Prevalence of reported violence in children and adolescents in the clinical work of health professionals: a systematic review and meta-analysis.

This article aims to analyze the prevalence of reporting and notification of violence in children and adolescents in the work of clinical health professionals. The search was performed in six electronic databases and the gray literature for studies published until June 1, 2022. Estimates of interest were calculated using random effects meta-analyses. Two reviewers independently evaluated the potentially eligible studies according to the following criteria: cross-sectional studies carried out with health professionals who provided clinical care for children and adolescents and dealt with violence cases. Two reviewers extracted data on included trial characteristics, methods, and outcomes. Expectations of interest were transformed using random effects meta-analyses. The meta-analysis of the prevalence of reports of violence performed with 42 articles was 41%. The notification meta-analysis occurred with 39 articles and was 30%. About one in two health professionals face situations of violence against children and adolescents in their clinical practice (41%), and approximately one in three health professionals report the cases (30%).

Adolescent pregnancy amongst displaced women in Bogota: playing between the barbs of structural violence-a qualitative study.

BACKGROUND: Colombia has high numbers of internally displaced people, forced to migrate due to the conflict. 1 in 3 displaced women undergo pregnancy during adolescence, compared to around 1 in 5 in the non-displaced population, alongside health and resource inequalities between these groups. There is limited qualitative information available from the perspectives of displaced women experiencing adolescent pregnancy. This research explores how structural violence may feature in their experiences. METHODS: Qualitative methods were used. Participants were recruited with purposive sampling, using key informants and snowball sampling technique. 14 semi-structured interviews were conducted in Ciudad Bolívar, Bogotá, involving 11 displaced women who began childbearing age 15-19 in the past 10 years, and 4 participants' mothers. Data was analysed using the theoretical framework of structural violence, and emergent themes categorised using thematic analysis. RESULTS: Pregnancy was considered advantageous in many ways, but this was contradicted by resulting disadvantages that ensued. Structural violence was embedded in life stories, manifesting in poverty and difficulties accessing reliable income, poor access to healthcare and education following pregnancy. Institutional and interpersonal discrimination confounded these challenges. CONCLUSIONS: Pregnancy during adolescence was a contradictory experience, representing both a safety net and a trap due to a complex interplay of structural and cultural violence in everyday survival. Policymakers must consider the importance of the context surrounding adolescent pregnancy and address systematic disadvantages affecting women in these positions.

The violent conflict in Colombia has left many people forced to leave their homes and become 'internally displaced'. Internally displaced women are more likely to become pregnant during their adolescence than non-displaced women. This work tries to understand more about the everyday lives of displaced women who experience adolescent pregnancy, through interviews. The interviews were analysed and results interpreted using the theory of 'structural violence'. Structural violence describes how social structures such as racism, sexism, war and poverty determine life choices, leading to suffering and inequality. The work found that pregnancy and motherhood in adolescence for displaced women was positive in many ways by bringing purpose, status and companionship. However, these women also experienced many challenges after pregnancy, such as exclusion from education and secure employment and difficulty accessing healthcare. This demonstrated that structural violence features in multiple interconnected forms in the daily lives of displaced adolescent mothers. The work urges policymakers to appreciate the complexity of context surrounding adolescent pregnancy and motherhood, and to address the structural disadvantages facing women in these situations.

Does Escalating Violence and Associated Fear of Crime Worsen Psychological Well-Being in Community Dwellers Living in a Rural Setting? Results From the Atahualpa Project Cohort.

BACKGROUND: Escalating street violence and criminal homicides have an adverse impact on psychological well-being. However, these consequences have been difficult to evaluate. Using a recently validated scale, we aimed to assess the impact of fear of crime on the psychological status of middle-aged and older adults living in a rural setting afflicted by endemic violence. METHODS: Participants were selected from Atahualpa residents included in previous studies targeting psychological distress in the population. A validated scale was used to objectively quantify fear of crime in participants. Differences in symptoms of depression and anxiety between baseline and follow-up were used as distinct dependent variables and the continuous score of the fear of crime scale was used as the independent variable. Linear regression models were fitted to assess the association between the exposure and the outcomes, after adjusting for relevant confounders. RESULTS: A total of 653 participants (mean age = 53.2 ± 11.5 years; 57% women) completed the requested tests. We found a 13% increase in symptoms of depression and anxiety during the peak of violence in the village compared with previous years. Linear regression models showed a significant association between the total score on the fear of crime questionnaire and worsening symptoms of depression (ß = .24; 95% CI = 0.14-0.35) and anxiety (ß = .31; 95% CI = 0.24-0.37), after adjustment for relevant confounders. CONCLUSIONS: This study shows a significant aggravating effect of fear of crime on pre-existing symptoms of depression and anxiety and a deleterious effect of these conditions on overall well-being.

Life-course influences of poverty on violence and homicide: 30-year Brazilian birth cohort study.

BACKGROUND: Homicide is the leading cause of death among young people in Latin America, one of the world's most violent regions. Poverty is widely considered a key cause of violence, but theories suggest different effects of poverty, depending on when it is experienced in the life-course. Longitudinal studies of violence are scarce in Latin America, and very few prospective data are available worldwide to test different life-course influences on homicide. METHODS: In a prospective birth cohort study following 5914 children born in southern Brazil, we examined the role of poverty at birth, in early childhood, and in early adulthood on violence and homicide perpetration, in criminal records up to age 30 years. A novel Structured Life Course Modelling Approach was used to test competing life-course hypotheses about 'sensitive periods', 'accumulation of risk', and 'downward mobility' regarding the influence of poverty on violence and homicide. RESULTS: Cumulative poverty and poverty in early adulthood were the most important influences on violence and homicide perpetration. This supports the hypothesis that early adulthood is a sensitive period for the influence of poverty on lethal and non-lethal violence. Results were replicable using different definitions of poverty and an alternative outcome of self-reported fights. CONCLUSION: Cumulative poverty from childhood to adulthood was an important driver of violence and homicide in this population. However, poverty experienced in early adulthood was especially influential, suggesting the importance of proximal mechanisms for violence in this context, such as unemployment, organized crime, drug trafficking, and ineffective policing and justice systems.

Atenção primária à saúde e a violência contra pessoa idosa: revisão integrativa / Primary health care and violence against elderly people: an integrative review / Atención primaria de saludy violencia contra las personas mayores: unarevisión integrativa

Introdução:O envelhecimento populacional é uma realidade mundial. Trata-se de um processo natural do período de desenvolvimento humano, caracterizado por progressiva perda celular e declínio funcional do organismo, associado a maior probabilidade de convívio com doenças crônicas e violências. Objetivo:Analisara produção científica a respeito da violência contra pessoas idosas nos espaços da Atenção Primária à Saúde, posta como ordenadora do Sistema Único de Saúde. Metodologia:Trata-se de um estudo de Revisão Integrativa, cuja metodologia baseia-se na Prática Baseada em Evidências, utilizando as bases de dados: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Medical Literature Analysis and Retrieval Sistem online (Medline) e Base deDados de Enfermagem (BDENF) e tendo como critério de inclusão os artigos publicados nos últimos 5 anos (2018-2023), em português, inglês e espanhol. Resultados:Oito artigos foram selecionados para síntese qualitativa. Os trabalhos selecionados indicam Nível de Evidência entre 2, 4 e 5, ou seja, 62,5% dos achados possuem Nível de Evidência 4, conforme Classificação de Oxford Centre for Evidence-based Medicine. Também, foram aglutinados em eixos temáticos, sendo: Violências e suas manifestações, Formação profissional e sua (des)continuidade, O cuidado na Atenção Primária à Saúdesobre situações de violência contra a pessoa idosa e seus impasses e a Saúde do cuidador invisibilizada. Conclusões:Foipossível observar que há políticas públicas destinadas a essaproblemática (de saúdee social), entretanto,os serviços públicos ainda executamde forma limitadao que está preconizadopela legislação. Verificamos que existem ações propostas para o cuidado desse grupo de risco, no entanto, há que ser mais efetiva e a estratégia da educação permanente nesses espaços poderá ser um recurso potente para melhor gestão do cuidado (AU).

Introduction:Population aging is a global reality. It is a natural process in human development, characterized by progressive cell loss and functional decline of the organism, associated with a higher probability of living with chronic diseases and violence. Objective:To analyze the scientific production regarding violence against elderly people in Primary Health Care settings, positioned as the coordinator of the Unified Health System.Methodology:This is an Integrative Review study, whose methodology is based on Evidence-Based Practice, using the databases: LatinAmerican and Caribbean Literature in Health Sciences (LILACS), Medical Literature Analysis and Retrieval System Online (Medline), and Nursing Database (BDENF), with inclusion criteria of articles published in the last 5 years (2018-2023), in Portuguese, English, and Spanish.Results:Eight articles were selected for qualitative synthesis. The selected works indicate Evidence Levels between 2, 4, and 5, with 62.5% of the findings having Evidence Level 4, according to the Oxford Centre for Evidence-Based Medicine Classification. They were also grouped into thematic axes, namely: Violence and its manifestations, Professional training and its (dis)continuity, Care in Primary Health Care regarding situations of violence against the elderly and its impasses, and Invisible caregiver health.Conclusions:It was observed that there are public policies aimed at addressing this issue (both health and social aspects). However, public services still implement what is recommended by legislation in a limited manner. We found that there are proposed actions for the care of this at-risk group; nevertheless, these actions need to be more effective. The strategy of continuing education in these spaces could be a powerful resource for better care management (AU).

Introducción:El envejecimiento poblacional es una realidad mundial. Se trata de un proceso natural del período de desarrollo humano, caracterizado por la pérdida celular progresiva y el declive funcional del organismo, asociado a una mayor probabilidad de convivencia con enfermedades crónicas y violencias. Objetivo: Analizar la producción científica respecto a la violencia contra las personas mayores en los espacios de Atención Primaria de Salud, posicionada como ordenadora del Sistema Único de Salud.Metodología: Se trata de un estudio de Revisión Integrativa, cuya metodología se basa en la Práctica Basada en la Evidencia, utilizando las bases de datos: Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Sistema de Análisis y Recuperación de Literatura Médica en Línea (Medline) y Base de Datos de Enfermería (BDENF), teniendo como criterio de inclusión los artículos publicados en los últimos 5 años (2018-2023), en portugués, inglés y español.Resultados: Se seleccionaron ocho artículos para la síntesis cualitativa. Los trabajos seleccionados indican un Nivel de Evidencia entre 2, 4 y 5, es decir, el 62,5% de los hallazgos tienen un Nivel de Evidencia 4, según la Clasificación del Centro Oxford de Medicina Basada en la Evidencia. También fueron agrupados en ejes temáticos, siendo: Violencias y sus manifestaciones, Formación profesional y su (des)continuidad, El cuidado en la Atención Primaria de Salud sobre situaciones de violencia contra la persona mayor y sus impases, y la Salud invisibilizada del cuidador.Conclusiones:Se pudo observar que existen políticas públicas destinadas a esta problemática (de salud y social), sin embargo, los servicios públicos aún ejecutan de forma limitada lo que está preconizado por la legislación. Verificamos que existen acciones propuestas para el cuidado de este grupo de riesgo, no obstante, es necesario que sean más efectivas y la estrategia de la educación permanente en estos espacios podría ser un recurso potente para una mejor gestión del cuidado (AU).

Surveillance for Violent Deaths - National Violent Death Reporting System, 48 States, the District of Columbia, and Puerto Rico, 2021.

Problem/Condition: In 2021, approximately 75,000 persons died of violence-related injuries in the United States. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) on violent deaths that occurred in 48 states, the District of Columbia, and Puerto Rico in 2021. Results are reported by sex, age group, race and ethnicity, method of injury, type of location where the injury occurred, circumstances of injury, and other selected characteristics. This report introduces additional incident and circumstance variables, which now include child victim-specific circumstance information. This report also incorporates new U.S. Census Bureau race and ethnicity categories, which now account for more than one race and Native Hawaiian or other Pacific Islander categories and include updated denominators to calculate rates for these populations. Period Covered: 2021. Description of System: NVDRS collects data regarding violent deaths from death certificates, coroner and medical examiner records, and law enforcement reports. This report includes data collected for violent deaths that occurred in 2021. Data were collected from 48 states (all states with exception of Florida and Hawaii), the District of Columbia, and Puerto Rico. Forty-six states had statewide data, two additional states had data from counties representing a subset of their population (31 California counties, representing 64% of its population, and 13 Texas counties, representing 63% of its population), and the District of Columbia and Puerto Rico had jurisdiction-wide data. NVDRS collates information for each violent death and links deaths that are related (e.g., multiple homicides, homicide followed by suicide, or multiple suicides) into a single incident. Results: For 2021, NVDRS collected information on 68,866 fatal incidents involving 70,688 deaths that occurred in 48 states (46 states collecting statewide data, 31 California counties, and 13 Texas counties), and the District of Columbia. The deaths captured in NVDRS accounted for 86.5% of all homicides, legal intervention deaths, suicides, unintentional firearm injury deaths, and deaths of undetermined intent in the United States in 2021. In addition, information was collected for 816 fatal incidents involving 880 deaths in Puerto Rico. Data for Puerto Rico were analyzed separately. Of the 70,688 deaths, the majority (58.2%) were suicides, followed by homicides (31.5%), deaths of undetermined intent that might be due to violence (8.2%), legal intervention deaths (1.3%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force acting in the line of duty, excluding legal executions), and unintentional firearm injury deaths (<1.0%). The term "legal intervention" is a classification incorporated into the International Classification of Diseases, Tenth Revision, and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement.Demographic patterns and circumstances varied by manner of death. The suicide rate was higher for males than for females. Across all age groups, the suicide rate was highest among adults aged ≥85 years. In addition, non-Hispanic American Indian or Alaska Native (AI/AN) persons had the highest suicide rates among all racial and ethnic groups. Among both males and females, the most common method of injury for suicide was a firearm. Among all suicide victims, when circumstances were known (84.4%), suicide was most often preceded by a mental health, intimate partner, or physical health problem or by a recent or impending crisis during the previous or upcoming 2 weeks. The homicide rate was higher for males than for females. Among all homicide victims, the homicide rate was highest among persons aged 20-24 years compared with other age groups. Non-Hispanic Black or African American (Black) males experienced the highest homicide rate of any racial or ethnic group. Among all homicide victims, the most common method of injury was a firearm. When the relationship between a homicide victim and a suspect was known, the suspect was most frequently an acquaintance or friend for male victims and a current or former intimate partner for female victims. Homicide most often was precipitated by an argument or conflict, occurred in conjunction with another crime, or, for female victims, was related to intimate partner violence. Nearly all victims of legal intervention deaths were male, and the legal intervention death rate was highest among men aged 30-34 years. The legal intervention death rate was highest among AI/AN males, followed by Black males. A firearm was used in the majority of legal intervention deaths. When circumstances were known, the most frequent circumstances reported for legal intervention deaths were as follows: the victim used a weapon in the incident and the victim had a substance use problem (other than alcohol use). Other causes of death included unintentional firearm injury deaths and deaths of undetermined intent. Unintentional firearm injury deaths were most frequently experienced by males, non-Hispanic White (White) persons, and persons aged 15-24 years. These deaths most frequently occurred while the shooter was playing with a firearm and were precipitated by a person unintentionally pulling the trigger. The rate of deaths of undetermined intent was highest among males, particularly among AI/AN and Black males, and among adults aged 30-54 years. Poisoning was the most common method of injury in deaths of undetermined intent, and opioids were detected in nearly 80% of decedents tested for those substances. Interpretation: This report provides a detailed summary of data from NVDRS on violent deaths that occurred in 2021. The suicide rate was highest among AI/AN and White males, whereas the homicide rate was highest among Black males. Intimate partner violence precipitated a large proportion of homicides for females. Mental health problems, intimate partner problems, interpersonal conflicts, and acute life stressors were primary precipitating circumstances for multiple types of deaths examined. Public Health Action: Violence is preventable, and data can guide public health action. NVDRS data are used to monitor the occurrence of violence-related fatal injuries and assist public health authorities in developing, implementing, and evaluating programs, policies, and practices to reduce and prevent violent deaths. NVDRS data can be used to enhance prevention efforts into actionable strategies. States or jurisdictions have used their Violent Death Reporting System (VDRS) data to guide suicide prevention efforts and highlight where additional focus is needed. For example, North Carolina VDRS program data have played a significant role in expanding activities related to firearm safety and injury prevention. The program served as a primary data source for partners, which led to the creation of the Office of Violence Prevention in the state, focusing on combatting firearm-related deaths. In Maine, the VDRS provided data on law enforcement officer suicides that were used to help support a bill mandating mental health resiliency and awareness training in the state's law enforcement training academy, along with plans for similar training addressing mental health, substance use, and alcohol problems among corrections officers. In addition, states and jurisdictions have also used their VDRS data to examine factors related to homicide in their state or jurisdiction. For example, Georgia VDRS collaborated with the City of Atlanta Mayor's Office of Violence Reduction to develop two public dashboards that not only offer comprehensive data on violent deaths but also present data on the geographic distribution of populations disproportionately affected by violence to help inform violence prevention interventions.

Interpersonal violence against people with intellectual disabilities in São Paulo, Brazil: characteristics of victims, perpetrators and referrals.

INTRODUCTION: Interpersonal violence is a phenomenon that can occur with different people and conditions. However, people with intellectual disabilities have increased vulnerability to this problem, with potential risks to their health and well-being. The aim of this study was to identify the sociodemographic characteristics of people with disabilities who have been victims of interpersonal violence, the profile of the perpetrators and the measures taken after the victims have been cared for. METHODS: This is an exploratory, descriptive, cross-sectional study using the Interpersonal Violence Notification Forms entered into the Brazilian Ministry of Health's Notifiable Diseases Information System. The city of São Paulo was chosen as the setting because it is the largest city in Latin America and has a faster data processing system than other cities. The period covered notifications made between 2016 and 2022. The information was collected between October and November 2023 and a univariate statistical analysis was carried out. Fisher's exact test was used, with a significance level of 5% (α = 0.05). RESULTS: There were 4,603 notifications against people with intellectual disabilities in the period. The forms of physical violence, neglect/abandonment and psychological/moral violence were more frequent in the 15-19 age group, while sexual violence was more frequent in the 10-14 age group (p < 0.001). The sex most often attacked was female in all the forms investigated (p < 0.001) and the skin colors of the most victimized people were black and/or brown, except in cases of neglect/abandonment (p = 0.058). Most of the victims had little schooling (p = 0.012). The aggressions were committed by one person (p < 0.001), known or related to the victim, such as mother or father, except in cases of sexual violence, where strangers were the main perpetrators (p < 0.001). The sex of the perpetrator was male, except in cases of neglect and/or abandonment (p < 0.001), and the age was between 25 and 29 (p = 0.004). In cases of sexual violence, rape was the most frequent and the procedures carried out were blood collection followed by prophylaxis for Sexually Transmitted Infections (STIs) were the main procedures carried out by health professionals (p = 0.004). The majority of referrals made after receiving care were to the health and social assistance network, with few referrals to bodies such as the human rights reference center, guardianship council and police stations (p < 0.001). CONCLUSION: People with intellectual disabilities are highly vulnerable to the forms of violence studied, especially children and adolescents, black or brown, with low levels of education. The perpetrators are usually close people, male and older than the victims. The referrals made by health professionals did not prioritize the victim's safety and the guarantee of human rights. Lines of care for the health of victims of violence should be implemented, taking into account special aspects, such as people with intellectual disabilities, whose search for help can be difficult.

Interpersonal violence against transgender and cisgender women in Brazilian municipalities: trends and characteristics. / Violência interpessoal em mulheres transgêneras e cisgêneras nos municípios brasileiros: tendências e características.

Violence against women is characterised by male symbolic domination underpinned by patriarchy and expressing gender inequality in society. This study examined reporting of interpersonal violence against cisgender and transgender women 20 to 59 years old in Brazilian municipalities, from 2015 to 2021. This repeat panel study used data from the information system, and time-trend analysis by the Prais-Winsten method. A total of 605,983 notifications were eligible, 1.8% of which involved transgender women. Notifications regarding cisgender women were recorded in 84.8% of the municipalities and transgender women, in 31.7%. Notifications involved predominantly women who were younger (71.9%) and black (55.3%), and proportionally more transgender women (p<0.001). Most notifications were of physical violence (84.8%), followed by psychological violence (40.1%), which was higher among cisgender women (p<0.001) and at shorter intervals among transgender women (ß=-0.71; p=0.005). Notifications of violence still do not reflect the realities, particularly as regards transgender women. Psychological violence, however, which usually starts the cycle of aggression, now ranks second among notifications in Brazil, despite conservative reverses of recent years.

A violência contra mulher caracteriza-se pela dominação simbólica masculina com pilares no patriarcado, expressando a desigualdade de gênero existente na sociedade. O objetivo deste estudo é analisar a notificação de violência interpessoal em mulheres cisgêneras e transgêneras, de 20 a 59 anos, nos municípios brasileiros, no período de 2015 a 2021. Trata-se de estudo do tipo painéis repetidos, utilizando dados do sistema de informação, e análise de tendência temporal pelo método Prais-Winsten. Foram elegíveis 605.983 notificações, sendo 1,8% de transgêneras. As notificações foram registradas em 84,8% dos municípios para mulheres cisgêneras e 31,7% para transgêneras. Houve predomínio em jovens (71,9%) e negras (55,3%), sendo proporcionalmente maior entre as transgêneras (p<0,001). A maioria das notificações foi de violência física (84,8%); seguida de violência psicológica (40,1%), sendo maior nas cisgêneras (p<0,001) e com redução no período para as transgêneras (ß=-0,71; p=0,005). A notificação de violência ainda não reflete a realidade, em particular para mulheres transgêneras. A violência psicológica, entretanto, que costuma ser o início do ciclo de agressão, já ocupa o segundo lugar entre as notificações no país, apesar dos retrocessos vivenciados nos últimos anos.

"I suffered in silence and certainly all women are like that" - Silenced: reproduction of, and breaking with, violence against women living in rural areas. / "Eu sofria calada e certamente toda mulher é assim" - Silenciamentos: reproduções e rupturas da violência contra as mulheres que vivem em contextos rurais.

By way of life stories drawn from 20 interviews of women in two municipalities of Rio Grande do Sul, this qualitative study examined how violence against women living in rural areas is silenced and the challenges involved in breaking that silence. Narrative Analysis arrived at two categories: "I suffered in silence and certainly all women are like that" (Violence silenced) and "We take care of her" (Breaking the silence). The first relates to the oppression of imposed silence and how women were affected by violence and isolation. The second shows the challenges facing women who break the silence and leave abusive relationships and how, through their narratives, to access the stories of other women who suffer violence. The narratives stress that the imposition of silence, which arose from gender roles and constraints on freedom, contributed to their continuing in the abusive relationship. The violence was sustained by the rural setting, where women were even more isolated, alone and unsupported, which heightened their fears, guilt, shame and financial dependence. An inter-sector approach, with more information and care for rural women, is fundamental to addressing this problem.

Este estudo se dedica, através de histórias de vida, a analisar a violência contra as mulheres que vivem em contextos rurais, seu silenciamento e os desafios de rompê-lo. Trata-se de uma pesquisa qualitativa a partir de 20 entrevistas com mulheres rurais em dois municípios do Rio Grande do Sul. Através da Análise de Narrativas chegamos a duas categorias: "Eu sofria calada e certamente toda mulher é assim" - A violência e o silenciamento; e "A gente cuida dela" - Rompendo o silêncio. A primeira, faz referência a opressão do silenciamento e como as mulheres foram afetadas através da violência e do isolamento. A segunda, apresenta os desafios enfrentados pelas mulheres ao romper o silenciamento e sair da relação abusiva, e como, através de suas narrativas, acessamos a histórias de outras mulheres que sofrem violência. As narrativas reforçam que o silenciamento, advindo dos papeis de gênero e do cerceamento de liberdade, contribuiu para a permanência na relação abusiva. A violência teve sustentáculo no contexto rural, no qual as mulheres ficavam ainda mais isoladas, sozinhas e sem apoio, acentuando seus medos, culpa, vergonha, dependência financeira. É fundamental haver um trabalho intersetorial para o enfrentamento a essa problemática com mais informação e assistência às mulheres rurais.

Factors associated with the recurrence of violence against children and adolescents. Mato Grosso-Brazil, 2013 to 2019. / Fatores associados à recorrência de violência em crianças e adolescentes. Mato Grosso-Brasil, 2013 a 2019.

This study examined factors associated with the recurrence of interpersonal violence against children and adolescents in Mato Grosso state, considering cases recorded in the Notifiable Diseases Information System, from 2013 to 2019. Associations between variables were estimated by logistic regression and stratified by age group (children and adolescents). The frequency of recurrent violence against children was 49.0% and, against adolescents, 42.9%. For both, recurrent violence was positively associated with occurrence at home, psychological or emotional violence, aggressors' being more than two, their being relatives and threats being the means of aggression. Neglect or abandonment and male or both-sex aggressors were positively associated with recurrent violence against children. Against adolescents, poor education, sexual violence and intimate-partner aggressors were positively associated with recurrent violence, while other aggressors and firearms or physical force were negatively associated. The findings offer significant contributions to knowledge of factors associated with recurrent violence, which is still little studied in the national and international literature. This is essential in order to inform strategies to reduce the recurrence of violence and protect children and adolescents.

O objetivo do estudo foi analisar os fatores associados à recorrência da violência interpessoal contra crianças e adolescentes em Mato Grosso. Estudo com casos registrados no Sistema Informação de Agravos de Notificação no período de 2013 a 2019. A associação entre as variáveis foi estimada pela regressão logística, estratificada por faixa etária (crianças e adolescentes). A frequência da violência recorrente em crianças foi de 49,0%, e de 42,9% em adolescentes. Para ambos, a violência recorrente associou-se positivamente com ocorrência em residência, violência psicológica/moral, com mais de dois agressores envolvidos, agressores familiares e meio de agressão, ameaça. Para as crianças, negligência/abandono, sexo do agressor masculino ou ambos associaram-se positivamente com a recorrência da violência. Para adolescentes, baixa escolaridade, violência sexual e agressor parceiro íntimo estiveram associados positivamente à recorrência da violência, enquanto outros agressores e arma de fogo ou força corporal associaram-se negativamente. Os resultados trazem contribuições relevantes para o conhecimento dos fatores associados à violência recorrente, ainda pouco estudada na literatura nacional e internacional, sendo fundamental para apoiar estratégias de redução da recorrência da violência e de proteção às crianças e adolescentes.

Association between bullying, childhood adversities and social capital among adolescents.

This study aims to analyze the association between bullying behaviors, adverse childhood experiences and social capital in late adolescence. Secondary school students aged 15-19 of a metropolitan region of Brazil were recruited for a sectional epidemiological survey, with a sample of 2,281 students, stratified by municipality of school location. Descriptive and inferential statistics were performed from three instruments: Olweus Bully/Victim Questionnaire, Childhood Adversity History Questionnaire and Integrated Questionnaire to Measure Social Capital, in adapted versions. The results showed that the factors associated with bullying victims were gender and adversity in childhood. The factors associated to bullying aggressors were gender, childhood adversities, and cognitive social capital. And the factors associated with bullying aggressor-victims were gender, childhood adversities, and cognitive social capital. It is concluded that bullying is associated with adversity in childhood and also with cognitive social capital and they point out the need to address the causes of violence in order to provide a healthy and safe development for children and adolescents, preventing negative outcomes for physical and mental health.

Armed violence in Manguinhos/RJ, Brazil: health and daily life of health and education workers. / Violência armada em Manguinhos/RJ, Brasil: saúde e cotidiano de trabalhadoras(es) de saúde e educação.

The article presents the results of qualitative action research on armed violence with health and education professionals and territorial community services in Manguinhos, Rio de Janeiro, Brazil. It is justified by the urgent nature of this violence in the territory and aims to identify its impacts on their health and work, coping, protection, and care strategies. The effects of armed violence on health and education professionals and the territory are discussed through interviews and focus groups with participant observation, identifying some of its transversalities, such as the Brazilian State racist public security policy based on a warlike logic of confrontation with groups with armed control of the territory, which makes life precarious by exposing residents and workers to constant risks, weakening the community fabric and preventing full access to health and education.

O artigo apresenta resultados de uma pesquisa qualitativa sobre violência armada, do tipo pesquisa-ação, com profissionais de saúde e de educação e serviços comunitários territoriais em Manguinhos/RJ. Justifica-se pela premência dessa violência no território, tendo como objetivo identificar seus impactos na saúde e no trabalho, assim como as estratégias de enfrentamento, proteção e cuidado empreendidas. A partir de entrevistas e grupos focais com profissionais de saúde e da educação e observação participante, discutem-se os efeitos da violência armada sobre elas(es) e o território, identificando algumas de suas transversalidades, como a política de segurança pública racista empreendida pelo Estado brasileiro, baseada numa lógica bélica de confronto com grupos que têm domínio armado de território, que precariza a vida ao expor moradoras(es) e trabalhadoras(es) a riscos constantes, enfraquece o tecido comunitário e impede o pleno acesso à saúde e à educação.

Effects of Two Early Parenting Programmes on Child Aggression and Risk for Violence in Brazil: a Randomised Controlled Trial.

Violence is a major public health problem globally, with the highest rates in low- and middle-income countries (LMICs) in the Americas and southern Africa. Parenting programmes in high-income countries can diminish risk for violence, by reducing risk factors such as child aggression and harsh parenting, and increasing protective factors such as child cognitive development and school readiness. However, there is critical need to identify low-cost programmes with replicable benefits that work in real-world LMICs contexts. A three-arm, randomised, single-blind trial evaluated effects of two low-cost, group-based parenting programmes recommended for LMICs (ACT: Raising Safe Kids; DBS: dialogic book-sharing) on child aggression (primary outcome), child development, parenting, maltreatment, and stress. Participants were 369 children with medium-high levels of aggression (mean age 3.1 years at baseline) in poor households. Interventions were implemented in city health and education services in southern Brazil. Maternal reports, filmed observations, child tasks, and hair cortisol were assessed at baseline, 1-month post-intervention, and 8-month follow-up. Intention-to-treat analyses compared each of ACT and DBS with a control group. Three hundred sixty-eight (99.7%) participants completed follow-up assessments 8 months after the interventions. There was no effect of ACT (standardised mean difference, SMD 0.11, 95% CI - 0.05, 0.27) or DBS (SMD 0.05, 95% CI - 0.11, 0.21) on the primary outcome of child aggression. ACT reduced harsh parenting behaviour post-intervention (SMD - 0.23; 95% CI - 0.46, - 0.01), but not at follow-up. DBS improved book-sharing practices at both time points (e.g., maternal sensitivity at follow-up SMD 0.33; 95% CI 0.08, 0.57). There were no benefits of either programme for other parenting, child development, or stress outcomes. Two parenting programmes in Brazil had small effects on parenting practices but did not reduce child aggression or several other important risk/protective factors for violence. Effective early interventions that reduce violence in real-world LMIC settings are highly desirable but may be challenging to achieve.

Less-lethal weapons: ocular trauma in Chile as psychosocial trauma. Challenges from a human rights and comprehensive perspective.

INTRODUCTION: In October 2019 in Chile, massive protests broke out in the so-called social uprising. The repressive response of the armed forces and Carabineros (Police) resulted in serious and mas-sive violations of human rights, with between 400 and 500 victims of ocular trauma caused mainly by shots from anti-riot shotguns, constituting the largest number of cases in the world linked to a single event. It is proposed to evaluate the different dimensions of the impact of ocular trauma due to state violence, using the concept of psychosocial trauma and a support model that integrates the medical-psychological and social dimensions. METHODS: Human rights violations of the period are described, focusing on cases of ocular trauma, and state and civil society responses. The requests of a survivors' organisations regarding truth, justice and reparation is presented. A clinical case of ocular trauma treated in our centre is analyzed. RESULTS: Survivors of ocular trauma manifest post-traumatic reactions regardless of the severity of their ocular injuries. The impact on the mental health of survi-vors of ocular trauma due to state violence is a phenomenon where the psychic and psychosocial im-pact of trauma due to socio-political violence intersects with the short- and long-term mental health effects. DISCUSSION: The impact of sociopolitical trauma must be understood considering both the in-dividual and social subject, considering their cultural, socioeconomic and political reality. Recovery from traumatic psychological injury must be addressed in its medical, sensory rehabilitation, psycho-logical and psychosocial dimensions, including processes of social recognition, search for justice and comprehensive reparation of damage. In contexts of impunity, a model is proposed that integrates rehabilitation with psycho-legal support, promotion of agency and organisation, within the frame-work of commitment to the movement and principles of human rights.

The Movement in Resistance against Eye Aggressions by MOCAO as a social movement for justice, reparation and the right to peace and freedom in Colombia.

The collective action of MOCAO, Movimiento en resistencia contra las agresiones oculares del ESMAD (Escuadrón Móvil An-tidisturbios) is a social strateg y to demand access to justice and the fulfilment of guarantees of reparation and non-repetition in Colombia. A brief account of significant events in our trajecto-ry as a social movement is presented, together with our letter of petitions to the national government as victims and survivors of ocular aggressions in the framework of police violence. Al-though ESMAD today has been reformed under the name of the Unit for Dialogue and Maintenance of Order (UNDMO), we consider that there have not yet been structural changes to ensure that its function is related to protecting the constitution-al right to social protest.

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

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

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

Giving meaning to internalized violence throughout life by older adults living in rural areas.

OBJECTIVES: to understand the meanings of violence internalized throughout life by older adults living in rural areas. METHODS: a qualitative study, anchored in the Symbolic Interactionism theoretical framework and the Grounded Theory methodological framework in the constructivist aspect. Data collection occurred through individual interviews. Data were coded using the Atlas.ti software. RESULTS: it was possible to identify that the context of rural areas strengthens patriarchy culture as well as contributing to violence silence and naturalization. It was also found that violence is a product of social inequality and gender inequality. FINAL CONSIDERATIONS: older adults living in rural areas internalized the violence suffered in a unique way, and this scenario's specific aspects can increase intra-family abuse, as there is a patriarchal culture that promotes social and gender inequality.

Violencia y maltrato infantil. El aporte del médico radiólogo al abordaje integral multidisciplinario / Child maltreatment and violence. Contributions from radiologists to a comprehensive multidisciplinary approach

El maltrato infantil es definido por la Organización Mundial de la Salud (OMS) como "el abuso y la desatención que sufren los niños menores de 18 años. Incluye todo tipo de maltrato físico y/o emocional […] que resulte en un daño real o potencial para la salud, la supervivencia, el desarrollo o la dignidad del niño". Al examinar los rastros corporales del maltrato físico, siguiendo los mecanismos de lesión más frecuentemente implicados, es posible detectar patrones radiológicos típicos. La evaluación imagenológica del hueso en reparación permite inferir cronologías para correlacionar con los datos obtenidos en la anamnesis. Los profesionales de la salud deben detectar oportunamente lesiones radiológicas sospechosas y activar de forma temprana el resguardo del menor. Nuestro propósito es realizar una revisión sobre las publicaciones recientes referidas al estudio imagenológico en niños de quienes se sospeche que puedan ser víctimas de violencia física.

The World Health Organization (WHO) defines child maltreatment as "the abuse and neglect that occurs to children under 18 years of age. It includes all types of physical and/or emotional ill-treatment [...], which results in actual or potential harm to the child's health, survival, development or dignity." By examining the bodily traces of physical abuse, following the most frequently involved mechanisms of injury, it is possible to identify typical radiological patterns. The imaging studies of the bone under repair allows inferring a timeline that may be correlated to the data obtained during history taking. Health care providers should detect suspicious radiological lesions in a timely manner and promptly activate the safeguarding of the child. Our objective was to review recent publications on the imaging studies of children suspected of being victims of physical violence.

Estratégias adotadas pelos profissionais de enfermagem a partir da violência sofrida na urgência e emergência / Strategies adopted by nursing professionals based on the violence suffered in urgency and emergency / Estrategias adoptadas por los profesionales de enfermería basadas en la violencia sufrida en urgencia y emergencia

Objetivo: identificar os significados e estratégias adotadas pelos profissionais de enfermagem em situações de violência em uma unidade de urgência e emergência. Método: estudo descritivo, qualitativo, tendo como suporte teórico-conceitual o interacionismo simbólico, que utilizou um grupo focal de oito profissionais da equipe de enfermagem de um serviço de urgência e emergência hospitalar. Resultados: os significados foram complexos e as estratégias adotadas foram tolerância à violência para manter o controle no ambiente de trabalho, gerenciamento de conflito, tentando aplacar a situação de violência, buscar a segurança de terceiros e adotar um posicionamento de afastamento do atendimento ao paciente/acompanhante agressor. Conclusão: a violência significou diversas concepções frequentemente negativas, e as estratégias adotadas pelos profissionais de enfermagem evidenciam a tentativa de evitar o sofrimento perpetuado pelos pacientes no serviço de urgência e emergência hospitalar. Os diversos atores sociais devem sinergicamente propiciar meios para a proteção dos profissionais.

Objective: To identify the strategies adopted and meanings constructed by nursing professionals exposed to violence in an urgency and emergency unit. Method:A descriptive, qualitative study based on symbolic interactionism was conducted with eight nursing professionals from a hospital urgency and emergency service by means of a focus group. Results: The meanings were complex and the strategies adopted were tolerance towards violence to maintain control in the workplace, conflict management seeking to placate the situation, seek the safety of third parties and withdrawal from caring for the offending patient/companion. Conclusion: Violence was often conceptualized negatively and the strategies adopted by nursing professionals show an attempt to avoid the harm perpetrated by emergency patients. The various social actors implicated should synergistically provide means for protecting professionals

Objetivo: identificar los significados y estrategias adoptadas por los profesionales de enfermería en situación de violencia en una unidad de urgencia y emergencia. Método:estudio descriptivo, cualitativo, con interaccionismo simbólico como marco teórico y conceptual, que utilizó un grupo focal formado por ocho profesionales del equipo de enfermería de un servicio de urgencia y emergencia hospitalaria. Resultados: los significados fueron complejos, y las estrategias adoptadas se centraron en la tolerancia a la violencia para mantener el control en el ambiente de trabajo, el manejo de conflictos buscando aplacar la situación de violencia, la búsqueda de seguridad de terceros y la adopción de una posición de retiro de la atención al paciente/acompañante infractor. Conclusión: la violencia significó varias concepciones que muchas veces son negativas, y las estrategias adoptadas por los profesionales de enfermería muestran el intento de evitar el sufrimiento perpetuado por los pacientes en el servicio de emergencia hospitalaria. Los diversos actores sociales deben proporcionar sinérgicamente medios para la protección de los profesionales