Análise ética dos impactos da pandemia de COVID-19 na saúde de crianças e adolescentes / An ethical analysis of the impacts of the COVID-19 pandemic on the health of children and adolescents / Análisis ético acerca dos impactos de la pandemia COVID-19 en la salud de niños y adolescentes

A pandemia de COVID-19 trouxe impactos significativos para a vida de crianças e adolescentes em todo o mundo. Considerando esse contexto, o objetivo deste artigo foi examinar como as crianças e os adolescentes no Brasil foram impactados pela pandemia à luz de uma análise ética. Para tanto, uma análise interpretativa de estudos brasileiros sobre a saúde da criança e do adolescente durante a pandemia foi realizada. A tarefa de reconhecer essa dimensão ética é importante para entender como as respostas a situações de crise, tais como a presente situação da pandemia de COVID-19, podem ser moldadas e identificar quais as prioridades de ação de acordo com todas as partes interessadas, situando a criança entre essas partes de interesse. A análise demonstrou que tanto os efeitos diretos quanto os indiretos implicam em processos de tomada de decisão que precisam utilizar e sustentar o direito de participação da criança para que a ação tomada esteja o máximo possível focada nos melhores interesses da criança. Contudo, a realidade brasileira tem demonstrado uma exclusão estrutural das vozes infantis. Recomenda-se que mais estudos sejam conduzidos a fim de aprofundar o conhecimento sobre os melhores interesses das crianças e sua participação nas ações tomadas durante a pandemia

The COVID-19 pandemic has impacted the lives of children and adolescents around the world. This article aims to examine how the pandemic has impacted children and adolescents in Brazil using an ethical analysis. An interpretive analysis of Brazilian studies on child and adolescent health during the pandemic was conducted. The task of recognizing this ethical dimension is important to understand how responses to crisis situations, such as the current situation of the COVID-19 pandemic, can be shaped and where are the priorities for action according to all stakeholders, situating the child between these parts of interest. Our analysis highlighted both direct and indirect effects surrounding the decision-making processes for children in the COVID-19 pandemic reality. These decisional processes must sustain the child's right to participation to ascertain that the action taken is in the child's best interests. However, Brazilian reality has shown a structural exclusion of children's voices in decisions that affect them, particularly related to the effects of the pandemics in their lives. More studies must be conducted to deepen the knowledge about children's best interests and their participation in actions planning during the pandemic

La pandemia de COVID-19 ha afectado las vidas de niños y adolescentes de todo el mundo. Este artículo tiene como objetivo examinar cómo la pandemia ha afectado a los niños y adolescentes en Brasil mediante un análisis ético. Se realizó un análisis interpretativo de los estudios brasileños sobre salud del niño y del adolescente durante la pandemia. La tarea de reconocer esta dimensión ética es importante para entender cómo las respuestas a situaciones de crisis, como la situación actual de la pandemia COVID-19, pueden configurarse y dónde están las prioridades de acción según todos los actores, situando al niño entre estas partes. de interés. Estos procesos de decisión deben sustentar el derecho del niño a la participación para asegurarse de que las medidas tomadas respondan al interés superior del niño. Sin embargo, la realidad brasileña ha mostrado una exclusión estructural de las voces de los niños en las decisiones que los afectan, particularmente en relación con los efectos de las pandemias en sus vidas. Se deben realizar más estudios para profundizar el conocimiento sobre el interés superior de los niños y su participación en la planificación de acciones durante la pandemia

For Victims of Fatal Child Abuse, Who Has the Right to Consent to Organ Donation?

In rare circumstances, children who have suffered traumatic brain injury from child abuse are declared dead by neurologic criteria and are eligible to donate organs. When the parents are the suspected abusers, there can be confusion about who has the legal right to authorize organ donation. Furthermore, organ donation may interfere with the collection of forensic evidence that is necessary to evaluate the abuse. Under those circumstances, particularly in the context of a child homicide investigation, the goals of organ donation and collection and preservation of critical forensic evidence may seem mutually exclusive. In this Ethics Rounds, we discuss such a case and suggest ways to resolve the apparent conflicts between the desire to procure organs for donation and the need to thoroughly evaluate the evidence of abuse.

Buenas prácticas, tensiones y desafíos ético-deontológicos en la evaluación psicológica forense del maltrato y abuso sexual infantil / Good practices, tensions and ethical-deontological challenges in the forensic psychological assessment of child mistreatment and sexual abuse / Bones pràctiques, tensions I desafiaments ètico-deontològics en l'avaluació psicològica forense del maltractament I abús sexual infantil

La evaluación psicológica forense del maltrato y del abuso sexual ha sido abordada prioritariamente desde una perspectiva técnico-metodológica. La consideración de los aspectos ético-deontológicos implicados ha resultado más incipiente y comienzan gradualmente a integrarse como una dimensión relevante de la práctica profesional. El presente artículo explora las principales tensiones y desafíos para los psicólogos que realizan evaluaciones forenses en esta materia. Se revisan cómo los principios rectores de la bioética se adaptan a la realidad de las evaluaciones forenses que permiten orientar el desarrollo de buenas prácticas en el área

The forensic psychological evaluation of mistreatment and sexual abuse has been addressed primarily from a technical-methodological perspective. Considerations of the ethical-deontological aspects involved has been more incipient, and gradually beginning to be integrated as a relevant dimension of professional practice. This article explores the main tensions and challenges for psychologists who perform forensic evaluations in this area. We review how the guiding principles of bioethics adapt to the reality of forensic evaluations that allow to guide the development of good practices in the área

L'avaluació psicològica forense del maltractament I abús sexual ha estat abordada prioritàriament des d'una perspectiva tècnico-metodològica. La consideració dels aspectes ètico-deontològics implicats ha resultat més incipient I comencen gradualment a integrar-se com una dimensió rellevant de la pràctica professional. El present article explora les principals tensions I desafiaments per als psicòlegs que realitzen avaluacions forenses en aquesta matèria. Es revisen com els principis que regeixen la bioètica s'adapten a la realitat de les avaluacions forenses que permeten orientar el desenvolupament de bones pràctiques al sector

"His body is human, but he has a tiracchana heart": An ethnographic study of the epigenesis of child abuse in Cambodia.

In Cambodia, more than half of all children experience physical, emotional, or sexual abuse. This article examines how Cambodians view the causes and effects of child abuse and analyses its underlying cultural forces. Adopting a conceptual framework originally developed for the cultural context of violence against women, 110 cases of child abuse were ethnographically studied, comprising 61 cases of sexual abuse (50 girls and 11 boys), 26 cases of physical abuse (13 girls and 13 boys), and 23 cases of emotional abuse or neglect (13 girls and 10 boys). The perpetrators included fathers and other close relatives, lay Buddhist officiants and monks, and neighbors. Most informants viewed the sexual or physical abuse of children as stemming from "cultural attractors," including blighted endowment caused by deeds in a previous life, a bad character starting early in life, astrological vulnerability to abuse, preordained entanglement between the child and the abuser (they are "fated" to meet), sexual craving, "entering the road to ruin," and a moral blindness that portrays the abuser as blameless. Although these traits are similar to those identified in the explanations of violence against women, there were notable differences such as the role of the tiracchana in explaining sexual abuse, including incest. Using these findings, this article identifies a cultural epigenesis of child sexual abuse, and provides a blueprint for developing a culturally responsive plan to prevent child abuse.

Perceptions of Adolescents and Caregivers of Corporal Punishment: A Qualitative Study Among Indo-Caribbean in Suriname.

While the protection of children from all forms of violence is a fundamental right guaranteed by the Convention on the Rights of the Child, violence remains a part of life for children around the globe. Corporal punishment is a form of violence and a dominant practice as a method of corrective parenting in the Caribbean. While researchers are starting to ask children directly about their experiences of violence, there is limited research on children's perspectives of the function, legality, and boundaries of corporal punishment, particularly in low-and middle-income countries. This study begins to address this gap by reporting on 12 focus groups that were conducted with adolescents (aged 12 to 18 years) and caregivers of Indo-Caribbean background in Suriname. The aim is to explore adolescents' and caregivers' shared perspectives about the prevalence of corporal punishment in Suriname, responses to and feelings about its use as a discipline strategy and perspectives of the rationales for and against corporal punishment, and their views on banning it. Analyses were done using ATLAS.ti version 1.0.50, a qualitative data package. Corporal punishment showed to be an everyday experience in children's lives in Suriname. There was no clear consensus regarding adolescents' and caregivers' perspectives on the parental use of corporal punishment. Many participants hesitated to support efforts to prohibit corporal punishment legally. Messages arising from this study could usefully inform the development of a public information campaign on safe and effective discipline of children in Suriname.

Child Abuse, Incarceration, and Decisions About Life-sustaining Treatment.

Most critical care interventions for children occur in the framework of a supportive environment with loving parents that are present at the bedside to help to guide medical interventions through shared decision-making. What happens, however, if the parents are precluded from being at the bedside because of legal entanglements? How should clinical decisions progress in those cases? In this Ethics Rounds, we present the case of an infant with severe hypoxic-ischemic encephalopathy at birth whose mother was incarcerated shortly after delivery. We explore clinical and legal challenges that the medical team faces in determining best interests for the infant in this context and difficulties in deciding what therapies to provide and for how long.

Medical Marijuana for Minors May Be Considered Child Abuse.

The Food and Drug Administration categorizes marijuana (cannabis) as a Schedule I drug, meaning that it has no currently accepted medical use, a high potential for abuse, and no good data on safety. Other Schedule I drugs are heroin, lysergic acid diethylamide, peyote, methaqualone, and 3,4-methylenedioxymethamphetamine ("ecstasy"). The authors of some studies have shown that marijuana can reduce nausea and vomiting from chemotherapy, can improve food intake in patients with HIV, can reduce neuropathic pain, and may slow the growth of cancer cells. In many states, marijuana use is illegal. No state has approved its use for children. What, then, should doctors do if they become aware that parents are using marijuana to treat medical conditions in their children? What if the children have adverse reactions to the marijuana? In this Ethics Rounds, we present such a case and ask experts in child protection and child abuse to discuss the appropriate response.

Youth self-report of child maltreatment in representative surveys: a systematic review. / Maltraitance envers les enfants déclarée par les jeunes eux-mêmes à l'occasion d'enquêtes représentatives de la population : revue systématique.

INTRODUCTION: This systematic review identified population-representative youth surveys containing questions on self-reported child maltreatment. Data quality and ethical issues pertinent to maltreatment data collection were also examined. METHODS: A search was conducted of relevant online databases for articles published from January 2000 through March 2016 reporting on population-representative data measuring child maltreatment. Inclusion criteria were established a priori; two reviewers independently assessed articles to ensure that the criteria were met and to verify the accuracy of extracted information. RESULTS: A total of 73 articles reporting on 71 surveys met the inclusion criteria. A variety of strategies to ensure accurate information and to mitigate survey participants' distress were reported. CONCLUSION: The extent to which efforts have been undertaken to measure the prevalence of child maltreatment reflects its perceived importance across the world. Data on child maltreatment can be effectively collected from youth, although our knowledge of best practices related to ethics and data quality is incomplete.

INTRODUCTION: Cette revue systématique a permis de recenser des enquêtes sur les jeunes représentatives de la population et comportant des questions sur la maltraitance envers les enfants déclarée par ces derniers. Nous avons également examiné la qualité des données et les questions d'ordre éthique pertinentes pour la collecte de données sur la maltraitance. MÉTHODOLOGIE: Nous avons effectué une recherche dans diverses bases de données en ligne pour sélectionner les articles publiés entre janvier 2000 et mars 2016 qui contenaient des données représentatives de la population mesurant la maltraitance envers les enfants. Les critères d'inclusion ont été établis a priori et deux examinateurs ont évalué indépendamment l'un de l'autre les articles pour s'assurer que les critères étaient respectés et pour vérifier l'exactitude des données extraites. RÉSULTATS: Au total, 73 articles portant sur 71 enquêtes ont répondu aux critères d'inclusion. Nous avons relevé diverses stratégies visant à assurer l'exactitude des renseignements et à atténuer la détresse des participants à l'enquête. CONCLUSION: L'ampleur des efforts déployés pour mesurer la prévalence de la maltraitance envers les enfants est le reflet de l'importance accordée à cette dernière à l'échelle de la planète. Malgré des connaissances incomplètes en matière de pratiques exemplaires liées à l'éthique et de qualité des données, il est possible de recueillir efficacement auprès des jeunes eux-mêmes des données sur la maltraitance dont ils font l'objet.

Intervención educativa sobre violencia intrafamiliar y maltrato infantil en familias disfuncionales / Educative intervention about intrafamily violence and children abuse in dysfunctional families

Introducción: la familia es la célula elemental de la sociedad, donde sus integrantes satisfacen sus intereses afectivos y sociales, pero a menudo se ve afectada por la presencia de violencia. Objetivo: evaluar los conocimientos que sobre violencia intrafamiliar y maltrato infantil tienen las familias disfuncionales antes y después de una estrategia de intervención. Métodos: se realizó una investigación tipo cuasi experimental antes y después sin grupo control de las familias disfuncionales pertenecientes al consultorio número 11 del Policlínico Docente Marta Martínez Figuera ubicado en Güines, Mayabeque, en el periodo comprendido entre el mes de febrero del año 2015 a mayo del año 2017. El universo de estudio estuvo conformado por 245 familias, la muestra fue de 178 familias disfuncionales. Resultados: antes de la intervención los resultados encontrados evidenciaron que la ingestión de alcohol fue la condición en el medio familiar más asociada a violencia, los golpes y/o castigos físicos fueron la principal manifestación de maltrato infantil, la persona del núcleo que más propició el maltrato fue la madre, los niños hipercinéticos fueron los más vulnerables y reconocieron el maltrato físico como forma más frecuente. Después de la intervención, se evidenciaron los gritos y/o amenazas verbales como principal manifestación de maltrato infantil, los niños rebeldes a la disciplina son los más afectados y la forma más relevante fue el maltrato psicológico y/o emocional. Conclusiones: antes de la intervención existían escasos conocimientos relacionados con la violencia intrafamiliar y el maltrato infantil, ganándose estos, después de la estrategia de intervención(AU)

Introduction: the family is the main cell of the society, where its members satisfy the affective and social interests, but sometimes it is affected by the presence of violence. Objective: to evaluate knowledge about intrafamily violence, and children abuse that dysfunctional families have before and after an intervention strategy.Methods: a cuasi experimental investigation before and after without control group of dysfunctional families from Doctor's Office # 11 at "Marta Martinez Figuera" teaching policlinic located in Güines, Mayabeque, was performed from February, 2015 to May, 2017. The universe was formed by 245 families; the sample was of 178 dysfunctional families. Results: before the intervention, the found results evidenced that alcohol ingestion was the most associated condition to violence within the families, bumps and physical punishments were the main manifestations of children abuse, the person from the household that most favored the abuse was their mothers, hyperactive children were the most vulnerable and recognized the physical abuse as the most frequent cause. After the intervention, shouts and verbal intimidations resulted as the main manifestations of children abuse, rebelled children to discipline are the most affected and the most relevant were the psychological and/or emotional abuse. Conclusions: before the interventions there were insufficient knowledge related to intrafamily violence and children abuse, and they were improved after the intervention strategy(AU)

Physical punishment: Sanctioned violence against children.

Australian society continues to support physical punishment of children and is currently conducting a Royal Commission unto violence against children in custody. By contrast, New Zealand has banned physical punishment of children. Australian society needs to address this issue.

Pediatric Inpatient Nurses' Perceptions of Child Maltreatment.

PURPOSE: The purpose of this study was to explore the perceptions of child maltreatment among inpatient pediatric nurses. DESIGN AND METHODS: A cross-sectional survey was used to obtain responses to an online survey designed to examine perceptions of child maltreatment from inpatient pediatric nurses. RESULTS: Many nurses surveyed (41.25%) indicated that they had not received adequate training or had never received training on child maltreatment identification and many (40%) also indicated they were not familiar with the applicable reporting laws. CONCLUSIONS: Due to the serious immediate and long term effects of child maltreatment, it is imperative that pediatric inpatient nurses have adequate training on how to identify potential abuse and neglect cases, as well as legal reporting requirements, since they are in a unique position to identify potential cases of maltreatment. PRACTICE IMPLICATIONS: There is a continuing need for training on child maltreatment identification and reporting laws for inpatient pediatric nurses.

Parents' Perceptions of Answering a Survey on Violence Against Children.

The effects of participation in research is an important ethical question in studies involving human participants. In research concerning violence, the common presumption is that participation is especially harmful for those who have personally experienced violence. In this article, parents' perceptions of answering a violence-related survey are analyzed based on free-text comments. A total of 3,170 parents responded to the survey about their violent behavior toward their child (ages 0-12), and 45% (2,047) of those reflected on their perceptions of answering the survey. These answers are analyzed using a thematic analysis. In addition to describing the perceptions, the associations between perceptions and experiences of violence are analyzed. The vast majority of the participants perceived participating in answering as being positive. Negative perceptions, such as distress, were also reported, but these perceptions were mostly reported together with positive perceptions, especially among those who personally had experienced violence.

Confidentiality in Pediatric and Adolescent Gynecology: When We Can, When We Can't, and When We're Challenged.

Maintaining confidentiality is an important aspect of adolescent health care. Different states and provinces have laws around the provision of confidential health care to minors for specific health concerns such as reproductive health, mental health and substance abuse. However, there are situations where confidentiality cannot be assured, particularly if the adolescent is being abused. Educating teens and parents about the circumstances in which confidentiality is necessary is sometimes challenging for the clinician. Moreover, with the advent of electronic medical records, patient portals and other requirements to share health information with parents and the adolescent patient, confidentiality is sometimes not easy to assure. The following is the Elsevier Lecture from the 2015 Meeting of the North American Society for Pediatric and Adolescent Gynecology.

[Medicolegal aspects of child abuse]. / Rechtsmedizinische Aspekte der Kindesmisshandlung.

CLINICAL ISSUE: The prevention and clinical diagnostics of maltreatment of children and adolescents represents a great challenge to all medical disciplines concerned; therefore, an interdisciplinary collaboration is indispensable. DIAGNOSTICS: Medicolegal experts require specific radiological examination methods for the differentiation between accidental and non-accidental injuries, depending on the corresponding point in question. In addition, a clear and structured radiological appraisal of the findings is necessary. On the other hand, radiologists require an appropriate succinctly phrased question from the medicolegal expert. PRACTICAL RECOMMENDATIONS: A close collaboration between radiologists and medicolegal experts is mandatory for a better recognition of cases of child abuse; therefore, the joint establishment of diagnostic standards and a comprehensive implementation is necessary.

[Accident or maltreatment? Radiographic X­ray patterns in non­accidental trauma : The concept of sentinel injuries]. / Unfall oder Misshandlung? Radiologische Befunde beim nichtakzidentiellen Trauma : Das Konzept der "sentinel injuries".

The focus of this review article is on child abuse and the radiographic pattern of X­ray findings. The radiologist should be able to recognize typical injuries resulting from child abuse. In some cases the findings are highly specific for abuse and these include metaphyseal corner fractures of the long bones in children aged up to 24 months. In other cases the fractures are not specific but highly indicative of child abuse: rib fractures, for example can be associated with child abuse in more than 50 % of the cases; however, maltreatment is difficult to diagnose without taking the entire pattern of skeletal findings into consideration so that a radiological screening of the entire skeleton is often necessary. The concept of sentinel injuries might be helpful for deciding in which cases a complete skeletal screening should be performed. In the age group up to 24 months old a complete skeletal status (with some exceptions) is recommended if one of the three sentinel injuries of rib fractures, intracranial bleeding and abdominal trauma is present.

[Shaken baby syndrome]. / Shaken-Baby-Syndrom.

The shaken baby syndrome (SBS) or shaking trauma describes the occurrence of subdural hematoma, retinal hemorrhage and diffuse injury to the brain by vigorous shaking of an infant that has a poor prognosis. Rapid cranial acceleration and deceleration leads to tearing of bridging veins, retinal hemorrhages and diffuse brain injuries. In addition to clinical symptoms, such as irritability, feeding difficulties, somnolence, apathy, seizures, apnea and temperature regulation disorders, vomiting also occurs due to increased intracranial pressure. Milder forms of SBS often go undiagnosed and the number of unreported cases (grey area) is probably much higher. Up to 20 % of patients die within days or weeks due to SBS and survivors often show cognitive deficits and clinical symptoms, such as physical disabilities, impaired hearing, impaired vision up to blindness, epilepsy and mental retardation as well as a combination of these conditions; therefore, prevention is very important.

[Child abuse from a pediatric perspective]. / Kindesmisshandlung aus pädiatrischer Sicht.

CLINICAL ISSUE: Child abuse is the physical, sexual or emotional maltreatment, or neglect of a child or children. Child maltreatment is defined as any act or series of acts of commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child. Child abuse can occur in a child's home, or in the organizations, schools or communities the child interacts with. There are four major categories of child abuse: neglect, physical abuse, psychological or emotional abuse, and sexual abuse. DIAGNOSTIC WORK-UP: In child abuse, establishing an early diagnosis is essential. Apart from taking a detailed history and performing a meticulous physical examination, including forensic evaluation as indicated, further diagnostic steps (imaging studies, ophthalmic examination/funduscopy, laboratory studies, etc.) may be warranted. PRACTICAL RECOMMENDATIONS: In addition to providing acute medical help, longer-term, multidisciplinary interventions have to be put in place in cases of child abuse. This article summarizes the most important facts pertinent to this subject.