Análise das políticas públicas de enfrentamento da violência sexual infantojuvenil Analysis of public policies for combating sexual violence against children and adolescents

Este artigo tem como objetivo analisar a principal política pública brasileira para o enfrentamento da violência sexual infantojuvenil no Brasil (Plano Nacional de Enfrentamento da Violência Sexual Contra Crianças e Adolescentes) sob o enfoque do seu eixo de atendimento, denominado "garantia de atendimento integral e especializado". Através de uma análise documental conduzida pelo método de análise do conteúdo, são discutidos os limites e potencialidades das ações do Programa Sentinela, que constitui importante estratégia de execução do plano em sua meta "atendimento especializado e multiprofissional às vítimas de violência sexual e seus familiares". O estudo mostra que, apesar de contemplar a maioria das diretrizes propostas para o atendimento, o programa ainda apresenta dificuldades intersetoriais no que tange a articulação com a rede assistencial, processos de referência e contra-referência e interlocução dos profissionais envolvidos. Os indicadores de avaliação do atendimento são precários, inviabilizando o monitoramento adequado das ações realizadas. Por sua vez, as capacitações oferecidas aos profissionais que atuam no Sentinela não são sistemáticas, ocasionado uma falta de padronização de condutas de atendimento. No âmbito da Saúde, poucos são os serviços estruturados com equipes habilitadas para fornecer este tipo de atendimento. Conclui-se que, apesar de beneficiar muitas crianças, adolescentes e familiares em situação de violência sexual, o atendimento especializado ainda demanda, tanto na área social como na da saúde, maiores investimentos e reestruturações para o preenchimento das lacunas ainda existentes.<br>The purpose of this article is to analyze the main Brazilian public policy for tackling sexual violence against children and adolescents (National Plan for the Combat of Sexual Violence Against Children and Adolescents), focusing on its assistance axis, called "guarantee of integral and specialized assistance". Based on a documental analysis carried out by the method of content analysis, this article discusses the limits and potentialities of the actions of Programa Sentinela (Sentry Program), which is an important execution strategy of the Plan concerning its goal "specialized and multiprofessional assistance for victims of sexual violence and their families". The study shows that in spite of complying with most of the guidelines proposed for assistance, the program still presents intersector difficulties regarding articulation with the assistance network, reference and counter-reference processes and dialogue among the involved professionals. The service's evaluation indicators are precarious, impeding the proper monitoring of the accomplished actions. In addition, the qualification programs offered to the professionals that work in Program Sentinela are not systematic; therefore, the assistance conducts are not standardized. In the scope of Healthcare, there are few structured services with qualified teams to provide this kind of service. Finally, the study shows that despite benefitting a lot of children, adolescents and relatives in situation of sexual violence, specialized assistance still demands larger investments and restructurings in the social and health areas to fulfill the gaps that still exist

613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review

Background Rupture of the spleen in the absence of trauma or previously diagnosed disease is largely ignored in the emergency literature and is often not documented as such in journals from other fields. We have conducted a systematic review of the literature to highlight the surprisingly frequent occurrence of this phenomenon and to document the diversity of diseases that can present in this fashion. Methods Systematic review of English and French language publications catalogued in Pubmed, Embase and CINAHL between 1950 and 2011. Results We found 613 cases of splenic rupture meeting the criteria above, 327 of which occurred as the presenting complaint of an underlying disease and 112 of which occurred following a medical procedure. Rupture appeared to occur spontaneously in histologically normal (but not necessarily normal size) spleens in 35 cases and after minor trauma in 23 cases. Medications were implicated in 47 cases, a splenic or adjacent anatomical abnormality in 31 cases and pregnancy or its complications in 38 cases. The most common associated diseases were infectious (n = 143), haematologic (n = 84) and non-haematologic neoplasms (n = 48). Amyloidosis (n = 24), internal trauma such as cough or vomiting (n = 17) and rheumatologic diseases (n = 10) are less frequently reported. Colonoscopy (n = 87) was the procedure reported most frequently as a cause of rupture. The anatomic abnormalities associated with rupture include splenic cysts (n = 6), infarction (n = 6) and hamartomata (n = 5). Medications associated with rupture include anticoagulants (n = 21), thrombolytics (n = 13) and recombinant G-CSF (n = 10). Other causes or associations reported very infrequently include other endoscopy, pulmonary, cardiac or abdominal surgery, hysterectomy, peliosis, empyema, remote pancreato-renal transplant, thrombosed splenic vein, hemangiomata, pancreatic pseudocysts, splenic artery aneurysm, cholesterol embolism, splenic granuloma, congenital diaphragmatic hernia, rib exostosis, pancreatitis, Gaucher's disease, Wilson's disease, pheochromocytoma, afibrinogenemia and ruptured ectopic pregnancy. Conclusions Emergency physicians should be attuned to the fact that rupture of the spleen can occur in the absence of major trauma or previously diagnosed splenic disease. The occurrence of such a rupture is likely to be the manifesting complaint of an underlying disease. Furthermore, colonoscopy should be more widely documented as a cause of splenic rupture