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1.
J Pak Med Assoc ; 71(6): 1704-1708, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34111106

RESUMO

OBJECTIVE: To determine the awareness and practices of doctors and dentists in detecting and reporting suspected cases of child physical abuse. METHODS: The cross-sectional study was conducted from November 2017 to June 2018 at the Hamdard College of Medicine and Dentistry, Karachi, and comprised doctors and dentists practising in public and private hospitals across Pakistan. Data was collected using a predesigned questionnaire to assess knowledge of the social indicators of child physical abuse, response to child physical abuse, and actions taken by the professionals when they believed a child abuse case had been detected. Data was analysed using SPSS 22. RESULTS: Of the 575 healthcare professionals, 371(64.5%) were doctors and 204(35.5%) were dentists; 347(60.3%) were males; 446(77.6%) were working in private hospitals; 384(66.8%) had <10 years of experience; and 99(17.2%) had received formal training of child abuse. While 450(78.3%) subjects strongly agreed on the value of identifying and documenting child physical abuse, 336(58%) did not take any action in suspected cases. CONCLUSIONS: Although doctors and dentists had a positive attitude regarding child physical abuse, the majority preferred to remain silent in suspected cases.


Assuntos
Maus-Tratos Infantis , Abuso Físico , Atitude do Pessoal de Saúde , Criança , Maus-Tratos Infantis/diagnóstico , Estudos Transversais , Odontólogos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Paquistão , Inquéritos e Questionários
2.
BMC Public Health ; 21(1): 1082, 2021 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-34090417

RESUMO

BACKGROUND: Child maltreatment is prevalent and associated with both short- and long-term health problems. Previous studies have established child maltreatment as a risk factor for a wide range of problems over the life course such as mental- and somatic health problems, self-harm, alcohol- and drug abuse and decreased work-life participation. Still, there are few large and well-conducted longitudinal studies focusing on describing prevalence and identifying risk factors and long-term consequences of child maltreatment. The purpose of the current study is to recruit a large number of children and adolescents exposed to maltreatment and follow them long-term. METHODS/DESIGN: The current study is a longitudinal cohort study and will use a multi-informant design (child/adolescent, caregiver, and administrative data). Participants will be recruited from the Stine Sofie Centre (SSC), a learning and coping centre for children and adolescents (≤18 years) exposed to maltreatment, which includes physical and emotional abuse, neglect and/or sexual abuse. Questionnaire-based assessments from self-reports (as well as parent-reports) will be carried out at regular time intervals throughout their lives, on topics such as abuse, negative life events, mental and somatic health problems, resilience and coping, satisfaction with health services, social-, family-, and school function, as well as self-harm and substance abuse. Participants will be assessed upon entry to the centre and followed up annually until they reach 18 years and bi-annually after. Given written consent, participants' responses will be linked to relevant national registries in order to examine predictive factors and important outcomes in terms of subsequent health, education, criminal records and work affiliation. DISCUSSION: This study will examine short- and long-term consequences of child maltreatment across a range of health-related outcomes in a longitudinal perspective. Results from the current study might have implications for the development of preventive and intervention programs related to child maltreatment and the organization and follow-up of the services these children receive. The current study will hopefully contribute with knowledge of risk-factors, short- and long-term health-related and other issues that can contribute to practices aimed at improving the overall life-course for children and adolescents who have experienced childhood maltreatment.


Assuntos
Maus-Tratos Infantis , Adolescente , Criança , Estudos de Coortes , Inquéritos Epidemiológicos , Humanos , Estudos Longitudinais , Noruega/epidemiologia
4.
Pediatr Radiol ; 51(6): 1076-1078, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33999248

RESUMO

It seems paradoxical that facts, data and science are still considered controversial despite the harrowing death of a multitude of people from coronavirus disease 2019 (COVID-19), an unparalleled health care crisis of our lifetime. In addition, while scientists are desperately attempting to produce a vaccine for COVID-19, a large segment of the populace still believes in conspiracies related to vaccines. Therefore, it is not surprising that the diagnosis of abusive head trauma (AHT) faces similar challenges - the difference being that AHT challenges are mostly in the realms of law courts rather than actual clinical management of these infants. Against this backdrop, the Child Abuse Imaging Committee of the Society for Pediatric Radiology (SPR) collaborated with other leading experts to develop the consensus statement on AHT. This consensus statement has had a significant impact since its publication. It is now endorsed by 17 multinational, multidisciplinary organizations. The consensus statement has helped educate the diverse stakeholders of AHT and has helped further our understanding of AHT and the issues related to it. This could serve as the template for developing future consensus documents.


Assuntos
Maus-Tratos Infantis/diagnóstico , Consenso , Traumatismos Craniocerebrais/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Criança , Pré-Escolar , Humanos , Lactente , Pediatria , Radiologia , Sociedades Médicas
5.
Glob Public Health ; 16(6): 815-819, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34024252

RESUMO

Violence against children occurs in all countries, affecting children of all ages, genders, race and socio-economic strata. A multiplicity of factors contributes to children's experience of violence. Social and gender norms can act as risk and protective factors exposing children to violence or preventing them from having well-being and healthy development. This Special Symposium was conceived of during the first International Viable and Operable Ideas for Child Equality (VOICE) Conference in 2018 in Bali, Indonesia. The four manuscripts in this Special Symposium illustrate with evidence the importance of social norms to preventing violence against children and the importance of understanding norms in context. The authors find that understanding how geographic location, social cohesion, group roles and identities, age and gendered expectations inform whether, when and which children experience violence, who perpetrates it, and how individuals and communities respond to it. The global COVID-19 pandemic has illustrated how rapidly behaviours can shift towards caregiving and health, as well as against it. If we are to prevent violence against children, and ensure the safety, well-being, and opportunity to thrive for all children, advancing our understanding of norms in relation to violence against children is critical to effective programming and learning.


Assuntos
Maus-Tratos Infantis/prevenção & controle , Congressos como Assunto , Normas Sociais , Violência/prevenção & controle , Adolescente , COVID-19 , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pandemias , SARS-CoV-2
9.
BMJ Open ; 11(5): e047074, 2021 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-33980529

RESUMO

INTRODUCTION: Child maltreatment (physical abuse, sexual abuse, emotional abuse, neglect and exposure to domestic violence) is widely understood to be associated with multiple mental health disorders, physical health problems and health risk behaviours throughout life. However, Australia lacks fundamental evidence about the prevalence and characteristics of child maltreatment, its associations with mental disorders and physical health, and the associated burden of disease. These evidence gaps impede the development of public health strategies to better prevent and respond to child maltreatment. The aims of this research are to generate the first comprehensive population-based national data on the prevalence of child maltreatment in Australia, identify associations with mental disorders and physical health conditions and other adverse consequences, estimate attributable burden of disease and indicate targeted areas for future optimal public health prevention strategies. METHODS AND ANALYSIS: The Australian Child Maltreatment Study (ACMS) is a nationwide, cross-sectional study of Australia's population aged 16 years and over. A survey of approximately 10 000 Australians will capture retrospective self-reported data on the experience in childhood of all five types of maltreatment (physical abuse, sexual abuse, emotional abuse, neglect and exposure to domestic violence). A customised, multimodule survey instrument has been designed to obtain information including: the prevalence and characteristics of these experiences; diagnostic screening of common mental health disorders; physical health; health risk behaviours and health service utilisation. The survey will be administered in March-November 2021 to a random sample of the nationwide population, recruited through mobile phone numbers. Participants will be surveyed using computer-assisted telephone interviews, conducted by trained interviewers from the Social Research Centre, an agency with extensive experience in studies of health and adversity. Rigorous protocols protect the safety of both participants and interviewers, and comply with all ethical and legal requirements. Analysis will include descriptive statistics reporting the prevalence of individual and multitype child maltreatment, multiple logistic and linear regression analyses to determine associations with mental disorders and physical health problems. We will calculate the population attributable fractions of these putative outcomes to enable an estimation of the disease burden attributable to child maltreatment. ETHICS AND DISSEMINATION: The study has been approved by the Queensland University of Technology Human Research Ethics Committee (#1900000477, 16 August 2019). Results will be published to the scientific community in peer-reviewed journals, scientific meetings and through targeted networks. Findings and recommendations will be shared with government policymakers and community and organisational stakeholders through diverse engagement activities, a dedicated Advisory Board and a systematic knowledge translation strategy. Results will be communicated to the public through an organised media strategy and the ACMS website.


Assuntos
Maus-Tratos Infantis , Transtornos Mentais , Austrália/epidemiologia , Criança , Efeitos Psicossociais da Doença , Estudos Transversais , Humanos , Transtornos Mentais/epidemiologia , Prevalência , Queensland , Estudos Retrospectivos
10.
BMC Psychiatry ; 21(1): 248, 2021 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-34001033

RESUMO

BACKGROUND: The association between sexual and physical abuse and subsequent depression is well-established, but the associations with specific depressive symptoms and sex differences remain relatively understudied. We investigated the associations of sexual and physical abuse with depressive symptoms in men and women in a large population cohort. METHODS: Observational study based on 151,396 UK Biobank participants. Exposures included self-reported experiences of childhood physical abuse and sexual abuse. Mid-life outcomes included current depressive symptoms score, individual depressive symptoms, and lifetime depression. We used logistic regression to test associations of childhood sexual/physical abuse with depressive outcomes. RESULTS: Recalled childhood sexual and physical abuse were both associated with current depressive symptoms score in adults. Results for individual symptoms-based analyses suggest that sexual and physical abuse are associated with all depressive symptoms, particularly suicidal behaviours. The associations between lifetime depression and sexual/physical abuse were not fully explained by current depressive symptoms score, indicating that these findings may not be fully attributable to recall bias. There was no indication of differential risk for specific depressive symptoms among men and women. CONCLUSIONS: Sexual and physical abuse are robust risk factors for depression/depressive symptoms regardless of sex. Higher risk of suicidal behaviours associated with childhood sexual/physical abuse are of particular concern. Longitudinal research into sex-specific associations for individual depressive symptoms is required.


Assuntos
Maus-Tratos Infantis , Delitos Sexuais , Adulto , Bancos de Espécimes Biológicos , Criança , Depressão/epidemiologia , Feminino , Humanos , Masculino , Abuso Físico , Reino Unido/epidemiologia
11.
Dev Psychopathol ; 33(2): 394-408, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33955343

RESUMO

As championed by the work of Ed Zigler, investing in nurturing environments for all children is a chief tenet of primary prevention that will have far-reaching benefits to the health and welfare of all members of society. Children who endure child maltreatment (CM) are among society's most vulnerable. Prospective longitudinal research aimed at a comprehensive understanding of the mechanisms linking CM to subsequent adverse health consequences is needed to improve outcomes and to strengthen causal inference. This paper outlines the methods of the Child Health Study (CHS), a large, state-wide longitudinal cohort of recently maltreated and nonmaltreated youth aged 8-13 who will be assessed every 2 years. The CHS is designed to include in-depth assessments of multiple environmental, behavioral, neural, physiological, and molecular mechanisms through which CM may impact a broad spectrum of youth development, including behavioral and physical health outcomes. In addition to describing the conceptual framework and methods underlying the CHS, we provide information on valuable "lessons learned" in the hopes of supporting future research efforts facing similar challenges. The ultimate goal of this research is demonstrating how policies regarding CM impact the well-being, resilience and recovery of survivors and that they are worthy of large public investment.


Assuntos
Maus-Tratos Infantis , Adolescente , Criança , Maus-Tratos Infantis/prevenção & controle , Estudos de Coortes , Família , Humanos , Estudos Prospectivos
14.
Artigo em Inglês | MEDLINE | ID: mdl-33801428

RESUMO

BACKGROUND: Previous research has shown a strong relationship between childhood trauma and worsened physical and mental health. The Childhood Trauma Questionnaire (CTQ) is a commonly used tool assessing early traumatic experiences. The aim of this study was to verify the psychometric properties of the Slovak version of the CTQ. METHODS: Data were collected on a representative Slovak sample (N = 1018, mean age 46.24 years, 48.7% of men). The dimensional structure of the CTQ was tested by confirmatory factor analysis (CFA); convergent validity was assessed using the Adverse Childhood Questionnaire (ACE-IQ). RESULTS: CFA confirmed the standard 5-factor CTQ model. The subscales of the CTQ and the ACE-IQ questionnaires showed moderate to high correlations. The internal consistency of the scale was found to be acceptable. Emotional neglect (EN) was reported in 48.1%, physical neglect (PN) in 35.8%, emotional abuse in 15.8%, physical abuse (PA) in 11.0%, and sexual abuse (SA) in 9.1% of the Slovak population, according to the scoring, when even low abuse or neglect is assessed as trauma. CONCLUSION: The CTQ questionnaire fulfilled the validation criteria and appeared to be a suitable method for assessing retrospectively reported childhood trauma experiences in the Slovak population.


Assuntos
Maus-Tratos Infantis , Inquéritos e Questionários/normas , Criança , Maus-Tratos Infantis/diagnóstico , Feminino , Humanos , Masculino , Psicometria , Estudos Retrospectivos , Eslováquia/epidemiologia
15.
Artigo em Inglês | MEDLINE | ID: mdl-33802518

RESUMO

Identifying risk factors from pregnancy is essential for preventing child maltreatment. However, few studies have explored prenatal risk factors assessed at pregnancy registration. This study aimed to identify prenatal risk factors for child maltreatment during the first three years of life using population-level survey data from pregnancy notification forms. This prospective cohort study targeted all mothers and their infants enrolled for a 3- to 4-month-old health check between October 2013 and February 2014 in five municipalities in Aichi Prefecture, Japan, and followed them until the child turned 3 years old. Administrative records of registration with Regional Councils for Children Requiring Care (RCCRC), which is suggestive of child maltreatment cases, were linked with survey data from pregnancy notification forms registered at municipalities (n = 893). Exact logistic regression was used for analysis. A total of 11 children (1.2%) were registered with RCCRC by 3 years of age. Unmarried marital status, history of artificial abortion, and smoking during pregnancy were significantly associated with child maltreatment. Prenatal risk scores calculated as the sum of these prenatal risk factors, ranging from 0 to 7, showed high predictive power (area under receiver operating characteristic curve 0.805; 95% confidence interval (CI), 0.660-0.950) at a cut-off score of 2 (sensitivity = 72.7%, specificity = 83.2%). These findings suggest that variables from pregnancy notification forms may be predictors of the risk for child maltreatment by the age of three.


Assuntos
Maus-Tratos Infantis , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Japão/epidemiologia , Mães , Gravidez , Estudos Prospectivos , Fatores de Risco
16.
Artigo em Inglês | MEDLINE | ID: mdl-33807669

RESUMO

(1) Background: Numerous studies suggest strong associations between childhood maltreatment and nonsuicidal self-injury (NSSI); this is also true for the roles of dopaminergic genes in the etiology of some psychopathologies related to NSSI. Investigating the interactions of environments and genes is important in order to better understand the etiology of NSSI. (2) Methods: Within a sample of 269 Chinese male adolescents (Mage = 14.72, SD = 0.92), childhood maltreatment and NSSI were evaluated, and saliva samples were collected for MAOA T941G and COMT Val158Met polymorphism analyses. (3) Results: The results revealed no primary effects attributable to MAOA T941G and COMT Val158Met polymorphism on NSSI. However, there was a significant three-way interaction between MAOA, COMT, and child abuse (ß = -0.34, p < 0.01) in adolescent NSSI. Except for carriers of the T allele of MAOA and the Met allele of COMT, all studied male adolescents displayed higher NSSI scores when exposed to a higher level of child abuse. A similar three-way interaction was not observed in the case of child neglect. (4) Conclusions: The results indicate that the MAOA gene and COMT gene play moderating roles in the association between child abuse and NSSI of male adolescents and suggest the polygenic underpinnings of NSSI.


Assuntos
Maus-Tratos Infantis , Comportamento Autodestrutivo , Adolescente , Alelos , Catecol O-Metiltransferase/genética , Criança , Genótipo , Humanos , Masculino , Monoaminoxidase/genética , Comportamento Autodestrutivo/epidemiologia , Comportamento Autodestrutivo/genética
17.
N Z Med J ; 134(1534): 17-30, 2021 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-33927435

RESUMO

AIM: To document the prevalence of child physical punishment by parents and associated predictors in the Christchurch Health and Development Study (CHDS) birth cohort over a 15-year period. METHOD: A cohort of 1,265 CHDS individuals were followed from birth (1977) to age 40 years. At ages 25 (n=155), 30 (n=337), 35 (n=585) and 40 years (n=636), the cohort members with dependent children (<16 years of age) were interviewed about their use of child physical punishment in the past 12 months using the Parent-Child Conflict Tactics Scale. Parent, child and family predictors were also examined. RESULTS: The most common forms of physical punishment were smacking on bottom and slapping on hand, arm or leg. Rates of all forms of physical punishment declined with age, ranging from 77% reporting any physical punishment at age 25 to 42% at age 40. In multivariable models, significant predictors included parental age, numbers/ages of children in the household, childhood family socioeconomic status, parental history of adolescent mental health problems and concurrent intimate partner violence. CONCLUSION: Use of physical punishment remains a relatively common form of child discipline despite the 2007 anti-smacking legislation and reduced public tolerance for physical violence towards children. Implications for prevention/intervention are discussed.


Assuntos
Maus-Tratos Infantis/estatística & dados numéricos , Relações Pais-Filho , Poder Familiar/psicologia , Comportamento Problema/psicologia , Punição/psicologia , Adulto , Criança , Maus-Tratos Infantis/psicologia , Estudos de Coortes , Humanos , Masculino , Nova Zelândia
18.
BMC Pediatr ; 21(1): 204, 2021 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-33910536

RESUMO

BACKGROUND: Presently, 1 in 4 Lebanese adolescents is involved in bullying, with 12% being perpetrators. In Lebanon, around 90% of bullying incidents occur in schools. Given the lack of studies tackling bullying perpetration in Lebanon, this study aims to identify and target risk factors of bullying perpetration among Lebanese adolescents, which would serve future prevention and intervention programs. METHODS: This cross-sectional study took place between January and May 2019 in a proportionate random sample of schools from all Lebanese districts. A total of 1810 (90.5%) out of 2000 students accepted to participate. RESULTS: Results showed that 831 (49.1%, CI: 0.46-0.51) participants had bullied other people. A stepwise linear regression, using as the dependent variable the bullying perpetration score, showed that higher psychological (ß = 0.12; 95% CI 0.083-0.176), sexual (ß = 0.26; 95% CI 0.128-0.411), neglect (ß = 0.08; 95% CI 0.051-0.120), physical abuse (ß = 0.13; 95% CI 0.036-0.235), higher internet addiction (ß = 0.07; 95% CI 0.057-0.097), higher social fear (ß = 0.10; 95% CI 0.075-0.140), and having separated parents (ß = 1.60; 95% CI 0.561-2.650) were significantly associated with more bullying perpetration. Higher social avoidance (ß = - 0.03; 95% CI -0.062- -0.003) was significantly associated with less bullying perpetration. CONCLUSION: The results revealed that bullying perpetration is significantly associated with parental status, child abuse, internet addiction, and social fear. Educational and relevant governmental institutions could use our findings to develop and implement efficient bullying prevention and intervention programs for all involved parties.


Assuntos
Bullying , Maus-Tratos Infantis , Adolescente , Criança , Estudos Transversais , Humanos , Líbano/epidemiologia , Instituições Acadêmicas
20.
Cochrane Database Syst Rev ; 4: CD014955, 2021 04 22.
Artigo em Inglês | MEDLINE | ID: mdl-33884613

RESUMO

BACKGROUND: Drowning is responsible for an estimated 320,000 deaths a year, and over 90% of drowning mortality occurs in low- to middle-income countries (LMICs), with peak drowning rates among children aged 1 to 4 years. In this age group, mortality due to drowning is particularly common in rural settings and about 75% of drowning accidents happen in natural bodies of water close to the home. Providing adequate child supervision can protect children from drowning, and organized formal day care programs could offer a way to achieve this. OBJECTIVES: Primary objective • To assess the effects of day care programs for children under 6 years of age on drowning-related mortality or morbidity, or on total drowning accidents (fatal and non-fatal), in LMICs, compared to no day care programs or other drowning prevention interventions Secondary objectives • To assess the effects of day care programs in LMICs for children under 6 years of age on unsafe water exposure • To assess safety within these programs (e.g. transmission of infection within day care, physical or sexual abuse of children within day care) • To assess the incidence of unintentional injury within these programs • To describe the cost-effectiveness of such programs, in relation to averted drowning-related mortality or morbidity SEARCH METHODS: On November 23, 2019, and for an update on August 18, 2020, we searched MEDLINE (PubMed), Embase, CENTRAL, ERIC, and CINAHL, as well as two trial registries. On December 16, 2019, and for an update on February 9, 2021, we searched 12 other resources, including websites of organizations that develop programs targeted to children. SELECTION CRITERIA: We included randomized, quasi-randomized, and non-randomized controlled studies (with explicitly listed specific study design features) that implemented formal day care programs as a single program or combined with additional out-of-day care components (such as educational activities aimed at preventing injury or drowning or early childhood development activities) for children of preschool age (below 6 years of age) in LMICs for comparison with no such programs or with other drowning prevention interventions. Studies had to report at least one outcome related to drowning or injury prevention for the children enrolled. DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection and data extraction, as well as risk of bias and GRADE assessment. MAIN RESULTS: Two non-randomized observational studies, conducted in rural Bangladesh, involving a total of 252,631 participants, met the inclusion criteria for this review. One of these studies compared a formal day care program combined with parent education, playpens provided to parents, and community-based activities as additional out-of-day care components versus no such program. Overall we assessed this study to be at moderate risk of bias (moderate risk of bias due to confounding, low risk of bias for other domains). This study showed that implementation of a formal day care program combined with parent education, provision of playpens to parents, and community-based activities, in a rural area with a high drowning incidence, likely reduces the risk of death from drowning over the study period of 4 years and 8 months compared to no day care program (hazard ratio 0.18, 95% confidence interval [CI] 0.06 to 0.58; 1 study, 136,577 participants; moderate-certainty evidence). Drowning morbidity (non-fatal drowning resulting in complications), total drowning (fatal and non-fatal), unsafe water exposure, and program safety (e.g. transmission of infection within day care, physical or sexual abuse of children within day care) were not reported, nor was the incidence of other unintentional injuries. Cost-effectiveness was reported as 812 USD (95% CI 589 to 1777) per disability-adjusted life-year averted as a consequence of drowning (moderate-certainty evidence). The second study compared day care programs with or without playpens provided to parents as an additional component versus only playpens provided to parents as an alternative drowning prevention intervention. Overall we assessed the study to be at critical risk of bias because we judged bias due to confounding to be at critical risk. As the certainty of evidence was very low, we are uncertain about the effects on drowning mortality rate of implementing a day care program compared to providing playpens (rate ratio 0.25, 95% CI 0.15 to 0.41; 1 study; 76,575 participants; very low-certainty evidence). Likewise, we are uncertain about the effects of a day care program with playpens provided as an additional component versus playpens provided alone (rate ratio 0.06, 95% CI 0.02 to 0.12; 1 study, 45,460 participants; very low-certainty evidence). The other outcomes of interest - drowning morbidity, total drowning, unsafe water exposure, program safety, incidence of other unintentional injuries, and cost-effectiveness - were not reported. AUTHORS' CONCLUSIONS: This review provides evidence suggesting that a day care program with additional out-of-day care components such as community-based education, parent education, and playpens provided to parents likely reduces the drowning mortality risk in regions with a high burden of drowning compared to no intervention.


Assuntos
Cuidado da Criança/organização & administração , Países em Desenvolvimento , Afogamento/prevenção & controle , Avaliação de Programas e Projetos de Saúde , Bangladesh , Maus-Tratos Infantis , Abuso Sexual na Infância , Cuidado da Criança/métodos , Pré-Escolar , Intervalos de Confiança , Transmissão de Doença Infecciosa , Afogamento/mortalidade , Humanos , Lactente , Estudos Observacionais como Assunto
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