Joviana Quintes Avanci

Aim: The link between violence‐related epigenetic changes and attentional problems (APs) is still not well understood. This article examines if exposure to family and community violence during childhood and adolescence may shape DNA methylation patterns associated with attention in youth. Method: This study used data from a longitudinal cohort with 500 first‐grade Brazilian students. The following measures were investigated: attention problems, family violence, and community violence. Mann–Whitney‐ U and Kruskal–Wallis were used to identify group differences and Spearman correlation to access variables associations. Top 1% CpGs were overlapped. Epigenetics analyses were performed using Epigenome‐wide association study (EWAS, 850K) and Prediction Analysis of Microarray (PAM). Linear regression models were applied to candidate genes analyses. All models used significance level at 5%. Results: AP was correlated to three types of violence (family, psychological family, and community violence). EWAS and PAM identified five genes in common: SLC43A2 , SMN1 / 2 , TPO, DTNA , and CLMN, collectively implicating neurodevelopmental, cellular homeostatic, and endocrine mechanisms. PAM successfully predicted attention problems (AP) in two models (AP alone and AP combined with physical violence). Among the selected genes, several were related to neurodevelopment and neuronal maintenance ( SMN1/2, MYT1L ); structural organization ( DTNA, CLMN ); and cellular signaling ( DTNA ) functions; and immune, metabolic, and endocrine responses ( SLC43A2 , TPO ). These alterations were associated with attention problems and exposure to family and community violence. Conclusion: Early‐life violence is biologically embedded through epigenetic modifications affecting attention, pointing to a complex interplay between environmental adversity and gene regulation. Integrative prevention strategies targeting psychosocial/molecular pathways of vulnerability are needed.

Although exposure to violence has been linked to executive functioning impairments, the biological mechanisms underlying this association remain unclear. This study examined CpG sites associated with executive functions in 78 young adults and their links to family (psychological and physical) and community violence during childhood. The scales used were Conflict Tactics (family violence); Things I Have Seen and Heard (community violence); Barkley Deficits in Executive Functioning. Mean differences (Mann–Whitney‐ U /Kruskal–Wallis) and Spearman correlations were assessed. An epigenome‐wide association study identified differentially methylated CpGs, and linear regressions examined associations with violence exposures. Girls reported more family and psychological violence. Black participants experienced higher family violence. Executive dysfunction (ED) correlated with psychological family and community violence, and family violence forms were interrelated. Differentially methylated positions highlighted genes tied to key biological processes: MRGPRD (sensory neurons development); DPPA3 (germ‐cell development); UNKL (cell differentiation); GPR6 (learning and memory); DUSP5 (cell proliferation and differentiation); and CAPN13 (signal transduction, cytoskeletal remodeling and cell differentiation). Candidate gene analysis found associations between executive dysfunction and methylation levels in these genes. Exploratory pathway analysis suggested enrichment of neurodevelopment and synaptic plasticity, intracellular trafficking and cytoskeletal remodeling, genome stability and cellular stress responses, and neuroimmune and inflammatory signaling. These findings suggest associations between ED, childhood violence exposure, and differential DNA methylation in cognition‐ and health‐related genes, suggesting that epigenetic markers may be associated with pathways linking early adversity to later outcomes, although no causal inference can be drawn.

Cyberbullying is a public health problem with effects on the mental health of those involved, including the roles of victims, aggressors, and victims/aggressors. The study investigated the bidirectional relationship between cyberbullying roles and mental health indicators in adolescents (depression, self-esteem, psychological distress, self-harm, suicide attempts, and drug use). This is a cross-sectional study with multistage cluster sampling totaling 480 adolescents aged 15 to 19 years, in the 10th grade of public and private schools in two Brazilian capitals. The Revised Cyberbullying Inventory (RCBI) and mental health indicators were used, with logistic models adjusted for gender, family structure, age, color/race, religion, and social class. The results reveal that the roles of victim and aggressor/victim are more likely to lead to adverse outcomes in mental health. All mental health outcomes showed a significant association with cyberbullying roles, strongest for suicidal ideation: victim (OR=11.83; 95%CI 2.48-56.59; p=0.005) and victim/aggressor (OR=5.65; 95%CI 2.51-12.69; p<0.001). The study contributes to the reflection about associations of different roles in cyberbullying.

Resumo O ensino remoto emergencial (ERE) trouxe reflexões sobre as práticas pedagógicas, que passaram a ser mediadas por tecnologias digitais. Busca-se analisar fatores associados ao ERE no processo de aprendizagem, a partir da ótica de pós-graduandos em saúde da Fiocruz. Foi utilizada base secundária de dados de cursos lato (LS) e stricto sensu (SS). Participaram 736 discentes (302 LS e 434 SS) com matrícula ativa entre 2020-2022. Foi aplicado questionário digital anônimo sobre perfil discente, organização/experiência com ERE, relação institucional e o impacto do ERE no processo de aprendizagem. Utilizaram-se modelos de regressão logística bruta e ajustada, com análise bivariada. Os resultados mostram que o prejuízo de atividades acadêmicas teóricas (RC 0,15 LS e RC 0,05 SS) e teórico-práticas (RC 0,18 LS e RC 0,28 SS) tiveram menos chance de impacto positivo na aprendizagem, assim como estabelecer interação regular (RC 0,32 LS e RC 0,15 SS) e ruim (RC 0,09 LS) com os docentes. Assistir à maior parte das aulas remotas em casa/outros espaços teve 3,44 vezes mais chance de impacto positivo nos alunos LS, assim como receber algum apoio da instituição (RC 2,58); já no SS, o resultado foi inverso. Os achados revelam elementos-chave do ensino mediado por tecnologias educacionais na pós-graduação.

Resumen Este artículo analiza cómo las acciones de monitoreo y notificación de las violencias están incorporadas en los diferentes niveles de atención en Brasil, según el tamaño poblacional y la pertenencia regional. Se caracteriza por un estudio transversal, con carácter descriptivo, combinando técnicas cuantitativas y cualitativas, con la aplicación de cuestionarios en 290 servicios de atención primaria, 128 hospitalarios y 113 de rehabilitación en 379 municipios brasileños. En el enfoque cualitativo se entrevistaron a 63 profesionales de la salud o gestores de los servicios. Los datos se analizan según las frecuencias por nivel de atención, región y tamaño poblacional. Las entrevistas fueron sometidas a análisis de contenido en modalidad temática. Los resultados muestran que las unidades hospitalarias se destacan en la notificación, que los servicios de atención primaria sobresalen en la concertación de flujos y divulgación de información, y que las acciones de formación continua necesitan ser ampliadas. Se recomienda: integración entre los sistemas de información; retroalimentación de la información en la atención y vigilancia; mejora de los registros sobre violencia autoprovocada y la creación de historias clínicas electrónicas para la articulación en la red.

Resumo Analisou-se a implementação de duas diretrizes da Política Nacional de Redução da Morbimortalidade por Acidentes e Violências (PNRMAV) referentes à atenção pré-hospitalar (APH) e hospitalar (AH). Gestores de APH e AH dos municípios brasileiros participaram de estudo transversal (2020-2022), respondendo a um questionário via plataforma Redcap. Foram realizadas análises descritivas e comparativas. A taxa de resposta foi de 2,3% dos municípios (n=128), incluindo nove capitais. Essas apresentaram melhores resultados nos itens avaliados. Na APH móvel, 82,8% dos municípios e 100% das capitais utilizam transporte próprio para pacientes. Nas capitais, os serviços recebem e encaminham mais os casos intersetorialmente (valor-p<0,05). Na AH, as capitais fazem mais uso de protocolos (p=0,008) e 40% dos gestores consideram os leitos adequados às necessidades. A implementação da diretriz da PNRMAV que trata da Sistematização do atendimento pré-hospitalar foi boa em 59,4% municípios e 77,8% das capitais, enquanto a de assistência interdisciplinar às vítimas foi regular em 45,1% dos municípios e boa em 75% das capitais. Apesar dos avanços na implementação da PNRMAV, é necessário fortalecer as redes de atenção a urgência e emergência e otimizar os recursos disponíveis.

Resumen Se analizó la implementación de dos directrices de la Política Nacional de Reducción de la Morbimortalidad por Accidentes y Violencia (PNRMAV) relativas a la atención prehospitalaria (APH) y hospitalaria (AH). Los gestores de APH y AH de los municipios brasileños participaron en un estudio transversal (2020-2022), respondiendo a un cuestionario a través de la plataforma Redcap. Se realizaron análisis descriptivos y comparativos. La tasa de respuesta fue del 2,3% de los municipios (n=128), 9 de los cuales eran capitales. Las capitales mostraron mejores resultados en todos los ítems evaluados. En APH móvil, el 82,8% de los municipios y el 100% de las capitales utilizan transporte propio para los pacientes. En las capitales, los servicios reciben y derivan más casos intersectorialmente (p-valor<0,05). En AH, las capitales utilizan más los protocolos (p=0,008) y el 40% de los gestores consideran que las camas son adecuadas a sus necesidades. La implementación de la directriz de Sistematización de la atención prehospitalaria fue buena en 59,4% de los municipios y 77,8% de las capitales, mientras que la de Asistencia interdisciplinaria a las víctimas fue regular en 45,1% de los municipios y buena en 75% de las capitales. A pesar de los avances en la implementación de la PNRMAV, es necesario fortalecer las redes de atención a urgencias/emergencias y optimizar los recursos disponibles.

The implementation of two guidelines of the National Policy for Reducing Morbidity and Mortality from Accidents and Violence (PNRMAV) regarding pre-hospital care (APH) and hospital care (AH) was analyzed. APH and AH managers from Brazilian municipalities participated in a cross-sectional study (2020-2022), answering a questionnaire via the Redcap platform. Descriptive and comparative analyses were performed. The response rate was 2.3% of the municipalities (n=128), of which 9 were capitals. Capitals presented better results in all items evaluated. In mobile APH, 82.8% of the municipalities and 100% of the capitals use their own transportation for patients. In the capitals, the services receive and refer more cases intersectoral (p-value<0.05). In AH, the capitals make greater use of protocols (p=0.008) and 40% of managers consider the beds adequate for their needs. The implementation of the Systematization of pre-hospital care guideline was good for 59.4% of the municipalities and 77.8% of the capitals, while the Interdisciplinary Assistance to Victims guideline was regular in 45.1% of the municipalities and good in 75% of the capitals. Despite the advances in the implementation of the PNRMAV, it is necessary to strengthen the emergency care networks and optimize the available resources.

Resumen El artículo analiza la implementación de la directriz de atención interdisciplinaria e intersectorial a las víctimas de accidentes y violencias de la Política Nacional de Reducción de la Morbimortalidad por Accidentes y Violencia (PNRMAV) desde la Atención Primaria de Salud. El estudio se basa en la triangulación de métodos cuantitativos y cualitativos para la recolección y análisis de datos. Se realizaron cuestionarios y entrevistas a gestores y profesionales de los servicios de atención primaria de las capitales brasileñas y de algunos municipios. La Red de Salud, los Servicios de Asistencia Social y el Consejo Tutelar son los principales órganos con los que la atención primaria articula el cuidado en los casos analizados. La frecuencia de los flujos y protocolos de derivación es elevada y, en general, bien evaluada por el grupo que participó en el estudio. Sin embargo, la atención a las víctimas de accidentes es más limitada. Ha habido avances en la coordinación intersectorial en todas las regiones del país. Sin embargo, la escasa formación y la elevada rotación del personal en los equipos son los principales obstáculos. Se concluye que es necesario fortalecer la implantación de la PNRMAV en la atención primaria porque su papel es muy importante en sí mismo y en el enlace con otros servicios para la calidad de vida de los usuarios y la construcción de la paz.