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Background: Massive Open Online Courses (MOOCs) are a teaching format with universal access and the potential and viability to be implemented by health professionals. Despite their proven success in providing high-quality continuing education, usage and offerings of this technology are still scarce in Brazil. Materials and Methods: This article describes the development of an online-based education strategy (MOOC) on the topic of health policies aimed at the Lesbian, Gay, Bisexual, Transgender, and Intersex (LGBTI+) population and analyzes its performance and reach after 6 months. Results: This introductory MOOC course on LGBTI+ health included an assortment of multimedia material and consisted of 30 h of autonomous learning activities divided into two modules, with problem-based evaluation strategies. During its 6-month promotion period, the course had a total of 3,000 people enrolled with a completion rate of â¼20%. Conclusions: Results point to a high interest in LGBTI+ health and high demand for training on this topic among health professionals. This was the first course of its kind administered in Brazil. The MOOC format was successful and reliable in enabling the teaching-learning process.
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Educação a Distância , Minorias Sexuais e de Gênero , Pessoas Transgênero , Brasil , Feminino , Promoção da Saúde , HumanosRESUMO
Intimate partner violence (IPV) is a challenge in Brazil; the country is ranked 6th globally for femicide and one in four women experience physical and/or sexual IPV in their lifetimes. Safety decision aids (SDA) are tools for women experiencing IPV. Building upon previously developed and tested online SDA tools, we intend to adapt an SDA tool for use in Brazil. The purpose of this study was to examine the feasibility of a technology-based SDA to support Brazilian women living with IPV, tailored for the Brazilian context. Our participatory-action research approach built upon research between 2018 and 2019 at the House of the Brazilian Woman (HBW) of Curitiba, Brazil, a cross-sectoral one-stop center (OSC) providing comprehensive care for IPV survivors. Field research included observation, field notes, and in-depth interviews with twenty-eight (n = 28) participants (HBW staff and survivors). The results were grouped into four main thematic categories: advantages; uncertainties; barriers; and suggestions. The triangulated results showed that the majority of participants considered the SDA feasible, highlighting flexibility and confidentiality; information about IPV; and access to resources for formal help-seeking as advantages of the tool. Participants also expressed uncertainties about SDA's ability to increase women's safety and its accessibility for the most vulnerable. They made suggestions for improvement to meet the unique needs of Brazilian women. This study provided evidence on the potential of an SDA tailored for use within a comprehensive program of women survivors in Brazil. This step was crucial to inform the future implementation and evaluation.
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The COVID-19 pandemic led to family and routine reorganization, triggering social problems. Women were further exposed to domestic violence, especially intimate partner violence (IPV), with consequences to their and their children's health. However, few Brazilian studies address the issue, especially considering the pandemic and its restrictive measures. The objective was to verify the relationship between mothers'/caregivers' IPV and their children's neuropsychomotor development (NPMD) and quality of life (QOL) during the pandemic. Seven hundred one female mothers/caregivers of children (0-12 years old) responded to the online epidemiological inquiry. NPMD was investigated with the Caregiver Reported Early Development Instruments (CREDI-short version); QOL, with the Pediatric Quality of Life Inventory (PedsQL™); and IPV, with the Composite Abuse Scale (CAS). The independence chi-square test was used, with Fisher's exact statistics, in SPSS Statistics 27®. Children whose mothers were exposed to IPV were 2.68 times as likely to have a "low" QOL score (χ2(1) = 13.144, P < .001; φ = 0.137). This indicates a possible environmental influence on the children's QOL, which may have been aggravated by strict social distancing during the COVID-19 pandemic.
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Using a mixed-methods triangulation approach we piloted the Composite Abuse Scale-Brazilian version (CAS-Brazil) at the House of the Brazilian Woman of Curitiba among 62 survivors of intimate partner violence and four professionals serving survivors to assess its feasibility for use. Quantitative data were tabulated using descriptive statistics while qualitative data were recorded, coded, and thematically analyzed. Four qualitative domains emerged: (a) conceptual understanding; (b) item definitions; (c) women's experiences; and (d) professionals' perspectives. Comprehension of the CAS-Brazil appeared high across participants from diverse backgrounds. Professionals viewed it as highly feasible for use in Brazilian cross-sectoral services to support survivor decision-making.
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Intimate partner violence (IPV) is a challenge in Brazil. The country holds one of the highest rates of femicide in the world, most of which are preceded by IPV. We conducted a cross-sectional study with 34,334 women, aged 18 to 59 years, from the 2019 Brazilian National Health Survey to analyze the prevalence of IPV and its subtypes among the Brazilian adult women in the last 12 months, encompassing their health consequences and the use of health services resulting from IPV. We also used logistic regression models to estimate the association of sociodemographic characteristics and self-perceived health status with IPV. The prevalence of IPV among Brazilian adult women in the last 12 months was 7.6% (95% confidence interval [CI] [7.0, 8.2]). Women aged 18 to 39 years, not married, and with income of up to 1 minimum wage (MW), had higher odds of suffering IPV. Among those who reported health consequences due to IPV, 69% reported psychological consequences, and 13.9% sought health care, mostly in primary or secondary health care services in the Brazilian Unified Health System (41.9%). Regarding the self-perceived health variables, women who reported eating problems (odds ratio [OR] = 1.29; [1.01, 1.65]), lack of interest/absence of pleasure (OR = 1.41; [1.11, 1.79]), depressive feelings (OR = 1.39; [1.03, 1.88]), feeling of failure (OR = 1.75; [1.36, 2.24]), and suicidal thoughts (OR = 1.73; [1.25, 2.41]) had greater odds of reporting IPV compared to those who did not report these same perceptions. The results show that younger, divorced or single, low-income women with eating problems and mental health disorders were more likely to suffer IPV. IPV often led to health problems, and many abused women sought support from public health services. Health professionals must be trained to identify and care for these women, thereby acting as allies in preventing and reducing IPV.
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Violência por Parceiro Íntimo , Adulto , Humanos , Feminino , Brasil/epidemiologia , Estudos Transversais , Violência por Parceiro Íntimo/psicologia , Parceiros Sexuais , Autoimagem , Prevalência , Fatores de RiscoRESUMO
Transgender people often live with social vulnerability, largely promoted by gender-based prejudice. Our aim in this article was to raise preliminary data on how the COVID-19 pandemic and perceived prejudice have contributed to the problem of food and food insecurity in the transgender communities in Brazil. We conducted a web-based cross-sectional study, in which 109 transgender people from all regions of Brazil participated. We used the Chi-Square test and Poisson regression modeling with robust variance to estimate the association between food insecurity and the investigated factors. In our sample, 68.8% of transgender people experienced food insecurity, of these, 20.2% experienced severe food insecurity. Our results showed that the difficulties in purchasing food in the transgender community predate the COVID-19 pandemic, yet that the restrictive measures adopted have also impacted overall access to quality food. However, the main explanations for food insecurity were income and employment. In predicting food insecurity, the experiences of prejudice must be considered, and give rise to the hypothesis that specific conditions to which transgender people are exposed explain, to some degree, their vulnerability to food insecurity.
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COVID-19 , Pessoas Transgênero , Humanos , COVID-19/epidemiologia , Fatores Socioeconômicos , Brasil/epidemiologia , Estudos Transversais , Pandemias , Abastecimento de Alimentos , Insegurança AlimentarRESUMO
The aim was to analyze the relations between homicidal violence, human development, inequality, population size, and urbanization rates in Brazilian municipalities. This is a retrospective ecological study of 5,570 Brazilian municipalities which analyzes the relations between the average rate of homicides registered in the Brazilian Mortality Information System (from 2005 to 2015) and selected indicators: municipal human development indices (HDI-M), Gini index, urbanization rates, and quantitative population. Analysis of the relative effect (%) of the variables on the risk for homicidal violence showed a greater association with more populous municipalities (log 10) (80.8%, 95%CI: 73.0; 88.8), more urbanized ones (8%, 95%CI: 6.7; 9.2), with higher Gini index (6%, 95%CI: 2.6; 9.5); whereas the relation with HDI-M is inverse (-17.1%, 95%CI: -21.4; -12.6). National policies which aim to limit population growth and the urbanization of the most populous Brazilian cities could reduce homicide rates across the country. Reducing inequalities and investing in municipal social education, health, and income policies could also reduce the number of homicides. We estimated that improving the HDI-M of the municipalities by 0.1 would cause a national reduction between 7,560 and 12,834 annual homicides, whereas decreasing income inequality (Gini index) by 0.1 would mean saving between 1,569 to 5,448 lives per year.
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Homicídio , Urbanização , Humanos , Brasil/epidemiologia , Estudos Retrospectivos , Determinantes Sociais da Saúde , ViolênciaRESUMO
In this document, we present to the scientific community a proposal on how to deal with the challenge imposed on surveillance and health actions in Brazil regarding monkeypox, including points and directions that have the potential to support learning and enable advances in the current scenario.
Neste documento trazemos um posicionamento para a comunidade científica e a sociedade civil acerca do desafio imposto à vigilância e às ações em saúde no Brasil relacionadas à monkeypox. Apresentamos pontos e encaminhamentos que podem subsidiar os aprendizados e os avanços a partir do atual cenário.
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Sistemas de Informação em Saúde , Mpox , Minorias Sexuais e de Gênero , Feminino , Humanos , Masculino , Identidade de Gênero , Mpox/epidemiologia , Brasil , Comportamento Sexual , Surtos de DoençasRESUMO
OBJECTIVE: To perform the translation and cross-cultural adaptation from English into Brazilian Portuguese of the Composite Abuse Scale, an instrument that identifies and quantifies intimate partner violence. METHODS: This study is based on the strict implementation of its previously published protocol, which consists of ten steps: (a) conceptual analysis; (b) double-blind translation; (c) comparison and first reconciled version of the two translations; (d) back-translation; (e) review of the back-translation by the developer and second reconciled version; (f) expert committee review (n = 6); (g) comparison of expert reviews and third reconciled version; (h) cognitive interviews with women from the Casa da Mulher Brasileira in Curitiba (n = 15); (i) assessments of user perceptions and final reconciliation; and (j) submission of the final version of the questionnaire to the developer. RESULTS: The implementation of the 10 steps of the protocol allowed the idiomatic, semantic, conceptual and experiential equivalences of the Composite Abuse Scale, incorporating suggestions and criticisms from the different participants of the process. Participants included the developer, professional translators, researchers specialized on the subject, women in situation of intimate partner violence, and professionals who provide care to them. Experts and cognitive interviews with women were instrumental in ensuring equivalence, and facilitating the understanding, including: (1) adaptation of the term "intimate relation" to "affective or conjugal relation"; (2) substitution of enclisis for proclisis cases in 20 items; (3) adoption of gender-neutral language, allowing its use in heterosexual, bisexual, and same-sex relations; (4) materialization of an instrument of scientific rigor and self-applicable, which may help women to visualize the situations of abuse in their relations. CONCLUSIONS: The translation and cross-cultural adaptation process of the Composite Abuse Scale resulted in the Composite Abuse Scale Brazilian Portuguese Version, a 30-item self-applicable instrument, capable to identify and quantify intimate partner violence, its frequency, severity and typologies (physical, emotional, harassment and severe combined violence).
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Comparação Transcultural , Traduções , Feminino , Humanos , Brasil , Idioma , Inquéritos e QuestionáriosRESUMO
Establishing rigorous translation and cross-cultural adaptation (TCCA) processes for abuse questionnaires is challenging. We propose a methodological TCCA protocol for abuse questionnaires based on our current adaptation of the Composite Abuse Scale (CAS) into Brazilian Portuguese. This 10-step protocol includes: (a) conceptual analysis; (b) double-blinded forward translation; (c) comparison of forward translations; (d) back-translation; (e) developer analysis; (f) specialist committee review; (g) comparison of specialist reviews; (h) cognitive interviews; (i) final reconciliation; and (j) presenting the final version to the developer. We aim to rigorously implement this protocol to achieve a reliable Brazilian Portuguese version of the CAS.
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Comparação Transcultural , Traduções , Brasil , Etnicidade , Humanos , Inquéritos e QuestionáriosRESUMO
This article aims to reflect on the current health challenges of lesbians, gays, bisexuals, transgenders, intersex, and other sexual and gender minorities (LGBTI+) within the Brazilian scenario. This study adopted a triangulation approach, based on two studies developed in the Southeast and South of Brazil, which included policy analysis and qualitative research on the perceptions of key actors from the Brazilian Unified Health System (SUS) - LGBTI+ users, workers, and managers. All data were analyzed by an interdisciplinary team of researchers. The main problems faced by the LGBTI+ population were registered, indicating some of the necessary progress. Some of these challenges include: access of the LGBTI+ population to SUS; the need to train health professionals; the decentralization of health services sensitive to the LGBTI+ population; the distinct forms of violence and discrimination; the lack of research in health care conducted with specific groups, such as lesbians, bisexuals, intersex, and other sexual minorities. The results reinforce the urgency for the complete implementation of the "National Policy for the Comprehensive Health of LGBT". The recognition of the LGBTI+ health needs will aid in achieving the principles which are the guiding principles of SUS.
Este artigo objetiva refletir sobre os desafios da saúde de pessoas lésbicas, gays, bissexuais, travestis, transexuais, intersexuais e outras minorias sexuais e de gênero (LGBTI+) no cenário brasileiro atual. Baseado no método de triangulação, incluiu análise de políticas, pesquisa qualitativa sobre percepções de atores-chave do Sistema Único de Saúde (SUS) - pessoas usuárias LGBTI+, profissionais e gestores(as) - a partir de dois projetos desenvolvidos no Sudeste e Sul do Brasil, analisados por equipe interdisciplinar de pesquisadores(as). Foram elencados os principais problemas enfrentados pela população LGBTI+, sinalizando alguns dos avanços necessários. Alguns desses desafios incluem: o acesso de LGBTI+ ao SUS; a necessidade de capacitação de profissionais; a interiorização e descentralização de serviços sensíveis à LGBTI+; as distintas formas de violências e discriminação; lacunas de pesquisas em saúde de segmentos específicos, como de lésbicas, bissexuais, intersexos e outras minorias sexuais. Os resultados corroboram a urgência da implementação plena da "Política Nacional de Saúde Integral de LGBT". O reconhecimento das demandas dessa população contribui para alcançar os princípios que norteiam o SUS.
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Homossexualidade Feminina , Minorias Sexuais e de Gênero , Pessoas Transgênero , Brasil , Atenção à Saúde , Feminino , Humanos , MasculinoRESUMO
This article aims to describe and analyze the violence experienced by transvestites in their trajectories (often ending in their murder), focusing particularly on the violence that continues even after their death. The idea is to understand a type of violence that manifests in post-mortem gender normalization that attempts to erase the history and traces of crossdressing existence. The study is based on a qualitative methodology through ethnographic research. The article's ethnographic stage took place from September 2019 to February 2020, responding to the assassination of five transvestites. The results indicate the existence of a post-mortem normalization that acts against the final wishes of transvestites, denying them a decent death.
Este artigo busca descrever e analisar as violências vivenciadas pelas travestis em suas trajetórias (que, muitas vezes, culminaram em seus homicídios), direcionando o olhar para as violências que continuam mesmo após a morte. A intenção é compreender um tipo de violência que se manifesta na normalização de gênero pós-morte que busca apagar a história e os rastros da existência travesti. Trata-se de estudo baseado em metodologia qualitativa, por meio de pesquisa etnográfica. A etapa etnográfica deste artigo ocorreu entre os meses de setembro de 2019 e fevereiro de 2020, sendo decorrente do assassinato de cinco travestis. Os resultados indicaram a existência de um dispositivo de normalização pós-morte que atua contra o desejo final das travestis, negando-lhes uma morte digna.
Este artículo busca describir y analizar las violencias vividas por las travestis en sus trayectorias (que, muchas veces, culminaron en sus homicidios), dirigiendo la mirada hacia la violencia que se continúa perpetrando incluso tras la muerte. La intención es comprender un tipo de violencia que se manifiesta en la normalización de género post mortem, que busca borrar la historia y los rastros de la existencia travesti. Se trata de un estudio basado en metodología cualitativa, mediante investigación etnográfica. La etapa etnográfica de este artículo se produjo entre los meses de setiembre de 2019 y febrero de 2020, tras el asesinato de cinco travestis. Los resultados indicaron la existencia de un dispositivo de normalización post mortem que actúa contra el deseo final de las travestis, negándoles una muerte digna.
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Homicídio , Violência , Brasil/epidemiologiaRESUMO
This study aimed to describe a panorama of Indigenous homicide in Brazil, analysing the main characteristics and territorial distribution between 2010 and 2014. Demographic study of Indigenous population data obtained from the Brazilian Institute of Geography and Statistics and Indigenous homicide data (2010-2014) from the Ministry of Health. Data were analysed using descriptive statistics, victims' characteristics, type of homicides and geographical distribution, which were then plotted on maps using ArcGIS. Findings revealed: 1) a national estimated average of Indigenous homicide rate of 22.5 per 100,000 Indigenous inhabitants per year; 2) a map showing where homicides were registered and the mean homicide rates for Brazilian regions and states, with highest rates in Roraima and Mato Grosso do Sul; 3) the main homicide method were sharp or penetrating objects; 4) Indigenous male homicide rate was 2.4 times higher than female, but Indigenous female rate was more than double that of non-Indigenous; 5) high homicide rates of Indigenous children (under 1-year-old) in areas of the states of Roraima and Amazonas. We advise careful consideration of Indigenous cultural beliefs to avoid errors of judgement, reflecting how Indigenous populations are at risk of homicide in some areas.
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Mapeamento Geográfico , Homicídio/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Homicídio/etnologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Adulto JovemRESUMO
Objetivo: analisar as percepções de profissionais da atenção primária à saúde de Paranaguá/PR sobre as relações entre a pandemia de COVID-19 e casos de violência doméstica em seus territórios adscritos, identificando desafios na abordagem, impactos nas famílias e manejo dos casos. Metodologia: pesquisa qualitativa com entrevistas semiestruturadas e grupos focais com 36 profissionais de duas unidades básicas de saúde de Paranaguá, litoral paranaense. Resultados: profissionais da atenção primária à saúde foram unânimes em relatar o aumento no número de casos de violência doméstica naquelas comunidades, com impactos tanto para mulheres, quanto para crianças e adolescentes, sendo o fechamento das escolas um fator agravante. Como principais desafios, foram reportados: a desestruturação da atenção primária à saúde durante o auge da pandemia com deslocamento de profissionais e recursos; desinformação sobre fluxos de encaminhamento nos casos de violência doméstica na rede intersetorial; medo dos profissionais, tanto da pandemia, quanto de denunciar casos de violência doméstica; e rotatividade de profissionais. Conclusão: o período de isolamento social causado pela pandemia intensificou os casos de violência doméstica segundo as percepções de profissionais da atenção primária à saúde de Paranaguá. O desmonte da rede intersetorial prejudicou ainda mais o cuidado de pessoas em situação de vulnerabilidade e/ou violência. A ausência de diretrizes nacionais do governo federal deixou municípios e profissionais da atenção primária à saúde à própria sorte para lidar com o problema.
Objective: to analyze the perceptions of primary health care professionals in Paranaguá/PR about the relationship between the COVID-19 pandemic and cases of domestic violence in their assigned territories, identifying challenges in the approach, impacts on families and case management. Methodology: qualitative research was conducted using semi-structured interviews and focus groups with 36 professionals from two primary health care units in Paranaguá, on the Paraná coast. Results: primary health care professionals unanimously reported an increase in the number of domestic violence cases in those communities, affecting women, children, and adolescents, with the closure of schools identified as an aggravating factor. The main challenges highlighted were the disruption of primary health care services during the peak of the pandemic due to the reallocation of professionals and resources; misinformation about referral processes for domestic violence cases within the intersectoral network; fear among professionals regarding the pandemic and reporting domestic violence cases; and high staff turnover. Conclusion: the period of social isolation caused by the pandemic intensified domestic violence cases, according to the perceptions of primary health care professionals in Paranaguá. The dismantling of the intersectoral network further compromised the care of individuals in situations of vulnerability and/or violence. The absence of national guidelines from the federal government left municipalities and primary health care professionals on their own to deal with the issue.
Objetivo: analizar las percepciones de los profesionales de la atención primaria de salud de Paranaguá/PR sobre las relaciones entre la pandemia de COVID-19 y los casos de violencia doméstica en sus territorios asignados, identificando desafíos en el abordaje, impactos en las familias y gestión de casos. Metodología: investigación cualitativa con entrevistas semiestructuradas y grupos focales con 36 profesionales de dos unidades básicas de salud de Paranaguá, en la costa de Paraná. Resultados: los profesionales de la atención primaria de salud fueron unánimes al reportar el aumento del número de casos de violencia doméstica en esas comunidades, con afectaciones tanto a mujeres, niños y adolescentes, siendo el cierre de escuelas un agravante. Se informaron los principales desafíos: la interrupción de la atención primaria de salud durante el apogeo de la pandemia con el desplazamiento de profesionales y recursos; desinformación sobre los flujos de derivación de casos de violencia doméstica en la red intersectorial; miedo entre los profesionales, tanto a la pandemia como a denunciar casos de violencia doméstica; y rotación profesional. Conclusión: el período de aislamiento social provocado por la pandemia intensificó los casos de violencia doméstica según la percepción de los profesionales de la atención primaria de salud en Paranaguá. El desmantelamiento de la red intersectorial perjudicó aún más la atención a personas en situación de vulnerabilidad y/o violencia. La ausencia de directrices nacionales por parte del gobierno federal dejó a los municipios y a los profesionales de atención primaria de salud a su suerte a la hora de abordar el problema.
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Direito SanitárioRESUMO
Brazil currently has the highest absolute number of homicides in the world, which results from a complex range of factors. This study aimed at understanding the associations between socio-environmental determinants of health (SDH) and homicides in Brazil through a systematic literature review. The review followed PRISMA guidelines, selecting quantitative and qualitative studies published in Portuguese, English, and Spanish carried out between 2002 and 2017, available in the PubMed, MEDLINE, LILACS, SciELO and BVS-BIREME databases. Two trilingual reviewers tracked studies independently by basing on the eligibility criteria. We critically assessed the selected studies with the Critical Appraisal Skills Programme (CASP) or the Checklist for Analytical Cross-Sectional Studies, depending on the study design. We considered 60 studies and grouped their SDH into categories to develop a narrative synthesis about each SDH. These categories were: territory; race/ethnicity; gender; age; social inequalities and economic factors; development; education; work and employment; drugs and trafficking; other SDH. We found some SDH were more associated with homicides, such as being young, black, male, of low education level, and also people who lived in places of high social inequality, such as urban suburbs and agricultural frontiers. Unemployment and drug trafficking, as well as intersections between various SDH were also prominent. Education seems to be a protective factor for homicide. Despite the limited capacity of interpretation due to the high range of methodological approaches, this review shows the importance of considering SDH and their intersections when developing homicide prevention policies.
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Homicídio/estatística & dados numéricos , Determinantes Sociais da Saúde , Brasil , Etnicidade , Humanos , Masculino , Características de Residência , Fatores Sexuais , Fatores SocioeconômicosRESUMO
Domestic violence creates multiple harms for women's health and is a 'wicked problem' for health professionals and public health systems. Brazil recently approved public policies to manage and care for women victims of domestic violence. Facing these policies, this study aimed to explore how domestic violence against women is usually managed in Brazilian primary health care, by investigating a basic health unit and its family health strategy. We adopted qualitative ethnographic research methods with thematic analysis of emergent categories, interrogating data with gender theory and emergent Brazilian collective health theory. Field research was conducted in a local basic health unit and the territory for which it is responsible, in Southern Brazil. The study revealed: 1) a yawning gap between public health policies for domestic violence against women at the federal level and its practical application at local/decentralized levels, which can leave both professionals and women unsafe; 2) the key role of local community health workers, paraprofessional health promotion agents, who aim to promote dialogue between women experiencing violence, health care professionals and the health care system.
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Violência Doméstica , Violência de Gênero , Atenção Primária à Saúde/organização & administração , Política Pública , Brasil , Agentes Comunitários de Saúde/organização & administração , Vítimas de Crime/psicologia , Saúde da Família , Feminino , Política de Saúde , Humanos , Relações Profissional-PacienteRESUMO
Resumo Introdução: Pessoas trans pertencem a um grupo marginalizado e vulnerável na sociedade e sofrem com dificuldades no atendimento no sistema de saúde. Este estudo objetivou compreender o processo saúde-doença-cuidado dessas pessoas e seu acesso aos serviços de saúde na cidade de Curitiba-PR, Brasil. Metodologia: Pesquisa qualitativa hermenêutica, por meio de dez entrevistas semiestruturadas com pessoas trans de Curitiba, que foram gravadas, transcritas e codificadas. Apreenderam-se as experiências e percepções sobre a saúde desses sujeitos e suas trajetórias de atendimento no sistema de saúde, analisando-se pela perspectiva hermenêutica. Resultados: As narrativas mostram que ainda há muito despreparo dos profissionais da saúde, e isso gera situações de desconforto à população trans. Essas experiências moldam a conduta dessa população frente aos serviços de saúde, muitas vezes evitando-os. Toda essa dificuldade no acesso à saúde gera questões de saúde mental e sentimentos de ideação suicida. Conclusão: O estudo evidenciou a falta de reconhecimento e de aceitação da forma que pessoas trans se expressam e a existência de uma série de ações discriminatórias por parte dos trabalhadores da saúde. A compreensão dessas dificuldades aponta para o que pode ser modificado para garantir um acesso à saúde de maior qualidade para essa população.
Abstract Introduction: Trans people belong to a marginalized and vulnerable group in society and suffer from difficulties in receiving care in the health system. This study aimed to understand the health-disease-care process of trans people and their access to health services in Curitiba, PR, Brazil. Methodology: Qualitative hermeneutic research, through semi-structured interviews with ten trans persons from Curitiba. The interviews were recorded, transcribed, coded and submitted to hermeneutic analysis. Analysis enabled to understand participants' experiences and perceptions about their health and trajectories of care in the health system. Results: The narratives showed that there is still a lot of unpreparedness of health professionals and this produces discomfortable care for the trans persons. These experiences shape the behavior of the trans population towards health services, often avoiding them. All this difficulty in accessing health care generates mental health issues and feelings of suicidal ideation. Conclusion: The study highlighted the lack of recognition and acceptance of the way trans people express themselves and the existence of several discriminatory actions practiced by health workers. Understanding these challenges points to what need to be improved, such as increasing access and the healthcare quality for this population.
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Humanos , Masculino , Feminino , Pessoal de Saúde/ética , Pessoas Transgênero/psicologia , Integralidade em Saúde , Violência de Gênero , Sistema Único de Saúde , Saúde Mental , Sexismo , Diversidade de Gênero , Transfobia , Acesso à Atenção PrimáriaRESUMO
INTRODUCTION: Intimate partner violence (IPV) considerably harms the health, safety and well-being of women. In response, public health systems around the globe have been gradually implementing strategies. In particular, low-income and middle-income countries (LMIC) have been developing innovative interventions in primary healthcare (PHC) addressing the problem. This paper describes a protocol for a systematic review of studies addressing the impacts and outcomes of PHC centre interventions addressing IPV against women from LMIC. METHODS AND ANALYSIS: A systematic search for studies will be conducted in African Index Medicus, Africa Portal Digital Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Index Medicus for the Southeast Asia Region, IndMed, Latin American and Caribbean Health Science Literature Database (LILACS), Medecins Sans Frontieres, MEDLINE, Minority Health and Health Equity Archive, ProQuest, PsycINFO, Scientific Electronic Library Online, (SciELO) and Social Policy and Practice. Studies will be in English, Spanish and Portuguese, published between 2007 and 2017, addressing IPV against women from LMIC, whose data quantitatively report on the impacts and outcomes for survivors and/or workers and/or public health systems preintervention and postintervention. Two trilingual reviewers will independently screen for study eligibility and data extraction, and a librarian will cross-check for compliance. Risk of bias and quality assessment of studies will be measured according to: (1) the Cochrane Collaboration's tool for assessing risk of bias for randomised controlled trials and (2) the Methodological Index for Non-Randomised Studies (MINORS). Data will be analysed and summarised using meta-analysis and narrative description of the evidence across studies. This systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols(PRISMA P) guidelines. ETHICS AND DISSEMINATION: This systematic review will be based on published studies, thus not requiring ethical approval. Findings will be presented in conferences and published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42017069261.
Assuntos
Países em Desenvolvimento , Violência de Gênero/prevenção & controle , Violência por Parceiro Íntimo/prevenção & controle , Atenção Primária à Saúde/métodos , Saúde Pública/métodos , Saúde da Mulher , Feminino , Humanos , Determinantes Sociais da Saúde , Revisões Sistemáticas como AssuntoRESUMO
The aim was to analyze the relations between homicidal violence, human development, inequality, population size, and urbanization rates in Brazilian municipalities. This is a retrospective ecological study of 5,570 Brazilian municipalities which analyzes the relations between the average rate of homicides registered in the Brazilian Mortality Information System (from 2005 to 2015) and selected indicators: municipal human development indices (HDI-M), Gini index, urbanization rates, and quantitative population. Analysis of the relative effect (%) of the variables on the risk for homicidal violence showed a greater association with more populous municipalities (log 10) (80.8%, 95%CI: 73.0; 88.8), more urbanized ones (8%, 95%CI: 6.7; 9.2), with higher Gini index (6%, 95%CI: 2.6; 9.5); whereas the relation with HDI-M is inverse (-17.1%, 95%CI: -21.4; -12.6). National policies which aim to limit population growth and the urbanization of the most populous Brazilian cities could reduce homicide rates across the country. Reducing inequalities and investing in municipal social education, health, and income policies could also reduce the number of homicides. We estimated that improving the HDI-M of the municipalities by 0.1 would cause a national reduction between 7,560 and 12,834 annual homicides, whereas decreasing income inequality (Gini index) by 0.1 would mean saving between 1,569 to 5,448 lives per year.
O objetivo foi analisar as relações entre violência homicida, desenvolvimento humano, desigualdade, tamanho populacional e taxas de urbanização nos municípios brasileiros. Trata-se de um estudo ecológico retrospectivo de 5.570 municípios brasileiros que analisa as relações entre a taxa média de homicídios registrados no Sistema de Informações sobre Mortalidade (de 2005 a 2015) e indicadores selecionados: índices municipais de desenvolvimento humano (IDH-M), coeficientes de Gini, taxas de urbanização e população quantitativa. A análise do efeito relativo (%) das variáveis sobre o risco de violência homicida mostrou maior associação com municípios mais populosos (log 10) (80,8%, IC95%: 73,0; 88,8), mais urbanizados (8%, IC95%: 6,7; 9,2), com maiores coeficientes de Gini (6%, IC95%: 2,6; 9,5); enquanto a relação com IDH-M é inversa (-17,1%, IC95%: -21,4; -12,6). Políticas nacionais que visam limitar o crescimento populacional e a urbanização das cidades brasileiras mais populosas poderiam reduzir as taxas de homicídios em todo o país. Reduzir as desigualdades e investir em políticas municipais de educação social, saúde e renda também poderiam reduzir o número de homicídios. Estima-se que uma melhoria de 0,1 no IDH-M dos municípios causaria uma redução nacional entre 7.560 a 12.834 homicídios anuais, enquanto uma diminuição de 0,1 em desigualdade de renda (coeficiente de Gini) significaria salvar entre 1.569 e 5.448 vidas por ano.
El objetivo de este estudio fue analizar las relaciones entre la violencia homicida, el desarrollo humano, la desigualdad, el tamaño poblacional y las tasas de urbanización en municipios brasileños. Se trata de un estudio ecológico, retrospectivo realizado con 5.570 municipios brasileños, con el fin de analizar la relación entre el promedio de homicidios, registrado en el Sistema de Información de Mortalidad (2005-2015), y los indicadores seleccionados: índices de desarrollo humano del municipio (IDH-M), coeficientes de Gini, tasas de urbanización y población cuantitativa. El análisis del efecto relativo (%) de las variables sobre el riesgo de violencia homicida mostró una asociación mayor con los municipios más poblados (log 10) (80,8%, IC95%: 73,0; 88,8), más urbanizados (8%, IC95%: 6,7; 9,2), con coeficientes de Gini más altos (6%, IC95%: 2,6; 9,5); mientras que la relación con el IDH-M es inversa (-17,1%, IC95%: -21,4; -12,6). Las políticas nacionales destinadas a limitar el crecimiento de la población y la urbanización en las ciudades más pobladas de Brasil podrían reducir las tasas de homicidio en todo el país. La reducción de las desigualdades y las inversiones en políticas municipales de educación social, salud y renta también podrían contribuir con la disminución de la tasa de homicidios. Si el IDH-M de los municipios tuviese una mejora del 0,1, habría una reducción nacional de 7.560 a 12.834 homicidios al año, mientras que una disminución de 0,1 en la desigualdad de renta (coeficiente de Gini) salvaría entre 1.569 y 5.448 vidas al año.
RESUMO
This study aimed to analyze how the Brazilian Ministry of Health (MS) is implementing the Sex Reassignment Process (SRP) in the Unified Health System (SUS), through research of public domain official documents, systematization of surgery's quantitative data and analysis of meeting reports of the LGBT Health Technical Committee (CTSLGBT) of the MS. We conducted exploratory research combining quantitative and qualitative methods, using as methodological basis the normative proposal of health programs and systems evaluation study. The study resulted in the total data calculation of sex reassignment surgeries performed by the SUS (2008-2016), which highlight no deaths and unequal regional access; and in the monitoring of the implementation of actions of the National LGBT Health Policy by a specific committee appointed by the MS. Despite considerable progress, challenges remain. Currently, the most threatening hurdle is the possibility of a setback imposed by conservative sectors from the Executive and Legislative branches. Therefore, the visibility of achievements is a decisive step toward maintaining and enhancing SRP in the SUS.