Ana Lúcia Ferreira

A notificação da violência intrafamiliar contra crianças e adolescentes por profissionais de saúde

Reporting family violence against children has two main benefits: it protects the child from the violence and improves epidemiological control of violence. Health professionals play an important role in this area, since they are required to report any known or even suspected case of violence. Nevertheless, when and how to report has been questioned recently. This paper discusses the problems faced by health professionals and suggests specific solutions to the Brazilian case. The authors conclude that it is necessary: (a) to clarify the legal notion of violence in Brazil, specifically the concept of suspicion; (b) to create technical manuals to guide action in this area; (c) to improve the number and quality of services to assist the population; (d) to improve studies and discussion of the consequences of reporting, mainly concerning the notion of justice transmitted to Brazilian families through this practice.

Implicações éticas da violência doméstica contra a criança para profissionais de saúde

Baseando-se em alguns problemas com os quais profissionais de saude se deparam no atendimento a criancas vitimas de violencia, discutem-se as implicacoes eticas da interferencia na dinâmica familiar utilizada para promover a protecao dessas criancas. Partindo do principio de que a violencia contra a crianca e prima facie moralmente errada, aborda-se a questao dos direitos da crianca e discute-se a intervencao praticada a partir de algumas teorias eticas: consequencialismo, utilitarismo e deontologia. Conclui-se que uma interferencia que proteja a crianca, tentando preservar a integridade familiar sempre que possivel, e moralmente justificavel.

A prevenção da violência contra a criança na experiência do Ambulatório de Atendimento à Família: entraves e possibilidades de atuação

O artigo apresenta alguns aspectos relacionados a complexidade do atendimento as criancas vitimas de violencia e suas familias a partir do trabalho desenvolvido pelo Ambulatorio de Atendimento a Familia do Instituto de Puericultura e Pediatria Martagao Gesteira, hospital pediatrico da Universidade Federal do Rio de Janeiro. O objetivo do trabalho e discutir questoes relacionadas a definicao da clientela atendida, a forma como as familias trazem o problema e lidam com a violencia e a limitacao da atuacao da equipe interdisciplinar. Sao tambem abordadas a interferencia de aspectos sociais no acompanhamento dos casos e alguns aspectos da notificacao aos conselhos tutelares. A luz dos problemas discutidos, os autores relatam os procedimentos adotados no Ambulatorio, que representam formas de atuacao no nivel de prevencao terciaria da violencia contra as criancas.

Domestic violence in the conception of health professionals trainers

This article identifies the conceptions and suggestions of professors of medicine and nursing courses about the insertion of this subject in the formation of their students. An exploratory research was carried out using a questionnaire applied to coordinators of disciplines in such courses at public and private universities in the cities of Rio de Janeiro and Cuiabá. Many of them recognizes violence as a health problem, although 40.7% of medicine professors and 71.1% of nursing professors of the two cities discusses this subject in their classes. The medicine professors suggests the insertion of the violence subject in their students formation with visits to institutions, meeting groups with people in violence situations and interviews with experienced professionals of the area. The nursing professors prefer resources such as films and videos, seminaries and conferences. Gaps were also identified in the students and professors formation, which do not feel able to discuss this thematic. It is indicated that a renovation in the curriculum is urgently necessary.

Acompanhamento de crianças vítimas de violência: desafios para o pediatra

OBJECTIVE: To review practical questions about the initial assistance and follow-up of child abuse victims and their families by pediatricians. SOURCES OF DATA: A literature review was carried out using the MEDLINE and LILACS databases, including the years 2000 to 2005. Some articles from past years and books were included due to their importance. SUMMARY OF THE FINDINGS: Initial assistance is one of the most important actions by health professionals for the protection of abused children in different healthcare sectors (community, outpatient clinics, emergency rooms and infirmary), and it is fundamental for the reduction of immediate and long-term negative consequences of violence. The protection services cannot monitor all the families under their responsibility and most child abuse cases are not even reported to those institutions; therefore, regular follow-up by a pediatrician is advisable. It is important to provide the family with support and guidance until the child is safe. The main challenges are: to be involved without causing more violence; to consider all the family as the focus of attention, including the family members who have committed the assault, helping them to change inadequate behaviors; to develop specific abilities to carry out this work, which must be multiprofessional, interdisciplinary and intersectoral. CONCLUSIONS: Families face difficulties when their children are abused and when the situation gains notoriety, demanding interventions from many institutions. In this process, a pediatrician can guide and help them to guarantee the protection and healthy development of their children. To overcome challenges, health professionals have to be technically and emotionally prepared.

Analysis of quality-of-care indicators for physically abused children and adolescents

There has still been limited evaluation in Brazil on the care provided to physically abused children and adolescents. The current study aimed to analyze indicators used in research on services that provide care to such children and adolescents. An exploratory study was conducted, selecting five studies in four services: two nongovernmental organizations in two cities in the interior of São Paulo State and two organizations, one nongovernmental and the other governmental, in the city of Rio de Janeiro. The analysis aimed to identify the indicators used (structure, process, or result) and which aspect of care they proposed to measure (dynamics of care, treatment adherence, case-resolving capacity, and integration with the network). Eighteen process indicators and nine results indicators were identified. A minimum set of essential indicators is recommended to evaluate care for children and adolescents and their families.

Follow-up of child abuse victims: challenges for the pediatrician

OBJECTIVE To review practical questions about the initial assistance and follow-up of child abuse victims and their families by pediatricians. SOURCES OF DATA A literature review was carried out using the MEDLINE and LILACS databases, including the years 2000 to 2005. Some articles from past years and books were included due to their importance. SUMMARY OF THE FINDINGS Initial assistance is one of the most important actions by health professionals for the protection of abused children in different healthcare sectors (community, outpatient clinics, emergency rooms and infirmary), and it is fundamental for the reduction of immediate and long-term negative consequences of violence. The protection services cannot monitor all the families under their responsibility and most child abuse cases are not even reported to those institutions; therefore, regular follow-up by a pediatrician is advisable. It is important to provide the family with support and guidance until the child is safe. The main challenges are: to be involved without causing more violence; to consider all the family as the focus of attention, including the family members who have committed the assault, helping them to change inadequate behaviors; to develop specific abilities to carry out this work, which must be multiprofessional, interdisciplinary and intersectoral. CONCLUSIONS Families face difficulties when their children are abused and when the situation gains notoriety, demanding interventions from many institutions. In this process, a pediatrician can guide and help them to guarantee the protection and healthy development of their children. To overcome challenges, health professionals have to be technically and emotionally prepared.

Concepções de docentes em relação ao manual sobre violência intrafamiliar

INTRODUCTION: The Brazilian Ministry of Health has published a technical manual entitled Domestic Violence: Guidelines for Health Services as a strategy to help identify, intervene in, and prevent domestic violence. OBJECTIVES: To identify insights, criticisms, and suggestions from professors of the various health fields concerning the manual. METHODOLOGY: An exploratory study was conducted, using the three-point method. A questionnaire was given to appropriate health field professors in the cities of Rio de Janeiro and Cuiaba, containing open-ended and closed questions on the manuals characteristics and practicality. RESULTS: The manuals characteristics and practicality were both evaluated as good. However, most professors did not use the manual in their classes, finding its content insufficient for training health professionals. Conclusion: The manual is recommended for use in classes offered at the beginning of academic programs in the various health fields. The aim is to attract the attention of undergraduates in relation to epidemiological and clinical aspects and prevention of domestic violence, without intending to train them to treat victims.

Adaptação e aplicabilidade do componente "maus-tratos" à estratégia da Atenção Integrada às Doenças Prevalentes na Infância no Brasil

OBJETIVOS: descrever o processo de adaptacao ao contexto brasileiro e da aplicabilidade do conteudo do modulo de maus-tratos no âmbito da estrategia Atencao Integrada as Doencas Prevalentes na Infância (AIDPI), a partir do original proposto pela Organizacao Pan-Americana da Saude. METODOS: O protocolo original foi traduzido para o portugues, retro-traduzido e revisado de forma independente. Foram incorporados aspectos relativos a legislacao, contexto de saude e organizacao dos servicos brasileiros. O material foi discutido por especialistas de diferentes areas ate obter consenso a respeito de compreensao e correspondencia sobre os conceitos e os instrumentos propostos. A versao preliminar foi testada com grupo de monitores da estrategia AIDPI. Sugestoes foram incorporadas ao texto. O modulo final foi aplicado com sucesso em treinamento para monitores em AIDPI na Regiao Nordeste. RESULTADOS: o material mostrou-se util, claro e coerente. A classificacao de gravidade para maus tratos psicologicos e negligencia, alem de textos com orientacoes aos profissionais e pais sobre o desenvolvimento psicomotor e emocional normais da crianca foram incluidos. CONCLUSOES: A incorporacao desse modulo de maus-tratos em treinamentos formais na estrategia AIDPI pode preencher uma lacuna na educacao do profissional de saude na atencao primaria, onde problemas relacionados a violencia contra a crianca sao frequentes.

Queimadura de genitália: acidente ou violência? Preocupações que transcendem o tratamento das lesões

Objective: To describe a case of genital burn which raised the suspicion of maltreatment (sexual abuse and neglect by lack of supervision). Case description: An infant was taken to the Emergency Room of a pediatric hospital with an extensive burn in the vulva and perineum. The mother claimed the burn had been caused by a sodium-hydroxide-based product. However, the injury severity led to the suspicion of sexual abuse, which was then ruled out by a multidisciplinary team, based on the consistent report by the mother. Besides, the lesion type matched those caused by the chemical agent involved in the accident and the family context was evaluated and considered adequate. The patient had a favorable outcome and was discharged after four days of hospitalization. Outpatient follow-up during six months after the accident enabled the team to rule out neglect by lack of supervision. Comments: Accidents and violence are frequent causes of physical injuries in children, and the differential diagnosis between them can be a challenge for healthcare workers, especially in rare clinical conditions involving patients who cannot speak for themselves. The involvement of a multidisciplinary trained team helps to have an adequate approach, ensuring child protection and developing a bond with the family; the latter is essential for a continued patient follow-up.OBJECTIVE: To describe a case of genital burn which raised the suspicion of maltreatment (sexual abuse and neglect by lack of supervision). CASE DESCRIPTION: An infant was taken to the Emergency Room of a pediatric hospital with an extensive burn in the vulva and perineum. The mother claimed the burn had been caused by a sodium-hydroxide-based product. However, the injury severity led to the suspicion of sexual abuse, which was then ruled out by a multidisciplinary team, based on the consistent report by the mother. Besides, the lesion type matched those caused by the chemical agent involved in the accident and the family context was evaluated and considered adequate. The patient had a favorable outcome and was discharged after four days of hospitalization. Outpatient follow-up during six months after the accident enabled the team to rule out neglect by lack of supervision. COMMENTS: Accidents and violence are frequent causes of physical injuries in children, and the differential diagnosis between them can be a challenge for healthcare workers, especially in rare clinical conditions involving patients who cannot speak for themselves. The involvement of a multidisciplinary trained team helps to have an adequate approach, ensuring child protection and developing a bond with the family; the latter is essential for a continued patient follow-up.