Skills training followed by either EMDR or narrative therapy for posttraumatic stress disorder in adult survivors of childhood abuse: a randomized controlled trial.

Background: Individuals suffering from PTSD following childhood abuse represent a large subgroup of patients attending mental health services. The aim of phase-based treatment is to tailor treatment to the specific needs to childhood abuse survivors with PTSD with a Skills Training in Affective and Interpersonal Regulation (STAIR) phase, in which emotion dysregulation and interpersonal problems are targeted, and a trauma-focused phase.Objective: The purpose of this study was to compare STAIR + Eye Movement Desensitization and Reprocessing (EMDR) vs. STAIR + Narrative Therapy (NT) as treatments for PTSD following childhood-onset trauma in a routine clinical setting.Method: Sixty-eight adults were randomly assigned to STAIR/EMDR (8 STAIR-sessions followed by 12 EMDR-sessions) or STAIR/NT (8 STAIR-sessions followed by 12 NT-sessions). Assessments took place at pre-treatment, after each treatment phase and at 3 and 12 months post-intervention follow-up. Primary outcomes were interviewer-rated and self-reported symptom levels of PTSD. Secondary outcomes included symptom levels of depression and disturbances in emotion regulation and interpersonal skills.Results: Multilevel analyses in the intent-to-treat sample indicated that patients in both treatments improved substantially on PTSD symptom severity (CAPS: d = 0.81 to 1.29; PDS: d = 1.68 to 2.15), as well as on symptom levels of depression, anxiety, emotion regulation, dissociation and interpersonal skills. Effects increased or were maintained until 12-month follow-up. At mid-treatment, after STAIR, patients in both treatments improved moderately on PTSD symptom severity (PDS: d = 1.68 to 2.15), as well as on symptom levels of depression (BDI: d = .32 to .31). Symptoms of anxiety, emotion dysregulation, interpersonal problems and dissociation were not decreased after STAIR. There were no significant differences between the two conditions on any outcome.Conclusion: PTSD in adult survivors of childhood interpersonal trauma can effectively be treated by phase-based interventions using either EMDR or NT in the trauma-processing phase.Trial registration: ClinicalTrials.gov identifier: NCT01443182..

The study directly compares Skills Training in Affective and Interpersonal Regulation (STAIR) followed by either EMDR or Narrative Therapy in the trauma-processing phase in routine clinical setting.The brief phase-based treatment was found to be effective in reducing both symptoms of PTSD as well as emotion regulation and interpersonal problems in survivors of childhood abuse.Posttraumatic Stress Disorder in adult survivors of childhood interpersonal trauma can effectively be treated by phase-based interventions using either EMDR or Narrative Therapy in the trauma-processing phase.

Autolesión no suicida en población general: frecuencia y factores asociados en Paraguay

Introducción: La investigación sobre la autolesión no suicida permite aumentar la conciencia sobre este fenómeno, posibilita su detección temprana y la implementación de estrategias más eficaces en prevención y tratamiento. Esto conlleva a una reducción del sufrimiento individual, los costos económicos y el impacto en la sociedad en su totalidad. Objetivo: Determinar la frecuencia y factores asociados a autolesión no suicida en una muestra de población adulta de Paraguay. Metodología: Estudio descriptivo de asociación cruzada, de corte transversal y prospectivo. Una encuesta en línea fue difundida a través de redes sociales y aplicaciones de mensajería. Esta incluía preguntas sobre datos sociodemográficos y clínicos. La presencia de autolesiones se determinó a través de la versión en español de la escala Self-Harm Questionnaire. Se utilizó estadística descriptiva para todas las variables. Para buscar asociaciones se utilizó la prueba chi cuadrado. Resultados: Participaron 241 personas (media de edad=32±12 años, 74,7% mujeres). Se encontró una frecuencia de autolesiones de 24,5% (n=59). De estos, el 91,5% había tenido ideación suicida al menos una vez. Se encontró asociación entre el nivel de ingresos y la frecuencia de autolesiones (χ

Introduction: Research on non-suicidal self-injury raises awareness of this phenomenon, enabling the early detection and implementation of more effective strategies in prevention and treatment. This leads to a reduction in individual suffering, economic costs, and impact on society. Objective: To determine the frequency and associated factors of non-suicidal self-injury in a sample of the adult population of Paraguay. Methodology: This was a descriptive, cross-sectional, and prospective study. An online survey was disseminated through social networks and messaging applications. The survey included questions on sociodemographic and clinical data. The presence of self-injury was determined by using the Spanish version of the Self-Harm Questionnaire. Descriptive statistics were used for all the variables. The chi-square test was used to examine associations. Results: There were 241 participants (mean age=32±12 years, 74.7%female). A non-suicidal self-injury frequency of 24.5% (n=59) was observed. Of these, 91.5% reported suicidal ideation at least once. An association was found between income level and the frequency of non-suicidal self-injury (χ

Adverse childhood experience is associated with an increased risk of reporting chronic pain in adulthood: a stystematic review and meta-analysis.

Background: Adverse childhood experiences (ACEs) have been shown to negatively affect health in adulthood. Estimates of associations between ACEs and chronic painful conditions are lacking.Objectives: This systematic review and meta-analysis aimed to evaluate associations between exposure to ACEs and chronic pain and pain-related disability in adults.Methods: We searched 10 electronic databases from inception to February 2023. We included observational studies assessing associations between direct ACEs (childhood sexual, physical, emotional abuse, or neglect) alone or in combination with indirect ACEs (witnessing domestic violence, household mental illness), and adult chronic pain (≥3 months duration) and pain-related disability (daily activities limited by chronic pain). Pairs of reviewers independently extracted data and assessed study risks of bias. Random-effect models were used to calculate pooled adjusted odds ratios [aOR]. Tau square [T2], 95% prediction intervals [95%PI] and I2 expressed the amount of heterogeneity, and meta-regressions and subgroup meta-analyses investigated sources of heterogeneity (PROSPERO: CRD42020150230).Results: We identified 85 studies including 826,452 adults of which 57 studies were included in meta-analyses. Study quality was generally good or fair (n = 70). The odds of reporting chronic pain in adulthood were significantly higher among individuals exposed to a direct ACE (aOR, 1.45, 95%CI, 1.38-1.53). Individuals reporting childhood physical abuse were significantly more likely to report both chronic pain (aOR, 1.50, 95CI, 1.39-1.64) and pain-related disability (1.46, 95CI, 1.03-2.08) during adulthood. Exposure to any ACEs alone or combined with indirect ACEs significantly increase the odds of adult chronic painful conditions (aOR, 1.53, 95%CI, 1.42-1.65) and pain-related disability (aOR, 1.29; 95%CI, 1.01-1.66). The risk of chronic pain in adulthood significantly increased from one ACE (aOR, 1.29, 95%CI, 1.22-1.37) to four or more ACEs (1.95, 95%CI, 1.73-2.19).Conclusions: Single and cumulative ACEs are significantly associated with reporting of chronic pain and pain-related disability as an adult.

Previous meta-analyses highlighted the negative impact of adverse childhood experiences on physical, psychological, and behavioural health across the lifespan.We found exposure to any direct adverse childhood experience, i.e. childhood sexual, physical, emotional abuse, or neglect alone or combined, increased the risk of reporting chronic pain and pain-related disability in adulthood.The risk of reporting chronic painful disorders increased with increasing numbers of adverse childhood experiences.

[Determining factors of domestic violence in women from Guanajuato]. / Factores determinantes de violencia doméstica en mujeres de Guanajuato.

Background: Women across the globe are at risk of physical or sexual abuse by an intimate partner or other offender. Violence against women can lead to physical injuries, impaired mental health, and specific chronic diseases. In some cases, such types of violence can even result in disability or death for some victims. Objetive: To identify the factors that cause domestic violence in women of Guanajuato. Material and methods: Prospective, observational, analytical and cross-sectional study. 325 patients of 18 years or older who were literate and visited a third level hospital were included. The Scale of Violence in Couple Relations with a Likert-type response was administered. Data were analyzed by descriptive statistics. Frequencies and percentages of all variables, chi-square test, and bivariate analysis were used. Results: Of 325 women of 36 (30-46) years of age, 214 (65.8%) were married. The majority were high school graduates, 152 (46.8%). 52% of women reported having experienced domestic violence at least once. Knowing the existence of a domestic violence protection law produced an OR 0.34 (0.20-0.57), p-0.001 and knowing the meaning of domestic violence gave an OR 0.35 (0.21-0.58 ), p<0.001. Conclusions: A high percentage of women reported having experienced domestic violence at least once. The determinants of violence were similar in women with and without exposure to it. Protective factors were knowledge of the law and the meaning of domestic violence.

Introducción: las mujeres de todo el mundo corren el riesgo de sufrir abuso físico o sexual por parte de su pareja u otro agresor. La violencia en la mujer puede provocar lesiones físicas, deterioro de la salud mental y enfermedades físicas crónicas específicas. En algunos casos, tales tipos de violencia pueden incluso resultar en discapacidad o muerte para algunas víctimas. Objetivo: identificar los factores determinantes que causan violencia doméstica en mujeres de Guanajuato. Material y métodos: estudio prospectivo, observacional, analítico y transversal. Se incluyeron 325 pacientes mayores de 18 años que sabían leer y escribir y que fueron atendidas en un hospital de tercer nivel. Se les aplicó la Escala de Violencia en las Relaciones de Pareja, con respuesta tipo Likert. Los datos se analizaron con estadística descriptiva. Se usaron frecuencias y porcentajes, chi cuadrada y analisis bivariado. Resultados: fueron entrevistadas 325 mujeres de 36 años (30-46); 214 (65.8%) eran casadas y en su mayoria con preparación escolar secundaria 152 (46.8%). El 52% reportaron haber experimentado violencia intrafamiliar al menos alguna vez. Conocer una ley de protección resultó con una RM de 0.34 (0.20-0.57), p < 0.001 y conocer el significado de violencia con una RM de 0.35 (0.21-0.58 ), p < 0.001. Conclusiones: un porcentaje elevado de mujeres reportó haber experimentado violencia doméstica al menos alguna vez. Los determinantes de violencia fueron similares en las mujeres con y sin exposicion a ella; los factores protectores fueron el conocimiento de una ley y del significado de violencia.

Gender Differences in Patients with Substance Use Disorder and Physical/Sexual Abuse: A Preliminary Study / Las diferencias de género en pacientes con trastorno por consumo de sustancias y abuso físico/sexual: un estudio preliminar

Aim: To explore the differential characteristics in sociodemographic variables, severity of consumption, psychopathological symptomatology, life maladjustment, trauma characteristics, and post-traumatic stress symptomatology between women and men who seek treatment for substance use disorder (SUD) and have experienced lifetime physical and/or sexual abuse. Method: The sample consisted of 26 women and 31 men who had experienced physical/sexual abuse and sought treatment for SUD. Results: Women had been victims of sexual abuse in a significantly higher percentage than men. Women presented a significantly higher frequency of revictimization to another traumatic event and a significantly higher presence of avoidance symptoms than men. Conclusions: This study supports the existence of a more severe profile in women than in men with SUD who have experienced lifetime physical and/or sexual abuse. Consequently, gender-related trauma-informed practice in SUD treatment programmes should be promoted. More research in this field is needed, as this is a preliminary study. (AU)

Objetivo: Explorar las diferencias de género en distintas variables (sociodemográficas, gravedad del consumo, sintomatología psicopatológica, inadaptación a la vida cotidiana, características del trauma y sintomatología de estrés postraumático) en pacientes que acuden a tratamiento por trastorno por consumo de sustancias (TCS) y han sufrido abuso físico y/o sexual. Método: La muestra estuvo compuesta por 26 mujeres y 31 hombres que habían sufrido abuso físico y/o sexual y buscaban tratamiento para TCS. Resultados: Las mujeres habían sido víctimas de abuso sexual en un porcentaje significativamente mayor que los hombres. Además presentaban una frecuencia significativamente mayor de revictimización a otro evento traumático y una presencia significativamente mayor de síntomas de evitación que los hombres. Conclusiones: El estudio confirma la existencia de un perfil más grave en las mujeres que en los hombres con TCS que han sufrido abuso físico y/o sexual a lo largo de la vida. En consecuencia, se debe promover la atención informada sobre el trauma con perspectiva de género en los programas de tratamiento del TCS. Dada la naturaleza preliminar de este estudio, se necesita más investigación en este campo. (AU)

Elaboración de un cuestionario sobre violencia(s) sufrida(s) por profesionales del ámbito de la Fisioterapia / Developing a questionnaire about violence(s) suffered by professionals in the field of Physiotherapy

FUNDAMENTOS: La violencia en el sector sanitario es un problema importante y con graves consecuencias. Se desconoce laprevalencia de la violencia en el ámbito clínico sobre los fisioterapeutas en España. El objetivo de este trabajo fue crear y validar unaherramienta para detectar casos de violencia sexual, física y psicológica y/o verbal ejercida por pacientes/acompañantes/familiaressobre la población de fisioterapeutas de España. MÉTODOS: A partir de la bibliografía disponible, se elaboró un cuestionario que fue analizado por un grupo de seis fisioterapeutasdel Consejo a cargo de la gestión y observación de la violencia sufrida por fisioterapeutas o profesionales destacadas en el movimien-toMe Too Fisio. Finalmente, se realizó una prueba piloto en una muestra de conveniencia de catorce fisioterapeutas. RESULTADOS: El cuestionario obtenido incluye preguntas sobre los hechos sufridos por los/las profesionales de esta disciplina,así como los principales datos del perfil de persona agresora (sexo, edad, condición mental, etc.), el contexto en el que la violencia esmás prevalente (campo laboral, tamaño del municipio, etc.) y las principales características del/de la profesional que sufre la violencia(sexo, edad, experiencia profesional, etc.). Además se recoge información sobre estrategias formales e informales utilizadas paraenfrentar la violencia y la percepción de su impacto. CONCLUSIONES: Una utilización anual de esta herramienta ayudará a valorar la exposición de este grupo de profesionales deforma específica y, también, la evolución en el tiempo de cada violencia por separado, con la finalidad de establecer políticas yprogramas formativos exitosos.(AU)

BACKGROUND: Violence in the health sector is a big problem and it has serious consequences. The prevalence of clinical violencesuffered by Spanish physiotherapists is unknown. The objective of this paper was to create and validate a tool in order to detect casesof sexual, physical and psychological and/or verbal violence in the Spanish physiotherapists. METHODS: A questionnaire was elaborated according to the available bibliography. It was analyzed by a group of six physiotherapistsin charge of the Union observation and management of violence or from Me-Too Fisio movement. Finally, a pilot test was carried out ona convenience sample of fourteen physiotherapists.RESULTS: The questionnaire obtained includes questions about the facts suffered by the professionals in this discipline, as wellas the main data on the profile of the aggressor (sex, age, mental condition…), the contexts where violence is more prevalent (clinicalfield, size of the population where the center is located…), and the main characteristics of the professional who suffers it (sex, age,professional experience…). Moreover, information about formal and informal strategies used to deal with violence and perception ofits impact, will be assessed. CONCLUSIONS: The annual use of this tool will allow the exposure of this group of professionals to be assessed specifically and,also, to assess the evolution over time of each violence separately for providing direction for successful policies and training.(AU)

Systematic Investigation of Meta-Analysis Data on Treatment Effectiveness for Physical, Psychological, and Sexual Intimate Partner Violence Perpetration / [Investigación sistemática de los datos de meta-análisis sobre la eficacia del tratamiento de la agresión de pareja física, psicológica y sexual]

Intimate partner violence can lead to physical, economical, mental, and sexual well-being issues, and even death, and it is most commonly experienced by women. There exist a number of treatment models for the prevention and treatment of intimate partner violence (IPV). In this study, we provided a comprehensive meta-regression analysis of the effectiveness of batterer treatment programs, with a view to characterizing the interplay between different forms of IPV (physical, psychological, and sexual). Using meta-regression, we explore the effect sizes and whether IPV treatment methods have distinct impacts on the outcomes. We use the difference normalized by pretreatment mean and variance foldchange to uncover the relationship between different violence subtypes and how they drive each other. Specifically, our study found that studies with more pre-treatment psychological and/or sexual violence, lead to less favorable outcomes while the studies that start with more physical violence are able to demonstrate their effects more effectively. Results of this study can be used to help the clinician effectively select the treatment for the perpetrator based on the violence type and severity of violence in order to more effectively treat the needs for each specific relationship.(AU)

La violencia de pareja puede llegar a afectar al bienestar físico, económico, mental y sexual e incluso llevar a la muerte, siendo experimentada con más frecuencia por las mujeres. Hay diversos modelos de prevención y tratamiento de la violencia de pareja (VP). En este estudio se lleva a cabo un análisis global de meta-regresión de la eficacia de los programas de tratamiento para maltratadores centrado en caracterizar la interacción entre diferentes formas de VP (física, psicológica y sexual). Mediante meta-regresión se explora el tamaño del efecto y si los distintos métodos de tratamiento de la VP influyen de modo distinto en los resultados. Se utiliza la diferencia normalizada por la media y la reducción de la heterogeneidad (varianza) del pretratamiento para analizar la relación entre los distintos tipos de violencia y cómo se influyen mutuamente. En concreto en este trabajo encontramos que los estudios con más violencia psicológica y/o sexual en el pretratamiento tienen resultados menos favorables, mientras que los que comienzan con más violencia física pueden demostrar sus efectos de un modo más eficaz. Los resultados de este estudio pueden ser de ayuda para que el profesional seleccione de modo más eficaz el tratamiento para el agresor teniendo en cuenta el tipo de violencia y su gravedad, con el fin de tratar de forma más adecuada las necesidades de cada relación específica.(AU)

Examination of ICD-11 PTSD and CPTSD using the International Trauma Questionnaire - Child and Adolescent version (ITQ-CA) in a sample of Danish children and adolescents exposed to abuse.

Background: International research has established that children and adolescents are at risk for posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as defined by the WHO ICD-11. There is a need for a Danish language version of the International Trauma Questionnaire - Child and Adolescent (ITQ-CA) to assess symptoms of PTSD and CPTSD.Objective: To test the ICD-11 formulations of PTSD and DSO (Disturbances of Self-Organization) using the ITQ-CA version in a sample of children exposed to abuse. Additionally, to study the distribution of symptoms and probable prevalence of ICD-11 PTSD and CPTSD among the population of children exposed to violence or sexual abuse.Method: Confirmatory factor analysis of competing models of the dimensionality of the ITQ-CA was tested among a sample of 119 children and adolescents that were referred to the Danish Children Centres on suspicion of physical or sexual abuse or both. Latent class analysis (LCA) was used to study the distribution of symptoms and consequences of different operationalisations of functional impairment were explored.Results: Findings supported a two-factor second-order model corresponding to the operationalisation of CPTSD in ICD-11 as the best representation of the data. Findings from the LCA suggested that symptoms were distributed in a pattern consistent with the ICD-11 proposal for CPTSD. CPTSD was more prevalent than PTSD regardless of the operationalisation of functional impairment.Conclusion: ITQ-CA is a valid tool for identifying symptoms of ICD-11 PTSD and CPTSD among Danish children exposed to physical or sexual abuse. Further research is needed to study the relationship between ICD-11 C/PTSD symptomatology and anxiety and depression in this population.

The International Trauma Questionnaire ­ Child and Adolescent version (ITQ-CA) is a valid measure of symptoms of ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD among Danish children exposed to physical or sexual violence.The structure of the ITQ-CA in the Danish sample reflects the ICD-11 diagnostic algorithm.CPTSD is a more prevalent disorder among children recently exposed to violence than PTSD.

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.

Lesiones de causa externa y su relación con el alcohol en pacientes atendidos en un hospital de emergencia de Lima, Perú / External lesions and their relationship with alcohol consumption in patients attending in an emergency hospital in Lima, Peru

RESUMEN Objetivo: Describir las características demográficas, temporales y espaciales de las personas con lesiones de causa externa (LCE) y la relación con el consumo y la disponibilidad de alcohol, ocurridos en el distrito y atendidos en un hospital de emergencias. Material y métodos: Estudio descriptivo retrospectivo de personas atendidas por LCE en el Hospital de Emergencias José Casimiro Ulloa en el periodo 2014-2016 y la información de la denuncia policial por los afectados, en la comisaría del distrito. Se determinó la asociación entre las variables demográficas, temporales y espaciales con el tipo de LCE y la presencia de alcohol mediante pruebas de regresión logística. Resultados : Se encontró que era más probable la presencia de alcohol en un accidentado con LCE, cuando este era del sexo masculino en los días jueves a domingo. La contusión en una LCE en vez de una herida cortante, fue más probable cuando el accidentado era de sexo masculino, edades entre 15 a 38 años, la causa era una agresión, la ocurrencia del evento se producía entre las 00:00 a 18:00 horas, los días jueves a domingo y en los años 2014 y 2016. Geográficamente, la ocurrencia fue mayor en avenidas principales a no más de 500 metros de lugares donde se vendía y consumía licor. Conclusiones : La persona que va atenderse por lesiones de causa externa causadas como consecuencia de la violencia tiene una alta probabilidad de ser varón, además ocurren con mayor frecuencia los fines de semana y en avenidas principales en donde se puede usar un transporte público y no a más de 500 metros de lugares en donde se puede vender y consumir alcohol sin necesidad de ser residentes del distrito de ocurrencia, sin descartar que el consumo de alcohol pueda considerarse un factor de riesgo.

SUMMARY Objective: To describe demographic, temporal and spatial relationships of external lesions (EL) with alcohol consumption in patients attending an emergency hospital in Lima. Methods: Retrospective study of patients with EL attended at Hospital de Emergencias Casimiro Ulloa from 2014-2016 including information on police investigation. Logistic regression analysis was carried-out to evaluate association between type of EL and alcohol consumption. Results: The relationship of alcohol consumption and EL was stronger in males and from Thursday to Sunday. Contusions instead of stab wounds were more likely when the victim was male from 15-38 years of age and when had occurred from 00:00 to 18:00 from Thursdays to Sundays. EL occurred more frequently near main avenues at no more than 500 meters from alcoholic beverages were sold. Conclusions: Victims of EL are more likely to be males not necessarily living in the district where the aggression occurred, which tended to happen near main avenues close to where alcoholic beverages are offered. Alcohol consumption could not be ruled-out as a risk factors for EL.

Caracterización sociodemográfica y clínica en menores de 18 años con maltrato infantil atendidos entre los años 2011 a 2016 en la Clínica Universitaria Bolivariana de Medellín, Colombia / Social-demographic and clinical characterization in children under 18 years of age with child abuse treated between 2011 and 2016 at the Bolivariana University Clinic of Medellin, Colombia

Resumen Introducción: El maltrato infantil es definido por la Organización Mundial de la Salud como todo abuso y desatención que sufren niños, niñas y adolescentes. Si bien en Colombia existen informes generales sobre menores víctimas de maltrato, hay pocos estudios acerca de la frecuencia, tipos y características a nivel departamental o municipal, información importante para enfocar acciones de salud colectiva e individual. Objetivo: Realizar una caracterización sociodemográfica, clínica y según el tipo de maltrato en una población de menores de 18 años con antecedente de maltrato infantil, atendidos entre los años 2011 a 2016, en la Clínica Universitaria Bolivariana de Medellín, Colombia. Materiales y métodos: Estudio descriptivo, retrospectivo y transversal, realizado en el período de tiempo entre enero de 2011 a diciembre de 2016. Se usaron fuentes secundarias de información tipo historia clínica. Se seleccionó una muestra de 29 menores de 18 años tras aplicar criterios de elegibilidad. Resultados: El sexo femenino y la tipología familiar monoparental materna fueron los más frecuentes. El abuso sexual, fue el tipo más común de maltrato, seguido por maltrato físico y psicológico, con diferentes distribuciones según el sexo. Discusión: Las características de salud de las víctimas de maltrato infantil son variables, pero al parecer el sexo y la edad son características que influyen en el tipo del maltrato. Conclusiones: Se realizó un acercamiento desde una visión médica, respecto a la complejidad de una problemática de origen y alcance intersectorial que abarca diferentes formas, las cuales varían por condiciones sociales, familiares y del agresor. MÉD.UIS.2021;34(3): 19-27.

Abstract Introduction: Child abuse is defined by the World Health Organization as all abuse and neglect suffered by children and adolescents. Although in Colombia there are general reports on child victims of abuse, there are few studies on the frequency, types, and characteristics at the departmental or municipal level, important information to focus collective and individual health actions. Objective: To carry out a sociodemographic, clinical characterization and according to the type of abuse in a population of children under 18 years of age with a history of child abuse, attended between 2011 and 2016, at the Bolivariana University Clinic of Medellin, Colombia. Materials and methods: Descriptive, retrospective, and cross-sectional study, carried out in the period from January 2011 to December 2016. Secondary sources of information such as clinical history was used. A sample of 29 children under 18 years of age was selected after applying eligibility criteria. Results: The female sex and the maternal single-parent family type were the most frequent. Sexual abuse was the most common type of abuse, followed by physical and psychological abuse, with different distributions according to sex. Discussion: The health characteristics of victims of child abuse vary, but apparently the sex and age of the victim are characteristics that influence the type of abuse. Conclusions: An approach was made from a medical perspective, regarding the complexity of a problem of intersectoral origin and scope that encompasses different forms, which vary by social, family and aggressor conditions. MED.UIS.202i;34(3): 19-27.

'Unheard voices': Perceptions of women with mental illness on nurses screening routinely for domestic violence: A qualitative analysis / "Voces no escuchadas": Percepciones de las mujeres con enfermedades mentales sobre el cribado rutinario de la violencia doméstica por parte de las enfermeras. Un análisis cualitativo / "Vozes não ouvidas": percepções de mulheres com transtorno mental sobre o rastreamento cotidiano da violência doméstica por enfermeiras. Uma análise qualitativa

Objective. To explore women's experiences of violence and their opinion on routine screening for domestic violence by nursing professionals in mental health care settings. Methods. This qualitative narrative research design was carried out among 20 asymptomatic women with mental illness at a tertiary care centre in Bangalore, India. Results. Narrative content analysis was performed, and five dominant themes have emerged: 1. Understanding the nature and signs of violence (subtheme: Meaning of violence), 2. Abusive experiences of women with mental illness (subthemes: Physical violence, psychological violence, social violence, sexual violence and financial violence), 3. Experiences on disclosure of violence (subthemes: Identification of violence by nursing professionals, Experiences of disclosure of violence), 4. Barriers for disclosure of abuse(subthemes: Fear of consequences, the hectic schedule of nursing staff, helplessness and hopelessness, perceived poor family support). 5.Routine screening for violence by nursing professionals (subthemes: reasons for routine inquiry of violence, nature of inquiry by the nursing professionals). Conclusion. Women with mental illness were undergoing more than one form of violence, and most of the participants supported routine screening by nursing professionals. Nurses play an essential role in identifying and supporting abused women in mental health care settings.

Objetivo. Explorar las experiencias de violencia que sufren las mujeres y su opinión sobre el cribado rutinario de la violencia doméstica por parte de los profesionales de enfermería en los centros de salud mental. Métodos. Esta investigación narrativa cualitativa se llevó a cabo con 20 mujeres asintomáticas con enfermedades mentales en un centro de atención terciaria en Bangalore, India. Resultados. Se realizó un análisis de contenido narrativo y surgieron cinco temas dominantes: 1. Comprensión de la naturaleza y los signos de la violencia (subtema: Significado de la violencia), 2. Experiencias abusivas de las mujeres con enfermedades mentales (subtemas: Violencia física, violencia psicológica, violencia social, violencia sexual y violencia económica), 3. Experiencias sobre la revelación de la violencia (subtemas: Identificación de la violencia por parte de los profesionales de enfermería, Experiencias de revelación de la violencia), 4. Barreras para la revelación del abuso (subtemas: Miedo a las consecuencias, el agitado horario del personal de enfermería, impotencia y desesperanza, percepción de un escaso apoyo familiar). 5. Indagación rutinaria de la violencia por parte de los profesionales de enfermería (subtemas: razones para la indagación rutinaria de la violencia, naturaleza de la indagación por parte de los profesionales de enfermería). Conclusión. Las mujeres con enfermedades mentales sufrieron más de una forma de violencia y la mayoría de las participantes apoyó el cribado rutinario por parte de los profesionales de enfermería. Las enfermeras desempeñan un papel esencial en la identificación y en el apoyo a las mujeres maltratadas en los entornos de atención en la salud mental.

Objetivo. Explorar as experiências de violência sofrida por mulheres e sua opinião sobre o rastreamento rotineiro de violência doméstica por profissionais de enfermagem em centros de saúde mental. Métodos. Esta pesquisa narrativa qualitativa foi realizada com 20 mulheres assintomáticas com doença mental em um estabelecimento de cuidados terciários em Bangalore, Índia. Resultados. Realizou-se uma análise de conteúdo narrativo e emergiram cinco temas dominantes: 1. Compreendendo a natureza e os sinais da violência (subtópico: Significado da violência), 2. Experiências abusivas de mulheres com transtorno mental (subtópicos: Violência física, violência psicológica, violência social, violência sexual e violência econômica), 3. Experiências sobre a divulgação da violência (subtópicos: Identificação da violência por profissionais de enfermagem, Experiências da divulgação da violência), 4. Barreiras para a divulgação do abuso (subtópicos: medo das consequências, enfermagem ocupada horas de trabalho, desamparo e desesperança, percepção de pouco apoio familiar) 5. Inquérito de rotina sobre violência por profissionais de enfermagem (subtópicos: motivos de inquérito de rotina sobre violência, natureza do inquérito por profissionais de enfermagem). Conclusão. Mulheres com doença mental sofreram mais de uma forma de violência e a maioria das participantes apoiava o rastreamento de rotina pelos profissionais de enfermagem. Os enfermeiros desempenham um papel essencial na identificação e apoio às mulheres agredidas em ambientes de cuidados de saúde mental.

A qualitative study on factors associated with intimate partner violence in Colombia

Abstract Intimate partner violence (IPV) is a human rights violation and a serious global public health problem. This study investigated factors associated with IPV in female survivors in Colombia. Four focus group discussions with female survivors of IPV and 15 key informant interviews with professionals from psychological, social and legal services and community leaders were conducted in Cali and Tuluá. Participant recruitment was via purposive sampling. Transcripts were analysed manually taking a social constructivist standpoint and a content analysis approach. Factors associated with IPV were divided into four themes: cultural beliefs, jealousy, alcohol abuse, and personal history of IPV. The first theme was divided into: patriarchy, gender roles, normalisation of violence, and unawareness of rights, economic dependence, and 'men own women'. The sub-themes were all inter-related and underpinned by patriarchal values. IPV was described as a sociocultural construction formed by patriarchal values ingrained in community and societal norms and individual processes. Therefore, academia, governmental and non-governmental bodies and society are urged to together, create preventative, context specific strategies for individuals, communities and societies.

Resumo A violência por parceiro íntimo (VPI) é uma violação dos direitos humanos e um grave problema de saúde pública global. Este estudo investigou fatores associados à VPI em mulheres sobreviventes na Colômbia. Quatro discussões de grupos focais com mulheres sobreviventes de VPI e 15 entrevistas com informantes-chave com profissionais de serviços sócio-médico-legais foram realizadas usando amostragem intencional nas cidades de Cali e Tuluá. As transcrições foram analisadas manualmente, sob um ponto de vista construtivista social e uma abordagem de análise de conteúdo. Os fatores associados à VPI foram divididos em 4 temas: crenças culturais, ciúmes, abuso de álcool e história pessoal da VPI. O primeiro tema foi dividido em: patriarcado, papéis de gênero, normalização da violência, desconhecimento de direitos, dependência econômica e 'homens possuem mulheres'. VPI foi descrita como uma construção sociocultural formada por valores patriarcais e processos individuais. A VPI é causada por uma complexa interação de diferentes fatores nos níveis do indivíduo, relacionamentos, comunidade e social. Os órgãos governamentais e não governamentais e a sociedade são instados a criar juntos estratégias preventivas e específicas no contexto.

Effect of physical and sexual violence during childhood and/or adolescence on the development of menstrual related mood disorders: A systematic review and meta-analysis / Efecto de la violencia física y sexual durante la infancia y/o la adolescencia en el desarrollo de trastornos del estado de ánimo relacionados con la menstruación: Una revisión sistemática y metaanálisis

Abstract Background Abuse in early life stages has been proposed as an etiological risk factor for developing menstrually-related mood disorders (MRMDs). Objetive To evaluate whether there is a relation between the occurrence of physical and/or sexual violence in childhood and/or adolescence and the development of MRMDs in adulthood. Method A systematic search was conducted in PubMed, Web of Science, and ScienceDirect, with the route ("Premenstrual Syndrome"[Mesh]) OR ("Premenstrual Dysphoric Disorder"[MeSH]) AND ("Violence"[Mesh]) / ("menstrually-related mood disorders" AND "abuse"). Fifty-four articles were initially reviewed and 32 were excluded based on the criteria. Twenty-two articles were thoroughly reviewed. Finally, five articles (publication years 2014, 2013, 2012, 2007, and 2003) were included in the systematic review and submitted to a meta-analysis. Results Results indicate that having been exposed to physical and/or sexual violence in childhood and/or adolescence increases 1.99 times the risk of experiencing MRMDs in adulthood in comparison with women who did not experience that type of violence (odds ratio [OR] = 1.99; 95% confidence interval [1.58, 2.51]). Discussion and conclusion The present work provides evidence that a woman who experienced violence through physical and/or sexual abuse during childhood and/or adolescence has a greater risk of developing MRMDs in adulthood.

Resumen Antecedentes El abuso en las etapas tempranas de la vida se ha propuesto como un factor de riesgo etiológico para desarrollar trastornos del estado de ánimo relacionados con la menstruación (TEARM). Objetivo Evaluar si existe una relación entre la ocurrencia de violencia física y/o sexual en la infancia y/o la adolescencia y el desarrollo de MRMD en la edad adulta. Método Se realizó una búsqueda sistemática en PubMed, Web of Science y ScienceDirect con la ruta ("Premenstrual Syndrome"[Mesh]) OR ("Premenstrual Dysphoric Disorder"[MeSH]) AND ("Violence"[Mesh]) / ("menstrually-related mood disorders" AND "abuse"). Cincuenta y cuatro artículos fueron revisados inicialmente y 32 fueron excluidos con base en los criterios establecidos. Veintidós artículos fueron revisados exhaustivamente. Por último, se incluyeron cinco artículos (años de publicación 2014, 2013, 2012, 2007 y 2003) en la revisión sistemática, y cinco de ellos fueron sometidos a un metaanálisis. Resultados Los resultados indican que haber estado expuesta a violencia física y/o sexual en la niñez y/o la adolescencia aumenta 1.99 veces el riesgo de experimentar TEARM en la edad adulta en comparación con las mujeres que no experimentaron ese tipo de violencia (odds ratio [OR] = 1.99; intervalo de confianza del 95% [1.58-2.51]). Discusión y conclusión El presente trabajo aporta evidencia de que una mujer que experimentó violencia por abuso físico y/o sexual durante la niñez y/o la adolescencia tiene un mayor riesgo de desarrollar TEARM en la edad adulta.

Frecuencia del maltrato y homicidio infantil en Medellín (Colombia)

RESUMEN Introducción: El maltrato y el homicidio infantil se destacan dentro del espectro de la violencia intrafamiliar por las consecuencias severas que generan en la salud, el desarrollo socioeconómico de una región y en la calidad de vida de los menores y sus familiares. Objetivo: Caracterizar el maltrato físico, sexual y los homicidios ejercidos hacia los niños y niñas menores de doce años, ocurridos en el contexto familiar en Medellín, Colombia, durante 2010-2015. Metodología: Estudio descriptivo, retrospectivo y transversal. Se realizó un análisis estadístico descriptivo de la ocurrencia de los eventos violentos intrafamiliares en menores de doce años atendidos por el Instituto Nacional de Medicina Legal y Ciencias Forenses en la ciudad de Medellín. Resultados: Se reportaron 3 519 casos de maltrato físico y sexual infligido a menores de doce años dentro del contexto familiar. 56,9 % de los hechos corresponden a maltrato sexual, siendo las mujeres las principales víctimas de este tipo de abuso; por su parte los hombres fueron los más afectados por maltrato físico. Los menores entre los seis y once años son los más maltratados. Se reportaron nueve casos de homicidio, de los cuales siete fueron cometidos contra mujeres y cinco de estos fueron perpetrados por el padrastro de las víctimas. Conclusiones: El maltrato infantil intrafamiliar ha sido un problema persistente en la ciudad de Medellín, y esto lo demuestra el alto número de casos registrados. No obstante, aunque los reportes de homicidio infantil han sido pocos, no se deben subestimar dada la importancia y las grandes consecuencias que esto presenta para la sociedad.

ABSTRACT Introduction: Child abuse and homicide are highlighted in the spectrum of intrafamily violence due to the severe consequences they generate on health, the economic and social development of a region and the quality of life of children and their families. Objective: characterize the physical and sexual abuse, and homicide exercised against children under twelve years old, occurred in the family context in Medellin Colombia, during 2010-2015. Methodology: Descriptive study, retrospective and cross-sectional. It was made a descriptive statistical analysis of the occurrence of intrafamily violent events attended by the National Institute of Legal Medicine and Forensic Sciences in Medellín. Results: 3,519 cases of physical and sexual abuse inflicted on children under twelve years old within the family context were reported. Of these, 56.9% of the events correspond to sexual abuse and women are the main victims of this type of abuse; men are the most affected in physical abuse. Children between six and eleven years old are the most vulnerable. Nine cases of homicide were reported, of which seven were committed against women and five of these were perpetrated by the victims' stepfather. Conclusions: Intrafamily child abuse is a persistent problem in Medellín, and this is demonstrated by the high cases recorded. However, there have been few cases of child homicide, this does not diminish the importance and the number should not be underestimated, because of the enormous consequences they have for society.

Características y factores asociados al maltrato percibido en internos de medicina en Perú / Characteristics and associated factors with mistreatment perception in medical interns in Peru

RESUMEN Objetivo: Determinar las características y factores asociados a la percepción de maltrato en internos de medicina del Perú. Materiales y métodos : Estudio multicéntrico, transversal y analítico. Se encuestaron a internos de medicina de dieciocho hospitales del Perú. Se aplicó una encuesta entre marzo y abril del 2016 que incluían características sociodemográficas y una escala que media la percepción de maltrato psicológico, físico y sexual. Se realizaron modelos lineales generalizados y se estimaron razones de prevalencia crudas y ajustadas (RPa) con intervalos de confianza al 95%. Resultados : Participaron 418 internos de medicina. El maltrato psicológico, físico y sexual percibido fue de 91,9%; 55,5% y 34%, respectivamente. Los factores asociados con el maltrato psicológico fueron proceder de una universidad privada (RPa:1,07; IC95%:1,01- 1,13), respecto al maltrato físico fueron la edad (RPa: 1,08; IC95%: 1,05-1,12), realizar internado en un hospital de la selva (RPa: 1,27; IC95%: 1,03-1,56) y en un hospital del Seguro Social (RPa:0,66; IC95%:0,44-0,94) y para el maltrato sexual el ser mujer (RPa:1,52; IC95%:1,15-2,01). Conclusiones : Existe una alta percepción de maltrato reportado por los internos de medicina siendo el psicológico el más frecuente. Existen diferencias en la percepción de maltrato psicológico y físico según el tipo de financiamiento de la universidad de procedencia y del hospital donde se realiza el internado. Una alta frecuencia de maltrato sexual fue reportada por mujeres luego de los tres primeros meses del internado hospitalario.

ABSTRACT Objective: To determine the characteristics and factors associated with the perception of abuse in medicine interns of Peru. Material and Methods : This is a cross-sectional multicenter and analytical study. Medicine interns from eighteen Peruvian hospitals were interviewed. A survey was administered between March and April 2016, which included socio-demographic characteristics and a scale measuring psychological and physical abuse, as well as sexual harassment perception. Generalized linear models were used and crude and adjusted prevalence rates (aPR) were estimated, with 95% confidence intervals (CI). Results: 418 medical interns participated in the study. Psychological and physical abuses were perceived by 91,9% and 55,5% of the studied population. Sexual harassment was perceived by 34% of all interviewed interns. Associated factors with psychological abuse were studied in a private university (aPR: 1.07; 95% CI: 1.01-1.13). Factors associated with physical abuse were age (aPR: 1.08; 95% IC: 1.05-1.12), performing internship in an Amazonian area hospital (aPR: 1,27; 95% CI: 1,03-1,56), and in a Social Security Hospital (aPR: 0,66; 95% CI: 0,44-0,94); and for sexual harassment, being female was the main associated factor (aPR: 1,52; 95% CI: 1,15-2,01). Conclusions: There is a high perception of abuse experienced by medicine interns, being psychological abuse the most frequent condition. There are some differences in the perception of psychological and physical abuse, according to the medical school the interns come from, as well as with respect to the healthcare facility where internship is performed. A high frequency of sexual harassment was reported by female interns after three months of having started their training period.

Exploring the determinants and outcomes of intimate partner violence during pregnancy for Guyanese women: Results from a nationally representative cross-sectional household survey / Análisis de los determinantes y las consecuencias de la violencia de pareja durante el embarazo en mujeres de Guyana: resultados de una encuesta domiciliaria transversal representativa a nivel nacional / Conhecendo os determinantes e os desfechos da violência por parceiro íntimo contra mulheres na gravidez na Guiana: resultados de uma pesquisa transversal domiciliar com representatividade nacional

ABSTRACT Objective. To determine predictors associated with physical violence during pregnancy, and to determine the relationship between exposure to intimate partner violence during pregnancy and women's health and suicide ideation in Guyana. Methods. A secondary data analysis of a cross-sectional household survey. Multivariate logistic regression models were fitted to the data to estimate the association between physical violence during pregnancy, controlling partner behavior, and other predictors. Ordered logistic regression models were fitted to estimate the association between physical violence during pregnancy and women's health, and lifetime physical partner violence and overall health. Logistic regression models were fitted to estimate associations between physical violence during pregnancy and lifetime physical partner violence and overall health and suicide ideation. Results. The prevalence of lifetime physical/sexual intimate partner violence was 38.8%, current physical/sexual intimate partner violence 11.1%, and violence during pregnancy 9.2%. Controlling partner behavior was significantly and positively associated with maternal experience of physical violence during pregnancy. Experiencing physical partner violence during pregnancy, but not lifetime physical partner violence, was associated with significantly increased odds of poor overall health. Physical violence during pregnancy and lifetime physical violence were both significantly associated with increased odds of suicide ideation. Conclusions. The prevalence of violence during pregnancy in Guyana is high and is associated with adverse health outcomes. These findings suggest the need for intimate partner violence prevention, and for integrating intimate partner violence screening and treatment into antenatal care, reproductive health services, and maternal and child health programs and services to identify and treat at-risk women.

RESUMEN Objetivo. Determinar los factores predictivos relacionados con la violencia física durante el embarazo y determinar la relación entre la exposición a la violencia de pareja durante el embarazo y la ideación suicida y la salud de las mujeres en Guyana. Métodos. Se realizó un análisis secundario de los datos obtenidos de una encuesta domiciliaria transversal. Se adaptaron modelos multifactoriales de regresión logística a los datos para calcular la asociación entre la violencia física durante embarazo, comportamiento controlador de la pareja y otros factores predictivos. Se emplearon modelos ordenados de regresión logística para calcular la asociación entre la violencia física durante el embarazo y la salud de la mujer, y la violencia de pareja a lo largo de la vida y la salud en general. Se aplicaron modelos de regresión logística para calcular la asociación entre la violencia física durante el embarazo y la violencia de pareja a lo largo de la vida y la ideación suicida y la salud en general. Resultados. La prevalencia de la violencia física o sexual infligida por la pareja a lo largo de la vida fue 38,8%, la violencia física o sexual infligida por la pareja en la actualidad fue 11,1% y la violencia durante el embarazo fue 9,2%. El comportamiento controlador de la pareja mostró una asociación positiva y significativa con una experiencia materna de violencia física durante el embarazo. Sufrir violencia física durante el embarazo, aunque no a lo largo de la vida, se asoció significativamente con mayores probabilidades de un estado de salud general deficiente. Tanto la violencia física durante el embarazo como la violencia física a lo largo de la vida se asociaron significativamente con mayores probabilidades de ideación suicida. Conclusiones. La prevalencia de la violencia durante el embarazo en Guyana es alta y está relacionada con consecuencias adversas en materia de salud. Estos resultados ponen de manifiesto la necesidad de prevenir la violencia de pareja y de integrar su detección y tratamiento en la atención prenatal, los servicios de salud reproductiva y los programas y servicios de salud maternoinfantil para detectar y tratar a las mujeres en riesgo.

RESUMO Objetivo. Determinar as variáveis preditivas associadas à violência física contra mulheres na gravidez e avaliar a relação entre exposição à violência por parceiro íntimo na gravidez e saúde e ideação suicida em mulheres na Guiana. Métodos. Foi realizada uma análise dos dados secundários de uma pesquisa transversal domiciliar. Modelos de regressão logística multivariada foram ajustados ao conjunto de dados para estimar a associação entre violência física na gravidez, controlando-se o efeito do comportamento do parceiro e outras variáveis preditivas. Modelos de regressão logística ordinal foram ajustados para estimar a associação entre violência física na gravidez e saúde das mulheres e violência física por parceiro íntimo ao longo da vida e saúde geral. Modelos de regressão logística foram ajustados para estimar a associação entre violência física na gravidez e violência física por parceiro íntimo ao longo da vida e saúde geral e ideação suicida. Resultados. Observou-se uma prevalência de 38,8% de violência física/sexual por parceiro íntimo ao longo da vida, 11,1% de violência física/sexual por parceiro íntimo no momento presente e 9,2% de violência física/sexual na gravidez. Controlando-se o efeito do comportamento do parceiro, verificou-se uma associação positiva significativa com experiência materna de violência física na gravidez. Sofrer violência física por parceiro íntimo na gravidez, mas não violência física por parceiro íntimo ao longo da vida, foi associado a uma chance significativamente maior de saúde geral ruim. Verificou-se uma associação significativa entre violência física na gravidez e violência física ao longo da vida e uma maior chance de ideação suicida. Conclusões. A prevalência da violência contra mulheres na gravidez na Guiana é alta e está associada a desfechos de saúde adversos. Esses resultados apontam para a necessidade de prevenir a violência por parceiro íntimo e integrar a avaliação da violência por parceiro íntimo e o tratamento das mulheres aos serviços de assistência pré-natal e de saúde reprodutiva e programas e serviços de saúde materno-infantil para identificar e tratar as mulheres em risco.

Experiencias traumáticas y resiliencia en población expuesta a la violencia / Traumatic experiences and resilience in population exposed to violence

El objetivo de este estudio fue examinar la relación entre eventos traumáticos en la infancia y la resiliencia, en población expuesta a la violencia en la región del Urabá antioqueño. Se contó con una muestra final de 86 adultos (53.5%, los hombres, 43% mujeres y 3.5% mujeres transgénero) entre 18 y 60 años. Este es un estudio descrip-tivo, correlacional, de corte transversal, en el cual se midieron eventos traumáticos que fueron evaluados con el Inventario de Experiencias Traumáticas en la Infancia (ETI-SRCol) y niveles de resiliencia con la Escala de Resiliencia en Adultos (ER). Para determinar la relación se usó el coeficiente de correlación de Spearman p<0.005, que fue considerado significativo. Los datos obtenidos del cuestionario ETI-SRCol evidencian puntajes importantes al comparar las medias del grupo de participantes con las del grupo de adaptación de la prueba para la población colombiana en las variables de violencia sociopolítica, abuso sexual, acontecimientos generales y en la de pobreza. Los resultados de este estudio indican correlaciones débiles entre los fac-tores del trauma infantil y los niveles de resiliencia en la edad adulta.

The objective of this study was to examine the relationship between traumatic events in childhood and resilience in a population exposed to violence in the region of Urabá, Antioquia. A final sample of 86 adults (53.5%, men, 43% women and 3.5% transgender women) between 18 and 60 years old. The traumatic events were eva-luated using the Inventory of Traumatic Experiences in Childhood (ETI-SRCol) and resilience levels with the Adult Resilience Scale (ER). Spearman's correlation coefficient was used to determine the relationship, p<0.05 was considered significa-tive. The data obtained from the ETI-SRCol questionnaire showed significant scores when comparing the participant group averages with those of the test adaptation group for the Colombian population pertaining to the variables of sociopolitical violence, sexual abuse, general events and in the variable poverty. Results indicate weak correla-tions between child trauma factors and resilience levels in adulthood.

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.

Abuse in Colombian elderly and its association with socioeconomic conditions and functionality / Maltrato en adultos mayores colombianos y su asociación con condiciones socioeconómicas y funcionalidad

Abstract Objective: To describe the presence of abuse in elderly people in Colombia and its association with socio-demographic and functional conditions. Methods: Cross-sectional and descriptive research. Data were taken from the SABE Colombia Survey, a population study, with a national representative sample of 23,694 adults aged over 60 years. Presence and type of abuse by partners or family members, members were investigated. Generalized linear models with Poisson link function were used to estimate the causes of the prevalence of abuse by area of residence, region, age, sex, dependence on activities of daily living and living arrangements. Results: 15.1% of the elderly in Colombia reported some type of abuse, and over 50% reported more than one form of abuse. Abuse proportion is greater in people who are aged 60-69, in women, people with lower levels of education, people who belong to lower socioeconomic status, people who live alone, people who live with children, and people in urban areas. The most frequent abuse form is psychological, followed by neglect and physical abuse. Dependence on basic and instrumental daily living activities increases the probabilities of suffering abuse. Conclusions: Home is a risky place for the elderly people, especially for those with functional dependence, those who belong to low socioeconomic strata and women. Results should encourage debate among researchers, professionals and decision makers on public policy about necessary actions and means to change violent family dynamics in homes with elderly people.

Resumen Objetivo: Describir la presencia de maltrato en las personas mayores en Colombia y su asociación con condiciones sociodemográficas y funcionales. Métodos: Estudio transversal y descriptivo. Se tomaron los datos de la Encuesta SABE Colombia, un estudio poblacional, con una muestra representativa a nivel nacional de 23,694 adultos mayores de 60 años. Se indagó por la presencia y tipo de maltrato, por parte de los miembros de la familia, hogar o convivientes. Se utilizaron modelos lineares generalizados con función de vínculo de Poisson para estimar las razones de prevalencia de maltrato por zona de residencia, región, edad, sexo, dependencia en actividades de la vida diaria y convivencia. Resultados: Reportaron algún tipo de maltrato el 15.1% de las personas mayores en Colombia y más de la mitad refiere más de una forma de maltrato. Hay mayor proporción de maltrato en las personas de 60-69 años, en mujeres, con menor escolaridad, quienes viven en estratos bajos, solos, con hijos y en zona urbana. El maltrato más frecuente es el psicológico, seguido de negligencia y maltrato físico. La dependencia en actividades básicas e instrumentales de la vida diaria, incrementa la probabilidad de sufrir maltrato. Conclusiones: El hogar es un lugar de riesgo para los adultos mayores, especialmente aquellos con dependencia funcional, de estratos bajos y mujeres. Los resultados deberán animar el debate entre investigadores, profesionales y tomadores de decisiones de política publica, en torno a las acciones y los medios necesarios para transformar las dinámicas familiares violentas en hogares con personas mayores.