Rol del odontopediatra en la detección del maltrato infantil: revisión sistemática

INTRODUCCIÓN: El maltrato infantil (MI) es un problema de salud pública de impacto global, con manifestaciones orales y dentales que pueden ser indicativas de abuso. Por tanto, resulta fundamental sensibilizar a los profesionales de la salud para que estén alerta a cualquier signo que presente sospecha de MI. OBJETIVOS: Se propuso contribuir con la actualización de manifestaciones clínicas del MI. Además, construir una guía sobre indicadores clínicos que colaboren en el diagnóstico de abuso. MATERIAL Y MÉTODO: Se realizó un estudio documental, utilizando criterios de inclusión, exclusión y palabras claves con el fin de fundamentar de forma teórica el papel del odontopediatra en el diagnóstico de MI. Se realizó una revisión sistemática siguiendo las directrices PRISMA. Se utilizaron bases de datos Medline/PubMed con términos MeSH, cubriendo artículos publicados entre 2020 y 2023. Se aplicaron filtros de idioma (inglés y español) seleccionando artículos relevantes, eliminando duplicados o fuera del alcance del estudio. RESULTADOS: De 26 artículos incluidos, el 65,4% fueron publicados en revistas odontológicas y el 16% en pediátricas. Se determinó que ninguna lesión odontológica por abuso físico es patognomónica, aunque algunas infecciones orales (gonorrea y sífilis) son indicativas claras de abuso sexual. Se observó que lesiones y enfermedades causadas por negligencia resultaron frecuentes, pero no definitivas para diagnosticar abuso sin la presencia de otros factores de riesgo. Se destacó la implementación de espacios educativos continuos para profesionales ya que fortalecen el reconocimiento de signos de MI y evitan que el niño sea nuevamente agredido. CONCLUSIÓN: Las lesiones orales asociadas con el MI son comunes, pero no siempre concluyentes. Los pediatras y odontopediatras deben actualizar su capacitación en estos indicadores, así como en la documentación y denuncia de casos sospechosos. Una mejor formación y colaboración entre especialistas incrementa la prevención y detección del MI, y la protección de los menores vulnerable

Linking inclusive school practices and mental health in sexual and gender minority youth in Europe

Sexual and gender minority (SGM) youth often face stressors such as stigma and discrimination, leading to high rates of depression, anxiety, and suicidal ideation. There is a need to identify effective school practices across different countries to reduce these minority stressors and the resulting mental health disparities. A total of 17,733 SGM high school students (aged 14+) across 13 European countries completed an online survey between September 2020 and January 2022. Participants reported on school inclusivity practices (i.e., inclusive sex education, SGM representation in classroom, and teacher inclusivity), minority stressors (i.e., perceived unsafety at school, experiences of bias-based bullying, and internalized stigma) and mental health (i.e., depression, anxiety, and suicidal ideation). SGM-inclusive sex education and teacher inclusiveness were associated with lower odds of depression, anxiety, and suicidal ideation. A positive representation of SGM issues in classrooms was associated with low odds of depression and suicidal ideation, whereas negative representation was associated with increased odds of depression, anxiety, and suicidal ideation. The associations between such practices and the mental health outcomes were partially mediated by perceived unsafety at school, experiences of bias-based bullying, and internalized stigma. Across European countries, incorporating positive representations of LGBTQI + topics in the classroom, providing inclusive sex education, and fostering inclusive attitudes and behaviors among teachers can create a more supportive and affirming educational environment for SGM youth. By addressing issues of perceived unsafety, bias-based bullying, and internalized stigma, these practices can play a critical role in reducing mental health disparities and promoting well-being among SGM students

Prevention of congenital malformations and other adverse pregnancy outcomes with 4.0 mg of folic acid : community-based randomized clinical trial in Italy and the Netherlands

Background: In 2010 a Cochrane review confirmed that folic acid (FA) supplementation prevents the first- and second-time occurrence of neural tube defects (NTDs). At present some evidence from observational studies supports the hypothesis that FA supplementation can reduce the risk of all congenital malformations (CMs) or the risk of a specific and selected group of them, namely cardiac defects and oral clefts. Furthermore, the effects on the prevention of prematurity, foetal growth retardation and pre-eclampsia are unclear.Although the most common recommendation is to take 0.4 mg/day, the problem of the most appropriate dose of FA is still open.The aim of this project is to assess the effect a higher dose of peri-conceptional FA supplementation on reducing the occurrence of all CMs. Other aims include the promotion of pre-conceptional counselling, comparing rates of selected CMs, miscarriage, pre-eclampsia, preterm birth, small for gestational age, abruptio placentae.Methods/Design: This project is a joint effort by research groups in Italy and the Netherlands. Women of childbearing age, who intend to become pregnant within 12 months are eligible for the studies. Women are randomly assigned to receive 4 mg of FA (treatment in study) or 0.4 mg of FA (referent treatment) daily. Information on pregnancy outcomes are derived from women-and-physician information.We foresee to analyze the data considering all the adverse outcomes of pregnancy taken together in a global end point (e.g.: CMs, miscarriage, pre-eclampsia, preterm birth, small for gestational age). A total of about 1,000 pregnancies need to be evaluated to detect an absolute reduction of the frequency of 8%. Since the sample size needed for studying outcomes separately is large, this project also promotes an international prospective meta-analysis.Discussion: The rationale of these randomized clinical trials (RCTs) is the hypothesis that a higher intake of FA is related to a higher risk reduction of NTDs, other CMs and other adverse pregnancy outcomes. Our hope is that these trials will act as catalysers, and lead to other large RCTs studying the effects of this supplementation on CMs and other infant and maternal outcomes.Trial registration: Italian trial: ClinicalTrials.gov Identifier: NCT01244347.Dutch trial: Dutch Trial Register ID: NTR3161

Land‐use change and bioenergy production: Soil consumption and characterization of anaerobic digestion plants

The exploitation of bioenergy plays a key role in the process of decarbonising the economic system. Huge efforts have been made to develop bioenergy and other renewable energy sys-tems, but it is necessary to investigate the costs and problems associated with these technologies. Soil consumption and, in particular, soil sealing are some of these aspects that should be carefully evaluated. Agricultural biogas plants (ABPs) often remove areas dedicated to agricultural activities and require broad paved areas for the associated facilities. This study aimed to (i) assess the surfaces destined to become facilities and buildings in ABPs, (ii) correlate these surfaces with each other and to the installed powers of the plants, and (iii) estimate the consumption of soil in bioenergy applications in Italy. Two hundred ABPs were sampled from an overall population of 1939, and the ex-tents of the facilities were measured by aerial and satellite observations. An ABP with an installed power of 1000 kW covers an average surface area of up to 23,576 m2. Most of this surface, 97.9%, is obtained from previously cultivated areas. The ABP analysis proved that 24.7 m2 of surface area produces 1 kW of power by bioenergy. The obtained model estimated a total consumption of soil by ABPs in Italy of 31,761,235 m2. This research can support stakeholders in cost‐benefit analyses to design energy systems based on renewable energy sources

Suicidal Ideation among Italian and Spanish Young Adults: The Role of Sexual Orientation

The purpose of the current study was to identify demographic, social, and psychological variables associated with suicidal ideation in an Italian sample and a Spanish sample, taking into account the relevance of sexual orientation as a risk factor for suicide. Three hundred twenty gay and bisexual men, 396 heterosexual men, 281 lesbians and bisexual women, and 835 heterosexual women were recruited. In chi-square and multivariable logistic regression analyses we identified several consistent cross-national risk factors for suicidal ideation: having lower education, not being religious, being homosexual or bisexual, not being engaged in a stable relationship, having lower level of peer and parental attachment, and having depressive symptoms. Interestingly, the strongest risk factor in both samples, after depression symptoms, was sexual orientation

Same-sex parent families in Italy: Validation of the Coparenting Scale-Revised for lesbian mothers and gay fathers

Even though Italy is still struggling to establish equal rights and access to assisted reproduction techniques for sexual minorities, an increasing number of lesbian women and gay men are now becoming parents. There are only a few studies that have evaluated coparenting in same-sex couples. However, these addressed adoptive couples and not the lesbian and gay parent families through donor insemination or surrogacy, respectively. This study examined the psychometric properties of the Coparenting Scale-Revised and its relationship with dyadic adjustment, discipline management, and internalized sexual stigma in Italian same-sex-planned families. The factor structure showed a satisfactory internal consistency and criterion validity with correlates of coparenting behaviours. While Family Integrity factor was confirmed, Disparagement and Reprimand dimensions collapsed into Conflict factor. Non-genetic parents showed lower levels of conflict than genetic parents. Most importantly, coparenting emerged as a significant function not shaped by gender, but influenced by parental status and internalized sexual stigma

Sexism and Attitudes Toward Same-Sex Parenting in a Sample of Heterosexuals and Sexual Minorities: the Mediation Effect of Sexual Stigma

The present study aimed to: (a) investigate the relationship between attitudes toward same-sex parenting and sexism both in heterosexuals and sexual minorities; (b) verify whether sexism predicted negative attitudes toward same-sex parenting via the mediating role of sexual stigma (sexual prejudice in heterosexual people and internalized sexual stigma [ISS] in lesbians and gay men [LG]). An Italian sample of 477 participants (65.6% heterosexual people and 34.4% LG people) was used to verify three hypotheses: (a) heterosexual men showed higher levels of sexism than heterosexual women and LG people; (b) heterosexual men reported more negative attitudes toward same-sex parenting than those of heterosexual women and LG people; and (c) sexual prejudice in heterosexual people and ISS in LG people mediated the relationship between sexism and attitudes toward same-sex parenting. Overall, men and heterosexual people showed stronger sexist tendencies and more negative attitudes toward same-sex parenting. Moreover, sexism affected attitudes toward same-sex parenting via sexual prejudice in heterosexual people and ISS in LG people. These results suggest that negative attitudes toward same-sex parenting reflect sociocultural inequalities based on the traditional gender belief system and points to the necessity of social policies to reduce prejudice toward sexual minority groups