"I Am from the Ghetto, I Am Black, I Live in the Slum and They Think: Why Bother with Her?" - Racism in Seeking Help Experiences for Domestic Violence in Brazil.

Despite the majority of Brazilians identifying as black, racial disparities are significant. Black women encounter disproportionate difficulties, with greater rates of homicide, unemployment, and poverty. After the Maria da Penha Law (2006), which is regarded as one of the most comprehensive laws to address domestic violence, there has been a notable increase in femicide among black women and a decrease in cases among white women. This paper aims to analyze the differences between white and black survivors of domestic violence in terms of the access and support they received from the violence against women multi agency network in the city of São Paulo, Brazil. To this end, in-depth interviews (IDI) were conducted with nine white and nine black women who were seeking help in the justice system in June of 2018. The IDI were analyzed under critical path and structural racism theories, in order to understand how inequality markers such as race might affect the institutional response to the survivor's help seeking. The results indicated that black women received less information and support while seeking institutional help, as they faced more obstacles compared to white women. Among the interviewees critical paths, the access to the services was denied by providers 13 times for black women in contrast with 1 access denial for white women-also considering cases that discontinued the needed assistance due to institutional violence. The observed obstacles lived by black women in the multiagency network not only resulted in the path for these women toward support being longer but in many cases being repeated unsuccessfully multiple times. This study concludes that thus all women face obstacles while seeking help in formal institutions, black women may face greater barriers in this path due to how structural racism is reproduced in the services that should guarantee rights.

Temporal relationship between intimate partner violence and postpartum depression in a sample of low income women.

To estimate whether there is a temporal association between Postpartum Depression (PPD) and intimate partner violence (IPV), and to assess the potential role of social support on this relationship. A cross-sectional study was conducted between January 2006 and March 2007 with 701 low income women who received prenatal and postpartum care in primary health care units of the public sector in São Paulo, Brazil. The Self-Report Questionnaire (SRQ-20) was used to assess the presence of PPD. Structured standardized questionnaires were used to assess IPV and social support. The prevalence of PPD was estimated with a 95 % confidence interval. Crude and adjusted prevalence ratios were calculated using Poisson regression to examine the association between PPD and exposure variables. Values of p < 0.05 were considered statistically significant. The prevalence of PPD was 27.9 % (95 %CI 24.6:31.2). The prevalence of psychological IPV was 38.6 %, physical IPV 23.4 %, and sexual IPV 7.1 %. The multivariate analysis showed that PPD was strongly associated with current psychological and physical/sexual violence, after controlling for confounding factors, and less so with past (prenatal or lifetime) IPV. Presence of social support was an independent protective factor for PPD. Identifying and addressing intimate partner violence, including psychological violence, in the postpartum period should be considered as part of a comprehensive approach to caring for new mothers.

An evidence-based primary health care intervention to address domestic violence against women in Brazil: a mixed method evaluation.

BACKGROUND: Health systems have a critical role in a multi-sectoral response to domestic violence against women (DVAW). However, the evidence on interventions is skewed towards high income countries, and evidence based interventions are not easily transferred to low-and middle-income countries (LMIC) where significant social, cultural and economic differences exist. We evaluated feasibility and acceptability of implementation of an intervention (HERA-Healthcare Responding to Violence and Abuse) to improve the response to DVAW in two primary health care clinics (PHC) in Brazil. METHODS: The study design is a mixed method process and outcome evaluation, based on training attendance records, semi-structured interviews (with 13 Primary Health Care (PHC) providers, two clinic directors and two women who disclosed domestic violence), and identification and referral data from the Brazilian Epidemiological Surveillance System (SINAN). RESULTS: HERA was feasible and acceptable to women and PHC providers, increased providers' readiness to identify DVAW and diversified referrals outside the health system. The training enhanced the confidence and skills of PHC providers to ask directly about violence and respond to women's disclosures using a women centred, gender and human rights perspective. PHC providers felt safe and supported when dealing with DVAW because HERA emphasised clear roles and collective action within the clinical team. A number of challenges affected implementation including: differential managerial support for the Núcleo de Prevenção da Violência (Violence Prevention Nucleus-NPV) relating to the allocation of resources, monitoring progress and giving feedback; a lack of higher level institutional endorsement prioritising DVAW work; staff turnover; a lack of feedback from external support services to PHC clinics regarding DVAW cases; and inconsistent practices regarding documentation of DVAW. CONCLUSION: Training should be accompanied by system-wide institutional change including active (as opposed to passive) management support, allocation of resources to support roles within the NPV, locally adapted protocols and guidelines, monitoring progress and feedback. Communication and coordination with external support services and documentation systems are crucial and need improvement. DVAW should be prioritised within leadership and governance structures, for example, by including DVAW work as a specific commissioning goal.

Equity and women's health services for contraception, abortion and childbirth in Brazil.

This paper addresses equity in health and health care in Brazil, examining unjust disparities between women and men, and between women from different social strata, with a focus on services for contraception, abortion and pregnancy. In 2010 women's life expectancy was 77.6 years, men's was 69.7 years. Women are two-thirds of public hospital services users and assess their health status less positively than men. The total fertility rate was 1.8 in 2011, and contraceptive prevalence has been high among women at all income levels. The proportion of sterilizations has decreased; lower-income women are more frequently sterilized. Abortions are mostly illegal; women with more money have better access to safe abortions in private clinics. Poorer women generally self-induce abortion with misoprostol, seeking treatment of complications from public clinics. Institutional violence on the part of health professionals is reported by half of women receiving abortion care and a quarter of women during childbirth. Maternity care is virtually universal. The public sector has fewer caesarean sections, fewer low birthweight babies, and more rooming-in, but excessive episiotomies and inductions. Privacy, continuity of care and companionship during birth are more common in the private sector. To achieve equity, the health system must go beyond universal, unregulated access to technology, and move towards safe, effective and transparent care.

[Reasons and mechanisms for admission of children and adolescents to a psychiatric hospital: the control circuit]. / Motivos e mecanismos de internação de crianças e adolescentes em hospital psiquiátrico: o circuito do controle.

Important strides in psychiatric reform include the implementation of mental health services that replace the traditional psychiatric logic. However, admissions to psychiatric hospitals continue to occur, including children and adolescents. This study analyzed the reasons for admission to a psychiatric hospital from the institution's perspective and that of the hospitalized children and adolescents. This was a qualitative study with a hermeneutic-dialectic approach, based on a reading of the institutional documents, open interviews with eight adolescents, and participant observation. The results showed that the main alleged reason for admission reported by the psychiatric hospital was "aggressiveness", justified by the idea of "risk to self and others", while the children reported multiple reasons for their hospitalization, including drug use, minor scuffles, and misdemeanors. The analysis showed that the mechanism for admission to the psychiatric hospital involve, during anamnesis, defining an individual as deviating from social norms and, subsequently, assignment of a diagnosis to back the psychiatric institutionalization. It also showed that the backing and continuity of psychiatric hospitalizations occur in a circuit of control that is operated between different institutions for the deviants' custody. The study demonstrates that to avoid psychiatric hospitalizations, besides closing psychiatric hospitals, it is necessary to overcome the psychiatric paradigm, which in turn requires deinstitutionalization of practices and psychosocial care in open, community and substitutive mental health services.

Os avanços da reforma psiquiátrica incluem a implantação de serviços de saúde mental substitutivos à lógica asilar. Porém, internações em hospitais psiquiátricos, inclusive de crianças e adolescentes, continuam ocorrendo. Esse estudo buscou compreender os motivos de internação em um hospital psiquiátrico a partir da perspectiva da instituição e das crianças e adolescentes internados. Trata-se de pesquisa qualitativa, de abordagem hermenêutico-dialética, tendo sido feita a leitura de documentos institucionais, entrevistas abertas com oito adolescentes e observação participante. Os resultados indicaram que o motivo principal alegado pelo hospital psiquiátrico para internação foi nomeado como "agressividade", justificada pelo "risco para si e para outros", enquanto, para as crianças e os adolescentes, os motivos de internação eram múltiplos, incluindo uso de drogas, pequenas brigas e infrações. A análise indicou que os mecanismos para a internação pelo hospital psiquiátrico envolvem, durante a anamnese, uma leitura sobre o outro que o define como desviante de normas sociais e a posterior atribuição de um diagnóstico, avalizando a internação psiquiátrica. Também indicou que a sustentação e continuidade de internações psiquiátricas ocorrem em um circuito do controle operado entre diferentes instituições para tutela dos desviantes. Este estudo evidencia que, para evitar internações em hospitais psiquiátricos, além do fechamento destes, é preciso superar o paradigma psiquiátrico, sendo, para isso, necessárias as práticas de desinstitucionalização e na perspectiva da atenção psicossocial nos serviços de saúde mental abertos, territoriais e substitutivos.

Los avances de la reforma psiquiátrica incluyen la implantación de servicios de salud mental substitutivos a la lógica de los asilos, no obstante, los internamientos en hospitales psiquiátricos, incluidos los de niños y adolescentes, continúan ocurriendo. Este estudio buscó comprender los motivos de internamiento en un hospital psiquiátrico, a partir de la perspectiva de la institución, y de los niños y adolescentes internados. Se trata de una investigación cualitativa, de abordaje hermenéutico-dialéctico, habiéndose realizado la lectura de documentos institucionales, entrevistas abiertas con ocho adolescentes y observación participante. Los resultados indicaron que el motivo principal alegado por el hospital psiquiátrico para el internamiento fue denominado "agresividad", justificada por el "riesgo para sí mismos y para otros", mientras que para los niños y adolescentes los motivos de internamiento eran múltiples, incluyendo el uso de drogas, pequeñas peleas e infracciones. El análisis indicó que los mecanismos para el internamiento por el hospital psiquiátrico implican, durante la anamnesis, una lectura sobre lo que lo define como una conducta desviada respecto a normas sociales, y la posterior atribución de un diagnóstico, avalando el internamiento psiquiátrico. También indicó que el mantenimiento y continuidad de los internamientos psiquiátricos se producen en un circuito del control operado entre diferentes instituciones para la tutela de los que desvían de las normas sociales. Este estudio evidencia que, para evitar internamientos en hospitales psiquiátricos, además del cierre de los hospitales psiquiátricos, es necesaria la superación del paradigma psiquiátrico, siendo para eso necesarias prácticas de desinstitucionalización y desde la perspectiva de la atención psicosocial contar con servicios de salud mental abiertos, territoriales y substitutivos.

Are We Asking Too Much of the Health Sector? Exploring the Readiness of Brazilian Primary Healthcare to Respond to Domestic Violence Against Women.

BACKGROUND: There is growing recognition of the health sector's potential role in addressing domestic violence (DV) against women. Although Brazil has a comprehensive policy framework on violence against women (VAW), implementation has been slow and incomplete in primary healthcare (PHC), and little is known about the implementation challenges. This paper aims to assess the readiness of two PHC clinics in urban Brazil to integrate an intervention to strengthen their DV response. METHODS: We conducted 20 semi-structured interviews with health managers and health providers; a document analysis of VAW and DV policies from São Paulo and Brazil; and 2 structured facility observations. Data were analysed using thematic analysis. RESULTS: Findings from our readiness assessment revealed gaps in both current policy and practice needing to be addressed, particularly with regards to governance and leadership, health service organisation and health workforce. DV received less political recognition, being perceived as a lower priority compared to other health issues. Lack of clear guidance from the central and municipal levels emerged as a crucial factor that weakened DV policy implementation both by providers and managers. Furthermore, responses to DV lost visibility, as they were diluted within generic violence responses. The organizational structure of the PHC system in São Paulo, which prioritised the number of consultations and household visits as the main performance indicators, was an additional difficulty in legitimising healthcare providers' time to address DV. Individual-level challenges reported by providers included lack of time and knowledge of how to respond, as well as fears of dealing with DV. CONCLUSION: Assessing readiness is critical because it helps to evaluate what services and infrastructure are already in place, also identifying obstacles that may hinder adaptation and integration of an intervention to strengthen the response to DV before implementation.

Psychometric properties of a condition-specific PROM for the psychosocial consequences of Labelling hypertension by using Rasch analysis.

BACKGROUND: A previous qualitative assessment of the psychosocial consequences of labelling hypertension describes the diagnosis of hypertension as a labelling event with potential unintended negative long-term psychosocial consequences (labelling effects). Until now, the benefits of diagnosing hypertension have been far more reported than the harms. To obtain the net result of the preventive interventions for cardiovascular disease, such as diagnosing and treating mild hypertension, assessing benefits and harms in the most comprehensive way possible is necessary, including the psychosocial consequences of labelling. When measuring psychosocial consequences of labelling hypertension, a questionnaire with high content validity and adequate psychometric properties is needed. OBJECTIVES: The aim of this study was to describe the psychometric parameters of face and content-validated pool of items. Other objectives were also to screen the item pool by using Rasch model analysis and confirmatory factor analysis (CFA) for identifying such items with sufficient fit to the hypothesised models. METHODS: We surveyed the pool of items as a draft questionnaire to Brazilians recruited via social networks, sending e-mails, WhatsApp® messages and posting on Facebook®. The inclusion criteria were to be older than 18 years old, to be healthy and to have only hypertension. We used Rasch model analysis to screen the item pool, discarding items that did not fit the hypothesised domain. We searched for local dependence and differential item functioning. We used CFA to confirm the derived measurement models and complementarily assessed reliability using Cronbach's coefficient alpha. RESULTS: The validation sample consisted of 798 respondents. All 798 respondents completed Part I, whereas 285 (35.7%)-those with hypertension-completed Part II. A condition-specific questionnaire with high content validity and adequate psychometric properties was developed for people labelled with hypertension. This measure is called 'Consequences of Labelling Hypertension Questionnaire' and covers the psychosocial consequences of labelling hypertension in two parts, encompassing a total of 71 items in 15 subscales and 11 single items. CONCLUSION: We developed a tool that can be used in future research involving hypertension, especially in scenarios of screening, prevention, population strategies and in intervention studies. Future use and testing of the questionnaire may still be required.

Child and adolescent mental health policy: history and paths to participation. / Políticas públicas na atenção à saúde mental de crianças e adolescentes: percurso histórico e caminhos de participação.

People with mental disorders play an important role in the mental health reform process, which involves the creation of new public policies, practices, knowledge, and ways of relating to this experience. Using a guiding question addressing the history of child and adolescent mental health in Brazil and the participation of child and adolescent mental health service users in the policy construction process, a narrative literature review was undertaken framing the main policy developments and advances in this area within the overall context of the Brazilian mental health reform. A search of technical, institutional, and legal documents in the thematic area Mental Health was conducted using a national database. The material analyzed addressed milestones in child and adolescent mental healthcare, highlighting the paths taken in building this field. The article also discusses the participation of child and adolescent mental health service usersin this process in the form of a commentary. Finally, the article highlights the need to guarantee the participation of this group to enable them to play a leading role in the struggle for the construction and realization of rights.

Na reforma psiquiátrica brasileira, é importante a participação de pessoas com experiência de sofrimento psíquico enquanto atores sociais na construção desse processo, que envolve a criação de novas políticas públicas, práticas, saberes e modos de relação com essa experiência. A partir do questionamento acerca do percurso histórico específico da saúde mental infantojuvenil e da participação de crianças e adolescentes nesse processo, foi feita uma revisão narrativa da literatura que busca evidenciar os momentos principais dessa trajetória, no que concerne à produção de políticas públicas e legislações. A revisão consistiu na busca de documentos técnicos e institucionais da área temática da Saúde Mental em base de dados nacionais, além de documentos legais. O material analisado versou sobre um conjunto de marcos da atenção à saúde mental de crianças e adolescentes e a análise assinalou os caminhos trilhados na construção desse campo. Ainda, na perspectiva de um comentário, foi discutida a participação de crianças e adolescentes com sofrimento psíquico nesse processo. Este artigo destaca a necessidade de construir garantias concretas de participação dessa população, possibilitando que assumam o papel de protagonista na luta pela construção e garantia de direitos.

Development of an item pool for a questionnaire on the psychosocial consequences of hypertension labelling.

BACKGROUND: Hypertension is the most prevalent risk factor for cardiovascular disease globally. Roughly one-third of the adult population has hypertension. However, most people diagnosed with hypertension do not benefit from blood pressure control with pharmacologic interventions: they are overdiagnosed and overtreated and might experience negative psychosocial consequences of being labelled. These consequences are relevant outcomes that need to be assessed and validly measured to identify all benefits and harms related to interventions designed to prevent cardiovascular disease. OBJECTIVES: To develop a pool of items with high content validity for a draft version of a condition-specific questionnaire to measure the psychosocial consequences of being labelled with mild hypertension. METHODS: We selected relevant items from existing Consequences of Screening (COS) questionnaires. These items belonged to two groups: COS core items and potential condition-specific items. All items were originally in Danish and were translated into Brazilian Portuguese using the dual-panel method. Individual and group interviews were conducted with people with mild hypertension and low risk for cardiovascular disease, and were designed to test the translated items for face and content validity and were also used to generate new relevant items. Structured individual interviews were conducted to categorise all the items into domains. RESULTS: The Brazilian Portuguese dual-panel translation of both groups of items was found to be relevant for adults diagnosed with hypertension. We generated 52 new items to achieve high content validity. The result was a set of 132 items divided into 22 domains in 2 parts. Part I was directed at the general population, whereas part II was directed only at people diagnosed with hypertension and it consisted of 38 items in 8 domains. Twelve items remained as single items. High content validity was achieved with the pool of 132 items divided into 22 domains in 2 parts. DISCUSSION: High content validity was achieved for a condition-specific questionnaire measuring the psychosocial consequences of being labelled with mild hypertension. This instrument encompassed 132 items divided into 22 domains in 2 parts. Thereby, a draft of the Consequneces of Hypertension questionnaire (COH) was developed. The psychometric properties of this questionnaire will be discussed in a diferent paper.

[Health administrators and public policies to deal with gender violence against women in São Paulo, Brazil]. / Gestores de saúde e o enfrentamento da violência de gênero contra as mulheres: as políticas públicas e sua implementação em São Paulo, Brasil.

The study focuses on policies to deal with violence against women in the city of São Paulo, Brazil. The objectives were to map the public policies and the proposals for institutional organization of a network of comprehensive care, in addition to analyzing the implementation of these policies, highlighting the health sector, with reports by administrators and policymakers. The study addresses the relationship between management practice and the public policy provisions, the weight of administrators' personal values and perspectives, and the weight of the socially dominant discourse in decision-making for implementation of these policies. Data were produced through semi-structured interviews with 32 administrators working at different levels in the institutional organization of the Municipal Health Department, including some policymakers in the state and national scenarios. The body of data were submitted to thematic content analysis, examining each of the interviews and relating them to the literature and conceptual framework. The study concludes that health administrators, as agents of practices, are influenced by the prevailing structures and beliefs and reference to their social and historical context for decision-making. However, when they relate to such structures, they are also capable of intervening in the ways care is produced and provided for women in situations of violence, especially by addressing the training and awareness-raising processes and new references concerning recognition of women's rights as human rights.

Estudam-se as políticas de enfrentamento da violência contra as mulheres no Município de São Paulo, Brasil. Os objetivos foram mapear as políticas públicas e as propostas de organização institucional de uma rede de atenção integral, assim como conhecer suas implementações nos serviços, com destaque ao setor de saúde, pelos relatos de gestores e formuladores da política, trabalhando-se a relação da prática da gestão com o enunciado nas políticas públicas, o peso dos valores e da perspectiva pessoal dos gestores e o peso do discurso socialmente dominante nas tomadas de decisão para a implementação destas políticas. A produção dos dados foi realizada por intermédio de entrevistas semiestruturadas com 32 gestores operando em diferentes níveis da organização institucional da Secretaria Municipal da Saúde, dentre eles alguns formuladores das políticas nos cenários estadual e nacional. A análise desse córpus de dados foi temática de conteúdo, examinando-se cada uma das entrevistas e relacionando-as com a literatura e referencial conceitual utilizado. Conclui-se que os gestores, como agentes de práticas, são influenciados pelas estruturas e crenças vigentes, pela referência ao contexto sociohistórico a que estão inseridos para tomadas de decisão de gestão. Porém, são também capazes de, ao relacionar-se com tais estruturas, interferir nas formas de produzir e ofertar cuidado às mulheres em situação de violência, em especial ao aproximarem-se de processos de formação e sensibilização e de novos referenciais acerca do reconhecimento dos direitos das mulheres como direitos humanos.

En este trabajo se estudian las políticas de lucha frente la violencia contra las mujeres en el municipio de São Paulo, Brasil. Los objetivos fueron mapear las políticas públicas y las propuestas de organización institucional de una red de atención integral, así como conocer sus implementaciones en los servicios, destacando el sector de salud, por los relatos de gestores y formuladores de políticas, trabajando la relación de la práctica de gestión con el enunciado en las políticas públicas, el peso de valores y la perspectiva personal de los gestores, así como el peso del discurso socialmente dominante en las tomas de decisión para la implementación de estas políticas. La producción de datos se realizó mediante entrevistas semiestructuradas con 32 gestores operando en diferentes niveles de la organización institucional dentro de la Secretaría Municipal de Salud, entre ellos, algunos formuladores de las políticas en los escenarios estatal y nacional. El análisis de ese corpus de datos fue la temática de contenido, examinando cada una de las entrevistas y relacionándolas con la literatura y marco de referencia conceptual utilizado. Se concluye que los gestores, como agentes de prácticas, son influenciados por las estructuras y creencias vigentes, por la referencia al contexto sociohistórico en el que están insertados para las tomas de decisión en la gestión. No obstante, son también capaces de, al relacionarse con tales estructuras, interferir en las formas de producir y ofertar cuidado a las mujeres en situación de violencia, en especial al aproximarse a procesos de formación y sensibilización, así como nuevos marcos de referencia acerca del reconocimiento de los derechos de las mujeres como parte de los derechos humanos.

[The "tug of war" in healthcare: psychologists' conception and practice concerning Matrix-Based Support in the Center for Family Health Support]. / O "cabo de força" da assistência: concepção e prática de psicólogos sobre o Apoio Matricial no Núcleo de Apoio à Saúde da Família.

The current study analyzed the conception and practice of matrix-based support among psychologists working at the Center for Family Health Support (NASF in Portuguese) in the city of São Paulo, Brazil. A qualitative methodology was used with semi-structured interviews that were taped, transcribed, and submitted to thematic content analysis. The study revealed dilemmas between the work as prescribed and what is possible to achieve in practice, and between idealization of the collaborative proposal and its implementation. Exchanges of knowledge and training appear as the principal meanings in the matrix-based concept. The practice revealed a complex context with heterogeneous work organization, lack of linkage between management levels and tensions in the execution of shared work, such as unequal division of tasks, in with the family health teams take responsibility for direct care to the population, while the NASF occupies the role of training and supervising, thereby generating conflicts over responsibility for care and creating a context which is hardly conducive to comprehensive, shared, and collaborative care.

Análise das trajetórias assistenciais ofertadas às mulheres em situação de violência doméstica de gênero na Atenção Primária à Saúde

Objetivo: analisar a assistência prestada às mulheres em situação de violência doméstica de gênero em serviços de Atenção Primária à Saúde, no município de São Paulo, no Sistema Único de Saúde. Método: A análise se deu a partir de quatro fluxogramas analisadores construídos com base nas informações coletadas em prontuários, como das entrevistadas realizadas com quatro mulheres em situação de violência, e dos 13 profissionais de saúde envolvidos na assistência dessas mulheres, analisados sob a metodologia Análise de Conteúdo. Resultados: As narrativas mostram que as mulheres "desabafam" para os trabalhadores, principalmente para os Agentes Comunitárias de Saúde. A violência é frequente e reconhecida, mas se torna um problema para a equipe de saúde quando há o envolvimento de crianças, ou um pedido de ajuda direto das mulheres. A assistência ofertada se mostra como tentativa dos profissionais de saúde em "consertarem" o problema da violência, com tendência às práticas prescritivas, ofertas genéricas, sem agregar as escolhas e os caminhos considerados possíveis pelas mulheres. Conclusão: Apesar das barreiras, percebe-se a inclusão da rede de enfrentamento e a compreensão da violência como uma barreira para se viver a vida.

Controlling behaviours and technology-facilitated abuse perpetrated by men receiving substance use treatment in England and Brazil: Prevalence and risk factors.

INTRODUCTION AND AIMS: Controlling behaviours are highly prevalent forms of non-physical intimate partner violence (IPV). The prevalence of perpetrating controlling behaviours and technology-facilitated abuse (TFA) was compared by men receiving substance use treatment in England (n = 223) and Brazil (n = 280). Factors associated with perpetrating these behaviours towards their current/most recent partner and their association with other types of IPV were explored. DESIGN AND METHODS: Secondary analysis from two cross-sectional studies was performed. Data on socio-demographic characteristics, infidelity, IPV perpetration and victimisation, adverse childhood experiences (ACE), attitudes towards gender relations and roles, substance use, depressive symptoms and anger expression were collected. RESULTS: Sixty-four percent (143/223) and 33% (73/223) of participants in England and 65% (184/280) and 20% (57/280) in Brazil reported controlling behaviours and TFA, respectively, during their current/most recent relationship. Excluding IPV victimisation from the multivariate models; perpetrating controlling behaviours was associated with a higher number of ACE, higher anger expression (England) and severe physical IPV perpetration (Brazil), and perpetrating TFA was associated with younger age. Including both IPV victimisation and perpetration in the multivariate models; perpetrating controlling behaviour was associated with experiencing a higher number of ACE, higher anger expression (England), emotional IPV victimisation (England) and experiencing controlling behaviour from a partner (England). The perpetration of TFA was associated with younger age and experiencing TFA from a partner. CONCLUSIONS: Technological progress provides opportunities for perpetrators to control and abuse their partners. Controlling behaviours and TFA should be addressed to reduce IPV perpetration by males in substance use treatment. [Gilchrist G, Canfield M,Radcliffe P, d'Oliveira AFPL. Controlling behaviours and technology-facilitated abuse perpetrated by men receiving substance use treatment in England and Brazil: Prevalence and risk factors. Drug Alcohol Rev 2017;36:52-63].

[Contributions and challenges associated with bodily practices and meditation for health promotion in the public primary care system in the city of São Paulo, Brazil]. / Contribuições e desafios das práticas corporais e meditativas à promoção da saúde na rede pública de atenção primária do Município de São Paulo, Brasil.

The article presents an analysis of contributions and challenges associated with bodily practices and meditation for health promotion in the public primary care system. The qualitative study was developed in 16 healthcare units in the city of São Paulo, Brazil, using interviews with 29 health professionals and 36 practitioners of bodily practices and meditation, including participant observation of 31 practices such as Tai Chi, Lian Gong, Qigong, Yoga, Capoeira, Dance, Meditation, Relaxation, Mindfulness, and Body Awareness. There was an improvement in joint pain, mobility, balance, memory, depression, and anxiety, besides greater ease in coping with chronic conditions. Such contributions are related to favoring practitioners' autonomy, building health references through self-awareness; the combination of health promotion and therapeutic care in the approaches; and support for access to cultural goods and community spaces. The challenges identified here were precarious integration with the supply of other health services, lack of supervision and evaluation, and the predominance of a health-sector culture.

O artigo apresenta análise das contribuições e os desafios das práticas corporais e meditativas à promoção da saúde na rede pública de atenção primária. A pesquisa qualitativa foi desenvolvida em 16 unidades de saúde do Município de São Paulo, Brasil, por meio de entrevistas de 29 profissionais e 36 praticantes, e observação participante de 31 práticas, entre Tai Chi, Lian Gong, Qi Gong, Yoga, Capoeira, Danças, Meditação, Relaxamento, Consciência e Percepção Corporal. Houve melhora de dores articulares, mobilidade, equilíbrio, memória, depressão e ansiedade, e maior facilidade ao lidar com condições crônicas. Tais contribuições são relacionadas ao favorecimento da autonomia dos praticantes, pela construção de referências de saúde por intermédio do autoconhecimento; à união entre promoção e cuidado terapêutico nas abordagens; e ao apoio ao acesso a bens culturais e espaços de cidadania. Os desafios identificados são a precariedade na integração com as demais ofertas dos serviços de saúde, a carência de supervisão e avaliação, assim como o predomínio de uma cultura setorial na saúde.

El artículo presenta un análisis de las contribuciones y los desafíos de las prácticas corporales y meditativas a la promoción de la salud en la red pública de atención primaria. La investigación cualitativa se desarrolló en 16 unidades de salud del municipio de São Paulo, Brasil, mediante entrevistas de 29 profesionales y 36 practicantes, y una observación participante de 31 prácticas, entre Tai Chi, Lian Gong, Qi Gong, Yoga, Capoeira, Bailes, Meditación, Relajamiento, Consciencia y Percepción Corporal. Hubo una mejora de los dolores articulares, movilidad, equilibrio, memoria, depresión y ansiedad, y mayor facilidad al lidiar con condiciones crónicas. Tales contribuciones se relacionan con el favorecimiento de la autonomía de los practicantes, por la construcción de referencias de salud mediante el autoconocimiento; a la unión entre promoción y cuidado terapéutico en los enfoques; y el apoyo al acceso a bienes culturales y espacios de ciudadanía. Los desafíos identificados son la precariedad en la integración con las demás ofertas de los servicios de salud, la carencia de supervisión y evaluación, así como el predominio de una cultura sectorial en la salud.

Accounting for intimate partner violence perpetration. A cross-cultural comparison of English and Brazilian male substance users' explanations.

INTRODUCTION AND AIMS: This paper describes how substance use features in the accounts of intimate partner violence (IPV) perpetrators in treatment in England and Brazil. The aim of the research was to better understand cross cultural constructions of IPV perpetration amongst men in treatment for substance use. DESIGN AND METHODS: Semi-structured interviews were conducted with 40 men in community substance use treatment in Sao Paolo, Brazil and London and the South East of England who had reported IPV perpetration in a questionnaire survey. A thematic, narrative analysis was carried out of men's explanations for IPV perpetration. FINDINGS: Three types of narratives were distinguished: (i) disputes, centred on substance use, that escalate to IPV perpetration; (ii) IPV perpetration that is explained by uncharacteristic loss of control, as a result of intoxication; and (iii) IPV perpetration provoked by a perceived betrayal, in which substance use is incidental. In all types of accounts hegemonic principles of male and female roles and behaviour provided a context for and make IPV perpetration explicable. DISCUSSION AND CONCLUSIONS: Substance use and IPV are culturally constructed and contextually defined. Understanding the meaning-making of substance using IPV perpetrators has implications for the treatment of both substance abuse and IPV. [Radcliffe P, d'Oliveira AFPL, Lea S, dos Santos Figueiredo W, Gilchrist G. Accounting for intimate partner violence perpetration. A cross-cultural comparison of English and Brazilian male substance users' explanations. Drug Alcohol Rev 2017;36:64-71].

The prevalence and factors associated with ever perpetrating intimate partner violence by men receiving substance use treatment in Brazil and England: A cross-cultural comparison.

INTRODUCTION AND AIMS: Intimate partner violence (IPV) perpetration is common among men who use substances. Substance use is a contributing factor for IPV perpetration. This cross-sectional study determined lifetime prevalence and factors associated with ever perpetrating IPV by men receiving substance use treatment in Brazil (n = 281) and England (n = 223). DESIGN AND METHODS: IPV, adverse childhood experiences, attitudes towards gender relations and roles, current health state, substance use, depressive symptoms and anger expression were assessed. Logistic regression determined factors associated with ever perpetrating any (emotional, physical and/or sexual) IPV. Multinomial logistic regression determined factors associated with ever perpetrating different types of IPV. RESULTS: 74.6% (373/500) reported ever perpetrating IPV: 16.5% (82/498) emotional IPV only, 46.4% (231/498) physical IPV (with/without emotional IPV) and 11.6% (58/498) sexual IPV (with/without emotional and/or physical IPV). Higher anger expression, higher depressive symptoms, fighting physically with another man in the past year (Brazil only), experiencing a greater number of adverse childhood experiences and a higher hazardous drinking score (England only) predicted ever perpetrating IPV. Compared to never perpetrating any IPV, anger expression was associated with emotional and physical IPV perpetration; fighting physically with another man in the past year was associated with physical IPV perpetration and experiencing a greater number of adverse childhood experiences and a higher hazardous drinking score were associated with both physical and sexual IPV perpetration. DISCUSSION AND CONCLUSIONS: Integrated interventions that address IPV and substance use delivered in substance use treatment could improve outcomes for perpetrators and victims.[Gilchrist G, Radcliffe P, Noto AR, d'Oliveira AFPL. The prevalence and factors associated with ever perpetrating intimate partner violence by men receiving substance use treatment in Brazil and England: A cross-cultural comparison. Drug Alcohol Rev 2017;36:34-51].

Revista de Saúde Pública in scientific publications on Violence and Health (1967-2015).

This article retrieved the publications from the Revista de Saúde Pública journal (from 1967 to 2015) on violence and health, on the SciELO and PubMed bases, by searching for the terms "violence", "suicide", "aggression", "bullying", and "external causes", registered in any part of the text. We found 130 articles (the first one published in 1974). We observed: increase of publications over time, with decrease in the last five years; similar production volume in lethal and non-lethal violence; later publication of the latter; few studies in qualitative research; mostly descriptive production; and visualization of the problem more by the acts than by contexts or motivations and aggressors. Social markers were little approached, appearing, from largest to smallest frequency, social class, gender, race/ethnicity, and generation. Human rights were little used and only recently used as analytical framework, connected more to gender than to social class. Although Revista de Saúde Pública has registered the theme in its publications, consolidating it as scientific production line, there is still great explanatory theoretical rarefaction and little intersectionality between violence, social inequalities, and human rights. RESUMO A produção da Revista de Saúde Pública (de 1967 até 2015) sobre violência e saúde foi recuperada nas bases SciELO e PubMed utilizando-se os termos "violência", "suicídio", "agressões", "bullying" e "causas externas", registrados em qualquer parte do texto. Foram encontrados 130 artigos (o primeiro deles publicado em 1974). Constatou-se: aumento das publicações no tempo, com decréscimo nos últimos cinco anos; volume similar de produção em violência letal e não letal; publicação mais tardia desta última; poucos estudos em pesquisa qualitativa; produção majoritariamente descritiva; e visibilização do problema, mais pelos atos que pelos contextos ou motivações e agressores. Os marcadores sociais foram pouco tematizados, aparecendo da maior para a menor frequência, classe social, gênero, raça/etnia e geração. Direitos humanos foi pouco, e apenas recentemente, usado como referencial analítico, conectado mais ao gênero do que à classe social. Embora a Revista de Saúde Pública tenha inscrito o tema em suas publicações, consolidando-o como linha de produção científica, há, ainda, grande rarefação teórica explicativa e pouca interseccionalidade entre violência, desigualdades sociais e direitos humanos.

[Art, mental health, and public healthcare: profile of a care culture in the history of São Paulo city]. / Arte, saúde mental e atenção pública: traços de uma cultura de cuidado na história da cidade de São Paulo.

By studying the inclusion of artistic and cultural activities in the care provided throughout the history of public mental healthcare in greater São Paulo, Brazil, we can better understand and characterize the practices adopted in the Psychosocial Care Centers in the city today. Experiments carried out between the 1920s and 1990s are investigated, based on bibliographic research. The contemporary data were obtained from research undertaken at 126 workshops at 21 Psychosocial Care Centers in the same city between April 2007 and April 2008. The findings indicate that the current trend in mental healthcare, whose clinical perspective spans the realms of art and mental health and has territorial ramifications, has maintained some of the features encountered in earlier mental healthcare experiments.

Mudanças históricas na rede intersetorial de serviços voltados à violência contra a mulher - São Paulo, Brasil / Historical changes in the intersectoral network of services targeted at violence against women - São Paulo, Brazil / Cambios históricos en la red intersectorial de servicios enfocados en la violencia contra la mujer - São Paulo, Brasil

A violência contra a mulher ganhou espaço impulsionado, na agenda política, pelo movimento de mulheres com diversas políticas públicas voltadas para a assistência às mulheres. Analisam-se resultados de uma pesquisa no município de São Paulo, Brasil, com profissionais da rede de serviços intersetoriais especializados em relação às mudanças ocorridas com a Lei Maria da Penha. Os dados mostram que, apesar da ampliação dos serviços de assistência, defesa e proteção da mulher, há dificuldades para um trabalho integrado nas ações e na interação dos profissionais a fim de buscarem um projeto assistencial comum, fundamento considerado principal para atuação em rede. Conclui-se que a superação dessas dificuldades é um desafio no contexto político atual de sucateamento dos serviços e enfraquecimento das políticas públicas voltadas para os direitos das mulheres.(AU)

Violence against women has gained space in the political agenda, driven by the women's movement, with the making of public policies targeted at assistance for women. We analyze the results of a study carried out in the city of São Paulo, Brazil, with professionals from the specialized intersectoral services network, focusing on the changes that have occurred due to the Maria da Penha Law. Data show that, in spite of the expansion of the services that provide assistance, defense and protection for women, there are difficulties concerning integrated work in professionals' actions and interaction, which hinders the outline of a common assistance project - the most important principle for a networked action. The conclusion is that overcoming these difficulties is a challenge in the current political context of degeneration of the services and weakening of public policies targeted at women's rights.(AU)

La violencia contra la mujer ganó espacio impulsado, en la agenda política, por el movimiento de mujeres con diversas políticas públicas enfocadas en la asistencia a las mujeres. Se analizan resultados de una investigación en el municipio de São Paulo, Brasil, con profesionales de la red de servicios intersectoriales especializados en relación con los cambios habidos en función de la Ley Maria da Penha. Los datos muestran que, a pesar de la ampliación de los servicios de asistencia, defensa y protección de la mujer, hay dificultades para un trabajo integrado en las acciones y en la interacción de los profesionales para que busquen un proyecto asistencial común, fundamento considerado principal para la actuación en red. Se concluyó que la superación de estas dificultades constituye un desafío en el contexto político actual de desmantelamiento de los servicios y debilitación de las políticas públicas enfocadas en los derechos de las mujeres.(AU)

Obstáculos e facilitadores para o cuidado de mulheres em situação de violência doméstica na atenção primária em saúde: uma revisão sistemática / Obstáculos y facilitadores para el cuidado de mujeres en situación de violencia doméstica en la atención primaria de la salud: una revisión sistemática / Obstacles and facilitators to primary health care offered to women experiencing domestic violence: a systematic review

Trata-se de uma revisão sistemática da produção bibliográfica sobre obstáculos e facilitadores para o cuidado de mulheres em situação de violência doméstica na atenção primária à saúde (APS) no Brasil. O levantamento bibliográfico encontrou 1.048 referências. Analisamos 39 artigos, conforme critérios de inclusão e exclusão. A produção centrou-se em representações e crenças dos profissionais. Os principais obstáculos foram a constituição da violência doméstica contra a mulher (VDM) como questão do escopo da saúde, traduzida em dificuldades na identificação do problema e manejo no encontro assistencial, ausência de treinamento, trabalho em equipe, rede intersetorial, medo e falta de tempo. Os facilitadores focaram-se na introdução da perspectiva de gênero e direitos humanos, vínculo, acolhimento e trabalho em equipe e multisetorial. Apesar da potencialidade da APS para trabalhar com VDM, houve raros estudos que consideraram a perspectiva da gestão e financiamento, fundamental para a superação dos problemas apontados.(AU)

Revisión sistemática de la producción bibliográfica sobre obstáculos y facilitadores para el cuidado de mujeres en situación de violencia doméstica (VDM) en la atención primaria de la salud (APS) en Brasil. La revisión bibliográfica encontró 1.048 referencias. Analizamos 39 artículos, conforme criterios de inclusión y exclusión. La producción se concentró en representaciones y creencias de los profesionales. Los principales artículos fueron la constitución de la VDM como cuestión del alcance de la salud, traducida en dificultades en la identificación del problema y el manejo en el encuentro asistencial, ausencia de capacitación, trabajo en equipo, red intersectorial, miedo y falta de tiempo. Los facilitadores se enfocaron en la introducción de la perspectiva de género y derechos humanos, vínculo y acogida, trabajo en equipo y multisectorial. A pesar de la potencialidad de la APS para trabajar con VDM, fueron raros los estudios que consideraron la perspectiva de la gestión y financiación, fundamental para la superación de los problemas señalados.(AU)

Systematic review of the literature addressing obstacles and facilitators for the care of women, in situations of domestic violence (DV) in primary health care (PHC) in Brazil. The bibliographic review found 1,048 references. The analysis encompassed 39 articles complying with the inclusion and exclusion criteria. The material was centered on representations and beliefs of practitioners. The main obstacles were related to: conceptualizing DV as a health issue, resulting into difficulties to identify the problem and managing care encounters; lack of training and teamwork; scarce intersectoral network, fear and lack of time. The facilitators were mainly: introducing a gender and human rights perspective, bonding and embracement, teamwork and multisectoral work. Despite the potential of PHC to address the issue, few studies considered perspectives of management and financing, considered as key to overcome the problems pointed out.(AU)