RESUMEN
RESUMEN Objetivo: Integrar la evidencia teórica y empírica relacionada con la violencia de pareja íntima en el contexto de atención en salud pública. Materiales y Método: Se realizó una revisión integradora de la literatura siguiendo la propuesta de Dixon-Woods, Agarwal, Jones, Young y Sutton. Las bases de datos consultadas fueron PubMed, Scielo, Medline, Lilacs, Proquest, ESBCO, Science Direct y Scopus y el meta-buscador Google académico en los idiomas inglés, español y portugués. Se utilizaron los siguientes descriptores: Partner Violence, Intimate Violence, Intimate Partner, Intimate Partner Abuse, Partner Abuse, Intimate Spouse Abuse, Public Health. Resultados: Se identificaron 119 artículos relacionados con la violencia de pareja íntima en el ámbito mundial. Latinoamérica y Norteamérica fueron las regiones del mundo con mayor proporción de artículos identificados (37.2 y 32.2 % respectivamente). Los países de Latinoamérica con más aportes en el tema son Brasil, con el 17 %; Colombia, con el 6.9 % y México, con el 4.3 %; mientras en Norteamérica, en los Estados Unidos se publicaron el 29.4 % de los artículos encontrados. En el periodo estudiado (2015-2020), se encontró un mayor número de artículos publicados en los años 2017 y 2020, la mayoría de ellos (57.1 %) utilizó una metodología cuantitativa. Conclusiones: Los patrones temáticos que emergen de esta revisión integradora develan los entramados de la violencia de pareja muestran cómo las relaciones de poder, la desigualdad de género y las múltiples violencias a las que se ven expuestas las mujeres están directamente influenciadas por la cultura machista y patriarcal.
ABSTRACT Objective: To integrate the theoretical and empirical evidence related to intimate partner violence in the context of public health care. Materials and Method: An integrative review of the literature was carried out following the proposal of Dixon-Woods, Agarwal, Jones, Young and Sutton. The databases consulted were PubMed, Scielo, Medline, Lilacs, Proquest, ESBCO, Science Direct and Scopus and the academic Google metasearch engine in English, Spanish and Portuguese. The following descriptors were used: Partner Violence, Intimate Violence, Intimate Partner, Intimate Partner Abuse, Partner Abuse, Intimate Spouse Abuse, Public Health. Results: 119 articles related to intimate partner violence worldwide were identified. Latin America and North America were the world regions with the highest proportion of identified articles (37.2 % and 32.2%, respectively). The Latin American countries with the most contributions on the subject are Brazil, with 17 %; Colombia, with 6.9 %, and Mexico, with 4.3 %; While in North America, 29.4 % of the articles found were published in the United States. In the period studied (2015-2020), a greater number of articles published in the years 2017 and 2020 were found, most of them (57.1 %) used a quantitative methodology. Conclusions: the thematic patterns that emerge from this integrative review reveal the networks of intimate partner violence and show that asymmetric relationships, gender inequality and the multiple forms of violence to which women are exposed are directly influenced by the macho culture and patriarchal.
RESUMEN
Intimate partner abuse (IPA) affects women's health, requiring accurate questions to identify the abuse. We investigated the accuracy of three questions about fear of an intimate partner in identifying exposure to IPA. We compared the sensitivity and specificity of these questions with the Composite Abuse Scale (CAS) using secondary data analysis of four existing studies. All studies recruited adult women from clinical settings, with sample sizes ranging from 1,257 to 5,871. We examined associations between demographic factors and fear through multivariate logistic regression, and analysis of the sensitivity and specificity of the questions about fear and IPA (CAS), generating a receiver operating curve (ROC). The prevalence of lifetime fear of a partner ranged from 9.5% to 26.7%; 14.0% of women reported fear in the past 12 months; and current fear ranged from 1.3% to 3.3%. Comparing the three questions, the question "afraid of a partner in the past 12 months" was considered the best question to identify IPA. This question had the greatest area under the ROC (0.80, 95% confidence interval (CI) = [0.78-0.81]) compared with "are you currently afraid" (range 0.57-0.61) or "have you ever been afraid" (range 0.66-0.77); and demonstrated better sensitivity (64.8%) and specificity (94.8%). Demographic factors associated with "fear of a partner in the past 12 months" included being divorced/separated (odds ratio [OR] = 8.49, 95% CI = [6.70-10.76]); having a low income (OR = 4.21, 95% CI = [3.46-5.13]); and having less than 12 years of education (OR = 2.48, 95% CI = [2.04-3.02]). The question "In the last 12 months did you ever feel frightened by what your partner says or does?" has potential to identify a majority of women experiencing IPA, supporting its utilization where more comprehensive measures are not possible.
Asunto(s)
Violencia de Pareja , Adulto , Estudios Transversales , Miedo , Femenino , Humanos , Prevalencia , Parejas SexualesRESUMEN
O objetivo do presente artigo é revisar a literatura que aborda a relação entre violência por parceiro íntimo contra a mulher e insegurança alimentar. A busca por materiais foi realizada nas bases de dados Pubmed, SciELO, Lilacs e Medline. Foram incluídos estudos prospectivos, retrospectivos e transversais. O critério de inclusão foram estudos que relacionassem a violência por parceiro íntimo contra a mulher e insegurança alimentar, sendo selecionados16 artigos com esse tema. A avaliação da violência e da insegurança foi realizada com escalas e questionários próprios, que mediam, além da incidência, o nível de insegurança e os tipos de violência. Todos os estudos identificaram uma forte associação entre ambos os temas, identificando-se forte associação, bidirecional, entre violência por parceiro íntimo e insegurança alimentar, relação mediada principalmente por problemas psicológicos e econômicos.(AU)
El propósito de este artículo es revisar la literatura sobre la relación de la violencia por parte de compañero íntimo contra la mujer e inseguridad alimentaria. La búsqueda se realizó en las bases de datos Pubmed, SciELO, Lilacs y Medline. Se incluyeron estudios prospectivos, retrospectivos y transversales. Los criterios de inclusión comprendieron estudios que relacionaron la violencia por parte de compañero íntimo contra la mujer con la inseguridad alimentaria, siendo seleccionados 16 artículos con esa temática. La evaluación de la violencia y de la inseguridad se realizó con escalas y cuestionarios propios que medían, además de la incidencia, el nivel de inseguridad y los tipos de violencia. Todos los estudios identificaron una fuerte asociación entre ambos temas, identificando una fuerte asociación, bidireccional, entre violencia por parte de compañero íntimo e inseguridad alimentaria, relación mediada principalmente, por problemas psicológicos y económicos.(AU)
The purpose of this article is to review the literature on the relationship between intimate partner violence against woman and food insecurity. The search was carried out in the Pubmed, SciELO, Lilacs and Medline databases. Prospective, retrospective, and cross-sectional studies were included. The inclusion criteria included studies that related intimate partner violence against women with food insecurity, being selected 16 articles with this theme. The assessment of violence and insecurity was made using scales and questionnaires, measuring the incidence, as well as the level of insecurity and the types of violence. All studies identified a strong and robust association between both topics, identifying a strong association, in a bidirectional way, between intimate partner violence and food insecurity, a relationship was mediated mainly by psychological and economic problems.(AU)
Asunto(s)
Mujeres , Violencia de Pareja , Inseguridad Alimentaria , Literatura de Revisión como Asunto , Factores de Riesgo , Violencia contra la MujerRESUMEN
resumen está disponible en el texto completo
Abstract: Introduction Violence is recognized as a Public Health problem around the world. In the specific case of Intímate Partner Abuse, which occurs at home, women are particularly vulnerable to be abused by their partners. In Mexico, as in other countries in Latin America, the systematic study of violence towards women is incipient. However, it is a highly predominant problem, which has a big impact on women's health, and represents a significant challenge to the Health System demanding health care due to intentional injuries. This paper analyzed information generated by the first National Survey of violence against women in 2003 (ENVIM, by his name in Spanish). Objective The main objective is to identify the factors associated with the health services utilization by women, because of partner abuse. Methodology A cross-sectional design was used, including women users of health care services on public institutions all over the country in 2003. Intimate partner abuse was defined as "the repetitive event of abuse from the male partner side towards the woman, that is characterized by coercive conducts that could include physical, emotional or sexual violence". It was measure in a scale of 27 items, using the Index of Spouse Abuse (ISA) and the Severity of Violence against Women Scale (SVAWS). Both indexes were vali-dated previously in Mexican population. A factorial analysis was used and the factors that explain the variability were obtained. The selection of women to be interviewed was done using a probabilistic stratify biethapic sample. For the first one, medical unites were selected, and for the second, women over 14 years old who went to those medical unities to demand any kind of health care services. The ethic considerations were resolved using the next procedures: participants received information about the research objectives and signed an informant consent letter endorsed by the ethical committee of the Institution. They also received a brochure with information about the local institutions where they can go in case of abuse. Interviewers trained in technical areas as well as abuse management using a questionnaire on private spaces did the data collection. The answer rate was of 98%. The analyzed variables were Socio demographic, search of support on the health staff or reasons for not doing this. An index of socio-economic level categorized as very low, medium and high. Type of institution and services used. The dependent variable was utilization of the health services to attend the injuries due to a partner abuse event, during the last 12 months. The analysis used was simple and bivariate using chi square, and binary logistic regression model. The final model included the variables that in the binary showed a value of p<0.25. We ad-justed the model using the Goodness of Fit Test of Pearson. Results From 24,958 women that utilized public health services 21% reported to have had a partner abuse event in the last year. From these, only 7.3% utilized health services. The more important variables were: age between 25 to 34 years old, elementary schooling and women having a job. Of the sample 94% belong to the very low and medium socio-economic levels; almost half of them (47%) do not have health insurance. More than 80% have a partner at present; 7.6% reported severe violence. From those who had injuries, 72% declared to have had just one minor injury (bruises, body aches), 25.5% reported more than one type of injuries, from which 10.8% were severe and required surgery or hospitalization. The type of injuries that demand more utilization of health services were those subsequent to sexual abuse as genital infection and genital bleeding. Only 45% of the women users' report to have medical insurance. Less than 6% of abused women talked with the health staff about their abuse situation and the main reason was the lack of trust. The factors associated to the utilization of health services were ages over 24 years(ORA 1.57, CI 95% 1.9 - 2.06) alcohol intake by the women (ORA =1.66 CI 95% 1.57-1.75) High Socio economic status (ORA =1.29 CI95% 1.07-1.54). The model was adjusted by severity index and to having medical insurance. There were not significative interactions (p>0.15) and the global adjusted model was p= 0.23. Discussion and conclusions There is a low percentage of abused women injured that utilize formal medical care. This is a very important result for the identification of prevention and control strategies of the partner abuse problem in the health services. The study shows the existence of different types of injuries or medical problems such as genital infections and bleedings, fainting spells, body aches that provoked on one hand that women did not seek medical attention immediately and on the other that the health staff could not identify this kind of health problems with intimate partner abuse. There is a group of more vulnerable women who do not use health services to take care of the consequences of abuse, because they are uninsured. This inequality reveals that it is urgent to provide support services to poor women in the country. The finding about the difficulty for battered women to report their injuries to the health staff because of their lack of trust, agrees with different studies that report the different obstacles found by abused women in facing the health services. The last situation reveals the obstacles to be solved for the NOM implementation too. It is important to mention the study limitations related with the design utilized, and the selection bias due to the inclusion only of users of services. This situation leaves at one side women with less resources, who confront big obstacles for the utilization of health services, and at the other, women from high socio-economic levels, who utilize private health services; therefore there is no accuracy the point out differences. The way in which the question about the utilization of health services was made, makes it difficult to know the number of times these were used. This variable must be explored in future studies. The information generated by the ENVIM allows the Health Sector to define identification-attention strategies of battered women and provides information about the importance of training the health staff to generate trust among in partner-abused women.