Transmission of anogenital warts in children and association with sexual abuse

INTRODUÇÃO: A incidência do condiloma acuminado anogenital em crianças mostra notável aumento nas últimas duas décadas, bem como o interesse por sua associação com o abuso sexual. No entanto, essa relação apresenta controvérsias quanto à etiologia da infecção, o que torna o atendimento desafiador, particularmente nos aspectos ético-legais. OBJETIVO: Revisão da literatura sobre transmissão do HPV em crianças e relação com abuso sexual. MÉTODO: Síntese de dados da consulta ao Journal Citation Reports (JCR-ISI), Medical Literature Analysis and Retrieval System Online (Medline), Scientific Eletronic Library Online (Scielo) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs). Foram utilizados descritores MeSH Terms com sintaxes (HPV [All Fields]) AND ("Child Abuse, Sexual" [MeSH Terms]). Artigos relevantes entre 1989 e 2009 foram selecionados. Aspectos ético-legais foram consultados na legislação penal e Estatuto da Criança e do Adolescente. RESULTADOS: Diferentes formas de transmissão não sexual do HPV em crianças estão documentadas, destacando-se a transmissão vertical, auto e heteroinoculação de verrugas cutâneas, e aquisição por instrumentos. Estudos são discordantes quanto à aplicabilidade do DNA-HPV para diferenciar a transmissão sexual e não sexual das verrugas anogenitais. CONCLUSÃO: Evidências indicam que em crianças com menos de dois anos de idade a transmissão não sexual do HPV deve ser fortemente considerada na ausência de lesões genitais, de outra DST, ou de história consistente de abuso. A probabilidade de associação entre HPV e abuso sexual aumenta diretamente com a idade, principalmente após os cinco anos.INTRODUCTION: the incidence of anogenital condyloma acuminata in children shows remarkable increase in the last two decades, as well as by its association with sexual abuse. However, this relationship presents controversies regarding the etiology of infection, which makes answering challenging, particularly in legal-ethical aspects. OBJECTIVE: review of the literature about HPV transmission in children and relationship with sexual abuse. METHODS: synthesis of data from the query to Journal Citation Reports (JCR-ISI), Medical Literature Analysis and Retrieval System Online (Medline), Scientific Electronic Library Online (Scielo) and the Latin American and Caribbean Health Sciences (Lilacs). MeSH descriptors were used Terms with syntax (HPV [All Fields]) AND ("Child Sexual Abuse," [MeSH Terms]). Relevant articles between 1989 and 2009 were selected. Legal-ethical aspects were consulted in the criminal law and Brazilian Child and Adolescent Statute. RESULTS: different forms of non-sexual transmission of HPV in children are documented, including the vertical transmission, self and hetero inoculation of cutaneous warts, and acquisition by instruments. Studies are conflicting as to the applicability of HPV-DNA to differentiate the sexual transmission and not sexual anogenital warts. CONCLUSION: evidence indicates that in children under two years non-sexual transmission of HPV should be strongly considered in the absence of genital lesions, another STD, or consistent history of abuse. The likelihood of association between HPV and sexual abuse increases directly with age, especially after five years

The Lipodystrophy Syndrome as a Risk Marker for Cardiovascular Disease in Patients with HIV/AIDS Treated with HAART

Introduction: The classic risk factors for cardiovascular disease in healthy individuals are well known, however, it lacks in the literature the mechanisms that predicts cardiovascular disease in the population living with HIV-AIDS treated with HAART and presenting syndrome lipodystrophy. We aimed to investigate the risk of cardiovascular disease in HIV-AIDS patients treated with HAART and lipodystrophy syndrome. Methods: A search was performed in Medline, SciELO, Lilacs and Cochrane using the intersection between the keywords: "cardiovascular disease", "HIV", "AIDS", "HAART" and "lipodystrophy syndrome". Results: The selected studies demonstrated that metabolic disorders such as hyperlipidemia, central adipose hypertrophy and peripheral lipoatrophy, besides the metabolic syndrome and lipodystrophy are maker clear risks of developing cardiovascular disease in these individuals. Conclusion: The metabolic alterations in HIV-AIDS treated with HAART and presenting lipodystrophy syndrome may potentiate the development of cardiovascular diseases

Motor intervention in children with school learning difficulties

This study sought to evaluate motor development in children aged 6 to 11 years with learning\ud difficulties and school characteristics of delayed motor development, before and after application of\ud a motor intervention program. The sample consisted of 28 children with a mean age of 107.21 ±\ud 16.56 months, who were evaluated by the Motor Development Scale and received motor intervention\ud for 6 months, followed by reassessment. We observed a statistically significant difference between\ud the average of the motor activity ratios in all areas of the evaluation and reevaluation. Also verified\ud in the evaluation were the concentration ratios of children with motor activity greater than or equal\ud to 80 and there was a revaluation increase in this concentration on re-evaluation, the areas with the\ud greatest increase in concentration and significant differences being: Body Schema, Space and temporal\ud Organization. In the overall evaluation of MDS, most children presented the classification of “low\ud normal”. However, in the reassessment most have evolved into the “average normal”, only 4 of\ud themremaining in the same classification. Therefore, in this study, children with learning disabilities\ud also showed motor deficits and the intervention applied contributed to an increase in the motor\ud ratios with consequent improvement in motor development. Besides psychopedagogical asistance,\ud it is essential to reassess them and if necessary apply the intervention in the motor development of\ud children with learning difficultie

Overweight in preschool children: analysis of a possible intervention

INTRODUÇÃO: a obesidade vem aumentando progressivamente na infância. Em resposta a essa tendência, diversas instituições têm realizado programas de prevenção à obesidade infantil. OBJETIVO: elaborar um projeto de intervenção voltado para a prevenção do excesso de peso de crianças de 2 e 3 anos de idade de creches públicas e analisar a viabilidade de sua implantação. MÉTODO: foram sorteadas probabilisticamente nove creches: quatro compondo a amostra objeto da intervenção e cinco para o grupo sem intervenção. Realizaram-se observações sistematizadas para reconhecimento da rotina de alimentação e de atividades físicas nas creches, a partir das quais se delineou e implantou uma intervenção. Foi pré-estabelecido que a intervenção devesse ser simples, de baixo custo, praticamente não elevar a carga de trabalho local e resultar num processo participativo. RESULTADOS: a alimentação era programada pela empresa de merenda escolar terceirizada pela Prefeitura, que oferecia porções superdimensionadas. As atividades físicas eram restritas e sem programação regular. A intervenção nutricional adequou às porções oferecidas no almoço, inclusive evitando a repetição da refeição. Para as atividades físicas, estabeleceu-se que seriam diárias, com 30 minutos de duração e de elevado gasto energético. Todas as alterações foram elaboradas e implantadas com participação efetiva do pessoal das creches em, no máximo, 12 semanas. CONCLUSÃO: é possível elaborar e implantar uma intervenção simples, feita sob medida para a realidade local de creches, visando a melhoria do estado nutricional das crianças em idade pré-escolar.INTRODUCTION: Obesity is increasing progressively in childhood. In response to this trend, several institutions have carried out programs to prevent childhood obesity. OBJECTIVE: To develop an intervention project aimed at the overweight prevention in 2-3 year-old children at public daycare centers and analyze the feasibility of its implementation. METHODS: nine daycare centers were randomly selected probabilistically: four composing the sample object of intervention and five in the group without intervention. There have been comments systematized for the recognition of the routine of feeding and physical activity of daycare centers, from which was outlined and implemented an intervention. It was predefined that the intervention should be simple, of low cost, hardly raising the burden of local labor and result in a participatory process. RESULTS: Food was scheduled by the school lunch company outsourced by the city, which offered oversized portions. Physical activities were restricted and without regular schedule. The nutritional intervention adapted the quantity of food served at lunch, also avoiding the repetition of the meal. For physical activities, it was established that they would be daily, during 30 minutes and of high energy expenditure. All changes were designed and implemented with effective participation of staff in the daycare, in a maximum of 12 weeks. CONCLUSION: it is possible to develop and deploy a simple intervention, tailored to local realities of daycare centers, aimed at improving the nutritional status of children

Pregnancy resulting from sexual abuse: Reasons alleged by Brazilian women for carrying out the abortion - Pregnancy and violence

http://www.healthmedjournal.com/vol06-no3.pd

Social representation of the hospital ludic: look of the child

Introdução: o brincar tem se tornado objeto de estudo nos diversos setores da sociedade, sendo considerado como uma atividade espontânea inata ao ser humano e necessário ao desenvolvimento infantil físico, social, emocional e cognitivo, facilita comunicação, ajuda na socialização e adaptação a ambientes e pessoas. Quando hospitalizadas, as criança se sentem vulneráveis, com pessoas desconhecidas, procedimentos invasivos e dolorosos, e a limitação das atividades exercidas por ela, tendem a tornar a situação pior. Objetivos: descrever a percepção da criança, acerca do lúdico no ambiente hospitalar e verificar a representação social da brinquedoteca para as crianças internadas a partir da técnica de Desenho-Estória com tema. Método: tratou-se de um estudo qualitativo e exploratório que utilizou como instrumento de coleta de dados a técnica do Desenho – Estória com tema, tendo como sujeitos 12 crianças com idade entre 06 e 11 anos. A análise dos dados foi realizada a partir da discussão com subsídios teóricos estudados, além da observação dos pesquisadores, que possibilitou encontrar respostas ao problema pesquisado, estabelecendo as relações necessárias entre os dados obtidos e as hipótesesformuladas. Resultados: para as crianças o lúdico no contexto hospitalar estava ligado ao espaço da brinquedoteca, de forma que, a maior parte relatou que não brincavam no quarto, ou em qualquer outro local do hospital. Logo, sua representação social para as crianças foi identificada como um lugar onde acontece socialização, recuperação, onde se pode manipular imaginariamente o ambiente para aproximar-se da realidade cotidiana, ou transformar a situação vivenciada em algo familiar. Percebeu-se que a ludicidade mudam as idéias previamente formadas pela criança sobre o hospital, passando este, a ser percebido como um espaço que proporciona bem-estar e prazer, e onde se pode brincar. O desenho contextualiza e revela simbolicamente a situação de hospitalização, além de apresentar-se como elementoestruturante para a criança do ponto de vista emocional. Conclusões: a brinquedoteca é capaz de aumentar a adaptação da criança à nova situação que vivencia, e inclusive atuar sobre o restabelecimento de sua saúde. Por fim, constatamos que o lúdico é fator de proteção para crianças durante a hospitalização. Embora a obrigatoriedade da presença das brinquedotecas hospitalares em instituições de saúde com atendimento pediátrico seja um grande avanço para as políticas públicas, há ainda alguns desafios que necessitam ser superados, dentre eles a necessidade de engajamento dos profissionais de saúde e estabelecimento de uma rotina de funcionamento.Introduction: Play has become an object of study in various sectors of society, as it is viewed as an innate, spontaneous activity that is critical for a child’s physical, social, emotional and cognitive development, which facilitates communication, socialisation and adaptation to environments and people. During hospitalisation, children feel vulnerable as they have to cope with strange carers, invasive and painful procedures. Barriers to their regular activities tend to make the situation worse. Objectives: To describe the child’s view of his/her playfulness in the hospital environment and investigate the social representation of a hospital playroom for children exposed  to the story-drawing technique. Methods: This qualitative exploratory research used storydrawing as a tool for data collection with a sample of 12 children aged 6 to 11 years, while they were hospitalised. Data analysis was supported by a literature review and direct observation, which allowed the researchers to draw relationships between theory, the research hypotheses and the data collected. Findings: The children’s construction and representation of playfulness while in hospital was directly related to the playroom, since most of them reported not conceiving of the possibility to play in bed or elsewhere in the hospital. Soon the playroom was further viewed as a place for socialising and recovering from illness as they approximated this environment to their reality in an attempt to make it a closest-as-possible representation of their homes. It was observed that play changed the children’s preconceived ideas of the hospital, as they began to view the playroom as an environment in which they felt able to play and consequently well. Their story-drawings contextualised symbolically their current hospitalisation situation and became a scaffolding tool for their emotional well-being. Conclusions: The playroom can effectively aid hospitalised children to cope better with the new situation and support the restoration of their health. Play is an emotionally protective factor for children during hospitalisation. Although in Brazil it is now mandatory for health institutions to have a playroom with paediatric care, this breakthrough policy is still challenging for some institutions with respect to being staffed with engaged health professionals and establishing routine procedures

Factors associated with the delay in seeking legal abortion for pregnancy resulting from rape

AbstractBackground: about 7% of rape cases in Brazil result in pregnancy. Brazilian  women generally are unaware of the right to legal interruption of pregnancy  after rape and try to end abortion in an unsafe manner or last to request the  procedure. Objective: to analyse factors associated with the time of seeking  legal abortion after rape in a public hospital. Methods: this is an observational,  analytical, and cross-sectional study. Data are from medical records of 1,270  women who complained of rape and have requested legal abortion in a public  hospital in São Paulo between 1994 and 2013. The variables age, education,  race, marital status, religion, form of intimidation, vulnerable condition,  perpetrator of sexual violence, number of perpetrators, and police report were analysed in relation to gestational age, according to multiple multinomial logistic  regression models. Results: the delay in requesting abortion at intermediate  gestational age is associated to when a woman is vulnerable (p=0.015), late  gestational age is associated with the presence of a police report (p=0.029) and 48 marital status as ngle (p=0.05). Be a relative of the aggressor is associated with  both intermediate (p=0.016) and late gestational age (p=0.002). Conclusions:  women without partners, who suffered intimidation with threats, in a vulnerable  condition, who made a police report and, above all, who were raped by relatives,  composed the group who took longer to get the health service.Keywords: sexual violence; rape; unwanted pregnancy; legal abortio

Characteristics of sexual violence against adolescent girls and adult women

Background: Sexual violence is considered a serious violation of human rights which affects mainly young women and adolescents. There is little information about the conditions under which sexual offences occur. We evaluated characteristics of sexual violence against adolescent girls and adult women.Method: This is a quantitative, retrospective, descriptive study of sexual violence against adolescent girls and adult women. Analyses were carried out on data collected from 1118 women, 546 adolescents (10-19 years) and 572 adults (>= 20 years), with a complaint of rape treated at Hospital Perola Byington, Sao Paulo, between 1994 and 1999. The age limit of the adolescent sample met the World Health Organization's (WHO) criteria. We analyzed the type of sexual contact, degree of intimidation, perpetrator and activity of the victim during the approach.Results: Crimes without penetration were five times more frequent in adolescents and use of threats of death or intimidation was common in both groups. Mental illness was more prevalent in adult victims and the majority of adolescent victims were aged < 14 years. Uncle and stepfather perpetrators were more frequent among adolescents and partners or former intimate partners in adult women. In most cases the approach occurred in public places, although sex crimes at the perpetrator's residence were more frequent amongst adolescents.Conclusions: Although children and adolescents require the same intervention measures and legal protection, a considerable proportion of adolescent sex offenders can face conditions similar to those of adult women

Neogene sharks and rays from the Brazilian ‘Blue Amazon’

The lower Miocene Pirabas Formation in the North of Brazil was deposited under influence of the proto-Amazon River and is characterized by large changes in the ecological niches from the early Miocene onwards. To evaluate these ecological changes, the elasmobranch fauna of the fully marine, carbonate-rich beds was investigated. A diverse fauna with 24 taxa of sharks and rays was identified with the dominant groups being carcharhiniforms and myliobatiforms. This faunal composition is similar to other early Miocene assemblages from the proto-Carribbean bioprovince. However, the Pirabas Formation has unique features compared to the other localities; being the only Neogene fossil fish assemblage described from the Atlantic coast of Tropical Americas. Phosphate oxygen isotope composition of elasmobranch teeth served as proxies for paleotemperatures and paleoecology. The data are compatible with a predominantly tropical marine setting with recognized inshore and offshore habitats with some probable depth preferences (e.g., Aetomylaeus groups). Paleohabitat of taxa particularly found in the Neogene of the Americas (†Carcharhinus ackermannii, †Aetomylaeus cubensis) are estimated to have been principally coastal and shallow waters. Larger variation among the few analyzed modern selachians reflects a larger range for the isotopic composition of recent seawater compared to the early Miocene. This probably links to an increased influence of the Amazon River in the coastal regions during the Holocene