Mental Health and Emotional Disorders During the COVID-19 Pandemics: Prevalence and Extent in PICU Staff.

OBJECTIVES: To assess the prevalence of burnout, anxiety and depression symptoms, and posttraumatic stress disorder (PTSD) in PICU workers in Brazil during the first peak of the COVID-19 pandemic. To compare the results of subgroups stratified by age, gender, professional category, health system, and previous mental health disorders. DESIGN: Multicenter, cross-sectional study using an electronic survey. SETTING: Twenty-nine public and private Brazilian PICUs. SUBJECTS: Multidisciplinary PICU workers. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Self-reported questionnaires were used to measure burnout (Maslach Burnout Inventory), anxiety and depression (Hospital Anxiety and Depression Scale), and PTSD (Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [PCL-5]) in 1,084 respondents. Subjects were mainly young (37.1 ± 8.4 yr old) and females (85%), with a median workload of 50 hours per week. The prevalence of anxiety and depression was 33% and 19%, respectively, whereas PTSD was 13%. The overall median burnout scores were high in the emotional exhaustion and personal accomplishment dimensions (16 [interquartile range (IQR), 8-24] and 40 [IQR, 33-44], respectively) whereas low in the depersonalization one (2 [IQR, 0-5]), suggesting a profile of overextended professionals, with a burnout prevalence of 24%. Professionals reporting prior mental health disorders had higher prevalence of burnout (30% vs 22%; p = 0.02), anxiety (51% vs 29%; p < 0.001), and depression symptoms (32.5% vs 15%; p < 0.001), with superior PCL-5 scores for PTSD ( p < 0.001). Public hospital workers presented more burnout (29% vs 18.6%, p < 0.001) and more PTSD levels (14.8% vs 10%, p = 0.03). Younger professionals were also more burned out ( p < 0.05 in all three dimensions). CONCLUSIONS: The prevalence of mental health disorders in Brazilian PICU workers during the first 2020 peak of COVID-19 was as high as those described in adult ICU workers. Some subgroups, particularly those reporting previous mental disorders and younger professionals, should receive special attention to prevent future crises.

Childhood sexual abuse, intimate partner violence during pregnancy, and posttraumatic stress symptoms following childbirth: a path analysis.

The aim of the study was to explore the pathways by which childhood sexual abuse (CSA), psychological and physical intimate partner violence (IPV) during pregnancy, and other covariates relate to each other and to posttraumatic stress disorder (PTSD) symptoms in the postpartum period. The sample comprised 456 women who gave birth at a maternity service for high-risk pregnancies in Rio de Janeiro, Brazil, interviewed at 6-8 weeks after birth. A path analysis was carried out to explore the postulated pathways between exposures and outcome. Trauma History Questionnaire, Conflict Tactics Scales and Posttraumatic Stress Disorder Checklist were used to assess information about exposures of main interest and outcome. The link between CSA and PTSD symptoms was mediated by history of trauma, psychiatric history, psychological IPV, and fear of childbirth during pregnancy. Physical IPV was directly associated with postnatal PTSD symptoms, whereas psychological IPV connection seemed to be partially mediated by physical abuse and fear of childbirth during pregnancy. The role of CSA, IPV, and other psychosocial characteristics on the occurrence of PTSD symptoms following childbirth as well as the intricate network of these events should be acknowledged in clinic and intervention approaches.

Intimate partner violence, common mental disorders and household food insecurity: an analysis using path analysis.

OBJECTIVE: To investigate the direct and indirect associations between psychological and physical intimate partner violence and the occurrence of common mental disorders (CMD) and how they relate to the occurrence of household food insecurity (HFI). DESIGN: This was a population-based cross-sectional study. Intimate partner violence was assessed using the Brazilian version of the Revised Conflict Tactics Scale (CTS2) and HFI was assessed using the Brazilian Food Insecurity Scale. The propositional analytical model was based on a review of the literature and was tested using path analysis. SETTING: Duque de Caxias, Greater Rio de Janeiro, Brazil (April-December 2010). SUBJECTS: Women (n 849) who had been in a relationship in the 12 months preceding the interview. RESULTS: Both psychological and physical violence were found to be major risk factors of HFI. Psychological violence was associated with HFI indirectly via physical violence and CMD, and directly by an unidentified path. The effects of physical violence seemed to be manifested exclusively through CMD. Most of the variables in the propositional model related to socio-economic position, demographic characteristics, degree of women's social support and partner alcohol misuse were retained in the 'final' model, indicating that these factors contribute significantly to the increased likelihood of HFI. CONCLUSIONS: The results reinforce the importance of considering domestic violence and other psychosocial aspects of family life when implementing interventions designed to reduce/eradicate HFI.

Impact of Intimate Partner Violence on Primary Health Care Use for Children: Evidences from Rio de Janeiro, Brazil.

Objectives To assess whether severe physical intimate partner violence (PIPV) after childbirth affects the number of pediatric visits in Primary Health Care (PHC) units during this period. Methods Cross-sectional study including 927 mothers of infants under 6 months, users of 27 PHC units in Rio de Janeiro, Brazil. PIPV from childbirth to the date of interview was measured using the Revised Conflict Tactics Scales (CTS2). The number of pediatric visits in the first 6 months of life was the outcome measure of interest. Poisson and multinomial regression models were used for data analysis to control for confounders. Results Children of mothers who experienced severe PIPV had a reduced number of pediatric visits than those not reporting it. This finding was identified only among children who had health problems: relative to five or more baseline pediatric visits, the chance of 3-4 and 1-2 visits increased three- and five-fold, respectively, when severe PIPV was present. Conclusions The maternal experience of severe PIPV reduces the number of pediatric visits in PHC services among the most vulnerable children. This is a hindrance to adequate health promotion, prevention and care, required for the healthy growth and development of children. Early violence detection by pediatricians and other health professionals could be a step in the right direction.

The role of intimate partner violence and other health-related social factors on postpartum common mental disorders: a survey-based structural equation modeling analysis.

BACKGROUND: Although studies suggest the relevance of intimate partner violence (IPV) and other health-related social characteristics as risk factors for postpartum mental health, literature lacks evidence about how these are effectively connected. This study thus aims to explore how socio-economic position, maternal age, household and marital arrangements, general stressors, alcohol misuse and illicit drug abuse, and especially psychological and physical IPV relate in a framework leading to postpartum common mental disorder (CMD). METHODS: The study was carried out in five primary health care units of Rio de Janeiro, Brazil, and included 810 randomly selected mothers of children up to five postpartum months waiting for pediatric visits. The postulated pathways between exposures and outcome were based on literature evidence and were further examined using structural equation models. RESULTS: Direct pathways to postpartum CMD arose from a latent variable depicting socio-economic position, a general stressors score, and both IPV variables. Notably, the effect of psychological IPV on postpartum CMD ran partly through physical IPV. The effect of teenage pregnancy, conjugal instability and maternal burden apparently happens solely through substance use, be it alcohol misuse, illicit drug abuse or both in tandem. Moreover, the effect of the latter on CMD seems to be entirely mediated through both types of IPV. CONCLUSION: Although the theoretical model underlying the analysis still requires in-depth detailing, results of this study may have shed some light on the role of both psychological and physical IPV as part of an intricate network of events leading to postpartum CMD. Health initiatives may want to make use of this knowledge when designing preventive and intervention approaches.

What have adolescents in Rio de Janeiro city, Brazil, done to reduce their community violence exposure? / O que os adolescentes do município do Rio de Janeiro, Brasil, têm feito para reduzir sua exposição à violência comunitária?

This study aims to identify the individual community strategies to avoid violence exposure most used by adolescents from public and private schools in the IX Administrative Region of Rio de Janeiro and investigate the profile of co-occurrence and its prevalence in specific population subgroups. This is a cross-sectional study with 693 individuals. A multidimensional questionnaire collected information regarding strategies to avoid community violence exposure and was self-completed in the classroom. The most used strategies were avoiding walking close to armed people (55.5%), avoiding walking alone (30.5%), and avoiding returning home at dawn (24.7%). Girls adopt more of all (concurrently) the four limiting behaviors to reduce their community violence exposure (53% vs. 32%). Notably, the adoption of such strategies differed by socioeconomic indicators and was higher among adolescents from lower-income households. These findings point to the high frequency of use of such strategies by adolescents, which may hinder and limit the full development of their social and cultural skills.

O objetivo do estudo é conhecer as estratégias individuais mais utilizadas por adolescentes de escolas públicas e privadas da IX Região Administrativa do município do Rio de Janeiro para evitar a exposição à violência comunitária, bem como investigar o perfil de coocorrência e sua prevalência em subgrupos populacionais específicos. Trata-se de um estudo seccional com 693 indivíduos. As informações referentes às estratégias para evitar a exposição à violência comunitária foram coletadas por meio de questionário multidimensional autopreenchido em sala de aula. As estratégias mais utilizadas foram: evitar passar onde há pessoas armadas (55,5%), evitar andar sozinho (30,5%) e evitar voltar para casa de madrugada (24,7%). Observou-se que as meninas adotam mais todos (concomitantemente) os quatro tipos de comportamento limitantes para reduzir sua exposição à violência comunitária (53% vs. 32%). Ressalta-se que a adoção de tais estratégias diferiu segundo os indicadores socioeconômicos, sendo maior entre os adolescentes oriundos de família de estratos de renda mais baixos. Tais achados chamam a atenção para a alta frequência de utilização de tais estratégias por adolescentes, o que pode cercear e limitar o pleno desenvolvimento de suas habilidades sociais e culturais.

Prevalence of alcohol use during pregnancy, Brazil, 2011-2012. / Prevalência de uso de álcool na gestação, Brasil, 2011-2012.

This is a national cross-sectional, hospital-based study, which interviewed 23,894 postpartum women in 2011-2012 aiming to estimate the prevalence of alcohol use during pregnancy and identifying more vulnerable groups. Alcohol use during pregnancy was identified using the TWEAK scale, and women with a score of ≥ 2 were classified as having a "presumable diagnosis of inadequate alcohol use". The national prevalence of alcohol use and the prevalence in subgroups were calculated according to maternal characteristics, with respective 95% confidence intervals (95%CI). Coexistence of smoking, inadequate prenatal consultations, and alcohol use during pregnancy were graphically identified. The prevalence of alcohol use was 14% (95%CI: 13.3-14.7), with 10% (95%CI: 9.3-10.6) of women presenting presumable diagnosis of inadequate alcohol us during pregnancy. Higher prevalence of alcohol use and presumable diagnosis of inadequate alcohol us was observed in black women, aged 12-19 years, with lower educational level, from a lower economic class, without a partner, without paid work, with more than three previous births, who did not want to get pregnant, with inadequate prenatal care, with previous delivery in public services, and who reported smoking during pregnancy. Among the interviewees, 1.2% presented all three risk factors for negative perinatal outcomes at the same time: smoking, alcohol use, and inadequate prenatal care. The results showed a high prevalence of alcohol use during pregnancy and presumable diagnosis of inadequate alcohol us, especially among women with worse social conditions. These data are relevant for the formulation of public policies to prevent alcohol use and provide support services to help this population stop alcohol use during pregnancy.

Estudo transversal, de base hospitalar, nacional, com entrevista de 23.894 puérperas, em 2011-2012, com os objetivos de estimar a prevalência de consumo de álcool na gestação e identificar grupos mais vulneráveis. O uso de álcool na gestação foi identificado por meio da escala TWEAK, sendo classificadas como "diagnóstico presumível de uso inadequado de álcool" mulheres com pontuação ≥ 2. Calculou-se a prevalência nacional de uso de álcool e em subgrupos de acordo com características maternas, com respectivos intervalos de 95% de confiança (IC95%). Foram encontradas, de forma gráfica, coexistência de tabagismo, inadequação de consultas pré-natais e ingestão de bebidas alcoólicas na gestação. A prevalência de uso de álcool foi de 14% (IC95%: 13,3-14,7), com 10% (IC95%: 9,3-10,6) das mulheres apresentando diagnóstico presumível de uso inadequado de álcool na gestação. Maiores prevalências de uso de álcool e de diagnóstico presumível de uso inadequado foram observadas em mulheres pretas, com 12-19 anos de idade, com menor índice de escolaridade, de classe econômica mais baixa, sem companheiro, sem trabalho remunerado, com mais de três partos anteriores, que não queriam engravidar, com assistência pré-natal inadequada, com parto em serviços públicos e que referiram tabagismo na gestação. Estima-se que 1,2% das mulheres entrevistadas apresentavam concomitância dos três fatores de risco para desfechos perinatais negativos: fumo, álcool e assistência pré-natal inadequada. Os resultados demonstraram alta prevalência de uso de álcool na gestação e de diagnóstico presumível de uso inadequado, principalmente por mulheres em situação de vulnerabilidade social. São relevantes a elaboração de políticas públicas que contemplem ações de prevenção do uso de bebidas alcoólicas e a prestação de serviços de apoio para cessação do uso de álcool na gravidez.

Estudio transversal, de base hospitalaria, nacional, con entrevistas a 23.894 puérperas, en 2011-2012, con el objetivo de estimar la prevalencia de consumo de alcohol durante el embarazo e identificar grupos más vulnerables. El consumo de alcohol durante el embarazo se identificó mediante la escala TWEAK, y las mujeres con puntuación ≥ 2 fueron clasificadas como "diagnóstico presumible de uso inadecuado de alcohol¨. Se calculó la prevalencia nacional de consumo de alcohol y subgrupos según características maternas, con sus respectivos intervalos de 95% de confianza (IC95%). Se identificó gráficamente la coexistencia de tabaquismo, consultas prenatales inadecuadas y consumo de alcohol durante el embarazo. La prevalencia de consumo de alcohol fue del 14% (IC95%: 13,3-14,7), siendo el 10% (IC95%: 9,3-10,6) de mujeres con diagnóstico presumible de uso inadecuado durante el embarazo. Se observaron mayores prevalencias de consumo de alcohol y diagnóstico presumible de uso inadecuado en mujeres de color/raza negra, de 12-19 años, con menos años de escolaridad, de clase económica más baja, sin pareja, sin trabajo remunerado, con más de tres partos previos, que no querían quedar embarazadas, con control prenatal inadecuado, con parto en el sistema público de salud y que relataron fumar durante el embarazo. Se estima que el 1,2% de las mujeres entrevistadas presentaron la concomitancia de tres factores de riesgo en resultados perinatales negativos: tabaquismo, alcohol y atención prenatal inadecuada. Los resultados demuestran una alta prevalencia de consumo de alcohol durante el embarazo y de diagnóstico presumible de uso inadecuado, especialmente en mujeres con las peores condiciones sociales, siendo relevante para la elaboración de políticas públicas que incluyan acciones de prevención del consumo de alcohol y servicios de apoyo para el cese del consumo de alcohol en el embarazo.

Characterization and completeness of notification sheet of violence against the older adults in Niterói-RJ, 2011-2020.

OBJECTIVE: to analyze the profile of violence against the elderly and the degree of completeness of event notification forms in Niterói, Rio de Janeiro, Brazil. METHODS: this was a descriptive study having as its data source violence notification forms held on the Notifiable Health Conditions Information System for the period 2011-2020; analysis of form completeness was performed according to criteria proposed by the Ministry of Health. RESULTS: of the 486 registered cases, physical violence was the most reported type of violence (48.1%), followed by psychological violence (22.2%) and self-harm (21.4%); the fields with the highest degree of incompleteness were victim's level of schooling (32.8%) and repeat violence (41.5%). CONCLUSION: despite the increase in notifications in the period, predominantly of physical violence, completeness of some of the form fields continues to be poor, which reinforces the importance of training professionals to improve the reporting process and data quality.

Violence and injuries in Brazil: the effect, progress made, and challenges ahead.

Although there are signs of decline, homicides and traffic-related injuries and deaths in Brazil account for almost two-thirds of all deaths from external causes. In 2007, the homicide rate was 26·8 per 100,000 people and traffic-related mortality was 23·5 per 100,000. Domestic violence might not lead to as many deaths, but its share of violence-related morbidity is large. These are important public health problems that lead to enormous individual and collective costs. Young, black, and poor men are the main victims and perpetrators of community violence, whereas poor black women and children are the main victims of domestic violence. Regional differentials are also substantial. Besides the sociocultural determinants, much of the violence in Brazil has been associated with the misuse of alcohol and illicit drugs, and the wide availability of firearms. The high traffic-related morbidity and mortality in Brazil have been linked to the chosen model for the transport system that has given priority to roads and private-car use without offering adequate infrastructure. The system is often poorly equipped to deal with violations of traffic rules. In response to the major problems of violence and injuries, Brazil has greatly advanced in terms of legislation and action plans. The main challenge is to assess these advances to identify, extend, integrate, and continue the successful ones.

Structural validity of the Conflict in Adolescent Dating Relationships Inventory (CADRI): A reduced version for use on respondents as victims and perpetrators.

OBJECTIVES: To evaluate CADRI's configural and metric structures and explore its performance from the perspective of the respondents as perpetrators and victims. In the process, we present shorter versions for both roles. METHODS: The sample consisted of 561 adolescents aged 15 and 19, enrolled in public and private schools in Rio de Janeiro, Brazil. Initially, confirmatory factor analyzes (CFA) tested the originally proposed dimensional structure. Since this model was rejected, the second step analyzed the data via Exploratory Structural Equation Models (ESEM) to reassess the instrument's structure. Applying a decision algorithm on a new dimensional structure, we proceeded to reduce the number of items to establish separate sets for victimization and perpetration. These final models were then analyzed via CFA to assess their psychometric properties. RESULTS: The final solutions contained 15 items comprising four and three factors for victimization and perpetration, respectively. Thirteen items were common to both models, but two were unique to their respective sets. Regardless of their small differences, the final solutions fitted adequately, held factorial item pertinence and unambiguity, contained reliable and non-redundant items, and sustained factor-based convergent and discriminant validities. CONCLUSION: The four and three-factor models were within the dimensional bounds proposed in the original CADRI, the shorter scales still succeeding in partially capturing what was envisaged in the first version of the instrument. However, the shorter versions suggested here are still tentative, thus requiring further examination.

Social vulnerabilities and sexual initiation of 10- to 14-year-old pupils in the city of Rio de Janeiro, Brazil. / Vulnerabilidades sociais e iniciação sexual entre 10 e 14 anos em estudantes do município do Rio de Janeiro, Brasil.

This study aimed to estimate the prevalence of sexual initiation of pupils aged 10 to 14 who attended the second year of public and private high school in the IX Administrative Region of the city of Rio de Janeiro, Brazil and to identify the most vulnerable subgroups. The sample consisted of 694 pupils who were selected through cluster-based and stratified sampling by considering school type (public or private) and course type (daytime or evening). Information was collected by means of a structured self-administered questionnaire. The chi-square test (χ2) and 95% confidence intervals were used to assess the heterogeneity of proportions among subgroups. The prevalence of the event was 18.4%; it was higher in boys, in subgroups of greater social vulnerability, among those who hooked up/dated up to 14 years of age, in victims of sexual violence in affective-sexual relationships and in pupils showing health risk behaviors. The high rate of sexual initiation in early adolescence, especially in more vulnerable groups, shows that the situation must be understood and addressed by means of intersectoral public policies that take into account a social context of multiple needs rather than reproductive health alone.

O objetivo do estudo foi estimar a prevalência de iniciação sexual entre 10 e 14 anos, em estudantes do segundo ano do ensino médio da rede pública e privada da IX RA do município de Rio de Janeiro-RJ, e identificar subgrupos mais vulneráveis à situação. A amostra foi composta por 694 estudantes, selecionados através de uma amostragem por conglomerados e estratificada por turno de aula e características administrativa da escola. As informações foram coletadas através de questionário estruturado de autopreenchimento. Intervalos de confiança a 95% e o teste Qui-Quadrado (χ2) foram usados para avaliar a heterogeneidade das proporções entre subgrupos. A prevalência do evento foi 18,4%, sendo maior: em meninos; em subgrupos de maior vulnerabilidade social; entre os que ficaram/namoraram até 14 anos; os que foram vítimas de violência sexual em relacionamentos afetivo-sexuais; e os que apresentaram comportamentos de riscos à saúde. A alta frequência de iniciação sexual na adolescência precoce, especialmente em grupos mais vulneráveis, evidencia que a situação deve ser compreendida e enfrentada com políticas públicas intersetoriais que leve em consideração um contexto social de múltiplas carências e não apenas à saúde reprodutiva.

The Role of Income on the Relationship Between the Brazilian Cash Transfer Program (Programa Bolsa Família) and Intimate Partner Violence: Evidence From a Multigroup Path Analysis.

Several initiatives are being proposed to reduce the incidence of intimate partner violence (IPV) worldwide. Actions aimed at women's economic empowerment through income transfer programs are one of those. Still, the literature on their impact is scarce and controversial. This study attempts to shed some light on this matter assessing whether the Brazilian Conditional Cash Transfer Program (Programa Bolsa Família [PBF]) is a protective factor for psychological and physical IPV against women in families of different levels of income. This is a cross-sectional, household-based study conducted in the city of Duque de Caxias, Rio de Janeiro, Brazil. The sample comprised 807 women reporting some intimate relationship in the 12 months before the interview. Information on IPV and participation on PBF were collected through face-to-face interviews using the Revised Conflict Tactics Scales (CTS2) and a direct question, respectively. A multigroup path analysis was applied to study the relations between PBF and psychological and physical IPV, considering confounding factors, some mediators, and moderation by income. The prevalence of both psychological and physical IPV are high, be it in the poverty and the extreme poverty income strata (psychological IPV: 66.2% and 72.7%, respectively; physical IPV: 26.2% and 40.6%, respectively). Results also showed a positive and direct association between PBF and psychological violence, yet only among families above the poverty line (ß = .287, p = .001). The same could be found regarding physical violence, but the effect of PBF was indirect, mediated by psychological violence (ß = .220, p = .003). Findings suggest that actions aimed at preventing IPV should go hand in hand with the PBF and, perhaps, other income transfer programs. This is even more relevant in relation to the less extreme poverty group where cash transfer may further raise conflicts and violence.

Prevalence and co-occurrence of Adverse Childhood Experiences: a school-based survey in Rio de Janeiro. / Prevalência e coocorrência de Experiências Adversas na Infância: um inquérito de base escolar no município do Rio de Janeiro.

This study aimed to estimate the prevalence of categories of adverse childhood experiences (ACE) among high school students in Rio de Janeiro, investigate the ACE co-occurrence profile, and examine the distribution of exposure to ACE according to individual, family, socioeconomic, and school characteristics. A cross-sectional study was conducted with 681 individuals selected using a complex random sampling design. Exposure to ACE categories was identified using a cross-culturally adapted version of the Childhood Trauma Questionnaire (CTQ) and direct questions. We calculated prevalence and correlation between ACE pairs and determined the co-occurrence profile of childhood adversities. The findings reveal that the most common adversities were emotional abuse and neglect and biparental family dissolution. Seventy percent of the sample reported having been exposed to at least one ACE and 9% had been exposed to four or more. Around 20% of respondents reported exposure to abuse and neglect and 9% to the co-occurrence of abuse, neglect, and absence of at least one parent during childhood. The most vulnerable subgroups were girls and respondents who were born to teenage mothers, not living with both parents, studying at public schools, and from low-income families. The high prevalence and co-occurrence profile of ACE reveals the need for wide-ranging intersectoral policies designed to prevent adverse childhood experiences and provide victim support.

Este estudo tem como objetivos estimar a prevalência de Experiências Adversas na Infância (EAI), investigar o seu perfil de coocorrência e sua distribuição de acordo com características individuais, familiares, socioeconômicas e escolares de adolescentes de escolas públicas e privadas de uma Região Administrativa do Rio de Janeiro. Trata-se de um estudo seccional com 681 indivíduos, selecionados através de amostragem aleatória complexa. As EAI foram identificadas através do questionário QUESI e perguntas diretas. Estimou-se as prevalências e a correlação entre pares das EAI e o perfil de coocorrência das EAI. Os resultados revelaram que abuso e negligência emocionais e dissolução da família biparental foram as adversidades mais comuns. Setenta por cento da amostra sofreu pelo menos uma EAI e 9%, quatro ou mais. Cerca de 20% vivenciou abuso e negligência e 9% a coocorrência de abuso, negligência e ausência de pelo menos um genitor durante a infância. Os subgrupos mais vulneráveis foram: meninas, filhos de mães adolescentes, os que não moravam com ambos os pais, os de escola pública e os de baixa renda. As altas prevalências e o perfil de coocorrência das adversidades sugerem que as políticas voltadas à prevenção e ao acolhimento de vítimas sejam abrangentes e multissetoriais.

[Distribution of scientific capital among tenured professors in the Social and Human Sciences and Epidemiology in the Collective Health field]. / Distribuição dos capitais científicos entre docentes permanentes de Ciências Sociais e Humanas e de Epidemiologia do campo da Saúde Coletiva.

Scientific capital in the Collective Health field has been organized in three subfields: Epidemiology; Policy, Planning, and Management; and Social and Human Sciences. Based on Bourdieu's field theory as the sociological reference, the study analyzed the distribution of a set of scientific capital between two of these groups of scientific agents. The data were extracted from the Lattes database of resumés for 191 tenured faculty members of Graduate Studies Programs in Collective Health assessed as excellent by the Brazilian Graduate Studies Coordinating Board (CAPES), of which 38 were in the Social and Human Sciences and 153 in Epidemiology, all consolidated in an Excel database. The dimensions analyzed were inherited or acquired capital; academic capital; political or economic power capital; university power capital; scientific prestige capital; and intellectual notoriety capital. The results presented a profile of the study population in relation to the various forms of capital, as well as a stratified analysis of these forms of capital considering the two groups and a multiple correspondence analysis. The two groups present similar distribution in most of the forms of capital, shaping a group with major scientific prestige. The exception is precisely in publication and citation, considered central forms of capital for measuring high prestige and recognition. The numerical predominance of Epidemiology may also allow greater occupation of decision-making spheres for measuring prestige. The conclusion is that the field's balance occurs in the affirmation of otherness, allowing distinct forms of capital to have more outstanding space in the measurement of scientific prestige.

A Saúde Coletiva tem se organizado a partir de três subcampos disciplinares: Epidemiologia; Política, Planejamento e Gestão e Ciências Sociais e Humanas. A partir do referencial sociológico da teoria dos campos de Bourdieu, analisou-se a distribuição de um conjunto de capitais científicos entre dois desses grupos de agentes científicos. Os dados foram extraídos do currículo Lattes de 191 docentes que fazem parte do corpo permanente dos Programas de Pós-graduação em Saúde Coletiva avaliados como de excelência pela Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), sendo 38 das Ciências Sociais e Humanas e 153 da Epidemiologia, sendo consolidados em um banco de dados em Excel. As dimensões analisadas foram: capital herdado ou adquirido, capital escolar, capital de poder político ou econômico, capital de poder universitário, capital de prestígio científico e capital de notoriedade intelectual. Apresentou-se o perfil da população de estudo com relação aos capitais estudados, assim como uma análise estratificada destes capitais considerando os dois grupos, além de uma análise de correspondência múltipla. Os dois grupos apresentam distribuição semelhante na maioria dos capitais, conformando um grupo de grande prestígio científico. A exceção se dá justamente nos capitais de publicação e citação, considerados centrais para a aferição de maior prestígio e reconhecimento. A predominância numérica da Epidemiologia também pode possibilitar maior ocupação nas instâncias decisórias de aferição de prestígio. Conclui-se que equilíbrio do campo se dá na afirmação da alteridade, permitindo que distintos capitais tenham espaço mais destacado na aferição de prestígio científico.

La Salud Colectiva se ha organizado a partir de tres subáreas disciplinarias: Epidemiología; Política, Planificación y Gestión; y Ciencias Sociales y Humanas. A partir del marco de referencia sociológico de la teoría de los campos de Bourdieu, se analizó la distribución de un conjunto de capitales científicos entre dos de esos grupos de agentes científicos. Los datos se extrajeron del currículo Lattes, compuesto por 191 docentes que forman parte del cuerpo permanente de los Programas de Posgrado en Salud Colectiva, evaluados como de excelencia por la Coordinación de Perfeccionamiento de Personal de Nivel Superior (CAPES), siendo 38 de Ciencias Sociales y Humanas y 153 de Epidemiología , registrando la información en un banco de datos en Excel. Las dimensiones analizadas fueron: capital heredado o adquirido, capital escolar, capital de poder político o económico, capital de poder universitario, capital de prestigio científico y capital de notoriedad intelectual. Se presentó el perfil de la población de estudio, en relación con los capitales estudiados, así como un análisis estratificado de estos capitales, considerando los dos grupos, además de un análisis de correspondencia múltiple. Los dos grupos presentan una distribución semejante en la mayoría de los capitales, constituyendo un grupo de gran prestigio científico. La excepción se produce justamente en los capitales de publicación y citación, considerados centrales para la evaluación de un mayor prestigio y reconocimiento. La predominancia numérica de la Epidemiología también puede posibilitar una mayor ocupación en las instancias decisorias de evaluación de prestigio. Se concluye que el equilibrio de esta área se produce en la afirmación de la alteridad, permitiendo que distintos capitales tengan un espacio más destacado en la evaluación del prestigio científico.

Sexual diversity in schools: a qualitative study with high school students in the Municipality of Rio de Janeiro, Brazil. / Diversidade sexual na escola: estudo qualitativo com estudantes do Ensino Médio do Município do Rio de Janeiro, Brasil.

LGBTphobia constitutes a context of vulnerability to the health of individuals whose sexuality is diverse from the heteronormative pattern, named sexual minorities, especially in adolescence, a period of sexual identities definition. The aim of this study was to analyze how did high school students perceive their peers of sexual minorities and how they understand the school's and educators' attitude regarding sexual diversity. The research used the qualitative method, with 13 focal groups comprising 132 students of both sexes, from public and private schools in the Municipality of Rio de Janeiro, Brazil. The data analysis was performed with the support of webQDA software in a comprehensive basis approach. Data were classified in two categories. In the first category, the students and sexual diversity, the participants perceived sexual diversity as normal because it is common and often present in their age. However, they confirmed homophobic attitudes against those whose gender behavior is not in accordance with what is expected for their biological sex. In the second category, the school and sexual diversity, the students recognized the adoption of discriminatory measures against same-sex couples by the school coordination and the absence of the theme of sexual diversity in educational activities. The outcomes indicate that sexual education policies are not sufficient to guarantee the human rights of sexual minorities and this represents greater health vulnerability of this population strata.

A LGBTfobia se configura como contexto de vulnerabilidade à saúde das pessoas cuja sexualidade é diversa do padrão heteronormativo, denominadas minorias sexuais, principalmente na adolescência, período de definição das identidades sexuais. O objetivo deste estudo foi analisar como estudantes do Ensino Médio percebem seus pares das minorias sexuais e como entendem a atitude da escola e educadores frente à diversidade sexual. O método utilizado foi qualitativo por meio de 13 grupos focais com 132 estudantes de ambos os sexos, de escolas públicas e privadas de Município do Rio de Janeiro, Brasil. A análise dos dados foi realizada com apoio do software webQDA, em uma abordagem de base compreensiva, e os dados classificados em duas categorias. Na primeira, denominada "os estudantes e a diversidade sexual", os participantes percebem a diversidade sexual como normal, pois é comum e se apresenta frequentemente na idade deles. Contudo, confirmaram atitudes homofóbicas contra aqueles cujo comportamento de gênero não está de acordo com o esperado para seu sexo biológico. Na segunda categoria, "a escola e a diversidade sexual", os estudantes reconhecem a adoção de medidas discriminatórias contra casais homoafetivos por parte da coordenação escolar e a ausência do tema diversidade sexual nas atividades educativas. Os resultados indicam que as políticas de educação sexual são insuficientes para a garantia dos direitos humanos das minorias sexuais, o que representa maior vulnerabilidade à saúde desse estrato populacional.

La LGBTfobia se conforma como un contexto de vulnerabilidad para la salud de las personas cuya sexualidad es diferente respecto al patrón heteronormativo, denominadas minorías sexuales, principalmente en la adolescencia, período de definición de las identidades sexuales. El objetivo de este estudio fue analizar cómo estudiantes de enseñanza media perciben a sus compañeros de minorías sexuales, y cómo entienden la actitud de la escuela, así como la de los educadores, frente a la diversidad sexual. El método utilizado fue cualitativo, mediante 13 grupos focales con 132 estudiantes de ambos sexos, de escuelas públicas y privadas del Municipio de Río de Janeiro, Brasil. El análisis de los datos se realizó con el apoyo del software webQDA, en un abordaje de base comprensivo y clasificados en dos categorías. En la primera, denominada estudiantes y diversidad sexual, los participantes perciben la diversidad sexual como normal, puesto que es común y se presenta frecuentemente en su edad. No obstante, confirmaron actitudes homofóbicas contra quienes cuyo comportamiento de género no está de acuerdo con lo esperado para su sexo biológico. En la segunda categoría, escuela y diversidad sexual, los estudiantes reconocen la adopción de medidas discriminatorias contra parejas homoafectivas por parte de la coordinación escolar y la ausencia del tema diversidad sexual en las actividades educativas. Los resultados indican que las políticas de educación sexual son insuficientes para la garantía de los derechos humanos de las minorías sexuales, lo que representa una mayor vulnerabilidad para la salud de ese estrato poblacional.

Teen-dating violence: conception of adolescents in a Brazilian metropolis.

BACKGROUND: Teen-dating violence (TDV) can lead to health problems for those involved, especially females, including homicides and is predictive of intimate partner violence in adulthood. METHODS: To analyze the adolescents' perception of definitions, justifications and consequences of TDV, a qualitative study through 13 focus groups with 132 high school students from public and private schools of Rio de Janeiro city, including 70 girls and 62 boys was conducted. We followed a guide with questions about interpersonal violence and participants completed a self-administered questionnaire on socio-demographic data. The data analysis included reading and comprehension of the textual data; coding of the reports according to the emerged categories; identification of the meanings attributed by the subjects to the questions raised; comparative dialogue with literature; and elaboration of interpretative synthesis. RESULTS: Most adolescents affirmed that TDV is not justifiable. However, in practice, they found it acceptable in certain situations. The narratives of the boys were based on the role of the perpetrator and the girls on that of the victim. Violence occurs when the man feels his power challenged and is influenced by situations of violence experienced in his own family as victims or witnesses. The TDV consequences are for the women and include, in addition to physical and psychological damage, relational problems in other spheres such as family, friends and school. The experience of violence was more common among public school students. CONCLUSIONS: The adolescents' narratives reflect the gender patterns of society in which violence results from inequality of power. The data of this study offer subsidies to policies on TDV prevention and its consequences. They can contribute to training primary care professionals to identify on clinical consultations signs and symptoms of violence and to develop interventions to reduce the health problems of victims.

Contributions to address violence against older adults during the Covid-19 pandemic in Brazil. / Violência contra idosos durante a pandemia de Covid-19 no Brasil: contribuições para seu enfrentamento.

Most Brazilian state and municipal governments have used social distancing as the primary strategy for reducing the transmission speed of the new Coronavirus (SARS-CoV-2), which causes COVID-19. However, this social isolation has had several adverse repercussions, including increased intrafamily violence against children, adolescents, and women. Recently, violence against older adults (VAOA) during the pandemic has also been on the agenda of concerns, although discussing possible strategies for coping with VAOA during COVID-19 is still unimpressive worldwide. Aiming to broaden the debate on the theme in Brazil, this paper aims to offer theoretical elements and evidence from previous studies for a greater understanding of the situation of vulnerability of older adults to situations of violence, of the possible motivations for the increased number of cases of VAOA during the COVID-19 pandemic, and possible strategies to address the problem.

O distanciamento social tem sido usado pela maioria dos governos estaduais e municipais do Brasil como principal estratégia para a redução da velocidade de transmissão do novo coronavírus (SARS-CoV-2), agente etiológico da COVID-19. Entretanto, esse isolamento social tem tido várias repercussões negativas, dentre elas o aumento da violência intrafamiliar contra crianças, adolescentes e mulheres. Recentemente, a violência contra a pessoa idosa (VCPI) durante a pandemia também vem entrando na pauta das preocupações, embora a discussão sobre as possíveis estratégias de enfrentamento da VCPI durante a COVID-19 ainda seja inexpressiva em todo o mundo. Visando ampliar o debate sobre o tema no Brasil, este artigo pretende oferecer elementos teóricos e evidências de estudos anteriores para uma maior compreensão da situação de vulnerabilidade do idoso às situações de violência, das possíveis motivações para o aumento do número de casos de VCPI durante a COVID-19, bem como sugerir possíveis estratégias para o enfrentamento do problema.

Violence against children and adolescents in Manaus, Amazonas State, Brazil: a descriptive study of cases and evaluation of notification sheet completeness, 2009-2016. / Violência contra crianças e adolescentes em Manaus, Amazonas: estudo descritivo dos casos e análise da completude das fichas de notificação, 2009-2016.

OBJECTIVE: to describe cases of violence against children and adolescents and completeness of notification forms registered on the Notifiable Health Conditions Information System (Sinan), Manaus, Amazonas, Brazil, 2009-2016. METHODS: this was a descriptive study based on 38 fields of the notification form held on the information system; analysis of completeness was based on the criteria proposed by the Ministry of Health. RESULTS: 69.3% of the 10,333 reported cases occurred among female children, and parents and step-parents were the perpetrators in 43.0% of cases; among adolescents, about » (24.9%) of cases were committed by friends/acquaintances; sexual violence was the most reported type of violence in both groups; field completeness ranged from 15.1% (occupation) to 100.0% (several fields). CONCLUSION: in contrast to the national scenario, sexual violence was the most reported form of violence in Manaus, indicating that other types of violence are underestimated; data quality points to the need for Sinan improvement in Manaus.

Body image dissatisfaction and associated factors in adolescents. / Insatisfação com a imagem corporal e fatores associados em adolescentes.

This study aimed to examine the factors associated with body dissatisfaction in adolescents. This is a cross-sectional study with students from two public and four private schools in the metropolitan region of Rio de Janeiro. Body dissatisfaction was evaluated using the Body Silhouette Scale, by the difference between the image they perceive as their current image and the one they would like to have. The association was assessed by hierarchical logistic regression multinomial model, by estimating odds ratios (OR) and 95% confidence intervals (95%CI). Among the 1,019 adolescents evaluated (13-19 years), 75% showed body dissatisfaction, 41.4% wishing for a smaller silhouette and 33.7% wishing for larger silhouettes. The wish for a smaller silhouette was more significant in girls, overweight adolescents, those with an unsatisfactory meal pattern, and with higher waist circumference. Adolescents that had been exposed to teasing due to their body shape increased the probability of wishing for both smaller and larger silhouettes. Strategies are required for a more positive perception of body image, especially for girls and for overweight adolescents, which provide guidance on adequate meal consumption and prevent exposure to peer teasing, valuing coexistence and well-being in the face of existing bodily differences.

O objetivo do estudo foi examinar os fatores associados a insatisfação com a imagem corporal (IIC) em adolescentes. Estudo transversal com estudantes de duas escolas públicas e quatro escolas privadas da região metropolitana do Rio de Janeiro. A IIC foi avaliada pela Escala de Silhuetas Corporais, pela diferença entre a imagem que percebem como a sua atual e a que gostariam de ter. A associação foi investigada por meio de regressão logística multinomial hierarquizada, estimando-se as odds ratios (OR) e intervalos de confiança de 95% (IC95%). Entre os 1.019 adolescentes avaliados (13 a 19 anos), 75,0% apresentaram IIC, 41,4% desejando ter silhueta menor e 33,7% desejando ter silhueta maior do que a auto percebida. O desejo de ter uma silhueta menor foi maior nas meninas, naqueles que tinham padrão de refeição insatisfatório, com excesso de peso e perímetro da cintura elevado. A exposição a provocações por causa do corpo aumentou a chance para desejar silhuetas menores e maiores. Evidencia-se a necessidade de estratégias para uma percepção mais positiva da imagem corporal, principalmente para meninas e jovens com excesso de peso, que orientem sobre consumo adequado de refeições e para prevenção de exposição a provocações pelos pares, valorizando a convivência e o bem estar frente às diferenças corporais existentes.

Contradictions in relation to sexual violence in the eyes of adolescents and the disconnect with the law defining "rape of vulnerable individuals". / Contradições acerca da violência sexual na percepção de adolescentes e sua desconexão da lei que tipifica o "estupro de vulnerável".

Article 217-A of Brazilian Law n. 12,015/2009 defines carnal knowledge or any other libidinous act with an individual under 14 years of age as "rape of a vulnerable individual" (statutory rape). Given the young average age at sexual initiation in current society, the study aimed to understand the adolescents' views of sexual initiation, sexual assault, and the law that defines sex at this age as "rape of a vulnerable individual". The authors used a qualitative approach with 13 focus groups totaling 132 secondary students from public and private schools in the city of Rio de Janeiro, Brazil. Data analysis used the webQDA software with a hermeneutic-dialectic approach that yielded three categories: feeling ready to initiate sexual activity, (in)vulnerability to sexual assault, and protective mechanisms. Girls associated sexual initiation with a romantic vision and feeling safe with and trusting the partner. Boys associated it with opportunity, regardless of other factors. Most of the students felt that when consent to the sexual act is mutual, regardless of age, there is no violence involved. At the same time, they wondered about the possibility of younger girls' discernment to consent to having sex. Most of these adolescents disagreed with the protective measures established by the law, arguing that it is the family's duty to provide this care. The contradictions in the adolescents' views concerning vulnerability to sexual assault and rape of vulnerable individuals as defined by the law lead us to conclude that it is necessary to expand and improve sex education in general for Brazilian adolescents, besides creating spaces for discussion that can help improve these legal provisions.

O Art. 217-A da Lei nº 12.015/2009 definiu como crime de estupro de vulnerável a conjunção carnal ou outro ato libidinoso praticados com menor de 14 anos. Diante da baixa idade de início da atividade sexual observada na atualidade, objetivamos neste estudo compreender a concepção de adolescentes acerca da iniciação sexual, da violência sexual e da lei que a tipifica como "estupro de vulnerável". Utilizamos método qualitativo por meio de 13 grupos focais com 132 estudantes do Ensino Médio de escolas públicas e privadas do Município do Rio de Janeiro, Brasil. A análise dos dados foi realizada com apoio do software webQDA, em uma abordagem hermenêutico-dialética que deu origem a três categorias: sentir-se apto a iniciar o sexo, (in)vulnerabilidade à violência sexual e mecanismos de proteção. A iniciação sexual para as moças está relacionada a uma visão romântica, a se sentirem seguras e terem confiança no parceiro, ao passo que, para os rapazes, está associada a oportunidade, livre de outros fatores. Para a maioria dos estudantes, quando o consentimento para a prática sexual é mútuo, independente da idade, não há violência. Ao mesmo tempo, questionam-se quanto à capacidade de discernimento das mais jovens para permitir o sexo. A maior parte discorda das medidas protetivas previstas na lei, por entender que é dever da família prover esse cuidado. As contradições na percepção dos adolescentes sobre a vulnerabilidade à violência sexual e o estupro de vulnerável previsto em lei nos levam a concluir que é necessário ampliar e qualificar a educação sexual de forma abrangente para adolescentes, assim como criar espaços de discussão que possam proporcionar aperfeiçoamento desse dispositivo legal.

El Art. 217-A de la Ley nº 12.015/2009 definió como delito la violación de personas vulnerables, la unión carnal, u otro acto libidinoso practicado con un menor de 14 años. Ante la baja edad para la iniciación sexual observada en la actualidad, el objetivo de este estudio fue comprender la concepción de los adolescentes sobre: iniciación sexual, violencia sexual y la ley que la tipifica la "violación de una persona vulnerable". Utilizamos el método cualitativo mediante 13 grupos focales con 132 estudiantes de enseñanza media de escuelas públicas y privadas del municipio de Río de Janeiro, Brasil. El análisis de datos se realizó con el apoyo del software webQDA, desde un enfoque hermenéutico-dialéctico que dio origen a 3 categorías: sentirse apto para iniciarse en el sexo, (in)vulnerabilidad ante la violencia sexual y mecanismos de protección. La iniciación sexual en el caso de las chicas está relacionada con la visión romántica, sentirse seguras y tener confianza en la pareja, mientras que, para los chicos, está asociada a la oportunidad, aparte de otros factores. Para la mayoría de los estudiantes, cuando el consentimiento para la práctica sexual es mutuo, independientemente de la edad, no hay violencia. Al mismo tiempo, se cuestionan respecto a la capacidad de discernimiento de las más jóvenes para permitir el sexo. La mayor parte está en desacuerdo con las medidas protectoras previstas en la ley, por entender que es un deber de la familia proporcionar ese cuidado. Las contradicciones en la percepción de los adolescentes sobre la vulnerabilidad a la violencia sexual y la violación de personas de vulnerables prevista en la ley nos llevan a la conclusión de que es necesario ampliar y mejorar la educación sexual de manera que abarque a los adolescentes, así como crear espacios de discusión que puedan perfeccionar este recurso legal.