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Proc Natl Acad Sci U S A ; 117(38): 23484-23489, 2020 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-32900924


While over 240,000 American students experienced a school shooting in the last two decades, little is known about the impacts of these events on the mental health of surviving youth. Using large-scale prescription data from 2006 to 2015, we examine the effects of 44 school shootings on youth antidepressant use. Our empirical strategy compares the number of antidepressant prescriptions written by providers practicing 0 to 5 miles from a school that experienced a shooting (treatment areas) to the number of prescriptions written by providers practicing 10 to 15 miles away (reference areas), both before and after the shooting. We include month-by-year and school-by-area fixed effects in all specifications, thereby controlling for overall trends in antidepressant use and all time-invariant differences across locations. We find that local exposure to fatal school shootings increases youth antidepressant use by 21.4% in the following 2 y. These effects are smaller in areas with a higher density of mental health providers who focus on behavioral, rather than pharmacological, interventions.

Antidepressivos/administração & dosagem , Depressão/tratamento farmacológico , Exposição à Violência/psicologia , Saúde Mental/estatística & dados numéricos , Estudantes/psicologia , Adolescente , Saúde do Adolescente/estatística & dados numéricos , Adulto , Depressão/psicologia , Exposição à Violência/estatística & dados numéricos , Feminino , Humanos , Masculino , Instituições Acadêmicas/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Estados Unidos , Adulto Jovem
Cochrane Database Syst Rev ; 9: CD011860, 2020 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-32898304


BACKGROUND: Workplace aggression constitutes a serious issue for healthcare workers and organizations. Aggression is tied to physical and mental health issues at an individual level, as well as to absenteeism, decreased productivity or quality of work, and high employee turnover rates at an organizational level. To counteract these negative impacts, organizations have used a variety of interventions, including education and training, to provide workers with the knowledge and skills needed to prevent aggression.  OBJECTIVES: To assess the effectiveness of education and training interventions that aim to prevent and minimize workplace aggression directed toward healthcare workers by patients and patient advocates. SEARCH METHODS: CENTRAL, MEDLINE, Embase, six other databases and five trial registers were searched from their inception to June 2020 together with reference checking, citation searching and contact with study authors to identify additional studies. SELECTION CRITERIA: Randomized controlled trials (RCTs), cluster-randomized controlled trials (CRCTs), and controlled before and after studies (CBAs) that investigated the effectiveness of education and training interventions targeting aggression prevention for healthcare workers. DATA COLLECTION AND ANALYSIS: Four review authors evaluated and selected the studies resulting from the search. We used standard methodological procedures expected by Cochrane. We assessed the certainty of evidence using the GRADE approach. MAIN RESULTS: We included nine studies-four CRCTs, three RCTs, and two CBAs-with a total of 1688 participants. Five studies reported episodes of aggression, and six studies reported secondary outcomes. Seven studies were conducted among nurses or nurse aides, and two studies among healthcare workers in general. Three studies took place in long-term care, two in the psychiatric ward, and four in hospitals or health centers. Studies were reported from the United States, Switzerland, the United Kingdom, Taiwan, and Sweden. All included studies reported on education combined with training interventions. Four studies evaluated online programs, and five evaluated face-to-face programs. Five studies were of long duration (up to 52 weeks), and four studies were of short duration. Eight studies had short-term follow-up (< 3 months), and one study long-term follow-up (> 1 year). Seven studies were rated as being at "high" risk of bias in multiple domains, and all had "unclear" risk of bias in a single domain or in multiple domains. Effects on aggression Short-term follow-up The evidence is very uncertain about effects of education and training on aggression at short-term follow-up compared to no intervention (standardized mean difference [SMD] -0.33, 95% confidence interval [CI] -1.27 to 0.61, 2 CRCTs; risk ratio [RR] 2.30, 95% CI 0.97 to 5.42, 1 CBA; SMD -1.24, 95% CI -2.16 to -0.33, 1 CBA; very low-certainty evidence). Long-term follow-up Education may not reduce aggression compared to no intervention in the long term (RR 1.14, 95% CI 0.95 to 1.37, 1 CRCT; low-certainty evidence). Effects on knowledge, attitudes, skills, and adverse outcomes Education may increase personal knowledge about workplace aggression at short-term follow-up (SMD 0.86, 95% CI 0.34 to 1.38, 1 RCT; low-certainty evidence). The evidence is very uncertain about effects of education on personal knowledge in the long term (RR 1.26, 95% CI 0.90 to 1.75, 1 RCT; very low-certainty evidence). Education may improve attitudes among healthcare workers at short-term follow-up, but the evidence is very uncertain (SMD 0.59, 95% CI 0.24 to 0.94, 2 CRCTs and 3 RCTs; very low-certainty evidence). The type and duration of interventions resulted in different sizes of effects. Education may not have an effect on skills related to workplace aggression (SMD 0.21, 95% CI -0.07 to 0.49, 1 RCT and 1 CRCT; very low-certainty evidence) nor on adverse personal outcomes, but the evidence is very uncertain (SMD -0.31, 95% CI -1.02 to 0.40, 1 RCT; very low-certainty evidence). Measurements of these concepts showed high heterogeneity. AUTHORS' CONCLUSIONS: Education combined with training may not have an effect on workplace aggression directed toward healthcare workers, even though education and training may increase personal knowledge and positive attitudes. Better quality studies that focus on specific settings of healthcare work where exposure to patient aggression is high are needed. Moreover, as most studies have assessed episodes of aggression toward nurses, future studies should include other types of healthcare workers who are also victims of aggression in the same settings, such as orderlies (healthcare assistants). Studies should especially use reports of aggression at an institutional level and should rely on multi-source data while relying on validated measures. Studies should also include days lost to sick leave and employee turnover and should measure outcomes at one-year follow-up. Studies should specify the duration and type of delivery of education and should use an active comparison to prevent raising awareness and reporting in the intervention group only.

Agressão , Pessoal de Saúde/educação , Violência no Trabalho/prevenção & controle , Viés , Estudos Controlados Antes e Depois , Exposição à Violência/prevenção & controle , Humanos , Assistentes de Enfermagem/educação , Recursos Humanos de Enfermagem/educação , Ensaios Clínicos Controlados Aleatórios como Assunto
Interv. psicosoc. (Internet) ; 29(3): 153-164, sept. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-194492


The inconsistency in the results both internally and between of previous meta-analyses on batterer intervention program efficacy, and the publication of new batterer interventions underscored the need for an up-to-date meta-analyticalreview. A total of 25 primary studies were found from literature search, obtaining 62 effect sizes, and a total sample of 20,860 intervened batterers. The results of a global meta-analysis showed a positive, significant, and of a mediummagnitude effect size for batterer interventions, but not generalizable. Nevertheless, the results exhibited a significantly higher rate of recidivism measured in couple reports (CRs) than in official records (ORs). As a consequence, intervention efficacy measuring in CRs was null, whilst in ORs was positive and significant. As for the intervention model, positive andsignificant effects were observed under the Duluth Model and cognitive-behavioural treatment programs (CBTPs), but a higher effect size was obtained with CBTPs in comparison to the Duluth Model (under this model, interventions may have negative effects, i.e., an increase in recidivism rate). In relation to intervention length, short interventions failed to reduce recidivism in ORs and may have negative effects, while long interventions were effective in reducing recidivism rate in ORs without negative effects. Efficacy evaluations in short follow-ups were invalid as artificially boosted recidivismreduction rate. Limitations of ORs and short follow-ups as measures of the intervention efficacy and implications of results for batterer intervention are discussed

La inconsistencia interna y entre las revisiones metaanalíticas en los resultados sobre la eficacia de los programas de intervención con maltratadores, así como la publicación de nuevos estudios, pone de manifiesto la necesidad de llevar a cabo una revisión metaanalítica actualizada. Se encontró un total de 25 estudios primarios, de los que se obtuvieron 62 tamaños del efecto para una muestra total de 20,860 maltratadores intervenidos. Los resultados del metaanálisis global mostraron un tamaño del efecto promedio positivo, significativo y de una magnitud moderada para la intervención con maltratadores, pero no generalizable. Sin embargo, los resultados revelaron una tasa de reincidencia mayor medida en los informes de las parejas (IPs) que en los registros oficiales (ROs). Como consecuencia, la eficacia de la intervención medida en los IPs resultó nula, mientras que en los ROs fue positiva y significativa. En relación al modelo de intervención, se encontraron tamaños del efecto positivos y significativos con el Modelo Duluth y los programas de tratamiento cognitivo-conductuales (PTC-Cs), pero el tamaño del efecto obtenido con los PTC-Cs era significativamente mayor que con el Modelo Duluth (con este modelo las intervenciones pueden tener efectos negativos, es decir, unincremento en la tasa de reincidencia). En relación a la longitud de la intervención, las intervenciones breves fallaron en la reducción de la reincidencia en los ROs y pueden tener efectos negativos, en tanto que las intervenciones largas fueron eficaces en la reducción de la tasa de reincidencia en los ROs y no dan lugar a efectos negativos. Las evaluacionesde la eficacia de la intervención en períodos cortos de seguimiento resultaron no válidas al incrementar artificialmente la tasa de reducción de la reincidencia. Se discuten las limitaciones de la medida de la eficacia de la intervención en los ROs y en períodos cortos de seguimiento, así como las implicaciones para la intervención con maltratadores

Humanos , Metanálise como Assunto , Exposição à Violência/psicologia , Violência/psicologia , Teoria Psicológica , Modelos Psicológicos , Terapia Cognitivo-Comportamental/métodos , Maus-Tratos Conjugais/psicologia
J Affect Disord ; 277: 129-137, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-32818776


OBJECTIVE: The novel coronavirus (COVID-19) is a substantial stressor that could eventuate in psychological distress. Evidence suggests that individuals previously exposed to traumatic events, and particularly to continuous traumatic stress (CTS), might be more vulnerable to distress when facing additional stressors. This study aimed to investigate these suppositions in the context of the ongoing shelling of Israel from the Israel-Gaza border, which continues even amidst the COVID-19 crisis. METHOD: An online survey was conducted among Israel's general population. The sample included 976 participants. Seven-hundred-and-ninety-three participants had been exposed to traumatic events, with 255 participants reporting CTS. Trauma exposure, COVID-19-related stressors, and psychological distress related to COVID-19 (anxiety, depression, and peritraumatic stress symptoms) were assessed. RESULTS: Most participants reported experiencing at least one psychiatric symptom related to COVID-19. Being younger, female, not in a relationship, having a below-average income, being diagnosed with the disease, living alone during the outbreak, having a close other in a high-risk group, and negatively self-rating one's health status were associated with elevated distress. Individuals who had been exposed to trauma, and to CTS in particular, had elevated anxiety, depression, and peritraumatic stress symptoms compared to individuals without such a history or to survivors of non-ongoing traumatic events. CTS moderated the relations between PTSD symptoms, anxiety symptoms, and peritraumatic stress symptoms, with significantly stronger relations found among individuals exposed to CTS. LIMITATIONS: This study relied on convenience sampling. CONCLUSIONS: Trauma survivors, and particularly traumatized individuals exposed to CTS, seem at risk for psychological distress related to COVID-19.

Ansiedade/epidemiologia , Infecções por Coronavirus , Depressão/epidemiologia , Exposição à Violência/estatística & dados numéricos , Pandemias , Pneumonia Viral , Angústia Psicológica , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Ansiedade/psicologia , Betacoronavirus , Depressão/psicologia , Exposição à Violência/psicologia , Feminino , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Transtornos de Estresse Pós-Traumáticos/psicologia , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia , Inquéritos e Questionários , Adulto Jovem
J Youth Adolesc ; 49(11): 2358-2371, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32840720


Self-serving cognitive distortions are biased or rationalizing beliefs and thoughts that originate from the individual persistence into immature moral judgment stages during adolescence and adulthood, increasing the individual's engagement in antisocial or immoral conducts. To date, the literature examining trajectories of cognitive distortions over time and their precursors is limited. This study sought to fill this gap, by examining effortful control and community violence exposure as individual and environmental precursors to developmental trajectories of cognitive distortions in adolescence. The sample consisted of 803 Italian high school students (349 males; Mage = 14.19, SD = 0.57). Three trajectories of cognitive distortions were identified: (1) moderately high and stable cognitive distortions (N = 311), (2) moderate and decreasing cognitive distortions (N = 363), and (3) low and decreasing cognitive distortions (N = 129). Both low effortful control and high exposure to community violence were significant predictors for moderately high and stable trajectory of cognitive distortions. These results point to the importance of considering moral development as a process involving multiple levels of individual ecology, highlighting the need to further explore how dispositional and environmental factors might undermine developmental processes of morality.

Comportamento do Adolescente , Exposição à Violência , Adolescente , Adulto , Cognição , Humanos , Itália , Masculino , Violência
Rev Bras Epidemiol ; 23: e200039, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32491044


INTRODUCTION: The isolated negative impacts of community violence and family violence on individuals' self-rated health (SRH) are known, but there is little evidence on the combined effect of these two types of interpersonal violence. OBJECTIVE: To analyze the association between exposure to community violence/by strangers and family violence/by acquaintances and negative SRH, distinguishing the type of violence suffered and also considering its cumulative exposure. METHODS: Epidemiological cross-sectional study developed with data from the National Health Survey (PNS) 2013. Crude multinominal logistic regression models were performed and adjusted to test the association of variables. RESULTS: All types of violence analyzed were associated with negative SRH. Isolated community/unknown interpersonal violence was associated with SRH as regular (odds ratio - OR = 1.38) and bad (OR = 1.79). Exposure to family violence/by acquaintances was associated with regular (OR = 1.52) and bad (OR = 2.70) self-assessment. Concomitant exposure to the two types of violence was associated with regular (OR = 4.00) and bad (OR = 7.81) health assessments, with this association being of greater magnitude than those for isolated violence. CONCLUSION: The cumulative effect of exposure to family/known and community/unknown violence enhances the negative assessment of health status. Health professionals must be aware of the multivitaminization and its impact on the health of victims who access health services.

Violência Doméstica/estatística & dados numéricos , Exposição à Violência/estatística & dados numéricos , Nível de Saúde , Autoavaliação , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Adulto Jovem
Psychol Trauma ; 12(S1): S193-S194, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32551773


Adverse childhood experiences, which is defined by different forms of abuse, neglect, and household dysfunction occurring before the age of 18 years, is a major public health problem in the United States that has the potential to worsen in the current COVID-19 pandemic. Moreover, the challenge is even greater for children and youth from low-income communities and communities of color. Thus, there is a greater need for investments in youth-serving systems within and beyond health care and public health to effectively address adverse childhood experiences and prevent its short- and long-term negative health and social sequelae well beyond the current public health crisis. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Experiências Adversas da Infância , Maus-Tratos Infantis , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Trauma Psicológico , Criança , Exposição à Violência , Humanos , Trauma Psicológico/diagnóstico , Trauma Psicológico/etiologia , Trauma Psicológico/terapia
Eur. j. psychol. appl. legal context (Internet) ; 12(1): 11-21, ene.-jun. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-189157


This study aimed to address how multiple risk factors that were previously related and derived from ecological levels, when taken together, could explain child-to-mother and child-to-father violence. A total of 298 Spanish adolescents (140 girls) who had committed CPV, with a mean age of 15.91 (SDage = 1.89), offender residents of specialized closed institutions for adolescents who had aggressed their parents (49.5%) and educational centres (50.6%) completed all measures. Both models obtained adequate fit indexes and explained about 50% of the variance in the two types of violence. At contextual (exosystem) level, peer deviance was indirectly related to both types of CPV. At family level (microsystem), the strongest direct predictor in both models was parental ineffectiveness in applying discipline. An additional direct path to child-to-mother violence was the use of corporal punishment. At individual level (ontogenic), the two strongest direct predictors in both models were adolescents' impulsivity and substance abuse. The models highlight the complexity of the variables involved in the development of CPV. Regarding intervention implications, the models show the importance of paying attention to family variables, such as parents' mode of implementation of disciplinary measures, and individual factors, such as adolescents' impulsivity and substance abuse

Este estudio tuvo como fin abordar de qué modo podría explicar la violencia filio-parental (VFP) hacia la madre y hacia el padre los múltiples factores de riesgo relacionados previamente y derivados de niveles ecológicos en su conjunto. Un total de 298 adolescentes españoles (140 chicas) que presentaban índices elevados de VFP, con una edad media de 15.91 (DT = 1.89) y pertenecientes a centros psicoterapéuticos cerrados especializados en el trabajo de la VFP (49.5%) y a centros educativos (50.6%) cumplimentaron todas las medidas. Ambos modelos obtuvieron índices de ajuste adecuados y explicaron aproximadamente el 50% de la varianza de los dos tipos de VPF. En el nivel contextual (exosistema), la influencia de compañeros conflictivos se relacionó indirectamente con ambos tipos de VFP. A nivel familiar (microsistema), el mayor predictor directo en ambos modelos fue la ineficacia parental en la aplicación de la disciplina. Una relación directa adicional en el caso de la VFP hacia la madre fue el uso del castigo físico. Al nivel individual (ontogénico), los dos mejores predictores directos en ambos modelos fueron la impulsividad y el abuso de sustancias por parte de los adolescentes. Los modelos subrayan la complejidad de las variables involucradas en el desarrollo de la VFP. Respecto a las implicaciones para la intervención, los modelos enfatizan la importancia de prestar atención a las variables familiares, como el modo en el que los progenitores implementan las estrategias disciplinarias, y a factores individuales, como la impulsividad y el abuso de sustancias de los adolescentes

Humanos , Masculino , Feminino , Adolescente , Comportamento Problema/psicologia , Comportamento do Adolescente/psicologia , Relações Pais-Filho , Agressão/psicologia , Violência Doméstica/psicologia , Análise Multivariada , Psicometria/métodos , Exposição à Violência/psicologia , Comportamento Impulsivo/classificação , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Delinquência Juvenil/estatística & dados numéricos
Eur. j. psychol. appl. legal context (Internet) ; 12(1): 43-51, ene.-jun. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-189160


Child-to-parent violence takes different forms (physical, psychological or economic) and can be addressed in the judicial system or in clinical practice. The current paper compares 61 clinical and 30 judicialized cases that were evaluated using the Child-to-Parent Violence Risk assessment tool (CPVR). Results showed a higher prevalence of risk factors in the judicial sample. This group of aggressors had worse profiles of violence (bidirectionality of the parent/child violence, violence other than CPV, and more CPV complaints), more psychological issues (low frustration tolerance, little anger management,narcissism, and violent attitudes) and, most notably, more dysfunctional families (violence between parents, cohabitation problems, inversion of the hierarchy, non-violent conflicts, and even criminal history of the parents). Logistic regression showed that narcissism, attitudes justifying violence, violence between parents, and problems of parents themselves (such mental disorders or drug abuse) allowed for correct classification of 89.4% of cases. Total CPVR scores differed between groups (25.8 vs. 14.2), and classification was good for both type of group (AUC = .830) and injuries to mother (AUC= .764). A cut-off score between 22 and 23 showed the best results in prediction of group and injuries to mother. Utility ofthe CPVR, and next steps in its development are discussed

La Violencia Filio-Parental (VFP) puede manifestarse de distintas formas (física, psicológica o económica) y su abordaje puede hacerse desde el sistema judicial o desde la práctica clínica. El presente estudio compara 61 casos clínicos (no judicializados) y 30 judicializados que fueron evaluados con la Guía para la Valoración del Riesgo de Violencia Filio-Parental (RVFP). Los resultados mostraron una mayor prevalencia de los factores de riesgo en la muestra judicial, con un perfil de violencia peor (más bidireccionalidad, más violencia distinta a la VFP y más denuncias por VFP), más complicaciones psicológicas en los agresores (baja tolerancia a la frustración, poco control de la ira, narcisismo y actitudes violentas) y, en especial, un perfil familiar más disfuncional (violencia entre los padres, problemas de convivencia, inversión de jerarquía, conflictos e incluso antecedentes delictivos en los padres). Una regresión logística puso de manifiesto que el narcisismo, las actitudes que justifican la violencia, la violencia entre los progenitores y los problemas de los padres (como trastorno mental o abuso de drogas) permitían clasificar correctamente al 89.4% de los casos. El grupo midió diferencias en la puntuación en la Guía RVFP (25.8vs. 14.2) y la clasificación fue buena para el tipo de grupo (AUC = .830) y lesiones a la madre (AUC = .764). Un punto de corte entre 22 y 23 mostró los mejores resultados en la predicción del grupo y las lesiones a la madre. Se discute la utilidad de la RVFP y los siguientes pasos en su desarrollo

Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Violência Doméstica/psicologia , Relações Pais-Filho , Comportamento Problema/psicologia , Narcisismo , Frustração , Exposição à Violência/psicologia , Características da Família , Fatores de Risco , Violência Doméstica/legislação & jurisprudência , Medição de Risco/métodos
Rev. SPAGESP ; 21(1): 51-65, jan.-jun. 2020. ilus, tab
Artigo em Português | LILACS, Index Psicologia - Periódicos técnico-científicos | ID: biblio-1092172


Esta revisão integrativa da literatura discute aspectos teórico-metodológicos na investigação do fenômeno do stalking na adolescência. Foi realizado um levantamento de artigos empíricos (n=9), com ênfase na população de adolescentes, nas bases PsycINFO, SciELO e PubMed, considerando descritores preestabelecidos - "stalking and adolescence" e "stalking and juvenile" - em publicações entre os anos de 2013 e 2018, e em língua inglesa. Os resultados apontaram diferentes descrições de comportamentos de assédio, perpetrados face-a-face ou no contexto online, por meio das tecnologias, indicando falta de consenso na literatura quanto aos critérios a serem adotados na definição do fenômeno. Observou-se ainda a falta de instrumentos padronizados na investigação do stalking na adolescência, uma vez que a maior parte dos estudos utiliza checklists para sua avaliação.

This integrative review of the literature discusses the theoretical-methodological aspects in the investigation of the phenomenon of stalking in adolescence. A survey of empirical papers (n=9) was carried out, with emphasis on the adolescent population, in databases PsycINFO, SciELO and PubMed, considering pre-established descriptors - "stalking AND adolescence" and "stalking AND juvenile"- in publications between 2013 and 2018, in English language. The results pointed out different descriptions of harassment behavior, perpetrated face-to-face or online through the technologies, indicating lack of consensus in the literature regarding the criteria to be applied on the definition of the phenomenon. We also observed the lack of standardized instruments in the investigation of stalking in adolescence, since most studies use checklists for their evaluation.

Esta revisión integrativa de la literatura discute los aspectos teórico-metodológicos en la investigación del fenómeno del stalking en la adolescencia. Se realizó un levantamiento de artículos empíricos (n=9), con énfasis en la población de adolescentes, en las bases PsycINFO, SciELO y PubMed, considerando descriptores preestablecidos - "stalking AND adolescence" y "stalking AND juvenile" - en publicaciones entre los años 2013 y 2018, en inglés. Los resultados apuntaron diferentes descripciones de comportamientos de acoso, perpetrados cara a cara o en línea, por medio de las tecnologías, indicando falta de consenso en la literatura cuánto a los criterios a ser adoptados en la definición del fenómeno. Se observó además la falta de instrumentos estandarizados en la investigación del stalking en la adolescencia, ya que la mayor parte de los estudios utiliza listas de verificación para su evaluación.

Humanos , Masculino , Feminino , Adolescente , Assédio Sexual , Perseguição , Exposição à Violência
J Pediatr ; 221: 224-229, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32446486


OBJECTIVES: To describe patterns of overall, within-household, and community adverse childhood experiences (ACEs) among children in vulnerable neighborhoods and to identify which individual ACEs, over and above overall ACE level, predict need for behavioral health services. STUDY DESIGN: This was a cross-sectional study that used a sample of 257 children ages 3-16 years who were seeking primary care services with co-located mental healthcare services at 1 of 2 clinics in Chicago, Illinois. The outcome variable was need for behavioral health services (Pediatric Symptom Checklist score ≥28). The independent variables were ACEs, measured with an adapted, 28-item version of the Traumatic Events Screening Inventory. RESULTS: Six ACE items were individually predictive of a clinical-range Pediatric Symptom Checklist score after adjusting for sociodemographic covariates: emotional abuse or neglect (OR 2.93, 95% CI 1.32-6.52, P < .01), natural disaster (OR 3.89, 95% CI 1.18-12.76, P = .02), forced separation from a parent or caregiver (OR 2.95, 95% CI 1.50-5.83, P < .01), incarceration of a family member (OR 2.43, 95% CI 1.20-4.93, P = .01), physical attack (OR 2.84, 95% CI 1.32-6.11, P < .01), and community violence (OR 2.35, 95% CI 1.18-4.65, P = .01). After adjusting for overall ACE level, only 1 item remained statistically significant: forced separation from a parent or caregiver (OR 2.44, 95% CI 1.19-5.01, P = .02). CONCLUSIONS: ACEs that disrupt attachment relationships between children and their caregivers are a significant predictor of risk for child emotional or behavioral problems.

Experiências Adversas da Infância , Transtornos do Comportamento Infantil/epidemiologia , Adolescente , Chicago/epidemiologia , Criança , Maus-Tratos Infantis/psicologia , Pré-Escolar , Estudos Transversais , Exposição à Violência/psicologia , Separação da Família , Feminino , Humanos , Modelos Logísticos , Masculino , Desastres Naturais , Apego ao Objeto , Abuso Físico/psicologia
BMC Public Health ; 20(1): 418, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32228553


BACKGROUND: Knowledge of the relationship between men's health and violence is flawed by narrow and faulty conceptualization and measurement of violence that often results in attribution of health problems to one form or type of violence without consideration of other exposures. Our purpose is to describe the development and initial testing of the Cumulative Lifetime Violence Severity scale designed for use in health research to measure men's perceptions of the severity of their cumulative lifetime violence. METHODS: We framed the dimensions of violence severity as: type (physical, psychological, sexual), timing (childhood, adulthood), focus (perpetrator, target), context, frequency, and degree of distress. Items reflecting these dimensions were vetted by local experts including individuals who identified as men, with particular attention to meaningful language for men. The measure was pretested, revised to 64 items, and tested for test-retest reliability prior to use in a study of 685 English-speaking Eastern Canadian men, ages 19 to 65 years. We used Principal Components Analysis to illuminate the underlying dimensionality of the items. RESULTS: Principal Components Analysis yielded a 44-item 11 component solution that accounted for 64.06% of variance with good model fit and a Cronbach's alpha of .92. All dimensions of our conceptualization of violence severity were reflected in the components, except Adult Target Sexual Violence. Convergent validity between the Cumulative Lifetime Violence Severity-44 Scale and a global lifetime violence rating scale was r = .750 (p < .001) and concurrent validity was moderate and significant between the Cumulative Lifetime Violence Severity-44 scale and measures of mental health problems commonly experienced by people with violence histories. CONCLUSIONS: The Cumulative Lifetime Violence Severity-44 scale shows promise as the first comprehensive measure of cumulative lifetime violence for health research that considers gender, individual distress and experiences as both perpetrator and target. Next steps include further exploratory analysis with a more diverse sample of men and confirmatory factor analysis.

Exposição à Violência/estatística & dados numéricos , Homens/psicologia , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Índice de Gravidade de Doença , Adulto , Idoso , Canadá , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Componente Principal , Reprodutibilidade dos Testes , Adulto Jovem
BMC Public Health ; 20(1): 532, 2020 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-32306937


BACKGROUND: Children's nutritional status influences their physical, socioemotional and cognitive development throughout the life course. We aimed to determine the role of armed conflict on the prevalence of childhood malnourishment in The Sudan, and understand the underlying mechanisms using a framework based on the social determinants of health. METHODS: We analysed cross-sectional data from the 2014-Sudan Multiple Indicator Cluster Survey (n = 14,081) to compare the prevalence of malnourishment in states undergoing armed conflict and states free of conflict. Four-level multilevel multivariate modelling was conducted to identify the contribution of the social determinants of malnourishment in explaining the role of armed conflict in child health, with conflict status as the central predictor and progressive adjustments for child-, household- and cluster- and state-level predictors. RESULTS: Armed conflict is strongly associated with greater risk of severe and moderate underweight among children under-5. Adjusting for key social determinants of health reduced the strength of the association between armed conflict and risk of underweight, but there is statistical evidence of association between armed conflict and risk of severe underweight (OR: 1.60, 95%CI: 1.03-2.49 for the low intensity group). CONCLUSION: Conflict-exposed children are particularly vulnerable to malnourishment, and this association is mostly explained by key socio-demographic factors. With the prolonged political instability in The Sudan, sustainable nutritional interventions are necessary to ease hard conditions in conflict-exposed states, and also among disadvantaged families in conflict-free regions.

Conflitos Armados/psicologia , Transtornos da Nutrição Infantil/epidemiologia , Exposição à Violência/psicologia , Desnutrição/epidemiologia , Magreza/epidemiologia , Criança , Saúde da Criança , Transtornos da Nutrição Infantil/psicologia , Fenômenos Fisiológicos da Nutrição Infantil , Pré-Escolar , Estudos Transversais , Características da Família , Feminino , Humanos , Masculino , Desnutrição/psicologia , Prevalência , Sudão/epidemiologia , Inquéritos e Questionários , Magreza/psicologia
Washington, D.C.; OPS; 2020-04-28.
em Espanhol | PAHO-IRIS | ID: phr-52043


El abuso sexual, que abarca la agresión sexual o la violación, de niños y adolescentes es un grave problema de salud pública en todo el mundo y una violación de los derechos humanos que tiene muchas consecuencias para la salud a corto y a largo plazo. Las consecuencias físicas, sexuales, para la salud reproductiva y la salud mental de ese abuso son de amplio alcance y deben abordarse. Los datos recabados en diferentes entornos indican que los niños y adolescentes están representados desproporcionadamente entre los casos de abuso sexual que se llevan a la atención de los prestadores de atención de salud. En esta directriz se formulan recomendaciones dirigidas en especial a los prestadores de atención de salud que se encuentran en la primera línea de acción (por ejemplo, médicos generales, enfermeras, pediatras, ginecólogos), que atienden a niños y adolescentes hasta la edad de 18 años, que han sufrido, o podrían haber sufrido algún tipo de abuso sexual, como la agresión sexual o la violación. También puede ser útil para otros cuadros de prestadores especializados de atención de salud que tienen probabilidad de atender a niños o adolescentes. En la directriz, aunque es de alcance mundial, se asigna particular importancia a su aplicación en entornos de atención de salud de los países de ingresos bajos y medianos, teniendo en cuenta que allí los recursos de atención de salud son más limitados. Por consiguiente, en la redacción se tuvo en cuenta la factibilidad de poner en práctica las recomendaciones en entornos de escasos recursos... La directriz se formuló según las normas y los requisitos especificados en el manual de la OMS para la elaboración de directrices, segunda edición. El proceso incluyó: a) la determinación de las preguntas de investigación fundamentales y sus resultados; b) la recuperación de la evidencia, lo que incluyó la ejecución de revisiones sistemáticas; c) la síntesis de la evidencia; d) la evaluación de la calidad, efectuada por un Grupo de Elaboración de las Directrices (GED); y e) la formulación de recomendaciones con el GED y aportes de un Grupo de Revisión Externa. No se detectaron conflictos de intereses importantes para el GED ni el Grupo de Revisión Externa. El documento también comprende principios generales que sustentan la práctica clínica y que se derivan de normas internacionales éticas y de derechos humanos. Incluye enunciados de prácticas adecuadas que se basan tanto en los principios orientadores como en los valores y las preferencias de las personas sobrevivientes, sus cuidadores y los prestadores de atención de salud. Las recomendaciones se fundamentan en las recomendaciones vigentes de la OMS, así como en el nuevo contenido elaborado como parte de este proceso de formulación de directrices. A continuación, se resumen los principios orientadores, las recomendaciones y los enunciados de las prácticas adecuadas.

Delitos Sexuais , Violência de Gênero , Exposição à Violência , Violações dos Direitos Humanos , Direitos Humanos , Saúde Mental , Serviços de Saúde do Adolescente , Serviços de Saúde da Criança
Artigo em Inglês | MEDLINE | ID: mdl-32111051


The exposure of adult children to inter-parental violence is an indirect form of victimization which has not been widely investigated in relation to its consequences in adulthood. The main goal of this study was to analyze predictors of dating violence based on an integrated model of intergenerational transmission of violence with the assessment of potential indirect effects of inter-parental violence exposure on dating violence through child-to-parent violence and sexism. A total of 847 college students participated in this study, ranging from 18 to 25 years of age. Inter-parental violence exposure plays a relevant role in dating violence, with indirect effects through child-to-parent violence and sexism. These results support social learning theory in explaining the intergenerational transmission of violence and indicate that further attention should be paid to children exposed to inter-parental violence. Intervention models to prevent the perpetration of dating violence should include the prevention of inter-parental violence exposure and child-to-parent violence.

Vítimas de Crime , Exposição à Violência , Violência por Parceiro Íntimo , Violência , Adolescente , Adulto , Criança , Humanos , Relações Pais-Filho , Estudantes , Adulto Jovem
Rev. esp. med. legal ; 46(1): 28-40, ene.-mar. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193987


El abordaje del maltrato infantil intrafamiliar (MII) es uno de los más complejos en medicina forense. Los objetivos periciales son la evaluación del daño físico-psíquico y de los indicadores de MII, el análisis de credibilidad del testimonio y el estudio de la dinámica familiar. En este artículo se revisa la sistemática de abordaje del MII (fuentes de documentación, evaluación psíquica, recogida del relato y uso de pruebas psicológicas); se propone un modelo de exploración psíquico basado en bloques, se formulan pautas para la determinación del nexo causal entre hechos denunciados y daño detectado, y para el análisis de la credibilidad con el fin de concluir sobre la coherencia del relato. También se describen los principales indicadores de MII. Las conclusiones del informe forense se deben basar en evidencias sólidas ya que una peritación deficiente podría producir daños irreparables en víctimas menores y sus familias

The approach to child abuse due to domestic violence is one of the most complex in forensic medicine. The objectives are the evaluation of the physical-psychological damage and of the indicators of child abuse, the analysis of credibility of the testimony and the study of the family dynamics. In this article, the systematic approach to child abuse is reviewed: sources of documentation, psychological evaluation, story gathering and use of psychological tests. A model of psychological exploration based on blocks is proposed, guidelines for the determination of the causal relationship between allegation of ill-treatment and damage detected are formulated, and recommendations for the analysis of credibility in order to conclude on the coherence of the story are suggested. The main indicators of child abuse are also described. The conclusions of the forensic report must be based on solid evidence, since poor evaluation could cause irreparable damage to children and their families

Humanos , Maus-Tratos Infantis/legislação & jurisprudência , Violência Doméstica/legislação & jurisprudência , Exposição à Violência/legislação & jurisprudência , Psicologia Forense/métodos , Notificação de Abuso , Detecção de Mentiras/psicologia , Vítimas de Crime/legislação & jurisprudência , Vítimas de Crime/psicologia , Barreiras de Comunicação
East Mediterr Health J ; 26(2): 189-197, 2020 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-32141597


Background: Exposure to violence is a significant risk factor for the development of psychopathology in young people. Research on the mental health consequences of violence exposure in youth has focused mostly on post-traumatic stress disorder, however, the association with depression and anxiety has also been established. As a result of the longstanding Israeli-Palestinian conflict, young Palestinians are vulnerable to exposure to various types of violence. Aims: We examined psychiatric symptomatology and its relationship to direct and indirect forms of violence exposure. Methods: A representative household survey of 2481 Palestinian youth was conducted in 2014. Self-report measures included psychiatric symptomatology (global distress, depression, anxiety) and violence exposure (personal victimization, witnessed, vicariously heard about). Results: The proportion of elevated symptoms of global distress (46%), depression (55%), and (37%) anxiety was high; 47% had been a personal victim, 71% had witnessed violence, and 69% had heard about violence experienced by someone close to them. In logistic regression analysis, controlling for other bivariate correlates, exposure to any violence event, as well as any of the 3 types of violence exposure, were independently associated with each of the 3 measures of elevated psychiatric symptomatology. Females were 4 times more likely to report elevated psychopathology, despite being less likely to experience each type of violence. Conclusions: These findings suggest the need for services that cater to the mental health needs of youth in settings of high violence exposure, and that gender-specific strategies may be useful.

Ansiedade/epidemiologia , Depressão/epidemiologia , Exposição à Violência , Saúde Mental , Adolescente , Adulto , Ansiedade/etiologia , Depressão/etiologia , Exposição à Violência/psicologia , Feminino , Humanos , Masculino , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Violência/psicologia , Adulto Jovem
BMC Oral Health ; 20(1): 54, 2020 02 17.
Artigo em Inglês | MEDLINE | ID: mdl-32066424


OBJECTIVES: In view of the association between early childhood caries (ECC])and maternal social risk factors, this study tried to determine if there were associations between indicators of processes, outputs and outcomes of women's empowerment, and the prevalence of ECC. METHODS: In this ecological study, indicators measuring the explanatory variables - economic empowerment, decision-making and violence against women - were selected from the Integrated Results and Resources Framework of the UN-Women Strategic Plan 2018-2021 and WHO database. Indicators measuring the outcome variables - the prevalence of ECC for children aged 0 to 2 years, and 3 to 5 years - were extracted from a published literature. The general linear models used to determine the association between the outcome and explanatory variables were adjusted for economic level of countries. Regression estimates (B), 95% confidence intervals and partial eta squared (η2) were calculated. RESULTS: Countries with more females living under 50% of median income had higher prevalence of ECC for 3 to 5-year olds (B = 1.82, 95% CI = 0.12, 3.52). Countries with higher percentage of women participating in their own health care decisions had higher prevalence of ECC for 0 to 2-year-olds (B = 0.85, 95% CI = 0.03, 1.67). Countries with higher percentage of women participating in decisions related to visiting family, relatives and friends had higher prevalence of ECC for 3 to 5-year-olds (B = 0.67, 95% CI = 0.03, 1.32). None of the indicators for violence against women was significantly associated with the prevalence of ECC. CONCLUSION: Empowerment of women is a welcome social development that may have some negative impact on children's oral health. Changes in policies and norms are needed to protect children's oral health while empowering women.

Tomada de Decisões , Cárie Dentária/epidemiologia , Empoderamento , Exposição à Violência/psicologia , Violência por Parceiro Íntimo/estatística & dados numéricos , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Saúde Bucal , Poder Psicológico , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Violência