Síndrome de niño agredido: reporte de caso / Battered child síndrome: case report

La valoración médico legal en los casos de Síndrome de niño agredido debe ser minuciosa, y abarcar todos los aspectos que indican los artículos y guías nacionales e internacionales, para tener una certeza diagnóstica, debe incluir una historia médico legal completa, examen físico detallado y estudios complementarios, así como diagnóstico diferencial. El presente artículo abarca algunos de los aspectos principales a tomar en cuenta ante la sospecha de abuso infantil, mediante la presentación y abordaje de un caso clínico.

The medical legal assessment in the cases of Attacked Child Syndrome must be thorough and cover all the aspects indicated in the articles and national and international guides, to have a diagnostic certainty, it must include a complete legal medical history, detailed physical examination and complementary studies, as well as differential diagnosis. This article covers some of the main aspects to consider when suspected of child abuse, through the presentation and approach of a clinical case.

Expectativas de mães e cuidadoras sobre participação em um programa de prevenção à violência / Expectations of mothers/caregivers regarding the participation in a violence prevention program / Expectativas de madres/cuidadoras sobre la participación en un programa de prevención de la violencia

O presente estudo qualitativo objetivou compreender as expectativas de mães e cuidadoras sobre a sua participação no Programa ACT para Educar Crianças em Ambientes Seguros na versão remota, no período da pandemia de covid-19. Também visou identificar a percepção das participantes sobre educar uma criança em um ambiente seguro. Foram realizadas entrevistas semiestruturadas on-line com doze mães e cuidadoras, antes da participação no Programa ACT. Os resultados indicaram diferentes expectativas sobre a participação no Programa ACT, entre elas: adquirir novos conhecimentos, aprimorar as habilidades parentais, trocar experiências, receber auxílio no momento da pandemia de covid-19 e possibilitar para a criança um desenvolvimento saudável. Na percepção das mães e cuidadoras, a versão remota do Programa ACT apresenta aspectos positivos; entre eles, a participação de pais e cuidadores que não residem na cidade em que é oferecida a intervenção. No entanto, apontaram como fatores negativos a ausência do contato físico e as interrupções que podem acontecer a partir das falhas de internet. Para as mães e cuidadoras, educar a criança em um ambiente seguro estava relacionado a promover os direitos estabelecidos no Estatuto da Criança e do Adolescente (ECA), como educação, saúde, lazer, cuidado, afeto, assim como protegê-la de situações de violência. Considera-se que as expectativas das participantes estavam alinhadas aos objetivos do Programa ACT. Torna-se prioritário oferecer programas de prevenção à violência aos pais e cuidadores, em especial em momentos adversos como o da pandemia de covid-19, a fim de promover o desenvolvimento e a saúde das crianças, assim como prevenir situações de violação de direitos.(AU)

This qualitative study aims to understand the expectations of mothers and caregivers about participating in the ACT Raising Safe Kids Program in its remote version, during the COVID-19 pandemic period. It also aims to identify the participants' perception of raising a child in a safe environment. Semi-structured on-line interviews were conducted with 12 mothers/caregivers, prior to participation in the ACT Program. The results indicated different expectations regarding the participation in the ACT Program, for example: acquiring new knowledge, improving parenting skills, exchanging experiences, receiving support during the COVID-19 pandemic, and enabling the child to have a healthy development. In the perception of mothers and caregivers, the remote version of the ACT Program has positive aspects, such as the participation of parents and caregivers who do not live in the city where the intervention is offered. However, they pointed out as negative factors absence of physical contact and interruptions due to internet failures. For the mothers/caregivers, educating children in a safe environment was related to promoting the rights established by the Brazilian Child and Adolescent Statute, namely education, health, leisure, care, affection, as well as protecting them from situations of violence. The expectations of the participants were aligned with the objectives of the ACT Program. Offering violence prevention programs to parents and caregivers is a priority, especially in adverse moments such as the COVID-19 pandemic, in order to promote the development and health of children, as well as prevent situations of violation of rights.(AU)

Este estudio cualitativo pretendió comprender las expectativas de madres y cuidadoras sobre la participación en el Programa de ACT para Educar a Niños en Ambientes Seguros en la versión remota, en el periodo de la pandemia de la COVID-19. También se propuso identificar la percepción de las participantes sobre educar a un niño en un ambiente seguro. Se llevaron a cabo entrevistas semiestructuradas en línea con 12 madres/cuidadoras, antes de la participación en el Programa ACT. Los resultados señalaron diferentes expectativas con la participación del Programa de ACT, entre ellas: adquirir nuevos conocimientos, perfeccionar las habilidades parentales, intercambiar experiencias, recibir auxilio en el momento de la pandemia de la COVID-19 y posibilitar al niño un desarrollo saludable. En la percepción de las madres y cuidadoras, la versión remota del Programa de ACT presenta aspectos positivos, como la participación de padres y cuidadores que no residen en la ciudad donde es ofrecida la intervención. Sin embargo, señalaron como factores negativos la ausencia del contacto físico y las interrupciones, que pueden ocurrir por fallas en Internet. Para las madres/cuidadoras, educar al niño en un ambiente seguro estaba relacionado a promover los derechos establecidos en el Estatuto del Niño y del Adolescente de Brasil, como educación, salud, ocio, cuidado, afecto, así como protegerlo de situaciones de violencia. Se considera que las expectativas de las participantes estaban alineadas con los objetivos del Programa de ACT. Es prioritario ofrecer programas de prevención a la violencia a los padres y cuidadores, en especial en momentos adversos como el de la pandemia de la COVID-19, con el fin de promover el desarrollo y la salud de los niños, así como prevenir situaciones de vulneración de derechos.(AU)

Implicações da prática profissional no acolhimento institucional de crianças: perspectiva de cuidadoras / Implications of professional practice in children's institutional sheltering: caregivers' perspective / Implicaciones de la práctica profesional en el alojamiento institucional de niños: perspectiva de cuidadoras

Este estudo qualitativo teve como objetivo compreender, a partir da teoria de bioecológica de desenvolvimento, as implicações da prática profissional no processo de acolhimento de crianças em uma casa-abrigo, na perspectiva de cuidadoras. As participantes foram 10 profissionais de uma casa-abrigo localizada na região sul do Brasil. Utilizou-se a entrevista semiestruturada e a organização e análise dos dados sustentou-se na Grounded Theory, com auxílio do software Atlas.ti 8.4.14. Os resultados evidenciaram uma centralização das ações de acolhimento e atenção em torno dos cuidados físicos das crianças. As ações para promover suporte e cuidados emocionais dentro da casa-abrigo eram delegadas às profissionais da equipe técnica da instituição. Observou-se que as dificuldades encontradas pelas cuidadoras diziam respeito à falta de segurança e preparação para responder e acolher as demandas emocionais das crianças, as quais estão presentes em diversos momentos do processo de acolhimento. Percebeu-se que as práticas institucionais afetaram decisivamente tanto as ações de acolhimento das participantes e o suporte emocional oferecido às crianças na passagem pela casa-abrigo quanto as cuidadoras, no sentido de vivenciarem no trabalho sentimentos de insegurança. Os resultados tensionam ecologicamente a interação nos processos proximais presentes no desenvolvimento humano. Advoga-se pela reflexão sobre as implicações das práticas institucionais de uma casa-abrigo e o desenvolvimento infantil, visando o cuidado integral dos acolhidos.(AU)

Based on the developmental bioecological theory, this study analyzes the implications of professional practice in children's user embracement at a shelter from the caregivers' perspective. Semi-structured interviews were conducted with 10 professionals from a shelter located in southern Brazil. Data organization and analysis was performed based on Grounded Theory using the Atlas.ti 8.4.14 software. Results showed that embracement and attention focus on the physical care of children. Support and emotional care activities were delegated to the institution's technical team. Caregivers faced difficulties regarding the lack of security and preparation to respond to and accept the children's emotional demands, which arise at different moments in the embracement process. The institutional practices decisively affected both user embracement actions and the emotional support offered to the children, as well as the caregivers, in the sense of experiencing feelings of insecurity. These findings ecologically tension the interaction in the proximal processes present in human development. Further reflections on the implications of institutional shelter-based practices for child development are needed to provide comprehensive care.(AU)

Este estudio cualitativo tuvo como objetivo comprender, desde la perspectiva de la teoría bioecológica del desarrollo, las implicaciones de la práctica profesional en el proceso de acogida de niños en una institución infantil desde la perspectiva de las cuidadoras. Las participantes fueron 10 profesionales de una institución de acogida infantil ubicada en la región Sur de Brasil. Se utilizó la entrevista semiestructurada, y para la organización y análisis de datos se aplicó Grounded Theory, con el uso del software Atlas.ti 8.4.14. Los resultados mostraron que las acciones de recepción y atención se centran en el cuidado físico de los niños. Las acciones de promoción de apoyo y cuidado emocional dentro del alojamiento se asignaron a los profesionales del equipo técnico de la institución. Se observó que las dificultades encontradas por las cuidadoras estaban relacionadas con la falta de seguridad y preparación para responder y aceptar las demandas emocionales de los niños, las cuales se encuentran presentes en diferentes momentos del proceso de acogida. Se notó que las prácticas institucionales afectaron decisivamente tanto las acciones de acogida de las participantes como el apoyo emocional que la institución brinda a los niños durante su paso, así como a las cuidadoras en el sentido de experimentar sentimientos de inseguridad en el trabajo. Estos resultados tensan ecológicamente la interacción en los procesos proximales presentes en el desarrollo humano. Se aboga por reflexionar sobre las implicaciones de las prácticas institucionales en los alojamientos institucionales y el desarrollo infantil, apuntando a la atención integral de los acogidos.(AU)

Atendimento psicossocial à mulher que comete ofensa sexual / Psychosocial attention for women that commit sexual offenses / Atención psicosocial para mujeres que cometen delitos sexuales

Objetivamos apresentar uma proposta de atendimento psicossocial grupal oferecida para mulheres adultas que cometeram ofensa sexual, cuidadoras e mães. A experiência está sendo desenvolvida no Distrito Federal, Brasil, com pessoas do gênero feminino provenientes de encaminhamento judicial. Carece que os profissionais das áreas da justiça, saúde, serviço social e psicologia avancem no estudo e na compreensão desta temática, de modo a pensarem a atuação e o apoio terapêutico a essas mulheres. O modo de atendimento é focal e breve, com ênfase na criação de um ambiente lúdico como facilitador das interações grupais e da discussão sobre os temas: identidade; confiança nas relações afetivas e sociais; vivência pessoal com violência física e sexual; configuração de gênero; e expressão da sexualidade e futuro. A abordagem individual também se baseia no enfoque dos temas mencionados. O oferecimento de ajuda à mulher cuidadora ou à mãe tem participação ativa na interrupção do circuito abusivo sexual, pois essa violência é extremamente ocultada, ocasionando uma prolongada vulnerabilidade para as vítimas. Ressalta-se o valor do texto indicando a descrição de ação voltada para uma população permanentemente não estudada e evitada em seu reconhecimento. Os limites desta proposta encontram-se na falta de outras iniciativas que possibilitem uma discussão sobre essa experiência.(AU)

We aim to present a proposal of a group psychosocial intervention offered for adult female sexual offenders, caregivers, and mothers. The intervention is being developed at Federal District, Brazil, with female people coming from judicial referrals. Professionals in the areas of justice, health, social work, and psychology need to advance in the study and understanding this theme to think about action and therapeutic support for these women. The intervention is a focal and brief approach, with emphasis on the creation of a ludic environment as a facilitator of group interactions and discussion about the themes: identity; trust in affective and social relationships; personal experience with physical and sexual violence; gender configuration; and sexuality expression and future. The individual approach is also based on focusing on these themes. The offering of help to the female caregiver or the mother has an active participation in the interruption of the sexual offense circuit, since this violence is extremely hidden, bringing a prolonged condition of vulnerability to the victims. The value of this text is highlighted indicating the description of an action directed to a population that is permanently not studied and whose recognition is avoided. The limits of this proposal are found in the absence of other initiatives that would allow a discussion about this experience.(AU)

Este texto presenta una propuesta de atención psicosocial grupal destinada a mujeres adultas que han cometido delito sexual, a cuidadoras y madres. La intervención se está desarrollando en el Distrito Federal (Brasil), con personas del género femenino provenientes de remisiones judiciales. Es necesario que los profesionales de las áreas de justicia, salud, trabajo social y psicología avancen en el estudio y comprensión de esta temática para pensar en el desempeño y apoyo terapéutico de estas mujeres. El servicio es enfocado y breve, con énfasis en la creación de un ambiente lúdico como facilitador de interacciones grupales y discusión sobre los temas: identidad; confianza en las relaciones afectivas y sociales; experiencia personal con violencia física y sexual; configuración de género; y expresión de la sexualidad y el futuro. El enfoque individual también se centra en estos temas. La oferta de ayuda a la mujer cuidadora o a la madre es importante para la interrupción del circuito de abuso sexual, ya que esta violencia es extremadamente oculta y provoca una vulnerabilidad prolongada a las víctimas. Se destaca el valor del texto con la descripción de la acción dirigida a una población que no es objeto de estudios ni reconocida. Los límites de esta propuesta se encuentran en la ausencia de otras iniciativas que permitan un debate sobre esta experiencia.(AU)

Síndrome de Niño Agredido: aspectos médico legales y la importancia de los estudios radiológicos Reporte de caso / Battered Child Syndrome: medico-legal aspects and the importance of radiological studies Case report

Resumen El síndrome de niño(a) agredido(a) comprende múltiples aspectos desde la definición propia del abuso infantil, en donde se incluye tanto cualquier acto como la omisión que arremeta contra la salud o el desarrollo del menor. Siendo necesario la valoración integral de cada uno de los casos sospechosos abarcando tanto aspectos relacionados con posibles maltratos físicos como los correlacionables por omisión de cuido de menor. Se presenta el caso de una evaluada con denuncia por Abuso de Patria Potestad para ser valorada por sospecha de maltrato infantil.

Abstract The battered child syndrome encompasses multiple aspects from the very definition of child abuse, which covers any act or omission that affects the health or development of the minor. The comprehensive assessment of each of the suspected cases is necessary, covering both aspects related to possible physical abuse and those correlatable by omission of childcare. The case of female with a complaint for Abuse of Parental Authority to be assessed for suspicion of child abuse is presented.

Characteristics and Hospital Costs of Spica Cast Treatment of Non-accidental-related Diaphyseal Femoral Fractures in Children Before Walking Age.

BACKGROUND: Fractures are one of the most common presentations of child abuse second only to soft tissue damage, with ∼60% of fractures being femur, humerus or tibia fractures. Although studies have shown increased health care costs associated with nonaccidental trauma (NAT), there is little data regarding the cost of NAT-associated fractures compared with accidental trauma (AT) related fractures. The purpose of this study was to consider the economic burden of NAT related femoral fractures compared with AT femoral fractures. METHODS: We performed a retrospective study of children under the age of one with femoral fractures treated with a spica cast at a Level 1 Pediatric Trauma Center between 2007 and 2016. Variables included age, sex, length of hospital stay, and estimated total billing cost obtained from this hospital's billing department. In addition, fracture site (mid-shaft, distal, proximal, and subtrochanteric) and pattern were assessed. RESULTS: Sixty children with a mean age of 7 months were analyzed. NAT was suspected in 19 cases (31.7%) and confirmed in 9 (15%) before discharge. Two groups were analyzed: the NAT group included suspected and confirmed cases of abuse (28) and the AT group contained the remaining 32 cases. There was no significant difference in the demographics between these 2 groups. Children in NAT group had a longer length of stay compared with AT group (78.9 vs. 36.7 h, P<0.001). Overall consumer price index-adjusted hospital costs were $24,726 higher for NAT group compared with AT group (P=0.024), with costs of laboratory workup, radiology, and nonorthopaedic physician fees being the top 3 components contributing to the increased costs. CONCLUSIONS: The overall incidence of NAT was 46.6% in children presenting with femoral fracture under 1 year of age. The overall hospital cost of treating fractures in the NAT group was 1.5 times higher than the AT group, with imaging charges the most significant contributor to cost difference. LEVEL OF EVIDENCE: Level III-retrospective review.

A four-year-old Nigerian boy with battered child syndrome: implications for public health.

Battered child syndrome (BCS) is a form of physical abuse that is characterised by multiple injuries and potentially fatal outcome. Despite the high prevalence of physical abuse in developing countries, BCS is rarely reported. Hence, this report highlighted a four-year-old Nigerian boy who suffered multiple injuries (scalp haematoma, bruises, right clavicular fracture, and burns) from the paternal uncle's wife. This case report is discussed along the line of public health approach for curbing the social menace.

Retinal and visual function in infants with non-accidental trauma and retinal hemorrhages.

PURPOSE: To investigate retinal function and visual outcomes in infants with retinal hemorrhages due to non-accidental trauma (NAT). METHODS: This is a retrospective review of full-field or multifocal electroretinogram (ERG) recordings, visual acuity in log minimum angle of resolution (logMAR), clinical status, and neuroimaging. Multifocal ERGs from the central 40° were compared to corresponding fundus imaging. Visual acuity was measured by Teller cards at follow-up. ERGs were compared to controls recorded under anesthesia. RESULTS: Sixteen children met inclusion criteria (14 recorded during the acute phase and 2 during long-term follow-up). During the acute phase, ERGs (n = 4 full field; n = 10 multifocal ERG) showed abnormal amplitude, latency, or both in at least one eye. Ten subjects had significantly reduced responses in both eyes, 3 of which had an ERG dominated by a negative waveform (absent b-wave or P1). The remaining six subjects had responses in one eye that were near normal (≥ 50% of controls). ERGs were sometimes abnormal in local areas without hemorrhage. ERGs could be preserved in local areas adjacent to traumatic retinoschisis. Two subjects with reduced visual acuity had belated ERGs: One had an abnormal macular ERG and the other had a normal macular ERG implying cortical visual impairment. At follow-up, 10 of 14 subjects had significant visual acuity loss (≥ 0.7 age-corrected logMAR); four subjects had mild vision loss (≤ 0.5 age-corrected logMAR). Visual acuity outcome was not reliably associated with the fundus appearance in the acute phase. All subjects with a negative ERG waveform had severe vision loss on follow-up. CONCLUSIONS: Retinal dysfunction was common during the acute phase of NAT. A near normal appearing fundus did not imply normal retinal function, and ERG abnormality did not always predict a poor visual acuity outcome. However, a negative ERG waveform was associated severe visual acuity loss. Potential artifacts of retinal hemorrhages and anesthesia could not fully account for multifocal ERG abnormalities. Retinal function can be preserved in areas adjacent to traumatic retinoschisis.

The Implementation of a Pediatric Nonaccidental Trauma Evaluation Protocol: A Quality Improvement Analysis.

BACKGROUND: Pediatric nonaccidental trauma (NAT) accounts for more than 1500 deaths annually and is a source of incalculable lifelong morbidity. Evidence-based NAT evaluation protocols are available; however, compliance studies are lacking. Here, we analyze the quality of implementation of a new NAT evaluation protocol. METHODS: A review of registry data from a level 3 trauma center was performed for patients with a suspicion of NAT from September 2014 to May 2016. Compliance rates and results of 2 new age-based evaluation protocols were examined before (phase 1) and after (phase 2) a multidisciplinary conference was initiated to improve performance. RESULTS: Seventy-five children underwent evaluation for NAT during the study period. In phase 1, median compliance rates with all of the protocol elements were low (63%). After a bimonthly multidisciplinary conference was initiated, compliance rates improved to 75%. Some elements, which were often missed, were found to be clinically irrelevant. If only clinically relevant elements were included, median compliance in phase 2 is 86%. CONCLUSIONS: Compliance with a new protocol for NAT was improved with the institution of a multidisciplinary conference. Protocol elements, which are shown to be clinically unnecessary, have also been identified and will be eliminated.

Histological ageing of fractures in infants: a practical algorithm for assessing infants suspected of accidental or non-accidental injury.

AIMS: This study is the first to systematically document histological features of fractures of known age in infants (≦12 months). It has been used to develop a tabulated database specifically to guide histopathologists to age fractures in children considered to have suffered accidental or non-accidental injury (NAI). Currently in the United Kingdom there are insufficient pathologists with experience in histological ageing of fractures to meet the medicolegal need for this examination. This study provides a practical tool that will allow those skilled paediatric and forensic pathologists currently involved in assessing infants for evidence of accidental or non-accidental injury a basis for extending their assessment into this area of unmet need. METHODS AND RESULTS: One hundred and sixty-nine fractures of known age at death were obtained from 52 anonymised infants over a period of 32 years (1985-2016 inclusive). Sections stained using haematoxylin and eosin (H&E) and Martius scarlet blue (MSB) were used to identify specific histological features and to relate them to fracture age. In 1999 the data were entered into a tabulated database for fractures accumulated between from 1985 to 1998 inclusive. Thereafter cases were added, and at 2-yearly intervals the accumulated data were audited against the previous database and adjustments made. CONCLUSIONS: This paper describes the final data set from the 2017 audit. The study was terminated at the end of 2016, as there had been no material changes in the data set for three consecutive audits.

Whole-Body MRI in Children and Adolescents - S1 Guideline. / Ganzkörper-Magnetresonanztomografie im Kindes- und Jugendalter ­ S1-Leitlinie.

Whole-body MRI is an imaging method that uses advanced modern MRI equipment to provide high-resolution images of the entire body. The goal of these guidelines is to specify the indications for which whole-body MRI can be recommended in children and adolescents and to describe the necessary technical requirements. CITATION FORMAT: · Schaefer JF, Berthold LD, Hahn G et al. Whole-Body MRI in Children and Adolescents - S1 Guidelines. Fortschr Röntgenstr 2019; 191: 618 - 625.

Behavioural beliefs of Ghanaian radiographers and reporting of child physical abuse.

INTRODUCTION: Radiographers are well placed to flag non accidental injury in children due to their unique position within the imaging chain. Being able to identify (or suspect) physical abuse in children and reporting the incident are, however, two different issues. This study was conducted to explore the external influences in the decision making of the Ghanaian radiographer to report suspected child physical abuse (CPA). METHOD: This was a qualitative study which applied interpretive phenomenology. Semi-structured interviews were conducted with 20 radiographers who were selected from various hospitals throughout the ten regions of Ghana using purposive sampling. Data was thematically analysed and managed with NVivo Version 10. Themes developed formed the basis of this discussion. RESULTS: Several socio-cultural beliefs and behaviours impacted on the Ghanaian radiographers' decisions to report suspected child physical abuse. The findings of this study indicated that cultural solidarity, superstition and police frustrations were among other factors that characterised the Ghanaian radiographer's inability to report child physical abuse when it occurred. CONCLUSION: Radiographers reported fear of both physical and spiritual attack when child physical abuse was reported. This paper argues that, to achieve the fight against child physical abuse in some African countries such as Ghana, radiographers would have to be educated and counselled against belief in superstition and adherence to some cultural values which affect child protection.

Risk factors for avoidable transfer to a pediatric trauma center among patients 2 years and older.

BACKGROUND: Effective and sustainable pediatric trauma care requires systems of regionalization and interfacility transfer. Avoidable transfer, also known as secondary overtriage, occurs when a patient is transferred to a regional trauma center after initial evaluation at another facility that is capable of providing definitive care. The purpose of this study was to identify risk factors for avoidable transfer among pediatric trauma patients in southwest Florida. METHODS: All pediatric trauma patients 2 years and older transferred from outlying hospitals to the emergency department of a single state-designated pediatric trauma center between 2009 and 2017 were obtained from the institutional registry. Transfers were classified as avoidable if the patient suffered only minor injuries (International Classification of Diseases-9th Rev. Injury Severity Score > 0.9), did not require invasive procedures or intensive care unit monitoring, and was discharged within 48 hours. Demographics and injury characteristics were compared for avoidable and nonavoidable transfers. Logistic regression was used to estimate the independent effects of age, sex, insurance type, mechanism of injury, diagnosis, within region versus out-of-region residence, suspected nonaccidental trauma, and abnormal Glasgow Coma Scale score on the risk of avoidable transfer. RESULTS: A total of 3,876 transfer patients met inclusion criteria, of whom 1,628 (42%) were classified as avoidable. Among avoidable transfers, 29% had minor head injuries (isolated skull fractures, concussions, and mild traumatic brain injury not otherwise specified), and 58% received neurosurgery consultation. On multivariable analysis, the strongest risk factors for avoidable transfer were diagnoses of isolated skull fracture or concussion. Suspected nonaccidental trauma was predictive of nonavoidable transfer. CONCLUSION: Among injured children 2 years and older, those with minor head injuries were at greatest risk for avoidable transfer. Many were transferred because of a perceived need for evaluation by a pediatric neurosurgeon. Future projects seeking to reduce avoidable transfers should focus on children with isolated skull fractures and concussions, in whom there is no suspicion of nonaccidental trauma. LEVEL OF EVIDENCE: Therapeutic/care management, level IV.

Exploración de conocimientos sobre maltrato infantil en odontólogos de Santa Marta, Colombia / Exploration of knowledge on child abuse among Santa Marta's dentists, Colombia

Objetivo: comprender los conocimientos, posturas y actitudes (representaciones sociales) sobre maltrato infantil que poseen odontólogos trabajadores de instituciones prestadoras de servicios de salud (IPS) de Santa Marta. Métodos: el presente estudio hace uso de un paradigma cualitativo, y su enfoque es etnometodológico. La técnica de recolección de la información es la entrevista semiestructurada, aplicada sobre una muestra de diez (10) odontólogos de IPS de Santa Marta, y determinada según el criterio de saturación de la muestra. Resultados: como resultado surgen dos categorías relacionadas con conocimientos y actitudes, que permitieron establecer que los odontólogos tienen conocimientos referentes a la definición del maltrato infantil y a sus signos físicos y conductuales, identifican a los perpetradores, e incluso reconocen la importancia de tomar medidas preventivas y de protección, aunque discrepan frente a los protocolos que utilizan o no para dicha intervención. Adicionalmente, los odontólogos manifiestan actitudes de rechazo, deseos de justicia y evitación de malas prácticas, y comparten las acciones de responsabilidad y compromiso profesional. Conclusiones: fue posible establecer que el colectivo de odontólogos posee diversas percepciones e interpretaciones dentro de su representación social del maltrato infantil; por ello, su conocimiento podría resultar útil para identificar debilidades en su forma de intervenir y, de este modo, orientar su intervención a prácticas más oportunas.

Objective: To understand the knowledge, attitudes and attitudes (social representations) about child abuse that dentists, workers, institutions providing health services (IPS's) of Santa Marta. Methods: The paradigm of the study is qualitative, and the approach is ethnomethodological. The technique used to collect information was the semi-structured interview, which was used in a sample of ten (10) IPS dentists of Santa Marta, determined according to the saturation criterion of the sample. Results: The dentists studied have knowledge regarding the definition of child abuse and its physical and behavioral signs, identify the perpetrators, even recognize the importance of taking preventive and protective measures, although they disagree with the protocols that use or not for such intervention; and manifest attitudes of rejection, desires for justice and avoidance of bad practices, sharing in addition the actions of responsibility and professional compromise. Conclusions: It is concluded that the group of dentists has various organizing principles within their social representation of child abuse, and through their knowledge it could be identified flaws in their way of intervening, and thus oriented to more timely practices.

Insurance status and pediatric mortality in nonaccidental trauma.

BACKGROUND: Nonaccidental trauma (NAT) is a leading cause of injury and death in early childhood. We sought to understand the association between insurance status and mortality in a national sample of pediatric NAT patients. MATERIALS AND METHODS: We performed a retrospective cohort study using the 2012-2014 National Trauma Databank. We included children ≤18 y hospitalized with NAT (The International Classification of Diseases, Ninth Revision codes: E967-968). The primary exposure was insurance status (categorized as public, private, and uninsured). The primary outcome was emergency department or inpatient mortality from NAT. RESULTS: We identified 6389 children with NAT. Mean age was 1.6 y (standard deviation 3.7), with 41% female and 42% of an ethnic or racial minority. Most were publicly insured (77%), with 17% privately insured and 6% uninsured. Mean injury severity score (ISS) was 13.9 (standard deviation 10.3). Overall, 516 (8%) patients died following NAT. Compared to patients who survived, those who died were more likely to be younger (mean age 1.0 y versus 1.6 y; P < 0.001), uninsured (13% versus 6%; P < 0.001), transferred to a higher-care facility (57% versus 49%; P < 0.001), and more severely injured (mean ISS 25.9 versus 12.8; P < 0.001). After adjusting for age, race, transfer status, and ISS, uninsured patients had 3.3-fold (95% CI = 2.4-4.6) greater odds of death compared to those with public insurance. For every 1 point increase in ISS, children had 12% (95% CI = 11%-13%) increased adjusted odds of death. CONCLUSIONS: Pediatric patients without insurance had significantly greater odds of death following NAT, compared to children with public insurance. Knowledge that uninsured children comprise an especially vulnerable population is important for targeting potential interventions.

En busca de la dimension clínica del apego a través de las narrativas infantiles / In search of the clinical dimension of attachment through children's narratives

La dimensión clínica de la Teoría del Apego permanece insuficientemente desarrollada, pero pueden encontrarse interesantes propuestas actuales en este ámbito. Abordamos los principios básicos que deben sostener un acercamiento clínico a la Teoría del Apego: situar el apego en el conjunto de sistemas motivacionales, atender a los distintos niveles de seguridad que comprende (físico, emocional, cognitivo) y considerar los procesos de autoregulación dañados por fallos en las relaciones de apego. Abordamos el papel de las narrativas en el desarrollo infantil, y su uso para evaluar las construcciones internas del apego; finalmente exponemos con detalle el uso de la Attachment Story Completion Test (ASCT) como instrumento útil para su evaluación

Clinical dimension of Attachment Theory is still illdeveloped, but interesting current proposals can be found. Basic principles necessary to bear a clinical approach to Attachment Theory are explained: placing attachment among other motivational systems, paying attention to the different safety levels included in attachment (physical, emotional, cognitive) and taking into account self-regulation processes which could be hampered by failures in attachment. The role of narratives in child development, and its utility to assess attachment internal models are considered; finally, a detailed account of the use of Attachment Story Completion Test (ASCT), as an useful assessment tool, is presented

Síndrome del niño maltratado con repercusión psicosocial / Abused child syndrome with psychological and social implication

El maltrato infantil es un problema universal y multicausal que involucra una gran variedad de factores biopsicosociales. Es toda agresión producida a los menores por sus padres, familiares u otras personas para castigarles o hacerles daño, incluida también la desatención de sus necesidades básicas de alimentación, hogar, vestido, salud, protección y cariño, por lo cual en este artículo se comenta en torno al tema y se expone la experiencia traumática vivida por 2 menores

Child abuse is an universal problem which has many causes that involve a great variety of biological psychological and social factors. It is all type of aggression of parents, family or other people to a child to punish or to damage him. It also includes the lack of care for his basic needs of feeding, housing, dressing, health, protection and affection, reason why in this work it is commented about the topic, and the traumatic experience lived by 2 children is exposed

Maltrato infantil. Presentación de un caso / Child abuse. Presentation of a case

RESUMEN El maltrato infantil constituye un problema de profundas repercusiones psicológicas, sociales, éticas, jurídicas y médicas. La definición de maltrato implica una valoración social en relación a lo que es peligroso o inadecuado para el niño. En eso reside la gran dificultad para definirlo. En este artículo se expone un caso poco común de maltrato infantil, que culminó con la muerte de la víctima de 22 meses de edad, que según los datos aportados por la instrucción policial, en horas de la noche, del día 4 de octubre del 2015, al llegar al cuerpo de guardia, la doctora de asistencia constata que la misma se encontraba fallecida y al examen físico presentó múltiples lesiones recientes y antiguas en el cuerpo. Se recoge el antecedente de maltrato familiar en varias ocasiones, siendo el último ocasionado alrededor de 2 días (AU).

ABSTRACT Child abuse is a problem of deep psychological, social, ethical, juridical and medical repercussions. The definition of abuse implies a social judgment in relation of what is dangerous or inadequate for a child. This is the cause of the enormous difficulty of defining it. An uncommon case of child abuse is described in this article. It ended up with the death of the 22-years-months child who, according with the data given by the police instruction, was death when arrived to the Emergency Unit on October 4th 2015 at night. At the arrival, the caregiver doctor stated that the child was death, and at the physical examination she presented multiple recent and old lesions in the body. It was recorded the antecedent of family abuse in several occasions, being the last one around two days ago (AU).