Knowledge and attitudes of rural healthcare providers regarding domestic violence against women: a systematic review

ABSTRACT BACKGROUND: Specific types of violence such as intimate partner sexual violence and intimate partner homicide occur more frequently in rural areas. OBJECTIVE: This study aimed to systematically review the literature on the knowledge and attitudes of rural healthcare providers regarding cases of domestic violence against women. DESIGN AND SETTING: Systematic review developed at Universidade Federal de Uberlândia. METHODS: We conducted an electronic search of six databases, which only included observational studies, regardless of the year, language, or country of publication, except for studies that used secondary data and were exclusively qualitative. Two reviewers performed the selection, data extraction, and risk of bias assessment using a specific Joanna Briggs Institute tool. RESULTS: Six studies met the inclusion criteria. All the studies had a low risk of bias. Approximately 38% of these professionals identified injuries caused by violence in patients. When asked about knowing the correct attitude to take in cases of confirmed violence, between 12% and 64% of rural healthcare providers answered positively; most of them would refer to specialized institutions and promote victim empowerment and counseling. The number of professionals with an educational background in the field ranged from 16% to 98%. CONCLUSIONS: The evident disparity across studies shows that some professionals have suboptimal knowledge and require training to adopt the correct attitude when identifying female victims of domestic violence in clinical practice. SYSTEMATIC REVIEW REGISTRATION: This systematic review was registered in the Open Science Framework Database under the registration http://doi.org/10.17605/OSF.IO/B7Q6S.

Caracterización de pacientes no adherentes al tratamiento de hipertensión arterial / Characterization of patients not adherent to high blood pressure treatment

Introducción. La falta del cumplimiento terapéutico es un problema en el control de la hipertensión arterial. Objetivo. Caracterizar los pacientes no adherentes al tratamiento de hipertensión arterial en pobladores de la V Región Sanitaria del Paraguay. Material y Métodos: Estudio transversal que incluyó pacientes hipertensos conocidos que se encontraban en tratamiento para la hipertensión arterial. Se utilizó la Escala de adherencia a la medicación de Morisky 8 ítems que mide comportamientos de adherencia específicos asociados a la ingesta de medicamentos. Resultados. Se incluyeron163 pacientes, todos considerados no adherentes al tratamiento según la Escala Morinsky MMAS-8. El 52,2% tenía más de 40 años, 66,3% del sexo femenino, 40,5% de nivel universitario, 57,1% casado y el 87,7% vive con la familia. El 66,9% informó trabajar hasta 8 horas por día y el 58,3% con ingresos mayores a 2 salarios mínimos. En cuanto al conocimiento el 53,9% fue alto. El 50% de los pacientes declaró utilizar plantas medicinales para su tratamiento, el 7,4% con depresión frecuentemente o casi siempre y el 22,1% ansiedad frecuentemente o casi siempre. En cuanto a las preguntas de no adherencia, el 53,4% olvidó tomar alguna vez su medicación o dejar de tomarla cuando siente que está bajo control (53,3%),el 44,2% deja de tomar su medicación porque se siente peor con ella y el 46,5% la olvida cuando viaja. Conclusión. La no adherencia en los pacientes de la V Región fue alarmante, por tanto, se deben de realizar medidas de acción respecto a las mismas. Palabras Clave: hipertensión; presión arterial; cumplimiento y adherencia al tratamiento; epidemiologia

Introduction. The lack of therapeutic compliance is a problemto control high blood pressure.Objective. To characterize patients who do not adhere to the treatment of arterial hypertension in the Vsanitary region of Paraguay. Material and Methods: A cross-sectional study was carried out in known hypertensive patients who were undergoing treatment for high blood pressure. The 8-item Morisky Medication Adherence Scale was used, which measures specific adherence behaviors associated with medication intake. Results.163 patients were included, all considered non-adherent to treatment according to the Morinsky MMAS-8 Scale. 52.2% were over 40 years old, 66.3% female, 40.5% with university level, 57.1% married, and 87.7% lived with their family. 66.9% reported working up to 8 hours per day and 58.3% with income greater than 2 minimum wages. Regarding knowledge, 53.9% was high. 50% of the patients declared using medicinal plants for their treatment, 7.4% with depression frequently or almost always and 22.1% with anxiety frequently or almost always. Regarding the non-adherence questions, 53.4% ever forgot to take their medication or stopped taking it when they feel they are under control (53.3%), 44.2% stop taking their medication because they feel worse with it and 46.5% forget it when traveling. Conclusion. The non-adherence in patients from Region V was alarming, therefore, action measures must be taken regarding them. Key words:hypertension; blood pressure; treatment adherence and compliance; epidemiology

Human identification established by the analysis of frontal sinus seen in anteroposterior skull radiographs using the mento-naso technique ­ a forensic case report / Identificação humana pela análise do seio frontal em radiografias anteroposteriores com incidência mento-naso em crânio humano ­ um relato de caso pericial

Introduction: Human identification is a challenging task, especially when the available information detected during the dental autopsy is scarce. In this context, distinctive morphological information may play a valuable role as additional and alternative identifiers. Objective: To report a case of human identification aided by the morphological analysis of the frontal sinus through anteroposterior radiographs of the skull with the mento-naso technique. Material and methods: The body of an edentulous adult male highly decomposed was referred to the local medico-legal institute for identification. The alleged relatives of the victim provided the comparative antemortem data (AM) ­ consisting of an anteroposterior (AP) skull radiograph taken with mento-naso projection. A postmortem AP radiograph of the deceased was taken in order to reproduce the AM data and to enable a comparative procedure. Results: The morphological information of the frontal sinuses converged between AM and PM radiographs both for metric and non-metric evidences. Conclusion: The analysis of the frontal sinus may be an additional and alternative approach for human identification ­ especially for edentulous victims

Introdução: O processo de identificação humana é uma tarefa desafiadora, especialmente quando as informações disponíveis durante o exame cadavérico são escassas. Neste contexto, características morfológicas distintivas podem exercer um papel importante como fontes adicionais e alternativas para a identificação. Objetivo: Relatar um caso pericial de identificação humana realizada com o auxílio da análise das características morfológicas do seio frontal em radiografias anteroposteriores do crânio com incidência mento-naso. Materiais e métodos: O corpo de um adulto edêntulo em avançado estágio de decomposição foi encaminhado para o instituto médico-legal local visando identificação. Os supostos pais da vítima providenciaram material comparativo antemortem (AM) ­ o qual consistia de uma radiografia anteroposterior do crânio obtida com incidência mento-naso. Uma radiografia postmortem (PM) anteroposterior foi obtida do cadáver para viabilizar a comparação. Resultados: As características morfológicas dos seios frontais da vítima convergiram entre os dados AM e PM tanto para fatores métricos como para não-métricos. Conclusão: A análise do seio frontal pode ser uma ferramenta adicional e alternativa para a identificação humana ­ especialmente em vítimas edêntulas

Efectos sobre factores ocupacionales y en el medio ambiente originados por el proceso de descarne a partir del curtido / Effects on occupational factors and environment as a result from rawhide process of the tanning

La ciudad de León cuenta con 500 empresas de curtiduría y 9 dedicadas al procesamiento del sebo cuyos subproductos (descarne) son desechos que se vierten al medio ambiente en grandes cantidades, ya que no representan un interés para su procesamiento y comercialización, lo que ha causado diversos problemas de contaminación en las zonas habitacionales circundantes por el vertido de aguas residuales, residuos sólidos y emisiones atmosféricas. El impacto al medio se puede considerar como adverso, directo y temporal; reversible, pero con un alto costo económico, lo que implica la necesidad de establecer medidas preventivas de control y mitigación. En el presente estudio se describen las etapas delproceso, las buenas y malas prácticas, los procedimientos estándares de operación y los impactos al medio ambiente originados por el inadecuado manejo de los residuos de las industrias sebaderas. Los resultados muestran que el 80 por ciento de las empresas procesadoras carece de sistemas de almacenamiento adecuado y no poseen sistemas de control ambiental. De igual manera, la mayoría de los operarios no cuenta con equipos de protección personal y no existe un adecuado manejo de sustancias utilizadas en los procesos, lo que incrementa el riesgo de accidentes laborales.

The city of León has 500 tannery companies and nine work in fat processing, whose by-product waste (rawhide) is dumped to the environment in tons because there is no interest in processing and commercializing this substance. This situation has caused several contamination problems in surrounding residential areas because ofthe discharge of wastewater, solid waste, and atmospheric emissions. Impact on environment can be considered as adverse, direct and temporal, as well reversible, but excessively expensive, which involvesthe need of established preventive measures of control and mitigation.The present study describes the different stages of the process, goodand bad practices, standard operational procedures, and environmentalimpacts due to the inadequate handling of waste by these companies. Results show that 80 percent of the processing companies lack appropriate storage systems and do not have an environmental control system. Additionally, most of the operators do not have personal protective equipment and there is not a proper handling of the substances used in processes; this increases the risk of work-related accidents.

Mãe, mulher, feminino, professora e... o falo / La madre, la mujer, el feminino, la profesora y... el falo / Mother, woman, feminine, teacher and... the phallus

Ao serem convidados a pensar sobre sua prática, alguns docentes (sujeitos da pesquisa A subjetividade docente produzida em tempos de declínio do discurso do mestre, realizada no período de 2007 a 2009 na Faculdade de Educação da UFMG) fizeram associações tanto com o que denominamos "maternagem", quanto com aspectos relacionados ao gênero. Julgamos então necessário recorrer tanto à psicanálise quanto a teóricos da Educação que escrevem sobre o tema, pois o que parece estar em jogo é a "feminização do magistério", bem como sua domesticidade. Tais características acabam por acarretar alguns prejuízos políticos para a consolidação de um corpus epistemológico que dê conta do impossível ato de educar e para o próprio exercício da pratica docente.

When asked to think about their practice, some teachers (subjects in the research project Teacher's subjectivity in times of decline of the master's discourse, at the Faculty of Education UFMG during the years 2007 to 2009) made associations with both what we call "mothering", as with aspects related to the gender of those involved. In order to analyze these findings, we deemed necessary to bring together approaches from both psychoanalysis and some Education's theorists since what seems at stake is the "feminization of teaching" as well as its domesticity. Such issues ultimately lead to some political damage to both the consolidation of an epistemological corpus able to give an account of the impossible act of teaching as to the actual teaching practice.

Cuando se invitó a pensar acerca de su práctica, algunos profesores (los sujetos de la investigación La subjetividad docente producida en tiempos de la declinación del discurso del maestro, realizada durante el período de 2007 a 2009, en la Facultad de Educación de la UFMG) hicieron asociaciones tanto con lo que llamamos "maternagen" como con los aspectos relacionados con el género. Para tal análisis, consideramos necesario aplicar tanto al psicoanálisis como algunos teóricos de la educación que escriben sobre el tema, porque lo que parece en juego es la "feminización del magisterio", así como su domesticidad. Estas características en última instancia conducen a un daño político tanto a la consolidación de un corpus epistemológico que dé cuenta del imposible del acto de educar como al ejercicio efectivo de la práctica docente.