Cumplimiento de las recomendaciones de la OMS para la notificación de COVID-19 en Argentina

Introducción : La Organización Mundial de la Salud (OMS) efectuó recomendaciones en relación con la recopilación y notificación de datos agregados semanales de COVID-19. Objetivo : Investigar el grado de cumplimiento de las recomendaciones elaboradas por la OMS para la notificación de casos y muertes de COVID-19 en la Argentina durante el año 2020 a 2022, y comparar la notificación de muertes con el número de defunciones por COVID-19 consolidadas en el registro de estadísticas vitales del país. Materiales y métodos : Estudio cuantitativo descriptivo, basado en revisión documental y en fuentes de datos secundarias. Se utilizó los reportes diarios de información epidemiológica y la base de datos Dataset, COVID-19 casos registrados en la República Argentina. Adicionalmente, para estimar la omisión en los registros epidemiológicos de fallecimientos por COVID-19 en los años 2020 y 2021, se cotejaron los resultados de las bases de datos Dataset COVID-19 con la base de las Estadísticas vitales de mortalidad por causa de defunción, proporcionadas por la Dirección de Estadísticas e Información en Salud (DEIS). Se analizaron las variables recomendadas por la OMS para la notificación de casos y muertes por COVID-19. En cuanto a las consideraciones éticas relacionadas con el uso de la información utilizada en este trabajo, las bases de datos cumplen con lo estipulado por la Ley Nacional N° 17.622 de Resguardo del Secreto Estadístico, garantizando que la información mantiene el carácter confidencial y reservado del informante. Resultados: Del análisis de los reportes diarios, durante 2020 se observó que, de los 13 indicadores recomendados, 9 presentan datos algunos meses y los 4 restantes no se relevaron; en 2021 solo 7 indicadores presentaron datos algunos meses, y en 2022 solo 3 indicadores se continuaron informando. Respecto al análisis de la base de datos Dataset COVID-19, la mayoría fueron captadas. Respecto a la comparación de los valores de las defunciones registradas por el sistema de vigilancia epidemiológica y por la DEIS para los años 2020 y 2021, las muertes registradas fueron superiores en el registro de la DEIS (9,6% y 14,2%). Conclusiones : El Estado argentino cumplió con gran parte de las recomendaciones que establece la OMS para la notificación de los casos de COVID-19. Estudios posteriores deberían analizar otros componentes de la calidad de los datos, así como la oportunidad de los registros de defunciones, característica necesaria para la toma de decisiones en salud pública.

Introduction : The World Health Organization (WHO) establishes recommendations regarding the collection and reporting of weekly aggregated data on COVID-19. Objective : To investigate the degree of compliance with the recommendations made by the WHO for the reporting of COVID-19 cases and deaths in Argentina during the years 2020 to 2022, and to compare death notifications with the number of COVID-19 deaths recorded in the country's vital statistics registry. Materials and methods : Descriptive quantitative study, based on a documentary review and secondary data sources. Daily reports of epidemiological information and the Dataset database containing registered COVID-19 cases in the Argentine Republic were used. Additionally, to estimate the omission in the epidemiological records of COVID-19 deaths in the years 2020 and 2021, the results of the Dataset COVID-19 databases were compared with the vital statistics death registry on cause of death, provided by the Directorate of Statistics and Health Information (DEIS, by its acronym in Spanish). The variables recommended by the WHO for the reporting of COVID-19 cases and deaths were analyzed. As for the ethical considerations related to the use of the information in this study, the databases comply with the provisions of National Law 17,622 on the Protection of Statistical Secrecy, ensuring that the information remains confidential and reserved for the informant. Results : From the analysis of daily reports, it was observed that in 2020, out of the 13 recommended indicators, 9 had data for some months, and the remaining 4 were not reported. In 2021 only 7 indicators had data for some months, and in 2022 only 3 indicators continued to be reported. Regarding the analysis of the Dataset COVID-19 database, most data were captured. In comparing the values of deaths recorded by the epidemiological surveillance system and by the DEIS for the years 2020 and 2021, the deaths recorded were higher in the DEIS registry (9.6% and 14.2%). Conclusions : The Argentine state largely complied with the recommendations established by the WHO for the reporting of COVID-19 cases. Subsequent studies should analyze other components of data quality, as well as the timeliness of death records, a necessary characteristic for public health decision-making.

Caracterização epidemiológica de violência sexual no sudeste da região norte do brasil / Epidemiological characterization of sexual violence in southeast of northern Brazil / Caracterización epidemiológica de la violencia sexual en el sureste del norte de Brasil

Introdução: A violência sexual é qualquer ato físico, coercivo, de intimidação com potencial psicológico contra outra pessoa, ocorrendo, especialmente,no sexo feminino, em qualquer faixa etária.Objetivo: Apresentar uma caracterização epidemiológica dos casos de violência sexual referente ao número de casos, faixa etária e gênero entre período de 2014 a 2019 no município de Tucuruí-Pará.Métodos:Trata-se de um estudo de caráter descritivo, comparativo e retrospectivo de corte transversal. A coleta dos dados foi realizada através de notificações em protocolos dos órgãos do governo estadual e do governo municipal, na cidade de Tucuruí-Pará.Para análise dos dados, foram utilizados o teste Exato de Fisher e teste de Mann Whitney.Resultados:A instituição com maior número de notificações foi pelo instrumento Estadual, com 771 casos notificados durante o período de 2014 a 2019, (∆%=631%; p<0,001) em relação ao instrumento municipal, que apresentou o total de 140 casos notificados. Quanto a diferença de gênero, as mulheres são as mais atingidas por este tipo de violência em ambos os órgãos analisados, assim como, com respeito a faixa etária mais acometida, a infância, adolescência e adultos jovens são os que mais sofrem com o problema da violência sexual, de acordo com os dados de ambos os órgãos.Conclusão: O perfil da violência sexual no município de Tucuruí é predominante entre mulheres, da faixa etária que vai desde a infância até a fase adulta. Os dados utilizados das duas instituições durante o período de estudo apresentaram diferenças estatísticas, sendo o instrumento de notificações Estadual o órgão com maior número de notificações em todas as comparações realizadas (AU).

Introduction: Sexual violence is any physical, coercive act of intimidation with psychological potential against another person, occurring especially among females, in any age group.Objective: Present an epidemiological characterization of cases of sexual violence regarding the number of cases, age group and gender between 2014 and 2019 in the municipality of Tucuruí-Pará.Methods: This is a descriptive, comparative and retrospective cross-sectional study. Data collection was carried out through notifications in protocols of state and municipal government agencies, in the city of Tucuruí-Pará.For data analysis, Fisher's exact test and Mann Whitney test were used.Results: The institution with the highest number of notifications was by the State instrument, with 771 cases notified during the period 2014 to 2019, (∆%=631%; p<0.001) compared to the municipal instrument, which presented a total of 140 cases notified. As for the gender difference, women are the most affected by this type of violence in both bodies analyzed, as well as, with respect to the most affected age group, childhood, adolescence and young adults are the ones who suffer most from the problem of sexual violence, according to data from both bodies. Conclusion: The profile of sexual violence in the city of Tucuruíis predominant among women, in the age group that goes from childhood to adulthood. The data used from the two institutions during the study period showed statistical differences, with the State notification instrument being the body with the highest number of notifications in all comparisons performed (AU).

Introducción: La violencia sexual es cualquier acto físico y coercitivo de intimidación con potencial psicológico contra otra persona,que ocurre especialmente entre mujeres, en cualquier grupo de edad.Objetivo:Presentar una caracterización epidemiológica de los casos de violencia sexual en cuanto al número de casos, grupo etario y género entre 2014 y 2019 en el municipio de Tucuruí-Pará. Métodos:Se trata de un estudio transversal descriptivo, comparativo y retrospectivo. La recolección de datos se realizó a través de notificaciones en protocolos de organismos gubernamentales estatales y municipales, en la ciudad de Tucuruí-Pará. Parael análisis de los datos se utilizó la prueba exacta de Fisher y la prueba de Mann Whitney. Resultados:La institución con mayor número de notificaciones fue por el instrumento Estatal, con 771 casos notificados durante el período 2014 a 2019, (∆%=631%; p<0,001) frente al instrumento municipal, que presentó un total de 140 casos notificados. En cuanto a la diferencia de género, las mujeres son las más afectadas por este tipo de violencia en ambos cuerpos analizados, así como, respecto al grupo de edad más afectado, la infancia, la adolescencia y los adultos jóvenes son quienes más sufren el problema de la violencia sexual, según datos de ambos organismos. Conclusión:El perfil de violencia sexual en la ciudad de Tucuruí es predominante entre las mujeres, enel grupo etario que va desde la niñez hasta la edad adulta. Los datos utilizados de las dos instituciones durante el período de estudio mostraron diferencias estadísticas, siendo el instrumento de notificación del Estado el organismo con mayor número de notificaciones en todas las comparaciones realizadas (AU).

Consultation-Liaison Case Conference: Assessment and Management of a Physician With Thoughts of Suicide.

We present the case of a physician who engages with a peer response team and discloses suicidal ideation while himself seeing patients in the hospital. Top experts in consultation-liaison psychiatry provide guidance for this clinical case based on their experience and a review of the available literature. Key teaching topics include a general approach to suicide risk assessment, peer response programs for healthcare workers, and ethical and clinical considerations in treating colleagues. Consultation-liaison psychiatrists should be familiar with suicide risk management, take a pro-active approach to addressing modifiable risk factors, and keep in mind unique challenges of treating colleagues referred for care.

Distribution, seroprevalence and risk factors for bovine brucellosis in Brazil: Official data, systematic review and meta-analysis.

Bovine brucellosis is an endemic disease in Brazil, and evidence-based assessments of the available literature on its seroprevalence and risk factors are limited. The aim of this study was to systematically review and summarize studies related to seroprevalence and risk factors of bovine brucellosis in the entire Brazil, in addition to comparing published data with the most recent official reports. Articles available in scientific databases and published between October 2006 and October 2021 were evaluated. Forty-five publications were included in the meta-analysis on the seroprevalence of brucellosis and 29 publications in the review on risk factors. The largest number of publications was found for the State of Mato Grosso do Sul (n=4), and the highest and lowest seroprevalences were observed in Acre (11%; 95% CI: 8.0-14.0%) and in the Federal District (0.4%; 95% CI: 0.2-0.7%). The main risk factors were the purchase of animals for breeding, vaccination, the number of heifers (female ≥2 years), the presence of calving paddocks and the occurrence of abortions. The need for new official studies has been suggested to determine the true prevalence of bovine brucellosis in Brazil, supported by the National Program for the Control and Eradication of Animal Brucellosis and Tuberculosis.

Elderly women's leading role in reporting violence: a grounded theory / El papel protagónico de las mujeres mayores en la denuncia de violencia: una teoría fundamentada / O protagonismo de mulheres idosas na denúncia da violência: uma teoria fundamentada

ABSTRACT Objective: to interpret the experience of empowering elderly women to report domestic violence and develop a theoretical model that explains it. Method: a qualitative study, carried out using Grounded Theory. Between February 2018 and January 2020, semi-structured interviews were conducted with 21 elderly women who filed police reports. Also, nine professionals working at the Women's Defense Station of the Civil Police of the State of São Paulo, Brazil, located in a medium-sized city in the countryside of São Paulo, were interviewed. Results: the phenomenon identified as "Taking the lead in coping with violence", based on the categories, revealed that elderly women experience multiple conditions of vulnerability resulting from the situation of dependency, conflicts in relationships and unfavorable living conditions. Even so, the impacts of this violence generate the need to take action against it and to be empowered to report it. After reporting it, they experience the complexity of it and find ways to deal with the situation. Conclusion: violence reporting by elderly women derives from the individual empowerment process, driven by the decision to stop the abuse, even with possible consequences, thus awakening critical awareness based on self-perception of the context of life.

RESUMEN Objetivo: interpretar la experiencia de empoderamiento de mujeres mayores para denunciar la violencia intrafamiliar y desarrollar un modelo teórico que la explique. Método: estudio cualitativo, realizado utilizando la Teoría Fundamentada. Entre los meses de febrero de 2018 y enero de 2020 se realizaron entrevistas semiestructuradas a 21 ancianas que registraron denuncias policiales. También fueron entrevistados nueve profesionales que trabajan en la Estación de Defensa de la Mujer de la Policía Civil del Estado de São Paulo, Brasil, ubicada en un municipio mediano del interior de São Paulo. Resultados: el fenómeno identificado "Iniciando la lucha contra la violencia", a partir de las categorías, reveló que las mujeres adultas mayores viven múltiples condiciones de vulnerabilidad derivadas de la situación de dependencia, conflictos en las relaciones de pareja y condiciones de vida desfavorables, aun así, los impactos de esta violencia generan la necesidad de tomar acciones frente a ella y empoderarse para denunciarla. Después de la denuncia, experimentan su complejidad y encuentran formas de afrontar la situación. Conclusión: la denuncia de la violencia por parte de mujeres mayores deriva del proceso de empoderamiento individual, impulsado por la decisión de detener el abuso, incluso con posibles consecuencias, despertando así una conciencia crítica basada en la autopercepción del contexto de vida.

RESUMO Objetivo: interpretar a vivência do empoderamento de idosas para realização da denúncia de violência intrafamiliar e desenvolver modelo teórico que o explicite. Método: estudo qualitativo, realizado por meio da Teoria Fundamentada nos Dados. Entre os meses de fevereiro de 2018 e janeiro de 2020, realizaram-se entrevistas semiestruturada com 21 idosas que registraram Boletins de Ocorrência. Também, entrevistaram-se nove profissionais atuantes em Delegacia de Defesa da Mulher da Polícia Civil do Estado de São Paulo, Brasil, localizada em município de médio porte do interior paulista. Resultados: o fenômeno identificado "Protagonizando o enfrentamento da violência", a partir das categorias, revelou que as mulheres idosas vivenciam múltiplas condições de vulnerabilidade decorrentes da situação de dependência, conflitos nas relações e condições de vida desfavoráveis, mesmo assim, os impactos dessa violência geram a necessidade de tomada de atitude frente a ela e ao empoderamento para a denúncia. Após a denúncia, vivenciam a complexidade da mesma e encontram formas para lidar com a situação. Conclusão: a realização da denúncia de violência por mulheres idosas deriva do processo de empoderamento individual, impulsionado pela decisão em interromper os abusos, mesmo com possíveis consequências, despertando, assim, consciência crítica a partir da autopercepção do contexto de vida.

Profile and characteristics of violence against older adults during the COVID-19 pandemic / Perfil e características da violência contra a pessoa idosa durante a pandemia COVID-19 / Perfil y características de la violencia contra los adultos mayores durante la pandemia de COVID-19

Abstract Objective: to identify the sociodemographic profile and the characteristics of interpersonal violence against older adults during the first year of the COVID-19 pandemic in a capital city from the Brazilian Southeast region. Method: a descriptive and exploratory research study with a cross-sectional design based on the notifications of suspected or confirmed cases of violence against older adults between March 2020 and March 2021. A univariate statistical analysis and Fisher's exact test (p<0.05) were performed. Results: a total of 2,681 notifications were recorded during the period. The main victims were individuals aged between 60 and 64 years old, female, white-skinned and with low schooling levels. The instances of violence were more frequent in the victims' homes. Physical and psychological violence predominated, through physical force/beatings and threats, respectively. Most of the aggressors were male, younger than the victims and generally their children or intimate partners. The aggressions were perpetrated more than once and were driven by generational conflicts. There was low referral to entities for the protection of older adults. Conclusion: the sociodemographic profile found evidences vulnerable victims, subjected to many types of violence, and at a potential risk against their overall health.

Resumo Objetivo: identificar o perfil sociodemográfico e as características da violência interpessoal contra a pessoa idosa no primeiro ano da pandemia COVID-19 em uma capital da região sudeste do Brasil. Método: pesquisa descritiva, exploratória, com delineamento transversal a partir da análise das notificações de casos suspeitos ou confirmados de violência contra a pessoa idosa, ocorridas entre março de 2020 e março de 2021. Foi realizada a análise estatística univariada e teste exato de Fisher (p<0,05). Resultados: houve 2681 notificações no período. As principais vítimas foram pessoas com idade entre 60 e 64 anos, do sexo feminino, brancas e com baixa escolaridade. As ocorrências tiveram maior frequência nos domicílios. As violências físicas e psicológicas foram as mais comuns, com uso de força física/espancamento e ameaça, respectivamente. O agressor era, em sua maioria, do sexo masculino, mais jovem do que a vítima, geralmente filho ou parceiro íntimo. As agressões ocorreram mais de uma vez e foram motivadas por conflitos geracionais. Houve baixo encaminhamento para órgãos de proteção a pessoa idosa. Conclusão: o perfil sociodemográfico encontrado evidencia vítimas vulneráveis, sujeitas a muitas formas de violência e com potenciais riscos à integralidade de sua saúde.

Resumen Objetivo: identificar el perfil sociodemográfico y las características de la violencia interpersonal contra los adultos mayores en el primer año de la pandemia de COVID-19 en una ciudad capital de la región sureste de Brasil. Método: investigación descriptiva, exploratoria con diseño transversal a partir del análisis de las notificaciones de casos sospechosos o confirmados de violencia contra el adulto mayor, ocurridos entre marzo de 2020 y marzo de 2021. Se realizó un análisis estadístico univariado y la prueba exacta de Fisher (p< 0,05). Resultados: hubo 2681 notificaciones en el período. Las principales víctimas fueron personas entre 60 y 64 años, de sexo femenino, blancas y con baja escolaridad. La mayoría de los casos se registró en el hogar. La violencia física y psicológica fueron las más comunes, con uso de fuerza física/golpes y amenaza, respectivamente. El agresor era generalmente del sexo masculino, más joven que la víctima, hijo o pareja. Las agresiones se produjeron más de una vez y fueron motivadas por conflictos generacionales. Hubo baja derivación a organismos de protección de adultos mayores. Conclusión: el perfil sociodemográfico obtenido revela que son víctimas vulnerables, sujetas a múltiples formas de violencia y que la integridad de su salud está en riesgo potencial.

Architecture Assessment of the Chilean Epidemiological Surveillance System for Notifiable Diseases (EPIVIGILA): Qualitative Study.

BACKGROUND: To fulfill their epidemiological vigilance function, authorities require valid, complete, timely, precise, and reliable information. Advancements in new technologies have facilitated public health control through vigilance systems for notifiable diseases; these systems can gather large numbers of simultaneous notifications, process a wide array of data, and deliver updated information in real time to relevant decision-makers. A large worldwide deployment of new information technologies was seen during the COVID-19 pandemic; these technologies proved to be efficient, resourceful tools . Platform developers should seek self-evaluation strategies to optimize functionality or improve the capacity of national vigilance systems. These tools exist in the Latin American region at various development stages, although publications reporting architectural characteristics of these tools are scarce. International publications are more abundant a nd serve as a basis for comparing the standards that need to be met. OBJECTIVE: This study aimed to assess the architecture of the Chilean epidemiological surveillance system for notifiable diseases (EPIVIGILA), as compared to that of the international systems reported in scientific publications. METHODS: A search for scientific publications was conducted to identify systematic reviews that documented the architectural characteristics of disease notification and vigilance systems. EPIVIGILA was compared to other systems from countries in Africa, the Americas, Asia, Europe, and Oceania. RESULTS: The following aspects of the architecture were identified: (1) notification provenance, (2) minimum data set, (3) database users, and (4) data quality control. The notifying organizations, including hospitals, clinics, laboratories, and medical consultation offices, were similar among the 13 countries analyzed; this contrasted with Chile, where the reporting agent is the physician who can belong to an organization. The minimum data set include patient identification, disease data, and general codifications. EPIVIGILA includes all these elements, in addition to symptomatology, hospitalization data, type of medicine and treatment result, and laboratory test types. The database users or data analyzers include public health organizations, research organizations, epidemiological organizations, health organizations or departments, and the Centers for Disease Control and Prevention. Finally, for data quality control, the criteria most often used were completeness, consistency, validity, timeliness, accuracy, and competencies. CONCLUSIONS: An efficient notification and vigilance system must be capable of promptly identifying probable risks as well as incidence and prevalence of the diseases under surveillance. EPIVIGILA has been shown to comply with high quality and functionality standards, at the level of developed countries, by achieving total national coverage and by providing timely, trustworthy, and complete information at high-security levels, thus obtaining positive assessment from national and international authorities.

Barriers and facilitators to the implementation of mandatory folate fortification as an evidence-based policy to prevent neural tube defects.

BACKGROUND: Neural tube defects continue to be one of the main congenital malformations affecting the development of the nervous system and a significant cause of disability and disease burden to individuals living with these conditions. Mandatory food fortification with folic acid is, by far, one of the most efficacious, safe, and cost-effective interventions to prevent neural tube defects. However, most countries fail to effectively fortify staple foods with folic acid, impacting public health and healthcare systems and generating dismal disparities. AIM: This article discusses the main barriers and facilitators for implementing mandatory food fortification as an evidence-based policy to prevent neural tube defects worldwide. METHODS: A comprehensive review of the scientific literature allowed the identification of the determinant factors acting as barriers or facilitators for the reach, adoption, implementation, and scaling up of mandatory food fortification with folic acid as an evidence-based policy. RESULTS: We identified eight barriers and seven facilitators as determinant factors for food fortification policies. The identified factors were classified as individual, contextual, and external, inspired by the Consolidated Framework for Implementation of Research (CFIR). We discuss mechanisms to overcome obstacles and seize the opportunities to approach this public health intervention safely and effectively. CONCLUSIONS: Several determinant factors acting as barriers or facilitators influence the implementation of mandatory food fortification as an evidence-based policy worldwide. Notoriously, policymakers in many countries may lack knowledge of the benefits of scaling up their policies to prevent folic acid-sensitive neural tube defects, improve the health status of their communities, and promote the protection of many children from these disabling but preventable conditions. Not addressing this problem negatively affects four levels: public health, society, family, and individuals. Science-driven advocacy and partnerships with essential stakeholders can help overcome the barriers and leverage the facilitators for safe and effective food fortification.

Impact of COVID-19 Mandatory Lockdown Measures on Cognitive and Neuropsychiatric Symptoms in Persons with Alzheimer's Disease in Lima, Peru.

BACKGROUND: Neuropsychiatric symptoms (NPS) in patients with Alzheimer's disease (AD) worsened during the COVID-19 lockdowns, but their progression thereafter is unknown. We present the first longitudinal study tracking them before, during, and after restrictions. OBJECTIVES: To describe the effect of the COVID-19 mandatory lockdowns on Cognitive and Neuropsychiatric symptoms in patients with Mild Cognitive Impairment (MCI) and Alzheimer's Disease (AD). METHODS: Cohort of 48 patients with amnestic MCI and 38 with AD in Lima, Peru. They received three rounds of cognitive (RUDAS, CDR, M@T), behavioral (NPI), and functional (ADCS-ADL) assessments. We assessed the change in score means across the time points and for each domain of NPS and tracked the changes in individual patients. RESULTS: RUDAS declined 0.9 (SD 1.0) from baseline to lockdown and 0.7 (SD 1.0) after restrictions. M@T declined 1.0 (SD 1.5) from baseline to lockdown and 1.4 (SD 2.0) after restrictions. CDR worsened in 72 patients (83.72%) from baseline to post-lockdown. NPI worsened by 10 (SD 8.3) from baseline to lockdown but improved by 4.8 (SD 6.4) after restrictions. Proportionally, 81.3% of all patients had worsened NPS during the lockdowns, but only 10.7% saw an increase thereafter. Improvement was statistically significant for specific NPS domains except hallucinations, delusions, and appetite changes. Anxiety, irritability, apathy, and disinhibition returned to baseline levels. CONCLUSION: Following confinement, cognition continued to decline, but NPS demonstrated either stability or improvement. This highlights the role modifiable risk factors may have on the progression of NPS.

Significados, concepções e experiências de enfermeiros da Estratégia Saúde da Família de Belo Horizonte frente ao abuso infantil: teorização sobre a não notificação / Meanings, conceptions, and experiences of nurses from the Family Health Strategy from Beautiful Horizon when faced with child abuse: theorization of non-reporting

O abuso infantil tem sido considerado um problema de saúde pública entre crianças e adolescentes sendo reconhecido, cada vez mais como uma questão social complexa e endêmica. Os profissionais da saúde desenvolvem um papel fundamental no combate ao abuso infantil, porém o padrão encontrado na atuação dos enfermeiros diante de casos de abuso infantil sugere a existência de dificuldades e barreiras, indicando uma alta prevalência de comportamento de não-notificação entre esses profissionais. Nesse contexto, este estudo objetivou compreender os significados, concepções e experiências de enfermeiros da Estratégia Saúde da Família (ESF) de Belo Horizonte frente ao abuso infantil, bem como, construir teorização sobre o comportamento de não notificação. Trata-se de um estudo qualitativo baseado no referencial metodológico da Teoria Fundamentada nos Dados (TFD) e teórico do Interacionismo Simbólico (IS). A seleção dos participantes (enfermeiros) se deu de forma intencional e paralelamente foi utilizada a técnica "snowball", na qual cada profissional entrevistado indicou outro para participar do estudo, possibilitando a definição da amostragem por referência. Foram realizadas 14 entrevistas intensivas com enfermeiros que atuam na ESF de nove Centros de Saúde de Belo Horizonte. A coleta e a categorização dos dados ocorreram simultaneamente segundo a TFD e a partir do processo de análise emergiram quatro categorias principais. A categoria "Concepção de abuso infantil", segundo os enfermeiros, é um assunto difícil de ser tratado, sendo associado à violação dos direitos da criança. A "Concepção sobre a notificação" dos enfermeiros da ESF evidenciou confusão teórica entre os termos notificação e denúncia, o que em parte, pode explicar o comportamento de não notificação. A categoria "Comunicação entre os profissionais e os órgãos de apoio" sugere que, a comunicação geralmente ocorre por meio de uma assistente social, sendo a atuação desta, para a maioria dos participantes, mais efetiva que a do conselho tutelar. "Barreiras e Facilitadores" incluem medo e alta demanda dos profissionais, o que pode dificultar a identificação e notificação do abuso. Treinamento, capacitação e reuniões da ESF foram identificados como possíveis fatores facilitadores para a notificação. Das conexões entre as categorias emergentes e suas relações construiu-se a "Teoria do comportamento de não notificação entre enfermeiros da Estratégia Saúde da Família". Entender as experiências, concepções e comportamentos dos enfermeiros frente ao abuso infantil, permitiu identificar ações que ainda precisam ser realizadas para que o propósito da notificação se cumpra, uma vez que estes profissionais desempenham um papel fundamental no cuidado das crianças e no combate ao abuso infantil.

Child abuse has been recognized as a complex and endemic social issue, and a public health problem among children and adolescents. Healthcare professionals play a pivotal role in addressing child abuse. However, the patterns observed in the actions of nurses when dealing with cases of child abuse suggest the existence of difficulties and barriers, suggesting a high prevalence of non-reporting behavior among these professionals. In this context, this study aimed at understanding the meanings, conceptions, and experiences of nurses from the Family Health Strategy (FHS) in Belo Horizonte regarding child abuse, as well as to construct a theory about non-reporting behavior. This is a qualitative study based on the methodological framework of Grounded Theory (GT) and the theoretical framework of Symbolic Interactionism (SI). The participants (nurses) were selected in an intentional manner, and the snowball technique was also used, which each interviewed professional indicated another to participate in the study, allowing for reference-based sampling. Fourteen intensive interviews were conducted with nurses working in the FHS of nine Health Centers in Belo Horizonte. Data collection and categorization occurred simultaneously according to GT, and four main categories emerged from the analysis process. The category "Conception of child abuse" suggests that nurses find it difficult to address this issue, as it is associated with the violation of children's rights. The category "Conception of reporting" revealed theoretical confusion among FHS nurses regarding the terms "reporting" and "denunciation," which may partly explain the non-reporting behavior. The category "Communication between professionals and support agencies" suggests that communication usually occurs through a social worker, and most participants perceived the social worker's actions as more effective than those of the child protective services. The category "Barriers and Facilitators" includes fear and high workload, which can jeopardize the identification and reporting of abuse. Training, and FHS meetings were identified as potential facilitators for reporting. By analyzing the connections between the emerging categories and their relationships, the "Theory of non-reporting behavior among nurses in the Family Health Strategy" was developed. Understanding nurses' experiences, conceptions, and behaviors regarding child abuse allowed for the identification of actions that still need to be taken to fulfill the purpose of reporting, as these professionals play a fundamental role in caring for children and combating child abuse.

Notificações de violência sexual contra crianças e adolescentes no Rio Grande do Sul: estudo descritivo, 2014-2018 / Notificaciones de violencia sexual contra niños y adolescentes en Rio Grande do Sul, Brasil: estudio descriptivo, 2014-2018 / Notifications of sexual violence against children and adolescents in Rio Grande do Sul, Brazil: a descriptive study, 2014-2018

Objetivo: descrever características das notificações de violência sexual contra crianças e adolescentes segundo a raça/cor da pele e sua distribuição no Rio Grande do Sul, Brasil, 2014-2018. Métodos: estudo descritivo de dados do Sistema de Informação de Agravos de Notificação (Sinan); foram analisadas distribuições de frequência, prevalências e diferenças estatísticas pelo teste qui-quadrado de Pearson. Resultados: das 8.716 notificações, a maioria ocorreu na capital (48,2%) e de vítimas do sexo feminino (82,2%) com idade entre 10 e 14 anos (38,1%); houve maior prevalência (370/100 mil) e frequência relativa de estupro (84,5%), exploração sexual (5,8%) e negligência/abandono (4,6%) entre vítimas de raça/cor da pele negra (p-valor < 0,05); 4,6% das notificações foram realizadas nos serviços de Atenção Básica à Saúde (ABS). Conclusão: houve maior frequência de notificações entre pré-adolescentes do sexo feminino e maior prevalência entre negros, alvos prioritários das medidas de proteção; torna-se necessário reforçar a vigilância dessa violência na ABS.

Objetivo: describir las características de las notificaciones de violencia sexual contra niños y adolescentes según raza/color de piel y su distribución en Rio Grande do Sul, Brasil, 2014-2018. Métodos: estudio descriptivo de datos del Sistema de Información de Enfermedades y Notificaciones (Sinan). Distribuciones de frecuencia, prevalencias y diferencias estadísticas fueron analizadas mediante la prueba de chi-cuadrado de Pearson. Resultados: de 8.716 notificaciones, la mayoría ocurrió en la capital (48,2%) y fueron de víctimas del sexo femenino (82,2%) con edades entre 10 y 14 años (38,1%). Hubo mayor prevalencia (370/100.000) y frecuencia relativa de violación (84,5%), explotación sexual (5,8%) y negligencia/abandono (4,6%) entre víctimas de raza/color de piel negro (p-valor < 0,05). Un 4,6% de las notificaciones ocurrió en servicios de atención primaria. Conclusión: hubo mayor frecuencia de notificaciones entre preadolescentes femeninas y mayor prevalencia entre víctimas negras, que deben presentar medidas de protección prioritarias. Es necesario reforzar la vigilancia de violencias en atención primaria.

Objective: to describe characteristics of notifications of sexual violence against children and adolescents according to race/skin color and their distribution in the state of Rio Grande do Sul, Brazil, between 2014 and 2018. Methods: this was a descriptive study of data retrieved from the Notifiable Health Conditions Information System (SINAN). Frequency distributions, prevalence and statistical differences were analyzed using Pearson's chi-square test. Results: of the 8,716 notifications, most occurred in the state capital (48.2%) and related to female victims (82.2%) aged between 10 and 14 years (38.1%). There was a higher prevalence (370/100,000) and relative frequency of rape (84.5%), sexual exploitation (5.8%) and neglect/abandonment (4.6%) among victims of Black race/skin color (p-value < 0.05). Only 4.6% of notifications occurred in primary health care services. Conclusion: notifications were more frequent among female pre-adolescents and prevalence was higher among Black people, who should be a priority target for protective measures. Surveillance of this form of violence needs to be strengthened in primary care.

Notificações de violência física, violência sexual, violência psicológica e negligência praticadas contra crianças no Brasil, 2011-2019: estudo ecológico de série temporal / Notifications of physical, sexual and emotional violence and neglect against children in Brazil, 2011-2019: an ecological time-series study / Notificaciones de violencia física, sexual, psicológica y negligencia practicada contra niños en Brasil, 2011-2019: estudio ecológico de serie temporal

Objective To describe the temporal trend of notifications of physical, sexual and emotional violence and neglect against children in Brazil between 2011 and 2019. Methods This was an ecological time-series study based on notifications of violence against children aged 0-9 years held on the Brazilian Notifiable Health Conditions Information System. Age-adjusted notification rates were calculated for Brazil as a whole, by national macro-region and by sex. Trends were assessed using Joinpoint Regression. Results We analyzed 88,820 notifications of physical violence, 87,141 notifications of sexual violence, 52,359 notifications of emotional violence and 166,664 notifications of neglect. A rising trend was identified for notifications of physical, sexual and emotional violence and neglect for Brazil as a whole and for both sexes. Neglect accounted for the highest rate (95.24 notifications per 100,000 children in 2019). The Northeast and Southeast macro-regions had rising trends for all forms of violence. Conclusion Notifications of physical, sexual and emotional violence and neglect showed rising trends in Brazil in the period studied.

Objetivo Describir la tendencia temporal de notificaciones de violencia física, sexual, psicológica y negligencia practicada contra niños en Brasil entre 2011 y 2019. Métodos Estudio ecológico de series temporales de notificaciones registradas en el Sistema de Información de Agravamientos de Notificación contra niños (0-9 años). Se calcularon las tasas de notificación ajustadas por edad para Brasil por macrorregión y sexo. Se analizó la tendencia mediante regresión joinpoint. Resultados Se incluyeron 88.820 notificaciones de violencia física, 87.141 de violencia sexual, 52.359 de violencia psicológica y 166.664 de negligencia. Se identificó una tendencia ascendente de las notificaciones de violencia física, sexual y psicológica y de negligencia para Brasil y para ambos sexos. La negligencia tuvo la tasa más alta (95,24 notificaciones por 100.000 en 2019).Noreste y Sureste presentaron tendencia creciente en todos los tipos de violencia. Conclusión Las notificaciones de violencia contra los niños mostraron tendencia creciente entre 2011 y 2019 en Brasil.

Objetivo Descrever a tendência temporal das notificações de violência física, violência sexual, violência psicológica e negligência praticadas contra crianças no Brasil, entre 2011 e 2019. Métodos Estudo ecológico de série temporal, sobre notificações de violência contra crianças de 0 a 9 anos no Sistema de Informação de Agravos de Notificação. Taxas de notificação ajustadas por idade foram calculadas para Brasil, macrorregiões nacionais e sexo. Analisou-se a tendência das taxas por regressão joinpoint. Resultados Foram analisadas 88.820 notificações de violência física, 87.141 de violência sexual, 52.359 de violência psicológica e 166.664 notificações de negligência. Identificouse tendência crescente de notificações de violência física, sexual, psicológica e negligência, para o Brasil e ambos os sexos. Negligência apresentou a maior taxa [95,24 notificações/100 mil crianças (2019)]. Nordeste e Sudeste apresentaram tendência crescente para todas as violências. Conclusão Notificações de violência física, sexual, psicológica e negligência contra crianças apresentaram tendência crescente no Brasil, no período.

Prevalência e fatores associados à negligência contra crianças em um estado brasileiro / Prevalencia y factores asociados a la negligencia contra niños en un estado brasileño / Prevalence and factors associated child neglect in a Brazilian state

RESUMO Objetivo Quantificar a prevalência da negligência contra a criança e identificar seus fatores associados, a partir dos casos notificados no estado do Espírito Santo no período entre 2011 e 2018. Métodos Estudo transversal com dados notificados no Sistema de Informação de Agravos de Notificação (SINAN) com todos os casos notificados de negligência contra a criança no período de 2011 a 2018 no Espírito Santo, Brasil. Foram estudadas as características da vítima, do autor e da agressão e as associações foram analisadas por meio da Regressão de Poisson. Resultados A frequência de negligência foi 31,3%, sendo mais prevalente no sexo masculino (RP: 1,48; IC95%: 1,34-1,63); na faixa etária de 0 a 2 anos (RP: 3,05; IC95%: 2,65-3,51); entre agressores do sexo feminino (RP: 16,20; IC95%: 9,98-26,32), e, em relação ao vínculo nota-se a maior prevalência de pais/padrastos (RP: 6,69; IC95%: 4,16-10,74), ambos os pais (RP: 4,41; IC95%: 2,84-6,85) e mães/madrastas (RP: 2,94; IC95%: 2,20-3,93). Conclusões e Implicações para a prática A magnitude de negligência contra crianças no Espírito Santo foi expressiva, demonstrando a necessidade de avançar no entendimento deste fenômeno e na implementação de políticas públicas intersetoriais ampliadas que visem garantir condições adequadas para o crescimento e desenvolvimento na infância.

RESUMEN Objetivo Cuantificar la prevalencia del abandono infantil e identificar sus factores asociados, a partir de los casos notificados en el estado de Espírito Santo entre 2011 y 2018. Métodos Estudio transversal con datos notificados en el Sistema de Información de Enfermedades de Declaración Notificable (SINAN) con todos los casos reportados de negligencia infantil entre 2011 y 2018 en Espírito Santo, Brasil. Se estudiaron las características de la víctima, del agresor y de la agresión y se analizaron las asociaciones mediante Regresión de Poisson. Resultados La frecuencia de abandono fue del 31,3%, siendo más prevalente en el sexo masculine (RP: 1,48; IC95%: 1,34-1,63); en el grupo de edad de 0 a 2 años (RP: 3,05; IC95%: 2,65-3,51); entre las mujeres agresoras (RP: 16,20; IC95%: 9,98-26,32), y en relación al vínculo hay mayor prevalencia de padres/padrastros (RP: 6,69; IC95%: 4,16-10,74), ambos padres (RP: 4,41; IC95%: 2,84-6,85) y madres/madrastras (RP: 2,94; IC95%: 2,20-3,93). Conclusiones e Implicaciones para la práctica La magnitud del abandono de los niños fue expresiva, demostrando la necesidad de avanzar en la comprensión de este fenómeno y en la implementación de políticas públicas intersectoriales ampliadas que tengam como objetivo garantizar condiciones adecuadas para el crecimiento y desarrollo en la infancia.

ABSTRACT Objective To quantify the prevalence of neglect against the child and identify its associated factors, based on the cases reported in the state of Espírito Santo between 2011 and 2018. Methods Cross-sectional study with data reported in the Notifiable Diseases Information System (SINAN) with all reported cases of child neglect from 2011 to 2018 in the state of Espírito Santo, Brazil. The characteristics of the victim, author, and aggression were studied, and the associations were analyzed by Poisson regression. Results The frequency of neglect was 31.3%, being more prevalent in males (PR: 1.48; 95%CI: 1.34-1.63); for the age group of zero to two years (PR: 3.05; 95%CI: 2.65-3.51); among female aggressors (PR: 16.20; 95%CI: 9.98-26.32), and regarding the bond to the victim, we note the highest prevalence of parents/stepfathers (PR: 6.69; 95%CI: 4.16-10.74), both parents (PR: 4.41; 95%CI: 2.84-6.85) and mothers/stepmothers (PR: 2.94; 95%CI: 2.20-3.93). Conclusions and Implications for the practice The magnitude of child neglect in Espírito Santo was significant, showing the need to advance in the understanding of this phenomenon and in the implementation of expanded intersectoral public policies aimed at ensuring adequate conditions for growth and development in childhood.

Do health sector measures of violence against women at different levels of severity correlate? Evidence from Brazil.

OBJECTIVE: To evaluate if characteristics of reports of violence against women at different levels of severity are similar and to test if their prevalence is correlated at the municipal level. METHODS: I use data from women ages 15-49 who were killed by homicide in Brazil's national death registry (N = 14,373), were hospitalized for aggression (N = 14,701), or were included in the medical mandatory reports of incidents of violence against women (N = 42,134) between 2011 and 2016 in select municipalities. I provide national level descriptive statistics from 2016 contrasting distributions of victims (age, education, and race) and distributions of the characteristics of the incidents (location and time of day). Then, for 63 municipalities with a high number of violent incidents, I calculate the correlation coefficients between measures of violence against women using quarterly data from 2011 to 2016. I use multiple regression of municipal characteristics at baseline to examine which factors (poverty, spending, health, and civic engagement) predict the correlation. RESULTS: Victim characteristics and incident characteristics are similar across the measures of violence at the national level. Despite these aggregate similarities, correlations at the municipal level are quite varied, ranging from - 0.69 to 0.83. I find no municipal characteristics that consistently predict these correlation coefficients. CONCLUSIONS: Despite some similarities at an aggregate level, these measures of violence against women do not have consistent patterns of correlation at the municipality level. Measures of severe levels of violence against women are not good proxies for incidence of violence at less severe physical levels. Lack of correlations could be due to differences in reporting, but may also be due to differences in underlying processes that share similar victims and event characteristics.

Citizen Stance towards Mandatory COVID-19 Vaccination and Vaccine Booster Doses: A Study in Colombia, El Salvador and Spain.

The infections and deaths resulting from Coronavirus Disease 2019 (COVID-19) triggered the need for some governments to make COVID-19 vaccines mandatory. The present study aims to analyze the position of 3026 adults in Colombia, El Salvador, and Spain regarding the possibility of making COVID-19 vaccine mandatory and the intention to be vaccinated with the booster or possible successive doses. Data from an online survey conducted from August to December 2021 among a non-representative sample of Spanish-speaking countries were collected. Multinomial Logistic Regression Models were used. A total of 77.4% of Colombians were in favor of mandatory vaccination compared to 71.5% of Salvadorians and 65.4% of Spaniards (p < 0.000). Women and people over 65 years of age were the groups most in favor of making the vaccine mandatory (p < 0.000). A total of 79.4% said they had received a third dose or would intend to receive the third dose or future doses, if necessary, compared with 9.4% who expressed doubts and 9.9% who refused to be vaccinated or did not intend to be vaccinated. Among the measures that could be taken to motivate vaccination, 63.0% and 60.6% were in favor of requiring a negative test to enter any place of leisure or work, respectively, compared to 16.2% in favor of suspension from work without pay. The acceptance of mandatory vaccination and of third or future doses varies greatly according to sociodemographic characteristics and work environment. As such, it is recommended that policy makers adapt public health strategies accordingly.

Prevalence of inadequate intake of folate in the post-fortification era: data from the Brazilian National Dietary Surveys 2008-2009 and 2017-2018.

The objectives were to compare the evolution of dietary folate intake, to estimate the prevalence of folate inadequacy (POFI) and the contribution of food groups to folate intake (dietary folate plus folic acid from fortified foods) in two post-fortification periods in the Brazilian population, according to life stages, geographic regions and per capita income. Population-based study including representative data from the National Dietary Survey - Brazilian Household Budget Surveys (NDS-HBS) 2008-2009 and 2017-2018, with a total of 32 749 (2008-2009) and 44 744 (2017-2018) individuals aged ≥ 10 years old, excluding pregnant and lactating women. The National Cancer Institute method was used to estimate the distributions of usual dietary folate intake. POFI was estimated according to estimated average requirement cut-off point method. After 10 years of the first NDS-HBS, POFI has increased in all sex-age groups, except for 10-13 years. POFI among women of reproductive age was around 30 and 40 % in 2008-2009 and 2017-2018. Higher POFI was observed in the North region. The top five food groups contributors to folate intake in Brazil were beans, breads, pasta and pizza, cakes and cookies and non-alcoholic beverages groups in both periods, differing in the rank order of the last two groups. Although being a country that has adopted mandatory folic acid flour fortification for almost two decades, increased POFI was observed in 2017-2018. This study brings significant scientific information, which can help understand folate dietary data in different contexts and consequently guide the approach for public health fortification strategies.

Child Labor in the State of Amazonas: Invisibility of the Notification System / Trabalho infantil no estado do Amazonas: a invisibilidade do sistema de notificação

ABSTRACT Objective: To describe the characteristics of reported cases of child labor in general and to compare official reported child labor data with data on sexual exploitation and occupational accidents involving children and adolescents between 2017 and 2021. Methods: Descriptive study based on data from the Notifiable Health Conditions Information System about child labor, work accidents and sexual exploitation of children and adolescents aged between 5 and 17 years. Annual disease notification rates were calculated and grouped by mesoregions of the state of Amazonas. Results: From 2017 to 2021, there were 312 reports of situations of child labor, being 46.8% involving children and 53.2% involving adolescents. Of these notifications, 20 corresponded to child labor itself, 141 to child and adolescent sexual exploitation, and 151 to work-related accidents involving children and adolescents. The South and Center regions were the ones that most underreported child sexual exploitation as child labor. The Southwest and South mesoregions, on the other hand, were the ones that most underreported work accidents involving children and adolescents as child labor. Conclusion: Child labor in Amazonas basically stems from sexual exploitation and, even though it is underreported, it is frequent, although uneven between regions. Confronting the problem in the state necessarily involves improving the information system in order to acknowledge the actual dimension of the problem and then define intervention measures and logistics.

RESUMO Objetivo: Descrever as características dos casos notificados de trabalho infantil em geral e comparar dados oficiais notificados de trabalho infantil com dados de exploração sexual e acidentes de trabalho envolvendo crianças e adolescentes entre 2017 e 2021. Métodos: Estudo descritivo com base nos dados do Sistema de Informação de Agravos de Notificação sobre trabalho infantil, acidente de trabalho e exploração sexual de crianças e adolescentes com idades entre 5 e 17 anos. Foram calculadas taxas de notificação anuais dos agravos e agregadas por mesorregião do estado do Amazonas. Resultados: No período de 2017 a 2021, houve 312 notificações de situações envolvendo trabalho infantil, sendo 46,8% com crianças e 53,2% com adolescentes. Dessas notificações, 20 correspondiam ao trabalho infantil propriamente dito, 141 de exploração sexual infantojuvenil e 151 casos de acidente de trabalho envolvendo crianças e adolescentes. As mesorregiões sul e centro foram as que mais subnotificaram exploração sexual infantojuvenil como trabalho infantil. Já as mesorregiões sudoeste e sul foram as que mais sub-registraram acidentes de trabalho envolvendo crianças e adolescentes como trabalho infantil. Conclusão: O trabalho infantil no Amazonas decorre basicamente de exploração sexual e, mesmo subnotificado, é de ocorrência frequente, porém desigual entre as regiões. O enfrentamento do agravo no estado passa, obrigatoriamente, pelo aperfeiçoamento do sistema de informação a fim conhecer a real dimensão do problema para, então, definir medidas e logística de intervenção.

Violência sexual contra crianças e adolescentes: um olhar a partir das notificações no estado do Rio Grande do Sul / Sexual violence against children and adolescents: a look at from notifications in the state of Rio Grande do Sul

A violência sexual contra crianças e adolescentes é uma face perversa e, frequentemente, oculta e banalizada da violência em geral, que necessita de esforços para ser enfrentada pela sociedade e pelo poder público. O objetivo deste estudo foi analisar o fenômeno no Estado do Rio Grande do Sul, a partir de notificações compulsórias. Trata-se de um estudo epidemiológico analítico transversal dos casos de violência sexual notificados no Sistema de Informação de Agravos e Notificações (SINAN) de janeiro de 2014 a dezembro de 2018. No total, foram notificados 11.099 casos de violência sexual, 8.716 (78,5%) perpetrados contra crianças e adolescentes. Ocorreu mais notificações entre vítimas de 10 a 14 anos (37,8%), do sexo feminino (81,7%), e a maioria dos prováveis autores da violência foram adultos (59,2%), do sexo masculino (94,2%). As ocorrências se deram mais na residência das vítimas (75,3%), perpetradas por parentes (53,4%) ou amigos/conhecidos (27,4%). Houve mais estupros (81,9%), recorrências (60,0%) e coocorrências com violência psicológica/moral (30,4%) e física (16%). Vítimas de raça/cor negra notificaram mais estupros (84,5%) e exploração sexual (5,8%) quando comparadas às de raça/cor branca, que notificaram mais assédio sexual. A notificação de estupro perpetrado por mais de um agressor simultâneo também foi maior nas vítimas de raça/cor negra (15,4%), assim como a coocorrência com negligência/abandono (4,6%). Mais da metade das notificações (56%) foi realizada por serviços hospitalares de referência do estado. O município que mais notificou foi Porto Alegre (48,2%). Pelotas (0,4%) e Alvorada (0,1%) apresentaram um menor número de notificações, comparado ao número de ocorrências, e 38,0% dos municípios do estado não realizaram nenhuma notificação ao longo de cinco anos. Os resultados deste estudo apontam que a violência sexual em crianças e adolescentes está relacionada com a interseccionalidade entre gênero e raça. Percebe-se a necessidade de educação permanente dos profissionais envolvidos no enfrentamento desse tipo de violência em relação ao seu reconhecimento como um objeto de intervenção no setor da saúde, principalmente, em âmbitos não-hospitalares, como na Atenção Básica, assim como de uma maior organização e integração das redes de proteção às vítimas, por parte das gestões, sobretudo, nos municípios com maiores índices de violência.

Sexual violence against children and adolescents is a perverse and often hidden and trivialized face of violence in general, which needs efforts to be faced by society and public authorities. The objective of this study was to analyze the phenomenon of sexual violence against children and adolescents in the State of Rio Grande do Sul based on compulsory notifications. This is a cross-sectional analytical epidemiological study of cases of sexual violence reported in the Information System for Diseases and Notifications (SINAN) from January 2014 to December 2018. In total, 11,099 cases of sexual violence were reported, of which 8,716 (78.5%) perpetrated against children and adolescents. There were more notifications among victims aged 10 to 14 years (37.8%) and females (81.7%) and most likely perpetrators of violence were adults (59.2%) and male (94.2%). The occurrences took place more in the victims' homes (75.3%), perpetrated by family members (53.4%) or friends/acquaintances (27.4%). There were more rapes (81.9%), recurrences (60%) and co-occurrences with psychological/moral (30.4%) and physical (16%) violence. Victims of black race/color reported more rapes (84.5%) and sexual exploitation (5.8%) when compared to white victims, who reported more sexual harassment. The notification of rape perpetrated by more than one simultaneous aggressor was also higher in victims of black race/color (15.4%), as well as the co-occurrence with neglect/abandonment (4.6%). More than half of the notifications (56%) were carried out by referral hospital services in the state. The municipality that most reported was Porto Alegre (48.2%). Pelotas (0.4%) and Alvorada (0.1%) had the lowest number of notifications, compared to the number of occurrences and 38.0% of the state's municipalities did not make any notification over five years. The results of this study indicate that sexual violence in children and adolescents is related to the intersectionality between gender and race. The need for permanent education of professionals involved in dealing with this type of violence is perceived, regarding its recognition as an object of intervention in the health sector, especially in non-hospital areas, such as in Primary Care, as well as a greater organization and integration of victim protection networks, by managements, especially in municipalities with higher rates of violence.

Analysis of interpersonal and self-inflicted violence in older adults / Análisis de la violencia interpersonal y autoinfligida en ancianos / Análise da violência interpessoal e autoprovocada na pessoa idosa

ABSTRACT Objective: to identify the prevalence of interpersonal and self-inflicted violence in older adults in the state of Espírito Santo and its association with victim and aggression characteristics. Method: this is a cross-sectional study with data on notifications of elder abuse registered in the state of Espírito Santo, Brazil between 2011 and 2018 in the Notifiable Diseases Information System (SINAN). Violence nature (interpersonal or self-inflicted) and victim and aggression characteristics were assessed. Multivariate analysis was conducted using Poisson regression with robust variance. The association was presented by Prevalence Ratio (PR) and 95% Confidence Interval (95%CI). Results: the prevalence of interpersonal violence was 85.0% (95%CI: 83.3-86.5), and of self-inflicted violence was 15.0% (95%CI: 13.5-16.7). Interpersonal elder abuse was associated with higher prevalence in female victims, aged 80 years or older, black/brown and without disability/disorder, with repetition history, with suspected use of alcohol, outside the residence, in urban areas and motivated by intolerances. On the other hand, self-inflicted violence among older adults was more prevalent in male victims, aged 60 to 69 years, white, with disabilities/disorders, when aggression occurred at home, without repetition history, without suspicion of alcohol use, in rural areas and without intolerance. Conclusion: Victim and aggression characteristics influence the occurrence of interpersonal and self-inflicted violence in older adults.

RESUMEN Objetivo: identificar la prevalencia de violencia interpersonal y autoinfligida en ancianos del estado de Espírito Santo y su asociación con las características de la víctima y de la agresión. Método: estudio transversal con datos de las notificaciones de violencia contra ancianos registradas en el estado de Espírito Santo-Brasil entre 2011 y 2018 en el Sistema de Información de Enfermedades de Declaración Obligatoria (SINAN). Se evaluó la naturaleza de la violencia (interpersonal o autoinfligida) y las características de la víctima y de la agresión. El análisis multivariado se realizó mediante regresión de Poisson con varianza robusta. La asociación se presentó por razón de prevalencia (RP) e intervalo de confianza del 95% (IC95%). Resultados: la prevalencia de violencia interpersonal fue del 85,0% (IC95%: 83,3-86,5), y de violencia autoinfligida fue del 15,0% (IC95%: 13,5-16,7). La violencia interpersonal contra los ancianos se asoció con mayor prevalencia en víctimas mujeres, con 80 años o más, negras/morenas y sin discapacidad/trastorno, con antecedentes de reincidencia, con sospecha de consumo de alcohol, fuera del hogar, en zona urbana y motivada por intolerancias. Por otro lado, la violencia autolesiva entre adultos mayores fue más prevalente en víctimas hombres, de 60 a 69 años, blancos, con discapacidades/trastornos, cuando la agresión ocurrió en el hogar, sin antecedentes de reincidencia, sin sospecha de consumo de alcohol, en zonas rurales y sin motivación para intolerancias. Conclusión: las características de la víctima y de la agresión influyen en la ocurrencia de violencia interpersonal y autoinfligida en ancianos.

RESUMO Objetivo: identificar a prevalência da violência interpessoal e autoprovocada na pessoa idosa no estado do Espírito Santo e sua associação com as características da vítima e da agressão. Método: estudo transversal com dados das notificações de violência contra a pessoa idosa registradas no estado do Espírito Santo, Brasil entre os anos de 2011 e 2018 no Sistema de Informação de Agravos de Notificação. Foram avaliadas a natureza da violência (interpessoal ou autoprovocada) e as características da vítima e da agressão. A análise multivariada foi conduzida por meio da regressão de Poisson, com variância robusta. A associação foi apresentada por razão de prevalências (RP) e intervalo de confiança de 95% (IC95%). Resultados: a prevalência da violência interpessoal foi de 85,0% (IC95%: 83,3-86,5), e da autoprovocada foi de 15,0% (IC95%: 13,5-16,7). A violência interpessoal contra a pessoa idosa esteve associada a maiores prevalências em vítimas do sexo feminino, com 80 anos ou mais, de cor preta/parda e sem deficiência/transtorno, com histórico de repetição, com suspeita de uso de álcool, fora da residência, em zonas urbanas e motivada por intolerâncias. Já a violência autoprovocada entre pessoas idosas se mostrou mais prevalente em vítimas do sexo masculino, com 60 a 69 anos, de cor branca, com deficiências/transtornos, quando a agressão ocorreu na residência, sem histórico de repetição, sem suspeita de uso de álcool, em zonas rurais e sem motivação por intolerâncias. Conclusão: as características da vítima e da agressão influenciam a ocorrência da violência interpessoal e autoprovocada na pessoa idosa.

Diagnóstico e notificação de casos de violência contra crianças e adolescentes: conhecimento de estudantes de Odontologia / Diagnosis and reporting of cases of violence against children and adolescents: knowledge of dental students

O objetivo desse estudo foi avaliar o conhecimento de estudantes de Odontologia acerca do diagnóstico e da notificação em casos de violência contra crianças e adolescentes (VCA). Trata-se de um estudo transversal, descritivo e exploratório realizado com os estudantes (n=100) que cursavam oitavoe décimo períodos no semestre 2018.1, dos turnos diurno e noturno do curso de Odontologia do Nordeste brasileiro.Os dados foram coletados por meiodequestionárioautoaplicável, composto por 22 perguntas. Os dados foram tabulados e analisadossegundo estatística descritiva e teste de associação entre as variáveis, considerando p-valor <0,05 como significância estatística. A importância do tema foi reconhecida pela quase totalidade dos estudantes(99,0%), no entanto,menos da metade (45,0%) considerou que as informações recebidas na graduação foram suficientes. Destaca-se, porém, que os estudantes demonstraram conhecimento razoável do assunto,com percentual de acertos de 75,27%. Não houve diferença significativa entre o número de acertos dos alunos do oitavo e décimo períodos. Embora 85,0% dos estudantes afirmaram que a conduta correta em caso suspeito de VCA seja fazer denúncia ao Conselho Tutelar da localidade, menos da metade afirmou conhecer a ficha de notificação específica e apenas 10,0% conheciam que a pena para os profissionais que não notificarem é multa de 3 a 20 salários de referência. Conclui-se que os estudantes apresentaram conhecimento satisfatório no que diz respeito ao diagnóstico de VCA e domínio sobre os meios de denúncia para notificação específica (AU).

The aim of this study was to evaluate the knowledge of dental students about the diagnosis and notification in cases of violence against children and adolescents (VCA). This is a cross-sectional, descriptive and exploratory study conducted with dental students (n = 100) attending the eighth and tenth periods, between March and June 2018, at an undergraduate dental program in a northeastern Brazilian city. Data were collected through a self-administered questionnaire consisting of 22 questions. Data were tabulated and analyzed according to descriptive statistics and association test between variables, considering a p-value <0.05 as statistically significant. The importance of the topic was recognized by almost all students (99.0%); however, less than half (45.0%) considered that the information received during the undergraduate course was sufficient. It is noteworthy that the students demonstrated reasonable knowledge of the subject, with a percentage of correct answers of 75.27%. There was no significant difference regarding the number of correct answers between the eighth-and tenth-period students. Although 85.0% of students said that the correct conduct in case of suspected VCA is to report them to the local Guardianship Council, less than half said they knew the specific notification form and only 10.0% knew that the penalty for professionalswho do not notify these cases is a fine ranging from 3 to 20 minimum wages. It was concluded that the students demonstrated satisfactory knowledge regarding the diagnosis of VCA and knew about the means of reporting these cases (AU).