Evidências científicas da prática da violência contra a pessoa idosa: revisão integrativa / Evidencias científicas de la práctica de violencia contra personas mayores: revisión integradora / Scientific evidence of the violence against the older adult: an integrative review

Resumo Objetivo: Analisar as evidências científicas da violência praticada contra a pessoa idosa, com destaque para a prevalência, o perfil da vítima e os fatores de risco. Métodos: Revisão integrativa de artigos disponíveis nas bases de dados da PubMed®, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Banco de Dados em Enfermagem (BDENF), Scientific Electronic Library Online (SciELO) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), publicados entre 2015 a 2019, a partir dos descritores: "idoso", " elderly ", " older person " , " aged ", " old ", " exposure to violence ", "exposição à violência", " aging ", envelhecimento", " elder abuse " , " domestic violence " , " violence ", "violência", "maus-tratos ao idoso" e "violência doméstica". Para refinamento, foram utilizadas as quatro fases do diagrama de fluxo de seleção de artigos do PRISMA. Resultados: Foram identificados 17 artigos que apresentaram como fatores de risco aumentados para a violência contra a pessoa idosa idade avançada, disfuncionalidade familiar, falta de acesso a direitos sociais e condições crônicas de incapacidade. Conclusão: O estudo traz contribuições diretas para os profissionais e setores interessados no enfrentamento da violência contra a pessoa idosa, a qual possui alta prevalência na sociedade atual.

Resumen Objetivo: Analizar las evidencias científicas de la violencia practicada contra personas mayores, con énfasis en la prevalencia, el perfil de la víctima y los factores de riesgo. Métodos: Revisión integradora de artículos disponibles en las bases de datos de PubMed®, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Banco de Dados em Enfermagem (BDENF), Scientific Electronic Library Online (SciELO) y Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), publicados entre 2015 y 2019, a partir de los descriptores: "anciano", " elderly ", " older person " , " aged ", " old ", " exposure to violence ", "exposición a la violencia", " aging ", "envejecimiento", " elder abuse " , " domestic violence " , " violence ", "violencia", "malos tratos al anciano" y "violencia doméstica". Para refinar la búsqueda, se utilizaron las cuatro fases del diagrama de flujo de selección de artículos PRISMA. Resultados: Se identificaron 17 artículos que presentaron los siguientes factores de riesgo aumentados en la violencia contra personas mayores: edad avanzada, disfuncionalidad familiar, falta de acceso a derechos sociales y condiciones crónicas de incapacidad. Conclusión: El estudio contribuye directamente para los profesionales y sectores interesados en el enfrentamiento a la violencia contra personas mayores, que tiene una alta prevalencia en la sociedad actual.

Abstract Objective: To analyze the scientific evidence of violence against the older adult, with emphasis on the prevalence, the profile of the victim, and the risk factors. Methods: An integrative review of articles available in the PubMed® databases, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Nursing Database (BDENF), Scientific Electronic Library Online (SciELO) and Latin American and Caribbean Research on Health Sciences (LILACS), published between 2015 and 2019, using the descriptors: "idoso" , "older adult", "older person", "aged", "old", "exposure to violence", " exposição à violência ", "aging", envelhecimento" , "elder abuse", "domestic violence", "violence", " violência", "maus-tratos ao idoso" and "violência doméstica" . As to refine it, the four phases of the PRISMA study selection flow diagram were used. Results: 17 articles were identified which presented as increased risk factors for violence against the older adult, family dysfunction, lack of access to social rights and chronic conditions of disability. Conclusion: The study brings direct contributions to professionals and sectors interested in facing violence against the older adult, which has a high prevalence in today's society.

Correlates of trichomoniasis among female sex workers who inject drugs in two Mexico-US border cities.

This paper evaluates correlates of trichomoniasis among female sex workers who inject drugs (FSWIDs) in two Mexico-US border cities. HIV-negative FSWIDs aged 18 years or older were enrolled in a study between 2008 and 2010 in Tijuana and Ciudad Juarez (Cd.), Mexico. All participants underwent a baseline interviewer-administered survey and did a rapid test for trichomoniasis. Using regression to estimate prevalence ratios, we examined sociodemographics, sex work characteristics, sexual health and behavior, substance use, and police and violence exposures as potential correlates of trichomoniasis. Of 584 women (284 in Tijuana, 300 in Cd. Juarez), prevalence of trichomoniasis was 33.6%. Factors associated with trichomoniasis in multivariable analysis were having money stolen by police in the past six months (adjusted prevalence ratio [aPR] =1.448, 95% confidence interval [CI] = 1.152-1.821), recent methamphetamine use (aPR = 1.432, CI = 1.055-1.944), lifetime syphilis infection (aPR = 1.360, CI = 1.061-1.743), ever use of a home remedy to treat vaginal symptoms (aPR = 1.301, CI = 1.027-1.649), and number of regular clients in the past month (aPR = 1.006 per client, CI = 1.004-1.009), while controlling for age and city of interview. Alongside the need for trichomoniasis surveillance and treatment programs, findings indicate that both structural and behavioral factors serve as primary correlates of trichomoniasis among FSWIDs in these cities.

Are out-of-school adolescents at higher risk of adverse health outcomes? Evidence from 9 diverse settings in sub-Saharan Africa.

OBJECTIVES: We analysed mutually comparable surveys on adolescent attitudes and behaviours from nine sites in seven sub-Saharan African countries, to determine the relationship between school enrolment and adolescent health outcomes. METHODS: Data from the Africa Research, Implementation Science, and Education Network cross-sectional adolescent health surveys were used to examine the associations of current school enrolment, self-reported general health and four major adolescent health domains: (i) sexual and reproductive health; (ii) nutrition and non-communicable diseases; (iii) mental health, violence and injury; and (iv) healthcare utilisation. We used multivariable Poisson regression models to calculate relative risk ratios with 95% confidence intervals (CI), controlling for demographic and socio-economic characteristics. We assessed heterogeneity by gender and study site. RESULTS: Across 7829 adolescents aged 10-19, 70.5% were in school at the time of interview. In-school adolescents were 14.3% more likely (95% CI: 6-22) to report that their life is going well; 51.2% less likely (95% CI: 45-67) to report ever having had sexual intercourse; 32.6% more likely (95% CI: 9-61) to report unmet need for health care; and 30.1% less likely (95% CI: 15-43) to report having visited a traditional healer. School enrolment was not significantly associated with malnutrition, low mood, violence or injury. Substantial heterogeneity was identified between genders for sexual and reproductive health, and in-school adolescents were particularly less likely to report adverse health outcomes in settings with high average school enrolment. CONCLUSIONS: School enrolment is strongly associated with sexual and reproductive health and healthcare utilisation outcomes across nine sites in sub-Saharan Africa. Keeping adolescents in school may improve key health outcomes, something that can be explored through future longitudinal, mixed-methods, and (quasi-)experimental studies.

OBJECTIFS: Nous avons analysé des enquêtes mutuellement comparables sur les attitudes et les comportements d'adolescents dans neuf sites dans sept pays d'Afrique subsaharienne, afin de déterminer la relation entre la scolarisation et les résultats de la santé des adolescents. MÉTHODES: Des données provenant d'enquêtes transversales sur la santé des adolescents menées par le Réseau Africain de Recherche, d'Implémentation, de Science et d'Education ont été utilisées pour examiner les associations existant entre la scolarisation, l'état de santé général autodéclaré et les quatre principaux domaines de la santé des adolescents: (i) santé sexuelle et reproductive ; (ii) nutrition et maladies non transmissibles; (iii) santé mentale, violence et blessures et (iv) utilisation des soins de santé. Nous avons utilisé des modèles de régression multivariée de Poisson pour calculer les rapports de risque relatifs avec des intervalles de confiance (IC) à 95%, en tenant compte des caractéristiques démographiques et socioéconomiques. Nous avons évalué l'hétérogénéité par sexe et par site d'étude. RÉSULTATS: Sur 7.829 adolescents âgés de 10 à 19 ans, 70,5% étaient à l'école au moment de l'enquête. Les adolescents scolarisés étaient 14,3% (IC95%: 6-22) plus susceptibles de déclarer que leur vie se passait bien, 51,2% (IC95%: 45-67) moins susceptibles de déclarer avoir déjà eu des rapports sexuels, 32,6% (IC95%: 39-91) plus susceptibles de signaler un besoin de soins de santé non satisfait et 30,1% (IC95%: 15-43) moins susceptibles de déclarer avoir rendu visite à un guérisseur traditionnel. La scolarisation n'était pas associée de manière significative à la malnutrition, à la mauvaise humeur, à la violence ou aux blessures. Une hétérogénéité substantielle a été identifiée entre les sexes pour la santé sexuelle et reproductive, et les adolescents scolarisés étaient particulièrement moins susceptibles de faire état de résultats défavorables pour la santé dans les milieux où la moyenne de scolarisation était élevée. CONCLUSIONS: La scolarisation est fortement associée aux résultats en matière de santé sexuelle et reproductive et d'utilisation des soins de santé dans neuf sites en Afrique subsaharienne. Garder les adolescents à l'école peut améliorer les principaux résultats de santé, ce qui peut être exploré dans le cadre de futures études longitudinales.

Association between violence during pregnancy and preterm birth and low birth weight in Colombia: Analysis of the demographic and health survey.

To explore the association between low birth weight and preterm birth with violence during pregnancy, we conducted a cross-sectional study by using the 2010 Colombian Demographic and Health Survey. We conducted bivariate analyses, binomial logistic regression, and stratified models by age, and 14,520 women were included. There was no association between violence and low birth weight. Nonetheless, an association with preterm birth in women aged over 35 was observed (OR 1.98, 95%CI 1.23, 3.17). Prenatal care appeared to be a protective factor for both outcomes. This research unexpectedly showed that supplementation with folic acid and iron was associated with preterm birth.

Converging drivers of interpersonal violence: Findings from a qualitative study in post-hurricane Haiti.

OBJECTIVE: Interpersonal violence affecting women and children is increasingly recognized as a public health priority in humanitarian emergencies. Yet, research and intervention efforts have been fragmented across gender-based violence and child protection sectors. Using data from the Transforming Households: Reducing Incidence of Violence in Emergencies (THRIVE) project, this study sought to qualitatively investigate the intersecting drivers of multiple forms of violence in Côteaux, Haiti, while obtaining insight on how these drivers may be influenced by a humanitarian emergency. METHODS: This analysis used transcripts obtained using a photo elicitation approach over the course of three sessions per person. Thirty-six individuals participated in the study: eight adult females, ten adult males, eight adolescent females, ten adolescent males. Participants were given cameras to capture images related to family relationships, family safety, and changes to family dynamics due to Hurricane Matthew and its aftermath. In subsequent sessions, these photographs were used as prompts for qualitative interviews. RESULTS: Multiple and converging drivers of interpersonal violence were identified including the accumulation of daily stressors, loss of power/control, learned behavior (intergenerational cycle of abuse), and inequitable gender norms, all of which were influenced by the humanitarian context caused by Hurricane Matthew. CONCLUSIONS: Our findings suggest multiple and converging drivers of violence may be exacerbated in times of crises, requiring interdisciplinary responses. In order to comprehensively address the drivers of violence, practitioners and policy makers should consider the needs of individuals and their families holistically, integrating community-led, gender transformative efforts and positive parenting with basic needs provision.

Violence against the elderly: the conceptions of nursing professionals regarding detection and prevention. / Violência contra idosos: concepções dos profissionais de enfermagem acerca da detecção e prevenção.

OBJECTIVE: To analyze the conceptions of the nursing professionals working in Basic Health Units regarding the detection and prevention of violence against the elderly. METHODS: Descriptive, exploratory, qualitative study. Performed in two BHUs in Mossoró/RN, using a semi-structured interview script, from March to August of 2013. Sample composed of four nurses and six nursing technicians. The content analysis, pre-analysis, material exploration, and treatment of results were performed. RESULTS: Four categories were identified: Strategies used to identify violence against the elderly; Types of violence against the elderly; Conduct used after finding a suspicion of violence; SUS and the problem of violence against the elderly. Many professionals recognize/distrust possible cases, however, they do not know how to proceed. The dimension of the problem requires that pragmatic interventions be performed in the clinical setting and in the social context. FINAL CONSIDERATIONS: There is a need for continuing education for professionals and greater communication between the bodies responsible for reporting and embracement.

Health system and law enforcement synergies for injury surveillance, control and prevention: a scoping review.

BACKGROUND: Healthcare providers and law enforcement (LE) officers are among the most common first responders to injuring events. Despite frequent interface between the health system (HS) and LE sectors, the published evidence that supports their collaboration in injury surveillance, control and prevention has not been comprehensively reviewed. METHODS: We conducted a scoping review of literature published from 1990 to 2016 that focused on local and regional HS and LE collaborations in injury surveillance, control and prevention. Our aim was to describe what is known and what remains unexplored about these cross-sector efforts. RESULTS: 128 articles were included in the final review. These were categorised by their focus on either surveillance activities or partnerships in injury control and prevention programmes. The majority of surveillance articles focused on road traffic injuries. Conversely, articles describing partnerships and programme evaluations primarily targeted the prevention of interpersonal violence. DISCUSSION: This review yielded two major findings: overall, the combination of HS and LE injury data added value to surveillance systems, especially as HS data augmented LE data; and HS and LE partnerships have been developed to improve injury control and prevention. However, there are few studies that have evaluated the impact and sustainability of these partnerships. CONCLUSIONS: The current evidence to support HS and LE collaboration in injury surveillance and control and prevention programmes is heterogeneous. Notable gaps suggest ample opportunity for further research and programme evaluation across all types of injury.

Violência contra idosos: concepções dos profissionais de enfermagem acerca da detecção e prevenção / Violencia contra ancianos: conceptos de profesionales de enfermería sobre la detección y prevención / Violence against the elderly: the conceptions of nursing professionals regarding detection and prevention

Resumo OBJETIVO Analisar as concepções dos profissionais de enfermagem atuantes em Unidades Básicas de Saúde quanto à detecção e prevenção de idosos violentados. MÉTODOS Estudo descritivo, exploratório, qualitativo. Realizado em duas UBS, Mossoró/RN, utilizando roteiro de entrevista semiestruturada, em março a agosto de 2013. Amostra composta por quatro enfermeiros e seis técnicos de enfermagem. Realizada análise de conteúdo. RESULTADOS Identificaram-se 4 categorias: Estratégias utilizadas para identificar a violência contra o idoso; Tipos de violências contra o idoso; Conduta utilizada após constatação de uma suspeita de violência; SUS e a problemática da violência contra o idoso. Muitos profissionais reconhecem/desconfiam dos possíveis casos, entretanto, não sabem como proceder. A dimensão do problema exige que sejam realizadas intervenções pragmáticas no meio clínico e no contexto social. CONCLUSÕES Há necessidade de educação permanente para profissionais e maior comunicação entre as instâncias responsáveis pela denúncia e acolhimento.

Resumen OBJETIVO Analizar los conceptos de enfermeros activos en unidades básicas de la salud sobre la detección y prevención del maltrato hacia personas ancianas. MÉTODOS Estudio exploratorio, descriptivo y cualitativo, realizado en dos UBS, en Mossoro/RN, por medio de entrevistas semiestructuradas entre marzo y agosto de 2013. Se realizó el estudio con cuatro enfermeros y seis técnicos de enfermería. Se llevó a cabo el análisis de contenido. RESULTADOS El análisis se divide en 4 categorías: Estrategias utilizadas para identificar la violencia contra ancianos; Tipos de violencia contra personas mayores; Acción utilizada luego de detectarse la violencia; y SUS y el tema de la violencia contra ancianos. Muchos profesionales reconocen/desconfían de los posibles casos, sin embargo, no saben cómo proceder. La magnitud del problema requiere de intervenciones pragmáticas que se lleven a cabo en el ámbito clínico y en el contexto social. CONSIDERACIONES FINALES Existe la necesidad de una educación continua para profesionales y una mayor comunicación entre los organismos responsables de la queja y acogida.

Abstract OBJECTIVE To analyze the conceptions of the nursing professionals working in Basic Health Units regarding the detection and prevention of violence against the elderly. METHODS Descriptive, exploratory, qualitative study. Performed in two BHUs in Mossoró/RN, using a semi-structured interview script, from March to August of 2013. Sample composed of four nurses and six nursing technicians. The content analysis, pre-analysis, material exploration, and treatment of results were performed. RESULTS Four categories were identified: Strategies used to identify violence against the elderly; Types of violence against the elderly; Conduct used after finding a suspicion of violence; SUS and the problem of violence against the elderly. Many professionals recognize/distrust possible cases, however, they do not know how to proceed. The dimension of the problem requires that pragmatic interventions be performed in the clinical setting and in the social context. FINAL CONSIDERATIONS There is a need for continuing education for professionals and greater communication between the bodies responsible for reporting and embracement.

Iluminando a invisibilidade: panorama das notificações de violência contra as populações negra e indígena no estado do Rio Grande do Sul / Illuminating invisibility: overview of violence reports against the black and indigenous populations in the state of Rio Grande do Sul

As populações negra e indígena, historicamente, têm sido privadas de direitos básicos, tornando frequentes casos de violência, de desrespeito, de discriminação e têm sofrido, também, com a invisibilidade nas políticas públicas. Este artigo tem o objetivo de levantar dados sobre a violência sofrida pelas populações que se autodeclararam da raça/cor preta ou indígena, durante o preenchimento das fichas de notificações de violência, no estado do Rio Grande do Sul. Trata-se de um estudo de abordagem quantitativa, descritiva e retrospectiva. Os dados foram coletados através do Sistema de Informações de Saúde do Departamento de Informática do Sistema Único de Saúde (Tabnet/Datasus). As informações foram analisadas sob a forma de números absolutos e proporções, com auxílio de tabelas e gráficos do programa Microsoft Excel. Os resultados demonstram que, apesar de alarmantes, os dados não expressam a magnitude da realidade, visto o processo de naturalização e de banalização da violência, consequência do racismo e da discriminação que acometem os grupos populacionais citados. A subnotificação da violência também interfere diretamente nos resultados. A discussão levantada evidencia a necessidade de debate e problematização acerca da qualificação das notificações e informações de modo a subsidiar as políticas públicas para a promoção da equidade a nível nacional.

Historically the black and indigenous populations have been deprived of their basic rights. Thus, cases of violence, disrespect and discrimination become more frequent, resulting in more suffering a sense of total invisibility in public policies. This article aims to collect data on the violence suffered by populations that have declared themselves black or indigenous during the filling of violence reports, in the state of Rio Grande do Sul. It is a quantitative, descriptive and retrospective study. Data were collected through the Health Information System of the IT Department of SUS (Brazilian Unified Health System) (Tabnet/Datasus). The information was analyzed using absolute numbers and proportions, through the Microsoft Excel tables and graphs. The results, although alarming, do not express the magnitude of reality, due to naturalization and banalization of violence, a consequence of racism and discrimination that affect the populations mentioned. The results are also affected by the underreporting violence. The discussion highlights the need for debate and questioning about the qualification of reports and information in order to subsidize public policies for the promotion of equity at a national level.

When the baby remains there for a long time, it is going to die so you have to hit her small for the baby to come out": justification of disrespectful and abusive care during childbirth among midwifery students in Ghana.

Despite global attention, high levels of maternal mortality continue to plague many low- and middle-income settings. One important way to improve the care of women in labour is to increase the proportion of women who deliver in a health facility. However, due to poor quality of care, including being disrespected and abused, women are reluctant to come to facilities for delivery care. The current study sought to examine disrespectful and abusive treatment towards labouring women from the perspective of midwifery students who were within months of graduation. Key Messages •Midwifery students in Ghana's public midwifery schools report witnessing and participating in many forms of disrespect and abuse during deliveries as part of their education. While they are clear as to why respectful care is important and necessary, they are able to justify and explain reasons for disrespectful and abusive care. This poor treatment of labouring women was explicitly and tacitly supported by these students' teachers and preceptors. •All study materials and methods were reviewed and approved by the Ghana Health Service Ethical Review Committee, the Kwame Nkrumah University of Science and Technology Committee on Publication and Human Ethics, and the University of Michigan Institutional Review Board. •This research was made possible through a grant from the African Studies Center, University of Michigan. For this study, we conducted focus groups with final year midwifery students at 15 public midwifery training colleges in all 10 of Ghana's regions. Focus group discussions were recorded and transcribed. A multi-disciplinary team of researchers from the US and Ghana analysed the qualitative data. While students were able to talk at length as to why respectful care is important, they were also able to recount times when they both witnessed and participated in disrespectful and abusive treatment of labouring women. The themes which emerged from these data are: 1) rationalization of disrespectful and abusive care; 2) the culture of blame and; 3) no alternative to disrespect and abuse. Although midwifery students in Ghana's public midwifery schools highlight the importance of providing high-quality, patient-centred respectful care, they also report many forms of disrespect and abuse during childbirth. Without better quality care, including making care more humane, the use of facility-based maternity services in Ghana is likely not to improve. This study provides an important starting point for educators, researchers, and policy makers to re-think how the next generation of healthcare providers needs to be prepared to provide high-quality, respectful care to women during labour and delivery in low-resource settings.

Characteristics of the Violence and Accidents Survey Conducted in Brazilian Sentinel Emergency Departments. / Perfil do Inquérito de Violências e Acidentes em Serviços Sentinela de Urgência e Emergência.

The Violence and Accidents Survey Conducted in Sentinel Emergency Departments (VIVA Survey) is the sentinel surveillance component of the Violence and Accidents Surveillance System (VIVA). It was conducted for the first time in 2006 and again in 2007, 2009, 2011 and 2014. The sample is comprised of victims of accidents and violence treated in Emergency Departments linked to the Brazilian National Health System (SUS). The services are selected intentionally. This isfollowed by probability sampling of 12-hour shifts by conglomerates in single-stage selection. Data is collected by trained interviewers using a standard form. The variables include data about the service site, the victim, the event, injury and case development. The VIVA Survey provides key information for the implementation of policies for addressing violence and accidents as well as for health and peace promotion policies.

Should violence services be integrated within abortion care? A UK situation analysis.

The prevalence of violence against women worldwide raises the question of the desirability and feasibility of integrating interpersonal violence (IPV) services within abortion care. By examining present services and context in an Inner London borough in the UK, this situation analysis explored the hypothesis that an established, integrated, health-based service (comprising raised awareness, staff training in routine IPV enquiry and referral to a community-based in-reach IPV service) would be transferable into abortion services. Four sources of qualitative data investigated views on integrating services: key stakeholder in-depth interviews including with providers of abortion and IPV services and commissioners and IPV survivors with past abortion service use (3 user, 15 provider); qualitative analysis of the open-ended part of a survey of current abortion service users with and without experience of IPV; feedback from an interactive workshop and data from field observations. While there was consensus among all informants that women experiencing IPV and seeking abortion have unidentified, unaddressed needs, how any intervention might be organised to address these needs was contested; thus questions remain about whether, when and how to raise the topic of IPV and what to offer. Two major anxieties surfaced: a practical concern in terms of interrupting a streamlined abortion service that suits the majority of staff and patients, and a conceptual concern about risk of stigmatising abortion seekers as 'victims in crisis'. Thus, our findings indicate: when integrating IPV interventions into abortion services, local context, the integrity of separate pathways, and women's safety and agency must be considered, especially when abortion rights are under attack. Novel approaches are required and should be researched.

Differences in polysubstance use patterns and drug-related outcomes between people who inject drugs receiving and not receiving opioid substitution therapies.

AIMS: To test if polysubstance use profiles and drug-related outcomes differ between those receiving and not receiving opioid substitution therapies (OST) among people who inject drugs (PWID). DESIGN: An annual cross-sectional, sentinel sample of PWID across Australia. SETTING: Data came from 3 years (2011-13) of the Illicit Drug Reporting System (IDRS). PARTICIPANTS: A total of 2673 participants who injected drugs from the combined national IDRS samples of 2011 (n = 868), 2012 (n = 922) and 2013 (n = 883). MEASUREMENTS: Latent class analysis (LCA) was used to summarize participants' self-reported use of 18 types of substances, with the resulting polysubstance use profiles then associated with participant experience of a number of drug-related outcomes. FINDINGS: Polysubstance use profiles exhibiting a broad range of substance use were generally at increased risk of negative drug-related outcomes, whether or not participants were receiving OST, including thrombosis among OST receivers [odds ratio (OR) = 2.13, 95% confidence intervals (CI) = 1.09-4.17], injecting with used needles among OST receivers and non-receivers, respectively (OR = 2.78, 95% CI = 1.50-5.13; OR = 2.15, 95% CI = 1.34-3.45) and violent criminal offences among OST receivers and non-receivers, respectively (OR =2.30, 95% CI = 1.16-4.58; OR = 1.87, 95% CI = 1.14-3.07). An important exception was non-fatal overdose which was related specifically to a class of PWID who were not receiving OST and used morphine frequently (OR = 1.83, 95% CI = 1.06-3.17) CONCLUSION: Regardless of opioid substitution therapies usage, people who inject drugs who use a broad-range of substances experience greater levels of injecting-related injuries and poorer health outcomes and are more likely to engage in criminal activity than other groups of people who inject drugs.

Violence in general practice: a gendered risk?

This article focuses on the extent to which violence against family doctors in England is experienced in gendered terms. It draws on data from two studies: a postal survey of 1,300 general practitioners (GPs) (62% response rate) and in-depth interviews with 26 doctors who have been assaulted or threatened; and 13 focus groups with primary care teams and 19 in-depth interviews with GPs who had expressed an interest in the topic of violence against doctors. Most GPs, regardless of gender, reported receiving verbal abuse over the last two years, often interpreted as a consequence of declining deference to professionals, while actual physical assaults and threats were much rarer and more likely to be reported by men. Overall, women GPs were much more likely to express concern about violence and to take personal precautions, although younger male GPs working in inner-city practices also had high levels of concern. The study shows how some aspects of family doctors' work has been organised on gendered lines and how these contribute to the differences in experience of violence. We suggest that the increasing proportion of women among family doctors may have implications for these, often tacit, organisational routines.

[Treatment of childhood injuries and violence in public emergency services]. / Atendimentos por acidentes e violências na infância em serviços de emergências públicas.

This study aimed to analyze the profile of treatment for accidents and violence involving children under 10 years of age in Brazil in the year 2011. This was a cross-sectional descriptive study in 71 emergency services in the Brazilian Unified National Health System (SUS), located in the national capital and 24 state capitals. Data were obtained from the Ministry of Health's system of sentinel surveillance services for Violence and Accidents (VIVA Survey). The highest proportion of injuries (67.4%) occurred inside the child's home. Among unintentional injuries, falls were the most frequent (52.4%), followed by running into objects or persons (21.8%) and traffic injuries (10.9%), especially as passengers (bicycles were an important means of transportation involved in the injuries). The vast majority of unintentional injuries are avoidable, and educational measures should be adopted, especially with parents, teachers, the community, and health workers, calling attention to the risks and the adoption of safe behaviors in the home, at school, and in leisure-time activities. Cases of violence are subject to mandatory reporting, and prompt measures should be taken to protect victims.

Atendimentos por acidentes e violências na infância em serviços de emergências públicas / Treatment of childhood injuries and violence in public emergency services / Atención por accidentes y violencia contra la infancia en servicios públicos de urgencias

O objetivo deste artigo foi analisar o perfil dos atendimentos de emergência por acidentes e violências envolvendo crianças menores de 10 anos no Brasil no ano de 2011. Foi realizado estudo transversal, descritivo, em 71 serviços de urgência e emergência no âmbito do SUS, localizados no Distrito Federal e em 24 capitais brasileiras. Os dados foram obtidos no sistema de serviços sentinelas de Vigilância de Violências e Acidentes (VIVA Inquérito), do Ministério da Saúde. A maior proporção das lesões (67,4%) ocorreu no ambiente domiciliar. Dentre as injúrias não intencionais, as quedas foram a ocorrência mais frequente (52,4%), seguidas de choque contra objetos/pessoas (21,8%) e lesões no trânsito (10,9%), destacando-se as vítimas na condição de passageiros, e dentre os meios de locomoção da vítima são destaque as bicicletas. As injúrias não intencionais na grande maioria são evitáveis e devem ser adotadas medidas educativas, em especial junto aos pais, educadores, comunidade, profissionais de saúde e educação, alertando para os riscos e adoção de comportamentos seguros em relação ao ambiente doméstico, escola e de lazer. As violências são objeto de notificação obrigatória, e as ações de proteção às vítimas devem ser instituídas prontamente.

This study aimed to analyze the profile of treatment for accidents and violence involving children under 10 years of age in Brazil in the year 2011. This was a cross-sectional descriptive study in 71 emergency services in the Brazilian Unified National Health System (SUS), located in the national capital and 24 state capitals. Data were obtained from the Ministry of Health’s system of sentinel surveillance services for Violence and Accidents (VIVA Survey). The highest proportion of injuries (67.4%) occurred inside the child’s home. Among unintentional injuries, falls were the most frequent (52.4%), followed by running into objects or persons (21.8%) and traffic injuries (10.9%), especially as passengers (bicycles were an important means of transportation involved in the injuries). The vast majority of unintentional injuries are avoidable, and educational measures should be adopted, especially with parents, teachers, the community, and health workers, calling attention to the risks and the adoption of safe behaviors in the home, at school, and in leisure-time activities. Cases of violence are subject to mandatory reporting, and prompt measures should be taken to protect victims.

El objetivo de este estudio fue analizar el perfil de las consultas de urgencia por causas externas que involucran a niños menores de 10 años en Brasil, 2011. Este estudio transversal, analizando datos de la Violencia de Vigilancia y Accidentes (VIVA), encuesta realizada en 71 servicios de urgencias y emergencias en el Sistema Único de Salud (SUS), con sede en el Distrito Federal y 24 capitales brasileñas. Como resultado de ello el 67,4 % se produjo en el entorno del hogar. Las caídas fueron las más frecuentes (52,4 %), seguidas por la colisión con objetos/personas (21,8%) y las lesiones de tráfico (10,9%). Las lesiones no intencionales en la gran mayoría son evitables y se producen en el hogar y se pueden prevenir. La violencia contra los niños más pequeños son más frecuentemente cometidas por miembros de la familia y están sujetas a notificación obligatoria, destinada a la implantación de medidas de protección a las víctimas.

Deaths due to injury, including violence among married Nepali women of childbearing age: a qualitative analysis of verbal autopsy narratives.

OBJECTIVES: Self-harm and interpersonal violence are important causes of death among women in Nepal. We analysed prospectively collected data to investigate the extent and nature of injury-related deaths among married women aged 15-49 years, recorded through verbal autopsy in rural Sarlahi District, Nepal. METHODS: Verbal autopsies were systematically collected on all deaths of married women of reproductive age (15-49 years) over a 3-year period (1994-1997) as part of a randomised community-based trial of maternal vitamin A and ß-carotene supplementation. This analysis included a three-way comparison of verbal autopsy data: qualitative free-response narratives, closed-ended responses, and physician-assigned consensus cause of death. RESULTS: We focused on 46 of 559 deaths (8.2%) that were determined to be injury-related. Of the 46, 28% were identified as intentionally self-inflicted, and 11% as intentionally inflicted by another. Inconsistencies were noted between verbal autopsy reports of causes of deaths and physician assessments. Conflicts within the family figured prominently in the narratives. Women with unstable family situations and suffering from mental illness were often described as having experienced violent deaths. CONCLUSIONS: Findings highlight that intervention efforts might be necessary especially in situations where there are poor family dynamics or mental health issues in order to prevent potential intrafamily violence and possible death. Results also point to the need for further documentation of violent deaths in rural Nepal.

Prevention of injury and violence in the USA.

In the first three decades of life, more individuals in the USA die from injuries and violence than from any other cause. Millions more people survive and are left with physical, emotional, and financial problems. Injuries and violence are not accidents; they are preventable. Prevention has a strong scientific foundation, yet efforts are not fully implemented or integrated into clinical and community settings. In this Series paper, we review the burden of injuries and violence in the USA, note effective interventions, and discuss methods to bring interventions into practice. Alliances between the public health community and medical care organisations, health-care providers, states, and communities can reduce injuries and violence. We encourage partnerships between medical and public health communities to consistently frame injuries and violence as preventable, identify evidence-based interventions, provide scientific information to decision makers, and strengthen the capacity of an integrated health system to prevent injuries and violence.

The invisible soldiers: understanding how the life experiences of girl child soldiers impacts upon their health and rehabilitation needs.

There are estimated 120,000 girl child soldiers worldwide. Recruitment makes girls vulnerable to the violence of war, torture, psychological trauma and sexual abuse with huge impact on their physical, mental and reproductive health. Despite this, girl soldiers often remain an invisible and marginalised group frequently neglected from disarmament, demobilisation and reintegration programmes. This is not just a local issue: with former child soldiers seeking asylum as refugees there is an increasing need for health workers in the destination countries to understand their health needs in order to inform appropriate holistic service provision. This review provides an overview of how the duties and life experiences of girl soldiers, including gender-specific abuses, impacts upon their health and concludes with a summary of recommendations as to how their rehabilitation needs can be addressed.

Bullying e autoestima em adolescentes de escolas públicas / Bullying and self-esteem in adolescents from public schools

OBJETIVOS: realizar diagnóstico situacional do bullying e autoestima em unidades municipais de ensino, por meio de estimativa da prevalência do bullying, segundo o sexo, faixa etária e situação do ator; identificar o nível de autoestima dos escolares segundo sexo e situação do ator e correlacionar com o envolvimento em situações de bullying. MÉTODOS: estudo transversal, realizado com 237 alunos, do 9º ano do ensino fundamental, em escolas públicas municipais do Programa Saúde na Escola de Olinda (PE). Foi utilizado um questionário dividido em três blocos, um sociodemográfico, outro sobre bullying, validado por Freire, Veiga e Ferreira, e um para avaliar a autoestima, de Rosenberg. RESULTADOS: a prevalência de bullying foi de 67.5%. A população do estudo foi composta por adolescentes do sexo feminino (56,4%), na faixa etária de 15-19 anos (51,3%), de raça/cor preta (69,1%). Grande parte mora com quatro ou mais pessoas (79,7%), em casa própria (83,8%) e com cinco ou mais cômodos na residência (79,1%). Presenciar ou sofrer bullying foram às situações mais registradas (59,9% e 48,9%, respectivamente); Quando se associou os papéis de bullying e autoestima em relação ao sexo verificou-se que no grupo de vítimas/agressores e agressores (p = 0,006 e 0,044; respectivamente), o sexo masculino apresentou escores de autoestima superiores estatisticamente significativos em relação aos do sexo feminino. CONCLUSÃO: os achados apontam para um número grande de alunos envolvidos nos diversos papéis do bullying, identificando-se associação entre estas características e o sexo/gênero e autoestima dos envolvidos. Identifica-se a necessidade de estudos adicionais sobre a natureza do evento.

OBJECTIVES: to perform a situational analysis of bullying and self-esteem in municipal school units, by estimating the prevalence of bullying, according to gender, age, and role in bullying situations; and to identify the level of self-esteem of students by gender and role in bullying situations and correlate with the involvement in bullying situations. METHODS: this was a cross-sectional study with 237 students in the ninth grade of middle school from public schools participating in the School Health Program in the city of Olinda (PE). The questionnaire used in the study was divided into three blocks: a sociodemographic block; a block on bullying, validated by Freire, Simão, and Ferreira (2006); and a block to assess self-esteem, by Rosenberg (1989). RESULTS: the prevalence of bullying was 67.5%. The study population consisted of adolescents, mostly female (56.4%), aged 15-19 years (51.3%), of black ethnicity (69.1%). Most students lived with four or more people (79.7%) in their family-owned homes (83.8%), which had five or more rooms (79.1%). Observing bullying or being bullied were the most often reported situations (59.9% and 48.9%, respectively); when the roles of bullying are associated with self-esteem in relation to gender, it was observed that in the group of victims/aggressors and aggressors (p = 0.006 and 0.044, respectively), males had higher statistically significant self-esteem scores when compared to females. CONCLUSION: the findings indicate a large number of students involved in the several roles of bullying, identifying an association between these characteristics and sex/gender and self-esteem of those involved. The present study has identified the need for further studies on the nature of the event.