Adverse childhood experiences of Korean mothers with young children: a latent class analysis.

Background: Adverse childhood experiences (ACEs) have negative impacts on women with children, including psychosocial and general health problems. However, there is limited research investigating ACEs identifying the characteristics of distinct subgroups according to the frequency of ACEs.Objective: Utilizing the national dataset of the Family with Children Life Experience 2017, this study aimed to classify patterns of ACEs based on the total number of types of ACEs and the types of predominant events, and to examine differences in general and psychological characteristics, as well as experiences of violence in adulthood among the classes identified.Method: A total of 460 Korean mothers raising infants or toddlers participated. Latent class analysis was performed to classify the patterns of ACEs, while t-tests and Chi-square tests were used to examine differences in general and psychological characteristics and experiences of violence between the ACEs subgroups.Results: The participants were classified into two subgroups: the 'high-ACEs group' and the 'low-ACEs group'. The high-ACEs group exhibited higher rates of child abuse, workplace violence perpetration and victimization, as well as lower self-esteem, higher depression levels, and increased suicidal thoughts compared to those of the low-ACEs group.Conclusion: The findings highlight the significant role of ACEs on the formation of an individual's psychological characteristics and their propensity to experience additional violence even into adulthood, as perpetrators and as victims. It is noteworthy how the influence of ACEs extends across generations through child abuse. These findings offer insights for developing interventions aimed at mitigating the negative effects of experiences of violence on mothers raising young children.

Two distinct subgroups were identified according to the frequency of ACEs: the 'high-ACEs group' and the 'low-ACEs group'.Compared to those of the low-ACEs group, the high-ACEs group presented higher rates of child abuse, workplace violence perpetration and victimization, lower self-esteem, higher depression levels, and increased suicidal thoughts.The low self-esteem induced by ACEs may contribute to the amplification of psychological vulnerabilities and the occurrence of additional violent experiences even in adulthood.

Correlates of Intimate Partner Violence, Including Psychological Partner Violence, in a Multisite U.S. Cohort of People in HIV Care.

We examined past-year intimate partner violence (IPV), including psychological violence without physical/sexual violence, and health outcomes among people with HIV (PWH) in care in a multi-site U.S. cohort. Between 2016 and 2022, PWH reported 12-month psychological, physical, and sexual IPV in a routine assessment. We used linear and logistic regression models adjusted for age, race/ethnicity, and site to examine relationships with health outcomes. Among 9748 PWH (median age 50 years, 81% cisgender male/16% cisgender female/1% transgender female; 44% non-Hispanic white/36% non-Hispanic Black/15% Hispanic), 9.3% (n = 905) reported any IPV in the past 12 months; half reported psychological IPV without physical/sexual IPV (n = 453). PWH reporting any type of IPV were on average younger than those who did not experience IPV. In adjusted models, any IPV was associated with increased likelihood of unstable housing, HIV viral load detection (HIV viral load ≥ 75 copies/mL), moderate-to-severe depressive symptoms, anxiety with panic symptoms, substance use (methamphetamines, cocaine/crack, illicit opioids, marijuana, heavy episodic/hazardous drinking), and concern about exposure to sexually transmitted infection. PWH reporting any IPV in the past 12 months had 4.2% lower adherence to antiretroviral therapy, 2.4 more HIV-related symptoms, a 1.9 point higher HIV stigma score, and a 9.5% lower quality of life score than those without IPV. We found similar associations among PWH reporting only psychological IPV, without physical/sexual IPV. IPV was common among PWH. Half reporting IPV reported only psychological IPV and had similarly poor outcomes as those reporting physical/sexual IPV, demonstrating the need to assess psychological as well as physical and sexual IPV.

RESUMEN: Examinamos la violencia de la pareja íntima (intimate partner violence, IPV) del año anterior, incluida la violencia psicológica sin violencia física y sexual, así como los resultados sanitarios entre las personas con VIH (people with HIV, PWH) que reciben atención en una cohorte multicéntrica de los Estados Unidos. Entre 2016 y 2022, las PWH informaron situaciones de IPV psicológica, física y sexual durante los 12 meses en una evaluación de rutina. Se utilizaron modelos de regresión lineal y logística ajustados por edad, raza/etnia y centro para examinar las relaciones con los resultados sanitarios. Entre 9748 PWH (mediana de edad de 50 años, 81% de hombres cisgénero/16% de mujeres cisgénero/1% de mujeres transgénero; 44% de blancos no hispanos/36% de negros no hispanos/15% de hispanos), el 9,3% (n = 905) informaron haber sufrido algún tipo de IPV en los últimos 12 meses; la mitad informó situaciones de IPV psicológica sin IPV física y sexual (n = 453). Las PWH que informaron de cualquier tipo de IPV fueron, en promedio, más jóvenes que las que no sufrieron IPV. En los modelos ajustados, cualquier IPV se asoció con una mayor probabilidad de vivienda inestable, detección de carga viral del VIH (carga viral del VIH ≥ 75 copias/ml), síntomas depresivos de moderados a graves, ansiedad con síntomas de pánico, consumo de sustancias (metanfetaminas, cocaína/crack, opioides ilícitos, marihuana, consumo excesivo episódico/peligroso de alcohol) y preocupación por la exposición a infecciones de transmisión sexual. Las PWH que informaron alguna situación de IPV en los últimos 12 meses tuvieron un 4,2% menos de cumplimiento de la terapia antirretrovírica, un 2,4% más de síntomas relacionados con el VIH, una puntuación de estigma del VIH 1,9 puntos más alta y una puntuación de calidad de vida un 9,5% más baja que las que no sufrieron IPV. Se encontraron asociaciones similares entre las PWH que informaron solo IPV psicológica, sin IPV física y sexual. La IPV fue común entre las PWH. La mitad de las personas que informaron IPV solo informaron IPV psicológica y tuvieron resultados igualmente deficientes que los que informaron IPV física y sexual, lo que demuestra la necesidad de evaluar la IPV psicológica, al igual que la IPV física y sexual.

Social capital as a moderator of the relationship between violent community environment and psychological distress.

OBJECTIVE: To evaluate the modifying effect of social capital on the relationship between living in violent communities and the presence of psychological distress in adolescents and youth in Mexico. METHOD: The analysis of the Social Cohesion Survey for the Prevention of Violence and Crime (ECOPRED, by its acronym in Spanish) was conducted. The analytic sample consisted of 39,639 participants aged 12 to 29 years. Community violence and social capital were measured at the census tract level using the average answers of a household's head sample. These environmental variables were independent of the experiences of the participants. Social capital variables included structural (social ties, recreational participation, collaborative participation, and social cohesion), and cognitive (trust in neighbors) dimensions. Multilevel structural equation models were used. RESULTS: Recreational participation, collaborative participation, and social cohesion modified the relationship between community environments and psychological distress. In females who lived in places with less recreational participation or less social cohesion, the higher the social disorder, the higher the psychological distress. A similar relationship between vandalism and psychological distress was identified, but only in males who lived in places with less collaborative participation, and in females with less social cohesion. CONCLUSIONS: Our results suggest that dimensions of the structural social capital (organization and interest in the community and its members) were the ones that had the buffering effect of the exposure to disordered community environments on psychological distress.

Mother-infant bonding: The role of postpartum depression, violence, and bonding established with one's own mother during childhood.

Mother-infant bonding is influenced by several risk and protective factors, and the literature has investigated the relationships between these factors independently. This study aimed to verify the interrelationships of some of these factors and how they influence mother-infant bonding in Brazil. In this study, 361 mothers participated, and the outcome variable of mother-infant bonding was assessed using the Postpartum Bonding Questionnaire (PBQ). Multivariate regression analysis was performed using a hierarchical model with three blocks structured according to the influence exerted on mother-infant bonding. The PBQ's factor scores were estimated and used in the subsequent analyses to decrease measurement error. The variable "violence experienced by mothers" was statistically significant for explaining the second block model but not significant for the third block. Network analysis was performed after multiple regression, showing that the violence experienced by mothers does not directly influence mother-infant bonding but rather is mediated by postpartum depression. This explains why violence is not significant in the hierarchical multiple regression when maternal depression is added to the model. This study's strengths lie in its utilization of PBQ factor scores and network analysis, enabling the estimation of conditional relationships among variables. This approach provides deeper insights into factors affecting mother-infant bonding.

Varios factores de riesgo y de protección ejercen influencia sobre la unión afectiva madre­infante; la literatura disponible ha investigado las relaciones entre estos factores de una manera independiente. Este estudio se propuso verificar las interrelaciones de algunos de estos factores y cómo ellos influyen en la unión afectiva madre­infante. Se consultó un total de 361 madres y el variable resultado de afectividad madre­infante se evaluó por medio del Cuestionario de Afectividad de Postparto (PBQ). Se llevaron a cabo análisis de regresión multivariados usando un modelo jerárquico con tres estructuras de bloques de acuerdo con la influencia ejercida sobre la unión afectiva madre­infante. Se estimaron y usaron los puntajes de factores del PBQ en los análisis subsecuentes para disminuir el error en la medida. La variable "violencia experimentada por las madres" fue estadísticamente significativa para explicar el segundo modelo de bloque, pero no significativa para el tercer bloque. Se llevó a cabo un análisis de interrelaciones después de la regresión múltiple, demostrando que la violencia experimentada por las madres no influye directamente la afectividad madre­infante, sino que la misma es mediada por la depresión posterior al parto. Esto explica por qué la violencia no es significativa en la jerárquica regresión múltiple cuando la depresión materna se le agrega al modelo. Entre los puntos fuertes de este estudio se incluye el uso de los puntajes de factores del PBQ y el análisis de interrelaciones, lo cual permitió que se estimaran las relaciones condicionales existente dentro del grupo de variables, aportando una mayor comprensión de algunos factores que interfieren en la unión afectiva madre­infante.

"Nenhuma Pessoa Idosa Merece Passar por Isso": Compreensão da Violência para Mulheres Gerontes / "Ninguna Persona Adulta Mayor Merece Pasar Por Esto": Comprensión de la Violencia para las Mujeres Adultas Mayores / "No Elderly Person Deserves to Go Through This": Understanding Violence Towards Elderly Women

Resumo Introdução: A violência contra idosos é um fenômeno crescente, ocasionando prejuízos à saúde, com diferentes desfechos e consequências às vítimas. A chance de idosas sofrerem-na no âmbito familiar supera a dos homens, sendo o gênero um fator de risco considerável. Objetivo: Analisar a compreensão da violência contra pessoas idosas segundo mulheres gerontes. Metodologia: Pesquisa descritiva com abordagem qualitativa desenvolvida com 22 idosas de uma comunidade no estado da Paraíba, Brasil, escolhidas por conveniência. Utilizou-se para coleta de dados entrevistas semiestruturadas, processadas pelo software Iramuteq, com posterior Análise de Conteúdo. Resultados: Foram evidenciadas cinco classes: ciclo de violência; rede de apoio ao idoso vítima de violência; Vivência de situações violentas; violência financeira; e simbologia da violência na sociedade, as quais denotam compreensão da violência envolvendo os diferentes tipos. Apoiam-se nos fatores da vivência familiar, cultura e outros, consubstanciando o profissional de saúde como fundamental para o desfecho. O gênero influenciou no que concerne ao olhar lançado sobre a violência física e psicológica, bem como na relevância dada às equipes de saúde para identificação de ocorrências e prevenção de possíveis danos. Conclusão: Os diversos tipos de violência contra a pessoa idosa foram reconhecidos, incluindo fatores individuais, comunitários e sociais no ciclo violento. Além disso, associaram o envelhecimento a maior suscetibilidade para sofrer violência, independente da tipologia. Destaca-se a potencialidade do serviço de saúde na assistência à pessoa idosa vítima de violência, elucidando casos e atuando precocemente para interrupção dos ciclos perpetrados, exigindo a necessidade constante de atualização profissional para lidar com situações detectadas.

Resumen Introducción: La violencia contra las personas adultas mayores es un fenómeno creciente, que causa daños a la salud, con diferentes desenlaces y consecuencias para las víctimas. La posibilidad de que las mujeres adultas mayores la sufran en el ámbito familiar supera la de los hombres, siendo el género un factor de riesgo considerable. Objetivo: Analizar la comprensión de la violencia contra las personas mayores según las mujeres adultas mayores. Metodología: Investigación descriptiva con enfoque cualitativo desarrollada con 22 mujeres adultas mayores de una comunidad en el estado de Paraíba, Brasil, elegidas por conveniencia. Para la recolección de datos, se utilizaron entrevistas semiestructuradas, procesadas por el software Iramuteq, con posterior análisis de contenido. Resultados: Se evidenciaron cinco tipos de violencia: ciclo de la violencia, red de apoyo población adulta mayor víctima de violencia, experimentar situaciones violentas, violencia financiera y simbología de la violencia en la sociedad, que denotan la comprensión de la violencia de diferentes tipos. Estas ideas están respaldadas en los factores de la experiencia familiar, la cultura y otros, donde la persona profesional de la salud se identifica como fundamental para el cuidado y apoyo. El género influyó en la mirada lanzada sobre la violencia física y psicológica, así como en la relevancia dada a los equipos de salud para la identificación de sucesos y la prevención de posibles daños. Conclusión: Se han reconocido los diversos tipos de violencia contra las personas mayores, incluidos los factores individuales, comunitarios y sociales en el ciclo de violencia. Además, asociaron el envejecimiento con una mayor susceptibilidad a sufrir violencia, independientemente de la tipología. Destaca la potencialidad del servicio de salud en la asistencia a la persona mayor víctima de violencia, mediante la identificación de casos y la actuación temprana para la interrupción de los ciclos perpetrados. De manera que, se evidencia la necesidad constante de actualización profesional para hacer frente a situaciones detectadas.

Abstract Introduction: Violence against the elderly is a growing phenomenon, causing damage to health, with different outcomes and consequences to the victims. The possibility of elderly women suffering it in the family context surpasses that of men, with gender being a considerable risk factor. Objective: To analyze the understanding of violence against the elderly according to elderly women. Method: Descriptive research with a qualitative approach developed with 22 elderly women from a community in the state of Paraíba, Brazil, chosen for convenience. The data collection was based on semi-structured interviews, processed by the Iramuteq software, with subsequent Content Analysis. Results: Five classes of violence against the elderly were evidenced: cycle of violence; support network for the elderly victims of violence; experience of violent situations; financial violence; and symbolism of violence in society, which denote an understanding of violence involving the different types. They are based on the factors of family experience, culture, and others, placing the health professional as a fundamental element for care and support. Gender influenced the perspective on physical and psychological violence, as well as the relevance given to health teams for the identification of occurrences and the prevention of possible damage. Conclusion: The various types of violence against the elderly have been recognized, including individual, community, and social factors in the violent cycle. In addition, they associated aging with greater susceptibility to suffering violence, regardless of the typology. It highlights the potential of the health service in assisting the elderly victim of violence, elucidating cases, and acting early to interrupt the cycles perpetrated, requiring the constant need for professional updating to deal with detected situations.

Conhecimentos e condutas dos cirurgiões-dentistas do estado do Rio Grande do Norte sobre denúncias e notificações de maus-tratos infantis / Knowledge and conduct of dentists of State of Rio Grande do Norte regarding complaints and notifications of child abuse

Os maus-tratos infantis são considerados um problema de saúde a nível mundial. Diante dessa realidade, destaca-se a relevante atuação dos profissionais de saúde na identificação, diagnóstico, notificação e, consequentemente, na redução no número de casos. O Cirurgião-Dentista apresenta-se em uma posição privilegiada no que diz respeito à identificação de casos de violência, visto que a maioria das lesões de ordem física a crianças e adolescentes se apresenta em região de cabeça e pescoço. Dessa forma, objetiva-se identificar as experiências e conduta dos cirurgiões-dentistas do Rio Grande do Norte sobre maus-tratos infantis. Foi realizado um estudo exploratório de caráter quantitativo mediante aplicação de um formulário eletrônico, com questões semiestruturadas, enviado aos dentistas com inscrições ativas no Conselho Regional de Odontologia do Rio Grande do Norte. Foi obtido um total de 100 questionários respondidos. Para análise dos dados, utilizou-se a estatística descritiva e testes de associação. Os resultados revelaram que 14% dos profissionais relataram ter visto caso suspeito de abuso físico, porém nenhum destes realizou notificação no último semestre. Apesar das médias das respostas terem sido superiores a 6 quanto à disposição para detecção, capacidade de diagnóstico e de identificação dos maus-tratos, esses resultados não corroboram com o número de profissionais que considera necessário maior qualificação em diagnóstico ou que desconhecem qualquer meio de notificação. A capacitação técnico-científica para a identificação e diagnóstico diferencial é importante e a responsabilidade pela notificação de casos suspeitos às autoridades é imprescindível para o exercício da profissão em consonância com os valores de cidadania e justiça

Child abuse is considered a global health problem. Given this reality, the relevant role of health professionals in identifying, diagnosing, reporting and, consequently, reducing the number of cases stands out. The dentist is in a privileged position with regard to identifying cases of violence, given that the majority of physical injuries to children and adolescents occur in the head and neck region. Thus, the objective is to identify the experiences and conduct of dentists in Rio Grande do Norte regarding child abuse. An exploratory quantitative study was carried out using an electronic form, with semi-structured questions, sent to dentists with active registrations at the Rio Grande do Norte Regional Dentistry Council. A total of 100 completed questionnaires were obtained. For data analysis, descriptive statistics and association tests were used. The results revealed that 14% of professionals reported having seen a suspected case of physical abuse, but none of them reported it in the last semester. Although the response averages were higher than 6 in terms of willingness to detect, diagnose and identify abuse, these results do not corroborate the number of professionals who consider it necessary to have greater qualifications in diagnosis or who are unaware of any means of reporting. Technical-scientific training for identification and differential diagnosis is important and the responsibility for reporting suspected cases to the authorities is essential for exercising the profession in line with the values of citizenship and justice

[Impact of gender violence on girls and adolescents]. / Impacto de la violencia de género en las niñas y las adolescentes.

Gender is an important determinant of health. Its relationship with inequality and violence allows us to consider being a woman as a risk factor for health. Girls and teenager girls are not exempt from this circumstance, which conditions their lives from before birth and can determine their health status throughout life. It can vary according to social contexts, as various factors intersect with gender, adding risk and vulnerability to being a woman. Gender-based violence is often identified as a problem for adult women; however, the experience of discriminatory gender-based violence is constructed throughout women's lives, producing serious individual and social consequences from childhood. Accepting this violence as a «private or domestic matter¼ often prevents seeing the true dimension of the problem, its consequences, and the need to address it as a global issue.

Repensando o Nascimento como um Direito Integral na Luta contra a Violência Obstétrica no Brasil / Rethinking Birth as a Comprehensive Right in the Fight against Obstetric Violence in Brazil / Reconsiderando el Nacimiento como un Derecho Integral en la Lucha contra la Violencia Obstétrica en Brasil

Objetivo: analisar o impacto da ausência de legislação federal e normativas na mitigação da violência obstétrica no Brasil, por meio de uma análise crítica, com ênfase na regulação legal. Metodologia: inicialmente, realizou-se uma revisão narrativa de abordagem qualiquantitativa e exploratória-descritiva nas bases de dados da Biblioteca Virtual em Saúde e da Scientific Electronic Library Online, no período entre 2018 e 2023. Os artigos foram selecionados utilizando descritores do Medical Subject Headings, como "obstetric violence" e "violence against women", combinados através do operador booleano "AND". Posteriormente, foi conduzida uma pesquisa documental buscando consultar a legislação estadual vigente no Brasil e identificar possíveis lacunas. Resultados: Identificou-se uma lacuna considerável em relação à violência obstétrica e à conscientização limitada sobre os direitos à autonomia das mulheres, que são preocupações evidentes. Em relação às legislações estaduais analisadas, 14 fazem menção à "violência obstétrica" e 8 abordam a "humanização do parto". Dessas, 19 têm caráter informativo, 28 são preventivas e 2 são punitivas. Considerações Finais: A ausência de consenso na definição da violência obstétrica e a escassa capacitação dos profissionais de saúde resultam em práticas obsoletas. A elevada taxa de cesarianas desnecessárias e a carência de estudos sobre mulheres quilombolas e indígenas são preocupantes. No âmbito jurídico, a falta de compreensão por parte dos magistrados e a fragmentação das legislações estaduais representam desafios significativos. Torna-se crucial adotar uma abordagem multidisciplinar e políticas públicas claras para prevenir essa violência e assegurar uma assistência ao parto segura e centrada nas necessidades das mulheres.

Objective: To analyze the impact of the absence of federal legislation and regulations on the mitigation of obstetric violence in Brazil through a critical analysis, with emphasis on legal regulation. Methodology: Initially, a narrative review with a qualiquantitative and exploratory-descriptive approach was conducted on the databases of the Virtual Health Library and the Scientific Electronic Library Online, between 2018 and 2023. Articles were selected using Medical Subject Headings descriptors such as "obstetric violence" and "violence against women", combined with the boolean operator "AND". Subsequently, a documentary search was conducted to consult the current state legislation in Brazil and identify possible gaps. Results: A considerable gap was identified regarding obstetric violence and limited awareness of women's autonomy rights, which are evident concerns. Regarding the analyzed state laws, 14 mention "obstetric violence" and 8 address "humanization of childbirth". Of these, 19 are informative, 28 are preventive, and 2 are punitive. Final Considerations: The lack of consensus in defining obstetric violence and the scarce training of healthcare professionals result in obsolete practices. The high rate of unnecessary cesarean sections and the lack of studies on quilombola and indigenous women are concerning. In the legal sphere, the lack of understanding by judges and the fragmentation of state legislation represent significant challenges. It is crucial to adopt a multidisciplinary approach and clear public policies to prevent this violence and ensure safe and woman-centered childbirth care.

Objetivo: Analizar el impacto de la ausencia de legislación federal y normativas en la mitigación de la violencia obstétrica en Brasil mediante un análisis crítico, con énfasis en la regulación legal. Metodología: Inicialmente, se realizó una revisión narrativa con enfoque cualicuantitativo y exploratorio-descriptivo en las bases de datos de la Biblioteca Virtual en Salud y la Scientific Electronic Library Online, entre 2018 y 2023. Se seleccionaron artículos utilizando descriptores del Medical Subject Headings como "obstetric violence" y "violence against women", combinados con el operador booleano "AND". Posteriormente, se realizó una búsqueda documental para consultar la legislación estatal vigente en Brasil e identificar posibles lagunas. Resultados: Se identificó una brecha considerable en relación con la violencia obstétrica y la conciencia limitada de los derechos de autonomía de las mujeres, que son preocupaciones evidentes. En cuanto a las leyes estatales analizadas, 14 mencionan "violencia obstétrica" y 8 abordan la "humanización del parto". De estas, 19 son informativas, 28 son preventivas y 2 son punitivas. Consideraciones Finales: La falta de consenso en la definición de la violencia obstétrica y la escasa formación de los profesionales de la salud resultan en prácticas obsoletas. La alta tasa de cesáreas innecesarias y la falta de estudios sobre mujeres quilombolas e indígenas son preocupantes. En el ámbito legal, la falta de comprensión por parte de los jueces y la fragmentación de la legislación estatal representan desafíos significativos. Es crucial adoptar un enfoque multidisciplinario y políticas públicas claras para prevenir esta violencia y garantizar una atención al parto segura y centrada en las necesidades de las mujeres.

A qualitative investigation of gender-based violence prevention and response using digital technologies in low resource settings and refugee populations.

Background: Governmental and non-governmental organizations across medical, legal, and psychosocial sectors providing care to survivors of gender-based violence (GBV) and their families rapidly digitalized services during the COVID-19 pandemic. GBV prevention/response services working with women and children who are forcibly displaced and/or living in low-and-middle income countries (LMIC) were no exception to the rapid digitalization trend. Literature is lacking a critical synthesis of best practices and lessons learned since digitalization replaced major operations involved in GBV prevention/response.Objective: This research qualitatively investigated how GBV service providers, located in a range of socio-political settings, navigated the process of digitalizing GBV prevention/response during the COVID-19 crisis.Method: Semi-structured key informant interviews (KII) with GBV service providers in varied sectors were implemented virtually (2020-2021) in Brazil, Guatemala, Iraq, and Italy (regarding forcibly displaced women/girls for the latter). Participants were recruited using purposive and snowball sampling. Interview guides covered a range of topics: perceived changes in violence and service provision, experiences with virtual services, system coordination, and challenges. The KIIs were conducted in Portuguese, Spanish, Arabic, and Italian. Interviews were audio-recorded, transcribed, and translated into English. The research team conducted thematic analysis within and between countries using a structured codebook of data driven and theory driven codes.Results: Major themes concerned the: (1) spectrum of services that were digitalized during the COVID-19 crisis; (2) gender digital divide as a barrier to equitable, safe, and effective service digitalization; (3) digital violence as an unintended consequence of increased digitalization across social/public services.Conclusion: Digitalization is a balancing act with respect to (1) the variety of remotely-delivered services that are possible and (2) the access/safety considerations related to the gender digital divide and digital violence.

Digitalization occurs when products and services are converted to digital forms; violence prevention/response services working with women and children who are forcibly displaced and/or living in low-and-middle income countries were no exception to the rapid trend of digitalization during the COVID-19 crisis.Using key informant interviews with service providers working in violence prevention and response sectors in Brazil, Guatemala, Iraq, and in Italy regarding forcibly displaced women/girls, we investigated the rapid digitalization of gender-based violence prevention/response during the COVID-19 crisis.The effectiveness, safety, and equitability of digitalized violence prevention/response services depends on how well they are balanced vis-a-vis the gender digital divide and risk of digital GBV.

Violence Exposure and Disability in Colombian Female Survivors of Intimate Partner Violence: the Mediating Role of Depressive Symptoms.

BACKGROUND: Violence is an important public health problem and one of the main causes of deaths worldwide. The mental health consequences of surviving intimate partner violence (IPV) include depression, anxiety and post-traumatic stress disorder. Previous studies have identified that there is a relationship between depression and level of disability in female survivors of IPV. Estimating the direct, indirect or total effect of an exposure on an outcome makes it possible to identify mediating effects between a group of variables. Detecting mediation effects is useful for identifying casual pathways that generate a final outcome and provides a rationale for designing interventions to target the mediator, which in turn positively affects the outcome. The objective was to identify the mediating role of depressive symptoms on the relationship between IPV and disability. METHODS: This was a cross-sectional study of 94 women over the age of 18 who were survivors of IPV by men. They were recruited from two public hospitals in Cali and Tuluá in southwest Colombia. An analysis of casual relationships was performed using structural equation modelling that was made up of: four exogenous observed variables (age, current relationship status [in a relationship or single], level of schooling, and history of an impairment), intermediate endogenous variables (violence and depressive symptoms), and the main endogenous variable (disability). The analyses were carried out in Stata14.2. RESULTS: The direct effect of IPV severity on the level of disability was not statistically significant (ß=0.09; P=0.63). However, the indirect effect of IPV severity on disability mediated by depressive symptoms was (ß=0.39; P<0.01). The total effect of IPV severity on the level of disability was even greater (ß=0.48; P=0.01). CONCLUSIONS: This study found a complete mediating role of depressive symptoms on the relationship between the severity of IPV and the level of disability for the female participants in this study. The results of this research contribute to defining strategies to prevent and address intimate partner violence, depressive symptoms and disability in this population.

Percepções de agentes comunitários de saúde acerca da violência doméstica contra crianças e adolescentes / Perceptions of community health agents about domestic violence against children and adolescents / Percepciones de los agentes de salud comunitarios sobre la violencia doméstica contra niños y adolescentes

Objetivo: Compreender as percepções de Agentes Comunitários de Saúde sobre violência doméstica contra crianças e adolescentes. Métodos: Estudo descritivo, exploratório, de abordagem qualitativa, realizado no município de Iguatu, Ceará, Brasil, com 68 agentes comunitários de saúde no ano de 2018, por meio de grupos focais. Os dados foram organizados em temáticas e interpretados de acordo com a literatura pertinente, utilizando a "Análise categorial de conteúdo". Resultados: Os participantes compreendem que a violência contra os menores perpassa a física, abrangendo a violência verbal e psicológica, sentindo-se desamparados na atuação a violência doméstica contra crianças e adolescentes, não reconhecendo o apoio das instituições de saúde e assistência social, focando-se no Conselho Tutelar. Ainda, sentem medo de represálias e reconhecem a fragilidade no trato ético dos casos de violência, com possível quebra de sigilo, entendendo que o enfrentamento da violência se faz com a abordagem da família, não apenas do menor. Conclusão: Evidenciou-se nas percepções dificuldades interventivas e o receio de represálias, comprometendo as atividades profissionais, gerando a subnotificação e a não intervenção efetiva dos casos de violência conta crianças e adolescentes. (AU)

Objective: To understand the perceptions of community health agents about domestic violence against children and adolescents. Methods: Descriptive, exploratory study with a qualitative approach, carried out in the city of Iguatu, Ceará, Brazil, with 68 community health workers in 2018, through focus groups. Data were organized into themes and interpreted according to the relevant literature, using the "Category analysis of content". Results: Participants understand that violence against minors permeates the physical, covering verbal and psychological violence, feeling helpless in acting on domestic violence against children and adolescents, not recognizing the support of health and social assistance institutions, focusing on them. if in the Guardianship Council. Still, they are afraid of reprisals and recognize the fragility in the ethical treatment of cases of violence, with possible breach of confidentiality, understanding that the confrontation of violence is done with the approach of the family, not just the minor. Conclusion: Interventional difficulties and fear of reprisals were evidenced in the perceptions, compromising professional activities, generating underreporting and non-effective intervention in cases of violence against children and adolescents. (AU)

Objetivo: Conocer las percepciones de los agentes comunitarios de salud sobre la violencia intrafamiliar contra niños, niñas y adolescentes. Métodos: Estudio descriptivo, exploratorio, con enfoque cualitativo, realizado en la ciudad de Iguatu, Ceará, Brasil, con 68 trabajadores comunitarios de salud en 2018, a través de grupos focales. Los datos fueron organizados en temas e interpretados de acuerdo con la literatura relevante, utilizando el "Análisis de contenido por categorías". Resultados: Los participantes comprenden que la violencia contra los menores traspasa lo físico, abarcando la violencia verbal y psicológica, sintiéndose impotentes al actuar sobre la violencia intrafamiliar contra los niños, niñas y adolescentes, desconociendo el apoyo de las instituciones de salud y asistencia social, enfocándose en ellos si en el Consejo de Tutela. Aún así, temen represalias y reconocen la fragilidad en el tratamiento ético de los casos de violencia, con posible ruptura de la confidencialidad, entendiendo que el enfrentamiento a la violencia se hace con el enfoque de la familia, no sólo del menor. Conclusión: Se evidenciaron dificultades intervencionistas y temor a represalias en las percepciones, comprometiendo las actividades profesionales, generando subregistro y no intervención efectiva en casos de violencia contra niños y adolescentes. (AU)

Developing and implementing survivor-centred approaches for college student-athletes: perspectives from athletic department, Title IX, and campus advocacy personnel.

ABSTRACTBackground: Sexual violence (SV) is a persistent issue on US college campuses, particularly among college student-athletes. Strategies to address SV are urgently needed. Yet, prior research shows that many university practices can be more harmful than helpful to SV survivors and necessitates a reimagination of how institutions support SV survivors. Survivor-centred approaches may be one way to effectively address SV for students, including student-athletes, across college campuses.Objective: This qualitative study explored campus personnel experiences with and perceptions of survivor-centred SV prevention and intervention policies and practices on college campuses and examined how these approaches serve SV survivors, including college student-athletes.Methods: As part of a larger study on campus SV and student-athletes across four institutions, semi-structured interviews with 22 representatives from athletic departments, campus advocacy, and Title IX were conducted. Guided by phenomenology, a thematic analysis approach was used to identify key patterns in survivor-centred SV prevention and intervention policies and practices. Participant demographic data were analysed descriptively.Results: Most participants identified as white (72.2%), heterosexual (63.6%), women (68.2%), and were an average of 41.8 years old (SD = 10.2). The majority were in positions associated with athletic departments (63.6%), and they had been in their role for an average of 5.6 years (SD = 6.6). Through thematic analysis, three main themes were identified: (1) education & accessibility; (2) interpersonal relationships & individual well-being; and (3) campus and societal norms.Conclusions: The findings from this study highlight clear policy and practice recommendations for survivor-centred SV prevention and intervention on college campuses, such as accessible, applicable SV training and the implementation of survivor-centred approaches. Further research is needed to understand existing survivor-centred practices and the facilitators and barriers to their implementation across institutions and within athletic departments.

Sexual violence is a persistent issue on US college campuses, particularly among college student-athletes. Strategies to address SV are urgently needed. Survivor-centred approaches may offer solutions to better serve survivors of sexual violence, including student-athletes.Through interviews with athletic department, Title IX, and campus advocacy personnel, three themes were identified related to developing and implementing survivor-centred approaches: (1) education & accessibility; (2) interpersonal relationships & individual well-being; and (3) campus and societal norms.Further research is needed to understand existing survivor-centred practices and the facilitators and barriers to their implementation across institutions, particularly for college student-athletes.

Guardians of health under fire: Understanding and combating violence against doctors.

Violence against physicians is not a newly emerged but an increasingly serious problem. Various studies have reported a prevalence of up to 90%. If not prevented, it not only causes physical and mental harm to physicians who are dedicated to serving humanity but also affects the entire healthcare system and, consequently, the whole community with its direct and indirect effects. Some interventions have a positive outcome when effectively managed. However, for these interventions to be permanent and effective, they need to be multidisciplinary, legally backed and adopted as public policy. In this article, the prevalence of violence against physicians in the literature, its causes, practices worldwide, and suggestions for solving this problem are compiled.

Violência doméstica: a pandemia de covid-19 provocou subnotificação de casos e/ou aumento de sua ocorrência? / Violencia doméstica: ¿la pandemia covid-19 ha causado un subreporte de casos y/o un aumento en su ocurrencia? / Domestic violence: has the covid-19 pandemic caused under-reporting of cases and/or an increase in their occurrence?

Introdução: O cenário pandêmico trouxe à tona e de forma potencializada alguns indicadores preocupantes acerca da violência domésticacontra a mulher.Dessa maneira, questiona-se: a pandemia de COVID-19 provocou diferença no número de ocorrências de casos de Violência Doméstica?Objetivo:Comparar a ocorrência de casos de violência doméstica contra mulheres em um estado brasileiro nos períodos de 2015 a 2018 e 2019a 2021 segundo dados da Polícia Civil do estado.Metodologia:Trata-se de um estudo documental e descritivo, realizado com dados secundários. As informações foram colhidas através da ouvidoria da Polícia Civil em 11 de março de 2021,a partir dos registros de boletins de ocorrências policiais sobre violência doméstica contra a mulher dos anos de 2015 a 2021.Resultados:Durante os anos de 2015 a 2021 foram registrados um total de 26.671 boletins de ocorrência por violência contra a mulher. De 2015 a 2018,a média mensal foi de 360,1ocorrênciase durante a pandemia, de 2019 a 2021, a média mensal foi de 360,9ocorrências. Notou-se um discreto aumento na quantidade de boletins de ocorrência feito durante a pandemia deCOVID-19, com destaque para 2020, que apresentou média mensal de 387,4ocorrências, período mais recrudescido da pandemia. A principal violência perpetrada foi a lesão corporal dolosa principalmente contra mulheres de 18 a 24 anos, que trabalhavam em casa ou estavam desempregadas.Conclusão:Apesar da falta de diferenças expressivas entre os anos pré e pós-pandemia, a análise reforça a urgência de discutir os fatores subjacentes à violência contra a mulher, especialmente a violência doméstica. Destaca-se a importância de medidas preventivas e de apoio às vítimas para enfrentar esse problema social. É essencial promover políticas visando uma sociedade mais segura e igualitária para todas as mulheres (AU).

Introduction:The pandemic scenario has brought to light, and in a intesified manner, some concerning indicators regarding domestic violence against women. Thus, the question arises: did the COVID-19 pandemic make a difference in the number of domestic violence cases? Objective: To compare the occurrence of domestic violence cases against Brazilian women in the periods from 2015 to 2018 and 2019 to 2021 according to data from the state's Civil Police. Methodology: This is a documentary and descriptive study, conducted with secondary data. The information was collected through the Civil Police ombudsman on March 11, 2021, based on police reports of domestic violence against women from 2015 to 2021. Results: During the year of 2015 to 2021, a total of 26,671 police reports of violence against women were registered. From 2015 to 2018, the monthly average was 360.1 occurrences, and during the pandemic, from 2019 to 2021, the monthly average was 360.9 occurrences. There was a slight increase in the number of police reports during the COVID-19 pandemic, with a peak in 2020, which had a monthly average of 387.4 occurrences, the most intense period of the pandemic. The main violence perpetrated was intentional bodily harm, mainly against women aged 18 to 24, who were either working from home or unemployed. Conclusion: Despite the lack of significant differences between pre and post-pandemic years, the analysis reinforces the urgency of discussing the underlying factors of violence against women, especially domestic violence. The importance of preventive measures and support for victims to address this social problem is emphasized. It is essential to promote policies aimed at a more equal and safer society for all women (AU).

Introducción: El escenario pandémico ha sacado a la luz algunos indicadores preocupantes sobre la violencia doméstica contra las mujeres. Entonces, surge la pregunta: ¿la pandemia de COVID-19 ha provocado una diferencia en el número de ocurrencias de casos de Violencia Doméstica?Objetivo:Comparar la ocurrencia de casos de violencia doméstica contra las mujeres en un estado brasileño en los períodos de 2015 a2018 y de 2019 a 2021 según datos de la Policía Civil del estado. Metodología:Se trata de un estudio documental y descriptivo, realizado con datos secundarios. La información fue recabada a través de la Defensoría del Pueblo de la Policía Civil el 11 de marzo de 2021,a partir de los registros de las denuncias policiales sobre violencia intrafamiliar contra las mujeres de 2015 a 2021.Resultados:De 2015 a 2021 se presentaron un total de 26.671 denuncias policiales por violencia contra las mujeres. De 2015 a 2018, el promedio mensual fue de 360,1 ocurrencias y durante la pandemia, de 2019 a 2021, el promedio mensual fue de 360,9 ocurrencias. Hubo un ligero aumento en el número de denuncias policiales realizadas durante la pandemia de COVID-19, especialmente en 2020, que tuvo un promedio mensual de 387,4 ocurrencias, el período más severo de la pandemia. La principal violencia perpetrada fueron lesiones corporales intencionales, principalmente contra mujeres de 18 a 24 años, que trabajaban en el hogar o estaban desempleadas.Conclusión:A pesar de la falta de diferencias significativas entre los años pre y post pandemia, el análisis refuerza la urgencia de discutir los factores que subyacen a la violencia contra las mujeres, especialmente la violencia doméstica. Se destaca la importancia de las medidas preventivas y de apoyo a las víctimas para hacer frente a esta problemática social. Es esencial promover políticas encaminadas a lograr una sociedad más segura e igualitaria para todas las mujeres (AU).

Cuidado na Atenção Primária à Saúde às mulheres em situação de violência: estudo bibliométrico na Web of Science / Care in Primary Health Care for women in situation of violence: bibliometric study in the Web of Science / Cuidado en la Atención Primaria de Salud a mujeres em situación de violencia: estudio bibliométrico en la Web of Science

O estudo apresentado neste artigo objetivou descrever a produção científica entre 2012 e 2022 sobre o cuidado médico na Atenção Primária à Saúde a mulheres em situação de violência. Trata-se de um estudo bibliométrico e descritivo de abordagem quantitativa, a partir de publicações indexadas na base de dados Web of Science mediante o uso dos descritores "Violence Against Women", "Medical Care", "Primary Health Care". Diante do que foi analisado, é perceptível uma falta de priorização de estratégias de cuidados pelos serviços de saúde, apesar de uma produção científica consideravelmente importante, bem como uma falta de atuação de alguns nichos dos profissionais de saúde. O desenho metodológico permitiu um mapeamento do perfil dos estudos voltados para a temática, assim como a necessidade de estudos sobre intervenções multidisciplinares, em especial o cuidado médico, na Atenção Primária à Saúde, a mulheres em situação de violência.

The study presented in this article aimed to describe the scientific production between 2012 and 2022 on medical care in Primary Health Care for women in situations of violence. This is a bibliometric and descriptive study of quantitative approach, from publications indexed in the Web of Science database through the use of the follow descriptors: "Violence Against Women", "Medical Care", "Primary Health Care". In the light of what has been analyzed, it is visible a lack of prioritisation of care strategies by the health services, despite a considerably important scientific production, as well as a lack of action by certain niches of health professionals. The methodological design made it possible to map out the profile of studies on the subject, as well as the need for studies on multidisciplinary interventions, especially the medical care by health services in Primary Health Care for women in situations of violence.

El estudio presentado en este artículo tuvo como objetivo describir la producción científica entre 2012 y 2022 sobre el cuidado médico en la Atención Primaria de Salud a mujeres en situación de violencia. Se trata de un estudio bibliométrico y descriptivo con enfoque cuantitativo, basado en publicaciones indexadas en la base de datos Web of Science utilizando el descriptores "Violence Against Women", "Medical Care", "Primary Health Care". Frente a lo analizado, es notoria una falta de priorización de las estrategias de atención por parte de los servicios de salud, a pesar de una producción científica considerable y importante, así como de una falta de actuación de determinados nichos de profesionales de la salud. El diseño metodológico permitió mapear el perfil de los estudios acerca del tema, así como la necesidad de estudios sobre intervenciones multidisciplinarias, especialmente el cuidado médico en los servicios de salud de la Atención Primaria de Salud a mujeres en situación de violencia.

[Health consequences of violence against women by the couple]. / Consecuencias para la salud de la violencia contra la mujer por la pareja.

Intimate partner violence against women (IPV) has devastating effects on the healthcare and well-being of women and their children. Physical, psychological, and social consequences, a worse perception of their own health, and loss of quality of life are well-documented, while aftereffects persist in time even after the end of abuse. Psychological consequences of abuse last longer and are more serious. IPV also affects sons and daughters, disabled people, family, and the attacker himself. Many health problems, both physical and mental, that lead women to go to healthcare services in search of help have an origin in the violence they experience. Treatment of the symptoms without awareness of its relation to such violence favours medicalization, iatrogenesis, and chronification. Psychological violence poses a threat that is invisible, subtle, cumulative, and difficult to detect; it is, however, the most destructive.

Violence as a Health Problem.

Violence is a public health problem, and when it affects childhood, it can cause illness throughout the individual's life. Apart from being able to cause damage in the physical, mental and social spheres, it represents a violation of the rights of the affected children, and a high consumption of resources, both economic and social. A multitude of investigations have improved attention to this violence. However, these advances are not consistent with the practical management of victims, both in Primary and Hospital Care. There is a significant area of improvement for paediatric care. Through this article, different professionals from all established paediatric health care facilities develop general lines of knowledge and action regarding violence against children. An overview is taken of the legislation related to childhood, the different types of abuse that exist, their effects, management and prevention. It concludes with an epilogue, through which we aim to move sensibilities. In summary, this work aims to promote the training and awareness of all professionals specialized in children's health, so that they pursue the goal of achieving their patients' greatest potential in life, and in this way, to help create a healthier society, with less disease, and more justice.

Evaluación del conocimiento y manejo de la violencia basada en género desde la perspectiva de los ginecotocólogos y posgrados en la práctica clínica en Uruguay

Introducción: la violencia basada en género (VBG) es un grave problema de salud con cifras alarmantes. Las mujeres víctimas de VBG acuden a los centros de salud para ser atendidas por este y otros motivos, siendo en muchos casos el primer y único contacto de las mujeres con el sistema sanitario. El objetivo de este estudio es investigar acerca del nivel de formación, conocimientos, actuación y percepciones sobre la atención por parte de los ginecotocólogos y posgrados de Ginecotocología en casos de VBG en la práctica clínica diaria en nuestro medio. Método: se realizó un estudio descriptivo observacional de corte transversal de una muestra por conveniencia. Se encuestaron 143 profesionales, comprendiendo ginecotocólogos y posgrados de Ginecotocología en el período comprendido entre el 1 y el 30 de septiembre de 2019. Resultados: 9 de cada 10 de los profesionales refirieron no realizar o realizar pocas preguntas sobre VBG en la práctica clínica, y 80% no tiene claro sobre cuál es su rol en la detección de una víctima de VBG, siendo profesionales que asisten a un promedio de 20 a 60 mujeres semanalmente. Un tercio de los encuestados manifestaron tener menos de una hora de formación académica en VBG. Conclusión: existe escasa formación académica en esta temática. Se mostró que entender el papel del profesional en la detección de casos de VBG y la capacidad para responder apropiadamente están íntimamente relacionados con la capacidad de identificar la VBG en la práctica clínica diaria.

Introduction: Gender-based violence (GBV) is a serious health problem that accounts for alarming figures. Women victims of GBV come to health centers to be treated for this and other reasons, in many cases being this the first and only contact they have with the health system. The objective of this study is to find out the level of training, knowledge, actions, and perceptions regarding care by gynecologists and gynecology postgraduates in cases of gender-based violence seen during daily clinical practice in our setting. Method: A descriptive observational study was conducted, with a cross-sectional design and convenience sample. A total of 143 professionals were surveyed, including gynecologists and gynecology postgraduates, between September 1st and September 30th, 2019. Results: Nine out of ten professionals reported not asking or asking few questions about GBV in their clinical practice, and 80% were unclear about their role in detecting GBV victims, despite assisting an average of 20 to 60 women weekly. One-third of respondents reported having less than an hour of academic training in GBV. Conclusion: There is limited academic training in this area. The study showed that understanding the professionals' role in detecting GBV cases and their ability to respond appropriately to it are closely related to the ability to identify GBV in daily clinical practice.

Introdução: a violência baseada em gênero (VBG) é um grave problema de saúde com números alarmantes. As mulheres vítimas de VBG procuram os centros de saúde para tratamento por esse e outros motivos e, em muitos casos, esse é o primeiro e único contato que as mulheres têm com o sistema de saúde. O objetivo deste estudo é pesquisar o nível de formação, conhecimento, desempenho e percepções do atendimento por tocoginecologistas e pós-graduandos em Tocoginecologia nos casos de VBG na prática clínica diária. Métodos: foi realizado um estudo observacional descritivo de corte transversal com uma amostra de conveniência. Foram incluídos 143 profissionais, incluindo tocoginecologistas e pós-graduandos em Tocoginecologia no período entre 1º e 30 de setembro de 2019. Resultados: 9 em cada 10 profissionais relataram não fazer nenhuma ou poucas perguntas sobre a VBG na prática clínica, e 80% não tinham clareza sobre seu papel na identificação de uma vítima de VBG em sua prática, sendo profissionais que atendem uma média de 20 a 60 mulheres por semana. Um terço dos entrevistados relatou ter menos de uma hora de formação acadêmica em VBG. Conclusão: Há pouca formação acadêmica nessa área. A compreensão do papel do profissional na detecção de casos de VBG e a capacidade de responder adequadamente estão intimamente relacionadas à capacidade de identificar VBG na prática clínica diária.

Qualidade da assistência ao parto na percepção da mulher assistida na rede pública de saúde / Quality of birth care in the perception of women assisted in the public health network

Levantar e analisar a perspectiva de mulheres acerca da assistência recebida durante o parto. Método: estudo epidemiológico, observacional, de abordagem quantitativa e transversal. Os dados coletados foram compilados em tabelas e gráficos, analisados comparativamente entre si e com dados levantados na literatura científica. Resultados: as 80 participantes, com idade média de 26,6 anos, foram assistidas, integralmente, por enfermeiras obstetras. Houve predomínio das pardas (55,0%), solteiras (53,7%) e com renda familiar inferior a salários-mínimos (77,5%). Constatou-se alto nível de satisfação relacionado à assistência recebida, entretanto, o toque vaginal e a falta liberdade de se posicionar ao dar à luz foram as queixas mais frequentes, e que gerou certo grau de insatisfação. Conclusão: a amostra analisada demonstrou satisfação com os cuidados recebidos, porém os dois indicadores, com menor grau de satisfação, precisam ser repensados na prática obstétrica de modo a promover o bem-estar e a segurança da mulher.(AU)

To survey and analyze women's perspectives on the care they received during childbirth. Method: an epidemiological, observational, quantitative, cross-sectional study. The data collected was compiled into tables and graphs and analyzed in comparison with each other and with data found in scientific literature. Results: the 80 participants, with an average age of 26.6 years, were attended entirely by obstetric nurses. There was a predominance of brown women (55.0%), single women (53.7%) and women with a family income of less than one minimum wage (77.5%). There was a high level of satisfaction with the care received; however, vaginal touch and the lack of freedom to position oneself when giving birth were the most frequent complaints, which generated a certain degree of dissatisfaction. Conclusion: The sample analyzed showed satisfaction with the care received, but the two indicators with the lowest level of satisfaction need to be rethought in obstetric practice in order to promote women's well-being and safety.(AU)

Encuestar y analizar las perspectivas de las mujeres sobre la atención recibida durante el parto. Método: estudio epidemiológico, observacional, cuantitativo y transversal. Los datos recogidos se compilaron en tablas y gráficos y se analizaron en comparación entre sí y con los datos encontrados en la literatura científica. Resultados: las 80 participantes, con edad media de 26,6 años, fueron atendidas en su totalidad por enfermeras obstétricas. Hubo predominio de mujeres morenas (55,0%), solteras (53,7%) y con renta familiar inferior a un salario mínimo (77,5%). Hubo un alto grado de satisfacción con la atención recibida; sin embargo, el tacto vaginal y la falta de libertad para colocarse al dar a luz fueron las quejas más frecuentes, lo que generó cierto grado de insatisfacción. Conclusión: La muestra analizada mostró satisfacción con la atención recibida, pero los dos indicadores con menor nivel de satisfacción necesitan ser repensados en la práctica obstétrica para promover el bienestar y la seguridad de las mujeres.(AU)

A pandemia de COVID-19 e casos de violência doméstica: percepções de profissionais da atenção primária à saúde no contexto de isolamento social / The COVID-19 pandemic and cases of domestic violence: perceptions of primary healthcare professionals in the context of social isolation / La pandemia de COVID-19 y la violencia doméstica: percepción de los profesionales de atención primaria de salud en el contexto del aislamiento social

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.