Violência e vida familiar: abordagens psicanalíticas e de gênero / Violence and family life: psychoanalytic and gender approaches

Busca-se examinar as possibilidades de diálogo interdisciplinar entre a psicanálise e a teoria de gênero, tal como tem sido usada em estudos acerca da violência na Saúde Coletiva, para abordar ocorrências de agressão e abuso na vida familiar e seus possíveis impactos na saúde, com especial atenção às repercussões psíquicas nas crianças e mulheres, bem como no grupo familiar como um todo. Com base em autores clássicos para ambos os aportes disciplinares, examina-se um caso concreto extraído de situação de atendimento à família. Esse exame é composto de três dimensões interpretativas: primeiro, considerações sobre o caso individual em seu contexto familiar; segundo, o caso visto da perspectiva das questões culturais; por fim, a relação entre a cultura e sua expressão individualizada no caso. Aponta-se para a possibilidade de se realizar uma abordagem que integre a dimensão intrapsíquica, que diz respeito ao funcionamento do mundo interno dos sujeitos envolvidos, à realidade sociocultural e histórica que constitui o seu contexto de vida. E com vistas a uma atenção mais integral dos casos, aponta-se a importância prática de combinar a reflexão e intervenção de natureza psicodinâmica, fruto do exame dos impactos intrapsíquicos da violência a partir de conceitos como trauma e terror, com reconhecimentos das expressões culturais no plano individual e familiar, que reforçam aceitações normativas de agressões, vitimizações, silenciamentos e banalizações das violências. O diálogo interdisciplinar permite compreender o desenvolvimento de sentimentos e comportamentos, reforçados culturalmente, tais como medos e vergonhas nas vítimas e reiteração das violências nos agressores.

We aim to examine the possibilities for an interdisciplinary dialogue between Psychoanalysis and gender theory, as expressed in studies about violence on Collective Health, to approach occurrences of aggression and abuse in family life and their possible impacts on health, with particular attention to the psychological impacts on children and women, as well as in the family group as a whole. Based on classical authors for both disciplinary contributions, we examine a concrete case taken from a family care situation. This examination consists of three interpretative dimensions: first, considerations on the individual case in its family context; second, the case seen from the perspective of cultural issues; and third, the relation between culture and its individualized expression in the case. We show the possibility of conducting an approach that integrates the intrapsychic dimension, which concerns the functioning of the inner world of the individuals involved, with the sociocultural and historical realities that constitute their context of life. With the aim of a comprehensive care of the cases, we highlight the practical importance of combining reflection and action of psychodynamic nature, a result of the examination of the intrapsychic impacts of violence from concepts such as trauma and terror, with recognition of cultural expressions in the individual and family realms, which strengthen normative acceptances of aggressions, victimizations, silencing, and trivialization of violence. The interdisciplinary dialogue makes possible to understand the development of culturally reinforced feelings and behaviors, such as fear and shame in the victims and repetition of violence in the aggressors.

Gender-violence against the female nursing staff of a Brazilian hospital in São Paulo City.

OBJECTIVE: To estimate the occurrence of psychological, physical and sexual violence among female nursing staff. METHODS: This is a cross sectional study, conducted with a sample of 179 professionals (50 nurses and 129 nursing aides / nurse technicians) in a general hospital in the municipality of São Paulo, Southeastern Brazil, 2005-2006. A validated questionnaire was applied in face to face interviews with these professionals, conducted by trained interviewers. Psychological, physical and sexual forms of violence were addressed, involving both male and female aggressors who were classified as: intimate partners, family members and other aggressors such as acquaintances and strangers. A descriptive analysis was undertaken, in which the frequency of the occurrence of the different types of violence was calculated with a 95% confidence interval. RESULTS: The most frequent form of violence was intimate partner violence (63.7%; 95% CI: 55.7;70.4), followed by violence perpetrated by others (45.8%; 95% CI: 38.3;53.4) including patients and people accompanying them, colleagues within the field of health, head nurses, acquaintances and strangers. Family members occupied the third place as aggressors, (41.3%; 95% CI: 34.0;48.9), and the majority of these were fathers, brothers, uncles and cousins. In general, the nursing staff did not seek help frequently when acts of aggression occurred: only 29.7% of those who suffered intimate partner violence; 20.3% whose aggressors were others and 29.3% whose aggressors were family members sought help. Those who did not perceive their experience as a form of violence represented 31.9% of the subjects interviewed. CONCLUSIONS: The rates of gender violence among female health professionals were important, particularly with respect to violence committed by intimate partners and family members. However, the proportion of these women who sought help was low, considering the fact that this group has a significant educational level.

Violência de gênero contra trabalhadoras de enfermagem em hospital geral de São Paulo (SP) / Gender-violence against the female nursing staff of a Brazilian hospital in São Paulo City / Violencia de género contra trabajadoras de enfermería en hospital general de São Paulo, Brasil

OBJETIVO: Estimar a ocorrência de violência psicológica, física e sexual em profissionais de enfermagem. MÉTODOS: Estudo transversal com amostra de 179 profissionais (50 enfermeiras e 129 auxiliares/técnicas de enfermagem) de um hospital geral do município de São Paulo, SP, entre 2005 e 2006. Utilizou-se questionário aplicado face a face por entrevistadoras treinadas. A violência foi abordada em suas formas psicológica, física e sexual para agressores homens e mulheres, agrupados em: parceiros íntimos, familiares e outros agressores como conhecidos e estranhos. Procedeu-se a uma análise descritiva, calculando-se as freqüências dos tipos de violência com intervalo de confiança de 95 por cento. RESULTADOS: A violência por parceiro íntimo foi a mais freqüente (63,7 por cento; IC 95 por cento:55,7;70,4) seguida pela violência perpetrada por outros (pacientes/acompanhantes, colegas de trabalho da área da saúde, estranhos, chefia de enfermagem e conhecidos; 45,8 por cento; IC 95 por cento: 38,3;53,4). A violência por familiares ocupou o terceiro lugar (41,3 por cento; IC 95 por cento: 34,0;48,9) e foi cometida, principalmente por pai, irmãos(homens), tios e primos. Em geral, poucas profissionais de enfermagem que sofreram violência buscaram ajuda: 29,7 por cento para a violência por parceiro íntimo; 20,3 por cento para a violência por outros e 29,3 por cento para a violência por familiares. Não perceberam o vivido como violento, 31,9 por cento das entrevistadas. CONCLUSÕES: As taxas de violência de gênero entre mulheres profissionais de saúde foram significativas, principalmente para a violência cometida por parceiros íntimos e familiares. Entretanto, a busca de ajuda frente aos agravos sofridos foi baixa, considerando ser um grupo de escolaridade significativa.

[Intimate partner sexual violence among men and women in urban Brazil, 2005]. / Violência sexual por parceiro íntimo entre homens e mulheres no Brasil urbano, 2005.

OBJECTIVE: To estimate the prevalence of intimate partner sexual violence among men and women of the Brazilian urban population and factors associated to it. METHODS: The data analyzed is part of the study conducted between 1998 and 2005 among urban populations in Brazil. The data was obtained by means of a questionnaire applied to a representative sample of 5.040 individuals, men and women 16 to 65 years of age. Descriptive analysis was undertaken with weighted data, utilizing F design-based tests, with 5% significance. RESULTS: The global prevalence of intimate partner sexual violence was 8.6%, being predominant among women (11.8% versus 5.1%). Women consistently reported higher rates of violence then men, except in cases involving homo/bisexual partners. The rate verified for male homo/bisexuals was significantly greater than that found among male heterosexuals, but this difference in rates was not significant among women. The black population, irrespective of sex, referred more violence than the white population. The lower the income and years of formal education, the greater the rates of violence. However, men from poorer regions referred more violence, but this did not occur with respect to women. Diverse situations with respect to work, use of condoms, lower age at first intercourse and number of partners during the last five years differed significantly among women, but not among men. For both men and women sexual violence was associated with being separated or divorced, having had STDs, self -evaluation of being at risk for HIV, but was not associated with testing positive for HIV. CONCLUSIONS: The high magnitude of sexual violence as well as female surtax is confirmed. Violence as a result of gender conflicts, that pervades social stratification and ethnic groups is reiterated. As to the Aids epidemic, sexual violence is an important factor to be taken into consideration when discussing the feminization of the population affected by the disease.

Violência sexual por parceiro íntimo entre homens e mulheres no Brasil urbano, 2005 / Intimate partner sexual violence among men and women in urban Brazil, 2005

OBJETIVO: Estimar a prevalência de violência sexual por parceiro íntimo entre homens e mulheres da população urbana brasileira e fatores a ela associados. MÉTODOS: Os dados analisados fazem parte de pesquisa realizada em 1998 e 2005 no Brasil, em população urbana. Os dados foram obtidos por meio de questionários aplicados a amostra representativa de 5.040 indivíduos, homens e mulheres de 16 a 65 anos. Análise descritiva foi realizada com dados ponderados, usando-se os testes F design-based, com significância de 5 por cento. RESULTADOS: A prevalência global de violência sexual por parceiro íntimo foi de 8,6 por cento, com predominância entre as mulheres (11,8 por cento versus 5,1 por cento). As mulheres apresentaram taxas sempre maiores de violência do que os homens, exceto no caso de parcerias homo/ bissexuais. Foi significativa a diferença da maior taxa verificada para homens homo/bissexuais em relação aos heterossexuais, mas não para mulheres. A população negra, independente do sexo, referiu mais violência que a branca. Quanto menor a renda e a escolaridade, maior a violência, mas homens de regiões mais pobres referiram mais violência, o que não ocorreu com mulheres. Situações diversas do trabalho, uso de condom, menor idade na primeira relação sexual e número de parceiros nos últimos cinco anos diferiram significativamente para mulheres, mas não para homens. Para homens e mulheres a violência sexual associou-se a ser separado(a) ou divorciado(a), ter tido doença sexualmente transmissível, auto-avaliar-se com risco para HIV, mas não à sua testagem. CONCLUSÕES: Confirma-se a alta magnitude da violência sexual e a sobretaxa feminina. Reitera-se a violência como resultado de conflitos de gênero, os quais perpassam a estratificação social e a etnia. Quanto à epidemia de Aids, a violência sexual é um fator importante a ser considerado na feminilização da população atingida.

OBJECTIVE: To estimate the prevalence of intimate partner sexual violence among men and women of the Brazilian urban population and factors associated to it. METHODS: The data analyzed is part of the study conducted between 1998 and 2005 among urban populations in Brazil. The data was obtained by means of a questionnaire applied to a representative sample of 5.040 individuals, men and women 16 to 65 years of age. Descriptive analysis was undertaken with weighted data, utilizing F design-based tests, with 5 percent significance. RESULTS: The global prevalence of intimate partner sexual violence was 8.6 percent, being predominant among women (11.8 percent versus 5.1 percent). Women consistently reported higher rates of violence then men, except in cases involving homo/bissexual partners. The rate verified for male homo/bisexuals was significantly greater than that found among male heterosexuals, but this difference in rates was not significant among women. The black population, irrespective of sex, referred more violence than the white population. The lower the income and years of formal education, the greater the rates of violence. However, men from poorer regions referred more violence, but this did not occur with respect to women. Diverse situations with respect to work, use of condoms, lower age at first intercourse and number of partners during the last five years differed significantly among women, but not among men. For both men and women sexual violence was associated with being separated or divorced, having had STDs, self -evaluation of being at risk for HIV, but was not associated with testing positive for HIV. CONCLUSIONS: The high magnitude of sexual violence as well as female surtax is confirmed. Violence as a result of gender conflicts, that pervades social stratification and ethnic groups is reiterated. As to the Aids epidemic, sexual violence is an important factor to be taken into consideration when discussing the feminization...

[Prevalence of intimate partner violence against women in regions of Brazil]. / Prevalência da violência contra a mulher por parceiro íntimo em regiões do Brasil.

OBJECTIVE: To analyze the results from the "WHO Multi-country Study on Women's Health and Domestic Violence", on the prevalence of intimate partner violence against women found in Brazil. METHODS: This cross-sectional study was part of the "WHO Multi-country Study on Women's Health and Domestic Violence against women", which was carried out in ten countries between 2000 and 2003. All the countries used a standardized structured questionnaire, devised for this study. In order to obtain data from contrasting settings within each country, the biggest city and a rural region were investigated whenever feasible. A representative sample of women aged 15 to 49 years was selected from the city of São Paulo and 15 municipalities in a rural region of the northeast, the Zona da Mata de Pernambuco. The study included 940 women from São Paulo and 1,188 from Zona da Mata de Pernambuco who had had an intimate partner at some time in their lives. Violence was classified as psychological, physical and sexual types, and was analyzed in relation to overlapping, recurrence of episodes, severity and when it occurred. RESULTS: The women in São Paulo and Pernambuco respectively reported the following at least once in their lifetimes: psychological (N=383; 41.8% and N=580; 48.9%); physical (N=266; 27.2% and N=401; 33.7%); sexual (N=95; 10.1% and N=170; 14.3%) violence. There was significant overlapping among the types of violence, which seemed to be associated with the most severe types of violence. The greatest single type was psychological violence, in São Paulo and Pernambuco (N=164; 17.5% and N=206; 17.3%), and the smallest was sexual violence (N=2; 0.2% and N=12; 1.0%). CONCLUSIONS: The results show that violence is a very common phenomenon. The findings reiterate previous international studies results with regard to high magnitude and overlapping of types of intimate partner violence.

Prevalência da violência contra a mulher por parceiro íntimo em regiões do Brasil / Prevalence of intimate partner violence against women in regions of Brazil

OBJETIVO: Analisar os resultados do WHO Multi-country Study on Women´s Health and Domestic Violence sobre a prevalência da violência contra mulheres por parceiros íntimos encontrada no Brasil. MÉTODOS: Estudo transversal integrante do WHO Multi-country Study on Women's Health and Domestic Violence against women, realizado em dez países, entre 2000-2003. Em todos os locais foi utilizado questionário estruturado padronizado, construído para o estudo. Para conhecer contrastes internos a cada país, a maior cidade e uma região rural foram investigadas, sempre que factível. Foi selecionada amostra representativa da cidade de São Paulo e de 15 municípios da Zona da Mata de Pernambuco constituída por mulheres de 15 a 49 anos de idade. Foram incluídas 940 mulheres de São Paulo e 1.188 de Pernambuco, que tiveram parceria afetivo-sexual alguma vez na vida. A violência foi classificada nos tipos psicológica, física e sexual, sendo analisadas suas sobreposições, recorrência dos episódios, gravidade e época de ocorrência. RESULTADOS: Mulheres de São Paulo e Pernambuco relataram, respectivamente, ao menos uma vez na vida: violência psicológica (N=383; 41,8 por cento e N=580; 48,9 por cento), física (266; 27,2 por cento e 401; 33,7 por cento); sexual (95; 10,1 por cento e 170; 14,3 por cento). Houve sobreposição dos tipos de violência, que parece associada às formas mais graves de violência. A maior taxa da forma exclusiva foi, para São Paulo e Pernambuco, a da violência psicológica (N=164; 17,5 por cento e N=206; 17,3 por cento) e a menor da violência sexual (N=2;0,2 por cento e 12; 1,0 por cento) CONCLUSÕES: Os resultados mostram a violência como um fenômeno de alta freqüência. Os achados reiteram estudos internacionais anteriores quanto à grande magnitude e superposições das violências por parceiro íntimo.

OBJECTIVE: To analyze the results from the "WHO Multi-country Study on Women's Health and Domestic Violence", on the prevalence of intimate partner violence against women found in Brazil. METHODS: This cross-sectional study was part of the "WHO Multi-country Study on Women's Health and Domestic Violence against women", which was carried out in ten countries between 2000 and 2003. All the countries used a standardized structured questionnaire, devised for this study. In order to obtain data from contrasting settings within each country, the biggest city and a rural region were investigated whenever feasible. A representative sample of women aged 15 to 49 years was selected from the city of São Paulo and 15 municipalities in a rural region of the northeast, the Zona da Mata de Pernambuco. The study included 940 women from São Paulo and 1,188 from Zona da Mata de Pernambuco who had had an intimate partner at some time in their lives. Violence was classified as psychological, physical and sexual types, and was analyzed in relation to overlapping, recurrence of episodes, severity and when it occurred. RESULTS: The women in São Paulo and Pernambuco respectively reported the following at least once in their lifetimes: psychological (N=383; 41.8 percent and N=580; 48.9 percent); physical (N=266; 27.2 percent and N=401; 33.7 percent); sexual (N=95; 10.1 percent and N=170; 14.3 percent) violence. There was significant overlapping among the types of violence, which seemed to be associated with the most severe types of violence. The greatest single type was psychological violence, in São Paulo and Pernambuco (N=164; 17.5 percent and N=206; 17.3 percent), and the smallest was sexual violence (N=2; 0.2 percent and N=12; 1.0 percent). CONCLUSIONS: The results show that violence is a very common phenomenon. The findings reiterate previous international studies results with regard to high magnitude and overlapping of types of intimate partner violence.

Violência contra mulheres entre usuárias de serviços públicos de saúde da Grande São Paulo / Violence against women attending public health services in the metropolitan area of São Paulo, Brazil

OBJETIVO: Estimar a prevalência de violência contra mulheres (física, psicológica e sexual), por parceiro íntimo ou outro agressor, entre usuárias de serviços públicos de saúde e contrastá-la com a percepção de ter sofrido violência e com o registro das ocorrências nos serviços estudados. MÉTODOS: Estudo realizado em 19 serviços de saúde, selecionados por conveniência e agrupados em nove sítios de pesquisa na Grande São Paulo, entre 2001-2002. Questionários sobre violência sofrida alguma vez na vida, no último ano e agressor foram aplicados à amostra de 3.193 usuárias de 15 a 49 anos. Foram examinados 3.051 prontuários dessas mulheres para verificação do registro dos casos de violência. Realizaram-se análises comparativas pelos testes Anova, com comparações múltiplas e qui-quadrado, seguido de sua partição. RESULTADOS: As prevalências observadas foram: qualquer violência 76 por cento (IC 95 por cento: 74,2;77,8); psicológica 68,9 por cento (IC 95 por cento: 66,4;71,4); física 49,6 por cento (IC 95 por cento: 47,7;51,4); física e/ou sexual 54,8 por cento (IC 95 por cento: 53,1;56,6) e sexual 26 por cento (IC 95 por cento: 24,4;28,0). A violência física e/ou sexual por parceiro íntimo na vida foi de 45,3 por cento (IC 95 por cento: 43,5;47,1) e por outros que não o parceiro foi de 25,7 por cento (IC 95 por cento: 25,0;26,5). Apenas 39,1 por cento das que relataram qualquer episódio consideraram ter vivido violência na vida, observando-se registro em 3,8 por cento dos prontuários. As prevalências diferiram entre os sítios de pesquisa, bem como a percepção e registro das violências. CONCLUSÕES: A esperada alta magnitude do evento e sua invisibilidade foram confirmadas pelas baixas taxas de registro em prontuário. Constatou-se ser baixa a percepção das situações vividas como violência. Sugerem-se estudos ulteriores que avaliem a heterogeneidade das usuárias dos serviços.

OBJECTIVE: To estimate the prevalence of (physical, psychological, and sexual) violence against women by an intimate partner and non-partner perpetrators among users of public health services and to compare these women's perception of having ever experienced violence with reports of violence in their medical records in the different services studied. METHODS: The study was conducted in 19 health services, selected as a convenience sample and grouped into nine research sites, in metropolitan area of São Paulo from 2001 to 2002. Questionnaires on having ever experienced violence in their lifetime and in the last 12 months and perpetrators were applied to a sample of 3,193 users aged 15 to 49. A total of 3,051 medical records were reviewed to verify the notification of violence. Comparative analyses were performed by Anova with multiple comparisons and Chi-square test followed by its partition. RESULTS: The following prevalences were found: any type of violence 76 percent (95 percent CI: 74.2;77.8); psychological 68.9 percent (95 percent CI: 66.4;71.4); physical 49.6 percent (95 percent CI: 47.7;51.4); physical and/or sexual 54.8 percent (95 percent CI: 53.1;56.6), and sexual 26 percent (95 percent CI: 24.4;28.0). The prevalence of physical and/or sexual violence by an intimate partner in their lifetime was 45.3 percent (95 percent CI: 43.5;47.1), and by non-partners was 25.7 percent (95 percent CI: 25.0;26.5). Only 39.1 percent of women reporting any episode of violence perceived they had ever experienced violence in their lifetime and 3.8 percent of them had any reports of violence in their medical records. The prevalences were significantly different between sites as well as the proportion of perception and reports of violence in medical records. CONCLUSIONS: The expected high magnitude of the event and its invisibility was confirmed by low rate of reports in the medical records. Few perceived abuses as violence. Further studies are recommended...

[Violence against women attending public health services in the metropolitan area of São Paulo, Brazil]. / Violência contra mulheres entre usuárias de serviços públicos de saúde da Grande São Paulo.

OBJECTIVE: To estimate the prevalence of (physical, psychological, and sexual) violence against women by an intimate partner and non-partner perpetrators among users of public health services and to compare these women's perception of having ever experienced violence with reports of violence in their medical records in the different services studied. METHODS: The study was conducted in 19 health services, selected as a convenience sample and grouped into nine research sites, in metropolitan area of São Paulo from 2001 to 2002. Questionnaires on having ever experienced violence in their lifetime and in the last 12 months and perpetrators were applied to a sample of 3,193 users aged 15 to 49. A total of 3,051 medical records were reviewed to verify the notification of violence. Comparative analyses were performed by Anova with multiple comparisons and Chi-square test followed by its partition. RESULTS: The following prevalences were found: any type of violence 76% (95% CI: 74.2; 77.8); psychological 68.9% (95% CI: 66.4; 71.4); physical 49.6% (95% CI: 47.7; 51.4); physical and/or sexual 54.8% (95% CI: 53.1; 56.6), and sexual 26% (95% CI: 24.4; 28.0). The prevalence of physical and/or sexual violence by an intimate partner in their lifetime was 45.3% (95% CI: 43.5; 47.1), and by non-partners was 25.7% (95% CI: 25.0; 26.5). Only 39.1% of women reporting any episode of violence perceived they had ever experienced violence in their lifetime and 3.8% of them had any reports of violence in their medical records. The prevalences were significantly different between sites as well as the proportion of perception and reports of violence in medical records. CONCLUSIONS: The expected high magnitude of the event and its invisibility was confirmed by low rate of reports in the medical records. Few perceived abuses as violence. Further studies are recommended taking into account the diversity of service users.

[Violence and health: recent scientific studies]. / Violência e saúde: estudos científicos recentes.

An outline and critical analysis of scientific studies on Violence and Health is presented. On the basis of a non-exhaustive review, the construction of violence as a national and international field of knowledge and intervention is broached. Outbreaks of violence are shown to occupy a broad domain of social life that reaches practically everyone, in situations of both war and supposed peace. The unity of violence as an ethical-political question is highlighted and its extreme diversity as concrete situations for study and intervention is demonstrated. Through situating violence as related to collective, interpersonal and self-reported individual dimensions, and taking it to be intentional acts of physical force or power, resulting in physical, sexual or psychological abuse, and in negligence or deprivation, the studies examined mostly demonstrate a concern to respond to the widespread sense that violence is invisible, naturalized and inevitable. In order to do it, the studies show the high magnitude of violence, and the possibilities for controlling violence and attending to the multiplicity of harm to health. The initial approaches flow from a theoretical-methodological point of view related to social inequalities, family maladjustment, gender inequalities and, less frequently, race or ethnic inequalities. These imply reconstruction of the classical concepts of family, generation and social class. In conclusion, this problem is considered to be interdisciplinary and, returning to the notion of social-medical matters within Social Medicine, updating of this notion is recommended for topics that are as complex and sensitive as violence.

Violência e saúde: estudos científicos recentes / Violence and health: recent scientific studies

Apresenta-se panorama e reflexão crítica acerca da produção científica na temática violência e saúde. Com base em revisão não exaustiva, aborda-se a construção da violência como objeto de conhecimento e intervenção, nacional e internacionalmente. Mostra-se a tomada da violência como um domínio amplo da vida social, atingindo praticamente a todos, em situações de guerra e de suposta paz. Destaca-se a unificação da violência enquanto questão ético-política e a demonstração de sua extrema diversidade enquanto situações concretas de estudo e intervenção. Situando a violência como atinente a dimensões coletivas, interpessoais e individuais autoreferidas, e tomando-a por atos intencionais de força física ou poder, resultantes em abusos físicos, sexuais, psicológicos, e em negligências ou privações, os estudos examinados revelaram-se, como um todo, preocupados em responder ao senso comum que torna a violência invisível, naturalizada e inevitável. Fazem-no demonstrando sua alta magnitude, as possibilidades de seu controle e da assistência a seus múltiplos agravos à saúde. Do ponto de vista teórico-metodológico fluem das abordagens iniciais, relacionadas às desigualdades sociais ou desajustes familiares, às das iniqüidades de gênero e, menos freqüentemente, de raça ou etnia, o que implica em reconstruções dos conceitos clássicos de família, geração e classe social. Em conclusão, considera-se esta problemática como interdisciplinar e, retomando-se a noção de objetos médico-sociais da medicina social, recomenda-se sua atualização para temas tão complexos quanto sensíveis como a violência.

[Coverage and factors involved in submitting to the Papanicolaou test in the Municipality of São Paulo]. / Cobertura e motivos para a realização ou não do teste de Papanicolaou no Município de São Paulo.

This study estimated Pap smear coverage (at least one test in the lifetime and one in the last three years) among women aged 15 to 49 years old. The study also discusses whether the women received the results of their last test, as well as self-reported reasons for and against submitting to the test. A population-based survey was conducted in the city of São Paulo in 2000 with a randomly selected representative sample of 1,172 women. Among the women who were already sexually active (n = 1,050), 86.1% reported having had at least one Pap smear during their lifetime, and 77.3% had undergone the test in the previous 3 years. Among those who reported having had at least one Pap smear, 87.0% had received the result of the last test. The main reasons reported for having had the last test were: spontaneous demand (55.5%), medical referral (25%), and gynecological complaints (18.2%). The main reasons for never having had a Pap test were: no gynecological problems, embarrassment or fear, and difficulties in accessing health services. Despite high coverage of the Pap test and the fact that the majority of the women had self-reported a spontaneous demand, use of the Pap test was less prevalent among women with the lowest socioeconomic level (and consequently at greater risk of cervical cancer).

Cobertura e motivos para a realização ou não do teste de Papanicolaou no Município de São Paulo / Cervical cancer screening in the Municipality of São Paulo: coverage and factors involved in submitting to the Pap test

Investigou-se a prevalência da realização do teste de Papanicolaou alguma vez na vida e nos últimos três anos entre mulheres de 15 a 49 anos, o recebimento do resultado do último teste realizado e os motivos relatados para a realização ou não do exame. Um inquérito domiciliar foi realizado no Município de São Paulo em 2000, com uma amostra representativa de 1.172 mulheres selecionadas aleatoriamente em seus domicílios. Das mulheres que já tinham iniciado a vida sexual (n = 1.050), 86,1 por cento (932) realizaram o teste alguma vez na vida e 77,3 por cento (839) nos últimos três anos. Das que já realizaram o teste, 806 (87,0 por cento) receberam o resultado do último exame. Os principais motivos para a realização do último teste foram: demanda espontânea (55,5 por cento), recomendação médica (25 por cento) e presença de queixas ginecológicas (18,2 por cento). As principais razões para a não realização do exame foram: ausência de problemas ginecológicos, vergonha ou medo e dificuldades de acesso. A despeito do relativo aumento na cobertura do teste de Papanicolaou e de mais da metade das mulheres demandarem espontaneamente pelo exame, sua realização foi menor entre aquelas com as piores condições sócio-econômicas e, portanto, de maior risco para o câncer cervical.

[Violence against women: a study in a primary healthcare unit]. / Violência contra a mulher: estudo em uma unidade de atenção primária à saúde.

OBJECTIVES: There is scarce information on violence against women in the Brazilian society. This fact is rarely reported in medical records as part of the diagnosis and case management, despite evidence showing the significant impact of violence on the population's health. The study aim was to estimate the occurrence of violence against women, and to determine the nature and magnitude of the violent action and the relationship between women and her aggressors. METHODS: The study was conducted among women seen in a primary care unit of the city of São Paulo, Brazil, in a two-month period in 1998. The occurrence of violence cases was ascertained using standardized interviews to all women aged 15 to 49 years who sought health care during the study. Three-hundred and twenty-two women were interviewed. RESULTS: Of the participants, 143 (44.4%; IC95%=38.9-49.8%) reported at least one episode of physical violence in their adult life, 110 of those perpetrated by their partners or family members (34.1%; IC95%=28.9-39.3%). Thirty-seven women (11.5%; IC95%=8.0-14.9%) reported at least one episode of sexual violence in their adult life, 23 of those perpetrated by their partners or family members (7.1%; IC95%=4.3-9.9%). CONCLUSIONS: As reported in other countries, physical and sexual violence is highly frequent among women seen in primary care services. In most cases their partners and family members are the perpetrators and the episodes are mostly serious and recurrent.