: O cuidado gera motivação a qual é uma emoção capaz de provocar, manter e dirigir a conduta a um objetivo, a carga laboral há obrigado às enfermeiras a dedicar menos tempo ao cuidado o qual as leva a sentimentos de culpa, esgotamento e estresse. Conclusões: A tarefa de enfermagem significa a carga quando eles sentem que eles devem cuidar de tarefas que não são de sua competência profissional, ou que são impostas, limitando a sua autonomia. Ter que suportar a carga leva às enfermeiras à desmotivação.

Introduction: Nurses give the meaning to their daily work and its comprehension permits the design of proposals oriented to promote quality, humanization and service management. The objective was to understand the meaning that nurses give to their daily work. Materials and Methods: Qualitative study with ethnographic approach; groups interviews were conducted and a field day book was done. Results: Nurses must take ownership of the nurse department, which means to achieve an integral care and hold up the department. The weight of the department is to understand as the ability to hold up guilt, problems, interactions, indicators and protocols without enough time. Discussion: Health care creates motivation, which is a feeling capable to provoke, maintain and manage the behavior to a common objective; the work weight has forced the nurses to spend less time to the health care, which lead them to feel guilty, exhaustion and stress. Conclusions: The task of nursing means a burden when they feel that they must take care of tasks are not of her professional competence or that are imposed by limiting their autonomy. Holding up work weight, lead nurses to the demotivation.

[Design of a program for the positive development of schoolchildren and characteristics of participants (Medellin, Colombia)]. / Diseño y características de los participantes de un programa para el desarrollo positivo de escolares (Medellín, Colombia).

The design of the program for the promotion of personal potential and prevention of risky health behaviors in school-aged children, PILAS! Better Adults, Better Kids, was based on local and international evidence on programs for the prevention of school-based violence. The program offers a training process for parents and teachers through active methodologies and advice (provided for 10 months) based on topics that encourage individual child development and the delegitimization of violence in everyday interactions. A total of 306 teachers, 800 parents and 12,800 children benefited from the program. An initial measurement was conducted using a scale ranging from 0 to 100 in a sample of 1751 children. The results showed an average of 80 in the children's social skills, but caregivers reported high levels of aggression. Communication and supervision failures were found among parents, as well as punishment practices through psychological and physical aggression. Another finding was low social cohesion in the neighborhood.

Aggressors and resilient youths in Medellin, Colombia: the need for a paradigm shift in order to overcome violence.

The objective of this study was to estimate the ratio of resilient youth and compare this to youth with aggressive behavior, and to youth who also exhibit sexually risky behavior and drug use. A cross-section study of a representative sample of people between aged between 12 and 60 who are residents of Medellin, Colombia, and its metropolitan area (N = 4,654) was employed using probabilistic multi-stage sampling. Youth between 14 and 26 years old were selected for the present analysis (n = 1,780). The proportion of resilient youth is 22.9%, of aggressors is 11.3%, and that of youth with other risky conduct is 65.8%. The high ratio of resilient youth calls for a reorientation of public policy toward prevention and control of violence, prioritizing the promotion of resilient behavior instead of continuing with tertiary prevention actions.

Aggressors and resilient youths in Medellin, Colombia: the need for a paradigm shift in order to overcome violence / Agresores y resilientes en Medellín, Colombia: necesidad de un cambio de paradigma para superar la violencia / Agressores e resilientes em Medellín, Colômbia: necessidade de uma mudança de paradigma, a fim de superar a violência

The objective of this study was to estimate the ratio of resilient youth and compare this to youth with aggressive behavior, and to youth who also exhibit sexually risky behavior and drug use. A cross-section study of a representative sample of people between aged between 12 and 60 who are residents of Medellin, Colombia, and its metropolitan area (N = 4,654) was employed using probabilistic multi-stage sampling. Youth between 14 and 26 years old were selected for the present analysis (n = 1,780). The proportion of resilient youth is 22.9%, of aggressors is 11.3%, and that of youth with other risky conduct is 65.8%. The high ratio of resilient youth calls for a reorientation of public policy toward prevention and control of violence, prioritizing the promotion of resilient behavior instead of continuing with tertiary prevention actions.

Los objetivos fueron estimar la proporción de jóvenes resilientes y comparar dicha proporción con la de jóvenes con conductas agresivas y con otras conductas de riesgo. Estudio transversal en una muestra representativa de personas entre los 12 a 60 años, habitantes de Medellín, Colombia, y el área metropolitana (N = 4.654). Muestreo probabilístico polietápico. Se seleccionaron los jóvenes entre 14-26 años para el presente análisis (n = 1.780). La proporción de jóvenes resilientes es de un 22,9%, la de agresores un 11,3%, la de jóvenes con otras conductas de riesgo es de un 65,8%. La alta proporción de jóvenes resilientes obliga a reorientar las políticas públicas de la prevención terciaria y el control de la violencia a la promoción de las conductas resilientes y al desarrollo positivo de los niños y jóvenes en la sociedad.

Os objetivos foram estimar a proporção de jovens resistentes e compará-la com jovens com condutas agressivas, e jovens que também apresentam comportamento sexual de risco e uso de drogas. Estudo transversal de uma amostra representativa de pessoas com idades entre 12 e 60 anos, habitantes de Medellín e sua área metropolitana, na Colômbia (N = 4.654), foi utilizado a partir de amostragem probabilística multiestágio. Jovens entre 14 e 26 anos foram selecionados para a presente análise (n = 1.780). A proporção de jovens resistentes foi de 22,9%, de agressores 11,3%, e de jovens com conduta de risco foi de 65,8%. A alta proporção de jovens resistentes força uma reorientação das políticas públicas para a prevenção e controle da violência, privilegiando a promoção de condutas de resistência ao invés de continuar com ações de prevenção terciária.

Cultura de la ilegalidad en Medellín y suasociación con diversas formas de violencia / Culture of illegality in Medellin and its association with various forms of violence

Objetivo: analizar y resumir dos publicaciones del autorsobre la magnitud de la cultura de la ilegalidad en Medellíny su área metropolitana y sobre su asociación con diferentesformas de agresión. Metodología: Encuesta domiciliariacara a cara a una muestra representativa de la población de12 a 60 años de Medellín y el área metropolitana, muestreopolietápico, con una respuesta de 5781 personas, equivalentea 94,6 de respuesta. Resultados: Se documenta una muyalta prevalencia de cultura de la ilegalidad (44 a 72). Lacultura de la legalidad está íntimamente asociada a las pautasde educación y crianza, especialmente a las de la madre y lacultura de la ilegalidad asociada a la percepción de iniquidadsocial. La anomia es, después de vivir en un barrio violento,el principal factor de riesgo para la mayoría de las agresionesestudiadas. Por el contrario la madre vigilante y con la que sepuede tener una buena comunicación es el factor asociado enforma negativa a la mayoría de las formas de agresión estáasociada negativamente al 80-90 de las agresiones con armay al 50 de los robo sin arma. Conclusión: se documentauna altísima cultura de la ilegalidad en Medellín y el áreametropolitana, producto de la percepción de iniquidad, yasociada a la mayoría de las agresiones estudiadas, después dela asociación con residir en un barrio violento...

Objective: to analyze and resume two previous author´spublications on magnitude of illegality culture in Medellinand metropolitan area, and its association with several violentaggressive forms. Methodology: Face to face householdsurvey to a polietapic at at randon samble of 12 to 60 yearsof age Medellin and metropolitan area population, with a94.6 answer proportion (n= 5781). Results: There is avery high illegality culture (44 a 72). Illegality culture isnegatively associated with children rearing practices, mainlywith mother´s ones, and is very closed associate to iniquityperception. After living in a violent neighborhood, anomieis the principal risk factor to most of violence studied forms.Having a vigilant mother is a negatively associated factorto most of studied violent aggressive forms (associated to80-90 armed assaults and 50 to unarmed robberies).Conclusion: There is a very high illegality culture in Medellinand metropolitan area, which seems to be product of iniquityperception, and appears to be associated to most of aggressionsstudied, and is lower only to association with living in a violentneighborhood...

Reducing violence by transforming neighborhoods: a natural experiment in Medellín, Colombia.

Neighborhood-level interventions provide an opportunity to better understand the impact that neighborhoods have on health. In 2004, municipal authorities in Medellín, Colombia, built a public transit system to connect isolated low-income neighborhoods to the city's urban center. Transit-oriented development was accompanied by municipal investment in neighborhood infrastructure. In this study, the authors examined the effects of this exogenous change in the built environment on violence. Neighborhood conditions and violence were assessed in intervention neighborhoods (n = 25) and comparable control neighborhoods (n = 23) before (2003) and after (2008) completion of the transit project, using a longitudinal sample of 466 residents and homicide records from the Office of the Public Prosecutor. Baseline differences between these groups were of the same magnitude as random assignment of neighborhoods would have generated, and differences that remained after propensity score matching closely resembled imbalances produced by paired randomization. Permutation tests were used to estimate differential change in the outcomes of interest in intervention neighborhoods versus control neighborhoods. The decline in the homicide rate was 66% greater in intervention neighborhoods than in control neighborhoods (rate ratio = 0.33, 95% confidence interval: 0.18, 0.61), and resident reports of violence decreased 75% more in intervention neighborhoods (odds ratio = 0.25, 95% confidence interval 0.11, 0.67). These results show that interventions in neighborhood physical infrastructure can reduce violence.

Predicting resilient adolescents and youths: validation of a screening test in Colombia.

BACKGROUND: This article presents the validation of the Child and Youth Resilience Measure-58 (CYRM-58) in the Colombian context and in Spanish language. METHODS: CYRM-58 has 58 questions and was developed by an international team of researchers coordinated by the Resilience Research Centre (Dalhousie University, Canada). Simplified CYRM Colombia is a test that uses 7 questions of CYRM-58; for its validation we tested reproducibility in 22 persons aged 14 to 23 years. RESULTS: We validated content and internal consistency in 39 resilients, 43 youth with deviant behaviors, and 66 controls matched by age and sex. We estimated internal consistency by non-parametric factorial analysis, and we assessed content validity by means of the Mann-Whitney test, bootstrap regression and logistic regression. The reproducibility was found to be in the range of 75-86%. Correlation between measurements was 75%. CONCLUSION: The best predictive model or Simplified CYRM Colombia was found to have seven questions (sensitivity = 96%, specificity = 76%, power = 80%).

Violence witnessing, perpetrating and victimization in Medellín, Colombia: a random population survey.

BACKGROUND: The burden of injury from violence and the costs attributable to violence are extremely high in Colombia. Despite a dramatic decline in homicides over the last ten years, homicide rate in Medellin, Colombia second largest city continues to rank among the highest of cities in Latin America. This study aims to estimate the prevalence and distribution of witnesses, victims and perpetrators of different forms of interpersonal violence in a representative sample of the general population in Medellin in 2007. METHODS: A face-to-face survey was carried out on a random selected, non-institutionalized population aged 12 to 60 years, with a response rate of 91% yielding 2,095 interview responses. RESULTS: We present the rates of prevalence for having been a witness, victim, or perpetrator for different forms of violence standardized using the WHO truncated population pyramid to allow for cross-national comparison. We also present data on verbal aggression, fraud and deception, yelling and heavy pranks, unarmed aggression during last year, and armed threat, other severe threats, robbery, armed physical aggression, and sexual aggression during the lifetime, by age, sex, marital and socioeconomic status, and education. Men reported the highest prevalence of being victims, perpetrators and witnesses in all forms of violence, except for robbery and sexual violence. The number of victims per perpetrator was positively correlated with the severity of the type of violence. The highest victimization proportions over the previous twelve months occurred among minors. Perpetrators are typically young unmarried males from lower socio-economic strata. CONCLUSIONS: Due to very low proportion of victimization report to authorities, periodic surveys should be included in systems for epidemiological monitoring of violence, not only of victimization but also for perpetrators. Victimization information allows quantifying the magnitude of different forms of violence, while data on factors associated with aggression and perpetrators are necessary to estimate risk and protective factors that are essential to sound policies for violence prevention formulation.

Sistema de vigilancia epidemiológica de la violencia para los municipios colombianos / Epidemiological survellice system of violence in Colombian municipalities

Se analizan los diferentes sistemas de vigilancia epidemiológica sobre lesiones y violencia propuestos por organismos nacionales e internacionales; se hace énfasis en que ellos no tienen suficiente información sobre lesiones no fatales, características de los agresores ni factores de protección y de riesgo de las diferentes formas de violencia. Se propone un sistema que utilice información que, por norma legal deba ser recolectada a escala local y que tenga un bajo suregistro (muertes violentas y por accidentes de transito) y lesiones no fatales y, además, un sistema de encuestas periódicas, con diferentes formatos, que puedan aplicarse según la capacidad del respectivo municipio. Por medio de las encuestas se monitorea la magnitud y distribución de diferentes formas de violencia y de otros comportamientos de riesgo, por lo general asociados a ella, así como los factores de protección y de riesgo. Se indica que el sistema propuesto complementa y enriquece, mas no remplaza, los sistemas de vigilancia epidemiológica vigentes hoy por norma legal en el país.

The different systems of epidemiological surveillance of injuries and violence proposed by Colombian and international institutions are analyzed. The fact that those systems do not provide enough information on non fatal injuries, characteristics of the aggressors nor protection factors of the different forms of violence is emphasized. A system based on information which should be gathered at a small scale according to legal rules is proposed. This information should also be underreported (violent deaths, suicide, deaths due to traffic accidents, and non fatal injuries). The implementation of periodic and systematic community surveys is also suggested, designed in different formats according to the local circumstances of the municipalities. The magnitude and distribution of the different forms of violence and other risky factors are all monitored through the surveys mentioned above. The system proposed here does not replace the surveillance systems legally adopted by Colombian norms, but it does reinforce and complement them.

La violencia doméstica en Medellín y demás municipios del Valle de Aburrá, 2003-2004 / Domestic violence in Medellín and other municipalities of Aburrá Valley 2003-2004

Objetivo: estimar la magnitud y distribución por sexo de la violencia doméstica (de pareja, de padres a hijos y entre hermanos) en Medellín y los otros nueve municipios del Valle de Aburrá 2003-2004. Métodos: encuesta cara a cara en una muestra multietápica representativa de la población de 12 a 60 años, no institucionalizada, del área urbana de cada municipio. Resultados: en miembros de la pareja se encontró agresión y victimización verbal o sicológica (64 y 61%); física sin lesión (17 y 14%); física con lesión (2 y 3%). Se observan proporciones de agresión y victimización similares en hombres y en mujeres. La agresión verbal y física a hijos por sus padres es cercana a 60% y la que deja lesiones físicas es de 10%. En 55% de las familias hubo peleas entre hermanos y en 3%, secuelas de lesión física. En Medellín se presentan mayores proporciones de violencia doméstica que en los demás municipios agrupados. La proporción de no denuncia es muy alta (80 a 95%) y es significativamente mayor entre los hombres. Conclusiones: no es aconsejable fincar las políticas públicas y programas de prevención y control de la violencia doméstica en las estadísticas de las cuales dispone el Estado; se recomienda realizar encuestas periódicas en muestras poblacionales completas (hombres y mujeres). Se sugiere tener dos tipos de programas: unos de prevención de la violencia doméstica, considerando a la familia como una unidad total, y otros de rehabilitación de agresores crónicos y severos.

Objective: To estimate the magnitude and distribution by sex of domestic or family violence (between partners, siblings, and from parents to children) in Medellin, Colombia and nine surrounding municipalities (Medellin metropolitan area), 2003-2004. Methods: Household survey to a representative multistage sample to non institutionalized population, within 12 and 60 years of age, in the urban area of each municipality. Results: Verbal or psychological aggression and victimization: 64% and 61%, physical violence without physical injury: 17% and 14%, physical violence with physical injury: 2% and 3% between intimate partners. Intimate partners’ aggression and victimization do no differentiate by sex. Verbal, psychological and physical aggression from parents toward children is 60%, and physical aggression with physical injury is near 10%. 55% of families reported fights among siblings, and 3% with physical injury. Medellin has the highest rates of family or domestic violence compared with the other municipalities of Aburra Valley. Domestic violence charge is very low (5-20%), and masculine victims rather prefer not to report. Conclusions: We suggest not to ground public policies on current statistics, but to establish a system of periodic surveys, representative of general population or families. It seems important to have two different types of interventions: domestic or family violence prevention considering family as a unit that interaCTS with the surrounding; and rehabilitation of chronic and severe domestic aggressors.

Conductas socialmente indeseables asociadas a agresores y resilientes. Un estudio de casos y controles en Medellín, Colombia. 2003 - 2005 / Deviant behaviors associated with aggressors and resilient subjects. A case-control study in Medellin, Colombia. 2003-2005

Con base en un estudio de casos y controles realizado en Medellín, Colombia, entre 2003 y 2005 con el fin de estimar los factores asociados a formas severas de agresión y delincuencia, así como los factores de resiliencia frente a ellas, se estimaron las conductas socialmente indeseables o anómicas vinculadas a cada uno de los grupos estudiados. Metodología: Se estudiaron cinco grupos: agresores severos (n=62), agresores principalmente de riñas graves (n=81), miembros de las Autodefensas Unidas de Colombia (AUC) no reinsertados, comúnmente denominados paramilitares (n=72), resilientes (n=59) y controles comunitarios (n=103). A todos se les hizo una encuesta, respondida personalmente en las comunidades donde residen, para ello se los identificó y contactó por medio de entidades y personas de las comunidades que les merecieran respeto y confianza. Resultados: La magnitud de la prevalencia y el número de las conductas de agresión abierta, de agresión encubierta, de oposición y el consumo de sicoactivos es mayor entre los miembros de las AUC, los agresores severos y los agresores de riñas que entre los controles y resilientes. Los resilientes presentan menor número de conductas socialmente anómalas que los controles comunitarios y con una proporción de prevalencia menor. El grupo de AUC no se diferencia de los agresores más severos en cuanto a las conductas que están frecuentemente asociadas a cada uno de estos grupos.

Concurrent risky or deviant behaviors of serious offenders, resilient men and community controls were estimated through a case-control study carried out in Medellin, Colombia between 2003 and 2005. Methodology: Cases: serious offenders (n=62), men involved in violent quarrels or brawls (n=81), and members of Autodefensas Unidas de Colombia -Colombian paramilitary army- (AUC), also known as paramilitaries (n=72) were compared to resilient men (n=59) and community controls (n=103). All were interviewed face to face in their communities. Cases were interviewed at the site, day and hour agreed with the group leader. Controls and resilient men were referred by respected and trusted persons of the community and interviewed in their own communities in a place chosen by them. Results: Antecedents of overt and covert aggression, deviant behaviors and oppositional behaviors, and substance abuse was higher among AUC members (paramilitaries), serious offenders and men involved in quarrels than among community controls and resilient men. Resilient men report a smaller number of concurrent deviant and risky behaviors compared to community controls. AUC members (paramilitaries) are not different from serious offenders in their reports of concurrent risky and deviant behaviors.

Similitudes y diferencias entre miembros de las Autodefensas Unidas de Colombia, agresores severos y controles comunitarios en Medellín / Similarities and differences among paramilitaries, severe aggressors and communal control, a case-control study in Medellín, Colombia

Con base en un estudio de casos y controles llevado a cabo entre 2003 y 2005 en Medellín, Colombia, se compararon las características de agresores severos o delincuentes mayores con las de miembros de las Autodefensas Unidas de Colombia (AUC), comúnmente llamados paramilitares, y las de controles comunitarios. Los agresores severos y paramilitares tienen un menor nivel educativo que los controles, provienen en menor proporción de familias biparentales, en sus familias de origen había más problemas de consumo de drogas y abuso de alcohol y tuvieron en mayor grado desplazamiento forzado y asesinato de miembros de la familia. No hubo diferencias en cuanto al tiempo de residencia en la ciudad y en el barrio ni en cuanto a la forma de tenencia de la vivienda en la familia de origen, tampoco en cuanto a estresores en la familia actual. Tampoco las hubo en cuanto a la creencia en Dios, la práctica religiosa ni los motivos para practicar la religión. No hubo diferencias entre agresores severos y paramilitares con respecto a las anteriores variables. Los paramilitares indicaron haber padecido condiciones de extrema pobreza en su niñez en mayor grado que los agresores severos y los controles. Se exploró también la percepción de oportunidades de progreso en la sociedad.

A case-control study was performed in Medellín during 2003- 2004 to compare characteristics of severe aggressors, members of Colombian United Selfdefense Forces members (AUC), otherwise named paramilitaries, and communal control. Severe aggressors and paramilitaries have lower educational level than communal control; their families were biparental in a lower proportion, and experienced drug and alcohol abuse in a higher proportion than in the case of families of communal control. Severe aggressors and paramilitaries’ families suffered forced displacement and assassination of one of its members in a higher proportion than those of controls. There were no differences relating time of residence in Medellín or current neighborhood, or current family socioeconomic stressors. No differences were found regarding believing in God, religious practice and reasons for practicing religion. There were no significant differences for all mentioned variables between severe aggressors and paramilitaries. Paramilitaries did inform having suffered extreme poverty conditions during childhood in a higher proportion than severe aggressors and controls. Progress opportunities perception was also explored.

Reporte de hechos violentos en los municipios del Valle de Aburrá / Crime report in the cities of Aburra Valley metropolitan area

Este artículo analiza el reporte de hechos violentos en los municipios del Valle de Aburrá con base en la encuesta sobre magnitud, distribución y factores asociados a la violencia realizada entre 2003 y 2004 en el área urbana de los diez municipios del Valle de Aburrá. Prácticamente no se denuncian las formas de agresión menos severas y más del 75% de las víctimas de agresión severa no denuncian el hecho ante las autoridades. Se concluye que con estos niveles de subregistro no es posible apoyar políticas públicas que impacten estos hechos.

This article analyzes crime report in Valle de Aburrá cities, based on a household survey of a representative sample of subjects between 12 and 60 years old, interviewed in 2003-2004. Actually, there is almost no report of non severe aggressions and over 75% of victims of severe aggression do not report to authorities. Sexual aggression is almost no reported by men. According to these high rates of no reporting, it is not advisable to support public policies on such statistical reports.

[Lessons learned from an early intervention violence prevention program in Medellín, Colombia]. / Lecciones del programa de prevención temprana de la violencia, Medellín, Colombia.

OBJECTIVE: To describe the components and development of the Early Prevention of Violence Program in the city of Medellín, Colombia, and to evaluate the results of its first phase, three years after implementation. METHODS: A before (2001) and after (2004) study of four variables--direct aggression, indirect aggression, prosocial behavior, and scholastic achievement--was conducted among a convenience sample of 339 program participants and their families. RESULTS: Several program benefits were noted. Decreases in both direct and indirect aggression were observed, though the latter was reduced only in girls and in those over 12 years old. Prosocial behavior increased among children of all ages and both genders, including those who exhibited low levels of prosocial behavior in 2001. In addition, improved school performance was seen in the group as a whole. Results may have been affected by some changes to the prevention program's implementation and by the dangerous nature of the neighborhood, which limited the home visits. CONCLUSIONS: The program seems to be an effective intervention for highly aggressive children, among whom a decline in direct aggression was observed. It also offers preventive benefits, as evidenced by the rise of prosocial behaviors in less aggressive children.

Lecciones del programa de prevención temprana de la violencia, Medellín, Colombia / Lessons learned from an early intervention violence prevention program in Medellín, Colombia

OBJETIVO: Describir las características y la evolución del Programa de Prevención Temprana de la Violencia del Municipio de Medellín, Colombia, y evaluar los resultados de la primera etapa tres años después de su implementación. MÉTODOS: Se llevó a cabo un análisis anterior (año 2001) y posterior (año 2004) de cinco variables -síntomas de agresión directa, síntomas de agresión indirecta, síntomas de prosocialidad y rendimiento escolar- en una muestra por conveniencia de 339 niños y sus familias que habían participado en el programa. RESULTADOS: Se evidenciaron varios efectos positivos del programa. Se observó una disminución de los síntomas de agresión directa y de los de agresión indirecta, pero en este último caso sólo en niñas y en mayores de 12 años. Se evidenció asimismo un aumento en la prosocialidad en niños de todas las edades y de ambos sexos, incluso en los que presentaban menor grado de prosocialidad en 2001. También se observó en todo el grupo una mejora del rendimiento escolar. Estos resultados pueden haber sido afectados por algunas modificaciones en la implementación del programa de prevención y por la gran peligrosidad del barrio, que ocasionó una disminución de la frecuencia de las visitas domiciliarias a las familias. CONCLUSIONES: El programa parece tener efectos preventivos, puesto que se observa una disminución de la agresión directa en los niños con mayor nivel de agresión, y un efecto protector en el aumento de la prosocialidad en los niños menos agresivos.

OBJECTIVE: To describe the components and development of the Early Prevention of Violence Program in the city of Medellín, Colombia, and to evaluate the results of its first phase, three years after implementation. METHODS: A before (2001) and after (2004) study of four variables-direct aggression, indirect aggression, prosocial behavior, and scholastic achievement-was conducted among a convenience sample of 339 program participants and their families. RESULTS: Several program benefits were noted. Decreases in both direct and indirect aggression were observed, though the latter was reduced only in girls and in those over 12 years old. Prosocial behavior increased among children of all ages and both genders, including those who exhibited low levels of prosocial behavior in 2001. In addition, improved school performance was seen in the group as a whole. Results may have been affected by some changes to the prevention programÆs implementation and by the dangerous nature of the neighborhood, which limited the home visits. CONCLUSIONS: The program seems to be an effective intervention for highly aggressive children, among whom a decline in direct aggression was observed. It also offers preventive benefits, as evidenced by the rise of prosocial behaviors in less aggressive children.

Magnitud y distribución de diferentes formas de violencia en Medellín, 2003-2004 / Magnitude and distribution of different forms of violence in Medellin, 2003-2004

Objetivo: estimar la magnitud y distribución del hecho de haber sido testigo, víctima o agresor de diferentes tipos de violencia. Métodos: estudio de corte en muestra representativa de la población (12-60 años) de Medellín. La información se recolectó por encuestas domiciliarias en 2003-2004. Resultados: los hombres reportan las mayores proporciones como victimas, agresores y testigos por todas las formas de violencia excepto agresor sin arma y victima de desplazamiento forzado y de violencia sexual. El número de víctimas por agresor aumenta con la gravedad del tipo de violencia. Mas de 75 por ciento ha sido testigo de amenazas graves y asalto armado, 46 por ciento de robo y 10 por ciento de violencia sexual. Cerca de 40 por ciento ha sido victima de amenzas graves, robo y agresion armada; y el 6 por ciento, de violencia sexual. La mayor victimización en los últimos doce meses se presento en los menores de edad. El 10 por ciento de los menores de edad, 7 por ciento de 18 a 35 años han robado en sus vidas y el 4 por ciento de 18 a 54 años agradieron con arma. Aproximadamente una cuarta parte percibe que en su barrio hay problemas de peleas entre vecinos a entre pandillas y robos. Se presentan la probabilidad de ser agresor, victima y testigo en las 16 comunas urbanas de Medellín.