Joelza Pires - Academia.edu (original) (raw)
Papers by Joelza Pires
Jornal De Pediatria, Jul 15, 1999
Este artigo relata dois casos de Síndrome de Münchausen por procuração acompanhados em nosso serv... more Este artigo relata dois casos de Síndrome de Münchausen por procuração acompanhados em nosso serviço, visando chamar a atenção dos pediatras e profissionais de saúde para esta grave forma de violência contra crianças, bem como discutir elementos de seu diagnóstico. A Síndrome de Münchausen por procuração (SMPP) é uma forma de abuso na infância, recentemente relatada na literatura médica e definida inicialmente como uma desordem psiquiátrica, conforme proposto pelo DSM IV 1. Foi descrita pela primeira vez em 1977 por Meadow 2. Nesta síndrome, o perpetrador assume a doença indiretamente (por procuração), exacerbando, falsificando 3 ou produzindo histórias clínicas, evidências laboratoriais, causando lesões físicas 4 e induzindo a hospitalizações com procedimentos terapêuticos e diagnósticos desnecessários. Esta forma de abuso é ocultada pelo seu perpetrador, que demonstra aparente interesse e um envolvimento excessivo nos cuidados com a criança 2. A doença é usualmente "fabricada" pela mãe, mas ocasionalmente com a participação simbiótica do filho 3. Há uma grande variedade de sintomas, com seus respectivos métodos de indução e/ou simulação, descritos na literatura: apnéia (sufocação), vômitos intratáveis (intoxicação ou falso relato), sangramentos (intoxicação ou adição de substâncias: tinta, corantes, cacau), exantemas (intoxicação, arranhões, aplicação de cáusticos, pintura da pele), crises convulsivas (intoxicações, falso relato, sufocação), diar-Resumo Objetivo: Este artigo visa a chamar a atenção de pediatras e profissionais de saúde para a Síndrome de Münchausen por procuração, uma grave forma de violência contra a criança. Pacientes e métodos: Relatamos a história clínica e evolutiva de dois pacientes, revisados retrospectivamente entre casos do Comitê dos Direitos da Criança do Hospital da Criança Santo Antônio, para posterior discussão. O primeiro caso é de uma paciente de 5 anos de idade que apresentava crises convulsivas de difícil controle. Após atuação de vários especialistas e, posteriormente, do Comitê dos Direitos da Criança, teve um prognóstico excelente. O segundo caso é de um lactente de 5 meses com crises de apnéia, episódios de cianose e crises convulsivas. Comentário: A Síndrome de Münchausen por procuração é uma entidade relativamente rara, de difícil diagnóstico, levando a criança, muitas vezes, a procedimentos diagnósticos desnecessários e potencialmente danosos à mesma.
The goal of occupation rehabilitation is to preserve existing employment relationship and to prom... more The goal of occupation rehabilitation is to preserve existing employment relationship and to promote long-term integration into working life and thereby ensure social and economic participation of people with disabilities. Against this background, this paper compares labor market outcomes of people that were accepted to participate in occupational rehabilitation to people that were rejected. The analysis is concentrated on a group of adult applicants in returnto-work occupational rehabilitation scheme in 2008. We follow labor market outcomes of accepted and rejected applicants up to the end of 2014 and thus we can estimate short and long-term effects of entering occupational rehabilitation. Methodology & Theoretical Orientation: Direct comparison of labor market outcomes of accepted and rejected applicants is biased because these groups differ systematically. Participation in occupational rehabilitation is typically offered to persons that are both in need of a programme (due to occupational disability) and can benefit from it. Moreover, as documented in previous sections, groups of rejected and accepted applicants differ in terms of socioeconomic characteristics and labor market history. To address the selection issue, we follow a seminal study of Rosenbaum and Rubin (1983) who proposed to compare (match) observations based on the predicted probability (propensity score) to participate in a programme (in our case acceptance to participate in occupational rehabilitation). Comparison based on a propensity score is unbiased under the assumption that all relevant covariates that explain acceptance to participate in occupational rehabilitation and outcomes are simultaneously observed. Conclusion & Significance: Our main finding is that three years after the application, the group of accepted applicants relative to the group of rejected applicants had the higher share in regular employment and a lower share of recipients of unemployment and basic income support benefits. Results of the analysis are used to strengthen monitoring of the effects of occupational rehabilitation and to identify groups that are more likely to benefit from take-up of occupational rehabilitation. Sensitivity analysis suggests that the results are robust, but to obtain more precise estimates of the effects of occupational rehabilitation improvements in data collection are warranted. Biography Anton Nivorozhkin has his expertise in the evaluation of social programmes in developed and transition economies. As a Ph.D. candidate at Goteborg University (Sweden), he extensively studied labor market and social protection programmes in Russia and Sweden. Later, as a researcher at the Institute for Employment Research in Germany, he analyzed policies that increase labor market attachment of social welfare benefit recipients. He has also worked as a labor market economist at the OECD and as a consultant for the World Bank and contributed to the reports on employment and social protection policies in Russia, Lithuania and Kazakhstan.
Trends in Psychiatry and Psychotherapy, 2014
Introduction: Recurrent exposure to childhood sexual abuse (CSA) seems to be higher among victims... more Introduction: Recurrent exposure to childhood sexual abuse (CSA) seems to be higher among victims of sexual abuse. In this sense, experiences related to sexual violence can perpetuate within the family context itself in various ways. Here, we investigate the association between being exposed to CSA and having a child victim of sexual abuse. Method: We used a sample with 123 mothers, who were divided into 2 groups: one consisting of 41 mothers of sexually abused children and another consisting of 82 mothers of non-sexually abused children. History of exposure to CSA was evaluated by means of the Childhood Trauma Questionnaire - Short Form (CTQ) and we used a logistic regression model to estimate the prediction values regarding having or not a child exposed to sexual violence. Results: Mothers of sexually abused children had significantly higher scores on CTQ, especially on the sexual abuse subscale (SA). According to our logistic regression model, higher scores on the CTQ significant...
Revista Brasileira de Saúde Materno Infantil, 2005
OBJETIVOS: determinar os fatores que interferem na notificação de maus-tratos infantis, pelos ped... more OBJETIVOS: determinar os fatores que interferem na notificação de maus-tratos infantis, pelos pediatras, aos serviços de proteção à criança. MÉTODOS: estudo observacional transversal. Uma amostra aleatória de pediatras de Porto Alegre foi selecionada entre 990 inscritos na sociedade de pediatria local. Variáveis sócio-demográficas, formação profissional, conhecimento diante de casos de maus-tratos infantis foram obtidos através de questionário anônimo. Análises descritiva e multivariada foram utilizadas para determinar os fatores associados a não notificação. RESULTADOS: foram incluídos 97 pediatras dos quais 92 concordaram em participar do estudo. Oitenta identificaram casos de maus-tratos, e destes 63 notificaram ao menos um caso. A maioria revelou medo de envolver-se legalmente, apresentou nível suficiente de conhecimento e baixo grau de confiança nos órgãos de proteção à criança. Conhecimento insuficiente (OR = 3,94), trabalhar exclusivamente no setor privado (OR = 6,33) foram f...
Objective: To draw pediatrician's and healthcare workers’ attention to the Munchausen syndrom... more Objective: To draw pediatrician's and healthcare workers’ attention to the Munchausen syndrome by proxy, a serious kind of child abuse. Patients and Methods: We report the clinical history and the evolution of two patients, based on a review of these patients' files in the Children’s Rights Committee of the Hospital da Crianca Santo Antonio, for further discussion. The first case reports a 5yearoldchildthatpresenteddifficult-controllingseizures;thiscase hadanexcellentprognosisafterbeingexaminedbyseveralspecialists and later on by the Children’s Right Committee. The second case reported is a 5-month old infant who presented apnea crisis accompanied by cyanosis and seizures.
This paper determine the risk factors for not notifying child abuse for protection child services... more This paper determine the risk factors for not notifying child abuse for protection child services (CPS) by pediatricians. It is a cross-sectional study carried out in Porto Alegre, Brazil. A randomized sample of pediatricians was collected from records of the local pediatric association. Socio-demographic variables, post and graduation backgrounds, knowledge and behavior regarding to child abuse were obtained by means of an anonymous questionnaire and related to the attitude of not notifying a case of child abuse. After a descriptive analysis, a multivariate analysis was performed by a logistic regression model in order to determine the risk factors for not notifying. Hundred twenty nine were selected from 990 eligible pediatricians, 92 repplied the questionnaire. From them, 80 (86.9%) identified at least one case of child abuse and 63 (78.7%) notified at least one of these cases. The majority of pediatricians showed a level of knowledge regarding child abuse from adequate to suffic...
Jornal De Pediatria, Jul 15, 1999
Este artigo relata dois casos de Síndrome de Münchausen por procuração acompanhados em nosso serv... more Este artigo relata dois casos de Síndrome de Münchausen por procuração acompanhados em nosso serviço, visando chamar a atenção dos pediatras e profissionais de saúde para esta grave forma de violência contra crianças, bem como discutir elementos de seu diagnóstico. A Síndrome de Münchausen por procuração (SMPP) é uma forma de abuso na infância, recentemente relatada na literatura médica e definida inicialmente como uma desordem psiquiátrica, conforme proposto pelo DSM IV 1. Foi descrita pela primeira vez em 1977 por Meadow 2. Nesta síndrome, o perpetrador assume a doença indiretamente (por procuração), exacerbando, falsificando 3 ou produzindo histórias clínicas, evidências laboratoriais, causando lesões físicas 4 e induzindo a hospitalizações com procedimentos terapêuticos e diagnósticos desnecessários. Esta forma de abuso é ocultada pelo seu perpetrador, que demonstra aparente interesse e um envolvimento excessivo nos cuidados com a criança 2. A doença é usualmente "fabricada" pela mãe, mas ocasionalmente com a participação simbiótica do filho 3. Há uma grande variedade de sintomas, com seus respectivos métodos de indução e/ou simulação, descritos na literatura: apnéia (sufocação), vômitos intratáveis (intoxicação ou falso relato), sangramentos (intoxicação ou adição de substâncias: tinta, corantes, cacau), exantemas (intoxicação, arranhões, aplicação de cáusticos, pintura da pele), crises convulsivas (intoxicações, falso relato, sufocação), diar-Resumo Objetivo: Este artigo visa a chamar a atenção de pediatras e profissionais de saúde para a Síndrome de Münchausen por procuração, uma grave forma de violência contra a criança. Pacientes e métodos: Relatamos a história clínica e evolutiva de dois pacientes, revisados retrospectivamente entre casos do Comitê dos Direitos da Criança do Hospital da Criança Santo Antônio, para posterior discussão. O primeiro caso é de uma paciente de 5 anos de idade que apresentava crises convulsivas de difícil controle. Após atuação de vários especialistas e, posteriormente, do Comitê dos Direitos da Criança, teve um prognóstico excelente. O segundo caso é de um lactente de 5 meses com crises de apnéia, episódios de cianose e crises convulsivas. Comentário: A Síndrome de Münchausen por procuração é uma entidade relativamente rara, de difícil diagnóstico, levando a criança, muitas vezes, a procedimentos diagnósticos desnecessários e potencialmente danosos à mesma.
The goal of occupation rehabilitation is to preserve existing employment relationship and to prom... more The goal of occupation rehabilitation is to preserve existing employment relationship and to promote long-term integration into working life and thereby ensure social and economic participation of people with disabilities. Against this background, this paper compares labor market outcomes of people that were accepted to participate in occupational rehabilitation to people that were rejected. The analysis is concentrated on a group of adult applicants in returnto-work occupational rehabilitation scheme in 2008. We follow labor market outcomes of accepted and rejected applicants up to the end of 2014 and thus we can estimate short and long-term effects of entering occupational rehabilitation. Methodology & Theoretical Orientation: Direct comparison of labor market outcomes of accepted and rejected applicants is biased because these groups differ systematically. Participation in occupational rehabilitation is typically offered to persons that are both in need of a programme (due to occupational disability) and can benefit from it. Moreover, as documented in previous sections, groups of rejected and accepted applicants differ in terms of socioeconomic characteristics and labor market history. To address the selection issue, we follow a seminal study of Rosenbaum and Rubin (1983) who proposed to compare (match) observations based on the predicted probability (propensity score) to participate in a programme (in our case acceptance to participate in occupational rehabilitation). Comparison based on a propensity score is unbiased under the assumption that all relevant covariates that explain acceptance to participate in occupational rehabilitation and outcomes are simultaneously observed. Conclusion & Significance: Our main finding is that three years after the application, the group of accepted applicants relative to the group of rejected applicants had the higher share in regular employment and a lower share of recipients of unemployment and basic income support benefits. Results of the analysis are used to strengthen monitoring of the effects of occupational rehabilitation and to identify groups that are more likely to benefit from take-up of occupational rehabilitation. Sensitivity analysis suggests that the results are robust, but to obtain more precise estimates of the effects of occupational rehabilitation improvements in data collection are warranted. Biography Anton Nivorozhkin has his expertise in the evaluation of social programmes in developed and transition economies. As a Ph.D. candidate at Goteborg University (Sweden), he extensively studied labor market and social protection programmes in Russia and Sweden. Later, as a researcher at the Institute for Employment Research in Germany, he analyzed policies that increase labor market attachment of social welfare benefit recipients. He has also worked as a labor market economist at the OECD and as a consultant for the World Bank and contributed to the reports on employment and social protection policies in Russia, Lithuania and Kazakhstan.
Trends in Psychiatry and Psychotherapy, 2014
Introduction: Recurrent exposure to childhood sexual abuse (CSA) seems to be higher among victims... more Introduction: Recurrent exposure to childhood sexual abuse (CSA) seems to be higher among victims of sexual abuse. In this sense, experiences related to sexual violence can perpetuate within the family context itself in various ways. Here, we investigate the association between being exposed to CSA and having a child victim of sexual abuse. Method: We used a sample with 123 mothers, who were divided into 2 groups: one consisting of 41 mothers of sexually abused children and another consisting of 82 mothers of non-sexually abused children. History of exposure to CSA was evaluated by means of the Childhood Trauma Questionnaire - Short Form (CTQ) and we used a logistic regression model to estimate the prediction values regarding having or not a child exposed to sexual violence. Results: Mothers of sexually abused children had significantly higher scores on CTQ, especially on the sexual abuse subscale (SA). According to our logistic regression model, higher scores on the CTQ significant...
Revista Brasileira de Saúde Materno Infantil, 2005
OBJETIVOS: determinar os fatores que interferem na notificação de maus-tratos infantis, pelos ped... more OBJETIVOS: determinar os fatores que interferem na notificação de maus-tratos infantis, pelos pediatras, aos serviços de proteção à criança. MÉTODOS: estudo observacional transversal. Uma amostra aleatória de pediatras de Porto Alegre foi selecionada entre 990 inscritos na sociedade de pediatria local. Variáveis sócio-demográficas, formação profissional, conhecimento diante de casos de maus-tratos infantis foram obtidos através de questionário anônimo. Análises descritiva e multivariada foram utilizadas para determinar os fatores associados a não notificação. RESULTADOS: foram incluídos 97 pediatras dos quais 92 concordaram em participar do estudo. Oitenta identificaram casos de maus-tratos, e destes 63 notificaram ao menos um caso. A maioria revelou medo de envolver-se legalmente, apresentou nível suficiente de conhecimento e baixo grau de confiança nos órgãos de proteção à criança. Conhecimento insuficiente (OR = 3,94), trabalhar exclusivamente no setor privado (OR = 6,33) foram f...
Objective: To draw pediatrician's and healthcare workers’ attention to the Munchausen syndrom... more Objective: To draw pediatrician's and healthcare workers’ attention to the Munchausen syndrome by proxy, a serious kind of child abuse. Patients and Methods: We report the clinical history and the evolution of two patients, based on a review of these patients' files in the Children’s Rights Committee of the Hospital da Crianca Santo Antonio, for further discussion. The first case reports a 5yearoldchildthatpresenteddifficult-controllingseizures;thiscase hadanexcellentprognosisafterbeingexaminedbyseveralspecialists and later on by the Children’s Right Committee. The second case reported is a 5-month old infant who presented apnea crisis accompanied by cyanosis and seizures.
This paper determine the risk factors for not notifying child abuse for protection child services... more This paper determine the risk factors for not notifying child abuse for protection child services (CPS) by pediatricians. It is a cross-sectional study carried out in Porto Alegre, Brazil. A randomized sample of pediatricians was collected from records of the local pediatric association. Socio-demographic variables, post and graduation backgrounds, knowledge and behavior regarding to child abuse were obtained by means of an anonymous questionnaire and related to the attitude of not notifying a case of child abuse. After a descriptive analysis, a multivariate analysis was performed by a logistic regression model in order to determine the risk factors for not notifying. Hundred twenty nine were selected from 990 eligible pediatricians, 92 repplied the questionnaire. From them, 80 (86.9%) identified at least one case of child abuse and 63 (78.7%) notified at least one of these cases. The majority of pediatricians showed a level of knowledge regarding child abuse from adequate to suffic...