Violência de gênero: comparação da mortalidade por agressão em mulheres com e sem notificação prévia de violência

Factors associated with homicides of women in Brazil, by race or colour, 2016-2020

This ecological, time-trend study examined rates of homicide against women residing in Brazil, by state and race/colour, from 2016 to 2020, by performing. Multiple analysis by regression model on longitudinal data. During the study period, 20,405 homicides of women were recorded in Brazil. Standardised homicides rates were higher among black women (6.1/100,000) than among white women (3.4/100,000). From 2016 to 2020, rates decreased 25.2%, from 4.7 deaths per 100,000 women in 2016 to 3.5 in 2020, with a statistically significant downward trend among both black and white women. Statistically significant inverse relationships were found between female homicide rates and HDI, illiteracy rate and proportion of ill-defined causes. The average homicide rate decreased in 2019 and 2020, as compared with 2016. Despite the decreasing time trend in homicide rates for both black and white women, they differed substantially by race, with worse outcomes for black women.

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.

Female Homicides in Brazil and Its Major Regions (1980-2019): An Analysis of Age, Period, and Cohort Effects

The objective was to analyze the temporal effects of age, period, and cohort on mortality from all female homicides, and from female homicides and by firearms, in Brazil from 1980 to 2019. Data were accessed from Brazilian health records. There was an increase in the risk of death in the 2000s in the North and Northeast regions and a decrease in the Southeast, South, and Midwest. Younger women had a higher risk of death than women born between 1950 and 1954. The findings may be correlated with the inefficiency of the Brazilian state in protecting female victims of violence.

Physical violence against women in Brazil: Findings from the 3rd Brazilian household survey on substance use

Brazil has a historical gap regarding information on violence against women. Herein we aimed to evaluate the association of socioeconomic and demographic characteristics with physical violence against women in Brazil, as well as the possible escalation of violence to severe patterns of violence. We analysed data from the 3rd Brazilian Household Survey on Substance Use, in 2015. The main outcomes were reporting any physical violence and being stabbed/shot in the last 12-months. Logistic regressions were fitted to assess the association between socioeconomic and demographic variables with the outcomes. We estimated 3.8 million women reported any physical violence (5.52%): 3.79% reported threats to beat/ push/kick, 1.87% threats with knife/gun, 2.49% were beaten/pushed/kicked, 0.63% were spanked/ choked, and 0.21% were stabbed/shot. The higher the severity of violence, the higher the number of types of violence experienced. The likelihood of reporting any violence was higher among women 18-24 years, without a stable partner, who were at an informal job or unemployed, and who live in urban areas. The sociodemographic characteristics associated with reporting any violence reinforce the importance of addressing gender inequalities. Evidence of escalation violence reinforces the need to protect and care for women who report any type of violence.

Violence in Quilombola women living in rural communities in Brazil

OBJETIVE

To estimate the prevalence of psychological, physical, and sexual violence perpetrated against women by their intimate partner (IP) in Quilombola communities located in Espírito Santo State, Brazil.

METHODS

The data is from a population-based cross-sectional study of Quilombola women conducted from 2017 to 2018. In-person interviews collected information on women's sociodemographic characteristics, behaviors, and their experience of violence perpetrated by their IP. The analysis used chi-square test and hierarchical logistic regression.

RESULTS

219 women (94.8% of the invited ones) agreed to participate in the study. 59.0% (95%CI: 5.25-65.5) reported psychological violence; 41% (95%CI: 34.5-47.5) physical violence; and 8.2% (95%CI: 4.6-11.8) sexual violence. Psychological violence was associated with having three or more sexual partners in life, when compared to those who had up to two partners (p = 0,009), and previous violence involving other people outside of family increased the chance of suffering psychological violence by an IP more than nine times (p ≤ 0.001). Regarding physical violence, the association with use of barrier contraception (p = 0.031) and having a partner with other sexual partners (p = 0.024) were protective factors for IP violence. Having 3 or more sexual partners in the last 12 months (p = 0.006), partner using illicit drugs (p = 0,006), and alcoholism in the family (p = 0,001), increased the chance of suffer physical violence by the partner. Sexual violence perpetrated by the IP was associated with miscarriage (p = 0.016), partner using drugs (p = 0.020), and gynecological symptoms (p = 0.045).

CONCLUSIONS

These results showed the high frequency of intimate partner violence in Quilombola women and highlight the importance of reducing social and race inequities for interrupting the culture of violence against women.

Time trend and spatial distribution of the cases of lethal violence against women in Brazil

OBJECTIVE

to analyze the time trend and the spatial distribution of the cases of lethal violence against women in Brazil, according to age group and to race/skin color.

METHOD

an ecological study of time series, with spatial distribution of the deaths of women victims of aggression, registered in the Mortality Information System, resident in Brazil, Brazilian geographic regions and states. Due to underreporting of deaths in some states, correction factors of the mortality rates were employed. For the trend analysis, we adopted the polynomial regression model. In addition to that, the mean rates and annual upward/downward trends were distributed considering the Brazilian federative units as analysis units.

RESULTS

the mean rate was 6.24 cases of lethal violence per 100,000 women, with a significant variation across the Brazilian regions and states. The main victims of violent death in Brazil are young, black-/brown-skinned and indigenous women, with a growing trend in these population segments. The North and Northeast regions stood out with the most significant mean annual increases (0.33; r2= 0.96 and 0.26; r2= 0.92, respectively).

CONCLUSION

there was a stable trend regarding lethal violence against women, with significant regional differences. Young, black-/brown-skinned and indigenous women are more vulnerable to violent death in Brazil.

Do health sector measures of violence against women at different levels of severity correlate? Evidence from Brazil

Objective

To evaluate if characteristics of reports of violence against women at different levels of severity are similar and to test if their prevalence is correlated at the municipal level.

Methods

I use data from women ages 15–49 who were killed by homicide in Brazil’s national death registry (N = 14,373), were hospitalized for aggression (N = 14,701), or were included in the medical mandatory reports of incidents of violence against women (N = 42,134) between 2011 and 2016 in select municipalities. I provide national level descriptive statistics from 2016 contrasting distributions of victims (age, education, and race) and distributions of the characteristics of the incidents (location and time of day). Then, for 63 municipalities with a high number of violent incidents, I calculate the correlation coefficients between measures of violence against women using quarterly data from 2011 to 2016. I use multiple regression of municipal characteristics at baseline to examine which factors (poverty, spending, health, and civic engagement) predict the correlation.

Results

Victim characteristics and incident characteristics are similar across the measures of violence at the national level. Despite these aggregate similarities, correlations at the municipal level are quite varied, ranging from − 0.69 to 0.83. I find no municipal characteristics that consistently predict these correlation coefficients.

Conclusions

Despite some similarities at an aggregate level, these measures of violence against women do not have consistent patterns of correlation at the municipality level. Measures of severe levels of violence against women are not good proxies for incidence of violence at less severe physical levels. Lack of correlations could be due to differences in reporting, but may also be due to differences in underlying processes that share similar victims and event characteristics.

Epidemiological surveillance: a brief history and the experiences of the United States and the state of São Paulo

OBJECTIVE

The objective of this narrative review was to list some historical aspects of epidemiological surveillance, a technological intervention model initially designed to help control communicable diseases in the last century.

METHODS

This narrative was built based on texts selected to record the development of epidemiological surveillance in the United States and in the state of São Paulo, Brazil.

RESULTS

The origins of some of the actions that constitute epidemiological surveillance activities are presented, as well as a brief history of the establishment of the originally named Center for Disease Control, a United States agency that is held up as an example in relation to the way surveillance has been performed, practically all over the world. Likewise, we outline the paths that led to the establishment of the surveillance system in the state of São Paulo, drawing some parallels with the Brazilian system.

CONCLUSION

The narrative concludes with a conceptual differentiation between epidemiological surveillance, monitoring and health surveillance.

Temporal trend of sexual violence against adolescent women in Brazil, 2011-2018

This study aimed to analyze the temporal trend of sexual violence (SV) reports against adolescent women in Brazil from 2011 to 2018. An ecological time series study was performed on reports of SV against women aged 10 to 19, which were available in the National Notifiable Diseases Reporting System (SINAN). Data were collected in 2020 but are related to reports filed from 2011 to 2018. The Prais-Winsten linear regression model was applied to analyze the time trend, including a calculation of the annual percentage variation (APC) and 95% confidence intervals (95%CI). We found a significant trend increase in all Brazilian regions. Although the rates in the Northern region are higher at the beginning and at the end of the analyzed time period, the reporting rates of the Southeast (APC 14.56%; 95%CI 7.98;21.54) and the South (APC 14.19%; 95%CI 6.56;22.36) showed a greater increase. The increase of SV reports in recent years shows how vulnerable adolescent women are to this type of violence, but also indicates greater improvement of violence surveillance systems. We conclude that both reporting systems and public policies aimed at tackling SV against women need to be further developed.

Vida(s) Maria(s): a história de uma mulher e os (re)tratos da violência em narrativas contadas

Resumo Este artigo tem como objetivo analisar a narrativa de uma mulher em situação de violência doméstica e as imbricações entre sua história de vida, imposições de gênero e a construção da sua identidade. Para tanto, realizou-se uma pesquisa qualitativa, em que recorremos à triangulação de fontes metodológicas por meio de entrevistas narrativas, observações cotidianas e protocolos documentais. Os resultados consideraram os atravessamentos pessoais, familiares e relacionais para a confecção dos cenários em que a perpetração da violência de gênero possa ter sido corroborada na produção de personagens e resistências ao longo do tempo. Essas discussões contribuem para o avanço da compreensão da violência dirigida às mulheres no Brasil, tensionando uma análise crítica que ponha em questão os aspectos sociopolíticos que reforçam o exercício hegemônico de uma cultura patriarcal.

ANALYSIS OF REPORTS OF VIOLENCE AGAINST PREGNANT WOMEN IN BRAZIL IN THE PERIOD FROM 2011 TO 2018

ABSTRACT Objective: to analyze reports of violence made by pregnant women in Brazil between 2011 and 2018. Method: quantitative research of the analytical and retrospective type. Data from pregnant women aged between 11 and 49 years from a database containing information from the Information System for Reporting interpersonal/self-harm from 2011 to 2018 were analyzed. The analysis involved the description of the profile of the pregnant woman and the probable author and the characteristics of the events. Results: in 2017, five times more cases of violence against pregnant women were reported compared to 2011. Violence occurred more in people aged between 20 and 29 years (37.0%), black/brown (54.4%), with incomplete primary education (34.2%) and single (48.1%). The most frequent violence was physical (61.9%), followed by psychological (31.2%) and sexual (27.0%). Body strength and beatings were the means of aggression most used by the perpetrator of violence (54.0%). The partner or ex-partner (50.5%) was the aggressor most described by the pregnant women. Conclusion: to describe the characteristics of pregnant women in Brazil who suffer violence and their possible aggressor proposes an advance in the construction of a network of care for women victims of more structured violence, based on public policies aimed at ensuring qualified care by professionals who perform prenatal care in primary health care units.

Prevalence of exposure to violence among adults - Brazil, 2019

OBJECTIVE

To estimate the prevalence of exposure to violence, characterizing its magnitude, types and occurrence in the adult population in Brazil.

METHODS

Cross-sectional study with data from the National Health Survey conducted in 2019. The prevalence of violence in the last 12 months and respective 95% confidence intervals (95%CI) were estimated according to sociodemographic variables. Crude prevalence ratios were estimated by Poisson regression.

RESULTS

The prevalence of exposure to violence among adults in Brazil was 18.3% (95%CI 17.8-18.8), with a significantly higher frequency among women (19.4%; 95%CI 18.7-20.0), in the 18-29 age group (27.0%; 95%CI 25.7-28.4), in self-declared black people (20.6%; 95%CI 19.3-21.9) and mixed race (19.3%; 95%CI 18.6-20.1) and among inhabitants of the Northeast region (18.7%; 95%CI 18.0-19.5). Among the victims of violence, 15.6% (95%CI 14.2-17.0) sought health care, of which (91.2%; 95%CI 88.1-93.6) were attended. The most reported types of violence were: psychological (17.4%; 95%CI 16.9-17.9), physical (4.1%; 95%CI 3.9-4.4) and sexual (0.8%; 95%CI 0.7-0.9). Men were more exposed to violence with the use of firearms or sharp targets, while women were the predominant victims for all other types and mechanisms of violence. The aggressor most cited was the intimate partner, the most frequent place of occurrence of violence being the residence and public streets/places.

CONCLUSION

In Brazil, violence affected one in five adults. Women, young people and people with black skin were the population segments most exposed to violence, which should be a priority in prevention actions.

Brazilian Government Strategies to Protect Women

In 2018, 22,000,000 Brazilian women experienced some type of violence (either physical or psychological), and 42% of these episodes occurred in the domestic environment. Therefore, government strategies have been developed to solve this problem. This study aimed to (a) carry out a survey of Brazilian government strategies for the protection of women after the creation of the Maria da Penha Law (Law No. 11.340, 2006) and (b) discuss these strategies from the concept of cultural design. Sixteen laws, five decrees, and two ordinances were found and analyzed. In a general way, the analysis suggests that they are not effective cultural plans because most do not show long-term results, and some of the laws that typify crimes and those that relate to the aggressor's behavior do not specify the target behaviors, so there is no explicit contingency. Despite this, such strategies are relevant, as they end up providing the protective context for women from a social, legal, and political point of view. Finally, it is expected that the discussions raised in the present work can help prepare interventions that favor socially beneficial cultural practices.

Escala de Crenças Sobre Violência Conjugal (ECV): Versão Brasileira

Resumo Este estudo visou traduzir, adaptar e verificar evidências de validade da Escala de Crenças sobre Violência Conjugal (ECVC), bem como investigou diferenças nos índices de concordância com crenças legitimadoras de violência conjugal, considerando as variáveis gênero, escolaridade e possuir filhos. Os participantes foram adultos brasileiros (N = 1.337), maiores de 18 anos, sendo 66,34% pertencentes ao gênero feminino e 33,65% masculino. Foram realizadas análises fatoriais confirmatórias e exploratórias, e análise de comparação das médias através de uma ANOVA. Os 25 itens da escala apresentaram cargas fatoriais superiores a 0,46. A versão brasileira da escala apresentou estrutura unidimensional. Foi observado que os três indicadores utilizados para avaliar a consistência interna apresentaram valores satisfatórios. Por fim, identificou-se que participantes do gênero masculino, com menor escolaridade e com filhos apresentaram maior concordância com crenças legitimadoras de violência conjugal. Os resultados encontrados reforçam as qualidades psicométricas da escala indicando sua aplicabilidade.

Domestic violence against Latin American women and female mental health during the new coronavirus (SARS-CoV-2) outbreak

We aimed to discuss the impact of the coronavirus pandemic on the VAW scenario and how it affects women's mental health. The short communication from secondary data collected from the official websites of seven countries in Latin America was performed. The sample was non-probabilistic, for convenience. The collection took place in January 2021. During the COVID-19 pandemic, the increased contact of the victim with the aggressor (if he/she is the spouse), deepening of economic disparities, stressful environment, and loss of social support mechanisms are some of the factors that explain the possible increase in VAW rates. VAW is a sociological phenomenon whose bases are rooted in historical, political, religious, and economic conditions. In addition to the biological dimension of the pandemic, it is necessary to reflect on the long-term impacts of this new social configuration, especially on more vulnerable groups such as women in underdeveloped countries.

Factors associated with the homicides of women who are victims of violence

OBJECTIVES

to identify factors associated with homicides in women who had prior notification of violence in the state of Pernambuco, 2011 to 2016.

METHODS

a transversal, quantitative and observational study, guided by the STROBE tool, with data of homicides of women obtained from the Mortality Information System; and of violence against women, from the Grievance Notification Information System. The logistic regression model was used to verify the factors associated with the homicides.

RESULTS

there were 32,308 cases of violence against women and 1,162 homicides. The chances of homicide were higher for women: victims of physical violence (2.39 times more), aggression by object of court (2.32 times more), aggression by firearm (6 times more), and when there was a recurrence of violence (3.82 times more).

CONCLUSIONS

association of physical violence, agression by object of court, aggression by firearm, recurrence of violence with homicides of women in the state of Pernambuco was found.

Epidemiological profile of female firearm-related mortality

ABSTRACT

The mortality rate of women due to firearms increases every day in Brazil and globally. This study aimed to evaluate the trends of firearm-related mortality in women from the years 2007 to 2016 in order to determine their profile and to associate these indicators with public policy and strategies to reduce mortality.This is an ecological time-series study using secondary data of women aged 10 to 49 years old collected through the mortality information system (SIM) in Brazil. Furthermore, independent characteristics such as education, color, race and civil status were also collected from SIM. Data was analyzed using the Join Point open source software version.There was an increase in the mortality rate of women who received 4 to the 7 years of education, were single, and brown-skinned. There was a significantly increased rate of mortality in women whose ages ranged from 20 to 29 years followed by 30 to 39 years; the rate was also significantly higher in the northeast region followed by the southeast region.There is a need for professional training to assist women in vulnerable situations.

Violência contra crianças: descrição dos casos em município da baixada litorânea do Rio de Janeiro

Resumo Objetivo descrever os casos notificados de violência contra crianças em um município da baixada litorânea do estado do Rio de Janeiro. Método estudo epidemiológico e descritivo a partir de dados secundários. Foram incluídos todos os casos de maus-tratos na infância (crianças de zero a nove anos) entre 2009 e 2018, referentes ao município de Rio das Ostras, registrados no Sistema de Informação de Agravos de Notificação. Os dados foram analisados por meio de estatística descritiva. Resultados um total de 315 (100%) casos foi registrado no período analisado, com maior pico de ocorrência em 2014 (n=55/21,1%). A maioria das crianças era do sexo feminino (n= 187/59,4%), entre 1 a 4 anos (n= 136/43,2%) e brancas (n=100/31,7%), ademais, predominou a violência sexual (n=128/40,6%). Os principais agressores foram mães (n=110/34,9%) e pais (n=102/32,4%), por conseguinte, a residência, (n=216/69,0%), foi o local mais prevalente de ocorrência dos maus-tratos. Conclusão e implicações na prática os achados evidenciaram lacunas no preenchimento das informações no sistema de notificação, além da perpetuação da violência contra crianças em suas diferentes naturezas. O estudo pode contribuir para o estabelecimento de prioridades na elaboração e execução de programas locais para prevenção e manejo dos casos de violência infantil.

Desigualdade de Gênero e Escuta Psi de Mulheres Atendidas na Atenção Básica

Resumo Este estudo tem como objetivo investigar o que psicólogos na atenção básica de Porto Alegre identificam como necessidades em saúde mental das mulheres atendidas, buscando verificar se sua escuta profissional permite estabelecer nexos entre o sofrimento psíquico e a desigualdade de gênero vivenciada pelas usuárias. Em 2017, foi realizado grupo focal com nove psicólogas que atuam em unidades de Saúde da Família, em que foi construída coletivamente uma narrativa segundo o método de Grupo Focal Narrativo. Constituem a narrativa final oito núcleos argumentais: “Sofrimento mascarado”; “Os homens também sofrem com isso”; “Várias gerações de mulheres cuidadoras”; “Aquele desejo de constituir uma família a qualquer custo”; “Por que o homem acha que pode usar uma mulher como se fosse um objeto?”; “Maternidade compulsória”; “Novas formas de exercício da sexualidade”; e “O hospital tomou como uma afronta o empoderamento da mulher”. Considera-se que o estudo proporcionou às participantes um espaço de reflexão coletiva sobre si mesmas e suas práticas.

Violência contra mulheres idosas em Manaus

A violência contra a pessoa idosa é um grave problema mundial, cujas manifestações têm profundos impactos na saúde e na qualidade de vida dessas pessoas. Como problema sócio-histórico, a violência faz parte da história da humanidade e tem se manifestado de forma crescente contra mulheres, incluindo as idosas. O objetivo deste artigo é analisar as experiências sociais de mulheres idosas que sofreram violência e buscaram a rede de proteção, e a perspectiva dos profissionais que atuam nos serviços de atendimento à violência contra a pessoa idosa em Manaus. Os resultados apontam para a compreensão de violência associada à violência física predominantemente, seguida da violência verbal e moral, todas vivenciadas no âmbito das relações interpessoais. Apontam também para a necessidade de divulgar os instrumentos de proteção legal e capacitar melhor os profissionais para tratar as especificidades desse grupo.

Intimate partner violence against women: Operationalized Psychodynamic Diagnosis (OPD-2)

INTRODUCTION

Intimate partner violence against women is one of the most common forms of violence. Different research fields are trying to understand the cycle of violence, such as the psychological field, to understand how these women's relational patterns and intrapsychic conflict function in the cycle of violence.

OBJECTIVE

To investigate the operationalized psychodynamic diagnosis of women victims of domestic violence, exploring the severity and experience of violence, structural functions, dysfunctional interpersonal patterns, and intrapsychic conflicts.

METHOD

We conducted a cross-sectional quantitative study using the OPD-2 Clinical Interviews, which were recorded and transcribed. The sample was composed by 56 women victims of domestic violence, mean age 30.07 (SD = ±9.65). Reliability was satisfactory for judges interviews(k>0,6).

RESULTS

According to the OPD-2 evaluation, we found that the severity of the violence was associated with the intensity of women's subjective suffering. In the relational pattern, they stay in the relationship, leaving themselves vulnerable; perceive the partner as controlling, aggressive, offensive, and fear abandonment. As a defensive mechanism to relational discomfort and suffering victims anticipate the aggressor's desire, resulting in submissive behavior. The main psychic conflict was the "need for care versus self-sufficiency" (78.6%). And medium was the predominant structure level, in which they presented insecure internal objects, presenting difficulties in emotional regulation and perceiving reality in a distorted way. Hence, they do not recognize their limitations and needs. We found that 78.6% of the cases had some psychiatric disorder: MDD, PTSD.

CONCLUSION

This study provides empirical evidence on clinical observations on the psychological functioning of this population and the issues that make up the maintenance of domestic violence against women. The understanding of internalized patterns, structural functions, and motivational tensions are fundamental for the prevention of re-victimization and improving coping mechanisms, as well as promoting greater adherence to treatment.

Wounded adolescences: a portrait of firearm violence reported in Brazil

OBJECTIVE

To describe the notifications of interpersonal and self-inflicted firearm violence in adolescents and to identify the factors associated with the notification of this event.

METHODOLOGY

Cross-sectional study analyzing data from Sinan from 2011 to 2017, in adolescents aged 10-19 years, injured by firearms. The χ2 test was used to verify the gender ratio difference. Correlation analysis and multiple linear regression were performed between the logarithm of the firearm notification rate and each independent variable, in a sample of large municipalities.

RESULTS

There were 30,103 reports of firearm violence in adolescents, of which (74.7%) were males aged 15-19 years (83.8%). Among girls, violence is more common at home, with a known perpetrator, and with physical and sexual violence combined. The death rate by firearms was higher in Fortaleza, Maceió, João Pessoa, Salvador and Natal, ranging from 105.88 to 71.73 per 100 thousand. Higher notification rates of firearm violence were associated with higher firearm death rates and greater coverage of health facilities.

CONCLUSION

Firearm violence is a major public health problem in adolescents. Attacks on the disarmament statute and the loosening of gun possession and ownership directly confront the present and future of children and adolescents.

Violence against adolescents: analysis of health sector notifications, Brazil, 2011-2017

INTRODUCTION

Violence experienced in adolescence results in serious damage and suffering to society. This study aims to characterize the profile of violence victims and likely perpetrators of violence against adolescents, as well as to describe the percentage of notifying municipalities according to the federation unit.

METHODS

Cross-sectional study conducted with data on notification of violence against adolescents from the Information System for Notifiable Diseases, from 2011 to 2017. The chi-square test was used to assess the statistical significance of the differences between the proportions in the comparison between genders. Proportion ratios for the most frequent types of violence were estimated according to selected variables.

RESULTS

The notifications came from 75.4% of all the Brazilian municipalities. Physical violence predominated among males, aged 15-19 years. Psychological violence was predominant among females, between 10 and 14 years old, when perpetrated repeatedly at home by family aggressors. Sexual violence prevailed among females, aged 10 to 14 years old, in the indigenous, black and yellow races/colors, when perpetrated repeatedly at home. Negligence was more common among males, between 10 and 14 years old, when perpetrated repeatedly by family aggressors.

CONCLUSIONS

Sexual violence occurred predominantly against females and generated significant negative impacts on mental, physical, sexual and reproductive health. Community violence, perpetrated with sharp objects and firearms, were prominent among males and are important risk factors for male over-mortality. Because the problems are complex, addressing them requires intersectoral actions.

Violence against women: what happens when the Women's Protection Police Station is closed?

The study analyzes the differences among cases of violence against women registered in police reports (PR) at the Women's Protection Police Station (WPPS) during regular working hours, and those registered during after-hours, in a medium-sized city in the inland state of São Paulo, Brazil. This is a cross-sectional study based on data from PRs registered for one year (2013/2014). PRs were differentiated by period of registration, at regular working hours and after-hours (dependent variable). A chi-square test was used to compare groups. In total, 440 PRs were registered, 373 during regular working hours, and 67 during after-hours. Cases of violence registered during after-hours evidenced more significant threats to women's integrity, as shown by the higher number of cases of perpetrators' flagrante delicto, requests for protective measures and greater severity of assaults, such as bruises, need for hospitalization and referral to forensic medicine (IML), which characterize the greater severity of occurrences when WPPS are closed. Thus, women lack a specialized reception service and a full guarantee of rights in periods of highest risk and vulnerability.

Brazilian women’s transition to new relationships after ending a violent one: a case study

Abstract This study investigated characteristics of the transition to new relationships after the end of a violent one through case studies. Two young white Brazilian women who had experienced violent first relationships underwent a narrative interview and filled out the Experiences in Close Relationships Inventory. One of them had moved to a healthy relationship and the second one to another violent relationship. Awareness of violence and the adoption of strategies that enlarged models, world views, social circles, support and self care had not been enough to avoid the entrance in a new violent relationship. The development of the ability to access and validate one’s own feelings and wills, resulting in greater assertiveness, favored the transition to a healthy relationship. The approach to secure attachment style accompanied such changes. We discuss the implications to professional practice and preventive initiatives, as well as directions for future research.

Reflexões sobre Práticas e Cotidiano Institucional na Rede de Proteção à Mulher

Resumo Esse artigo é o relato de uma experiência de estágio curricular em Psicologia na Rede de Proteção à Mulher da cidade de Natal (RN). O objetivo consiste em refletir acerca do seu funcionamento institucional, com ênfase nas práticas profissionais, a partir de três eixos norteadores: 1. aspectos institucionais e operacionais da rede de proteção; 2. Articulação e fluxos intra/intersetoriais na rede de atenção local; 3. Práticas profissionais, com ênfase no cotidiano dos serviços. Para tanto, foi utilizado o referencial teórico da Análise Institucional para pensar os serviços e o trabalho dos agentes no cotidiano. Durante o período em questão foi possível constatar a fragilidade do funcionamento em rede, tanto em nível setorial, quanto intersetorial, revelando a desarticulação dos serviços e pouca fluidez do fluxo assistencial. Ademais, percebeu-se a atuação profissional ainda marcada por estereótipos de gênero, práticas prescritivas e posturas moralistas, assentadas no dualismo vítima-agressor. Portanto, faz-se essencial o aprimoramento das políticas públicas já existentes, tornando-as mais abrangentes e efetivas, fortalecendo, desse modo, o funcionamento em rede. Importante destacar a necessidade de projetos de formação continuada visando qualificar a atenção prestada às mulheres vítimas de violência.

Violência contra as mulheres na prática de enfermeiras da atenção primária à saúde

RESUMO Objetivo compreender como os enfermeiros que atuam na Atenção Primária à Saúde identificam a violência contra as mulheres e descrever a assistência de enfermagem prestada a essas mulheres. Método Estudo descritivo e de abordagem qualitativa, realizado entre agosto de 2018 a fevereiro de 2019 com dez enfermeiras que trabalham na Atenção Primária à Saúde. A coleta de dados foi realizada por meio de entrevista semiestruturada, sendo analisados pela análise temática de conteúdo. Resultados As narrativas revelaram como os colaboradores percebem a violência contra as mulheres e os significados atribuídos pelos mesmos. Emergiram três categorias: Percepção do enfermeiro sobre a violência contra as mulheres; Assistência de enfermagem às mulheres que sofrem violência e; Capacitação para o reconhecimento da violência pela própria mulher e pelo enfermeiro. Conclusões e implicações para a prática A assistência de enfermagem às mulheres em situação de violência ainda é de difícil abordagem no contexto da Atenção Primária à Saúde, o que é agravado pela dificuldade da mulher em revelar a sua própria violência e também do profissional que percebe sua incapacidade para reconhecer as situações que envolvem violência.

Brasil-Canadá: Lançando Sementes Através De Consulta Comunitária sobre o enfrentamento da violência contra a mulher

RESUMO Objetivos Relatar a primeira experiência da Cátedra de Pesquisa em Saúde Urbana (Universidade Ryerson-Canadá) no Brasil, em colaboração com a Universidade Federal da Paraíba por meio de uma consulta de opinião comunitária sobre as estratégias de enfrentamento da violência contra a mulher, e oferecer subsídios que estimulem uma visão renovada de colaborações e parcerias internacionais entre programas de Enfermagem. Método Abordagem descritiva do tipo relato de experiência de docentes e discentes de Enfermagem brasileiros e canadenses, desde o processo de planejamento até a análise das informações obtidas. Resultados Essa experiência foi fundamental para o estabelecimento de colaborações científicas recentemente implementadas e em planejamento, consolidando o potencial da Enfermagem em participar de acordos científicos e tecnológicos entre Brasil-Canadá. Conclusão e Implicações para a prática Recomendamos que programas de graduação e pós-graduação de Enfermagem no Brasil promovam o intercâmbio de seu corpo social com diversos países, não apenas em projetos de pesquisa, mas também em projetos de desenvolvimento social valorizados igualmente na construção de um corpo de conhecimentos para a Enfermagem global.

Mortality risk among women exposed to violence in Brazil: a population-based exploratory analysis

OBJECTIVES

The objective of this study was to estimate mortality risk among women exposed to violence in Brazil using population-based data.

STUDY DESIGN

This study used a linked database containing nearly 800,000 violence (against women) notifications and 16,500 associated deaths over the period 2011-2016.

METHODS

Aggregate age-standardized population-based rates of mortality were built to estimate risk ratios (RRs) at the national and state level, and for different forms of violence and causes of death, as well as type of offender involved, and across various characteristics of the women. RRs compared the rate of mortality among women exposed to violence with that in the general population of women - excess mortality due to violence was also derived from this comparison. The analysis was divided into two time periods (2011-13 and 2014-16).

RESULTS

During 2014-16, women exposed to violence had an estimated mortality risk that was 8.3 [95% confidence interval (CI): 8.2-8.5] times higher than that of the general woman population, and an estimated 100 women died on a weekly basis as a direct or indirect consequence of exposure to violence. Higher (all-cause) mortality risk was associated with physical violence and violence that involved repetition and that was self-inflicted. The risk of mortality increased when the cause of death involved external causes (RR: 51.2, 95% CI: 49.6-52.8). When death was attributable to (i) non-communicable diseases and (ii) communicable, maternal, neonatal, and nutritional diseases, the risk was 5.4 [95% CI: 5.3-5.6] and 6.7 [95% CI: 6.1-7.2] times, respectively. Women at greatest (all-cause) mortality risk include white and multiracial (parda) and single women in the age group 10-29 years, who live in the northeast part of the country. When the offender was a partner/ex., women aged 10-19 years showed the greatest (all-cause) mortality risk at 16.9 [95% CI: 13.9-19.8] times. Higher risk was also observed within the age group 30-59 years when death was attributable to external causes (RR: 74.6, 95% CI: 71.3-77.9). For younger women and girls, there was a clear gradient in (all-cause) mortality risk, with those living in the poorest municipalities at greater risk. Age-specific mortality risk also showed significant variation within and across states.

CONCLUSIONS

This analysis suggests that most women exposed to violence will likely experience an increased risk of mortality, regardless of her place of residence, age group, racial/ethnic background, marital status situation, and socio-economic status. The estimated RRs are only an approximation given the design of this analysis and should be interpreted with caution.

Understanding marital violence: a study in grounded theory

Objective:

to understand the phenomenon of marital violence based on the experience of women in judicial process and network professionals.

Method:

a qualitative study, with theoretical-methodological support in grounded theory. Data collection took place in two regional Courts for Peace in the Home in a municipality of the Brazilian Northeast. Interviews were conducted with 38 participants, who composed two sample groups: women in situations of violence and network professionals.

Results:

the understanding of marital violence emerged for the phenomenon “Experiencing marital violence as a progressive and cyclical process, with repercussions for health and implications for social relations”.

Conclusion:

in recognizing marital violence as a recurring problem in the life of women, with implications for their own health and that of their children, the study points to the relevance of coping strategies based on institutional and social support.

Profile of aggressors of older adults receiving care at a geriatrics and gerontology reference center in the Distrito Federal (Federal District), Brazil

Abstract Objective: To profile aggressors of older adults who receive care at a reference center in geriatrics and gerontology in the Distrito Federal (Federal District), Brazil, from 2008 to 2018. Method: A retrospective, documentary, descriptive study with a quantitative approach was performed, based on information obtained from the minutes book of the unit, which contained a record of mediation meetings of cases of conflict and violence against older adults, carried out by social workers, nurses and other members of the multidisciplinary team. The data collection instrument covered the sociodemographic characteristics of the aggressor, the sociodemographic and health profile of the older adults and the type of violence suffered. Result: 111 cases were analyzed. The children of the older adults were the main aggressors (72%), with a prevalence of men (62%) and the from 51 to 60 year age group (37%). The older adults who suffered violence were predominantly women (72%), almost half of whom were aged 81 to 90 years, followed by those aged 71 to 80 years (39%). A total of 16% of the older adults lived with their children or close family members. The main types of violence evidenced were negligence (56%) and psychological violence (29%), with physical violence representing 8% of cases. Conclusion: The study of the profile of the aggressor and the older adult who suffered violence reinforced the need to focus actions within family arrangements. Investigations that address those who practice violence can contribute to the promotion of public health policies and contribute to geriatric and gerontological clinical practices that combat violence against older adults.

Atuação dos enfermeiros na identificação e notificação dos casos de violência contra a mulher

O trabalho teve como questão norteadora: como é a atuação dos enfermeiros na identificação e notificação dos casos de violência contra a mulher nas Unidades de Pronto Atendimento? Assim, objetivou compreender a atuação destes profissionais na identificação e notificação dos casos de violência contra a mulher nessa modalidade de atendimento do Sistema Único de Saúde. Pesquisa qualitativa, realizada em 2014. Os sujeitos foram dez enfermeiros, sendo a amostra escolhida por conveniência e por critérios que englobaram o objetivo do estudo: pertencimento ao quadro funcional da UPA e atuação em gerência e/ou na assistência aos usuários. Utilizou-se entrevista semiestruturada, com questões que abordaram: a identificação dos tipos de violência mais frequente no serviço e o papel do enfermeiro na notificação, bem como a dificuldade para efetuá-la. A análise se deu de acordo com a análise do conteúdo de Bardin. Os tipos de violências mais comuns, dentificados pelos enfermeiros entrevistados, foram a psicológica e a física. O processo de identificação e notificação dos casos de violência contra a mulher esbarra na falta de preparo e o receio dos enfermeiros se envolverem no caso. Os mesmos confundem o ato de notificar com denúncia e criminalização, contribuindo para a invisibilidade do problema. É preciso capacitação, reflexão e suporte aos enfermeiros para que se sintam aptos e seguros a trabalhar com a problemática, uma vez que este tem um papel crucial na detecção de casos de violência contra a mulher nos serviços de saúde.