Silent Survivors.

Early in my medical training, I cared for a patient who survived a brutal sexual assault necessitating ICU level care. Months later, I was raped. This essay is a reflection on my experience as a survivor of sexual violence and as a provider for patients whose wounds from these traumas have flourished in atmospheres of shame and stigma. In this essay, I further explore how physicians and other health care providers can play a central role in restoring the health of individuals who silently suffer after these unspeakable events.

Diagnosing and Discussing Sexual Abuse: A Scoping Review on Training Methods for Health Care Professionals.

Purpose: Sexual abuse is a health issue with many consequences. Recognizing and discussing past sexual abuse has proven to be challenging for health care professionals. To improve overall quality of health care for sexual abuse victims, health care professionals need to be properly trained. The aim of this paper is to provide an overview of training methods for health care professionals and to report on their effectiveness. Methods: A scoping review was conducted. A broad search was executed in six databases in December 2022. Study selection was performed by two independent reviewers, followed by quality assessment and data extraction. Results: After screening of titles and abstracts and later full-text assessment for quality appraisal, seven articles were selected, consisting mostly of non-randomized trials, performed among a total of 1299 health care professionals. All studies were assessed to be of moderate to poor quality. The participants attended training courses with a wide variety of durations, settings, formats and methods. The outcomes showed improvements in self-perceived or measured knowledge, skills and confidence to discuss sexual violence. Changes in clinical practice were scarcely investigated. Training courses were most effective when a mix of didactic passive methods, such as lectures and videos, and active participatory strategies, such as discussions and roleplay, were applied. Timely iteration to reinforce retention of gained knowledge and skills also contributed to effectiveness. Participants most enjoyed incorporating opportunities for receiving feedback in small settings and sharing personal experiences. Conclusion: This scoping review summarizes on how to effectively train health care professionals. Flaws and difficulties in measuring the effectiveness of training courses were discussed. Recognition and discussion of past sexual abuse by health care providers can be effectively trained using an alternating mix of multiple active and passive training methods with room for feedback and personal experiences.

Identifying radiation therapists' perceptions of potentially triggering aspects of care for survivors of sexual violence undergoing radiotherapy.

INTRODUCTION: Research shows that for survivors of sexual violence (SV), cancer procedures can be retraumatizing due to perceived similarities to the original SV. To date, there is no training program designed specifically for the radiation therapist (RTT) on how to deliver care sensitively to survivors of SV. A key component of sensitive practice is working with patients to identify and develop strategies to manage situations that could be triggering. The goal of this study was to understand the RTT recognition of potential sensory/environmental, relational, and mixed triggers in radiation oncology settings. METHODS: This quantitative research study conducted a secondary analysis on RTT responses to a learning activity from an online cancer education training program. The first section of the activity asked trainees to identify two potential triggers in a brachytherapy video, and the second portion of the activity asked trainees to describe two potential triggers in their own work. RESULTS: Descriptive statistics, χ2 tests, and t tests were used to analyze 50 RTT responses. RTTs tended to identify different types of triggers depending on the question (brachytherapy video vs. self-reflection). Data indicated that despite a lack of formal didactic training in trigger management, RTTs could identify triggers, and were most likely to recognize "mixed" type triggers. DISCUSSION: Triggers identified are consistent with past research on childhood sexual abuse survivors' healthcare retraumatization in obstetrics and gynecology, and cancer care. As in past research, invasive techniques, and situations where the patient was in a submissive position were identified as triggering aspects of care. It is interesting to note when reflecting on their own practice, the least identified triggers all fell under the environmental/sensory trigger category. RTTs may not fully appreciate a variety of potential triggers such as sounds of treatment or silence because they are outside of the room administering the beam when the machine is delivering treatment. Thus, they may not hear certain sounds or silence during their daily routine. CONCLUSIONS: Relatively few trainees identified sensory/ environmental triggers (e.g., restricted visibility and sounds of treatment, including silence) when reflecting on their own practice, which could potentially reduce their likelihood of helping patients minimize the impact of (or avoid) such triggers. Future research should identify a comprehensive list of triggers and then develop a training specific to the RTT focused on identifying environmental/sensory triggers from the perspective of the patient in the often unfamiliar and frightening radiotherapy suite.

Interventions Focused by Nurses for Reducing Negative Effect of Traumatic Experience on Victims of Sexual Violence: A Scoping Review.

Sexual violence has increased quite rapidly. Sexual violence can be in the form of physical or verbal violence. The impact of sexual violence causes a traumatic experience that causes physical problems, psychological problems, loss of the future, and causes the risk of death. Nurses have an important role in reducing the impact of sexual violence on victims. The purpose of this study is to describe nursing interventions to reduce the impact of traumatic experiences experienced by victims of sexual violence. This study used a scoping review method. The literature used in this study is from CINAHL, PubMed, and Scopus. Keywords in this study are sexual violence, traumatic experience, impact, and victims. Search strategy used PRISMA Extension for Scoping Reviews to select articles for this study. The inclusion criteria were that the sample was female victims of sexual violence, studies employed a randomized control trial or quasi-experimental research design, and the publication period was of the last 10 years (2013-2022). We found 10 articles that matched the inclusion and exclusion criteria. The findings from this scoping review show that nursing interventions can reduce the impact of traumatic experiences on victims of sexual violence. There are three methods of nursing intervention, namely cognitive behavior, counseling, and web-based intervention. The samples are from developing and developed countries. The range of the samples are from 35-1250 respondents. Nursing interventions focus on victims in order to improve mental health and reduce the traumatic impact experienced by victims of sexual violence. The activities carried out were psychoeducation, keeping a daily journal, and discussions related to the traumatic experiences experienced. Nurses as health workers have a role to provide comprehensive nursing care to victims of sexual violence by taking into account the characteristics and impact of trauma experienced by victims of sexual violence.

Sexual violence perpetrated by health professionals.

Sexual violence (SV) perpetrated by health professionals concerns any sexual conduct, whether physical or verbal (with or without contact), toward a patient. There has been little scientific study and some disagreements have emerged regarding its definition, which has even been confused with violation of professional boundaries. In this descriptive-exploratory study, we aimed to characterize this phenomenon in the Portuguese context, using a sample of 491 participants who completed an online questionnaire adapted for this study. The results showed that 8.96% of the participants (5.5% indirect victims) suffered SV by a health professional, and the sociodemographic characteristics are very similar to those of SV in other contexts. Thus, after confirming this is not a problem alien to the Portuguese reality, we discuss the practical implications for prevention and intervention with victims.

Engaging Native American Youth and Their Caregivers in Sexual Violence Research: A Case Study Documenting Challenges, Opportunities, and Lessons Learned.

Native Americans (the preferred term of our partners/co-authors) experience high rates of sexual violence, which is rooted in colonization and multiple historical traumas. Sexual violence leads to numerous deleterious outcomes, underscoring the critical need for prevention early in life. Yet, most research to date on sexual violence has not focused on Native American populations, and we know little about the most effective strategies to recruit and retain Native American individuals in sexual violence prevention research. The purpose of the current study, grounded in principles of participatory action research, is to describe strategies that were used to recruit (e.g., traditional feeds, door knocking) and retain (e.g., monetary incentives, ongoing community engagement) Native American youth for a study that sought to assess, via surveys and qualitative interviews, the impacts of a youth-led sexual violence prevention initiative in a small city in the Great Plains. We also collected qualitative data from Native American caregivers regarding their perceptions of research. Overall, 67.9% (n = 545) of eligible Native American youth completed the survey, and school and door knocking were most effective methods of recruitment/enrollment followed by community and school events and texting. Over the course of 3 years of data collection, there were higher rates of attrition among Native American youth compared to white youth, and several factors (e.g., older age, sexual assault victimization) predicted attrition among Native American youth. Native American caregivers' responses reflected on reasons it is hard to engage youth and caregivers in research (e.g., lack of time, distrust) as well as strategies to enhance engagement (e.g., personal connection, providing community resources). Throughout the paper, Native American co-authors and project partners reflect on these findings. Implications for future sexual violence prevention research with Native American youth and their caregivers that uses decolonized, participatory action research methodologies are discussed.

[Positioning of nurses in Criavs and the role of specialized literature]. / Positionnement infirmier dans les Criavs et rôle de la documentation spécialisée.

The circular of August 8, 2008, which founded the resource centers for those working with perpetrators of sexual violence (Criavs), integrates a multidisciplinary vision including nurses. In an entity that does not function like a traditional medical unit, this role necessarily questions its positioning. In order to build up their skills, Criavs nurses will have to call upon all the information available to them, of which the specialized literature is an integral part.

To Do or Not to Do Primary Health Care Professionals Experiences With Mothers With Children Born of Sexual Violence.

Mothers and their children born of sexual violence are at heightened risk for developing an insecure attachment relationship. These mothers and their children often enter care late or not at all, as they are not identified by health care professionals. In this qualitative study, semi structured interviews were conducted with sixteen professionals in primary care for pregnant women and/or young mothers with the aim to identify the status quo in knowledge and skills, challenges, and opportunities. Participants included among others professionals working at Youth Services, psychologists, and clinical nurse specialists. Through a thematic analysis, five themes were identified: the knowledge of the professional, discussing the sexual violence, suitable interventions, points of attention during care, and recommendations. Analysis revealed that three groups of professionals can be distinguished, based on their level of awareness of this target group and their available knowledge and skills. To improve primary care for mothers with children born of sexual violence an increase in awareness, knowledge, and skills is a necessary prerequisite. Scientifically based best practices are therefore necessary for health care professionals to provide adequate care for mothers with children born of sexual violence.

Sexual Harassment in Clinical Practice-A Cross-Sectional Study Among Nurses and Nursing Students in Sub-Saharan Africa.

INTRODUCTION: Sexual harassment (SH) at the workplace is a globally discussed topic and one deserving of scrutiny. It is an issue that is often avoided although around 25% of nurses worldwide have experienced some form of SH at their workplace. Consequences of SH at workplaces can be very serious and an occupation hazard for nurses around the world. In Sub-Saharan Africa there is also a need for more studies in the field. OBJECTIVE: The overall aim was to determine the prevalence, types, and consequences of sexual harassment among nurses and nursing students at a regional university hospital in Tanzania. METHODS: The study has a cross-sectional design. A study specific questionnaire was distributed to a total of 200 nurses and nursing students. Descriptive statistics were used for calculation of frequencies, prevalence, including gender differences, types, and consequences of sexual harassment. RESULTS: The result show that 9.6% of the participants had experienced some form of SH at their workplace. Regarding the female nurses and students, 10.5% had been sexually harassed at work, whereas the number for males was 7.8%, but 36% knew about a friend who had been sexually harassed. The most common perpetrator were physicians. The victims of SH were uncomfortable going back to work, felt ashamed and angry. CONCLUSIONS: In conclusion, nearly 10% of the participants had been exposed to sexual harassment. However, an even greater number of victims was found when including by proxy victims of sexual harassment. SH can become a serious occupational hazard and stigmatization for nurses. Enhanced knowledge is needed, and hospitals and medical colleges should emphasize their possibilities to give support and assistance to the victims of SH. Education about SH in all levels and prevention methods should also be emphasized.

O aborto legal em casos de gravidez decorrente de violência sexual: percepções e vivências de médicas e médicos obstetras / Legal abortion in cases of sexual violence pregnancy: perceptions and experiences of obstetricians / El aborto legal en casos de embarazo resultante de violencia sexual: percepciones y experiencias de médicas y médicos obstetras

Resumo: Este estudo objetivou analisar as percepções de obstetras e residentes de ginecologia-obstetrícia, atuantes numa maternidade escola federal, sobre o aborto legal em casos de gravidez decorrente de violência sexual, desvelando suas motivações, resistências e sentimentos, e identificando suas experiências com o tema. A primeira etapa correspondeu ao preenchimento de um questionário autoaplicável. Os critérios de seleção foram: obstetras vinculados ao centro obstétrico; diretor da divisão médica; e residentes do programa de ginecologia-obstetrícia da instituição. Obtiveram-se 36 questionários respondidos. A segunda etapa correspondeu à realização de uma entrevista, tendo sido utilizado o critério de amostragem por saturação e foram entrevistados seis médicos. As entrevistas foram analisadas pelo método de análise de conteúdo, na modalidade temática. Os questionários retrataram que todos os participantes já haviam prestado assistência a mulheres em situação de violência sexual e que a maioria já havia participado da realização de um aborto legal. As entrevistas evidenciaram os dilemas enfrentados pelos profissionais na assistência a esses casos e a escassez da formação profissional em relação à temática. A palavra da mulher foi tida ora como objeto de suspeição em relação à veracidade do estupro, ora como capaz de suscitar afetação das profissionais em suas escutas, o que possibilitou que essas se aproximassem das vítimas e ofertassem uma assistência mais humanizada. Os resultados apontaram para a importância da temática ser abordada nos campos da saúde e da formação para além do enfoque técnico-científico, visando produzir novas estratégias de cuidado.

Abstract: This study aimed to analyze the perceptions of obstetricians and gynecology-obstetrics residents at a federal school maternity hospital regarding legal abortion in cases of sexual violence pregnancy, understand their motivations, strengths, and feelings, and identify their experience with this topic. The first stage consisted of answering a self-administered questionnaire. The selection criteria were: obstetricians linked to the obstetric center, director of the medical division, and residents of the institution's obstetrics-gynecology program. In total, 36 questionnaires were answered and returned. The second stage corresponded to an interview using a saturation sampling criterion. Six physicians were interviewed. The interviews were evaluated using a thematic content analysis. The questionnaires showed that all participants had already provided care to women in situations of sexual violence and that most of them had already participated in a legal abortion procedure in these cases. The interviews highlighted the dilemmas faced by professionals in providing care to these women and the lack of professional training to handle these cases. The speeches of women were sometimes seen as an object of suspicion regarding the veracity of sexual violence, and sometimes as an object that caused professionals to feel emotionally affected while listening to them, allowing professionals to approach the victims and offer more humanized care. The results pointed to the importance of addressing this topic in the areas of health and providing training beyond the technical-scientific focus in order to support the development of new care strategies.

Resumen: El estudio tuvo como objetivo analizar las percepciones de obstetras y residentes de gineco-obstetricia de una maternidad escolar federal sobre el aborto legal en casos de embarazo resultante de violencia sexual, revelar sus motivaciones, resistencias y sentimientos, e identificar sus experiencias con el tema. La primera etapa consistió en completar un cuestionario autoadministrado. Los criterios de selección fueron los siguientes: obstetras vinculados al centro obstétrico; director de la división médica; y residentes del programa de gineco-obstetricia de la institución. Se obtuvieron 36 cuestionarios cumplimentados. La segunda etapa consistió en una entrevista, utilizando un criterio de muestreo por saturación. Se entrevistó a 6 médicos. Las entrevistas se analizaron mediante el método de análisis de contenido, en la modalidad temática. Los cuestionarios mostraron que todos los participantes ya habían brindado asistencia a mujeres en situación de violencia sexual y que la mayoría ya había participado en la realización de un aborto legal en estos casos. Las entrevistas pusieron de manifiesto los dilemas que enfrentan los profesionales en la asistencia a estos casos y la escasa formación profesional con relación al tema. La palabra de la mujer fue vista a veces como objeto de sospecha con respecto a la veracidad de la violación, y a veces como un objeto capaz de suscitar la afectación de las profesionales en sus escuchas, lo que les permitió acercarse a las víctimas y ofrecer una asistencia más humanizada. Los resultados señalaron la importancia de que la temática sea abordada en los campos de la salud y de la formación más allá del enfoque técnico-científico, con el objetivo de producir nuevas estrategias de cuidado.

Violência sexual contra mulheres por parceiro íntimo e desigualdade de gênero na voz dos profissionais da Atenção Primária à Saúde / Violencia sexual contra las mujeres por parte de la pareja íntima y desigualdad de género en la voz de los profesionales de la Atención Primaria de Salud / Sexual violence against women by intimate partner and gender inequality in the voice of Primary Health Care professionals

É difícil reconhecer o sexo forçado vivido nas relações sexuais no âmbito doméstico como violência. Há também uma imprecisão entre a violência, tal como no sexo forçado, e a desigualdade de gênero, como na aceitação do dever marital. Buscou-se compreender o que profissionais da Atenção Primária pensam sobre essas duas experiências, como interpretam relatos das mulheres e o que fazem sobre isso. Entrevistados, os profissionais dizem que sexo forçado ou sexo sem consentimento explícito são ambos violência, e assim devem ser nomeados. Agindo desse modo, eles pensam esclarecer suas pacientes acerca dos direitos das mulheres. No entanto, no dia a dia, nem todos o fazem e ninguém reconheceu ou nomeou a aceitação do dever marital como desigualdade de gênero. Conclui-se que, se a violência está presente como questão, sua distinção quanto à desigualdade de gênero ainda é um desafio.(AU)

Es difícil reconocer el sexo forzado vivido en las relaciones sexuales en el ámbito doméstico como violencia. Hay también una imprecisión entre la violencia, tal como en el sexo forzado, y la desigualdad de género, como en la aceptación del deber conyugal. Se buscó entender lo que los profesionales de la atención primaria piensan sobre esas dos experiencias, cómo interpretan los relatos de las mujeres y qué hacen sobre eso. Al ser entrevistados, los profesionales decían que el sexo forzado o el sexo sin consentimiento explícito son violencia y deben ser denominados como tal. Actuando así, ellos piensan aclarar a sus pacientes los derechos de las mujeres. Sin embargo, en el cotidiano no todos lo hacen y ninguno reconoció o nombró la aceptación del deber conyugal como desigualdad de género. Se concluyó que la violencia está presente como cuestión y que su distinción con relación a la igualdad de género todavía es un desafío.(AU)

Studies show how difficult it is to recognize what is experienced in sexual relationships within households. There is an inaccuracy between violence as in the forced sex, and gender inequality as in the acceptance of the marital duty. We aimed to understand what health care providers think about these two experiences, how they interpret women's reports and what they do about it. Interviewed, the professionals say that both forced sex and sex with no explicit consent are violence and so they should be named. By doing so, professionals intend to enlighten their patients about women's rights. However, in everyday life not everyone does and no one recognized or named marital duty as gender inequality. We conclude that if violence is present as an issue, its distinction in relation to gender inequality is still a challenge.(AU)

Atendimento de enfermagem às mulheres em situação de violência sexual: representações sociais de enfermeiros / Nursing care for women in situations of sexual violence: social representations of nurses / Atención de enfermería a mujeres en situaciones de violencia sexual: representaciones sociales de los profesionales de enfermería

RESUMO Objetivo: conhecer as representações sociais de enfermeiros acerca do atendimento de enfermagem prestado às mulheres em situação de violência sexual. Método: estudo qualitativo, tipo exploratório-descritivo, fundamentado na Teoria das Representações Sociais, realizado em um centro de referência de um Hospital Universitário do Sul do Brasil. A coleta de dados foi realizada por meio de entrevistas semiestruturadas, com 20 enfermeiros. As entrevistas foram submetidas à análise de conteúdo com apoio do software Qualitativa Data Analysis Mine. Resultados: revelam, na vivência do atendimento prestado, representações como: condutas desenvolvidas pelos enfermeiros; dificuldades encontradas para o desenvolvimento das atividades assistenciais às mulheres em situações de violência sexual; e sugestões para melhorar o atendimento a essas mulheres. Conclusão: as representações sociais dos enfermeiros acerca do atendimento de enfermagem prestado às mulheres em situação de violência sexual estão ancoradas na execução de protocolos de forma humanizada, objetificada na noção de acolhimento.

ABSTRACT Objective: to know the social representations of nurses about the nursing care provided to women in situations of sexual violence. Method: qualitative, exploratory-descriptive study, based on the Social Representations Theory, conducted in a reference center of a University Hospital in southern Brazil. Data collection was performed through semi-structured interviews with 20 nurses. The interviews were submitted to content analysis with the support of the Qualitative Data Analysis Mine software. Results: they reveal, in the experience of the care provided, representations such as: conducts developed by nurses; difficulties encountered in the development of care activities for women in situations of sexual violence; and suggestions to improve care for these women. Conclusion: the social representations of nurses about the nursing care provided to women in situations of sexual violence are anchored in the execution of protocols in a humanized way, objectified in the notion of reception.

RESUMEN Objetivo: conocer las representaciones sociales de las enfermeras sobre la atención de enfermería prestados a las mujeres en situaciones de violencia sexual. Método: estudio cualitativo exploratorio-descriptivo, basado en la Teoría de las Representaciones Sociales, realizado en un centro de referencia de un Hospital Universitario del Sur de Brasil. Los datos se recogieron mediante entrevistas semiestructuradas a 20 enfermeras. Las entrevistas se sometieron a un análisis de contenido con el apoyo del software Qualitative Data Analysis Mine. Resultados: revelan, en la experiencia de los cuidados prestados, representaciones tales como: comportamientos desarrollados por las enfermeras; dificultades encontradas en el desarrollo de las actividades de atención a las mujeres en situación de violencia sexual; y sugerencias para mejorar la atención a estas mujeres. Conclusión: las representaciones sociales de los enfermeros sobre la atención de enfermería prestada a las mujeres en situación de violencia sexual se corresponden con la ejecución de protocolos de forma humanizada, objetivada en la noción de acolchamiento.

Atendimento de enfermagem às mulheres em situação de violência sexual: representações sociais de enfermeiros / Nursing care for women in situations of sexual violence: social representations of nurses / Atención de enfermería a mujeres en situaciones de violencia sexual: representaciones sociales de los profesionales de enfermería

RESUMO Objetivo: conhecer as representações sociais de enfermeiros acerca do atendimento de enfermagem prestado às mulheres em situação de violência sexual. Método: estudo qualitativo, tipo exploratório-descritivo, fundamentado na Teoria das Representações Sociais, realizado em um centro de referência de um Hospital Universitário do Sul do Brasil. A coleta de dados foi realizada por meio de entrevistas semiestruturadas, com 20 enfermeiros. As entrevistas foram submetidas à análise de conteúdo com apoio do software Qualitativa Data Analysis Mine. Resultados: revelam, na vivência do atendimento prestado, representações como: condutas desenvolvidas pelos enfermeiros; dificuldades encontradas para o desenvolvimento das atividades assistenciais às mulheres em situações de violência sexual; e sugestões para melhorar o atendimento a essas mulheres. Conclusão: as representações sociais dos enfermeiros acerca do atendimento de enfermagem prestado às mulheres em situação de violência sexual estão ancoradas na execução de protocolos de forma humanizada, objetificada na noção de acolhimento.

ABSTRACT Objective: to know the social representations of nurses about the nursing care provided to women in situations of sexual violence. Method: qualitative, exploratory-descriptive study, based on the Social Representations Theory, conducted in a reference center of a University Hospital in southern Brazil. Data collection was performed through semi-structured interviews with 20 nurses. The interviews were submitted to content analysis with the support of the Qualitative Data Analysis Mine software. Results: they reveal, in the experience of the care provided, representations such as: conducts developed by nurses; difficulties encountered in the development of care activities for women in situations of sexual violence; and suggestions to improve care for these women. Conclusion: the social representations of nurses about the nursing care provided to women in situations of sexual violence are anchored in the execution of protocols in a humanized way, objectified in the notion of reception.

RESUMEN Objetivo: conocer las representaciones sociales de las enfermeras sobre la atención de enfermería prestados a las mujeres en situaciones de violencia sexual. Método: estudio cualitativo exploratorio-descriptivo, basado en la Teoría de las Representaciones Sociales, realizado en un centro de referencia de un Hospital Universitario del Sur de Brasil. Los datos se recogieron mediante entrevistas semiestructuradas a 20 enfermeras. Las entrevistas se sometieron a un análisis de contenido con el apoyo del software Qualitative Data Analysis Mine. Resultados: revelan, en la experiencia de los cuidados prestados, representaciones tales como: comportamientos desarrollados por las enfermeras; dificultades encontradas en el desarrollo de las actividades de atención a las mujeres en situación de violencia sexual; y sugerencias para mejorar la atención a estas mujeres. Conclusión: las representaciones sociales de los enfermeros sobre la atención de enfermería prestada a las mujeres en situación de violencia sexual se corresponden con la ejecución de protocolos de forma humanizada, objetivada en la noción de acolchamiento.

Evaluation of a training program for health care workers to improve the quality of care for rape survivors: a quasi-experimental design study in Morogoro, Tanzania.

BACKGROUND: Sexual violence against women and children in Tanzania and globally is a human rights violation and a developmental challenge. OBJECTIVE: The aim of this study was to assess the impact of training health professionals on rape management. The specific objectives were to evaluate the changes of knowledge and attitudes toward sexual violence among a selected population of health professionals at primary health care level. DESIGN: A quasi-experimental design using cross-sectional surveys was conducted to evaluate health care workers' knowledge, attitude, and clinical practice toward sexual violence before and after the training program. The study involved the Kilombero (intervention) and Ulanga (comparison) districts in Morogoro region. A total of 151 health professionals at baseline (2012) and 169 in the final assessment (2014) participated in the survey. Data were collected using the same structured questionnaire. The amount of change in key indicators from baseline to final assessment in the two areas was compared using composite scores in the pre- and post-interventions, and the net intervention effect was calculated by the difference in difference method. RESULTS: Overall, there was improved knowledge in the intervention district from 55% at baseline to 86% and a decreased knowledge from 58.5 to 36.2% in the comparison area with a net effect of 53.7% and a p-value less than 0.0001. The proportion of participants who exhibited an accepting attitude toward violence declined from 15.3 to 11.2% in the intervention area but increased from 13.2 to 20.0% in the comparison area. CONCLUSIONS: Training on the management of sexual violence is feasible and the results indicate improvement in healthcare workers' knowledge and practice but not attitudes. Lessons learned from this study for successful replication of such an intervention in similar settings require commitment from those at strategic level within the health service to ensure that adequate resources are made available.

Exposición a la violencia durante la formación profesional de los residentes médicos / Exposure to violence during the vocational training of resident physicians

Resumen Las residencias médicas garantizan la formación y preparación de los futuros especialistas, no solo académica, sino también humana. Sin embargo, existe evidencia de maltrato, discriminación y abusos en los residentes médicos. El objetivo de este trabajo fue identificar experiencias de violencia física, psicológica o sexual de los residentes médicos del estado de Veracruz, México. Se realizó un estudio transversal descriptivo, mediante una metodología cuantitativa, de una población conformada por 656 médicos residentes de 16 unidades receptoras durante el año 2014. El 87 % reportó por lo menos una experiencia de agresión en su tiempo de formación como especialistas y hasta el 50.46 % refirió violencia psicológica. Sus principales agresores fueron jefes de servicio (33.5 %) y compañeros residentes (33.5 %), viéndose más afectados en el turno matutino (34.76 %). De la población total, 51.52 % son hombres y 48.48 % mujeres. En relación al análisis bivariado se obtuvieron los siguientes resultados: correlación entre sexo y violencia psicológica: X 2 = 9.740 6, p = 0.004; violencia fisica: X 2 = 4.876 4, p = 0.003; y violencia sexual: X 2 = 4.868 4, P = 0.001. Los varones presentaron tasas de agresión más altas en el grupo de médicos residentes sometidos a mayor nivel de violencia psicológica, física y sexual. Con este estudio se enfatiza la importancia de forjar valores institucionales en la práctica médica, como el respeto y la dignidad, entre los médicos residentes, superiores y/o profesionales que intervienen en la formación y perfeccionamiento de sus especialidades.

Abstract The Medical residencies guarantee the academic and human apprenticeship and training of the future medical specialists. Nevertheless, there is evidence of maltreatment, discrimination and abuse against the medical residents. The purpose of this work was to identify experiences of physical, psychological or sexual violence of medical residents in the state of Veracruz, Mexico. A cross-sectional quantitative analysis was carried out focusing on a population of 656 residents from 16 receiving medical centers during 2014. Results indicate that 87% reported at least one experience of physical violence during their medical internship as specialists. Additionally, and up to 50.46% it reported psychological violence. The main aggressors were reported to be chiefs of service (33T5 %) and resident partners (33.5 %) and participants were more affected during the morning shift (34.76 %). 51.52 % of the participating population are males and 48.48 % are fema les. As regards The bivariate analysis revealed the following results: correlation between gender and psychological violence: X2 = 9.740 6, p = 0.004; physical violence: X2 = 4.876 4, p = 0.003; and sexual violence: X2 = 4.868 4, p = 0.001. Males reported higher aggression rates in their medical internships since they were subject to higher levels of psychological, physical and sexual violence. The results of the study emphasize the importance of forging institutional values as an integral part of medical residency programs. Respect and the dignity among medical residents, superiors and health professionals who are involved in training and apprenticeships of specialists should be promoted.

Qualificação de profissionais da saúde para a atenção às mulheres em situação de violência sexual / Training of health care professionals for the care of women in instances of sexual violence / Cualificación de profesionales de la salud para la atención de mujeres en situación de violencia sexual

Resumo Analisou-se a qualificação de profissionais da saúde para a atenção às mulheres em situação de violência sexual em duas capitais brasileiras, em estudo qualitativo envolvendo 140 profissionais de diferentes categorias de 18 instituições de saúde em Fortaleza e Rio de Janeiro. Entrevistas semiestruturadas foram realizadas e o material empírico foi analisado segundo a técnica de análise de conteúdo. Lacunas na formação dos profissionais decorrentes da insuficiente abordagem do tema durante a graduação dos cursos da área da saúde foram observadas nos dois municípios. A fragilidade da qualificação profissional para esse tipo de atuação foi reforçada por lacunas nas ações de capacitação. No município do Rio de Janeiro essas ações mostraram-se mais frequentes e contínuas. Importante a inclusão do tema na formação profissional, a ampliação de processos de capacitação e a atualização das equipes de saúde nos serviços. Tais medidas podem viabilizar um entendimento crítico sobre o fenômeno, contribuindo para implementar intervenções diferenciadas.

Abstract We analyzed the training of health care professional for the care of women in instances of sexual violence in two Brazilian state capitals, in a qualitative study with 140 professionals of different categories working in 18 health care institutions in the cities of Fortaleza and Rio de Janeiro. Semi-structured interviews were performed, and the empirical material was analyzed according to the content analysis technique. Gaps in the training of the professionals due to an insufficient approach of this topic during the undergraduate studies in the field of health were observed in both municipalities. The weakness of the professional training for this kind of practice was reinforced by gaps in the training actions. In the city of Rio de Janeiro, these actions were more frequent and continuous. The inclusion of this topic in the professional training, the expansion of training processes, and the continuing education of the health care teams in the services are important. Such measures will make viable a critical understanding of this phenomenon, contributing to the implementation of diverse interventions.

Resumen Se analizó la cualificación de los profesionales de la salud para la atención de las mujeres en situación de violencia sexual en dos capitales brasileñas, en un estudio cualitativo abarcando 140 profesionales de diferentes categorías de 18 instituciones de salud en las ciudades de Fortaleza y Rio de Janeiro. Se realizaron entrevistas semiestructuradas y el material empírico se analizó de acuerdo con la técnica de análisis de contenido. En ambos municipios se observaron lagunas en la formación de los profesionales derivadas de un abordaje insuficiente del tema durante los estudios de grado en ciencias de la salud. La fragilidad de la cualificación profesional para este tipo de atención se vio reforzada por lagunas en las acciones de capacitación. En el municipio de Rio de Janeiro estas acciones demostraron una mayor frecuencia y continuidad. Es de suma importancia incluir este tema en la formación profesional, la ampliación de los procesos de capacitación y la actualización de los equipos de salud en los servicios de atención. Estas medidas pueden permitir una comprensión más crítica sobre el fenómeno, contribuyendo para implementar formas de intervención diferenciadas.

CONCEPÇÕES SOBRE ADOLESCENTES EM SITUAÇÃO DE VIOLÊNCIA SEXUAL / CONCEPCIONES SOBRE LOS ADOLESCENTES EN SITUACIÓN DE VIOLENCIA SEXUAL / CONCEPTIONS OF ADOLESCENTS IN SITUATIONS OF SEXUAL VIOLENCE

Resumo Trata-se de uma pesquisa de campo de abordagem qualitativa objetivando compreender as práticas discursivas dos profissionais de saúde sobre violência sexual contra crianças e adolescentes. Foram entrevistados dez profissionais (médicos, enfermeiros, agentes comunitários e coordenador do programa) que compõem três equipes da Estratégia de Saúde da Família (ESF) da cidade de Montes Claros, MG, Brasil. A abordagem discursiva para análise dos dados foi fundamentada em Michel Foucault, bem como em autores ligados ao campo da Saúde Coletiva. Os resultados indicam que, dentre os vários fatores que propiciam e/ou mantêm a violência sexual na forma de exploração comercial sexual de adolescentes, está a desigualdade econômica e social, aliada à desigualdade de gênero, pouco reconhecida pelos profissionais. A omissão/negação da questão se evidencia pela ausência de notificação obrigatória; inexistência de trabalhos preventivos na área; ações pontuais inadequadas às necessidades da adolescência, preconceito e falta de referência de uma rede de cuidados intersetoriais.(AU)

Resumen Este es un enfoque cualitativo de investigación de campo con el objetivo de entender las prácticas discursivas de profesionales de la salud sobre la violencia sexual contra niños y adolescentes. Diez profesionales fueron entrevistados (médicos, enfermeras, trabajadores comunitarios y coordinador del programa) que forman tres equipos de la Estrategia Salud de la Familia (ESF) en la ciudad de Montes Claros, MG, Brasil. El enfoque discursivo al análisis de datos se basó en Michel Foucault, así como autores vinculados al campo de la Salud Pública. Los resultados indican que entre los diversos factores proporcionan y / o mantener la violencia sexual en forma de explotación sexual comercial de los adolescentes son las desigualdades económicas y sociales, así como la desigualdad de género, mal reconocidos por los profesionales. Omisión / negación de la materia se evidencia por la ausencia de notificación obligatoria; falta de trabajo preventivo en la zona; inadecuadas acciones específicas a las necesidades de los adolescentes, los prejuicios y la falta de referencia de una red de atención intersectorial.(AU)

Abstract This is a field qualitative approach aiming to understand the discursive practices of health professionals on sexual violence against children and adolescents. Ten professionals (doctors, nurses, community workers and program coordinator) that make up three teams from the city of Montes Claros, MG, Brazil's Family Health Strategy (FHS) were interviewed. The discursive approach to data analysis was based on Michel Foucault, as well as authors linked to the field of Public Health. The results indicate that, among the various factors which provide and/or maintain the sexual violence in form of commercial sexual exploitation of adolescents, are the economic and social inequality, coupled with gender inequality, little recognized by professionals. Omission / denial of the issue is evidenced by the absence of mandatory reporting; lack of preventive work in the area; specific actions inadequate to the needs of adolescence, prejudice and lack of reference to a network of intersectoral care.(AU)

Conceitos, causas e repercussões da violência sexual contra a mulher na ótica de profissionais de saúde / Concepts, causes and repercussions of sexual violence against women from the perspective of healthcare professionals / Conceptos, causas y repercusiones de la violencia sexual contra la mujer a partir de la opinión de profesionales sanitários

OBJETIVO: Analisar os sentidos atribuídos por profissionais de saúde aos conceitos, causas e repercussões da violência sexual contra a mulher. MÉTODO: Estudo qualitativo realizado com 68 profissionais de saúde de nível superior integrantes de equipe multiprofissional de nove hospitais públicos do município de Fortaleza/CE, entre agosto e dezembro de 2013, por meio de entrevista semiestruturada, a qual norteou a coleta de dados, sendo estes submetidos à análise temática dos núcleos de sentido que emergiram. RESULTADOS: Entre os sentidos atribuídos ao conceito de violência sexual, destacam-se a violação dos direitos humanos e ênfase na perpetuação das questões de gênero; quanto às causas, sobressaiu o machismo, a existência de patologias do agressor e a reprodução da violência familiar ­ as repercussões atingem aspectos psicológicos, além da exposição a doenças e agressões físicas. CONCLUSÃO: O estudo possibilitou a análise dos sentidos atribuídos à violência sexual pela ótica dos profissionais de saúde investigados, que divergiram sobre a desigualdade de gênero e contexto social, cujas causas foram apontadas como sendo a cultura machista, a falta de informação das mulheres sobre os seus direitos e as questões sociais. Observou-se a dificuldade dos profissionais em trabalhar com o tema

OBJECTIVE: To analyze the meanings given by health professionals to the concepts, causes and repercussions of sexual violence against women. METHODS: Qualitative study conducted with 68 higher degree health professionals of the multiprofessional team of nine public hospitals in the municipality of Fortaleza, Ceará, between August and December 2013 using semi-structured interviews to collect data that underwent thematic analyses of the themes that emerged. RESULTS: The main meanings given to the concept of sexual violence were the violation of human rights and the emphasis on the perpetuation of gender issues; the main causes were misogyny, the existence of pathologies in the aggressors, the reproduction of family violence ­ the repercussions affect psychological aspects and lead to the exposure to disease and physical assaults. CONCLUSION: The study enabled the analysis of the meanings given to sexual violence from the perspective of the professionals interviewed, who presented different views regarding gender inequality and social context. The causes highlighted were misogyny, women's lack of information on their rights and social issues. It was observed that professionals had difficulties addressing the issue

OBJETIVO: Analizar los sentidos atribuidos por los profesionales sanitarios a los conceptos, causas y repercusiones de la violência sexual contra la mujer. MÉTODOS: Estudio cualitativo realizado com 68 profesionales sanitarios con educación superior participantes del equipo multiprofesional de nueve hospitales públicos del municipio de Fortaleza/CE entre agosto y diciembre de 2013 a través de entrevista semiestructurada la cual orientó la recogida de datos los cuales fueron sometidos al análisis temático de los núcleos de sentido. RESULTADOS: Entre los sentidos atribuídos al concepto de violencia sexual, se destacan la violación de los derechos humanos y el énfasis de la perpetuación de las cuestiones de género; entre las causas se destacó el machismo, las patologías del agresor y la reproducción de la violencia familiar ­ las repercusiones alcanzan los aspectos psicológicos además de la exposición para enfermedades y agresiones físicas. CONCLUSIÓN: El estudio ha permitido el análisis de los sentidos atribuidos a la violencia sexual a partir de la opinión de profesionales sanitários investigados que divergieron sobre la desigualdad de género y el contexto social cuyas causas fueron apuntadas como la cultura machista, la falta de información de las mujeres sobre SUS derechos y las cuestiones sociales. Se observó la dificultad de los profesionales para trabajar con el tema

Concepções sobre adolescentes em situação de violência sexual / Concepciones sobre los adolescentes en situación de violencia sexual / Conceptions of adolescents in situations of sexual violence

Trata-se de uma pesquisa de campo de abordagem qualitativa objetivando compreender as práticas discursivas dos profissionais de saúde sobre violência sexual contra crianças e adolescentes. Foram entrevistados dez profissionais (médicos, enfermeiros, agentes comunitários e coordenador do programa) que compõem três equipes da Estratégia de Saúde da Família (ESF) da cidade de Montes Claros, MG, Brasil. A abordagem discursiva para análise dos dados foi fundamentada em Michel Foucault, bem como em autores ligados ao campo da Saúde Coletiva. Os resultados indicam que, dentre os vários fatores que propiciam e/ou mantêm a violência sexual na forma de exploração comercial sexual de adolescentes, está a desigualdade econômica e social, aliada à desigualdade de gênero, pouco reconhecida pelos profissionais. A omissão/negação da questão se evidencia pela ausência de notificação obrigatória; inexistência de trabalhos preventivos na área; ações pontuais inadequadas às necessidades da adolescência, preconceito e falta de referência de uma rede de cuidados intersetoriais.

Este es un enfoque cualitativo de investigación de campo con el objetivo de entender las prácticas discursivas de profesionales de la salud sobre la violencia sexual contra niños y adolescentes. Diez profesionales fueron entrevistados (médicos, enfermeras, trabajadores comunitarios y coordinador del programa) que forman tres equipos de la Estrategia Salud de la Familia (ESF) en la ciudad de Montes Claros, MG, Brasil. El enfoque discursivo al análisis de datos se basó en Michel Foucault, así como autores vinculados al campo de la Salud Pública. Los resultados indican que entre los diversos factores proporcionan y / o mantener la violencia sexual en forma de explotación sexual comercial de los adolescentes son las desigualdades económicas y sociales, así como la desigualdad de género, mal reconocidos por los profesionales. Omisión / negación de la materia se evidencia por la ausencia de notificación obligatoria; falta de trabajo preventivo en la zona; inadecuadas acciones específicas a las necesidades de los adolescentes, los prejuicios y la falta de referencia de una red de atención intersectorial.

This is a field qualitative approach aiming to understand the discursive practices of health professionals on sexual violence against children and adolescents. Ten professionals (doctors, nurses, community workers and program coordinator) that make up three teams from the city of Montes Claros, MG, Brazil's Family Health Strategy (FHS) were interviewed. The discursive approach to data analysis was based on Michel Foucault, as well as authors linked to the field of Public Health. The results indicate that, among the various factors which provide and/or maintain the sexual violence in form of commercial sexual exploitation of adolescents, are the economic and social inequality, coupled with gender inequality, little recognized by professionals. Omission / denial of the issue is evidenced by the absence of mandatory reporting; lack of preventive work in the area; specific actions inadequate to the needs of adolescence, prejudice and lack of reference to a network of intersectoral care.

Violencia en la relación de pareja de los alumnos de enfermería, 2015 / Violence in the relationship of nursing students, 2015

Objetivo: Conocer y adentrarse en el estudio de violencia en las relaciones de pareja de los estudiantes de la ENEO-UNAM. Metodología: Se realizó un estudio descriptivo, la unidad de observación fueron alumnos de las carreras: Lic. en Enfermería y Lic. en Enfermería y Obstetricia, el muestreo fue no probabilístico. Se aplicó un cuestionario exprofeso “Detección de violencia en pareja”, de 15 reactivos. Resultados: Se estudiaron 112 alumnos, el 84.8% correspondió al género femenino, el 51% tienen menos 20 años, 37% tiene entre 20-23 y el 12% más de 23 años de edad. El 85.7% de las (os) alumnos, informo que tiene violencia emocional (controla su tiempo, celos y la acusa de ser le infiel), El 38.3% está en proceso de gestación de dependencia, el 15.8% tiene violencia económica, el 1.8% dijo tener violencia física, el 8.9% reportó violencia psicológica y solo se reportó un caso de violación por parte de su pareja. Conclusiones: Se confirma que existe violencia en las relaciones de pareja de tipo: emocional, dependencia, física, económica y sexual en los alumnos de enfermería, por lo que se debe de implementar y aplicar una intervención para disminuir esta. Es necesario fomentar que toda pareja llegue a acuerdos, donde se establezcan límites y distancias, sobre todo fomentar el mutuo respeto.

Introduction: The National Survey on the Dynamic of Household Relations (ENDIREH) 2011, reported that 46.1% of women over 15 have experienced violence by their partners. Objective: To determine and enter the study of violence in relationships of students ENEO-UNAM. Methodology: A descriptive study, the observation unit were students of the races: Lic. Nursing and Nursing and Midwifery, was non-probability sampling. a questionnaire exprofeso "Detection of violence as a couple" of 15 items was applied. Results: 112 students were studied, 84.8% were female, 51% are under 20 years, 37% are between 20- 23 and 12% over 23 years old. 85.7% of the (old) students reported having emotional violence (control your time, jealousy and accuses her of being unfaithful), 38.3% is in the making of dependence, 15.8% is economic violence, 1.8 % reported physical violence, 8.9% reported psychological violence and only one reported case of rape by an intimate partner. Conclusions: It is confirmed that there is violence in the relationships of type: emotional dependency, physical, economic and sexual in nursing students, so it must implement and apply an intervention to reduce this. It is necessary to encourage all couples reach agreements, which set limits and distances, especially foster mutual respect.