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Casas-Muñoz A, Velasco-Rojano ÁE, Rodríguez-Caballero A, Prado-Solé E, Álvarez MG. ACEs and mental health problems as suicidality predictors in Mexican adolescents. Child Abuse Negl 2024; 150:106440. [PMID: 37684115 DOI: 10.1016/j.chiabu.2023.106440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Various factors, including mental health comorbidity, family dysfunction, interpersonal violence, and community and social violence, cause suicidal behavior. Adverse Childhood Experiences (ACEs) encompass these risk factors and are correlated with mental health problems and suicidal behavior in Mexican adolescents. METHODS A survey was conducted among Mexican school-aged adolescents to measure ACEs, MHP symptoms, and suicidal behavior. A binary logistic regression was used to examine the relationship between these variables. The study was conducted with IRB approval, and all participants provided informed consent. Those at risk of suicide were referred for online psychological care. RESULTS 7325 adolescents participated; 60 % were women, with an average age of 16 years (SD + 1), 87 % of the participants reported at least one ACE, 13 % symptoms of at least one MHP and 10 % suicidal behavior. MHP predictors of suicidal behavior were: conduct problems (OR = 5.67), symptoms of depression (OR = 3.27), obsessive-compulsive disorder (OR = 2.11), somatic problems (OR = 1.98), and attention deficit (OR = 1.69). EAI predictors were: live sexual violence (OR = 2.53), physical violence (OR = 2.21), negligence (OR = 2.05), bullying (OR = 2.10), and a family member with a mental health diagnosis (OR = 1.35). The cumulative effect of ACEs and MHP significantly increased the risk (OR = 78.08). CONCLUSIONS 5 ACEs and 4 MHP were associated with suicidal behavior; their cumulative effect increased the risk to 78 times.
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Affiliation(s)
- Abigail Casas-Muñoz
- Centro de Estudios Avanzados sobre Violencia - Prevención (CEAVI-P), Instituto Nacional de Pediatría, Ciudad de México, Mexico.
| | - Ángel Eduardo Velasco-Rojano
- Centro de Estudios Avanzados sobre Violencia - Prevención (CEAVI-P), Instituto Nacional de Pediatría, Ciudad de México, Mexico.
| | - Aarón Rodríguez-Caballero
- Centro de Estudios Avanzados sobre Violencia - Prevención (CEAVI-P), Instituto Nacional de Pediatría, Ciudad de México, Mexico
| | - Eva Prado-Solé
- Fondo de las Naciones Unidas para la Infancia, UNICEF, Mexico
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Casas-Muñoz A, Velasco-Rojano ÁE, Rodríguez-Caballero A, Prado-Solé E, Álvarez MG. ACE-IQ extended version validation and ACE's frequency in Mexican adolescents. Child Abuse Negl 2024; 150:106492. [PMID: 37805276 DOI: 10.1016/j.chiabu.2023.106492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 09/11/2023] [Accepted: 09/29/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Adverse Childhood Experiences (ACEs) may have short, middle, and long-term consequences on people's development and physical and mental health. There is a need for information on this subject in low- and middle-income countries and a need to reduce recall bias in ACEs research worldwide. OBJECTIVE Hence our objectives were to translate, adapt and validate the Adverse Childhood Experiences extended version and to determine ACEs frequencies in a sample of Mexican adolescents. PARTICIPANTS AND SETTING A convenience sample of 5835 schooled Mexican adolescents (age: M = 16.13, SD = 1.32; 61.01 % females) from 20 states in Mexico completed a survey. METHOD A cross-sectional study was conducted with an extended version of the ACE-International Questionnaire (ACE-IQ), which assesses 23 ACEs organized into five categories: situations that cause household dysfunction, exposure to violence, violence from parents or guardians, interpersonal violence, and sociodemographic context. RESULTS Evidence of construct validity and reliability of the questionnaire was obtained, and 16 ACEs were included in the final ACE-IQ version. 90 % of adolescents had one or more ACEs. Neglect was the most experienced ACE reported by 73.30 % of the participants, with no significant difference by age, sex, or geographic region. CONCLUSION ACE-IQ questionnaire is a reliable and valid instrument to recommend its use for generating information on ACEs in studies on Mexican adolescents. The results on the frequency of ACEs revealed that 90 % of this schooled Mexican adolescent sample had experienced one or more ACEs, and about a third had experienced six or more.
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Affiliation(s)
- Abigail Casas-Muñoz
- Centro de Estudios Avanzados sobre Violencia-Prevención (CEAVI-P), Instituto Nacional de Pediatría, Ciudad de México, México
| | - Ángel Eduardo Velasco-Rojano
- Centro de Estudios Avanzados sobre Violencia-Prevención (CEAVI-P), Instituto Nacional de Pediatría, Ciudad de México, México.
| | - Aarón Rodríguez-Caballero
- Centro de Estudios Avanzados sobre Violencia-Prevención (CEAVI-P), Instituto Nacional de Pediatría, Ciudad de México, México
| | - Eva Prado-Solé
- Fondo de las Naciones Unidas para la Infancia, UNICEF, México
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Casas-Muñoz A, Carranza-Neira J, Intebi I, Lidchi V, Eisenstein E, Greenbaum J. Abordaje de la violencia sexual infantil: un llamado a la acción para los profesionales de América Latina. Rev Panam Salud Publica 2023; 47:e54. [PMID: 37008675 PMCID: PMC10065304 DOI: 10.26633/rpsp.2023.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/17/2022] [Indexed: 04/03/2023] Open
Abstract
El objetivo de esta comunicación es delinear los elementos clave de la capacitación en violencia sexual infantil (VSI) para profesionales de la salud en diferentes disciplinas medicina, psicología, odontología, enfermería, trabajo social, nutrición, fisioterapia, terapia ocupacional, química, bioquímica y obstetricia incluidas las parteras, entre otras y el desarrollo de protocolos de atención con base en las prácticas basadas en evidencia, así como proporcionar recursos que permitan optimizar ambos procesos. La capacitación sobre la violencia sexual hacia niñas, niños y adolescentes (NNA) es esencial para enfrentar este gran desafío en América Latina y permitir al personal de salud cumplir su función en defensa de la seguridad y el bienestar de NNA. El desarrollo de protocolos ayuda al personal de salud a definir las funciones y responsabilidades de los miembros del personal, resumir los posibles indicadores de VSI y describir las estrategias para identificar y abordar mejor las necesidades de salud y seguridad del paciente y su familia, por lo que deben incluir el enfoque informado sobre el trauma. El trabajo futuro debe centrarse en desarrollar y evaluar estrategias nuevas para aumentar la capacidad del sector de la salud para atender a los NNA que experimentan VSI y optimizar las formas de capacitar al personal. Apunta, también, a mejorar la generación de investigación y evidencia sobre la epidemiología y atención de la VSI en América Latina, incluidos los niños y adolescentes varones, grupos minoritarios y de atención prioritaria (p. ej. NNA migrantes, con discapacidad, en situación de calle, privados de la libertad, pertenecientes a comunidades indígenas y a la comunidad LGBTIQ+).
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Affiliation(s)
- Abigail Casas-Muñoz
- Centro de Estudios Avanzados sobre Violencia – Prevención (CEAVI-P)Instituto Nacional de PediatríaCiudad de MéxicoMéxicoCentro de Estudios Avanzados sobre Violencia – Prevención (CEAVI-P), Instituto Nacional de Pediatría, Ciudad de México, México.
- Abigail Casas-Muñoz,
| | - Julia Carranza-Neira
- Facultad de Ciencias de la SaludUniversidad Peruana de Ciencias AplicadasLimaPerúFacultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Perú.
| | - Irene Intebi
- Consultora independienteArgentinaConsultora independiente, Argentina.
| | - Victoria Lidchi
- Barnet, Enfield and Haringey Mental Health TrustLondresReino UnidoBarnet, Enfield and Haringey Mental Health Trust, Londres, Reino Unido.
| | - Evelyn Eisenstein
- Centro de Estudios IntegradosInfanciaAdolescencia y SaludRío de JaneiroBrasilCentro de Estudios Integrados, Infancia, Adolescencia y Salud, Río de Janeiro, Brasil.
| | - Jordan Greenbaum
- International Centre for Missing and Exploited ChildrenAlexandriaEstados Unidos de AméricaInternational Centre for Missing and Exploited Children, Alexandria, Estados Unidos de América.
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Casas-Muñoz A, Velasco-Rojano ÁE, González-García N, Benjet C, Caraveo-Anduaga JJ, Martínez-Vélez NA, Loredo-Abdalá A. ISPCAN Child Abuse Screening Tool for Children (ICAST-C): Translation and adaptation to Mexican Spanish, and psychometric properties tested in Mexico City adolescents. Child Abuse Negl 2022; 133:105826. [PMID: 35987050 DOI: 10.1016/j.chiabu.2022.105826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/20/2022] [Accepted: 07/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Research using the IPSCAN Child Abuse Screening Tool for Children (ICAST-C), has provided ample evidence of the magnitude of violence against children. Knowledge about its psychometric characteristics and validity is limited. Hence, our objective was to translate and culturally adapt the ICAST-C in adolescents from Mexico City and determine its psychometric properties. PARTICIPANTS AND SETTING To determine the psychometric properties of the instrument 723 adolescents between 11 and 18 years of age from 9 public secondary schools in Mexico City participated. METHODS The study was carried out in two phases: 1) translation and adaptation of the instrument (in 5 steps) and 2) pilot evaluation of the psychometric properties. Total and factor reliabilities were determined, Pearson correlation was used for temporal stability while construct validity was determined by Confirmatory Factor Analysis (CFA), and final adequacy of the items eliminated by the CFA. RESULTS We developed the culturally relevant Mexican Spanish version of the ICAST-C. The CFA confirmed the six-factor structure hypothesis. To improve the original model we eliminated ten items, the final model showed good global fit indices (χ2(1310) = 2207.68, p < .01, χ2/df = 1.68; CFI =0.95; RMSEA = 0.02 [CI95% 0.02-0.03]; SRMR = 0.08). Total and factor reliabilities were adequate (Alpha = 0.79-0.92, r = 0.52-0.75), except for the non-violent discipline factor (Alpha = 0.59, r = 0.38). CONCLUSIONS While these data suggest that this version of the ICAST-C is valid and reliable for adolescents in Mexico City public secondary schools, further research should evaluate the psychometric properties in a national sample.
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Affiliation(s)
- Abigail Casas-Muñoz
- Center for Advanced Studies on Violence - Prevention, National Pediatric Institute, México City, México (Centro de Estudios Avanzados sobre Violencia - Prevención, Instituto Nacional de Pediatría), Ciudad de México, Mexico.
| | - Ángel Eduardo Velasco-Rojano
- Center for Advanced Studies on Violence - Prevention, National Pediatric Institute, México City, México (Centro de Estudios Avanzados sobre Violencia - Prevención, Instituto Nacional de Pediatría), Ciudad de México, Mexico
| | - Noé González-García
- Center for Advanced Studies on Violence - Prevention, National Pediatric Institute, México City, México (Centro de Estudios Avanzados sobre Violencia - Prevención, Instituto Nacional de Pediatría), Ciudad de México, Mexico
| | - Corina Benjet
- National Institute of Psychiatry Ramón de la Fuente Muñiz, México City, México (Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz), Ciudad de México, Mexico
| | - Jorge Javier Caraveo-Anduaga
- National Institute of Psychiatry Ramón de la Fuente Muñiz, México City, México (Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz), Ciudad de México, Mexico
| | - Nora Angélica Martínez-Vélez
- National Institute of Psychiatry Ramón de la Fuente Muñiz, México City, México (Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz), Ciudad de México, Mexico
| | - Arturo Loredo-Abdalá
- Center for Advanced Studies on Violence - Prevention, National Pediatric Institute, México City, México (Centro de Estudios Avanzados sobre Violencia - Prevención, Instituto Nacional de Pediatría), Ciudad de México, Mexico
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Casas-Muñoz A, Velasco-Rojano ÁE, Ramírez-Tolentino CG, Rodríguez-Caballero A, Loredo-Abdalá A. Victimization and factors related to polyvictimization in adolescents of Mexico City. GAC MED MEX 2022; 158:229-234. [DOI: 10.24875/gmm.m22000680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Casas-Muñoz A, Velasco-Rojano ÁE, Ramírez-Tolentino CG, Rodríguez-Caballero A, Loredo-Abdalá A. Victimización y factores relacionados con polivictimización en adolescentes de la Ciudad de México. GAC MED MEX 2022. [DOI: 10.24875/gmm.22000015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Loredo-Abdalá A, Casas-Muñoz A, Villanueva-Clift HJ, Aguilar-Ceniceros A, González-Garay AG, Gutiérrez-Leyva CDJ, Juarez Olguin H. Pediatric Abusive Head Trauma: Multicentric Experience in Mexico. J Interpers Violence 2022; 37:644-658. [PMID: 32306826 DOI: 10.1177/0886260520916283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Abusive head trauma (AHT) is one of the most severe forms of child abuse due to its morbidity and mortality. However, AHT is still misdiagnosed in developing countries because of its nonspecific clinical picture and limited knowledge of it on the part of physicians. The aim of this study was to describe some characteristics of children with AHT, their families, and caregivers, as well as the clinical data that could serve as signs for its suspicion and the medical-legal resolution of the cases. Children suspect with AHT in emergency rooms in three Mexican hospitals were included after obtaining informed consent from the parents. All information was obtained from the parents by means of a questionnaire and from different clinical and radiological evaluations of the clinical records of the patients. 15 children, with a median age of 5 months and predominantly males (73.33%), were included in the study. 66% reported a history of irritability periods, and most of the patients (73.33%) had more than one habitual caregiver. The diagnosis of AHT was suspected in only 33.33% on admission in the Emergency Services. Acute symptomatology was present in 53.33%, while less severe symptoms were reported in the rest. Special attention should be paid on babies with history of irritable periods. When a child who is previously healthy and suddenly presents with a seizure or cardiorespiratory dysfunction or brought to the hospital dead, the diagnosis of AHT should be considered as a priority.
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Casas-Muñoz A, Loredo-Abdalá A, Sotres-Velasco B, Ramírez-Angoa LV, Román-Olmos JA, Cristerna-Tarrasa GH. Adverse childhood experiences. Knowledge and use by pediatrics residents. GAC MED MEX 2021; 157:10-17. [PMID: 34125807 DOI: 10.24875/gmm.m21000530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Adverse childhood experiences (ACEs) have been associated with the acquisition of risk behaviors and development of chronic and mental diseases since adolescence and in adult life. OBJECTIVE To identify the knowledge and the frequency pediatrics residents ask about ACEs with. METHODS Through an online survey sent to all resident physicians of the 2017-2018 academic year of a tertiary care children's hospital, demographic variables, knowledge, use, training and barriers to interrogate and search for ACEs were collected. RESULTS 21% of residents answered the survey; the majority were women (70 %), less than 5 % of participants were familiar with ACEs, 31 % enquired about them in parents and their children, and 71 % considered having some barrier to interrogate about them. CONCLUSIONS Participants in this study showed limited knowledge about ACEs, which had an impact on the frequency they enquired about them with in their patients and their parents; at least half had the perception that it is beyond the reach of the pediatrician to identify them.
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Affiliation(s)
- Abigail Casas-Muñoz
- Coordination of Advanced Studies on Child Abuse-Prevention, Instituto Nacional de Pediatría
| | - Arturo Loredo-Abdalá
- Coordination of Advanced Studies on Child Abuse-Prevention, Instituto Nacional de Pediatría
| | | | | | - Juan A Román-Olmos
- Coordination of Advanced Studies on Child Abuse-Prevention, Instituto Nacional de Pediatría
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Casas-Muñoz A, Loredo-Abdalá A, Sotres-Velasco B, Ramírez-Angoa LV, Román-Olmos JA, Cristerna-Tarrasa GH. Experiencias adversas en la infancia. Conocimiento y uso por médicos residentes de pediatría. GAC MED MEX 2021. [DOI: 10.24875/gmm.19005644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Loredo-Abdalá A, Casas-Muñoz A, González-Garay GA, Ortiz-Hernández R, González-Corona JM, Ramírez-Angoa LV. Non-accidental head injury in children: medical care direct economic cost in a tertiary care hospital. GAC MED MEX 2019. [DOI: 10.24875/gmm.m19000209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Loredo-Abdalá A, Casas-Muñoz A, González-Garay GA, Ortiz-Hernández R, González-Corona JM, Ramírez-Angoa LV. [Trauma craneal no accidental en niños: costo económico directo de la atención médica en un hospital de tercer nivel]. GAC MED MEX 2018; 154:671-680. [PMID: 30532090 DOI: 10.24875/gmm.18004399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Abusive head trauma (AHT) is an extreme form of physical abuse that is produced by abruptly shaking an infant or toddler. Objective To describe the direct economic cost of care during hospitalization of 14 children with confirmed diagnosis of AHT in a pediatric hospital. Method Analysis of the cost of disease in patients with AHT attended to between 2001 and 2010. Partial direct economic cost of medical care (days of hospital stay, laboratory tests and imaging studies, surgical procedures and subspecialist consultations) was calculated adjusting for inflation, with year 2001 taken as base year. Patients were classified in three groups (moderate, severe and fatal AHT). Descriptive and sensitivity analysis was carried out. Results Patients with severe AHT generated higher medical care costs ($105,794.88 ± 33,201.91) in comparison with the group of moderate ($37,012.95, ± 7,154.87) and fatal AHT ($18,595.04 ± 6424.47) (p <0.05). Total cost was $665,467.98 Mexican pesos ($71,249.25 international dollars). Conclusions Total cost for the 14 patients was an elevated figure, as in other parts of the world. The direct economic cost is closely related to the severity of the clinical presentation.
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Affiliation(s)
- Arturo Loredo-Abdalá
- Coordinación de Estudios Avanzados sobre el Maltrato Infantil y su Prevención, Ciudad de México, México
| | - Abigail Casas-Muñoz
- Coordinación de Estudios Avanzados sobre el Maltrato Infantil y su Prevención, Ciudad de México, México
| | | | - Raquel Ortiz-Hernández
- Dirección de Planeación. Secretaría de Salud, Instituto Nacional de Pediatría, Ciudad de México, México
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Loredo-Abdalá A, Casas-Muñoz A. Maltrato entre pares o acoso escolar (bullying). ¿Debemos enfrentar el problema cuando la tragedia es inevitable? Acta Pediatr Mex 2017. [DOI: 10.18233/apm38no3pp215-2171393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Como consecuencia del lamentable evento acaecido a mediados del mes de enero de 2017 enla ciudad de Monterrey, Nuevo León, y el cual ha desencadenado una serie de opiniones gubernamentales,en los medios de comunicación electrónica y escrita, así como en algunos grupos de la sociedad civil de México, primordialmente surge la siguiente pregunta: ¿es que ante estos eventos, los mexicanos y, específicamente, los pediatras debemos reaccionar?
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Loredo-Abdalá A, Vargas-Campuzano E, Casas-Muñoz A, González-Corona J, Gutiérrez-Leyva CJ. [Adolescent pregnancy: its causes and repercussions in the dyad]. Rev Med Inst Mex Seguro Soc 2017; 55:223-229. [PMID: 28296372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Teen pregnancy (TP) is a global public health problem that affects the physical and emotional health, educational and economic status of prospective parents and often also affects the product of gestation. In most cases, the TP is an unplanned event, and often difficult to accept by the couple. But it is more complicated for the future mother who suddenly finds herself without the protection of the couple, her family and her school companions. The risks to which the young mothers are exposed are diverse, but include: submitting to a clandestine abortion, falling into drug addiction, prostitution and crime; Also, it should be noted that with so many adversities, she can develop child maltreatment and frequently, she may be attacked at home, at school or in society giving rise to the twin phenomena of child abuse. To address this problem, it is necessary to develop preventive strategies aimed at risk of early pregnancy or acquiring sexually transmitted diseases by implementing educational programs for personal, family or schools for this age group range. It stresses the need for these programs to be consistent and persistent, as a basic strategy to reduce the consequent risks to unplanned or accepted sex life.
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Affiliation(s)
- Arturo Loredo-Abdalá
- Instituto Nacional de Pediatría, Coordinación de Estudios Avanzados sobre el Maltrato Infantil y su Prevención, Ciudad de México, México.
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Loredo-Abdalá A, Villanueva-Clift H, Aguilar-Ceniceros AM, Casas-Muñoz A. [Child abuse: its knowledge, attention and diffusion in three pediatric hospitals in Mexico]. Bol Med Hosp Infant Mex 2016; 73:219-227. [PMID: 29421384 DOI: 10.1016/j.bmhimx.2016.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 03/31/2016] [Indexed: 11/26/2022] Open
Abstract
Child abuse (CA) was observed in Mexico since the early 60's through isolated publications from clinical cases and where manifestations of physical injury or sexual abuse predominated. Since the 90's, the Clinic for Integral Care of the Abused Child was established at the National Institute of Pediatrics (CAINM-INP, for its Spanish acronym), which actions were addressed to the care, teaching and research on this topic. This approach was replicated in two hospital centers in the country: the Clinic for Integral Care of the Abused Children at Children's Specialty Care Hospital of Chihuahua and the Pediatric Service of the General Hospital of Mexicali. The main objective of this work was to present to the medical community, paramedics, and other professionals who interact with the pediatric population and society, the efforts that have been made in Mexico to address this legal, medical, and social pathology in a logical manner, and always aimed at protecting victims and their families.
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Affiliation(s)
- Arturo Loredo-Abdalá
- Coordinación del Centro de Estudios Avanzados sobre Maltrato Infantil/Prevención, Instituto Nacional de Pediatría, Ciudad de México, México.
| | - Héctor Villanueva-Clift
- Clínica de Maltrato Infantil, Hospital Infantil de Especialidades, Chihuahua, Chihuahua, México
| | | | - Abigail Casas-Muñoz
- Coordinación del Centro de Estudios Avanzados sobre Maltrato Infantil/Prevención, Instituto Nacional de Pediatría, Ciudad de México, México
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Loredo-Abdalá A, Casas-Muñoz A, Trejo-Hernández J, Melquiades-Parra I, Martín-Martín V. Síndrome del niño sacudido: cuadro clínico y evolución de 17 casos en el Instituto Nacional de Pediatría. Acta Pediatr Mex 2015. [DOI: 10.18233/apm36no2pp72-80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
<p>Introducción: el síndrome del niño sacudido es una modalidad grave del maltrato infantil: afecta al cerebro, la retina y a veces algunos huesos. Su frecuencia y características no se han precisado en México.</p><p>Objetivo: describir y determinar los posibles factores desencadenantes, los cuidadores, el cuadro clínico y la evolución de pacientes afectados por el síndrome del niño sacudido.</p><p><br />Materiales y métodos: estudio de serie de casos mediante el análisis de 17 expedientes de pacientes diagnosticados con síndrome del niño sacudido, en el Instituto Nacional de Pediatría, entre 2002 y 2010. </p><p> </p><p>Resultados: doce pacientes (70%) eran del sexo masculino; la edad promedio fue de 5.7 meses (límites de 2 a 14 meses). Los antecedentes en el niño que probablemente pudieron desencadenar el sacudimiento fueron: en 11 casos la irritabilidad (71%), en 8 (47%) el llanto inconsolable y en 6 la presencia de una enfermedad aguda (35%). En los padres se identificó como posible desencadenante impulsividad en cinco casos (29%), estrés en cinco (29%) y enojo en tres (18%). Los cuidadores habituales del menor fueron la madre en 11 casos (65%), los tíos en cinco (29%), ambos padres en cuatro (24%) y los abuelos en tres (18%); el padre presenció el inicio de los síntomas de gravedad en 6 casos (35%), los tíos en cuatro (24%), la madre en tres (18%) y ambos padres en dos (12%). El cuadro clínico se caracterizó por crisis convulsivas en 13 pacientes (76%), irritabilidad en siete (41%), dificultad respiratoria en siete casos (41%), cianosis en seis (35%) y rechazo al alimento en cinco (29%). En el hospital se corroboraron: crisis convulsivas en 14 casos (82%), alteraciones en el estado de conciencia en once (65%), necesidad de apoyo ventilatorio en siete (41%) e irritabilidad en tres (18%). La exploración de fondo de ojo reveló: hemorragia retiniana unio bilateral en 15 pacientes (88%), hemorragia vítrea en nueve (53%) y desprendimiento de retina bilateral en tres (18%). La tomografía axial<br />computada de cráneo mostró edema cerebral en diez casos (59%), hemorragia subaracnoidea en nueve (53%), hematoma subdural en cinco (29%) y fractura de cráneo en cinco (29%), alteraciones con las que se estableció el diagnóstico de síndrome del niño sacudido (71%) y síndrome de niño sacudido y azotado (35%). Fallecieron seis niños (35%). Todos los sobrevivientes (11 pacientes) tuvieron secuelas: daño visual (59%), daño motor (53%), crisis convulsivas (50%), problemas del lenguaje (41%) y problemas en la audición (18%).</p><p>Conclusión: el síndrome del niño sacudido es una forma de abuso físico que debe ser motivo de sospecha en un niño menor de un año que súbitamente presenta crisis convulsivas, dificultad cardiorrespiratoria o llega muerto al hospital.</p><p> </p>
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Ruiz-Palacios GM, Guerrero ML, Hernández-Delgado L, Lavalle-Villalobos A, Casas-Muñoz A, Cervantes-Apolinar Y, Moreira M, Schuerman L. Immunogenicity, reactogenicity and safety of the 10-valent pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) in Mexican infants. Hum Vaccin 2011; 7:1137-45. [PMID: 22048109 DOI: 10.4161/hv.7.11.17984] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The immunogenicity and safety of the 10-valent pneumococcal conjugate vaccine, PHiD-CV, have been documented in European and Asian studies. In this open study conducted in Mexico (NCT00489554), 230 healthy infants received three doses of PHiD-CV and DTPa-HBV-IPV/Hib vaccines at 2, 4 and 6 months of age and two doses of oral human rotavirus vaccine at 2 and 4 months. Serotype-specific pneumococcal responses and opsonophagocytic activity (OPA) were measured one month post-dose 3. PHiD-CV's primary vaccination course was highly immunogenic against each of the 10 pneumococcal vaccine serotypes and carrier protein D. Antibody responses against pneumococcal serotypes and protein D were generally higher in Mexican infants compared with European antibody responses, and functional OPA responses were also higher or in the same range. The most frequent solicited local symptom was pain, with high but similar incidences of grade 3 pain reported at both injection sites (up to 15% of all doses). PHiD-CV was well tolerated, with no serious adverse events considered as causally related to vaccination. Most solicited symptoms were mild and there was no increase in incidence of solicited symptoms with successive vaccine doses.
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