A credibilidade do testemunho da criança vítima de abuso sexual no contexto judiciário

Violência sexual contra crianças não é um evento incomum; no entanto, há a dificuldade de denúncia, pois, além do estabelecimento da relação de dominação que o agressor exerce sobre a vítima, a maneira como tal fato é recebido pela sociedade e como é encaminhado pelas instituições judiciárias responsáveis também é determinante para as omissões. Inserida no universo dos interrogatórios, muitas vezes, a criança causa confusão ao desmentir o que havia falado antes, reforçando possíveis preconceitos em relação a si mesma. O presente trabalho traz a análise das relações entre a infância e a instituição judiciária, com principal enfoque no sistema de comunicação e de notificação dos crimes sexuais contra a criança e as consequentes intervenções profissionais que buscam a validação, ou não, de seu testemunho. Para tanto, foram pesquisados 51 processos judiciais, dos quais foram selecionados dois casos exemplares. Este trabalho evidencia a possibilidade de preservar a criança da revitimização causada pela multiplicidade de interrogatórios, sem deixar de cumprir as normas jurídicas necessárias. A fragilidade da palavra da criança está na forma como é acolhida pelos adultos, desde a revelação na família até a denúncia aos órgãos oficiais, revelando a urgência de alterações nos procedimentos judiciais relacionados a essa problemática

Childhood trauma in substance use disorder and depression: An analysis by gender among a Brazilian clinical sample

Objective: In this study, we compared the frequency and intensity of childhood traumas in alcohol- or other drug-dependent patients, in patients with depression, and in a control group without psychiatric diagnoses. Methods: The study had a retrospective design of a clinical sample of men and women from the groups listed above. They were evaluated by the same standardized instrument: the Childhood Trauma Questionnaire.. Results: A higher frequency and intensity of emotional, physical, and sexual abuse were found in alcohol- and other drug-dependent patients than in patients with depression, who, in turn, presented significantly higher proportions than the control group. In all of the cases, the frequency was higher among women than men. Conclusion: Because of the high frequency and intensity of childhood traumas among alcohol- or other drug-dependent patients and depressed patients, the assessment of problems due to childhood traumas among these patients is essential to a better understanding of the etiology of those disorders and to their treatment. © 2010 Elsevier Ltd. All rights reserved.

Violência denunciada: ocorrências de maus tratos contra crianças e adolescentes registradas em uma unidade policial.

This study aimed to investigate the profile of the occurrence of abuse against children and adolescents. We analyzed the data recorded in police reports from the Department of Women's Defense, Araçatuba-SP, in 2008, relating to assault, victim-offender relationship, sociodemographic characteristics of offenders and victims, and victims' demand for health services. Among the accusations, there was a higher prevalence of physical abuse, being the residence the place of higher incidence of aggression. In most cases, the aggressor was the mother of the child, being the subject of aggression not reported, in most cases. Thus, we can define the profile of violent incidents against children, contributing to the visualization, knowledge and to deal with the problem.

Estudo do perfil epidemiológico da violência contra crianças, adolescentes e idosos em registros policiais

Pós-graduação em Odontologia Preventiva e Social - FOA

Abordagem dos maus tratos na infância por unidades de saúde da família

The goal of this study was to apprehend conceptualizations and professional experiences concerning child maltreatment as reported by physicians and nurses working for the Family Health Strategy implemented in a medium-sized city in São Paulo state. It is a descriptive qualitative study in which 20 professionals were included and semi-structured taped interviews were used. The data obtained were analyzed according to the Collective Subject Discourse and systematized into five themes: Conceptualizations of child maltreatment; Professional training to work in this field; Professional experiences related to such aggravations; Difficult and easy aspects faced during care provision to child maltreatment in the Family Health Strategy; Proposals to promote child safety. It was concluded that care provision to such aggravation types by family health units is configured as an important strategy to promote child safety and support families in relation to this issue. However, it was observed that, in order to qualify professionals for such care provision, it is necessary to invest in continuing education for the multiprofessional team. Also, municipal policies concerning care provision to child abuse, particularly in the organization of integrated work of the health care, education, social welfare and justice sectors must be urgently established by actively including the general society in such process

Violence against children and adolescents: the importance of knowledge of the spectrum of bruise colors in its diagnosis

Introduction: One of the violence types more observed against children is the physical abuse, which produces many types of traumatic injuries. Contusions are common trauma signs and may indicate aggression when frequently present in locations where accidental injuries are rare. Contusions in skin undergo color changes with the passage of time, and such change in color is called “spectrum of bruise colors of Legrand du Saulle”. Thus, it is possible to estimate the age of the lesion based on the evaluation of color. Injuries caused by child abuse often reach regions of head, face and neck, because they are exposed and easily accessible. Therefore, the dentist is responsible with regard to the diagnosis and the actions to be undertaken against the cases of child abuse. Objective: To present and discuss the significance of the spectrum of bruise colors as a considerable visible trace in suspicion of violence against children and adolescents, during dentists’ clinical routine. Literature review: The study of the “spectrum of bruise colors of Legrand du Saulle” refers to the estimation of the age of the injury, in respect to the color change. The application of this study is of great value for identify if a lesion occurred from a single incident or from multiple incidents, especially in cases where it occurs in the same region of the body, indicative of repetitive trauma. Conclusion: The spectrum of bruise colors is very important for health professionals, such as dentists, for the identification or suspicion of cases of abuse against children and adolescents. As great part of the lesions originated of abuse involve the areas of head and neck, it is unacceptable that these professionals are unaware of the basic signs to help in early diagnosis, which is the case of the colors of the lesions. However, concerning the chronology of the spectrum of bruise colors, it is not possible to establish rigorous times.

A violência familiar sofrida na infância: uma investigação na adolescência

This study aims to highlight the prevalence of situations of domestic violence experienced by adolescents during their childhood. It is cross-sectional study with 372 adolescents enrolled in a vocational training institution, Araçatuba-SP, utilizing the Childhood Trauma Questionnaire (CTQ), translated and validated. Gender and social class were also investigated. According to the results, 180 adolescents were female and 192 were male. The predominant social class was B2 (39.2%). Seventy two percent of teens reported having experienced at least some form of violence during childhood. Mild (28.7%) and moderate (9.2%) emotional abuse were the most prevalently associated, as well as between: physical and emotional violence, physical and sexual, physical and emotional neglect, sexual and emotional abuse, emotional neglect and emotional. Regarding social class, no associations were found. In conclusion, most teens suffered abuse in childhood, with a prevalence of emotional violence.

Abuso sexual infantil e incesto: a ética da escuta na clínica de Françoise Dolto

This paper will discuss some aspects of the problem of child sexual abuse, specifically incest, drawing on psychoanalysis and in particular the psychoanalytic proposed by Françoise Dolto allowing their concepts of castration simboligênica, symbolic function, image and body language unconsciously take incest as the object of study to propose a psychoanalytic clinic devoted to listening to the subject, going beyond the legal concerns of policies on reporting and complaints, but not meddle in them, reflecting on the role of the psychologist and psychoanalyst in the clinic for children of sexual abuse.

Prevalence of broncopulmonary and otorhinolaryngologic symptoms in children under investigation for gastroesophageal reflux disease: retrospective analysis

A Doença do Refluxo Gastroesofágico (DRGE) é uma afecção comum na infância, aumentando as evidências de que o refluxo gastroesofágico seja um cofator importante que contribui para as desordens de vias aéreas, principalmente na população pediátrica. É muito comum serem observadas manifestações em vias aéreas superiores e inferiores. Nosso objetivo é avaliar a presença de sintomas otorrinolaringológicos em crianças com idade de um a 12 anos e suspeita de doença do refluxo gastroesofágico. MATERIAIS E MÉTODO: Foram avaliados dados de prontuários de pacientes de até 12 anos submetidos à pHmetria de 24 horas de um ou dois canais, locados a 2 e 5 cm do EEI para confirmação de diagnóstico de Doença do Refluxo Gastroesofágico. RESULTADOS: Foram analisados 143 prontuários de crianças que realizaram pHmetria de 24 horas para investigação de DRGE; porém 65 foram incluídas. Os sintomas mais prevalentes nas crianças eram os broncopulmonares, encontrados em 89,2%, de sintomas nasossinusais (72,3%) , otológicos (46,1%) e de infecções de VAS de repetição (44,6%). Quando comparada a presença de cada grupo de sintomas com o resultado da pHmetria, não foi encontrada diferença significativa entre os sintomas e o resultado da pHmetria. CONCLUSÃO: DRGE pode se manifestar de diversas maneiras e os sintomas otorrinolaringológicos são frequentes em crianças.

The role of salt abuse on risk for hypercalciuria

Background: Elevated sodium excretion in urine resulting from excessive sodium intake can lead to hypercalciuria and contribute to the formation of urinary stones. The aim of this study was to evaluate salt intake in patients with urinary lithiasis and idiopathic hypercalciuria (IH).Methods: Between August 2007 and June 2008, 105 lithiasic patients were distributed into 2 groups: Group 1 (n = 55): patients with IH (urinary calcium excretion > 250 mg in women and 300 mg in men with normal serum calcium); Group 2 (n = 50): normocalciuric patients (NC). Inclusion criteria were: age over 18 years, normal renal function (creatinine clearance >= 60 ml/min), absent proteinuria and negative urinary culture. Pregnant women, patients with intestinal pathologies, chronic diarrhea or using corticoids were excluded. The protocol of metabolic investigation was based on non-consecutive collection of two 24-hour samples for dosages of: calcium, sodium, uric acid, citrate, oxalate, magnesium and urinary volume. Food intake was evaluated by the three-day dietary record quantitative method, and the Body Mass Index (BMI) was calculated and classified according to the World Health Organization (WHO). Sodium intake was evaluated based on 24-hour urinary sodium excretion.Results: The distribution in both groups as regards mean age (42.11 +/- 10.61 vs. 46.14 +/- 11.52), weight (77.14 +/- 16.03 vs. 75.99 +/- 15.80), height (1.64 +/- 0.10 vs. 1.64 +/- plusorminus 0.08) and BMI (28.78 +/- 5.81 vs. 28.07 +/- 5.27) was homogeneous. Urinary excretion of calcium (433.33 +/- 141.92 vs. 188.93 +/- 53.09), sodium (280.08 +/- 100.94 vs. 200.44.93 +/- 65.81), uric acid (880.63 +/- 281.50 vs. 646.74 +/- 182.76) and magnesium (88.78 +/- 37.53 vs. 64.34 +/- 31.84) was significantly higher in the IH group (p < 0.05). There was no statistical difference in calcium intake between the groups, and there was significantly higher salt intake in patients with IH than in NC.Conclusions: This study showed that salt intake was higher in patients with IH as compared to NC.

Ataque sexual infanto-juvenil doméstico: da revelação à responsabilização criminal do agressor

Pós-graduação em Psicologia - FCLAS

Condyloma acuminata in the tongue and palate of a sexually abused child: a case report

Condyloma acuminata caused by human papilloma viruses, (HPV) is a sexually transmitted disease (STD) appearing most frequently as soft, pink cauliflower like growths in moist areas, such as the genitalia, mouth and other places. The disease is highly contagious, can appear singly or in groups, small or large. In children, the isolation of a sexually transmitted organism may be the first indication that an abuse has occurred. Although the presence of a sexually transmissible agent from a child beyond the neonatal period is suggestive of sexual abuse, exceptions do exist. The authors report the clinical case of a five-year-old Caucasian male with lesions located in the dorsal surfaces of the posterior tongue and palate. Both lesions had a firm consistency, reddish appearance and presence of whitish areas and regions of ulceration. During the interview, the mother reported that the boy had been sexually abused. Sexually transmitted disease may occur during sexual abuse. Dentists as well as pediatricians have a role to play in identifying and treating these children. The diagnosis is essentially clinical (anamnesis and physical examination), but also the use of cytology eventually resorts to biopsy of the suspicious lesions for histological examination. The therapeutic option was the excision of the lesions.