Abordaje de la violencia sexual infantil: un llamado a la acción para los profesionales de América Latina

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+).

How can services be improved to effectively address the mental health of vulnerable children and young people?

This discussion article describes a Child and Adolescent Mental Health Service (CAMHS) in the United Kingdom developed to meet the mental health needs of children and young people particularly those vulnerable children and young people at risk of actual or potential harm through child abuse and neglect, but may not be therapy ready. The aim was to improve the level of access to CAMHS for vulnerable groups and the quality and effectiveness of services for children, young people and their families.The model of service delivery is underpinned by the THRIVE Framework for System Change (THRIVE) which builds on the resilience of families and the skills of the workers who have the closest relationships with them. The article describes how a redesign was accomplished in the London Borough of Camden between 2016- 2018 to do this. Qualitative evidence of the positive impact of the changes for service users and key workers and quantitative evidence of the increased service capacity are presented. Challenges and opportunities provided by the new service model are discussed.

ISPCAN Child Abuse Screening Tool Children's Version (ICAST-C): Instrument development and multi-national pilot testing

OBJECTIVE

To develop a child victimization survey among a diverse group of child protection experts and examine the performance of the instrument through a set of international pilot studies.

METHODS

The initial draft of the instrument was developed after input from scientists and practitioners representing 40 countries. Volunteers from the larger group of scientists participating in the Delphi review of the ICAST P and R reviewed the ICAST C by email in 2 rounds resulting in a final instrument. The ICAST C was then translated and back translated into six languages and field tested in four countries using a convenience sample of 571 children 12-17 years of age selected from schools and classrooms to which the investigators had easy access.

RESULTS

The final ICAST C Home has 38 items and the ICAST C Institution has 44 items. These items serve as screeners and positive endorsements are followed by queries for frequency and perpetrator. Half of respondents were boys (49%). Endorsement for various forms of victimization ranged from 0 to 51%. Many children report violence exposure (51%), physical victimization (55%), psychological victimization (66%), sexual victimization (18%), and neglect in their homes (37%) in the last year. High rates of physical victimization (57%), psychological victimization (59%), and sexual victimization (22%) were also reported in schools in the last year. Internal consistency was moderate to high (alpha between .685 and .855) and missing data low (less than 1.5% for all but one item).

CONCLUSIONS

In pilot testing, the ICAST C identifies high rates of child victimization in all domains. Rates of missing data are low, and internal consistency is moderate to high. Pilot testing demonstrated the feasibility of using child self-report as one strategy to assess child victimization.

PRACTICE IMPLICATIONS

The ICAST C is a multi-national, multi-lingual, consensus-based survey instrument. It is available in six languages for international research to estimate child victimization. Assessing the prevalence of child victimization is critical in understanding the scope of the problem, setting national and local priorities, and garnering support for program and policy development aimed at child protection.

Long-term follow-up following bone marrow transplantation for Hunter disease

Bone marrow transplantation (BMT) was performed in 10 patients with Hunter disease (mucopolysaccharidosis type II, iduronate-2-sulphatase deficiency). The donor was an HLA-identical sibling in 2 cases, an HLA-nonidentical relative in 6 cases, a volunteer unrelated donor in 1 case, and details were not available in 1 case. Only three patients have survived for more than 7 years post BMT; however, this high mortality probably resulted from poor donor selection. In two, there has been a steady progression of physical disability and mental handicap. One patient has maintained normal intellectual development, with only mild physical disability. It is possible that BMT may be useful in selected patients with MPS II.

Bone marrow transplantation for Maroteaux-Lamy syndrome (MPS VI): long-term follow-up

We describe the results of bone marrow transplantation (BMT) in four patients with mucopolysaccharidosis type VI (MPS VI, McKusick 253200)--Maroteaux-Lamy disease. The indications for transplantation were cardiomyopathy in three patients and severe obstructive sleep apnoea in one. The follow-up period ranges between 1 and 9 years, and three of the patients are at mainstream schools. In all of the patients the facial features have become less coarse and the cardiac manifestations have improved or remained stable. However, skeletal changes have persisted or even progressed, although posture and joint mobility have improved and all the patients have remained ambulatory and active. BMT appears to prolong survival and improve the quality of life in MPS VI patients, but careful selection of patients is essential.