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.

Variability in Occult Injury Screening Among Siblings/Household Contacts of Physical Abuse Victims.

OBJECTIVE: The objective of this study is to examine radiologic occult injury screening performance/yield among contacts presenting for precautionary medical assessments and assess factors associated with deferred screening. METHODS: Data were collected retrospectively from charts of contacts younger than 8 years presenting for precautionary evaluation to a level 1 pediatric emergency department January 1, 2018 to March 31, 2023. Demographics, radiologic performance/yield, physical examination, social work-based psychosocial assessment, reasons for deferred imaging, and diagnostic codes were abstracted. Descriptive statistics and χ 2 analysis are reported. RESULTS: Three hundred ninety contacts were identified; 364 (93.3%) were biological siblings. Most (276, 70.8%) were 2 to 8 years old. Statistically significant relationships were identified with age, insurance, and hospital social work assessment and screening. Thirty-four infants (54%) underwent neuroimaging; no studies were abnormal. Of 114 contacts, <2 years old, 97 (85%) underwent skeletal survey (SS); 9 (9%) SS were abnormal. Twenty-seven (24%) returned for follow-up SS; 4 (14.8%) were abnormal. For 2 contacts, an abnormal initial SS was refuted by follow-up imaging. Physical examinations were abnormal for 11% of contacts. Reasons for deferred imaging included contact well appearance, caregiver concerns, and clinician disagreement with indications. Encounter International Classification of Diseases codes varied, commonly reflecting nonspecific screening assessments. CONCLUSIONS: Despite national clinical practice guidelines, studies of abusive injury prevalence and radiologic yield among at-risk contacts exposed to unsafe environments are few. Screening evaluations inclusive of physical examination and radiologic studies identify abuse concerns among at-risk contacts. Further study of factors impacting radiologic screening decisions is needed. Considerations to advance epidemiologic research include standardized diagnostic coding and prospective assessment of radiologic yield.

Caracterização dos casos de violência contra a mulher em tempos de pandemia por Covid-19 em um município do sudoeste do Paraná / Characterization of cases of violence against women in times of pandemic by Covid-19 in a municipality in the southwest of Paraná / Caracterización de casos de violencia contra la mujer en tiempos de pandemia por Covid-19 en un municipio del sudoeste de Paraná

Introdução: A violência contra à mulher é caracterizada especialmente pela desigualdade de gênero, diferença hierárquica, subordinação e pela agressividade do parceiro ou ex-parceiro. Entre os principais subtipos, cita-se; a violência física, psicológica, sexual, patrimonial e moral. Com o surgimento da pandemia de coronavírus em 2020 na tentativa de contenção da doença, medidas protetivas como o isolamento social aumentaram o convívio familiar. Dessa forma, as vítimas de violência passaram a ficar ainda mais tempo expostas aos seus agressores e consequentemente com maiores dificuldades para denunciar os abusos sofridos, pois a prestação dos serviços públicos, instituições de segurança e judiciais também foram restringidas. Objetivo: Caracterizar os casos de violência contra a mulher em tempos de pandemia de coronavírus em um município do Sudoeste do Paraná. Materiais e métodos: Trata-se de um estudo descritivo, documental e transversal com abordagem quantitativa realizada em um município do Sudoeste do Paraná a partir da coleta de dados, por meio das fichas de notificação de violência contra a mulher entre 2019 e 2021. Resultados e discussão: O estudo demonstrou prevalência de notificações no ano de 2019 em mulheres com idade de 12 a 18 anos (27,2%), brancas (71,3%), com ensino médio (21,9%), sendo ainda estudantes (23,1%) ou desempregadas (17,2%), sem companheiro (52,4%), residentes da área urbana (74%), heterossexuais (50,6%), sem possuir algum tipo de deficiência (51,8%). Ao verificar a tipologia da agressão com maior incidência, observou-se a lesão autoprovocada (53,6%) por meio da intoxicação /envenenamento (41,4%). Quanto a violência interpessoal, notou-se que a maioria das agressões foram ocasionadas pelo próprio cônjuge da vítima (12,4%), utilizando da força física (29,3%), salienta-se que o álcool não estava presente na maior parte das agressões. Conclusão: Evidencia-se a prevalência de violência autoprovocada (53,6%), em adolescentes com ensino médio, brancas, sem companheiro, residentes da área urbana, agredidas em ambiente domiciliar, motivadas por conflitos geracionais, sendo as violências mais incidentes a física por meio de envenenamento/intoxicação. Diante do exposto é importante abordar o fato de que é necessário realizar capacitações com os profissionais de saúde referente a ficha de notificação e orientá-los da importância de preenchê-la de forma correta, para haja a tomada de providências de acordo com cada necessidade.

Introduction: Introduction: Violence against women is characterized especially by gender inequality, hierarchical difference, subordination and aggressiveness of the partner or ex partner. Among the main subtypes are physical, psychological, sexual, patrimonial and moral violence. With the emergence of the COVID-19 pandemic in 2020 in an attempt to contain the disease, protective measures such as social isolation increased family coexistence. As a result, the victims of violence have been exposed to their aggressors for even longer and consequently find it more difficult to report the abuse they have suffered, since the provision of public services, security and judicial institutions have also been restricted. Objective: To characterize the cases of violence against women during the COVID-19 pandemic in a municipality in the southwest of Paraná. Materals and methods: This is a descriptive, documentary, and cross-sectional study with a quantitative approach carried out in a municipality in the Southwest of Paraná from data collection performed through the notification forms of violence against women notified between 2019 and 2021. Results and discussion: The study showed a prevalence of notifications in the year 2019 in women aged 12 to 18 years (27.2%), white (71.3%), with high school education (21.9%), being still students (23.1%) or unemployed (17.2%), without a partner (52.4%), residents of the urban area (74%), more specifically the Padre Ulrico neighborhood (12.4%), heterosexual (50.6%), without having any type of disability (51.8%). When checking the type of aggression with the highest incidence, we observed self-harm (53.6%) through intoxication/ poisoning (41.4%). As for interpersonal violence, it was noted that most aggressions were caused by the victim's own spouse (12.4%), using physical force (29.3%), and alcohol was not present in most aggressions. Conclusion: The prevalence of self- inflicted violence (53.6%) is evident in adolescents with high school education, white, without a partner, urban residents, assaulted in the home environment, motivated by generational conflicts, with the most incident violence being physical violence through poisoning/intoxication. Given the above, it is important to address the fact that it is necessary to conduct training with health professionals regarding the notification form and guide them on the importance of filling it out correctly, so that there is taking action according to each need.

Introducción: La violencia contra las mujeres se caracteriza especialmente por la desigualdad de género, la diferencia jerárquica, la subordinación y la agresividad de la pareja o ex pareja. Entre los principales subtipos, se menciona; la violencia física, psicológica, sexual, patrimonial y moral. Con la aparición de la pandemia de coronavirus en 2020 en un intento de contener la enfermedad, las medidas de protección como el aislamiento social han aumentado la convivencia familiar. Así, las víctimas de la violencia han quedado aún más expuestas a sus agresores y, en consecuencia, tienen mayores dificultades para denunciar los abusos sufridos, ya que también se ha restringido la prestación de servicios públicos, de seguridad y de instituciones judiciales. Objetivo: Caracterizar los casos de violencia contra la mujer en tiempos de pandemia de coronavirus en un municipio del sudoeste de Paraná. Materiales y métodos: Se trata de un estudio descriptivo, documental y transversal con enfoque cuantitativo realizado en un municipio del suroeste de Paraná a partir de la recolección de datos a través de las formas de notificación de la violencia contra las mujeres entre 2019 y 2021. Resultados y discusión: El estudio mostró una prevalencia de notificaciones en 2019 en mujeres de 12 a 18 años (27,2%), de raza blanca (71,3%), con estudios secundarios (21,9%), siendo aún estudiantes (23,1%) o desempleadas (17,2%), sin pareja (52,4%), residentes en el área urbana (74%), heterosexuales (50,6%), sin tener algún tipo de discapacidad (51,8%). Al verificar el tipo de agresión con mayor incidencia, se observó la lesión autoinfligida (53,6%) a través de la intoxicación / envenenamiento (41,4%). En cuanto a la violencia interpersonal, se observó que la mayoría de las agresiones fueron causadas por el propio cónyuge de la víctima (12,4%), utilizando la fuerza física (29,3%), se destaca que el alcohol no estuvo presente en la mayoría de las agresiones. Conclusión: Se evidencia la prevalencia de la violencia autoprovocada (53,6%), en adolescentes con educación médica, brancas, sin compañía, residentes del área urbana, agredidos en ambiente domiciliario, motivados por conflictos geracionales, siendo las violencias más incidentes a la física por medio de envenenamiento/intoxicación. Dado lo anterior es importante abordar el hecho de que es necesario realizar una capacitación con los profesionales de la salud respecto a la ficha de notificación y orientarlos sobre la importancia de llenarla correctamente, para que exista la toma de acciones de acuerdo a cada necesidad.

Violent behavior by involuntarily committed female offenders with mental disorders: A population-based case series.

The goal of the current study was to investigate the socio-demographic, psychiatric, and criminological characteristics of female violent offenders with mental disorders involuntarily committed to a forensic psychiatric hospital. The present study was a population-based retrospective case series including all female offenders with mental disorders found not guilty by reason of insanity by the criminal courts in the state of Rio de Janeiro, Brazil, and involuntarily committed to a forensic psychiatric facility (n = 27). Patients were assessed with Structured Clinical Interview for DSM-IV Axis I Disorders and the Positive and Negative Syndrome Scale. We found that most offenders were Afro-Brazilian, uneducated unmarried women. Schizophrenia with active psychotic symptoms was the most common clinical condition. Relatives were the frequent victims of aggressive behavior. Most patients had already been diagnosed with a mental disorder and placed under psychiatric treatment, but poor adherence and treatment dropout were common. Violent behavior in psychiatrically ill female patients is associated with a specific socio-demographic and clinical profile and is thus potentially amenable to prevention particularly if the mental health and social services are to provide the much-needed support for economically, socially, and psychologically vulnerable women.

Ocorrência de suspeitas de zoofilia no atendimento clínico médico-veterinário em Marília/SP no período de 2018-2019: maus-tratos velado e negligenciado / Occurrence of suspected zoophilia in veterinary clinical care in Marilia/SP in 2018-2019: veiled and neglected animal abuse

O relacionamento entre homens e animais é uma entidade complexa iniciada com a domesticação dos animais e mantida até hoje graças aos efeitos positivos na saúde e comportamento humanos. A melhora psicológica e emocional das pessoas que convivem com animais de estimação, têm sido associada à melhoria na qualidade de vida e ao convívio social em geral. Porém, esse relacionamento nem sempre foi ético e ambientalmente correto, pois no cotidiano observam-se arbitrariedades praticadas pelo homem que aniquilam a dignidade dos animais, geralmente indefesos, promovendo todas as modalidades de abusos, maus-tratos e crueldade. O Brasil possui leis de amparo aos crimes praticados contra abuso e maus-tratos aos animais e dentre os vários tipos de maus-tratos existe a zoofilia ou bestialismo, prática do ato sexual pelo ser humano com animais de outras espécies. O presente trabalho levantou dados na prática clínica médico-veterinária em Marília (SP) quanto ao atendimento de casos suspeitos de zoofilia e discute aspectos psicológicos, culturais sobre a legislação que trata do tema. A metodologia adotada foi a aplicação de um questionário com questões abertas e de múltipla escolha a clínicos médicos-veterinários em atividade no município de Marília, estado de São Paulo, Brasil, e a revisão do assunto nos últimos cinco anos. A análise das informações obtidas com 50 médicos-veterinários, no período de setembro de 2018 a março de 2019, apresentou 54% de relatos de atendimento com suspeita de zoofilia com maior frequência em fêmeas, incluindo cães, equinos, pequenos ruminantes e ruminantes. Finalmente, é discutida a importância social do estabelecimento de um tipo penal específico para a bestialidade como o primeiro passo para construção de uma sociedade mais justa e menos maléfica e violenta, destacando-se também que as pessoas que praticam zoofilia necessitam ser devidamente tratadas por um profissional competente, pois essa prática é um grave problema psicológico.

The relationship between men and animals is a complex entity initiated with the domestication of animals and maintained until today that promotes positive effects on human health and behavior. It was demonstrated the psychological and emotional improvement of people due to living with pets, and also an improvement in their quality of life and social interaction in general. However, this relationship has not always been ethical and environmentally correct, since human can also promote all forms of abuse, mistreatment and cruelty to them that are defenseless. In Brazil there are laws for punishment of abuse and mistreatment of animals and among the various types of mistreatment there is zoophilia or bestiality which is the sexual act of humans with animals of other species. From September 2018 to March 2019 it was applied a questionnaire with open questions and multiple choices to 50 veterinary clinicians working in Marília, São Paulo State, Brazil, regarding the suspicion of cases of zoophilia, and it was also discussed the psychological, cultural aspects and specific legislation about this matter. The results obtained showed that 27 (54%) of the veterinarians reported the suspicion of zoophilia with more occurrence in females than males, and the most affected species were dogs, horses, small ruminants and ruminants. Finally, it was performed a discussion showing that the settlement of a specific legislation criminalizing zoophilia it is necessary to build a fairer and less harmful and violent society, and that the people who practice it must be properly treated by a competent professional, as it is also an indication of psychological problems.

Intimate partner violence during pregnancy: prevalence and associated factors.

OBJECTIVE: To identify the prevalence of violence during pregnancy and the association with the socioeconomic, behavioral and clinical characteristics of pregnant women. METHODS: Cross-sectional study in a low-risk maternity hospital in the municipality of Cariacica, Espírito Santo. A total of 330 puerperal women were interviewed from August to October 2017. Information on socioeconomic, behavioral, reproductive and clinical characteristics, as well as life experiences, was collected through a questionnaire. To identify the types of violence, the proper World Health Organization instrument was used. Gross bivariate and multivariate analysis was performed and adjusted for Poisson regression with robust variance. RESULTS: Prevalence was 16.1% (95%CI 2.5-20.4) for psychological violence, 7.6% (95%CI 5.1-11.0) for physical violence and 2.7% (95%CI 1.4-5.2) for sexual violence. Psychological violence remained associated with age, family income, beginning of sexual life, disease in pregnancy, desire to interrupt pregnancy and number of partners. Physical violence was associated with schooling, beginning of sexual life and disease in pregnancy. Sexual violence remained associated with marital status and desire to interrupt pregnancy (p < 0.05). CONCLUSIONS: Psychological violence by an intimate partner was the most prevalent among pregnant women. Women that were younger, had lower income and less schooling, who started their sexual life before the age of 14 and who wished to interrupt pregnancy, experienced violence more frequently during pregnancy.

Reporting of child physical abuse by a group of Brazilian primary care health professionals and associated factors.

BACKGROUND: Evidences points to the importance of health professionals to recognize child abuse, but also to a high frequency of underreporting, even in countries where reporting is mandatory, like Brazil. OBJECTIVE: To evaluate the frequency of non-reporting behavior of child physical abuse (CPA) among Brazilian primary care health professionals who recognized some cases in their careers and associated factors with reporting. METHODS: Cross-sectional study conducted with a representative sample of dentists, nurses, family physicians, and pediatricians from the Family Health Strategy network in the city of Belo Horizonte, Brazil. A validated self-administered questionnaire for use in Brazil was applied in-person to professionals in 2014 and 2015. Pearson's chi-squared test (p < 0.05) and a binary logistic regression model was used. RESULTS: A total of 715 professionals participated (response rate: 98.89%), 414 (57.3%) recognized cases, of which 171 (41.3%) reported. Reporting was associated with the type of profession, as pediatricians reported cases more than dentists [OR = 6.05 (95% CI: 1.24-29.50)], with the willingness to become involved [OR = 2.01 (95% CI: 1.02-3.97)] and knowledge regarding where to report cases [OR = 2.68 (95% CI: 1.25-5.74)]. Confidentiality was the barrier associated with a lower probability of reporting CPA cases [OR = 0.22 (95% CI: 0.08-0.66)]. CONCLUSIONS: There is a high frequency of non-reporting behavior. Pediatricians reported more CPA cases, followed by family doctors and nurses. Dentists were those who reported fewer cases. Reporting was also associated with a willingness to be involved in detecting/reporting abuse and knowing where to report CPA.

Pathways Linking Childhood Physical Abuse to Alcohol Misuse in Adolescent Boys and Girls: A Prospective Cohort Study From Rio de Janeiro, Brazil.

OBJECTIVE: The purpose of this study was to identify if childhood physical abuse is a risk factor for adolescent alcohol misuse and the specific pathways linking childhood physical abuse and alcohol misuse in boys and girls. METHOD: The study enrolled 785 students from the baseline and first wave of a prospective cohort study developed at six high schools in Rio de Janeiro, Brazil. The Childhood Trauma Questionnaire (CTQ), Conflict Tactics Scale-Form R (CTS-1), and Alcohol Use Disorders Identification Test (AUDIT) were used to identify childhood and adolescence physical abuse and alcohol misuse, respectively. Multigroup path analysis was performed to explore the postulated pathways between the exposures and outcomes. RESULTS: Childhood physical abuse was a significant risk factor for alcohol misuse in adolescence for both sexes. Among girls, childhood physical abuse increased the risk of adolescent revictimization and school delay, which were mediators between childhood physical abuse and alcohol misuse. Among boys, childhood physical abuse has a direct effect on increasing the risk of alcohol misuse. School delay was also a mediator from more social determinants to alcohol misuse in both sexes, whereas not living with the mother in adolescence mediated such effects only among boys. CONCLUSIONS: Childhood physical abuse increases the risk of alcohol misuse in adolescence through different pathways in boys and girls. Strategies aimed at reducing alcohol misuse and other mental health problems in adolescence should incorporate such specificities.

Analysis of the relationship between earthquake-related losses and the frequency of child-directed emotional, physical, and severe physical abuse in Haiti.

BACKGROUND: Child abuse is a public health and human rights issue that is prevalent worldwide. All forms of abuse against children can have negative physical and mental health consequences. Under post-disaster situations, where there is a potential for increased stress and decreased social support among caregivers, the risk of child abuse may be higher. OBJECTIVE: To explore the association between earthquake-related losses (family-related and property-related) and the experience of emotional, physical, and severe physical child abuse in the household for children aged 2-14 in Haiti. METHODS: A nationally representative sample of Haitian households from the 2012 Demographic and Health Survey (DHS) was used. Descriptive analyses were summarized using frequencies and measures of central tendency. Associations between earthquake-related loss and child abuse was assessed using log-binomial regression modelling. RESULTS: Two years following the earthquake, and after considering potentially confounding variables, death of a household member was associated with a higher likelihood of a child being victim to emotional (RR = 1.11, 95 % CI: 1.05-1.17) and severe physical abuse (RR = 1.50, 95 % CI: 1.15-1.96). Conversely, injury of a household member was associated with a lower likelihood of a child experiencing emotional abuse (RR = 0.93, 95 % CI: 0.87-0.99). CONCLUSIONS: There were associations between earthquake-related losses and some forms of child abuse; the results were not consistent across all exposures and outcomes. The high prevalence of reported child abuse indicates a need for interventions to reduce child abuse in homes overall. There is also need for further research into the aetiology and influences specific to different types of abuse.

Workplace violence in the health sector: validez y adaptación del instrumento al idioma español, en el contexto ecuatoriano para tipos de violencia / Workplace violence in the health sector: adaptation and validation of the questionnaire for types of violence in the ecuadorian context

Uno de los objetivos de la encuesta "Workplace Violence in the Health Sector" es investigar los factores que pueden contribuir a la violencia en el lugar de trabajo en el sector de salud en varios países del mundo para la toma de políticas públicas apropiadas. A pesar de que el inglés sea un idioma universal, en la práctica genera limitaciones para aplicarlo sobre todo en los países de América Latina. Esta investigación tiene como propósito validar el contenido, y constructo para que la encuesta se pueda aplicar en los países cuya lengua oficial es el español. Se emplearon las técnicas cualitativas y cuantitativas para validar el instrumento, con la revisión de expertos se validó la semántica e idioma. A través del el Alpha de Cronbach de 0,96 se puede aseverar la confiabilidad de este para medir la violencia de trabajo en el sector de la salud de los países de habla hispana.

The purpose of the survey "Violence in the workplace in the health sector" is to obtain information on the factors that could contribute to the workplace violence in the health sector within different countries of the world. Collecting data on the problem is therefore important of the appropriate public policy making. Despite of English is considered widely the universal language, in practice it generates limitations to apply especially in Latin American countries. This research aims to validate the content, and construction for the survey to the application in countries where Spanish is an official language. Qualitative and quantitative techniques were used to validate the questionnaire; experts review validated the semantics and language construction. The global inventory (Cronbach's alpha = 0.96) indicated good reliability to measure the workplace violence in the health sector for Spanish-speaking countries.

Intimate partner violence during pregnancy: prevalence and associated factors / Violências por parceiro íntimo na gestação: prevalências e fatores associados

ABSTRACT OBJECTIVE To identify the prevalence of violence during pregnancy and the association with the socioeconomic, behavioral and clinical characteristics of pregnant women. METHODS Cross-sectional study in a low-risk maternity hospital in the municipality of Cariacica, Espírito Santo. A total of 330 puerperal women were interviewed from August to October 2017. Information on socioeconomic, behavioral, reproductive and clinical characteristics, as well as life experiences, was collected through a questionnaire. To identify the types of violence, the proper World Health Organization instrument was used. Gross bivariate and multivariate analysis was performed and adjusted for Poisson regression with robust variance. RESULTS Prevalence was 16.1% (95%CI 2.5-20.4) for psychological violence, 7.6% (95%CI 5.1-11.0) for physical violence and 2.7% (95%CI 1.4-5.2) for sexual violence. Psychological violence remained associated with age, family income, beginning of sexual life, disease in pregnancy, desire to interrupt pregnancy and number of partners. Physical violence was associated with schooling, beginning of sexual life and disease in pregnancy. Sexual violence remained associated with marital status and desire to interrupt pregnancy (p < 0.05). CONCLUSIONS Psychological violence by an intimate partner was the most prevalent among pregnant women. Women that were younger, had lower income and less schooling, who started their sexual life before the age of 14 and who wished to interrupt pregnancy, experienced violence more frequently during pregnancy.

RESUMO OBJETIVO Identificar a prevalência das violências durante a gestação e verificar a associação com as características socioeconômicas, comportamentais e clínicas da gestante. MÉTODOS Estudo transversal em uma maternidade de baixo risco do município de Cariacica, Espírito Santo. Foram entrevistadas 330 puérperas de agosto a outubro de 2017. Informações sobre as características socioeconômicas, comportamentais, reprodutivas e clínicas, assim como experiências de vida, foram coletadas por meio de questionário. Para identificar os tipos de violência, foi utilizado o instrumento da Organização Mundial da Saúde. Foi realizada análise bivariada e multivariada bruta e ajustada por regressão de Poisson com variância robusta. RESULTADOS As prevalências foram 16,1% (IC95% 2,5-20,4) para violência psicológica, 7,6% (IC95% 5,1-11,0) para a física e 2,7% (IC95% 1,4-5,2) para a sexual. A violência psicológica manteve-se associada a idade, renda familiar, início da vida sexual, doença na gravidez, desejo de interromper a gestação e número de parceiros. A violência física esteve associada a escolaridade, início da vida sexual e doença na gravidez. Já a violência sexual manteve-se associada a situação conjugal e desejo de interromper a gestação (p < 0,05). CONCLUSÕES A violência psicológica perpetrada pelo parceiro íntimo foi a de maior prevalência entre as gestantes. Mulheres mais jovens, com menor renda e escolaridade, que iniciaram a vida sexual até os 14 anos e que desejaram interromper a gravidez vivenciaram com maior frequência a violência durante a gestação.

Sex and age effects in past-year experiences of violence amongst adolescents in five countries.

PURPOSE: To date, there has been insufficient focus on age and sex differences in studies of violence amongst adolescents and young adults in low- and middle-income countries. As adolescence is a formative period during which experiencing violence can have both short- and long-term consequences, we aim to investigate experiences of violence by age and sex across five countries. METHODS: Incidences of past-year violence victimization were estimated by sex across two-year age bands (13-24 years) using Violence Against Children Survey datasets from Cambodia, Haiti, Kenya, Malawi, and Tanzania. Analyses were conducted separately for each country. The presence of an association with age and each type of violence was identified using logistic regressions separately by sex. Sex was then added to the models as an interaction term and adjusted Wald tests were used to assess differences between males and females in age effects. RESULTS: Risk of physical violence by both an adult caregiver and a community member decreased with age for both sexes in all countries. In contrast, risk of IPV increased with age for both sexes in all countries. Although some countries displayed a steeper increase in risk of IPV and sexual violence with age for males, females face higher overall levels of risk for these forms of violence. CONCLUSION: Findings highlight how adolescents' and young adults' risk of violence changes with age and type of violence. The analysis underscores the importance of collecting violence data disaggregated by age and sex to best inform policies and programming. IMPLICATIONS AND CONTRIBUTIONS: We analyzed five Violence Against Children Surveys (VACS) and found age effects for physical, sexual, and intimate partner violence for adolescents 13-24 years old. Age effects for sexual violence are stronger among females than males. Future policies targeting adolescents should consider how age and gender influence risk of violence.

The association between disrespect and abuse of women during childbirth and postpartum depression: Findings from the 2015 Pelotas birth cohort study.

BACKGROUND: This study examined the association between disrespect and abuse of women during facility-based childbirth and postpartum depression (PD) occurrence. METHODS: We used data from the 2015 Pelotas (Brazil) Birth Cohort, a population-based cohort of all live births in the city. We assessed 3065 mothers at pregnancy and 3-months after birth. Self-reported disrespect and abuse experiences included physical abuse, verbal abuse, denial of care, and undesired procedures. We estimate the occurrence of each disrespect and abuse type, one or more types and disrespect and abuse score. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess PD. EPDS scores ≥13 and ≥15 indicated at least moderate PD and marked/severe. Odds ratios (OR) were calculated by logistic regression. RESULTS: The prevalence of at least moderate PD and marked/severe PD was 9.4% and 5.7%, respectively. 18% of the women experienced at least one type of disrespect and abuse. Verbal abuse increased the odds of having at least moderate PD (OR = 1.58; 95%CI 1.06-2.33) and marked/severe PD (OR = 1.69; 95%CI 1.06-2.70) and the effect among women who did not experience antenatal depressive symptoms was greater in comparison to those who did (OR = 2.51; 95%CI 1.26-5.04 and OR = 4.27; 95%CI 1.80-10.12). Physical abuse increased the odds of having marked/severe PD (OR = 2.28; 95%CI 1.26-4.12). Having experienced three or more mistreatment types increased the odds of at least moderate PD (OR = 2.90; 95%CI 1.30 - 35.74) and marked/severe PD (OR=3.86; 95%CI 1.58-9.42). LIMITATIONS: Disrespect and abuse experiences during childbirth were self-reported. CONCLUSIONS: Disrespect and abuse during childbirth increased the odds of PD three months after birth. Strategies to promote high quality and respectful maternal health care are needed to prevent mother-child adverse outcomes.

Physical violence against children and adolescents in Recife: a 5-year retrospective study.

The aim of the present study was to analyze the prevalence results of physical violence against children and adolescents in a 5-year period in Recife, Brazil. Inter-personal violence is one of the most recognizable forms of child aggression and has become as an imperative public health issue. All violence related forensic reports performed between 2009 and 2013 in the clinical services of the Institute of Legal Medicine Antônio Percivo Cunha were analyzed. Victims were classified according to sex, age, relationship with perpetrator, injuries and year of occurrence. Statistical analysis was performed using the SPSS (version 22.0). Continuous variables were described and when appropriate, frequencies were displayed and compared. The association between variables was evaluated using chi-square and Fisher's exact test. The margin of error for the statistical tests was 5.0%. A total of 9783 occurrences were evaluated, involving mainly male subjects (n=5447, 55.7%). Victims' mean age was 13.9 years, the most common perpetrators were victims' acquaintances (n=2538, 25.9%). Facial injuries were the most frequent affecting a little over a fifth of the total sample (n=3673, 20.1%). These findings support the important role dentists can play in identifying and reporting physical violence against children and adolescents.

Emotional and Physical Child Abuse in The Context of Natural Disasters: A Focus on Haiti.

OBJECTIVE: To investigate the social and living conditions of households in Haiti before and after the 2010 earthquake and to determine the prevalence of emotional and physical abuse of children aged 2 to 14 in households after the earthquake. METHODS: Nationally representative samples of Haitian households from the 2005/2006 and 2012 phases of the Demographic and Health Surveys were used. Descriptive data were summarized with frequencies and measures of central tendency. Chi-squared and independent t tests were used to compare pre-earthquake and post-earthquake data. Basic mapping was used to explore patterns of child abuse in relation to proximity to the epicenter. RESULTS: Comparison of pre-earthquake and post-earthquake data showed noteworthy improvements in the education attainment of the household head and possession of mobile phones after the earthquake. The prevalence of emotional, physical, and severe physical abuse in 2012 was estimated to be 78.5%, 77.0%, and 15.4%, respectively. Mapping revealed no conclusive patterns between the proximity of each region to the epicenter and the prevalence of the different forms of abuse. However, the prevalence of severe physical abuse was notably higher in settlement camps (25.0%) than it was in Haiti overall (15.4%). CONCLUSIONS: The high prevalence of child abuse in Haiti highlights an urgent need for interventions aimed at reducing occurrences of household child abuse.

Epidemiological and spatial characteristics of interpersonal physical violence in a Brazilian city: A comparative study of violent injury hotspots in familial versus non-familial settings, 2012-2014.

This study explores both epidemiological and spatial characteristics of domestic and community interpersonal violence. We evaluated three years of violent trauma data in the medium-sized city of Campina Grande in North-Eastern Brazil. 3559 medical and police records were analysed and 2563 cases were included to identify socioeconomic and geographic patterns. The associations between sociodemographic, temporal, and incident characteristics and domestic violence were evaluated using logistic regression. Using Geographical Information Systems (GIS), we mapped victims' household addresses to identify spatial patterns. We observed a higher incidence of domestic violence among female, divorced, or co-habitant persons when the violent event was perpetrated by males. There was only a minor chance of occurrence of domestic violence involving firearms. 8 out of 10 victims of domestic violence were women and the female/male ratio was 3.3 times greater than that of community violence (violence not occurring in the home). Unmarried couples were twice as likely to have a victim in the family unit (OR = 2.03), compared to married couples. Seven geographical hotspots were identified. The greatest density of hotspots was found in the East side of the study area and was spatially coincident with the lowest average family income. Aggressor sex, marital status, and mechanism of injury were most associated with domestic violence, and low-income neighbourhoods were coincident with both domestic and non-domestic violence hotspots. These results provide further evidence that economic poverty may play a significant role in interpersonal, and particularly domestic violence.

Urban-Rural Residence and Child Physical Abuse Hospitalizations: A National Incidence Study.

OBJECTIVE: To determine if child physical abuse hospitalization rates vary across urban-rural regions overall and after accounting for race/ethnicity and poverty demographics. STUDY DESIGN: This was a retrospective cross-sectional study of black, Hispanic, and non-Hispanic white children <5 years of age living in all US counties. US counties were classified as central metro, fringe/small metro, and rural. Incidence rates were calculated using child physical abuse hospitalization counts from the 2012 Kids' Inpatient Database and population statistics from the 2012 American Community Survey. Counties' race/ethnicity demographics and percent of children living in poverty were used to adjust rates. RESULTS: We identified 3082 child physical abuse hospitalizations occurring among 18.2 million children. Neither crude nor adjusted overall rates of child physical abuse hospitalizations varied significantly across the urban-rural spectrum. When stratified by race/ethnicity, crude child physical abuse hospitalization rates decreased among black children 29.1% (P = .004) and increased among white children 25.6% (P = .001) from central metro to rural counties. After adjusting for poverty, only rates among black children continued to vary significantly, decreasing 34.8% (P = .001) from central metro to rural counties. Rates were disproportionately higher among black children compared with white children and their disproportionality increased with population density, even after poverty adjustment. Rates among Hispanic children were disproportionately lower compared with white children in nearly all urban-rural categories. CONCLUSIONS: Our results suggest that urban black children have unique exposures, outside of poverty, increasing their risk for child physical abuse hospitalization. Identifying and addressing these unique urban exposures may aid in reducing black-white disproportionalities in child physical abuse.

Characteristics of Brazilian Offenders and Victims of Interpersonal Violence: An Exploratory Study.

The aim of this study was to characterize the profile of Brazilian offenders and victims of interpersonal violence, following a medicolegal and forensic perspective. A cross-sectional and exploratory study was performed in a Center of Forensic Medicine and Dentistry. The sample was made up of 1,704 victims of nonlethal interpersonal violence with some type of trauma. The victims were subject to forensic examinations by a criminal investigative team that identified and recorded the extent of the injuries. For data collection, a specific form was designed consisting of four parts according to the information provided in the medicolegal and social records: sociodemographic data of the victims, offender's characteristics, aggression characteristics, and types of injuries. Descriptive and multivariate statistics using cluster analysis (CA) were performed. The two-step cluster method was used to characterize the profile of the victims and offenders. Most of the events occurred during the nighttime (50.9%) and on weekdays (66.3%). Soft tissue injuries were the most prevalent type (94.6%). Based on the CA results, two clusters for the victims and two for the offenders were identified. Victims: Cluster 1 was formed typically by women, aged 30 to 59 years, and married; Cluster 2 was composed of men, aged 20 to 29 years, and unmarried. Offenders: Cluster 1 was characterized by men, who perpetrated violence in a community environment. Cluster 2 was formed by men, who perpetrated violence in the familiar environment. These findings revealed different risk groups with distinct characteristics for both victims and offenders, allowing the planning of targeted measures of care, prevention, and health promotion. This study assesses the profile of violence through morbidity data and significantly contributes to building an integrated system of health surveillance in Brazil, as well as linking police stations, forensic services, and emergency hospitals.

Domains of common mental disorders in women reporting intimate partner violence.

OBJECTIVE: to verify associations between the types of intimate partner violence and the domains of common mental disorders in women. METHOD: cross-sectional study with 369 women. The information was obtained through the instruments Self-Reporting Questionnaire and Conflict Tactic Scales. To analyze the data, Pearson's Chi-Square test, Fisher's exact test and Odds Ratio were used. RESULTS: women who reported physical abuse with and without sequela were respectively 2.58 and 3.7 times more likely to have symptoms of anxious depressed mood. The chances of experiencing symptoms of decreased vital energy increased by 2.27 times with psychological aggression, 3.06 times with physical abuse without sequelae and 3.13 times with physical abuse with sequelae. Somatic symptoms did not show statistical association with the types of violence. The propensity to develop symptoms of depressive thoughts increased 3.11 times with psychological aggression, 6.13 times with physical aggression without sequelae, 2.47 times with sexual coercion and 7.3 times with physical aggression with sequelae. CONCLUSION: the types of intimate partner violence are strongly associated with the domains of common mental disorders in women. This finding may contribute to more accurate interventions by health professionals to women victims of violence.

Patterns of Oral-Maxillofacial Trauma and Determinant Factors among Brazilian Victims of Physical Aggression: A 4-Year Study.

PURPOSE: To determine the prevalence of oral-maxillofacial trauma among Brazilian victims of physical aggression and identify its associated factors from a medico-legal and forensic perspective. MATERIALS AND METHODS: A cross-sectional study was carried out involving the analysis of complete medico-legal and social reports of 3668 victims of physical aggression treated at a centre of legal medicine and forensic dentistry over the course of four years. The dependent variable was the occurrence of oral-maxillofacial trauma. The independent variables were sociodemographic status and characteristics of physical aggression. Statistical analyses included the chi-squared test (p < 0.05) as well as univariate and multivariate logistic regression analyses. RESULTS: Oral-maxillofacial trauma occurred in 1655 cases (45.1%). Individuals who lived in suburban areas (OR = 1.32; 95%CI = 1.11-1.58) and those who were victims of community violence (OR = 1.20; 95%CI = 1.03-1.40) perpetrated by someone known to them (OR = 1.24; 95%CI = 1.03-1.40) using physical force (OR = 2.31; 95%CI = 1.96-2.72) on weekends (OR = 1.19; 95%CI = 1.04-1.37) and during nighttime hours (OR = 1.23; 95%CI = 1.08-1.41) were more likely to exhibit oral-maxillofacial trauma. CONCLUSION: The prevalence of oral-maxillofacial trauma was high and the associated factors were area of residence, type of violence, type of offender, mechanism of violence, day, and period of occurrence.