Atendimento de urgência de mulheres grávidas em decorrência de violência sexual: características e tendências observadas em 20 anos / Emergency care for women due to sexual assault: characteristics and tendency observed for 20 years

Objetivo: O atendimento médico de urgência (AMU) é fundamental na prevenção e na redução de agravos da violência sexual (VS), como o uso de anticoncepção de emergência (AE). O objetivo deste estudo é analisar 20 anos de AMU após VS entre gestantes decorrente de estupro. Métodos: Estudo transversal com 2.816 mulheres entre 1999 e 2018. Considerou-se buscar ou não o AMU após a VS e dados sociodemográficos. Analisou-se por dispersão de dados e curva exponencial de tendência. Resultados: O AMU ocorreu em 188 casos (6,7%). Neste grupo, não se prescreveu AE em 31 (16,5%) mulheres. Não houve diferença significativa nos dados sociodemográficos. Os extremos de variação dos percentuais para quem buscou AMU foram de 16,1%, em 1999, e de 2%, em 2010, com queda da linha de tendência exponencial (R2 = 0,4667). Conclusão: Não houve associação com características sociodemográficas e a queda expressiva dos percentuais de gestações sugere, indiretamente, melhora da eficácia dos serviços de saúde em prover a AE.(AU)

Objective: Emergency medical care (EMC) is essential in the prevention and reduction of sexual assault (SA), including the use of emergency contraception (EC). The aim of this study is to analyze 20 years of EMC after SA in pregnant women due to rape. Methods: Cross-sectional study with 2,816 women between 1999 and 2018. It was considered to seek or not EMC after SA and sociodemographic data. Statistical analysis was performed by data dispersion and exponential trend curve. Results: EMC occurred in 188 cases (6.7%). In this group, EC was not prescribed in 31 (16.5%). There was no significant difference in sociodemographic data. The extremes of percentage variation for those seeking EMC were 16.1% in 1999, and 2% in 2010, with a drop in the exponential trend line (R2 = 0.4667). Conclusion: There was no association with sociodemographic characteristics and the significant drop in the percentage of pregnancies indirectly suggests an improvement in the effectiveness of health services in providing EC.(AU)

Violencia contra la mujer en la relación de pareja; caracterización en cinco comunidades de Honduras / Violence against the woman in c ouple ́s relationship; characterization in five communities of Honduras

La violencia contra las mujeres es un problema mundial que se presenta en todas las clases sociales, incluye agresión física, psicológica, sexual y patrimonial. Objetivo: caracterizar la violencia doméstica en mujeres que han sido maltratadas por su pareja en cinco comunidades de Honduras. Material y Métodos: la población de estudio fueron 15 047 mujeres, mayores de 15 años en convivencia marital de cinco comunidades de Honduras. La muestra fue 1 629 mujeres; se hizo un cálculo individual por comunidad, considerando la población femenina en cada una de ellas. La información se obtuvo por medio de un cuestionario elaborado específicamente para el estudio, constaba de preguntas abiertas y cerradas que incluyó variables sociodemográficas, así como las características de las agresiones. Resultados: la prevalencia general fue de 737(45.2%), el tipo de violencia mayoritario fue verbal 383(52%), psicológica 31(4.2%), sexual 140 (19%) y física 151(20.5%). Predominó la violencia en mujeres entre 20-39 años de edad, con escolaridad primaria 434(58.9%), cuyo estado civil era unión libre. Conclusión: la violencia doméstica se presenta en mujeres jóvenes menores de 39 años, en unión libre, con escolaridad primaria, con hijos; la frecuencia de violencia fue de 45.2%, y predominó la verbal, física y sexual. De esta tipología, la observable es la física por provocar lesiones en diferentes partes del cuerpo, siendo la cara el área predominante y el puño como instrumento de lesión. Al momento de ocurrir la violencia el agresor se encontraba bajo el efecto del alcohol u otras drogas y son testigos presenciales principalmente los hijos. Por lo tanto, el hogar se ha transformado en un foco de violencia, de peligro para la mujer y los hijos...(AU)

Prevalence and Risk Factors of Domestic Violence Against Women Attending a Primary Care Center in Riyadh, Saudi Arabia.

Domestic violence (DV) against women can negatively affect the physical, mental, sexual, and reproductive health of the women as well as the well-being of their children. The objective was to estimate among Saudi women the prevalence of different types of DV, to identify its associated risk factors, and to determine the immediate victims' reactions to such violence. A cross-sectional study was carried between March and July, 2011. Self-administrated questionnaire was administered to ever-married Saudi women attending Al-Wazarat primary health care center, in Riyadh, Saudi Arabia. Out of the 720 women studied, 144 (20%) reported exposure to DV over the last year. The most common DV types were emotional (69%), social (34%), economic (26%), physical (20%), and sexual violence (10%). In multivariate logistic regression analysis, the following characteristics were independently associated with DV: younger women age, longer duration of marriage, higher women education, lower husband education, working husbands, military occupation, fewer children, husbands with multiple wives, smoking husbands, aggressive husbands, presence of chronic disease in women or husbands, and non-sufficient family income. The most common impacts of DV on women were medical or behavioral problems (72%) and psychiatric problems (58%). The most common reactions to DV were seeking separation (56%) and doing nothing (41%). More than 90% of children of abused women suffered psychological or behavioral problems. In conclusion, DV against Saudi women is considerable and the response is generally passive. Promoting a culture non-tolerant to DV and providing accessible, effective, and trustful social services to abused women are critically needed.

Características epidemiológicas da violência contra a mulher no Distrito Federal, 2009 a 2012 / Epidemiological characteristics of violence against women in the Federal District, Brazil, 2009-2012 / Características epidemiológicas de la violencia contra la mujer en el Distrito Federal, Brasil, 2009-2012

OBJETIVO: descrever as características epidemiológicas dos casos de violência contra a mulher notificados no Distrito Federal, Brasil, no período 2009-2012. MÉTODOS: estudo descritivo sobre casos de violência contra mulheres de 18 a 59 anos de idade registrados no Sistema de Informação de Agravos de Notificação (Sinan). RESULTADOS: foram notificados 1.924 casos de violência contra a mulher; os principais agressores foram desconhecidos (25,7%) ou cônjuges (19,0%) das vítimas; predominaram vítimas da cor parda (25,0%) e agressões em ambiente doméstico (38,5%); quanto ao tipo de violência, destaca-se a forma física (46,8%) por meio da força (48,0%), sendo os órgãos genitais (15,7%) e a cabeça (12,9%) as regiões mais afetadas. CONCLUSÃO: entre os casos notificados, verificou-se predominância da violência física, em ambiente doméstico e perpetrada por agressores desconhecidos; ainda, foram identificadas falhas no registro das notificações, o que evidencia a necessidade de aprimoramento da qualidade do sistema e capacitação dos profissionais envolvidos.

OBJECTIVE: to describe the epidemiological characteristics of cases of violence against women reported in the Federal District, Brazil, 2009-2012. METHODS: this was a descriptive study of cases of violence against women aged 18- 59 registered on the National Notifiable Diseases System (Sinan). RESULTS: 1,924 cases of violence against women were registered, the perpetrators of which were identified as unknown (25.7%) or spouses (19.0%) of the victims; violence mainly occurred against women of brown skin color (25.0%) and in the domestic environment (38.5%); regarding violence type, physical violence (46.8%) by force (48.0%) stood out, whereby the genitals (15.7%) and the head (12.9%) were the most affected regions. CONCLUSION: physical violence in domestic environments by unknown aggressors was the main type of violence among the reported cases; shortcomings were identified in recording reported cases, showing the need to improve system quality and train health workers involved.

OBJETIVO: describir las características epidemiológicas de los casos de violencia contra la mujer denunciados en el Distrito Federal, Brasil, en el período 2009-2012. MÉTODOS: estudio descriptivo de casos de violencia contra la mujer entre 18 y 59 años de edad registrados en el Sistema Nacional de Enfermedades de Declaración Obligatoria (Sinan). RESULTADOS: 1.924 notificaciones fueron registradas, los autores fueron identificados como desconocidos (25,7%) o cónyuges (19,0%) de las víctimas; predominaron victimas de color pardo (25,0%) y agresiones en el entorno doméstico (38,5%); en cuanto al tipo de violencia, predominó la forma física (46,8%) por la fuerza (48,0%) siendo los órganos genitales (15,7%) y cabeza (12,9%) las regiones más afectadas. CONCLUSIÓN: entre los casos notificados, la violencia física fue predominante, en ambientes domésticos y perpetrados por agresores desconocidos: fueron identificadas fallas en el registro de notificaciones, lo que evidencia la necesidad de mejorar la calidad del sistema y capacitación de profesionales.

Factors Mediating the Relationship Between Intimate Partner Violence and Cervical Cancer Among Thai Women.

Previous research suggests that intimate partner violence (IPV), particularly physical or sexual violence, was associated with cervical cancer. However, there is less work examining the mechanism of the relationship between IPV and cervical cancer. The purpose of this cross-sectional study was to examine psychosocial factors (e.g., stress, social support, self-esteem, and depressive symptoms) as mediators of the relationship between IPV and cervical cancer among 532 Thai women with gynecological problems. About 21.1% of participants reported any type of IPV (e.g., physical, sexual, or emotional violence) in the past year and 22.2% had cervical cancer. IPV was significantly positively associated with stress, depressive symptoms, and cervical cancer but negatively correlated with social support and self-esteem. Results from structural equation modeling indicated that not only did IPV exhibit significantly direct effects on social support, stress, and depressive symptoms, and indirect effects on self-esteem, but it also had a significant, positive, total effect on cervical cancer. IPV exhibited the significant indirect effect on cervical cancer through social support, self-esteem, stress, and depressive symptoms. The model fitted very well to the empirical data and explained 9% of variance. The findings affirmed that those psychosocial factors were mediators of the relationship between IPV and cervical cancer. Health care protocols for abused women should include screening for and treatment of IPV-related psychosocial factors. Interventions that provide social support and protect self-esteem should reduce stress and depressive symptoms among abused women, thereby reducing the risk of cervical cancer.

Relações entre mulheres trabalhadoras e violência doméstica: percepções de mulheres atendidas em um Centro de Atendimento à Mulher / Relations between working women and domestic violence: women's perceptions attending a Centre for Assistance to Women

A presente dissertação teve como objetivo analisar as relações entre mulheres em situação de violência doméstica e o seu trabalho a partir das percepções de mulheres agredidas por seus companheiros ou ex-parceiros, atendidas no Centro Especial de Orientação à Mulher Zuzu Angel (CEOM Zuzu Angel), no município de São Gonçalo, Rio de Janeiro. Para a realização deste trabalho, foi necessário conhecer o funcionamento da Instituição e também identificar as estratégias criadas pelas mulheres para lidar com a situação do seu trabalho diante da violência doméstica sofrida. O referencial teórico nos aproximou de uma perspectiva de gênero para entender o conceito de violência doméstica e suas possíveis relações com o trabalho. A metodologia adotada seguiu uma abordagem qualitativa. O desenvolvimento de levantamento bibliográfico, em fontes tanto nacional como estrangeira, a partir de artigos, livros e pesquisa virtual permitiu estabelecer parâmetros comparativos, históricos e dados atualizados sobre violências contra a mulher e suas estratégias de lutas. Foi realizado trabalho de campo no CEOM Zuzu Angel, com a utilização das seguintes ferramentas na busca pelo objetivo proposto: observação participante; levantamento documental das fichas de acompanhamento das mulheres atendidas do ano de 2014 que se adequavam aos critérios adotados por esse estudo; e entrevistas individuais com mulheres consideradas em situação de violência doméstica e que têm ou tiveram um trabalho remunerado durante o período de violência. Como resultado, destaca-se que a violência doméstica afeta o trabalho das mulheres agredidas por seus parceiros, influenciando principalmente no rendimento e rotina de trabalho. Entretanto, o trabalho também é visto pelas entrevistadas como uma válvula de escape, onde as atividades laborais auxiliavam na tentativa de esquecer os problemas que tinham no âmbito doméstico com seus parceiros. Outro ponto ressaltado é a vergonha que estas usuárias tinham em pedir auxílio a algum funcionário das empresas em que trabalhavam, procurando outras estratégias para lidar com a situação de violência que sofriam.

This dissertation analyzed the relationship between women in situations of domestic violence and their work from the perceptions of women abused by their partners or former partners, assisted at Centro Especial de Orientação à Mulher Zuzu Angel (CEOM Zuzu Angel), in São Gonçalo, Rio de Janeiro. For this work, it was necessary to know the functioning of the institution and also identify the strategies created by women to deal with the situation of their work in face of the domestic violence. The theoretical approached in a gender perspective to understand the concept of domestic violence and their possible relationship with the work. The methodology followed a qualitative approach. The development of literature in both domestic and foreign sources, from articles, books and virtual research allowed to establish comparative parameters, historical and updated data on violence against women and their struggles strategies. Fieldwork was conducted at CEOM Zuzu Angel, using the following tools in the search for the proposed objective: participant observation; documentary survey of the monitoring records of women seen in the year 2014 that suited the criteria adopted by this study; and individual interviews with women considered on a situation of domestic violence and who has or had a job during the period of violence. As a result, it is emphasized that domestic violence affects women's work abused by their partners, influencing mainly on income and routine work. However, work is also seen by interviewees as a place to escape, where work activities assisted in an attempt to forget about the problems they had in the domestic sphere with its partners. Another point highlighted is the shame that these users had to seek help from any employee of the companies they worked for, looking for other strategies to deal with the violence they suffered.

Características de saúde de mulheres em situação de violência doméstica abrigadas em uma unidade de proteção estadual / Health characteristics of female victims of domestic violence housed in a state care shelter

Resumo A promoção do atendimento às mulheres vítimas de violência implica uma ação não limitada ao combate, mas também à dimensão da assistência dada às vítimas. Este estudo visa conhecer as características sociodemográficas e de saúde das mulheres vítimas de violência que estão/estiveram sob a tutela protetora do Estado, antes e após a Lei Maria da Penha (LMP), bem como a assistência à saúde ofertada. Estudo seccional, exploratório-descritivo, documental, quali-quatitativo realizado em uma unidade de proteção especial de mulheres vítimas de violência do Estado do Ceará no segundo semestre de 2013. Amostra composta por 197 prontuários das mulheres atendidas entre 2001 e 2012. Poucas mudanças ocorreram no perfil de saúde de mulheres vítimas de violência doméstica atendidas pelo Estado, após a promulgação da LMP. Mudanças relevantes ocorreram no padrão de assistência oferecido, tais como maior investigação, promoção e registro de atividades relacionadas à saúde. Ainda é escassa a identificação de sequelas da agressão propriamente dita. Sugere-se inclusão de profissionais da saúde na equipe do abrigo para suprir essa demanda.

Abstract The promotion of care for female victims of violence implies action that is not limited to combatting the problem, but also to the dimension of care provided to the victims. This study seeks to understand the sociodemographic and health characteristics of female victims of violence who are/have been under the protective custody of the state, before and after the Maria da Penha Law (MPL), and the healthcare offered to them. It is a cross-sectional, exploratory-descriptive documentary study, with a qualitative/quantitative approach, conducted in the second semester of 2013 in a special unit for the protection of female victims of violence in the State of Ceará. The sample was composed of 197 medical records of women attended between 2001 and 2012. Few changes occurred in the health profile of female victims of domestic violence sheltered by the State after the enactment of the MPL. Significant changes occurred in the pattern of care provided, such as increased investigation, promotion, and registration of health-related activities. The identification of the aftereffects of aggression per se is still scarce. A suggested addition would be the inclusion of a health professional in the staff at the shelters to meet this demand.

Pay Now or Pay Later: An Economic Rationale for State-Funded Helping Services to Assist Women Leaving an Abusive Relationship.

There has been an increase in costing analysis of intimate partner violence in recent decades, including the monetary impact to government, society, and the individual. Using data collected in a Canadian longitudinal study, the empirical analysis in this article provides an economic rationale for mobilizing public resources that improve the well-being of women leaving an abusive relationship. I estimated six variants of a selection model and used a costing exercise to build an economic case for preventive and other helping services to support women over their healing journey. The removal of financial constraints suffered by abused women, in support of their training needs, as well as reduced barriers to preventive health care services, may potentially lead to fiscal resource savings in the long run.

Relación de maltrato en el noviazgo de jóvenes mexicanos: análisis diferencial por sexo y nivel de estudios / Intimate partner violence in the relationships of mexican youth: differential analysis by sex and level of schooling

El objetivo de este estudio es examinar la prevalencia de conductas de violencia o maltrato de pareja (dating violence), y las diferencias por sexo y nivel de estudios a través de los ocho factores reportados desde el cuestionario CUVINO (alfa = .92). La muestra utilizada fue de 3495 jóvenes mexicanos (1537 hombres y 1958 mujeres), de los cuales 55.2 por ciento eran preuniversitarios y 44.8 por ciento universitarios. Los resultados mostraron una elevada prevalencia de victimización especialmente en el tipo de maltrato categorizado como psicológico (desapego, coerción, humillación), por género y sexual; las adolescentes reportan más perpetración de violencia en el noviazgo y menos victimización, tanto en preuniversitarios como en universitarios. Los varones tienen una percepción de maltrato mayor, especialmente de tipo físico, castigo emocional e instrumental, aunque no son las conductas de mayor ocurrencia. Se discuten las implicaciones de los resultados.

The aim of this study is to examine the prevalence of violent behavior or partner abuse (dating violence), as well as gender differences and level of schooling in a sample of 3495 Mexican youth (1537 males and 1958 females; 55.2 percent pre-undergraduate and 44.8 percent undergraduate students) through the eight factors from the CUVINO measure (alpha = .92). The results showed a high prevalence of victimization, especially for the abuse categorized as psychological (detachment, coercion, humiliation), gender-related and sexual-related; Female adolescents report more perpetration of dating violence and less victimization, both at the pre-undergraduate and undergraduate levels. Males have a greater perception of abuse, especially physical, emotional and instrumental punishment, though not higher occurrence behaviors. The implications of the results are discussed.

Identifying and intervening with substance-using women exposed to intimate partner violence: phenomenology, comorbidities, and integrated approaches within primary care and other agency settings.

Substance use and/or disorders (SUDs) have been identified as a significant correlate of intimate partner violence (IPV) exposure and present complex issues that intersect with the topography of IPV, attendant mental health, and physical co-morbidities and may pose barriers to primary care- and other agency-based screening and intervention efforts. Despite substantial research indicating significantly higher rates of all types and severity of IPV victimization among women with SUDs and bidirectional associations between partner or self-use of drugs or alcohol and IPV victimization, effective screening, brief interventions, coordinated systems of care, and treatment approaches to address these co-occurring problems remain very limited. We integrated select research examining the intersection of IPV victimization and SUDs and several comorbidities that have significant public health impact and provided recommendations for scaling up targeted interventions to redress these co-occurring problems among women in primary, emergency, and other care settings.

Screening and intervention for intimate partner violence in healthcare settings: creating sustainable system-level programs.

Among the barriers to routine screening for intimate partner violence (IPV) are time constraints, a lack of protocols and policies, and departmental philosophies of care that may conflict with IPV screening recommendations. To address these barriers, systems-level interventions are needed; in this article, we describe one model that may overcome these obstacles. We discuss how this systemic approach may best be implemented in both out-patient clinics and emergency departments (EDs) and note that evidence for its success will be required.

Violencia física en el embarazo: realidad en el extremo sur de Chile / Physical violence in pregnancy: reality in the southern tip of Chile

Objetivo: Describir el perfil de las mujeres adscritas al Programa de Violencia, Punta Arenas, Chile, y que han presentado violencia física durante el embarazo. Método: Estudio de abordaje cuantitativo, con diseño descriptivo y retrospectivo. Se entrevistó a 59 mujeres, utilizando el Instrumento de la OMS sobre la violencia contra las mujeres Versión 9.1 para Chile modificado. Resultados: La prevalencia de violencia durante el embarazo fue 28,8 por ciento. En su mayoría el agresor fue la pareja y el 52,9 por ciento declaró que los golpes o patadas fueron en el abdomen. El 100 por ciento presento violencia psicológica, física leve y grave y 70,6 por ciento violencia sexual. El 58,8 por ciento tenía entre 15 a 29 años al momento de vivenciar la violencia, el 35,5 por ciento completó la enseñanza media, de religión católica, trabajan fuera del hogar, convivían, tenían tres o más hijos y con estrato socioeconómico medio y medio bajo. Las manifestaciones de violencia que se relacionaron con violencia física en el embarazo fueron la presencia de manifestaciones de violencia física leve: abofeteado o tirado cosas que pudieran herirla (p=0,000) y violencia física grave: golpeado con su puño u otra cosa que pudiera herirla (p=0,006), pateado, arrastrado o dado una golpiza (p=0,004), estrangularla a propósito (p=0,010), presencia de lesiones (p=0,048). Los factores que se relacionaron con la presencia de violencia física en el embarazo fueron el nivel educacional de la pareja (p=0,047), condición laboral de la mujer (p=0,018) y antecedentes de peleas físicas en la pareja con otros hombres (p=0,046). Conclusión: Los hallazgos obtenidos permiten identificar precozmente a las embarazadas con mayor riesgo de violencia, y permiten ofrecer una intervención oportuna, minimizando las graves consecuencias que tiene para la mujer y los hijos.

Aim: To describe the profile of the women assigned to the Violence Program who have submitted physical violence during pregnancy in Punta Arenas, Chile. Methods: Retrospective descriptive study with a quantitative approach. 59 women were interviewed using the WHO instrument on violence against women, modified Version 9.1 for Chile. Results: Prevalence of violence during pregnancy corresponded to 28.8 percent. Most of the time, the aggressor was the intimate partner and 52.9 percent declared that the blows or kicks were in the abdomen. 100 percent presented severe and mild physical and psychological violence, and 70.6 percent presented sexual violence. 58.8 percent were between 15 and 29 years at the time of experiencing violence. 35,5 percent were catholic women who have finished high school, worked outside home, lived together with an intimate partner, had three or more children, and belonged to a middle and lower middle socioeconomic strata. Manifestations of violence which were related to physical violence during pregnancy were slapping or throwing things that could hurt them (p=0.000). Severe physical violence included punching or being hurt with something that could hurt them (p=0.006); kicking, dragging on the ground or being beaten (p=0.004); strangling on purpose (p=0.010), and appearance of injuries (p=0.048). Factors related to manifestations of physical violence in pregnancy were: intimate partner's educational level (graduated high school or less than high school education (p=0.047), employment status of women (p=0.018) and the intimate partner history ofphysical fights with other men (p=0,046). Conclusion: The findings obtained in this study give us the opportunity to visualize the phenomenon of physical violence during pregnancy, contributing to early identification of pregnant women at increased risk in order to provide timely intervention, minimizing the serious consequences for women and children.

Risk factors of domestic violence in Iran.

OBJECTIVES: In this study, we have evaluated the lifetime and past-year prevalence of exposure to physical violence among married women in the city of Tehran and urban and rural areas of Hashtgerd. METHODS: The target population were noninstitutionalized female citizens, aged 15 years or older, who have at least one history of marriage and who resided in the capital city of Tehran or Hashtgerd County from the summer of 2008 to fall of 2010. We used a multistage sampling method. Tehran's District Six, a central district in Tehran, was selected as a representative cluster of all municipal districts in Tehran. A total of fifty blocks were randomly selected from this district, from which 1,000 married women aged 15 years or older were interviewed using a cross-sectional design. Data was gathered face-to-face using a structured questionnaire. The lifetime prevalence, past-year prevalence, and related factors of domestic violence were measured. SPSS version 11.5 was used for the analyses. RESULTS: Figures for lifetime prevalence and past-year prevalence were measured to be 38.7% and 6.6%, respectively. The independent effects of marital status and location and type of residency for women, along with education and smoking habits of their spouses, were statistically significant in multivariate logistic regression analysis. CONCLUSION: Domestic violence is a public health concern in Iran. Based on our findings, we propose that empowering women through education, and improving their ability to find employment and income, along with increasing public awareness of human rights issues through education could lower the prevalence of domestic violence.

Common mental disorders and intimate partner violence in pregnancy / Transtornos mentais comuns e violência por parceiro íntimo durante a gravidez / Trastornos mentales comunes y violencia por pareja íntima durante el embarazos

OBJECTIVE : To investigate the association between common mental disorders and intimate partner violence during pregnancy. METHODS : A cross sectional study was carried out with 1,120 pregnant women aged 18-49 years old, who were registered in the Family Health Program in the city of Recife, Northeastern Brazil, between 2005 and 2006. Common mental disorders were assessed using the Self-Reporting Questionnaire (SRQ-20). Intimate partner violence was defined as psychologically, physically and sexually abusive acts committed against women by their partners. Crude and adjusted odds ratios were estimated for the association studied utilizing logistic regression analysis. RESULTS : The most common form of partner violence was psychological. The prevalence of common mental disorders was 71.0% among women who reported all form of violence in pregnancy and 33.8% among those who did not report intimate partner violence. Common mental disorders were associated with psychological violence (OR 2.49, 95%CI 1.8;3.5), even without physical or sexual violence. When psychological violence was combined with physical or sexual violence, the risk of common mental disorders was even higher (OR 3.45; 95%CI 2.3;5.2). CONCLUSIONS : Being assaulted by someone with whom you are emotionally involved can trigger feelings of helplessness, low self-esteem and depression. The pregnancy probably increased women`s vulnerability to common mental disorders .

OBJETIVO : Investigar associação entre transtornos mentais comuns e violência por parceiro íntimo durante a gravidez. MÉTODOS : Estudo transversal realizado com 1.120 mulheres grávidas com idade entre 18 e 49 anos, cadastradas no Programa Saúde da Família da cidade do Recife, PE, entre 2005 e 2006. Os transtornos mentais comuns foram avaliados pelo Self-Reporting Questionnaire (SRQ-20). A violência por parceiro íntimo foi definida por atos concretos de violência psicológica, física e sexual infligidos à mulher pelo parceiro. Foram estimadas odds ratios simples e ajustadas para a associação estudada, utilizando-se análise de regressão logística. RESULTADOS : A violência psicológica foi a forma mais frequente de violência por parceiro íntimo. A prevalência de transtornos mentais comuns foi 71,0% entre as mulheres que relataram todas as formas de violência e 33,8% entre as que não relataram violência por parceiro íntimo. Os transtornos mentais mantiveram-se associados à violência psicológica (OR = 2,49, IC95% 1,8;3,5), mesmo na ausência de violência física ou sexual. Quando a violência psicológica esteve combinada com violência física ou sexual, o risco dos transtornos mentais comuns foi ainda mais elevado (3,45; IC95% 2,3;5,2). CONCLUSÕES : Ser agredido por alguém com quem você está emocionalmente envolvido pode desencadear sentimentos de impotência, baixa autoestima e depressão. A gravidez provavelmente aumenta a vulnerabilidade das mulheres aos transtornos mentais comuns. .

OBJETIVO : Investigar asociación entre trastornos mentales comunes y violencia por pareja íntima durante el embarazo. MÉTODOS : EEstudio transversal realizado con 1.120 mujeres embarazadas con edad entre 18 y 49 años, catastradas en el Programa Salud de la Familia de la ciudad de Recife, Pernambuco-Brasil, entre 2005 y 2006. Lo trastornos mentales comunes fueron evaluados por el Self-Reporting Questionnaire (SRQ-20). La violencia por pareja íntima fue definida por actos concretos de violencia psicológica, física y sexual infligidos a la mujer por la pareja. Se estimaron odds ratios simples y ajustados para la asociación estudiada, utilizándose análisis de regresión logística. RESULTADOS : La violencia psicológica fue la forma más frecuente de violencia por pareja íntima. La prevalencia de trastornos mentales comunes fue de 71,0% entre las mujeres que relataron todas las formas de violencia y 33,8% entre las que no relataron violencia por pareja íntima. Los trastornos mentales se mantuvieron asociados a violencia psicológica (OR= 2,49, IC95% 1,8;3,5), inclusive en ausencia de violencia física o sexual. Cuando la violencia psicológica estuvo combinada con la violencia sexual o física, el riesgo de los trastornos mentales comunes fue aún más elevado (3,45; IC95% 2,3;5,2). CONCLUSIONES : Ser agredido por alguien con quien se está emocionalmente involucrado puede desencadenar sentimientos de impotencia, baja autoestima y depresión. El embarazo probablemente aumenta la vulnerabilidad de las mujeres a los trastornos mentales comunes. .

Quemaduras intencionales con ácido. Nuevas expresiones de violencia contra la mujer en Medellín, Colombia. Serie de casos / [Deliberate burning with acid. New expressions of violence against women in Medellín, Colombia. Series of cases].

INTRODUCTION: The deliberate burns with acid are recognized as violence against women described in the 17th century. However, in the second half of the 20th Century this practice becomes frequent in South East Asia, Africa and Middle East. In Latin America is a recent phenomena over which little has been published in the scientific literature. OBJECTIVE: To describe the clinical and psychic-pathological characteristics of 8 Colombian women burned with acid in the context of violence based on gender. METHOD: retrospective series of cases, patients admitted at a university hospital in a period of 7 years after being burned with acid within the context of hetero-aggression. The patients were attended by a group of interdisciplinary health professionals, including the psychiatrists. The psychiatric analyses were carried out parting from the non structured psychiatric interview complying with diagnostic criteria of the Statistic and Diagnostic Manual. RESULTS: Eight women with an average age of 29.5 years were attacked with acid in a period of 8 years. The context for the aggression was violence based on gender. All the attackers were males. The body surface burned was 24

in average. The ocular involvement was present in 80

of the cases, two of them with bilateral blindness. The direct aggressor was the partner in three cases. The reason for the attack was jealousy and revenge due to rejection to sexual or love advancements or pretensions. CONCLUSIONS: The burns with acid constitute a new expression of the violence based on gender in Colombia. This type of aggressions generates suffering, rejection and social isolation and although, it does not have the intent to cause death to the victim, it does leave permanent scars of the aggression.

Trajectory of intimate partner violence and healthcare seeking over the life course: study of Japanese women in the Tokyo metropolitan area, Japan.

OBJECTIVES: To describe the trajectory of, and examine factors affecting, intimate partner violence (IPV) and IPV-specific healthcare seeking among Japanese women over the life course. STUDY DESIGN: Life course study. METHOD: One hundred and one women, aged 24-80 years, who had a lifetime history of IPV were interviewed in the Tokyo metropolitan area, Japan in 2005 and 2006. Life course data were collected according to the life history calendar method. Hierarchical linear modelling was used to examine IPV-specific healthcare seeking over the life course. RESULTS: Injury, formal or informal help seeking, public assistance, worse self-rated health status and smoking significantly increased the likelihood of IPV-specific healthcare seeking over the life course. There are significant cohort effects on healthcare seeking. The results suggest that women who experience IPV may seek healthcare services not only immediately after the first occurrence of IPV, but also later in life. CONCLUSIONS: IPV is not always associated with immediate healthcare seeking. In particular, sexual IPV is not significantly associated with healthcare seeking. Pursuing formal and informal help is associated with healthcare seeking.

Intimate partner violence: office screening for victims and perpetrators of IPV.

Intimate partner violence (IPV) affects more than 12 million individuals annually. Power and control are central concepts underlying abusive relationships. Physicians may see IPV victims, perpetrators, and their children for annual examinations, as well as for injuries and health conditions associated with abuse. In 2013, the US Preventive Services Task Force recommended that women of childbearing age (ie, 14 to 46 years) be screened for IPV. Brief, validated screening tools, such as the 4-item Hurt, Insult, Threaten, and Scream (HITS), can be used to facilitate screening. Physicians should always assess patients whose medical histories or presenting symptoms or injuries are consistent with abuse. Risk factors for IPV and consequences of abuse include general health conditions (eg, asthma, irritable bowel syndrome), reproductive issues (eg, gynecologic disorders, unintended pregnancies), psychological conditions (eg, depression, sleep disturbances), and risky health behaviors (eg, substance use, poor health care adherence). Tools for identifying perpetrators are under investigation. To prepare the practice to address IPV, physicians should educate themselves and staff and learn about community and national resources. By identifying and responding to IPV, clinicians may be able to reduce IPV and interrupt the intergenerational cycle of violence.

Intimate partner violence: counseling, community resources, and legal issues for IPV victims and perpetrators.

The family physician's office is a potentially safe place to discuss intimate partner violence (IPV). RADAR (Remember to ask routinely, Ask directly [in private], Document findings, Assess safety, Review options) is a tool for identifying and responding to IPV. Physicians should ask permission to document abuse, consider using a body map, and ensure confidentiality. They should also assess immediate safety by asking about weapons in the home, children's safety, and the likelihood that the perpetrator will harm him- or herself or others. Federal privacy laws require physicians to inform patients about health information disclosure. Because mandatory reporting varies by state, physicians should communicate clearly the office's responsibilities. Interventions are based on an advocacy model that requires appropriate training and establishment of links to community-based resources. Brief advocacy includes providing information cards, whereas intensive intervention includes IPV education, danger assessment, prevention options, safety planning, and community referrals. The Stages of Change Model may help physicians understand a patient's readiness and ability to make a change. For the IPV survivor who has left an abusive partner, physicians should be aware of the challenges of safety, health, legal, and financial issues; protection orders are a possible safety strategy. The most common intervention for perpetrators is a batterer intervention program. Couples counseling by family physicians is contraindicated.

Subnotificação e (in)visibilidade da violência contra mulheres na atenção primária à saúde / Primary healthcare and underreporting and (in)visibility of violence against women / Subnotificación e (in)visibilidad de la violencia contra las mujeres en la atención primaria a la salud

Esta pesquisa teve por objetivo mapear indicadores de violências contra mulheres em unidades básicas de saúde de Belo Horizonte, Minas Gerais, Brasil, e identificar as dificuldades experimentadas por profissionais de saúde na notificação de violências. Dados epidemiológicos sobre esse tipo de notificação foram levantados no sistema de informações da Secretaria Municipal de Saúde. Dados qualitativos foram produzidos com questionário semiestruturado e três sessões de grupos focais, com a participação de 270 profissionais da atenção primária à saúde. Os dados foram submetidos à análise de conteúdo, sendo codificados, categorizados e discutidos à luz da revisão de literatura. Um eixo analítico central foi denominado (in)visibilidade da violência contra mulheres. Emergem dos dados tanto o reconhecimento da violência como problema de saúde pública quanto a invisibilidade que impede o seu enfrentamento. Observa-se que a notificação é frequentemente tomada como denúncia, o que dificulta o avanço nas discussões e ações concernentes ao problema.

This study aimed to map indicators of violence against women as recorded by primary healthcare services in Belo Horizonte, Minas Gerais State, Brazil, and to identify difficulties experienced by health professionals in reporting such violence. Epidemiological data on this type of notification were collected in the information system of the Municipal Health Department. Data were produced with a semi-structured questionnaire and three focus group sessions with participation by 270 primary care professionals. The data were submitted to content analysis and were coded, categorized, and discussed in light of a literature review. A central analytical axis was called (in)visibility of violence against women. The data revealed both the recognition of violence as a public health problem and the invisibility that prevents dealing with it properly. Notification of such violence is often viewed as a fuss or commotion, which hampers progress in discussing and acting on the problem.

Esta investigación tiene como objetivo mapear indicadores de violencia contra las mujeres en las unidades básicas de Belo Horizonte, Minas Gerais, Brasil, e identificar las dificultades observadas por los profesionales de sanidad en la notificación de la violencia. Datos epidemiológicos sobre ese tipo de notificación fueron recogidos en el sistema de información de la Secretaría Municipal de Salud. Se consiguieron datos cualitativos mediante un cuestionario semiestructurado y tres sesiones de grupos focales, con la participación de 270 profesionales de atención primaria a la salud. Los datos fueron sometidos a un análisis de contenido, fueron codificados, categorizados y discutidos a la luz de la revisión de la literatura. Un eje analítico central fue denominado (in)visibilidad de la violencia contra las mujeres. Emergen dos datos, tanto el reconocimiento de la violencia como un problema de salud pública, como la invisibilidad que impide su enfrentamiento. Se observa que la notificación es frecuentemente entendida como denuncia, lo que dificulta el avance en las discusiones y acciones concernientes al problema.

Effective gender-based violence screening tools for use in primary health care settings in Afghanistan and Pakistan: a systematic review.

Health care providers have an important role to play in the prevention and response to violence against women. However, the existing tools for screening for gender-based violence have been mostly formulated in the context of developed countries. This paper assesses which violence screening tools designed for use as the primary health care level would be feasible for use in Afghanistan and Pakistan, countries characterized by limited resources, unsupportive institutional frameworks and gender and social norms that reinforce domestic violence. A systematic review was made of the literature to evaluate the different screening instruments. The Women's Experience with Battering Scale (short version) and the Ongoing Violence Assessment Tool were judged to be the most useful tools for screening for violence against women in Afghanistan and Pakistan because they are short, S easy to administer and to score and respond to health care provider identified barriers of time and knowledge constraints for conducting screening for intimate partner violence.