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2.
PLoS Med ; 17(11): e1003383, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33166288

RESUMEN

BACKGROUND: The INSPIRE framework was developed by 10 global agencies as the first global package for preventing and responding to violence against children. The framework includes seven complementary strategies. Delivering all seven strategies is a challenge in resource-limited contexts. Consequently, governments are requesting additional evidence to inform which 'accelerator' provisions can simultaneously reduce multiple types of violence against children. METHODS AND FINDINGS: We pooled data from two prospective South African adolescent cohorts including Young Carers (2010-2012) and Mzantsi Wakho (2014-2017). The combined sample size was 5,034 adolescents. Each cohort measured six self-reported violence outcomes (sexual abuse, transactional sexual exploitation, physical abuse, emotional abuse, community violence victimisation, and youth lawbreaking) and seven self-reported INSPIRE-aligned protective factors (positive parenting, parental monitoring and supervision, food security at home, basic economic security at home, free schooling, free school meals, and abuse response services). Associations between hypothesised protective factors and violence outcomes were estimated jointly in a sex-stratified multivariate path model, controlling for baseline outcomes and socio-demographics and correcting for multiple-hypothesis testing using the Benjamini-Hochberg procedure. We calculated adjusted probability estimates conditional on the presence of no, one, or all protective factors significantly associated with reduced odds of at least three forms of violence in the path model. Adjusted risk differences (ARDs) and adjusted risk ratios (ARRs) with 95% confidence intervals (CIs) were also calculated. The sample mean age was 13.54 years, and 56.62% were female. There was 4% loss to follow-up. Positive parenting, parental monitoring and supervision, and food security at home were each associated with lower odds of three or more violence outcomes (p < 0.05). For girls, the adjusted probability of violence outcomes was estimated to be lower if all three of these factors were present, as compared to none of them: sexual abuse, 5.38% and 1.64% (ARD: -3.74% points, 95% CI -5.31 to -2.16, p < 0.001); transactional sexual exploitation, 10.07% and 4.84% (ARD: -5.23% points, 95% CI -7.26 to -3.20, p < 0.001); physical abuse, 38.58% and 23.85% (ARD: -14.72% points, 95% CI -19.11 to -10.33, p < 0.001); emotional abuse, 25.39% and 12.98% (ARD: -12.41% points, 95% CI -16.00 to -8.83, p < 0.001); community violence victimisation, 36.25% and 28.37% (ARD: -7.87% points, 95% CI -11.98 to -3.76, p < 0.001); and youth lawbreaking, 18.90% and 11.61% (ARD: -7.30% points, 95% CI -10.50 to -4.09, p < 0.001). For boys, the adjusted probability of violence outcomes was also estimated to be lower if all three factors were present, as compared to none of them: sexual abuse, 2.39% to 1.80% (ARD: -0.59% points, 95% CI -2.24 to 1.05, p = 0.482); transactional sexual exploitation, 6.97% to 4.55% (ARD: -2.42% points, 95% CI -4.77 to -0.08, p = 0.043); physical abuse from 37.19% to 25.44% (ARD: -11.74% points, 95% CI -16.91 to -6.58, p < 0.001); emotional abuse from 23.72% to 10.72% (ARD: -13.00% points, 95% CI -17.04 to -8.95, p < 0.001); community violence victimisation from 41.28% to 35.41% (ARD: -5.87% points, 95% CI -10.98 to -0.75, p = 0.025); and youth lawbreaking from 22.44% to 14.98% (ARD -7.46% points, 95% CI -11.57 to -3.35, p < 0.001). Key limitations were risk of residual confounding and not having information on protective factors related to all seven INSPIRE strategies. CONCLUSION: In this cohort study, we found that positive and supervisory caregiving and food security at home are associated with reduced risk of multiple forms of violence against children. The presence of all three of these factors may be linked to greater risk reduction as compared to the presence of one or none of these factors. Policies promoting action on positive and supervisory caregiving and food security at home are likely to support further efficiencies in the delivery of INSPIRE.

3.
Inj Prev ; 24(2): 155-156, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-29353245

RESUMEN

Scientific information on violence can be difficult to compile and understand. It is scattered across websites, databases, technical reports and academic journals, and rarely addresses all types of violence. In response, in October 2017 WHO released the Violence Prevention Information System or Violence Info, an online interactive collection of scientific information about the prevalence, consequences, risk factors and preventability of all forms of interpersonal violence. It covers homicide, child maltreatment, youth violence, intimate partner violence, elder abuse and sexual violence.


Asunto(s)
Instrucción por Computador/métodos , Salud Global , Promoción de la Salud/métodos , Violencia/prevención & control , Organización Mundial de la Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Evaluación de Programas y Proyectos de Salud , Factores de Riesgo , Violencia/clasificación
4.
Lancet Public Health ; 2(8): e356-e366, 2017 08.
Artículo en Inglés | MEDLINE | ID: mdl-29253477

RESUMEN

BACKGROUND: A growing body of research identifies the harmful effects that adverse childhood experiences (ACEs; occurring during childhood or adolescence; eg, child maltreatment or exposure to domestic violence) have on health throughout life. Studies have quantified such effects for individual ACEs. However, ACEs frequently co-occur and no synthesis of findings from studies measuring the effect of multiple ACE types has been done. METHODS: In this systematic review and meta-analysis, we searched five electronic databases for cross-sectional, case-control, or cohort studies published up to May 6, 2016, reporting risks of health outcomes, consisting of substance use, sexual health, mental health, weight and physical exercise, violence, and physical health status and conditions, associated with multiple ACEs. We selected articles that presented risk estimates for individuals with at least four ACEs compared with those with none for outcomes with sufficient data for meta-analysis (at least four populations). Included studies also focused on adults aged at least 18 years with a sample size of at least 100. We excluded studies based on high-risk or clinical populations. We extracted data from published reports. We calculated pooled odds ratios (ORs) using a random-effects model. FINDINGS: Of 11 621 references identified by the search, 37 included studies provided risk estimates for 23 outcomes, with a total of 253 719 participants. Individuals with at least four ACEs were at increased risk of all health outcomes compared with individuals with no ACEs. Associations were weak or modest for physical inactivity, overweight or obesity, and diabetes (ORs of less than two); moderate for smoking, heavy alcohol use, poor self-rated health, cancer, heart disease, and respiratory disease (ORs of two to three), strong for sexual risk taking, mental ill health, and problematic alcohol use (ORs of more than three to six), and strongest for problematic drug use and interpersonal and self-directed violence (ORs of more than seven). We identified considerable heterogeneity (I2 of >75%) between estimates for almost half of the outcomes. INTERPRETATION: To have multiple ACEs is a major risk factor for many health conditions. The outcomes most strongly associated with multiple ACEs represent ACE risks for the next generation (eg, violence, mental illness, and substance use). To sustain improvements in public health requires a shift in focus to include prevention of ACEs, resilience building, and ACE-informed service provision. The Sustainable Development Goals provide a global platform to reduce ACEs and their life-course effect on health. FUNDING: Public Health Wales.


Asunto(s)
Estado de Salud , Acontecimientos que Cambian la Vida , Humanos
5.
Am J Prev Med ; 50(5): 652-659, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-26689979

RESUMEN

INTRODUCTION: Interpersonal violence affects millions of people worldwide, often has lifelong consequences, and is gaining recognition as an important global public health problem. There has been no assessment of measures countries are taking to address it. This report aims to assess such measures and provide a baseline against which to track future progress. METHODS: In each country, with help from a government-appointed National Data Coordinator, representatives from six to ten sectors completed a questionnaire before convening in a consensus meeting to decide on final country data; 133 of 194 (69%) WHO Member States participated. The questionnaire covered data, plans, prevention measures, and victim services. Data were collected between November 2012 and June 2014, and analyzed between June and October 2014. Global and country-level homicides for 2000-2012 were also calculated for all 194 Members. RESULTS: Worldwide, 475,000 people were homicide victims in 2012 and homicide rates declined by 16% from 2000 to 2012. Data on fatal and, in particular, non-fatal forms of violence are lacking in many countries. Each of the 18 types of surveyed prevention programs was reported to be implemented in a third of the 133 participating countries; each law was reported to exist in 80% of countries, but fully enforced in just 57%; and each victim service was reported to be in place in just more than half of the countries. CONCLUSIONS: Although many countries have begun to tackle violence, serious gaps remain, and public health researchers have a critical role to play in addressing them.


Asunto(s)
Salud Global , Salud Pública , Violencia/prevención & control , Femenino , Homicidio/prevención & control , Homicidio/estadística & datos numéricos , Homicidio/tendencias , Humanos , Masculino , Encuestas y Cuestionarios , Violencia/estadística & datos numéricos , Violencia/tendencias
7.
Child Abuse Negl ; 42: 146-62, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25757367

RESUMEN

This study estimated the health and economic burden of child maltreatment in the East Asia and Pacific region, addressing a significant gap in the current evidence base. Systematic reviews and meta-analyses were conducted to estimate the prevalence of child physical abuse, sexual abuse, emotional abuse, neglect, and witnessing parental violence. Population Attributable Fractions were calculated and Disability-Adjusted Life Years (DALYs) lost from physical and mental health outcomes and health risk behaviors attributable to child maltreatment were estimated using the most recent comparable Global Burden of Disease data. DALY losses were converted into monetary value by assuming that one DALY is equal to the sub-region's per capita GDP. The estimated economic value of DALYs lost to violence against children as a percentage of GDP ranged from 1.24% to 3.46% across sub-regions defined by the World Health Organization. The estimated economic value of DALYs (in constant 2000 US$) lost to child maltreatment in the EAP region totaled US $151 billion, accounting for 1.88% of the region's GDP. Updated to 2012 dollars, the estimated economic burden totaled US $194 billion. In sensitivity analysis, the aggregate costs as a percentage of GDP range from 1.36% to 2.52%. The economic burden of child maltreatment in the East Asia and Pacific region is substantial, indicating the importance of preventing and responding to child maltreatment in this region. More comprehensive research into the impact of multiple types of childhood adversity on a wider range of putative health outcomes is needed to guide policy and programs for child protection in the region, and globally.


Asunto(s)
Maltrato a los Niños/economía , Costo de Enfermedad , Adolescente , Asia/epidemiología , Niño , Maltrato a los Niños/estadística & datos numéricos , Preescolar , Emociones , Exposición a la Violencia/economía , Exposición a la Violencia/estadística & datos numéricos , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Islas del Pacífico/epidemiología , Prevalencia , Años de Vida Ajustados por Calidad de Vida
9.
Aggress Violent Behav ; 19(6): 655-662, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-29725241

RESUMEN

Through a global review, we identified gaps in the geographical distribution of violence prevention evidence outcome evaluation studies and the types of violence addressed. Systematic literature searches identified 355 articles published between 2007 and 2013 that evaluated programs to prevent interpersonal or self-directed violence; focused on universal or selected populations; and reported outcomes measuring violence or closely related risk factors. The number of studies identified increased annually from 2008 (n = 37), reaching 64 in 2013. Over half (n = 203) of all studies focused on youth violence yet only one on elder maltreatment. Study characteristics varied by year and violence type. Only 9.3% of all studies had been conducted in LMICs. These studies were less likely than those in high income countries (HICs) to have tested established interventions yet more likely to involve international collaboration. Evaluation studies successfully established in LMIC had often capitalized on other major regional priorities (e.g. HIV). Relationships between violence and social determinants, communicable and non-communicable diseases, and even economic prosperity should be explored as mechanisms to increase the global reach of violence prevention research. Results should inform future research strategies and provide a baseline for measuring progress in developing the violence prevention evidence-base, especially in LMICs.

10.
PLoS Med ; 9(11): e1001349, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-23209385

RESUMEN

BACKGROUND: Child sexual abuse is considered a modifiable risk factor for mental disorders across the life course. However the long-term consequences of other forms of child maltreatment have not yet been systematically examined. The aim of this study was to summarise the evidence relating to the possible relationship between child physical abuse, emotional abuse, and neglect, and subsequent mental and physical health outcomes. METHODS AND FINDINGS: A systematic review was conducted using the Medline, EMBASE, and PsycINFO electronic databases up to 26 June 2012. Published cohort, cross-sectional, and case-control studies that examined non-sexual child maltreatment as a risk factor for loss of health were included. All meta-analyses were based on quality-effects models. Out of 285 articles assessed for eligibility, 124 studies satisfied the pre-determined inclusion criteria for meta-analysis. Statistically significant associations were observed between physical abuse, emotional abuse, and neglect and depressive disorders (physical abuse [odds ratio (OR) = 1.54; 95% CI 1.16-2.04], emotional abuse [OR = 3.06; 95% CI 2.43-3.85], and neglect [OR = 2.11; 95% CI 1.61-2.77]); drug use (physical abuse [OR = 1.92; 95% CI 1.67-2.20], emotional abuse [OR = 1.41; 95% CI 1.11-1.79], and neglect [OR = 1.36; 95% CI 1.21-1.54]); suicide attempts (physical abuse [OR = 3.40; 95% CI 2.17-5.32], emotional abuse [OR = 3.37; 95% CI 2.44-4.67], and neglect [OR = 1.95; 95% CI 1.13-3.37]); and sexually transmitted infections and risky sexual behaviour (physical abuse [OR = 1.78; 95% CI 1.50-2.10], emotional abuse [OR = 1.75; 95% CI 1.49-2.04], and neglect [OR = 1.57; 95% CI 1.39-1.78]). Evidence for causality was assessed using Bradford Hill criteria. While suggestive evidence exists for a relationship between maltreatment and chronic diseases and lifestyle risk factors, more research is required to confirm these relationships. CONCLUSIONS: This overview of the evidence suggests a causal relationship between non-sexual child maltreatment and a range of mental disorders, drug use, suicide attempts, sexually transmitted infections, and risky sexual behaviour. All forms of child maltreatment should be considered important risks to health with a sizeable impact on major contributors to the burden of disease in all parts of the world. The awareness of the serious long-term consequences of child maltreatment should encourage better identification of those at risk and the development of effective interventions to protect children from violence.


Asunto(s)
Maltrato a los Niños/psicología , Enfermedad Crónica/epidemiología , Enfermedad Crónica/psicología , Costo de Enfermedad , Estilo de Vida , Salud Mental , Adolescente , Adulto , Niño , Humanos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo
12.
Infect Dis Clin North Am ; 25(3): 653-68, x, 2011 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-21896365

RESUMEN

Injury and violence rank among the leading causes of death worldwide, with more than 5 million deaths annually, representing a significant portion of the global burden of disease. This article examines how injury and violence relate to global health using recent global burden of disease data and selected key studies and databases, and further explores risk factors and intervention initiatives that address unintentional and intentional injuries. The article serves as a call to action to enhance understanding of the growing burden of injury and violence, especially in low-income and middle-income countries, where more than 90% of injuries occur.


Asunto(s)
Salud Global , Violencia , Heridas y Traumatismos , Accidentes de Tránsito/estadística & datos numéricos , Causas de Muerte , Países en Desarrollo , Humanos , Factores de Riesgo , Violencia/prevención & control , Violencia/estadística & datos numéricos , Heridas y Traumatismos/epidemiología , Heridas y Traumatismos/mortalidad , Heridas y Traumatismos/prevención & control
14.
Washington; OPS; 2011.
Monografía en Español | MMyP | ID: per_old-2459

RESUMEN

This manual, describes interventions of known effectiveness, those supported by emerging evidence, and those that could potentially be effective, but have yet to be sufficiently evaluated for their impact. For instance, school-based programs to prevent violence occurring in "dating relationships" have been shown to be effective in randomized trials in the USA and Canada. Evidence is emerging for the effectiveness of empowerment approaches which use microfinance combined with gender-equality training or are based on communications and relationship skills training such as the Stepping Stones training package, which has been widely used in low- and middle-income countries. Strategies that aim to prevent intimate partner and sexual violence through reducing the harmful use of alcohol also show promise. A six-step framework for planning, implementing and evaluating such prevention programs and policies is presented. This document is primarily aimed at policy-makers, program planners and donors from public health and related sectors who seek to advance the prevention of intimate partner and sexual violence against women. In addition to the principal audience, other interested parties will include those working in other government sectors such as education, child welfare, social care, criminal justice and departments of women or gender equality; advocates from civil society organizations; local authorities; environmental and urban planners; and researchers.


Asunto(s)
Humanos , Femenino , Violencia contra la Mujer , Violencia Doméstica , Delitos Sexuales , Maltrato Conyugal
16.
Bull World Health Organ ; 87(6): 447-55, 2009 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-19565123

RESUMEN

OBJECTIVE: To examine associations between exposure to physical violence (PV) or sexual violence (SV) and adverse health behaviours among a sample of children in five African countries. METHODS: In a cross-sectional analysis of data from Namibia, Swaziland, Uganda, Zambia and Zimbabwe - countries that participated in the Global School-based Student Health Survey in 2003 or 2004 - we compared the relative frequency of several adverse health behaviours among children (primarily students 13-15 years of age) who did and who did not report exposure to PV or SV. We estimated odds ratios (ORs) for such behaviours and their 95% confidence intervals (CIs) after adjusting for age and sex. FINDINGS: Exposure to PV during the 12 months preceding the survey was reported by 27-50% (average: 42%) of the children studied in the five countries, and lifetime exposure to SV was reported by 9-33% (average: 23%). Moderate to strong associations were observed between exposure to PV or SV and measures of mental health, suicidal ideation, current cigarette use, current alcohol use, lifetime drug use, multiple sex partners and a history of sexually transmitted infection (P < 0.05 for all associations). For example, the odds of being a current cigarette smoker were higher in children involved in one fight (OR: 2.20; 95% CI: 1.77-2.75), 2-5 fights (OR: 3.43; 95% CI: 2.54-4.63), or 6 fights or more (OR: 5.95; 95% CI: 4.37-8.11) (P for trend < 0.001) during the 12 months preceding the survey than in children unexposed to PV. CONCLUSION: Childhood exposure to PV and SV is common among African children in some countries and is associated with multiple adverse health behaviours. In developing countries, increased awareness of the frequency of exposure to violence among children and its potential health consequences may lead to heightened attention to the need for health promotion and preventive programmes that address the problem.


Asunto(s)
Conducta del Adolescente/psicología , Maltrato a los Niños/psicología , Conductas Relacionadas con la Salud , Trastornos de Estrés Traumático/psicología , Adolescente , África/epidemiología , Maltrato a los Niños/estadística & datos numéricos , Femenino , Humanos , Masculino , Delitos Sexuales/psicología
18.
Bull World Health Organ ; 87(5): 353-61, 2009 May.
Artículo en Inglés | MEDLINE | ID: mdl-19551253

RESUMEN

OBJECTIVE: To synthesize recent evidence from systematic and comprehensive reviews on the effectiveness of universal and selective child maltreatment prevention interventions, evaluate the methodological quality of the reviews and outcome evaluation studies they are based on, and map the geographical distribution of the evidence. METHODS: A systematic review of reviews was conducted. The quality of the systematic reviews was evaluated with a tool for the assessment of multiple systematic reviews (AMSTAR), and the quality of the outcome evaluations was assessed using indicators of internal validity and of the construct validity of outcome measures. FINDINGS: The review focused on seven main types of interventions: home visiting, parent education, child sex abuse prevention, abusive head trauma prevention, multi-component interventions, media-based interventions, and support and mutual aid groups. Four of the seven - home-visiting, parent education, abusive head trauma prevention and multi-component interventions - show promise in preventing actual child maltreatment. Three of them - home visiting, parent education and child sexual abuse prevention - appear effective in reducing risk factors for child maltreatment, although these conclusions are tentative due to the methodological shortcomings of the reviews and outcome evaluation studies they draw on. An analysis of the geographical distribution of the evidence shows that outcome evaluations of child maltreatment prevention interventions are exceedingly rare in low- and middle-income countries and make up only 0.6% of the total evidence base. CONCLUSION: Evidence for the effectiveness of four of the seven main types of interventions for preventing child maltreatment is promising, although it is weakened by methodological problems and paucity of outcome evaluations from low- and middle-income countries.


Asunto(s)
Maltrato a los Niños/prevención & control , Niño , Bases de Datos Bibliográficas , Humanos , Literatura de Revisión como Asunto
19.
Int J Inj Contr Saf Promot ; 15(4): 177-87, 2008 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-19051081

RESUMEN

More than 90% of violence-related deaths occur in low- to middle-income countries (LMICs), where the mortality rate due to violence is almost 2.5 times greater than in high-income countries. Over and above the substantial contribution of violence as a cause of death and physical injuries, victims of violence are also more vulnerable to a range of mental and physical health problems. Several studies describe the deleterious impact of different types of violence on a range of health outcomes, but no review has yet been undertaken that presents a composite overview of the current state of knowledge in LMICs. This paper reviews the scientific literature describing the nature, magnitude and impact of violence on health, describing the current state of violence-prevention policy developments within the global health agenda and highlighting the health consequences, disease burden and economic costs of violence. Although data are limited, the review indicates that costs relating to violence deplete health care budgets considerably and that scarce resources could be better used to address other health threats that hamper development.


Asunto(s)
Costo de Enfermedad , Países en Desarrollo , Costos de la Atención en Salud , Estado de Salud , Violencia , Violencia Doméstica/economía , Violencia Doméstica/psicología , Violencia Doméstica/estadística & datos numéricos , Humanos , Factores de Riesgo , Violencia/economía , Violencia/psicología , Violencia/estadística & datos numéricos , Heridas y Traumatismos/economía , Heridas y Traumatismos/etiología , Heridas y Traumatismos/mortalidad
20.
Int J Inj Contr Saf Promot ; 15(4): 197-208, 2008 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-19051083

RESUMEN

Violence is an enormous global public health problem that increases the risk of injury, disease and poor mental health while also impeding economic and social development. This paper articulates a framework for violence prevention in developing countries that is grounded in the knowledge gained from research and programmatic efforts in rich and in poor countries over several decades. This framework can be used by countries and funding agencies as a guide to building strong foundations for ongoing violence prevention efforts and for identifying violence prevention strategies most likely to be effective. The world has learned a lot about preventing violence and, without a doubt, there is a great deal more to learn. As a global community, however, it is not possible to wait for perfect solutions to these problems to act. The obligation is to act now to use the valuable knowledge that has been gained about violence prevention to improve the world.


Asunto(s)
Países en Desarrollo , Promoción de la Salud/métodos , Promoción de la Salud/organización & administración , Planificación Social , Violencia/prevención & control , Planificación en Salud , Humanos
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