This study examined the association between poverty and child neglect. The existence of a general association has been established for some time. However, there is much debate, and little detailed research, on the specific processes that create this association. This study focused on the form of neglect that involves the most health risk for children—physical neglect. It was hypothesized that poverty should increase the likelihood of a specific type of physical neglect, neglect of safety and basic needs, occurring more than other types. Using official child protective services data from a national data set three types of physical neglect were examined: abandonment, lack of safety or basic needs, and inadequate supervision. Hypothesis 1 was that poverty increases the odds of safety/basic needs neglect more than it influences the odds of either abandonment neglect or inadequate supervision neglect, controlling for prior neglect. Hypothesis 2 focused on a test of whether the link between poverty and physical neglect is not direct, but is instead mediated by caregiver stress. Three waves of longitudinal data were used for this test to establish causal time order between poverty and stress, and between stress and physical neglect. This study analyzed data from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), Assessments 0-3 from the National Data Archive on Child Abuse and Neglect at Cornell University. The data was analyzed using multinominal logistic regression for both models. The results did not confirm Hypothesis 1, though the analysis was limited somewhat due to low frequencies of some physical neglect types in certain age groups. Hypothesis 2 was confirmed showing that the effect of poverty on physical neglect was completely mediated by caregiver stress for the abandonment and safety/basic needs types of physical neglect. Implications of the results for research on the effects of poverty on child neglect, and for preventing child neglect are discussed. / Graduation date: 2012

Guardianship maltreatment is one of the most harmful crimes to a society, but the literature is somewhat neglected about it, for example, in comparison with the offense of battering a person living in common dwelling, namely domestic violence. Even so, it devotes some attention, at least that part of the issue related to the particular child victims of this crime. Crimes against persons who are unable to care for themselves on their own and are dependent on the care of another person who subsequently hurting is the socially very harmful or even liquidation. This offense is special both in terms of characteristics of the offender, and in terms of its subject, which is a victim of this crime. The most important peculiarity is that the object of attack is a person who is in the care of another. That person is helpless, unable to care for themselves properly. This is followed by another peculiarity of this crime, which is the relationship of the perpetrator to the victim. This has to be helping the victim in dealing with matters of everyday life and be so supportive to him. Instead, he uses this dependence, helplessness and utter reliance of the victim's person and tortures him. The sad truth is that most of the crime is committed by family members of the victim, that the victim of the person closest to him to...

ABSTRACT INTRODUCTION: Studies on the topic of adverse childhood experiences (ACEs) and childhood obesity collectively indicate an association, but there is a lack of replication in nationally representative sample of children aged 10-17 years. This study aims to expand on the definition of ACEs to include: socio-economic hardship, racial discrimination, witness or victim of neighborhood violence, and bereavement, and to examine their individual and joint association with BMI levels, especially childhood obesity (primary outcome). METHODS: The 2011-2012 National of Children’s Health (NSCH) was used for this study (N=45,309). One child interview weight was produced; hence, the estimates are generalized to all non-institutionalized children 10-17 years of age in the US and each state. Statistical methods used included descriptive statistics and multivariable multinomial logistic regression models. ACEs examined included: (1) Socioeconomic hardship, (2) Parental divorce or separation, (3) Bereavement, (4) Incarcerated family member, (5) Witness to domestic violence, (6) Victim/witness of neighborhood violence, (7) Household mental illness, (8) Household substance abuse, (9) Racial discrimination. BMI for the same sex and age (10-17 years) percentile relative measurement, using growth charts recommended by CDC, among children and teens were used as indicators of BMI. BMI-95th percentile or greater was considered obese. RESULTS: The prevalence of childhood obesity and ACE exposure was higher for boys compared to girls. Controlling for gender, among those who were obese, White-non-Hispanic children had the highest prevalence of obesity compared to other races for both genders. Southern States constituted 80% and 60 % of top 10 states with the highest prevalence of childhood obesity and ACE, respectively. Approximately 25.4 million (89.5%) children aged 10-17 years had experienced 3 or less ACE. The most prevalent ACE category of nine asked about for child was-living with parents who were either divorced or separated after his/her birth (26.77%) and the least prevalent was living with a parent who died (4.84 %). ACEs were not mutually exclusive, and all nine categories of ACEs were interrelated. The adjusted odds ratio of covariates to their reference groups that were only statistically significant for childhood obesity relative to healthy weight encompassed: a) Place of residence in metropolitan statistical area, b) two or more chronic health conditions of 18 asked about, c) Watching TV, videos, or playing video games across categories >1 to≥4 hours, d) family members in the household eat a meal together 7 days of the week, e) and computer, cell phone or electronic device use ≤1 hour. Moreover, the explanatory variables, namely, age, sex, the physical health status of parents, and physical activity, were strongly related to childhood obesity (associated both with higher odds and lower odds of outcome) compared to overweight and underweight BMI categories. CONCLUSIONS: This is the first study to explore the co-occurrence, individual and joint association of ACEs with childhood obesity using nationally representative sample of children aged10-17 years in the U.S. Having childhood obesity, BMI-95th percentile or above was strongly related to ACE dichotomy, ACE score ≥2 and two ACE types (socioeconomic hardship and bereavement) than the probability of overweight, BMI-85th to 94th percentile. Underweight-BMI less than 5th percentile had only statistically significant association with socioeconomic hardship ACE category. Sociodemographic, parental, and childhood related factors were also independently associated with childhood obesity.

Bullying in the intensive care units. The main mission of this thesis is to describe an issue called mobbing. The primary target is to get information about rate of bullying in the intensive care units in south Bohemia, especially in Prachatice and Strakonice city and to know how many percent of employees / paramedics of the intensive care units were already touched by bullying. This kind of information we got by anonymous questionnaires, set up from 23 questions with open and closed form. In theoretical part I deal with actual status, explaining term of mobbing, bossing, causes of bullying, characteristic of the participants, bullying in the health service in the Czech republic. In the conclusion I show prevention and tolerance of mobbing and bossing. In practical part I point on assesment of hypothesis and evaluation of the target of my thesis. I suppose that the chicane show up in small measure on the workplace of the intensive care units. From my point of view I think that women working in the intensive care units are getting in a touch of bullying much more than men. In this part I want to show a methodology of research, parameter of complex and evaluation of research. In conclusion I get back to evaluation of research and starting a discussion. Key words: mobbing, bullying, bossing, conflict,...

FALEIROS, J. M. Estudo da prevalência de maus - tratos em crianças matriculadas de 1ª à 4ª série do ensino fundamental em escolas da rede pública e particular da cidade de Ribeirão Preto. 150 p. Dissertação (Mestrado) Faculdade de Filosofia Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto. 2006. Os maus-tratos na infância têm se revelado um foco de preocupação no meio científico devido às descobertas das graves conseqüências a curto e longo prazo no desenvolvimento da criança. No meio político e social, no entanto, essa questão, e suas graves conseqüências, parece caminhar ainda muito lentamente na direção do estabelecimento de políticas públicas efetivas. A escassez de estatísticas e a ausência de um conhecimento mais aprofundado das diversas situações de maus-tratos fazem com que a problemática receba uma atenção pouca adequada e especializada. A literatura científica aponta a provável existência de um grande número de casos que não se chega a conhecer, para além dos números divulgados por órgãos oficiais de proteção. Com o objetivo de estimar de forma mais precisa o número de casos de maus-tratos domésticos na cidade de Ribeirão Preto, o presente estudo buscou mensurar a prevalência de maus-tratos, por amostragem, em crianças matriculadas de 1ª a 4ª série do ensino fundamental nos estabelecimentos educacionais da rede pública e particular, a partir de informações obtidas junto ao setor da educação. A investigação adotou uma abordagem quantitativa/descritiva, de caráter epidemiológico. O instrumento utilizado foi a artilha Epidemiológica, já testada em nossa realidade em estudo semelhante, em que se focou a faixa etária de 0 a 6 anos. Esta foi elaborada para abordar os profissionais da educação e, no presente, foi utilizada junto a professores responsáveis por salas de 1ª a 4ª série do ensino fundamental do sistema público e particular do município. Além do número de casos e de suas características, a Cartilha também permite investigar os fatores de risco associados e os indicadores comportamentais/emocionais das crianças assinaladas. Respeitando-se o princípio da aleatoriedade, procedeu-se a um sorteio das escolas, por região da cidade, tendo chegado a um número de 151 professores entrevistados responsáveis por 3.885 crianças. Os resultados indicaram uma prevalência de 3,9% que calculada para a população varia entre 3,3% e 4,6% (IC=95%). Os tipos de maus-tratos assinalados, mais freqüentemente, pelos professores foram Maltrato Emocional, Abandono Emocional e Falta de Controle Parental. O Desemprego, (32%), dificuldades econômicas graves (26%) e baixa escolaridade (26%) foram os fatores de risco mais freqüentemente assinalados nas famílias. 75% das crianças assinaladas têm problemas escolares, parecem não ter interesse em aprender (62%) e parecem ter baixa auto-estima (57%). Ainda, os professores relataram que, pelo menos 72% dos casos assinalados não eram conhecidos dos órgãos oficiais de proteção. Isso significa que em cada sala de aula existe pelo menos uma criança que está vivendo uma situação adversa em casa sem receber qualquer tipo de acompanhamento, confirmando as indicações da literatura quanto ao fato de os dados oficiais serem a ponta do iceberg. Além disso, as crianças assinaladas já estão apresentando conseqüências desenvolvimentais importantes. A negligência como tipo mais freqüente merece ser melhor compreendida em estudos posteriores, devido aos graves danos que provoca às crianças. Em relação aos fatores de risco, os professores assinalaram mais freqüentemente o fato de os adultos das famílias estarem desempregados, passando por dificuldades econômicas e de possuírem baixa escolaridade. Contudo, neste âmbito, o fato de os professores terem pouco conhecimento a respeito das famílias sobressai-se em relação ao que sabem, denotando uma enorme distância entre a família e escola, que deveria ser minorada. / FALEIROS, J.M. Prevalence of maltreatment in children from 7 to 10 years old studying in public and private schools in the city of Ribeirão Preto. 150 p. (Másters degree) Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto. 2006. Child maltreatment has become a focus of concern in scientific literature mainly because of the discoveries of the serious outcomes to child development. In social and politician circles, however, this issue and its serious consequences, seems to walk slowly in the direction of the establishment of effective politics. The lack of statistics and the absence of knowledge about the diverse situations of child maltreatment permits that the problematic still receives insignificant adequate and specialized attention. Scientific literature points the probable existence of a great number of cases that is not known despite the numbers showed by protection agencies. The objective of this study is to estimate the prevalence of maltreatment in children (from 7 to 10 years old) in the city of Ribeirão Preto. A representative sample was used gathering children from public and private schools. Teachers were interviewed answering The Cartilha Epidemiológica already tested in our reality in a similar study for children from 0 to 6 years old. Besides the number of cases and its characteristics, the Cartilha allows investigating the risk factors associated to the child maltreatment and behavioral/emotional problems of the children refereed by teachers. A descriptive/quantitative approach was used to analyze data. 151 teachers who were responsible for 3885 children answered the Cartilha. The results pointed a prevalence of 3,9% (3,3% and 4,6% ,IC=95%). The most frequently types of child maltreatment were: ?Emotional Maltreatment, Emotional Abandonment and Lack of Parental Supervision. The unemployment, (32%), serious economic difficulties (26%) and low level of education (26%) had been the risk factors more frequently in the childrens families. With respect to the behavioral/emocional problems, 75% of children had school problems, 62% had no interest in learning and 57% had low self-esteem. Teachers pointed as well that at least 72% of the maltreated children didn`t receive any attention of protective services. This means that in each classroom exist at least on child suffering form maltreatment without receive any help. These results also confirm the indications of literature with respect to the fact that official data is just the tip of iceberg. Moreover, all these children are presenting important desenvolvimentais outcomes. The negligence as the most frequent form of maltreatment deserves to be better understood in posterior studies. In relation to the risk factors, teachers frequently pointed the unemployment of the adults of the families passing thru economic difficulties and low rates of education. However, is important to consider the fact that teachers have insignificant knowledge about the families denoting an enormous distance between family and school that should be reduced.

Bakgrund: Hälso- och sjukvårdspersonal i Sverige har en lagstadgad skyldighet att göra orosanmälan till Socialtjänsten vid misstanke om att barn far illa. Anmälningsplikten infördes redan under 1920-talet och regleras i socialtjänstlagen. Statistik över inkomna orosanmälningar i Sverige visar att endast cirka 10 procent av anmälningarna kommer från hälso- och sjukvården. Sjuksköterskan spelar en viktig roll när det kommer till att identifiera riskfaktorer för barn som far illa men forskning visar att det av olika anledningar ibland råder osäkerhet och tveksamhet när det kommer till att göra orosanmälningar till Socialtjänsten. Syfte: Syftet var att utforska vad sjuksköterskor på beroendemottagningar har för erfarenheter av och hur de upplever att göra orosanmälan om barn som far illa till Socialtjänsten. Metod: En kvalitativ explorativ design valdes där datainsamling gjordes med semistrukturerade intervjuer. För att bearbeta materialet användes en kvalitativ innehållsanalys med induktiv ansats. Resultat: Analysen resulterade i tre kategorier, ett medvetet förhållningssätt, konsekvenser av handling samt det professionella samarbetets betydelse med sammanlagt sex underkategorier.  Diskussionen fördes utifrån Sigridur Halldórsdóttirs teori om caring and uncaring samt tidigare relevant forskning och litteratur. Slutsats: Att ha barnperspektivet underlättar för sjuksköterskor i beslutsfattandet av att göra orosanmälan för barn som far illa och kan även vara ett stöd i kommunikationen med patienten. / Background: Healthcare professionals in Sweden have a statutory obligation to report suspected child maltreatment to the Social Services. The notification requirement was introduced already in the 1920: s and is regulated in the Social Services Act. Statistics on incoming reports in Sweden show that only about 10% of the notifications come from the healthcare system. Nurses play an important role when it comes to identifying risk factors for child maltreatment, but research shows that for various reasons, there is sometimes uncertainty and doubt when it comes to making reports to the Social Services. Aim: The aim of this study was to explore nurses experience of reporting suspected child maltreatment to the Social Services. Method: A qualitative explorative design was chosen where data collection was done with semistructured interviews. A qualitative content analysis with inductive approach was used to analyze the collected material. Results: The analysis resulted in three categories, a conscious approach, consequences of action and the importance of professional cooperation with a total of six subcategories. The discussion was based on Sigridur Halldórsdóttir's theory of caring and uncaring, as well as previous relevant research and literature. Conclusions: Having the child perspective makes it easier for nurses to make the decision to report concern for child maltreatment and can also support the communication with the patient.

Background: Parent behaviours have a long-lasting impact on the health, education, and behaviour of the young people in their care. Group-based parenting interventions are a promising approach to improve parenting, as well as to prevent and reduce physical and emotional maltreatment of children. While a billion of adolescents live in low- and middle- income countries, few evaluations have examined parenting approaches for families with adolescents in these countries. Objectives: This study was nested within a randomised controlled trial of Sinovuyo Teen, a parenting programme for families with adolescents. The trial took place in rural South Africa in 2015-2016 with 552 families in 40 study clusters. Primary intervention outcomes included parenting and child maltreatment. This dissertation aims to: (1) describe the implementation (attendance, engagement, and fidelity) of the intervention delivered within the evaluation, (2) examine if participant characteristics affected attendance and engagement in the intervention, (3) examine if implementation characteristics affected programme results, and (4) examine if participant characteristics affected programme results. Methods: Programme implementation was assessed through observations of all programme group sessions and the records of the implementing organisation. The analyses also draw on participant self-report data from three time-points (baseline, immediate post-test, and follow-up). The data were analysed using a series of correlation and multilevel regression analyses, presented in three papers. Findings: Attendance levels in the intervention were somewhat lower than in previous similar studies, perhaps due to the role of home visits. Generally, more disadvantaged families participated at similar rates as families with more material and social resources. However, a number of factors affected attendance on individual and family levels, e.g. an overcrowded household, and at the community level, e.g. funeral and grant receipt days. Intervention fidelity was similar to the levels reported in high-income countries, thus suggesting that high implementation quality is feasible in a low-resource setting. There was no consistent impact of the variation in participation and implementation on participant outcomes. Baseline risks did not consistently affect variation in treatment effects, confirming recent findings that families at-risk can benefit from parenting support as much or more than less at-risk families.

Made available in DSpace on 2014-12-17T15:39:06Z (GMT). No. of bitstreams: 1 RodrigoSM_DISSERT.pdf: 847068 bytes, checksum: e172632cb10a4a98a38c217ce3b14c71 (MD5) Previous issue date: 2014-05-30 / Esse trabalho objetivou promover a adapta??o transcultural para o Brasil da VASS. Os passos para adapta??o transcultural seguir?o a proposta de operacionaliza??o alicer?ado na aprecia??o de diferentes tipos de equival?ncia: a conceitual e de itens, a sem?ntica e a de mensura??o. Para alcan?ar as duas primeiras etapas utilizou-se as t?cnicas de tradu??o e retrotradu??o associada ao procedimento intitulado Painel de Especialistas. Para o pr?-teste e verifica??o de equival?ncia de mensura??o, aplicou-se o question?rio com uma popula??o de 30 e 66 idosos, respectivamente. Para as an?lises dos resultados foi utilizada a estat?stica descritiva e inferencial, em especial o KR-20, teste T de student, correla??o de Pearson e ANOVA univariada, bem como o m?todo kappa de Fleiss para verifica??o do ?ndice de confiabilidade. Verificou-se que o conceito utilizado para constru??o do instrumento, bem como seus itens se mostram adequados ? investiga??o do fen?meno. Evidenciou-se boa equival?ncia sem?ntica entre os itens das retrotradu??es e do instrumento original, especialmente quanto aos resultados de T1 R1. Os ju?zes optaram pelo uso de 11 itens de T1 ? vers?o-s?ntese. A equival?ncia operacional mostrou-se satisfat?ria. Em geral, os resultados apresentados mostraram-se aceit?veis. Quanto ? etapa da equival?ncia de mensura??o, verificou-se que a idade dos participantes variou entre 60 a 84 anos, prevalecendo respondentes idosas (n = 38), representando 57,6% da amostra estudada. O valor do KR-20 para o escore geral do instrumento foi de 0,688 (IC95%: 0,670). Os valores encontrados para as quatro dimens?es propostas pelos autores do estudo inicial do instrumento foram 0,528, 0,289, 0,552 e 0,303, respectivamente. Apenas os valores de consist?ncia interna das subescalas Vulnerabilidade e Coer??o mostraram-se aproximados aos encontrados no estudo original, a saber, 0,550 e 0,390, respectivamente. Verificou-se que com a retirada dos itens n? 04, n? 06 e n? 10, houve aumento do ?ndice de consist?ncia interna da escala total. J? quanto aos valores da consist?ncia interna das subescalas, percebeu-se que apenas com a retirada dos itens n? 09, referente ? escala que dimensiona o Des?nimo, e n? 12, item da subescala Coer??o, ? que houve acr?scimo nesses valores. Destaca-se que esses s?o resultados preliminares, uma vez que ap?s a verifica??o da adequabilidade e de padr?es psicom?tricos iniciais acerca do uso do instrumento para a popula??o idosa, ainda h? de se dar continuidade ? etapa concernente ? verifica??o de propriedades psicom?tricas robustas do instrumento, que indiquem, por exemplo, evid?ncias de fidedignidade em situa??o de teste-reteste, validade de constructo e de crit?rio, se poss?vel e aplic?vel. A principal limita??o do estudo ? a falta de um instrumento padr?o-ouro para testar a fidedignidade, sensibilidade e especificidade do instrumento em quest?o. Apesar desta limita??o, a adapta??o transcultural e a verifica??o de propriedades psicom?tricas preliminares do instrumento de uma medida de autorrelato que afere indicativo de viol?ncia dom?stica contra o idoso tem sua relev?ncia e foi satisfat?ria

Dois estudos avaliaram o impacto e o processo de um modelo de grupoterapia cognitivo-comportamental para 49 meninas vítimas de abuso sexual com idade entre 9 e 16 anos. O Estudo I avaliou: o impacto do modelo na redução de sintomas de depressão, stress, ansiedade, transtorno do estresse pós-traumático (TEPT) e crenças distorcidas sobre o abuso e o efeito do tempo de espera por tratamento nestes sintomas; a manutenção do impacto da grupoterapia após 6 e 12 meses do término; e os fatores preditores para a resposta à grupoterapia. Os resultados, obtidos através do teste t para amostras pareadas apontaram que o modelo de grupoterapia apresentou impacto positivo, reduzindo significativamente os sintomas avaliados; o efeito da espera entre os grupos não revelou diferença significativa; os efeitos terapêuticos se mantiveram após um ano; e, os fatores preditores da resposta à grupoterapia foram: idade de início do abuso, presença de estupro e sintomas de revivência do TEPT antes da grupoterapia. O Estudo II avaliou o processo terapêutico a partir da análise clínica descritiva de dois casos, considerando as participantes que obtiveram escores extremos na análise da redução de sintomas. Os resultados apontaram que a idade de início do abuso, forma de abuso, experiência de abrigamento, resposta ao treino de inoculação do estresse e percepções de culpa foram aspectos que diferenciaram a resposta à grupoterapia. O modelo avaliado se mostrou efetivo para tratamento de meninas vítimas de abuso sexual. / Two studies assessed the effectiveness impact and process of a cognitive behavioral group therapy model applied to 49 female children and adolescents victims of sexual abuse (9-16 years). The Study I evaluated: the impact of the model in the reduction of symptoms of depression, anxiety, stress, post-traumatic stress disorder (PTSD) and the beliefs on the abusive experience and the effect of being in a waiting list for treatment in these symptoms; the permanence of the group therapy effects impact in a 6 and 12 months follow ups; the predictors factors for a group therapy response. The results, analyzed through the test t, revealed: the model showed positive impact, reducing the evaluated symptoms; the effect of being in the waiting list did not reveal significant difference in both groups; the therapeutic impact were maintained through the follow ups; the predictor factors for a response to group therapy were: age of the sexual abuse, rape presence and re-experiencing symptoms of the PTSD before the group therapy. The Study II assessed the therapeutic process using a two cases clinic analysis, considering the participants that obtained extremes scores in the analysis of symptoms reduction. The results pointed out to: the age of the sexual abuse, rape presence, sheltering, response the stress inoculation training and self perceptions of blame were aspects that explained the different response to the group therapy. The model was effective to the treatment of the girls victims of sexual abuse.

The complex challenges facing the sexual assault nurse examiners program in a midwest state are underreporting, late reporting, and poor coordination of care for pediatric victims of child maltreatment with sexual abuse. The main objective of this quality improvement project was the identification of necessary practice-related approaches to care to decrease barriers associated with reporting suspicions of abuse or neglect. An evidence-based, multidisciplinary assessment clinical toolkit that followed clinical components of trauma-sensitive, child-centered screenings triggering a coordinated response to conduct a forensic medical exam within 96 hours of the alleged incident was evaluated. During 3 rounds of surveys following the Delphi technique, 10 members of an expert panel agreed upon critical success indicators were used for the review and final decision for adoption of the toolkit. The final consensus obtained, with an intraclass correlation of 0.924 with a 95% confidence interval, supported implementation of this trauma-informed toolkit which would ensure that medical care and throughput through the system of care addressed the physical and mental needs of the patient and caregivers as well as improvement in the forensic investigative data collection. A child-centered, trauma-sensitive approach to screening and evaluation by healthcare professionals will help decrease the delay to evaluation and to curtail long-term adverse impacts on survivors. This family-based primary prevention effort is a framework for healthcare practitioners to use and includes strategies (i.e., health history, mental health evaluation, family dynamics evaluation) that are child and family centered contributing significantly to positive social change.