Social support network of family members of abused children and adolescents: Perspectives and possibilities.

AIMS AND OBJECTIVES: To analyse the network of care and social support from the perspectives of family members of children and adolescents who have been abused. BACKGROUND: The theoretical-methodological background of the ecological model for understanding violence and the Paradigm of Complexity provide a broad perspective of violence. The paradigm considers all aspects that constitute a phenomenon as well as particular features. DESIGN: Qualitative research based on the Paradigm of Complexity, developed by Edgar Morin, the primary philosopher. We have adhered to the COREQ Checklist guidelines for qualitative research. METHODS: Data were collected through Minimal Maps of Personal Social Networks, and semi-structured interviews were held with 15 families who were assisted by a nongovernmental organisation in a Brazilian city. The notions of comprehension and contextualisation guided the data analysis. RESULTS: Two categories emerged from the data analyses: "Social isolation" and "Affective relationships needs." The maps revealed a weakened and limited network with low-density, homogeneous bonds and few significant bonds. Therefore, the network provided predominantly instrumental and material social support with few important effective relationships. The participants disclosed some strategies to empower their lives. CONCLUSIONS: We conclude that it is urgent to develop strategies in a broad manner to promote family empowerment, especially on education and employment dimension, and to construct supportive and respectful relationships between services and families as well. RELEVANCE TO CLINICAL PRACTICE: The present study contributes to international clinical nursing, especially in low- and middle-income countries, by discussing (a) looking at and caring for family members of children and adolescents who have been abused in a contextualised manner; (b) family empowerment, which enables them to have access to healthier environments and to educational/employment opportunities; and (c) broad comprehension of health care among the family members, which provides perspectives not only for looking at violence but also for strengthening supportive social relationships.

The care network of the families involved in violence against children and adolescents: the Primary Health Care perspective.

AIMS AND OBJECTIVES: To contribute the understanding of the network care provided to families involved in family violence against children and adolescents (FVACA), from the Primary Health Care (PHC) perspective. BACKGROUND: Children and adolescents figure among the main victims of violence around the world, which occurs predominantly in the family context. PHC-guided network care has emerged as a new process that contrasts with traditional approaches, which rely on fragmented, punctual and compensatory actions and produce simplified and segmented interventions in response to complex phenomena like violence. The Paradigm of Complexity interacts with the network care approach and, by articulating the multiple dimensions of the research phenomenon, contributes to its understanding. DESIGN: Qualitative research, based on the Paradigm of Complexity. METHODS: Data were collected through minimal maps of the external institutional social network, focus groups and semi-structured interviews held with 41 PHC professionals in Brazil. The notions of comprehension and contextualisation as well as dialogical, recursive and holographic principles from complexity theory guided the data analysis. RESULTS: The two thematic categories that emerged revealed reduced institutional networks, with low-density and homogeneous bonds, which resulted in fragmented care in all stages of the care process. CONCLUSIONS: Although the network organisation of care for the families involved in FVACA is fundamental, the construction of these networks still represents a great challenge, as it requires the joint work of a multiprofessional team. RELEVANCE TO CLINICAL PRACTICE: For nursing to respond to the contemporary care demands in a contemplative and pertinent manner, a perspective and a reference framework need to be developed, leading to broader and more contextualised actions, with a multidimensional approach to the families and communities of which child and adolescent victims of violence are a part.

Coping with domestic violence against children and adolescents from the perspective of primary care nurses. / Enfrentamento da violência doméstica contra crianças e adolescentes na perspectiva de enfermeiros da atenção básica.

OBJECTIVE: To analyse the actions reported by primary care nurses in the fight against domestic violence against children and adolescents. METHODS: Qualitative research conducted at five family health centres in the state of São Paulo, Brazil. Data were collected in the second half of 2013 through semi-structured. RESULTS: Two thematic cores emerged: "Public policies identified by the nurses" and "Nurses' actions regarding violence permeated by fear and conflicts". The nurses were familiar with public policies, but they were unable to put them into practice; they were unprepared to identify and cope with the violence; they did not participate in training courses; they were afraid to report the detected cases of violence. CONCLUSION: The main limitations to the practical work of nurses are work burden, lack of security, and the dynamics of work that is not articulated with the protection network, which causes the underreporting of cases of domestic violence.

[Social support from the perspective of adolescent victims of domestic violence]. / O apoio social sob a ótica de adolescents vítimas de violência doméstica.

OBJECTIVE: Assess the understanding of adolescents regarding the social support received in situations of domestic violence. METHOD: A qualitative study with data collection carried out through focus groups with 17 adolescent victims of domestic violence, institutionally welcomed in Campinas-SP, and through semi-structured interviews with seven of these adolescents. Information was analyzed by content analysis, thematic modality. RESULTS: Observing the thematic categories it was found that social support for the subjects came from the extended family, the community, the Guardianship Council, the interpersonal relationships established at the user embracement institution and from the religiosity/spirituality. CONCLUSION: The mentioned sources of support deserve to be enhanced and expanded. With the current complexity of the morbidity and mortality profiles, especially in children and adolescents, the (re)signification and the (re)construction of health actions is imperative.

Journalistic media and adolescents in the COVID-19 pandemic: a documental analysis.

OBJECTIVE: To analyze how the journalistic media has described the issues of quality of life (QoL), physical activity (PA) and mental health (MH) of adolescents during the COVID-19 pandemic. METHODS: This is a descriptive and qualitative study that used content analysis. Sixty-two journalistic publications were analyzed from a total of 8211 published by the most read newspapers in each Brazilian region between December 2019 and August 2021. RESULTS: The results were grouped and evaluated in three categories: QoL (n=11), PA (n =9) and MH (n=42). In the analyzed period, the adolescents had more time of exposure to screens, contributing to an inadequate diet, a decrease in PA and impairments in QoL. According to the media publications, the pandemic has also contributed to an increase in anxiety, depression, loneliness and fear resulting from the mental and emotional disorganization caused by the abrupt change in routine. Social vulnerability was presented as an aggravating factor in this context. The journalistic media did not pay the necessary attention to adolescents regarding the negative consequences of the pandemic on QoL, PA and MH. CONCLUSIONS: The analyzed reports showed that the pandemic caused a decrease in social interaction, feelings of uncertainty, fear and the appearance/exacerbation of symptoms of anxiety, stress and depression. Social vulnerability was presented as another obstacle to be faced in this problem.

Polymorphisms on rs9939609 FTO and rs17782313 MC4R genes in children and adolescent obesity: A systematic review.

The aim of this review was to assess whether the presence of rs9939609 and rs17782313 polymorphisms increase the risk for obesity among children and adolescents. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist and it was registered in PROSPERO. The search was performed in the PubMed/Medline, The Cochrane Library, and Web of Science databases. The risk of bias of the studies was accessed using the Newcastle-Ottawa scale and JBI Critical Appraisal Checklist for Analytical. The search of the databases retrieved 859 references. Twelve studies were eligible to be included in this systematic review. Five studies founded a positive association between overweight and obesity in children and adolescents with the presence of the rs17783213 and four studies with rs9939609. Three studies did not find an association between overweight and obesity in children and adolescents with the presence of rs17782313 or rs9939609. One found a protective effect for obesity in individuals with risk A allele referring to rs9939609, one found a synergistic effect in relation to the presence of polymorphisms rs17782313 and rs9939609 for obese phenotype, and one observed that the presence together of the rs9939609, rs17782313, and rs12970134 MC4R were significant for the presence of obesity in children and adolescents. The results suggest that depending on the population evaluated and ethnicity, the polymorphisms rs17782313 and rs9939609 could be associated with overweight and obesity in children and adolescents.

Journalistic media and adolescents in the COVID-19 pandemic: a documental analysis / Mídia jornalística e os adolescentes na pandemia da COVID-19: uma análise documental

ABSTRACT Objective: To analyze how the journalistic media has described the issues of quality of life (QoL), physical activity (PA) and mental health (MH) of adolescents during the COVID-19 pandemic. Methods: This is a descriptive and qualitative study that used content analysis. Sixty-two journalistic publications were analyzed from a total of 8211 published by the most read newspapers in each Brazilian region between December 2019 and August 2021. Results: The results were grouped and evaluated in three categories: QoL (n=11), PA (n =9) and MH (n=42). In the analyzed period, the adolescents had more time of exposure to screens, contributing to an inadequate diet, a decrease in PA and impairments in QoL. According to the media publications, the pandemic has also contributed to an increase in anxiety, depression, loneliness and fear resulting from the mental and emotional disorganization caused by the abrupt change in routine. Social vulnerability was presented as an aggravating factor in this context. The journalistic media did not pay the necessary attention to adolescents regarding the negative consequences of the pandemic on QoL, PA and MH. Conclusions: The analyzed reports showed that the pandemic caused a decrease in social interaction, feelings of uncertainty, fear and the appearance/exacerbation of symptoms of anxiety, stress and depression. Social vulnerability was presented as another obstacle to be faced in this problem.

RESUMO Objetivo: Analisar como a mídia jornalística tem descrito as questões de qualidade de vida (QV), atividade física (AF) e saúde mental (SM) de adolescentes durante a pandemia da COVID-19. Métodos: Trata-se de um estudo descritivo e qualitativo que utilizou a análise de conteúdo. Foram analisadas 62 publicações jornalísticas do total de 8.211 veiculadas pelos jornais mais lidos de cada região brasileira entre dezembro de 2019 e agosto de 2021. Resultados: Os resultados foram agrupados e avaliados em três categorias: QV (n=11), AF (n=9) e SM (n=42). No período analisado as publicações jornalísticas sugerem que os adolescentes apresentaram maior tempo de exposição a telas, contribuindo para uma alimentação inadequada, diminuição da AF e prejuízos na QV. A pandemia também contribuiu com aumento da ansiedade, depressão, solidão e medo resultantes da desorganização mental e emocional causada pela mudança abrupta de rotina. A vulnerabilidade social apresentou-se como um fator agravante nesse contexto. As mídias jornalísticas não deram a atenção necessária aos adolescentes no que se refere às consequências negativas da pandemia na QV, AF e SM. Conclusões: As reportagens analisadas mostraram que a pandemia causou diminuição na interação social, sentimentos de incerteza, medo e o aparecimento/exacerbação de sintomas de ansiedade, estresse e depressão. A vulnerabilidade social apresentou-se como mais um obstáculo a ser enfrentado nesta problemática.

Educação sexual: dificuldades dos pais de jovens com síndrome de down / Sex education: difficulties for parents of young people with down syndrome / Educación sexual: dificultades para los padres de jóvenes con síndrome de down

Com este estudo buscou-se conhecer as dificuldades e barreiras de pais na educação sexual de jovens com Síndrome de Down, a partir de uma pesquisa descritiva e de natureza qualitativa, utilizando-se o conceito das representações sociais como referencial teórico-metodológico. O estudo foi conduzido em uma Organização Não Governamental (ONG), localizada em Recife (PE), após aprovação do Comitê de Ética e Pesquisa, sob parecer consubstanciado 3.558.587. A amostra do estudo envolveu 11 pais de jovens com Síndrome de Down com idades entre 15 e 24 anos. A coleta de dados foi realizada por meio de entrevistas semiestruturadas. A abordagem escolhida para a interpretação desses dados foi a análise de conteúdo proposta por Bardin. Pode-se elencar como principais dificuldades enfrentadas pelos pais ao conversarem com seus filhos sobre sexualidade: a infantilização do jovem com Síndrome de Down, julgando-o incapaz de experienciar tais fenômenos e compreender a orientação que pudesse ser repassada; o medo em ultrapassar etapas e, de repente, "estimular" o filho a viver sua sexualidade de maneira "precoce"; e o fato de os pais também terem recebido pouca ou nenhuma orientação sexual por parte de suas famílias. Diante das narrativas dos pais, é possível perceber que ainda são muitos os mitos, tabus e preconceitos que permeiam a sexualidade dos jovens com Síndrome de Down, demonstrando que os responsáveis estão despreparados para dar as devidas orientações.(AU)

This study sought to know the difficulties and barriers of parents in the sexual education of young people with Down Syndrome, from a descriptive, qualitative study, using the concept of social representations as a theoretical-methodological framework. The study was conducted in a Non-Governmental Organization (NGO), located in Recife (PE) after approval by the Ethics and Research Committee, under substantiated opinion 3,558,587. The study sample involved 11 parents of young people with Down Syndrome aged between 15 and 24 years. The data collection was carried out by using semi-structured interviews. The approach chosen for interpretation of these data was the content analysis proposed by Bardin. The main difficulties faced by parents in talking with their children about sexuality can be listed as: the infantilization of young persons with Down Syndrome, deeming them incapable of experiencing such phenomena and understanding the guidance that could be given; the fear of overshooting the stages and, suddenly, "stimulating" the child to live their sexuality in an "early" way; and the facts of the parents also having received little or no sexual guidance from their families. Given the parents' narratives, it is possible to realize that there are still many myths, taboos, and prejudices that permeate the sexuality of young people with Down Syndrome, demonstrating that parents were unprepared to provide the right guidance.(AU)

Este estudio buscó conocer las dificultades y barreras de los padres en la educación sexual de los jóvenes con síndrome de Down a partir de un estudio descriptivo, cualitativo, que utilizó el concepto de representaciones sociales como marco teórico-metodológico. La investigación se llevó a cabo en una Organización No Gubernamental (ONG), ubicada en la ciudad de Recife (Pernambuco, Brasil), después de la aprobación del Comité de Ética e Investigación, bajo la opinión fundamentada 3.558.587. La muestra del estudio incluyó a 11 padres de jóvenes con síndrome de Down con edades comprendidas entre 15 y 24 años. La recolección de datos se realizó mediante entrevista semiestructurada. El enfoque elegido para la interpretación de los datos fue el análisis de contenido propuesto por Bardin. Pueden enumerarse como las principales dificultades que enfrentan los padres para hablar sobre la sexualidad con sus hijos: la infantilización del joven con síndrome de Down, considerándolo incapaz de experimentar tales fenómenos y comprender la orientación que se le puede dar; el miedo de ir más allá de las etapas y, de repente, "estimular" al niño a vivir su sexualidad de una manera "temprana"; y el hecho de que los padres también habían recibido poca o ninguna orientación sexual de sus familias. Dadas las narraciones de los padres, es posible darse cuenta de que todavía hay muchos mitos, tabúes y prejuicios sobre la sexualidad de los jóvenes con síndrome de Down, lo que muestra que los padres no estaban preparados para brindarles este tipo de orientación.(AU)

Health and Self-Care from the Perspective of Institutionalized Adolescents / Saúde e Autocuidado na Perspectiva de Adolescentes Institucionalizadas / La Salud y el Autocuidado desde la Perspectiva de Adolescentes Institucionalizadas

Abstract The health of institutionalized adolescents is permeated by peculiarities that are influenced by the different contexts in which they develop. This study aimed to understand the conceptions about health and self-care elaborated by adolescents under protective measures of institutional shelter, in the light of the Bioecological model. This is a qualitative and exploratory study, based on the Bioecological Theory. Fourteen adolescent girls participated in the study. Based on the ecological insertion methodology, data were collected from a field diary, medical records, a questionnaire, and semi-structured interviews, subjected to thematic content analysis. A plurality of understandings about health and self-care was verified, which are more associated with the institutional experience than with family life and evidenced a lack of actions that support healthcare habits and autonomy of adolescents within the family unit.

Resumo A saúde da adolescente institucionalizada é permeada por peculiaridades que são influenciadas pelos diferentes contextos em que se desenvolve. Este estudo teve como objetivo compreender as concepções sobre saúde e autocuidado com a saúde elaboradas por adolescentes em medida protetiva de acolhimento institucional, à luz do modelo Bioecológico. Estudo qualitativo e exploratório, embasado na Teoria Bioecológica. Participaram 14 adolescentes do sexo feminino. A partir da inserção ecológica os dados foram coletados por diário de campo, prontuário, questionário e entrevistas semiestruturadas, submetidas à análise temática do conteúdo. Verificou-se uma pluralidade de compreensões sobre saúde e autocuidado, que estão mais associadas à vivência institucional do que à convivência familiar e evidenciaram carência de ações que apoiem os hábitos de cuidados com a saúde e a autonomia das adolescentes dentro do núcleo familiar.

Resumen La salud de la adolescente institucionalizada tiene peculiaridades que están influenciadas por los diferentes contextos en los que se desarrollan. Este estudio tuvo como objetivo comprender las concepciones sobre la salud y el autocuidado de la salud elaboradas por las adolescentes en medidas de protección del acogimiento institucional, a la luz del modelo Bioecológico. Este es un estudio cualitativo y exploratorio, basado en la Teoría Bioecológica. Participaron 14 adolescentes mujeres. A partir de la inserción ecológica, los datos fueron recolectados mediante diario de campo, fichas médicas, cuestionario y entrevistas semiestructuradas, sometidas a análisis de contenido temático. Se verificó una pluralidad de comprensiones sobre la salud y el autocuidado, que están más asociadas a la experiencia institucional que a la vida familiar y mostraron una falta de acciones que apoyen los hábitos de cuidado de la salud y la autonomía de las adolescentes dentro del núcleo familiar.

Factors associated with the type of violence perpetrated against adolescents in the state of Pernambuco, Brazil.

To analyze the factors associated with the types of violence against adolescents reported in Pernambuco, Brazil, from 2009 to 2012. Prevalence study conducted through an electronic database from the Violence Surveillance Official System in a population of 5259 adolescents (aged 10-19 years). Poisson regression was used, with significance level at 5%. There was a significant increase of 204% in the number of violence reports, and the number of reporting units increased by 92.6%. When separately evaluated, physical violence was the most prevalent type, accounting for 44.7% of the reports. Taking as independent variables the age range of 15-19 years, female, having no disability, and public roads as place of occurrence, the positively and independently associated factors were: male gender (OR 1.5, 95% CI 1.4-1.6) with physical violence; having deficiency (OR 1.7, 95% CI 1.5-2.0) with psychological violence; age range of 10-14 years (PR 2.4, 95% CI 2.2-2.6) with sexual assault; and male (OR 3.9, 95% CI 2.0-7.5), having disabilities (PR 4.6, 95% CI 2.7-9.7), and occurrence in residence (PR 2.8, 95% CI 1.3-6.1) with neglect. Age between 10 to 14 years was associated with the occurrence of sexual assault; male with the occurrence of physical violence and neglect; having disabilities with psychological violence and neglect; and occurrence in the residence was associated with neglect.

Impact of Covid-19 on the mental health, quality of life and level of physical activity in university students / Impacto da Covid-19 na saúde mental, qualidade de vida e nível de atividade física em universitários

Young people can have negative repercussions on their mental health, quality of life and on illnesses related to physical inactivity due to social isolation and fear of the disease (Covid-19). This study aimed to analyze the impact of the Covid-19 pandemic on the quality of life, level of physical activity and mental health of university students. College students (16-24 years old) completed an online interview, considering possible changes in mental health, quality of life and physical activity level, evaluating the moment before and during the pandemic. The recruitment strategy of the participants was the snowball type. 1,167 young people (69.2%-women) attended in the study, of which 8.8% had a confirmed diagnosis of Covid-19. There was a worsening in all scores of quality of life, stress and depression during the pandemic when compared to the period prior to the pandemic (p < 0.001). The pandemic also increased inactivity among young people (49.1% vs 28%, p < 0.001). Female students, from the health area, who had their own home and who did not have confirmed diagnosis of Covid-19 showed increased stress in the pandemic period. The Covid-19 pandemic worsened the indicators of mental health, quality of life and level of physical activity among university students. It is noteworthy that despite not being a risk group for the aggravation of the disease and consequent higher mortality, restrictions related to the pandemic limited or prevented the movement of people and this isolation can represent important changes in health in the medium and long term in this population

Jovens podem ter repercussões negativas em sua saúde mental, qualidade de vida e em doenças relacionadas com a inatividade física devido ao isolamento social e medo da doença (Covid-19). Este estudo teve como objetivo analisar o impacto da pandemia da Covid-19 na qualidade de vida, nível de atividade física e saúde mental de jovens universitários. Jovens universitários (16 a 24 anos) completaram uma entrevista online, considerando possíveis mudanças na saúde mental, qualidade de vida e nível de atividade física considerando o momento anterior e durante a pandemia. A estratégia de recrutamento dos participantes foi do tipo bola de neve. Participaram 1.167 jovens (69,2% mulheres), dos quais 8,8% tiveram diagnóstico de Covid-19 confirmado. Houve uma piora em todos os escores de qualidade de vida, estresse e depressão durante a pandemia quando comparados com o período anterior à pandemia (p < 0,001). A pandemia também aumentou a inatividade nos jovens (49% vs 28%, p < 0,001). Estudantes do sexo feminino, da área de saúde, que tinham casa própria e que não tiveram diagnóstico confirmado de Covid-19 apresentaram aumento do estresse no período pandêmico. A pandemia Covid-19 piorou os indicadores de saúde mental, qualidade de vida e nível de atividade física de jovens universitários. Chama atenção que apesar de não ser um grupo de risco para o agravamento da doença e consequente maior mortalidade, restrições relacionadas a pandemia limitaram ou evitaram a circulação de pessoas e esse isolamento pode representar importantes modificações na saúde a médio e longo prazo nesse público

[Completeness of notifications of violence perpetrated against adolescents in the State of Pernambuco, Brazil]. / Completitude das notificações de violência perpetrada contra adolescentes em Pernambuco, Brasil.

The scope of this study was to analyze the trend of completeness of the data on violence perpetrated against adolescents registered in the State of Pernambuco between 2009 and 2012. This involved a cross-sectional survey of 5,259 adolescents, who were the victims of violence reported in SINAN-VIVA of the Pernambuco State Health Department. Simple linear regression was used to investigate the trend of completeness of the variables. The percentages of completeness were considered to be dependent variables (Y) and the number of years as independent variables (X). The results show a significant increase of 204% in the number of notifications. However, of the 34 variables analyzed, 27 (79.4%) showed a stationary trend, 6 (17.6%) a downward trend, and only one variable (2.9%) an upward trend. Completeness was considered 'Very Poor' for the variables: Education (47.3%), Full Address (21.3%), Occurrence Time (38%) and Use of Alcohol by the Attacker (47%). Therefore, despite the large increase in the number of notifications, data quality continued to be compromised, hampering a more realistic analysis of this group.

Consumo de álcool e drogas ilícitas e envolvimento de adolescentes em violência física em Pernambuco, Brasil / Alcohol and illicit drug consumption and involvement by adolescents in physical violence in Pernambuco, Brazil / Consumo de alcohol y drogas ilícitas e implicación de adolescentes en violencia física en Pernambuco, Brasil

O objetivo foi estimar a prevalência e analisar a associação do consumo de álcool e drogas ilícitas com indicadores de violência física em adolescentes. Estudo transversal repetido com estudantes do Ensino Médio em escolas da rede pública em Pernambuco, Brasil (2006, n = 4.207; 2011, n = 6.264). Os dados foram obtidos por questionário. Os indicadores de violência física foram: vitimização por violência física; envolvimento em brigas. As variáveis independentes foram: consumo de álcool e uso de drogas ilícitas. A regressão logística binária foi utilizada para verificar a associação entre o consumo de álcool e drogas e ter sofrido violência física. A prevalência do consumo de álcool por adolescentes que sofreram violência física reduziu em cinco anos, porém, nenhuma alteração foi constatada no uso de drogas ilícitas. As variáveis comportamentais estiveram associadas aos diferentes indicadores de violência, apresentando em geral uma tendência de aumento. Em 2006, adolescentes que usavam drogas ilícitas apresentaram uma chance 2,12 maior de sofrer violência física, e em 2011 este valor foi de 2,41 (IC95%: 1,80; 3,22). A chance de adolescentes que consumiam bebida alcoólica ter envolvimento em brigas aumentou de 1,96 (IC95%: 1,64; 2,34) em 2006, para 2,11 (IC95%: 1,78; 2,51) em 2011. O consumo de álcool pelos adolescentes que sofreram violência física diminuiu em cinco anos, entretanto, o risco de os adolescentes que consumiram bebida alcoólica ou usaram drogas ilícitas sofrerem violência física aumentou ao longo de cinco anos.

The article aimed to estimate prevalence and analyze the association between alcohol and illicit drug consumption and indicators of physical violence in adolescents. A repeated cross-sectional study was performed in public middle-school students in the State of Pernambuco, Brazil (2006, n = 4,207; 2011, n = 6,264). Data were obtained via a questionnaire. Indicators of physical violence were: victimization by physical violence and involvement in fights. The independent variables were alcohol and illicit drug consumption. Binary logistic regression was used to verify the association between alcohol and drug consumption and victimization from physical violence. Prevalence of alcohol consumption in adolescents that suffered physical violence decreased in five years, but no change appeared in the use of illicit drugs. The behavioral variables were associated with different indicators of violence, generally presenting an upward trend. In 2006, adolescents that used illicit drugs showed 2.12 higher odds of suffering physical violence, and in 2011 this value was 2.41 (95%CI: 1.80; 3.22). The odds of adolescents that consumed alcoholic beverages being involved in fights increased from 1.96 in 2006 (95%CI: 1.64; 2.34) to 2.11 in 2011 (95%CI: 1.78; 2.51). Alcohol consumption by adolescents that suffered physical violence decreased in five years, but the risk of adolescents that consumed alcohol or used illicit drugs and suffered physical violence increased over the course of five years.

El objetivo fue estimar la prevalencia y analizar la asociación del consumo de alcohol y drogas ilícitas con indicadores de violencia física en adolescentes. Se realizó un estudio transversal, repetido con estudiantes de enseñanza media en escuelas de la red pública en Pernambuco, Brasil (2006, n = 4.207; 2011, n = 6.264). Los datos se obtuvieron mediante cuestionario. Los indicadores de violencia física fueron: victimización por violencia física; implicación en peleas. Las variables independientes fueron consumo de alcohol y uso de drogas ilícitas. La regresión logística binaria fue utilizada para verificar la asociación entre consumo de alcohol y drogas y haber sufrido violencia física. La prevalencia del consumo de alcohol en adolescentes que sufrieron violencia física se redujo en cinco años, a pesar de que no se constató ninguna alteración en el uso de drogas ilícitas. Las variables comportamentales estuvieron asociadas a los diferentes indicadores de violencia, presentando en general una tendencia de aumento. En 2006, adolescentes que usaban drogas ilícitas presentaron una oportunidad 2,12 mayor de sufrir violencia física y en 2011 ese valor fue de 2,41 (IC95%: 1,80; 3,22). La oportunidad de adolescentes que consumían bebidas alcohólicas de que tuvieran implicación en peleas aumentó de 1,96 (IC95%: 1,64; 2,34) en 2006, a 2,11 (IC95% 1,78; 2,51) en 2011. El consumo de alcohol por parte de los adolescentes que sufrieron violencia física disminuyó en cinco años, no obstante, el riesgo de los adolescentes que consumieron bebidas alcohólica o consumieron drogas ilícitas sufrieran violencia física aumentó a lo largo de cinco años.

[Meanings attributed by children and adolescents to court cases concerning sexual crimes]. / A escuta de crianças e adolescentes nos processos de crimes sexuais.

This paper addresses the perception of members of the judiciary regarding the introductory deposition. The concept of comprehensive protection was used as a theoretical benchmark. It involves qualitative research, in which the semi-structured interview enabled the production of data, organized according to the content analysis technique, resulting in the following themes: production of evidence; protection; and challenges/needs. A positive perception of the interview was expressed in all themes. It became clear, however, that the culture observed in the judiciary arises as an obstacle to conducting the introductory deposition, since it is necessary to adapt the institution in order to apply the methodology. The enhancement of the physical infrastructure and training of the judiciary clerks are challenges to be overcome for the implementation of the interview as one of the court case procedures involving children and adolescents who are the victims or witnesses of violence.

Judiciary as the last resort to protect children and adolescents: intersectoral actions, investment in human resources, and structuring of services.

This study aimed to identify the work developed by the Judiciary to prevent sexual violence against children and adolescents within the family. The approach to social representations in a cultural perspective was used. The field study consisted in the 1st and 2nd Court of Crimes against Children and Adolescents, at the State Supreme Court of Pernambuco, Brazil. Participant observation, semi-structured interviews, and focus group with 17 subjects were the techniques for data collection, analyzed through the interpretation of meanings, allowing the identification of the category "The Judiciary as the ultimate level" and the following subcategories: "The public policies to prevent violence" and "The structure and dynamics of Courts". This study allows the visualization of the Judiciary's limitations with regard to the full protection and absolute priority, and that the work along with the victims demands investments in structure and human resources.

[Nursing actions face to sexual violence against children and adolescents]. / Atuação da enfermagem frente à violência sexual contra crianças e adolescentes.

The objective of this work was to think over the sexual violence against children and adolescents, focusing on the nurses` performance regarding their professional practice and Brazilian legislation. This is a bibliographical study in which 31 publications covering the period from 2005 until 2008 were researched. Through content analysis, thematic modality, the knowledge characterization was obtained in three cores: attention towards children and adolescents' health, notification and professional qualifications. The nurse must be able to care of children and adolescents based on the laws that protect them, being an imperative for that the involvement of health services, class entities and universities.

Enfrentamento da violência doméstica contra crianças e adolescentes na perspectiva de enfermeiros da atenção básica / El enfrentamiento de la violencia domestica contra niños y adolescentes bajo la perspectiva de enfermeros de la atención básica / Coping with domestic violence against children and adolescents from the perspective of primary care nurses

RESUMO Objetivo Analisar as ações relatadas por enfermeiros da atenção básica no enfrentamento da violência doméstica contra crianças e adolescentes. Métodos Pesquisa qualitativa, realizada em cinco Unidades de Estratégia de Saúde da Família do Estado de São Paulo, Brasil. Dados coletados no segundo semestre de 2013 através de entrevistas semiestruturadas com cinco enfermeiras e analisados através de análise de conteúdo, modalidade temática. Resultados Emergiram dois núcleos temáticos: "Políticas públicas identificadas pelas enfermeiras" e "Ações das enfermeiras diante da violência permeadas por medos e conflitos". As enfermeiras conheciam as políticas públicas, mas não conseguiam colocá-las em prática; estavam despreparadas para identificar e enfrentar a violência; não participavam de cursos de capacitação; temiam notificar os casos detectados de violência. Conclusão As principais limitações ao trabalho prático dos enfermeiros são a sobrecarga de trabalho, a falta de segurança e a dinâmica de trabalho desarticulada com a rede de proteção as quais levam à subnotificação dos casos de violência.

RESUMEN Objetivo Analizar las acciones relatadas por enfermeros de la atención básica en el enfrentamiento de la violencia doméstica contra niños y adolescentes. Método Investigación cualitativa, desarrollada en cinco Centros de Salud de Familia del estado de São Paulo, Brasil. Datos recolectados en la segunda mitad de 2013, mediante entrevistas semiestructuradas con cinco enfermeras y analizados a través de análisis de contenido, modalidad temática. Resultados Emergieron dos núcleos temáticos: "Políticas públicas identificadas por las enfermeras" y "Acciones de las enfermeras ante la violencia permeadas por miedos y conflictos". Las enfermeras conocían las políticas públicas, pero no lograban colocarlas en práctica; no estaban preparadas para identificar y enfrentar la violencia; no participaban de cursos de capacitación; temían notificar los casos detectados de violencia. Conclusión Las principales limitaciones para el trabajo práctico de las enfermeras son la sobrecarga de trabajo, la falta de seguridad y la dinámica del trabajo desarticulada con la red de apoyo, que conducen a subregistro de casos de violencia.

ABSTRACT Objective To analyse the actions reported by primary care nurses in the fight against domestic violence against children and adolescents. Methods Qualitative research conducted at five family health centres in the state of São Paulo, Brazil. Data were collected in the second half of 2013 through semi-structured Results Two thematic cores emerged: "Public policies identified by the nurses" and "Nurses' actions regarding violence permeated by fear and conflicts". The nurses were familiar with public policies, but they were unable to put them into practice; they were unprepared to identify and cope with the violence; they did not participate in training courses; they were afraid to report the detected cases of violence. Conclusion The main limitations to the practical work of nurses are work burden, lack of security, and the dynamics of work that is not articulated with the protection network, which causes the underreporting of cases of domestic violence.

Completitude das notificações de violência perpetrada contra adolescentes em Pernambuco, Brasil / Completeness of notifications of violence perpetrated against adolescents in the State of Pernambuco, Brazil

Resumo O objetivo deste trabalho foi analisar a tendência da completitude dos dados de violência perpetrada contra adolescentes registrados em Pernambuco, em 2009-2012. Estudo transversal, com 5.259 adolescentes vítimas de violência notificadas no SINAN-VIVA da Secretaria Estadual de Saúde de Pernambuco. Utilizou regressão linear simples para investigar a tendência de completitude das variáveis. Os percentuais de completitude foram considerados como variáveis dependentes (Y) e os anos da série, como independentes (X). Os resultados mostram um incremento significativo de 204% no número de notificações. Porém, das 34 variáveis analisadas, 27 (79,4%) apresentaram tendência Estacionária, 6 (17,6%) Decrescente e apenas uma (2,9%) Crescente. A completitude foi considerada ‘Muito Ruim’ para as variáveis: Escolaridade (47,3%), Complemento (21,3%), Hora da Ocorrência (38,0%) e Uso de Álcool Pelo Agressor (47,0%). Portanto, apesar do grande incremento no numero de notificações, a qualidade dos dados permaneceu comprometida, dificultando uma análise mais realista neste grupo.

Abstract The scope of this study was to analyze the trend of completeness of the data on violence perpetrated against adolescents registered in the State of Pernambuco between 2009 and 2012. This involved a cross-sectional survey of 5,259 adolescents, who were the victims of violence reported in SINAN-VIVA of the Pernambuco State Health Department. Simple linear regression was used to investigate the trend of completeness of the variables. The percentages of completeness were considered to be dependent variables (Y) and the number of years as independent variables (X). The results show a significant increase of 204% in the number of notifications. However, of the 34 variables analyzed, 27 (79.4%) showed a stationary trend, 6 (17.6%) a downward trend, and only one variable (2.9%) an upward trend. Completeness was considered ‘Very Poor’ for the variables: Education (47.3%), Full Address (21.3%), Occurrence Time (38%) and Use of Alcohol by the Attacker (47%). Therefore, despite the large increase in the number of notifications, data quality continued to be compromised, hampering a more realistic analysis of this group.

Rede de atendimento ao adolescente em situação de violência: percepções dos profissionais de saúde / Attention network to adolescents in situations of violence: perceptions of health professionals

O estudo objetivou compreender as percepções dos profissionais de saúde sobre a configuração dos vínculos entre um serviço de saúde e as instituições envolvidas na rede de enfrentamento da violência contra adolescentes. Estudo descritivo exploratório de abordagem qualitativa, realizado em 2013. Participaram do estudo gerentes de serviços de um hospital de referência para atendimento aos casos de violência, de uma capital do nordeste brasileiro. Os dados foram coletados por preenchimento do mapa de vínculos e entrevistas semiestruturadas, analisados por meio da técnica análise de conteúdo, modalidade temática. Os sujeitos reconhecem o serviço de saúde na rede de atendimento como relevante, entretanto identificaram limites de ordem política e estrutural. Conclui-se que a rede de atendimento é valorizada, mas considerada insuficiente e carente de normas técnicas específicas. É necessário o fortalecimento dos vínculos institucionais, de forma, que o trabalho em rede, contribua efetivamente com as ações de caráter integral, intersetorial e interdisciplinar.

The study aimed to comprehend perceptions of health professionals about the configuration of links between health services and institutions involved in the network to cope with violence against adolescents. An exploratory descriptive study of qualitative approach, conducted in 2013. Service managers of a reference hospital that attends violence cases participated in the study. The hospital was located in a capital at the northeast region of Brazil. Data were collected by filling the map of connections and semi-structured interviews, analyzed through content analysis technique, theme analysis. The subjects recognize health service in the attention network as relevant, however they identified political and structural limits. In conclusion, the attention network is valued, but considered insufficient and lacking specific technical norms. The strengthening of institutional links is necessary in a way that networks will effectively contribute to actions of integral, inter-sectoral and interdisciplinary character.

NETWORK ACTION FOR THE CARE OF ADOLESCENT VICTIMS OF VIOLENCE: CHALLENGES AND POSSIBILITIES / ACTUACIÓN EN RED EN EL ATENDIMIENTO AL ADOLECENTE VÍCTIMA DE VIOLENCIA: DESAFÍOS Y POSIBILIDADES / ATUAÇÃO EM REDE NO ATENDIMENTO AO ADOLESCENTE VÍTIMA DE VIOLÊNCIA: DESAFIOS E POSSIBILIDADES

The aim of the present study was to investigate the perception of health care service managers about the network action for the care of adolescent victims of violence. A qualitative, exploratory, descriptive study conducted from May to July of 2013. The subjects were 15 managers of a hospital that is a referral center for cases of violence in the Brazilian State of Pernambuco. Data were collected through semi-structured interviews and explored using content analysis. The results indicate that social work plays an aggregating and interconnecting role as required by the network action. The health care network is appreciated, but regarded as providing insufficient actions, with lack of standardization of care and service flow. We conclude that the subjects show a positive perception of the role of the studied service, but they point out a lack of specific technical standards in the health care sector aimed at high quality care for adolescents.

Objetiva investigar la percepción de los jefes de servicios de salud respecto a la actuación en red para el atendimiento a adolecentes víctimas de violencia. Estudio descriptivo, exploratorio, con enfoque cualitativo. El objeto del estudio fueron 15 jefes de servicios de salud en Pernambuco, Brasil. Los datos fueron recopilados por intermedio de entrevistas no estructuradas, explorados con base en el Análisis de Contenido. Los resultados indican que el servicio social ejerce una función de agregar y articular requerida por el servicio en red. La red de atendimiento es valorada, sin embargo es considerada insuficiente respecto a acciones, con falta de regularización del socorro y del atendimiento. Se concluye que el objeto en estudio demuestra percepción positiva de la función del servicio estudiado, aunque apunta carencia de normas técnicas específicas en el área de la salud dirigidas a un atendimiento de calidad para adolecentes.

O objetivo deste estudo foi investigar a percepção de gerentes de serviços de saúde sobre a atuação em rede para o atendimento aos adolescentes vítimas de violência. Estudo descritivo, exploratório, com abordagem qualitativa, realizado de maio a julho de 2013. Os sujeitos foram 15 gerentes de serviços de um hospital de referência para atendimento aos casos de violência, no Estado de Pernambuco, Brasil. Os dados foram coletados por meio de entrevistas semiestruturadas, explorados com base na Análise de Conteúdo. Os resultados indicaram que o serviço social exerce um papel agregador e articulador requerido pela atuação em rede. A rede de atendimento é valorizada, mas considerada insuficiente em ações, com falta de normatização da assistência e do fluxo de atendimento. Conclui-se que os sujeitos demonstram percepção positiva do papel do serviço estudado, mas apontam carência de normas técnicas específicas no setor da saúde voltadas a uma atenção de qualidade para adolescentes.