Salud

Población por tipo de cobertura médica; gráfico de hospitales con internación por tipo y especialidad, y de centros de salud; y promedio diario de niños y adolescentes beneficiados por distintas dependencias de la Dirección General de Niños/as y Adolescentes.

Did the UN convention on the rights of the child reduce child mortality around the world? An interrupted time series analysis.

BACKGROUND: Child mortality has been reduced by more than 50 % over the past 30 years. A range of secular economic and social developments have been considered to explain this phenomenon. In this paper, we examine the association between ratification of the Convention on the Rights of the Child (CRC), which was specifically put in place to ensure the well-being of children, and declines in child mortality. METHODS: Data come from three sources: the United Nations Treaty Series Database, the World Bank World Development Indicators database and, the Polity IV database. Because CRC was widely ratified, leaving few control cases, we used interrupted times series analyses, which uses the trend in the health outcome before policy exposure to mathematically determine what the trend in the health outcome would have been after the policy exposure, if it had continued 'as is' - meaning, if the policy exposure had not occurred. RESULTS: CRC ratification was associated with declining child mortality. CRC ratification was associated with a significant change in shorter-term child mortality trends in all groups except high-income, non-democratic countries and low-imcome democratic countries. CRC ratification was associated with long-term child mortality trends in all groups except middle-income, non-democratic countries. CONCLUSIONS: Child mortality rates would likely have declined even in the absence of CRC ratification, but CRC is associated with a larger decline. Our findings provide a way to assess the effects of widely-held societal norms on health and demonstrate the moderating effects of democracy and income level.

Outcry Consistency and Prosecutorial Decisions in Child Sexual Abuse Cases.

This study examines the correlation between the consistency in a child's sexual abuse outcry and the prosecutorial decision to accept or reject cases of child sexual abuse. Case-specific information was obtained from one Texas Children's Advocacy Center on all cases from 2010 to 2013. After the needed deletion, the total number of cases included in the analysis was 309. An outcry was defined as a sexual abuse disclosure. Consistency was measured at both the forensic interview and the sexual assault exam. Logistic regression was used to evaluate whether a correlation existed between disclosure and prosecutorial decisions. Disclosure was statistically significant. Partial disclosure (disclosure at one point in time and denial at another) versus full disclosure (disclosure at two points in time) had a statistically significant odds ratio of 4.801. Implications are discussed, specifically, how the different disciplines involved in child protection should take advantage of the expertise of both forensic interviewers and forensic nurses to inform their decisions.

Setting a minimum age for juvenile justice jurisdiction in California.

Purpose Despite the existence of minimum age laws for juvenile justice jurisdiction in 18 US states, California has no explicit law that protects children (i.e. youth less than 12 years old) from being processed in the juvenile justice system. In the absence of a minimum age law, California lags behind other states and international practice and standards. The paper aims to discuss these issues. Design/methodology/approach In this policy brief, academics across the University of California campuses examine current evidence, theory, and policy related to the minimum age of juvenile justice jurisdiction. Findings Existing evidence suggests that children lack the cognitive maturity to comprehend or benefit from formal juvenile justice processing, and diverting children from the system altogether is likely to be more beneficial for the child and for public safety. Research limitations/implications Based on current evidence and theory, the authors argue that minimum age legislation that protects children from contact with the juvenile justice system and treats them as children in need of services and support, rather than as delinquents or criminals, is an important policy goal for California and for other national and international jurisdictions lacking a minimum age law. Originality/value California has no law specifying a minimum age for juvenile justice jurisdiction, meaning that young children of any age can be processed in the juvenile justice system. This policy brief provides a rationale for a minimum age law in California and other states and jurisdictions without one.

Sixth graders in Israel recount their experience of verbal abuse by teachers in the classroom.

AIM: This study adopts a children's rights perspective stated in Articles 3, 12, 19, 28 of the Convention on the Rights of Children (1989) with the goal of listening to Israeli children articulate their experience of verbal abuse by teachers in 6th grade classrooms METHODS: A purposeful sample of sixty students was individually interviewed and content analysis was performed following Strauss' (1987) constant comparative method. RESULTS: Students reported teachers' yelling, name-calling and put-downs when failing to pay attention, complete their work, or obtain good grades. They condemned teachers as particularly hurtful and cruel for publically humiliating them in class. However, awareness of teachers' authority and fear of reprisal led to students' silence and reluctance to report the abuse to their parents or principal. Covert opposition was nevertheless exhibited as students engaged in a silent monologue telling teachers they had no right to mistreat them (females), silently cursing (males) and/or withdrawing participation (both genders). Repeated public humiliation and scapegoating resulted in the loss of interest in teacher's opinion and school and on rare occasions to the direct verbal confrontation or acting-out behaviour of the abused student. CONCLUSION: This study stresses the importance of gaining insight into the world of children by having them articulate their experience and denounce any form of abuse by teachers in the classroom. A child-safe school culture that listen to children's view and make them feel safe when reporting any form of abuse in the classroom are preconditions to serving children's best interests and wellbeing in schools.

The Community Pediatrics Training Initiative Project Planning Tool: A Practical Approach to Community-Based Advocacy.

Introduction: To impact social determinants of health, physicians require knowledge, skills, and attitudes to work with communities beyond the clinical milieu. The American Academy of Pediatrics (AAP) Community Pediatrics Training Initiative (CPTI) project planning tool can guide health care professionals and trainees to identify and define issues, build coalitions, assess interventions, and ensure sustainability of successful programs. The Accreditation Council for Graduate Medical Education guidelines for pediatric training require experiences in community health. To date, there have been no widely available tools to ensure both robust learning and validated assessment for pediatric residents in community pediatrics and advocacy training. Methods: The AAP CPTI project planning tool engages learners with a step-by-step process involving investigation, guided reflection, and structured assessment. Learners practice the skills necessary to plan, implement, and evaluate a community pediatrics/child health advocacy proposal focused upon a learner-defined area of interest. An assessment rubric maps to milestones. Results: This project planning tool has been used in a number of programs with learners at multiple levels, including undergraduate education, graduate education, and practicing health care providers. It can be employed to design and implement a community advocacy intervention or as a thought exercise and can be incorporated in a single block rotation or as a longitudinal experience. It can be used with individual learners or as a group exercise. Discussion: The project planning tool can be used by residency programs to demonstrate resident competence in community health and advocacy, either as a learning exercise or to guide actual implemented projects.

Toward a Child Rights Theory in Pediatric Bioethics.

This article offers a child rights theory in pediatric bioethics, applying the principles, standards, and norms of child rights, health equity, and social justice to medical and ethical decision-making. We argue that a child rights theory in pediatric bioethics will help pediatricians and pediatric bioethicists analyze and address the complex interplay of biomedical and social determinants of child health. These core principles, standards and norms, grounded in the U.N. Convention on the Rights of the Child (CRC), provide the foundational elements for the theory and a means for better understanding the complex determinants of children's health and well-being. Rights-based approaches to medical and ethical decision-making provide strategies for applying and translating these elements into the practice of pediatrics and pediatric bioethics by establishing a coherent, consistent, and contextual theory that is relevant to contemporary practice. The proposed child rights theory extends evolving perspectives on the relationship between human rights and bioethics to both child rights and pediatric bioethics.

Violencia escolar entre adolescentes: condiciones de vulnerabilidad / Violência entre adolescentes escolares: condições de vulnerabilidades / Violence among school adolescents: vulnerability conditionss

La adolescencia es un período de transformación en el que el adolescente se expone a condiciones de vulnerabilidad, así como a situaciones de violencia, tanto en la condición de víctima como en la de agresor. Este estudio tuvo como objetivo identificar el consumo de alcohol, drogas y conflictos familiares, junto con situaciones de violencia, ya sea en forma sufrida, ejercida, o tanto ejercida como sufrida. Estudio transversal realizado en las escuelas públicas en Cuiabá, Mato Grosso, con estudiantes de secundaria. Los datos procesados por Epi-Info se obtuvieron mediante un cuestionario cerrado. Entre 2.786 encuestados, el 44,4% se encontraba en una situación de violencia, en la que el 16,4% eran solo víctimas, 12,0% solamente agresores y 16,0% experimentaron tanto como víctimas como agresoress, predominando la violencia física y el bullying. En cuanto a las condiciones de vulnerabilidad, el 44,1% de los que experimentaron violencia consumen alcohol y 5.5% drogas. En cuanto al alcohol, consumir bebidas destiladas en fiesta, en casa de los amigos, quedando animados cuando beben, con inicio del consumo de 16 a 17 años, se han destacado en todas las situaciones de violencia. En cuanto a las drogas, el consumo en alguna ocasión, empezar a consumir porque un amigo le ofreció, siendo la marihuana la droga de mayor consumo, principalmente porque les gusta y para deshacerse de los problemas, a partir de 16-17 años, se impuso en todas las situaciones de violencia. Los tíos son los miembros de la familia que más consumen alcohol y / o drogas. El estudio pone de relieve la necesidad de acciones integradas entre escuela, servicios de salud, sociedad y familia, como formas de prevenir este fenómeno (AU)

A adolescência é um período de transformações, em que o adolescente está exposto a condições de vulnerabilidades bem como situações de violência, tanto na condição de vítima como na de agressor. Este estudo objetivou identificar o consumo de álcool, drogas e conflito familiar junto às situações de violência, seja na forma sofrida, exercida, e tanto sofrida como exercida. Estudo transversal, desenvolvido em escolas públicas de Cuiabá, Mato Grosso, com adolescentes do ensino médio. Os dados, processados pelo Epi-Info, foram obtidos por meio de questionário fechado. Entre 2.786 pesquisados, 44,4% se encontravam em situação de violência, em que 16,4% eram apenas vítimas, 12,0% somente agressores e 16,0% vivenciaram tanto a condição de vítimas como agressores, predominando a violência física e o bullying. Quanto às condições de vulnerabilidades, 44,1% dos que sofreram violência consomem álcool e 5,5% drogas. Quanto ao álcool, consumir bebidas destiladas, em festa, na casa de amigos, ficando animados quando bebem, com inicio do consumo aos 16-17 anos, se destacaram em todas as situações de violência. Quanto às drogas, consumir de vez em quando, iniciar o consumo porque um amigo ofereceu, sendo a maconha a droga mais consumida, principalmente porque gostam e para se livrar dos problemas, com início aos 16-17 anos, prevaleceram em todas as situações de violência. Os tios foram os membros familiares que mais consomem álcool e/ou drogas. O estudo evidencia a necessidade de ações integradas entre escola, serviços de saúde, sociedade e família, como formas de prevenção deste fenômeno (AU)

Adolescence is a period of transformation, in which the teenager is exposed to conditions of vulnerabilities as well as situations of violence, both as victim and aggressor. This study aimed to identify the consumption of alcohol, drugs and family conflict along with situations of violence, whether in the form suffered, exercised, and both suffered as exercised. A cross-sectional study, developed in public schools in Cuiabá, Mato Grosso, with high school teenagers. The data processed by the Epi-Info, were obtained through a closed questionnaire. Between 2,786 surveyed, 44.4% were in a situation of violence, in which 16.4% were just victims, 12.0% aggressors only, and 16.0% have experienced both the condition of victims as offenders, predominating physical violence and bullying. As regards the conditions of vulnerabilities, 44.1% of those who suffered violence consume alcohol and 5.5% drugs. Regarding alcohol consuming distilled beverages, in party at the home of friends, getting excited when they drink, with beginning of consumption at 16-17 years old, stood out in all situations of violence. Regarding drugs, consume every once in a while, start the consumption because a friend offered, being the most consumed drug marijuana, mainly because they like and to get rid of the problems, beginning at the age of 16-17 years old, prevailed in all situations of violence. The uncles were family members who consume alcohol and/or drugs. The study highlights the need for integrated actions among school, health services, society and family as ways of preventing this phenomenon (AU)

Using child advocacy center tracking data to examine criminal disposition times.

Given the difficulty of obtaining criminal justice data on child abuse cases, information from child advocacy centers could be an important resource for answering questions about criminal justice outcomes for child abuse cases. In this exploratory study, we use data from one child advocacy center (N = 632) to examine the feasibility of using NCAtrak, a national computerized, Web-based case tracking system, to examine criminal disposition timeframes in child abuse cases. The system data indicated that the time frame for the cases to be criminally resolved varied widely. About one in four child physical and sexual abuse cases with adult offenders took more than one year to reach a final disposition. About 11% of child sexual abuse cases with juvenile offenders took more than one year to reach a criminal disposition. We encourage child advocacy centers using computer-based data systems to think of additional ways they might use this potentially rich source of data.

Chinese immigrant parents' vaccination decision making for children: a qualitative analysis.

BACKGROUND: While immunization coverage rates for childhood routine vaccines in Hong Kong are almost 100%, the uptake rates of optional vaccines remain suboptimal. Understanding parental decision-making for children's vaccination is important, particularly among minority groups who are most vulnerable and underserved. This study explored how a subsample of new immigrant mothers from mainland China, a rapidly-growing subpopulation in Hong Kong, made decisions on various childhood and adolescent vaccines for their offspring, and identified key influences affecting their decision making. METHODS: Semi-structured in-depth interviews were conducted with 23 Chinese new immigrant mothers recruited by purposive sampling. All interviews were audio-taped, transcribed and analyzed using a Grounded Theory approach. RESULTS: Participants' conversation revealed five underlying themes which influenced parents' vaccination decision-making: (1) Institutional factors, (2) Insufficient vaccination knowledge and advice, (3) Affective impacts on motivation, (4) Vaccination barriers, and (5) Social influences. The role of social norms appeared overwhelmingly salient influencing parents' vaccination decision making. Institutional factors shaped parent's perceptions of vaccination necessity. Fear of vaccine-targeted diseases was a key motivating factor for parents adopting vaccination. Insufficient knowledge about vaccines and targeted diseases, lack of advice from health professionals and, if provided, suspicions regarding the motivations for such advice were common issues. Vaccination cost was a major barrier for many new immigrant parents. CONCLUSIONS: Social norms play a key role influencing parental vaccination decision-making. Insight gained from this study will help inform healthcare providers in vaccination communication and policymakers in future vaccination programme.

Longitudinal change in the use of services in autism spectrum disorder: understanding the role of child characteristics, family demographics, and parent cognitions.

The aim of this study was to identify child characteristics, family demographics, and parent cognitions that may affect access to early intervention, special education, and related services. The sample included 70 families of young children with autism spectrum disorders. All parents were enrolled in a short education program, providing them with basic information and resources on advocating for a young child with autism spectrum disorders (Parent Advocacy Coaching). Longitudinal change in children's intervention program in the community was evaluated over a period of about 27 months, starting 12 months prior to enrollment in Parent Advocacy Coaching. Results revealed large individual differences in the intensity of children's individual and school-based services. Despite this variability, only two child characteristics (age, gender) emerged as independent predictors. In contrast, the intensity of children's intervention programs was independently predicted by a broad range of demographic characteristics, including parental education, child ethnicity and race, and family composition. Finally, even after child characteristics and family demographics were statistically controlled, results revealed associations between specific parental cognitions (parenting efficacy, understanding of child development) and the subsequent rate of change in the intensity of children's intervention programs. Implications for improving educational programs that aim to enhance parent advocacy are discussed.

Parental employment status and symptoms of children abused during a recession.

Incidences and severity of child abuse have increased since the start of the recession. This study examined the relationship between employment status and severity of symptoms in children abused during a recession year. Participants included 154 females and 65 males between 2 and 17 years old referred to Dallas Children's Advocacy Center after surviving child sexual abuse, physical abuse, and/or neglect. We found that child abuse survivors whose mothers were unemployed showed higher symptom severity. Larger differences were found when participants were broken down by age, ethnicity, and living situation. Father's employment status did not affect symptom severity probably because many children lived with single mothers. We concluded that child abuse survivors whose mothers are unemployed have increased risk for psychological symptoms.

Teacher Reporting Attitudes Scale (TRAS): confirmatory and exploratory factor analyses with a Malaysian sample.

The Teacher Reporting Attitude Scale (TRAS) is a newly developed tool to assess teachers' attitudes toward reporting child abuse and neglect. This article reports on an investigation of the factor structure and psychometric properties of the short form Malay version of the TRAS. A self-report cross-sectional survey was conducted with 667 teachers in 14 randomly selected schools in Selangor state, Malaysia. Analyses were conducted in a 3-stage process using both confirmatory (stages 1 and 3) and exploratory factor analyses (stage 2) to test, modify, and confirm the underlying factor structure of the TRAS in a non-Western teacher sample. Confirmatory factor analysis did not support a 3-factor model previously reported in the original TRAS study. Exploratory factor analysis revealed an 8-item, 4-factor structure. Further confirmatory factor analysis demonstrated appropriateness of the 4-factor structure. Reliability estimates for the four factors-commitment, value, concern, and confidence-were moderate. The modified short form TRAS (Malay version) has potential to be used as a simple tool for relatively quick assessment of teachers' attitudes toward reporting child abuse and neglect. Cross-cultural differences in attitudes toward reporting may exist and the transferability of newly developed instruments to other populations should be evaluated.

Child sexual abuse: community concerns in urban Tanzania.

The aim of this study was to explore community perceptions about child sexual abuse in Tanzania. Thirteen focus group discussions were conducted with adult community members. The core category, children's rights challenged by lack of agency, was supported by eight categories. Aware but distressed portrayed feelings of hopelessness, lack of trust in the healthcare and legal systems reflected perceived malpractice, decreased respect for children's rights referred to poor parental care and substance abuse, myths justifying CSA illustrated cultural beliefs to rationalize child sexual abuse, disclosure threatened by fear of stigma and discrimination aligned the manifestations that prevent disclosure, actions driven by economic circumstances described the economical dependence of victims, urging a change in procedures reflected informants' wish to ally with local governance and pressure groups, and willingness to act indicated the community's role in supporting victims. The study showed how lack of agency calls for efforts to increase children's human rights at all levels.

The role of the medical provider in the evaluation of sexually abused children and adolescents.

It was only 30 years ago that the medical community began to develop an increased awareness of child sexual abuse, and the role of the medical provider in the evaluation of sexually abused children has evolved significantly. As clinicians worldwide develop a greater understanding of the impact of the sexual abuse evaluation on the child, the roles of the physician and nurse have changed. In the United States, current practice often uses a multidisciplinary assessment involving skilled forensic interviewing of the child and a medical examination done by a medical provider with specialized training in sexual abuse. In order to minimize child interviews, these assessments are frequently held in settings such as child advocacy centers, where forensic interviewers and medical clinicians, child protective service workers, and police and district attorneys can work jointly to address the legal and protective issues in a coordinated fashion.

Exploring nonoffending caregiver satisfaction with a Children's Advocacy Center.

This study is a case evaluation research report on one Children's Advocacy Center that provides a coordinated response to allegations of child maltreatment, particularly sexual abuse. The data come from a mailed survey of nonoffending caregivers measuring their satisfaction with services provided through the Children's Advocacy Center. The results indicate overall satisfaction with the Children's Advocacy Center; however, they also suggest that the forensic interview may be perceived or experienced as distinct from the ongoing investigative and legal processes. Recommendations are made to better assess nonoffending caregiver satisfaction with Children's Advocacy Center services and to encourage consumer driven service improvement.