Analysis of reported cases of sexual violence in Espírito Santo, southeastern Brazil, 2011-2018.

BACKGROUND: sexual violence includes all sexual acts consummated or attempt to obtain them, unwanted sexual comments and actions that go against the other's sexuality through coercion, which can be done through the use of physical force, psychological pressure, extortion or threat, this phenomenon appears in all life cycles. Identified the frequency and characteristics of sexual violence against women in a state in the southeastern region of Brazil. from 2011 to 2018. METHOD: this is a cross-sectional epidemiological study that evaluated all cases of sexual violence reported in Espírito Santo, present in the Information System of Diseases and Notifications of the Ministry of Health from 2011 to 2018. The analysis was based on performed in Stata 14.1. RESULTS: the prevalence of notification of sexual violence was 13.2% (CI95%: 12.8-13.5). Most victims were women (PR: 3.38), aged between 0 and 9 years (PR: 19), with a higher prevalence in people without disabilities or disorders (PR: 1.18) and residents of urban/periurban area (PR: 1.15). Men were the most frequent aggressors (PR: 13.79), with the most prevalent cases being reported by people unknown to the victim (PR: 6.01). The occurrence was 78% more reported at home and committed by an aggressor (PR:1.19). Most cases were repeated (PR:1.13). CONCLUSIONS: the notification of sexual violence in Espírito Santo was high and evidenced the vulnerability of some groups, as well as the profile of the perpetrators. It is necessary to work on training professionals in the areas of health and education in relation to the identification of cases of sexual violence, mainly due to the significant involvement of children and adolescents.

Lifelong robbery victimisation and mental disorders at age 18 years: Brazilian population-based study.

PURPOSE: Urban violence is a major problem in Brazil and may contribute to mental disorders among victims. The aim of this study was to assess the association between robbery victimisation and mental health disorders in late adolescence. METHODS: At age 18 years, 4106 participants in the 1993 Pelotas Birth Cohort Study were assessed. A questionnaire about history of robbery victimisation was administered, the Self-Report Questionnaire was used to screen for common mental disorders, and the Mini International Neuropsychiatric Interview was used to assess major depressive disorder and generalised anxiety disorder. Cross-sectional prevalence ratios between lifetime robbery victimisation and mental disorders were estimated using Poisson regression with robust standard errors, adjusting for socioeconomic variables measured at birth and violence in the home and maltreatment measured at age 15. RESULTS: There was a dose-response relationship between frequency of lifetime robberies and risk of mental disorders. Adolescents who had been robbed three or more times had twice the risk (PR 2.04; 95% CI 1.64-2.56) for common mental disorders, over four times the risk for depression (PR 4.59; 95% CI 2.60-8.12), and twice the risk for anxiety (PR 1.93; 95% CI 1.06-3.50), compared with non-victims, adjusting for covariates. Experiencing frequent robberies had greater impact on common mental disorders than experiencing an armed robbery. Population attributable fractions with regard to robbery were 9% for common mental disorders, 13% for depression, and 8% for anxiety. CONCLUSIONS: Robberies are associated with common mental disorders in late adolescence, independently of violence between family members. Reducing urban violence could significantly help in preventing common mental illnesses.

Violence against women and cervical cancer screening: a systematic review.

AIMS AND OBJECTIVES: To present a systematic review of papers published on the relationship between violence against women and cervical cancer screening. BACKGROUND: Violence against women is a serious public health problem. This phenomenon can have negative effects on victims' health and affect the frequency at which they receive cervical cancer screening. DESIGN: A systematic literature review. METHODS: This study was carried out in October 2015 with searches of the Lilacs, PubMed and Web of Science databases using the following keywords: violence, domestic violence, battered women, spouse abuse, Papanicolaou test, vaginal smears, early detection of cancer and cervix uteri. RESULTS: Eight papers published between 2002-2013 were included in this review, most of which were cross-sectional studies. Three studies found no association between victimisation and receiving Pap testing, and five studies reported an association. These contradictory results were due to higher or lower examination frequencies among the women who had experienced violence. CONCLUSION: The results of this study indicate that the association between violence against women and cervical cancer screening remains inconclusive, and they demonstrate the need for more detailed studies to help clarify this relationship. RELEVANCE TO CLINICAL PRACTICE: Professionals who aid women should be knowledgeable regarding the perception and detection of violence so that they can interrupt the cycle of aggression, which has harmful impacts on victims' health.

Quality assessment of a system of prenatal information. / Avaliação da qualidade de um sistema de informação de pré-natal.

Objective To evaluate the quality of the Prenatal Information System of the city of Vitoria - ES. Methods This is a cross-sectional study with an analysis of the Prenatal Information System Data (SISPRENATAL) from a municipality in the Southeast Region of Brazil. The quality of the system was evaluated according to the accessibility criteria, methodological clarity, timeliness and completeness defined by the Economic Commission for Latin America and the Caribbean (ECLAC). Completeness was evaluated according to the criteria of incompleteness proposed by Romero and Cunha, and assigned scores in degrees of evaluation for: excellent, good, fair, bad and very bad. Results Most of the results presented scores of bad and very bad quality. Fields with excellent or good quality for incompleteness are related to the mandatory items. Conclusion Professionals need to be aware of the proper registration of the care provided to pregnant women.

Hospitalizations for coronavirus disease 2019: an analysis of the occurrence waves.

The pandemic has been characterized by several waves defined by viral strains responsible for the predominance of infections. We aimed to analyze the mean length of hospital stay for patients with COVID-19 during the first three waves of the pandemic and its distribution according to sociodemographic and clinical variables. This retrospective study used the notifications of patients hospitalized for COVID-19 in a Brazilian state during the period of the three waves of the disease as the data source. There were 13,910 hospitalizations for confirmed COVID-19 cases. The first wave was the longest, with 4101 (29.5%) hospitalizations, while the third, although shorter, had a higher number of hospitalized patients (N = 6960). The average length of stay in the hospital in all waves was associated with age groups up to 60 years old., elementary, high school and higher education, residents of the periurban area Regarding the presence of comorbidities, there was a statistically significant difference in the mean number of days of hospitalization among patients with chronic cardiovascular disease and obesity (P < 0.001). In conclusion, the COVID-19 pandemic has been distinctly revealed among the waves.

Prevalence and factors associated with recurrent violence in a southeastern Brazilian state: Cross-sectional study.

Violence is a serious public health problem and its repetitive character points to a chronic phenomenon and its insertion in the daily lives of victims. To identify the frequency of repeat violence reported in adults in a Brazilian state and its association with the characteristics of the victim, the aggressor, and the aggression. This is an epidemiological cross-sectional study conducted with data from the notifications of violence recorded in the Notifiable Diseases Information System in Espírito Santo, Brazil from 2011 to 2018. Bivariate analysis was performed using Pearson Chi-Squared test and the multivariate Poisson regression, using a widely used hierarchical model, with the victim's characteristics in the first level and the aggressor's characteristics and the occurrence in the second level. In the multivariate analysis, the variables that obtained P  < .2 in the bivariate analysis were included in the model, keeping those with P  < .05. Data were expressed by prevalence ratio (PR), with confidence intervals of 95%. During the period, 9933 cases of violence were registered in the adult population, referring to 1061 notifications of male adults and 8872 notifications of female adults. The prevalence of repeat violence was 56.7% (95% CI: 56.0 - 57.5). It was more prevalent among women (PR: 1.73; 95% CI: 1.63 - 1.83), in the age groups over 40 years (PR: 1.12; 95% CI: 1.08 - 1.16), black and mixed-race ( P : 1.04; 95% CI: 1.01 - 1.07), and with a partner ( P : 1.09; 95% CI: 1.05 - 1.12). Victims with disabilities or disorders suffered 34% more from this problem (95% CI: 1.29 - 1.38) and lived in urban or peri-urban areas (PR: 1.16; 95% CI: 1.10 - 1.23). As for the aggressors, they were under 25 years of age (PR: 1.06; 95% CI: 1.02 - 1.11), of both sexes (PR: 1.32; 95% CI: 1.06 - 1.64), and were the victim's intimate partner (PR: 3.91; 95% CI: 3.25 - 4.71). The aggressions had only 1 perpetrator (PR: 1.17; 95% CI: 1.07 - 1.28) and occurred in the residence (PR: 1.33; 95% CI: 1.26 - 1.41). Repeat violence showed high frequency among notifications and was associated with characteristics of the victim, aggressor, and event. The results point to a phenomenon present in the daily life of communities that is potentially capable of negatively impacting the different areas of the subjects lives. Studies on the subject are important to understand the phenomenon and implement strategic actions to confront it.

Intimate partner violence against women during covid-19: A population-based study in Vitória, state of Espírito Santo, Brazil.

BACKGROUND: Violence against women has a negative impact on multiple dimensions of women's health. During the Covid-19 pandemic, intimate partner violence against women has continued, and in some contexts has intensified. The aim of this study was to identify the prevalence of intimate partner violence against women during covid-19 pandemic and its association with socioeconomic, behavioral, and life-experience factors. METHODS AND FINDINGS: Cross-sectional, population-based study conducted in the municipality of Vitória, state of Espírito Santo, from January to May 2022, where 1,086 women aged 18 years and over were interviewed. The World Health Organization (WHO) instrument on violence against women was used to screen outcomes. The prevalence of violence during the pandemic (psychological, physical, and sexual) and bivariate analysis with sociodemographic, behavioral, family, and life history characteristics of women were estimated. The multivariate analysis was carried out for each type of violence, the Poisson regression model was performed with an estimate of robust variance, inserting the variables of interest with (p<0.20). Those with p<0.05 remained in the adjusted model. RESULTS: The prevalence of violence psychological against women perpetrated by an intimate partner during the pandemic was the most frequent (20.2%), followed by physical (9.0%) and sexual violence (6.5%). Women with less schooling and who were single had a higher prevalence of physical and psychological violence, as did those with a history of sexual abuse in childhood and whose mothers had been beaten by their intimate partners. Sexual violence was more prevalent among non-white, with up to eight years of schooling, whose mothers had a history of intimate partner violence, and who consumed alcohol during four days or more (p<0.01). CONCLUSION: Psychological, physical, and sexual violence perpetrated by the intimate partner during the pandemic presented high magnitude among women living in Vitória. Sociodemographic, behavioral factors, and personal and maternal experiences of violence were associated with the phenomenon.

Completeness and quality of information about death from COVID-19 in a Brazilian state: A descriptive population-based register study.

Health information is particularly essential in times of pandemics in which rapid response is crucial for political and stakeholder decision-making processes, and therefore the availability of data as well as its quality analysis are necessary. This study aimed to describe the completeness and quality of the e-Sistema Único de Saúde (SUS) Health Surveillance database (SUS Vigilância em Saúde) of the state of Espírito Santo, Brazil, from the notification of deaths from corana virus disease 2019 (COVID-19) from January 2020 to June 2021. A descriptive population-based register study was conducted from the analysis of the completeness of secondary data from the record of deaths from COVID-19, retrieved from the e-SUS Vigilância em Saúde (Health Surveillance) (VS) database of the state of Espírito Santo, Brazil, from January 2020 to June 2021. A total of 11,359 death records from COVID-19 via e-SUS VS in the state of Espírito Santo, Brazil, were evaluated. The score used to assess incompleteness was the 1 proposed by Romero and Cunha which classifies as excellent (when < 5%), good (between 5% and 10%), regular (between 10% and 20%), poor (between 20% and 50%), and very poor (when > 50%), according to the percentage of the absence of information. Descriptive statistical analyses were conducted in the Stata program, version 15.1. "Case identification" variables, and "condition" variables were classified as excellent completeness. Among the evolution variables, only "hospitalization" was classified as regular. Among the laboratory variables, only the polymerase chain reaction presented excellent completeness, while the "rapid test" and "serologies for immunoglobulin G, and immunoglobulin M" variables were classified as good completeness. It is concluded that most of the variables available in e-SUS VS of the state of Espírito Santo, Brazil, of notification of deaths from COVID-19 in 2020 presented excellent completeness, confirming the excellent quality of the state database.

Prevalence and Factors Associated with Sexual Violence against Children in a Brazilian State.

Sexual violence is one of the forms of violence against children worldwide. Understanding its magnitude and its associated factors is essential to promote effective protection policies to childhood. The objective was to verify the prevalence and analyze the factors associated with sexual violence against children in a Brazilian state. This is a cross-sectional study analyzing data from reported cases of violence against children in the state of Espírito Santo, Brazil, between 2011 and 2018. The characteristics of the victim, perpetrator and aggression were studied, and the associations were analyzed using Poisson regression. The frequency of sexual violence was 41.8% and was more prevalent in girls, in the age groups 3 to 5 and 6 to 9 years old, in white ethnicity/color and in the urban area. The offenders were mainly men, known to the victim and occurred mainly in the residence. Sexual violence was the most reported violence among children in Espírito Santo, occurring within their circle of trust, demonstrating the need to provide support for families and to advance public policies to guarantee children's rights.

Intimate partner violence during pregnancy: a focus on partner characteristics. / Violência por parceiro íntimo na gestação: um enfoque sobre características do parceiro.

This study analyzes the association between violence against women during pregnancy and intimate partner socioeconomic and behavioral characteristics. We conducted an analytical cross-sectional study with 327 postpartum women admitted to a maternity hospital in a city in Espírito Santo, Brazil using a questionnaire to collect data on intimate partner socioeconomic and behavioral characteristics. Intimate partner violence was assessed using questions based on the World Health Organisation instrument "Violence against Women (WHO VAW STUDY)". Associations were tested using crude and adjusted Poisson regression. The prevalence of psychological violence during pregnancy was higher among women whose partners consumed alcohol, refused to use condoms, and were not the infant's biological father. Physical violence was associated with women whose partners did not work and refused to use condoms. The prevalence of sexual violence during pregnancy was more than nine times higher among women with partners who refused to use condoms. The findings demonstrate that antenatal care is an opportune time to approach partners about health care and address violence. It is necessary to promote the utilization of health services by men in order to address risk factors for violence during pregnancy.

Este estudo analisa a associação das violências contra a mulher durante a gestação segundo as características socioeconômicas e comportamentais do parceiro íntimo. Trata-se de um estudo transversal analítico em uma maternidade de um município do Espírito Santo com 327 puérperas, onde foram coletados dados sobre as características do parceiro íntimo. O instrumento da Organização Mundial da Saúde foi utilizado para rastrear a violência por parceiro íntimo na gestação. Foram obtidas as associações pela regressão de Poisson bruta e ajustada. Puérperas cujos parceiros consumiam bebida alcoólica, não eram os pais biológicos da criança e se recusavam a usar preservativo tiveram maior prevalência de violência psicológica na gestação. A violência física se associou às puérperas cujos parceiros não trabalhavam e se recusavam a usar preservativo. Puérperas com parceiros que se recusavam a usar preservativo tiveram prevalência nove vezes maior de sofrer violência sexual na gestação. Desse modo, o pré-natal se apresenta como um momento oportuno para abordar os parceiros quanto ao cuidado em saúde e enfrentamento à violência. É necessário ampliar o acolhimento dos homens pelos serviços de saúde para intervir nos fatores que favorecem a violência na gestação.

Prevalence and factors associated with the use of sleep-inducing medication among women receiving Primary Health Care: a cross-sectional study in Vitória, Espírito Santo, Brazil, 2014. / Prevalência e fatores associados ao uso de medicamento indutor do sono entre mulheres assistidas na Atenção Primária à Saúde: estudo transversal em Vitória, Espírito Santo, 2014.

OBJECTIVE: To verify prevalence and factors associated with the use of sleep-inducing medication among women receiving primary health care (PHC) in Vitória, ES, Brazil. METHODS: This was a cross-sectional study conducted in 2014 with women aged 20-59. We analyzed association of sleep-inducing medication use with socioeconomic factors and experiences of violence (Poisson regression). RESULTS: Out of 991 participants, 18.5% were using sleep-inducing medication and 45.9% had used it at some point in their lives. Current and lifetime use of these medications was associated with age, years of education, as well as psychological, physical and sexual violence in the last year (p-value<0.05). Lower family income (PR=1.30; 95%CI 1.03;1.64) and controlling partner (PR=1.35; 95%CI 1.08;1.69) were associated with current use, while experience of sexual violence in childhood (PR=1.33; 95%CI 1.13;1.56) was associated with lifetime use. CONCLUSION: Use of sleep-inducing medication was frequent among PHC service users, and was associated with socioeconomic factors and experiences of violence.

Sexual Violence against Adolescents in the State of Espírito Santo, Brazil: An Analysis of Reported Cases.

OBJECTIVE: We describe the prevalence of the reported cases of sexual violence against adolescents and analyze their associated factors. METHODS: A cross-sectional analytical study (n = 561) was conducted with reported data on sexual violence against adolescents in the state of Espírito Santo registered in SINAN between 2011 and 2018 to understand the prevalence and predictors of sexual violence against adolescent victims, as well as to describe the perpetrators and the nature of the aggression. Variables to characterize the victim, aggression, and perpetrator were used. Bivariate analyses were performed using chi-square (χ2) and Fisher's exact tests, and multivariate analyses were conducted using log-binomial models; the results were presented with prevalence ratios. All analyses were stratified by sex. RESULTS: The prevalence of sexual violence was 32.6%, and 93% of the victims were female. In both males and females, the reported sexual violence was associated with a younger age (10-12 years old), living at home, being related to the perpetrator, and a history of sexual violence. In females, the reported sexual violence was also associated with the number of perpetrators, and in males, with the perpetrator's age. CONCLUSIONS: Our findings show the high frequency of reporting of sexual violence and the characteristics of the victim, the aggression, and the aggressor as factors associated with its occurrence in both sexes. The importance of health information systems for disseminating data and the need for measures to prevent and treat the violence among adolescents is urgent.

Recurring violence against adolescents: an analysis of notifications. / Violência recorrente contra adolescentes: uma análise das notificações.

OBJECTIVE: to identify the frequency of reported cases of recurring violence against adolescents and their association with victim, violence, and aggressor characteristics. METHOD: cross-sectional study conducted with notified data on violence against adolescents, produced by Epidemiological Surveillance and registered in the Information System of Diseases and Notification (SINAN), from 2011 to 2018, in the state of Espírito Santo, Brazil. RESULTS: the frequency of recurring violence against adolescents was 46.4%. Higher occurrence was observed among girls (PR: 1.26; 95%CI: 1.15 - 1.38) between 10 and 14 years of age (PR: 1.20; 95%CI: 1.13 - 1.28), and people with a disability or disorder (PR: 1.52; 95%CI: 1.42 - 1.62). Psychological violence/neglect was 30% more prevalent in recurrence than self-harm. Most cases occurred at home (PR: 1.56; 95%CI: 1.37 - 1.77). Results showed a 1.11 times higher prevalence of recurring violence perpetrated by aggressors aged 20 years or older and higher evidence in male aggressors (95%CI: 0.97 - 1.17). CONCLUSION: recurring violence was associated with victim, aggressor, and event characteristics. Health intersectoriality is crucial to reduce cases of recurring violence.(1) Frequency of recurring violence against adolescents was 46.4%. (2) Higher recurrence was observed among girls between 10 and 14 years of age. (3) Most cases occurred at home. (4) Recurring violence was associated with victim, aggressor, and event characteristics. (5) Results show 1.11 times > prevalence of recurring violence perpetrated by men ≥ 20 years old.

Analysis of Survival of Patients Hospitalized with COVID-19 in Espírito Santo, Brazil.

Objective: To analyze the survival of patients hospitalized with COVID-19 and its associated factors. Methods: Retrospective study of survival analysis in individuals notified and hospitalized with COVID-19 in the state of Espírito Santo, Brazil. As data source, the reports of hospitalized patients in the period from 1 March 2020, to 31 July 2021 were used. The Cox regression analysis plus the proportional risk assessment (assumption) were used to compare hospitalization time until the occurrence of the event (death from COVID-19) associated with possible risk factors. Results: The sample comprised 9806 notifications of cases, with the occurrence of 1885 deaths from the disease (19.22%). The mean age of the group was 58 years (SD ± 18.3) and the mean hospital length of stay was 10.5 days (SD ± 11.8). The factors that presented a higher risk of death from COVID-19, associated with a lower survival rate, were non-work-related infection (HR = 4.33; p < 0.001), age group 60−79 years (HR: 1.62; p < 0.001) and 80 years or older (HR = 2.56; p < 0.001), presence of chronic cardiovascular disease (HR = 1.18; p = 0.028), chronic kidney disease (HR = 1.5; p = 0.004), smoking (HR = 1.41; p < 0.001), obesity (HR = 2.28; p < 0.001), neoplasms (HR = 1.81; p < 0.001) and chronic neurological disease (HR = 1.68; p < 0.001). Conclusion: It was concluded that non-work-related infection, age group above or equal to 60 years, presence of chronic cardiovascular disease, chronic kidney disease, chronic neurological disease, smoking, obesity and neoplasms were associated with a higher risk of death, and, therefore, a lower survival in Brazilian patients hospitalized with COVID-19. The identification of priority groups is crucial for Health Surveillance and can guide prevention, control, monitoring, and intervention strategies against the new coronavirus.

COVID-19 Mortality in Public Hospitals in a Brazilian State: An Analysis of the Three Waves of the Pandemic.

OBJECTIVE: To analyze COVID-19 deaths in public hospitals in a Brazilian state, stratified by the three waves of the pandemic, and to test their association with socio-clinical variables. METHODS: Observational analytical study, where 5436 deaths by COVID-19 occurred in hospitals of the public network of Espírito Santo, between 1 April 2020, and 31 August 2021, stratified by the three waves of the pandemic, were analyzed. For the bivariate analyses, the Pearson's chi-square, Fisher's Exact or Friedman's tests were performed depending on the Gaussian or non-Gaussian distribution of the data. For the relationship between time from diagnosis to death in each wave, quantile regression was used, and multinomial regression for multiple analyses. RESULTS: The mean time between diagnosis and death was 18.5 days in the first wave, 20.5 days in the second wave, and 21.4 days in the third wave. In the first wave, deaths in public hospitals were associated with the following variables: immunodeficiency, obesity, neoplasia, and origin. In the second wave, deaths were associated with education, O2 saturation < 95%, chronic neurological disease, and origin. In the third wave, deaths were associated with race/color, education, difficulty breathing, nasal or conjunctival congestion, irritability or confusion, adynamia or weakness, chronic cardiovascular disease, neoplasms, and diabetes mellitus. Origin was associated with the outcome in the three waves of the pandemic, in the same way that education was in the second and third waves (p < 0.05). CONCLUSION: The time interval between diagnosis and death can be impacted by several factors, such as: plasticity of the health system, improved clinical management of patients, and the start of vaccination at the end of January 2021, which covered the age group with the higher incidence of deaths. The deaths occurring in public hospitals were associated with socio-clinical characteristics.

Intimate Partner Violence against Mastectomized Women: Victims' Experiences.

Exposure to situations of domestic violence during the treatment for breast cancer may compromise the treatment and quality of life of women patients, so it is essential that health professionals act in tracking this phenomenon in the approach to and care of women with breast cancer. The purpose of this study was to examine experiences of violence against women by their intimate partners after mastectomy. This is an exploratory descriptive study, with a qualitative approach, carried out in the Rehabilitation Program for Mastectomized Women in a Brazilian reference hospital for oncological treatment. Semi-structured interviews were conducted with 16 mastectomized women. For data analysis, a content analysis technique was performed. The women interviewed were predominantly brown, with a minimum age of 44 years and maximum of 72 years. They presented with low education, were married, and had a mean period of five years of breast cancer diagnosis. The participants reported that after mastectomy, they experienced episodes of violence at a time when they were extremely vulnerable due to the various cancer treatments. Three major thematic categories emerged from interview data across the data collection: (1) experiences of psychological violence, (2) experiences of physical violence, and (3) experiences of sexual violence. Psychological violence took the form of humiliation and contempt for their condition. Physical violence involved assault and sexual violence in the form of forced sex by coercion. Violence was a phenomenon present after mastectomy, practiced in the domestic environment by the intimate partner. We emphasize the importance of health professionals in screening for this issue by listening to and welcoming women, recording cases, exposing this situation, and contributing to prevention.

Health Policies for Rare Disease Patients: A Scoping Review.

OBJECTIVE: To identify and map the available evidence on the implementation of public health policies directed at individuals with rare diseases, and to compare the implementation of these health policies between Brazil and other countries. METHOD: A scoping review guided by the PRISMA-ScR and JBI checklists. The search for articles was conducted in eight electronic databases, MEDLINE/Pubmed, Embase, Cochrane Library, Web of Science, Scopus, CINAHL, PsycINFO, and LILACS, using controlled descriptors, synonyms, and keywords combined with Boolean operators. All steps of this review were independently conducted by two researchers. The selected studies were classified by evidence hierarchy, and a generic quantitative tool was used for the assessment of the studies. RESULTS: A total of 473 studies were identified, of which 13 which met all the inclusion criteria were selected and analyzed. Of these studies, 61.5% (n = 8) had final scores equal to or greater than 70%, i.e., they were classified by this tool as being well-reported. The comparative analysis of international rare diseases demonstrates that public authorities' priorities and recommendations regarding this topic also permeate and apply to the Brazilian context. CONCLUSIONS: The evaluation and monitoring of public policies directed at rare disease patients are urgent and necessary to improve and implement such policies with less bureaucracy and more determination for this unique population that requires timely and high-quality care.

[Association between social capital and bullying among adolescents aged between 15 and 19: relations between the school and social environment]. / Associação entre capital social e bullying em adolescentes de 15 a 19 anos: relações entre o ambiente escolar e social.

The scope of this study was to analyze the association between social capital and bullying among adolescents aged 15 to 19 years, in high schools in the Greater Vitória Metropolitan Area in the State of Espírito Santo, Brazil. A cross-sectional epidemiological survey was carried out at the school base, with a sample of 2293 students, stratified by municipality of school location. Descriptive and inferential statistics were performed using two instruments: Integrated Questionnaire to Measure Social Capital of the World Bank and adapted versions of the Olweus Bully/Victim Questionnaire. The results showed that victims of bullying were more likely to present low level of cognitive social capital (p = 0.001; OR = 1.9, 95%CI = 1.29-2.68), underlying (p = 0.002; OR = 1.7, 95%CI = 1.20-2.38) and total (p < 0.001; OR = 1.80, 95%CI = 1.32-2.59). Bullying offenders were associated with low levels of cognitive social capital (p < 0.001; OR = 3.2, 95%CI = 2.34-4.44) and total (p = 0.042; OR = 1.7, 95%CI = 1.24-2.27). High levels of social capital are related to the reduction of bullying and victimization behaviors. Therefore, healthy social relationships should be promoted in the spaces of mutual coexistence of adolescents to stimulate other positive reactions in school environments.

O objetivo deste estudo foi analisar a associação entre capital social e bullying em adolescentes de 15 a 19 anos em escolas do ensino médio na Região Metropolitana da Grande Vitória, Espírito Santo, Brasil. Foi realizado um inquérito epidemiológico seccional de base escolar, com amostra formada por 2.293 estudantes, estratificada por município de localização escolar. Foram executadas estatísticas descritivas e inferenciais a partir de dois instrumentos: o "Questionário integrado para medir capital social do Banco Mundial" e o "Olweus bully/victim questionnaire", em versões adaptadas. Os resultados demostraram que as vítimas de bullying tiveram maiores chances de apresentar baixo nível de capital social cognitivo (p = 0,001; OR = 1,9; IC 95% = 1,29-2,68), subjacente (p = 0,002; OR = 1,7; IC 95% = 1,20-2,38) e total (p < 0,001; OR = 1,80; IC 95% = 1,32-2,59). Os agressores de bullying foram associados a baixos níveis de capital social cognitivo (p < 0,001; OR = 3,2; IC 95% = 2,34-4,44) e total (p = 0,042; OR = 1,7; IC 95% = 1,24-2,27). Elevados níveis de capital social estão relacionados à redução dos comportamentos de vitimização e de agressão por bullying. Portanto, deve-se promover relações sociais saudáveis nos espaços de convivência comum dos adolescentes para estimular outras reações positivas nos ambientes escolares.

Recurrent violence against children: analysis of cases notified between 2011 and 2018 in Espírito Santo state, Brazil. / Violência recorrente contra crianças: análise dos casos notificados entre 2011 e 2018 no Estado do Espírito Santo.

OBJECTIVE: To identify the frequency of reported cases and factors associated with recurrent childhood violence in Espírito Santo State, Brazil. METHODS: This was a cross-sectional study of cases notified on the Notifiable Health Conditions Information System between 2011-2018. Associations were tested using Pearson's Chi-Square test and Poisson Regression stratified by sex. RESULTS: The frequency of recurrent violence was 32.5%. In boys, it was associated with the child's age (PR=1.38 - 95%CI 1.11;1.73) and the aggressor's age (PR=1.85 - 95%CI 1.30;2.63) and occurrence at home (PR=1.61 - 95%CI 1.23;2.11); in girls, it was associated with age (PR=1.39 - 95%CI 1.20;1.60), presence of disabilities/disorders in the victim (PR=1.43 - 95%CI 1.22;1.67), abusive parents (PR=3.70 - 95%CI 1.65;8.32) and occurrence at home (PR=1.39 - 95%CI 1.10;1.75). CONCLUSION: Recurrent violence was present in almost one third of the reports of violence against children in Espírito Santo State, requiring the recognition of its associated factors for the development of prevention policies.

Physical violence and associated factors in participants of the National Student Health Survey (NSHS). / Violência física e fatores associados em participantes da Pesquisa Nacional de Saúde do Escolar (PeNSE).

The objective of this article was to analyze the association between physical violence in students with socioeconomic factors, family context, mental health, individual risky behaviors, and unsafe environment. Study with data from the National School Health Survey (NSHS) in 2015, with 9th graders. The outcome variable was the report of involvement in a physical struggle and the associated exposure variables used were related to socioeconomic and demographic conditions, family supervision and support, mental health, risky behaviors, and unsafe environment. Multivariate logistic regression with a hierarchical approach was used in the analyzes. The prevalence of involvement in a fight was higher in boys (30.2%; CI 29.3-31.0) than in girls (16.7%; CI 16.0-17.4). In both genders, there was a greater chance of involvement with physical violence when using drugs, missing classes, sedentary lifestyle, insomnia, loneliness and insecurity at school or in the community and, especially, when victimized by family aggression, OR 2.59 (CI 2.31-2.90) in boys and girls OR 2.42 (CI 2.17-2.71). There was a reduction in the chance of involvement in physical violence in boys because they were working and, in girls, when they study in a private school, having their problems and concerns welcomed by their parents or their participation in school activities.

O objetivo deste artigo foi analisar a associação entre a violência física em escolares com fatores socioeconômicos, contexto familiar, saúde mental, comportamentos individuais de risco e ambiente inseguro. Estudo com os dados da Pesquisa Nacional de Saúde Escolar (PeNSE), 2015, com alunos do 9o ano. A variável desfecho foi o relato de envolvimento em luta física e as variáveis de exposição associadas utilizadas foram relativas à condição socioeconômica e demográfica, supervisão e apoio familiar, saúde mental, comportamentos de risco e ambiente inseguro. Utilizou-se nas análises a regressão logística multivariada com abordagem hierarquizada. A prevalência de envolvimento em briga foi maior em meninos (30,2%; IC 29,3-31,0) comparada às meninas (16,7%; IC 16,0-17,4). Em ambos os sexos houve maior chance de envolvimento com violência física quando uso de drogas, falta às aulas, sedentarismo, insônia, solidão e insegurança na escola ou na comunidade e, principalmente, quando vítima de agressão familiar OR 2,59 (IC 2,31-2,90) em meninos e, em meninas OR 2,42 (IC 2,17-2,71). Houve redução da chance de envolvimento em violência física em meninos pelo fato de estarem trabalhando, em meninas, por estudarem em escola privada, e terem seus problemas e preocupações acolhidos pelos pais ou a participação destes nas atividades escolares.