Anna Tereza Miranda Soares de Moura

[Detection of child abuse: missed opportunities in emergency rooms in Rio de Janeiro, Brazil].

Emergency rooms require special consideration since their often-distressful routines may hamper the detection and handling of family violence cases. This study estimated the magnitude of violence against children reported by users of two emergency hospitals in Rio de Janeiro, Brazil. It also evaluated the degree of underreporting by contrasting the present findings to cases reported routinely. 524 parents/guardians of children under 12 treated at the hospitals from January to March 2005 were interviewed. Twelve-month prevalence of family violence was measured with the Conflict Tactics Scales: Parent-Child (CTSPC). All cases reported by staff and officially recorded in the preceding year were identified. Prevalence of psychological aggression, negligence, and physical violence were 94.8% (95%CI: 92.9-96.2), 60.3% (95%CI: 55.9-64.7), and 47.2% (95%CI: 42.7-51.8), respectively. However, the corresponding prevalence rates according to routinely reported information were 0.007% (95%CI: 0.003-0.013), 0.24% (95%CI: 0.22-0.27), and 0.03% (95%CI: 0.02-0.04). This striking difference suggests that case identification and strategies to report violence against children in emergency rooms need to be reevaluated.

Violência urbana: um desafio para o pediatra

OBJECTIVES: To present the main aspects of an approach to urban violence among children and adolescents and to point out the social and educational role of pediatricians. SOURCES OF DATA: A literature review based on MEDLINE, LILACS and SciELO was carried out for the years 1993 to 2005, using the following keywords: urban violence, children and adolescents. In addition to the review, policies and institutional reports on violence were also analyzed. SUMMARY OF THE FINDINGS: The causal relationship of violence is presented in a range of different ways, from personal points of view to broader structural aspects. The literature suggests that urban violence results from varied actions, and also from specific risk behaviors. It is a worrying and complex phenomenon that results in high levels of morbidity and mortality, affecting children and adolescents. Special attention was given to homicide and to the psychological results of violent acts. Firearms are the most lethal instruments among adolescents and young males when compared to all other causes of death. CONCLUSIONS: Urban violence is one of the main social problems in Brazil. Violence prevention requires intersectoral and multiprofessional actions with the participation of the government and of the organized civil society. Children, and above all adolescents, are the groups that are most widely exposed to the consequences of urban violence. Pediatricians can have an important role in the process of prevention, diagnosis and treatment. Through their wide-ranging abilities, pediatricians are well-positioned to help victims and their families to establish a healthy and dynamic relationship with their environment and with themselves.

Violência contra a mulher ou mulheres em situação de violência? Uma análise sobre a prevalência do fenômeno

Objective To reflect upon possible differences between the terms “violence against women” and “women in a situation of violence” from the analysis of the occurrence of intimate partner violence. Methods It’s a cross-sectional study with a sample of 640 women, aged between 20 and 64, in four Health Family Units in the municipality of Nova Iguacu (RJ). The instrument used was the Portuguese version for the Revised Conflict Tactics Scales, that evaluated the forms – and their intersection – physical, psychological and sexual violence suffered and perpetrated by women at least once in life. Results It has been estimated the prevalence of intimate forms of violence practiced against women (9.8%; IC95%: 7.5/12.1), by women (4.5%; IC95%: 2.9/6.1), and in the cases that the women was the victim or perpetrator of the acts (13.1%; IC95%: 10.5/15.7), it was assumed in this study as violence in couples. Conclusion In an attempt to better understand the dynamics of intimate partner violence, it would be useful to consider role mobility within the couple beyond the demarcation of genre – historical and sometimes immobilizing – between victim and assailant.

Considerações éticas sobre pesquisas com mulheres em situação de violência

Este ensaio tem por objetivo refletir sobre os principios etico-metodologicos envolvidos em pesquisas com mulheres em situacao de violencia. O texto discute a aplicacao dos principios da beneficencia e nao maleficencia durante as pesquisas que envolvem esta tematica, apontando para recomendacoes balizadas pela privacidade, autonomia e contribuicoes imediatas para os sujeitos voluntarios. A seguir, tomando como referencial teorico os principios da justica e equidade, os autores propoem um debate sobre os aspectos metodologicos envolvidos na garantia de protecao das entrevistadas, com vistas a melhoria da qualidade dos dados obtidos e possiveis contribuicoes sociais.This essay aims at reflecting on the ethical and methodological principles involved in research with women in situation of violence. The text raises the discussion of the application of the principles of beneficence and non-maleficence during researches involving this issue, pointing to recommendations towards privacy, autonomy and immediate contributions for volunteers. Then, taking as theoretical reference the principles of justice and equity, the authors propose a debate on methodological aspects involved in protection of respondents, with a view at improving the quality of the data obtained and possible social contributions.

Urban violence: a challenge for pediatricians

OBJECTIVES To present the main aspects of an approach to urban violence among children and adolescents and to point out the social and educational role of pediatricians. SOURCES OF DATA A literature review based on MEDLINE, LILACS and SciELO was carried out for the years 1993 to 2005, using the following keywords: urban violence, children and adolescents. In addition to the review, policies and institutional reports on violence were also analyzed. SUMMARY OF THE FINDINGS The causal relationship of violence is presented in a range of different ways, from personal points of view to broader structural aspects. The literature suggests that urban violence results from varied actions, and also from specific risk behaviors. It is a worrying and complex phenomenon that results in high levels of morbidity and mortality, affecting children and adolescents. Special attention was given to homicide and to the psychological results of violent acts. Firearms are the most lethal instruments among adolescents and young males when compared to all other causes of death. CONCLUSIONS Urban violence is one of the main social problems in Brazil. Violence prevention requires intersectoral and multiprofessional actions with the participation of the government and of the organized civil society. Children, and above all adolescents, are the groups that are most widely exposed to the consequences of urban violence. Pediatricians can have an important role in the process of prevention, diagnosis and treatment. Through their wide-ranging abilities, pediatricians are well-positioned to help victims and their families to establish a healthy and dynamic relationship with their environment and with themselves.

Exposição aos fatores de risco do câncer do colo do útero na Estratégia de Saúde da Família de Nova Iguaçu, Rio de Janeiro, Brasil

Cervical cancer is a relevant public health problem in Brazil and in the world. Among the scenarios of health care, the Family Health Strategy seems to be a remarkable locus for its control. The aim of the study was to analyze the profile of clients and of cervical cancer screening usage on the Family Health Strategy of the municipality of Nova Iguacu, Rio de Janeiro, Brazil. Its a cross-sectional study based on household survey with a sample of 281 women aged between 20 and 59 years. It was observed that 95.37% of the respondents (95%CI 92.90-97.84) reported having done the exam once in their lives. Only 33.80% (95%CI 28.24-39.37) of them were not given an examination last year. It was observed that 79.71% (95%CI 74.98-84.44) of the women perform as a routine search for the cancer. It was found that the Family Health Strategy has been surpassing expectations and following the recommendations on the quantitative screening of cervical cancer. However, the risk factors profile and the interval between examinations emphasize the need for reflection on possible gaps in the organization and quality of prevention methods and early detection of the disease.

Relações entre a atenção primária e as internações por condições sensíveis em um hospital universitário

OBJECTIVE To analyze the relations between the presence and orientation of the Primary Health Care and hospitalizations due to sensitive conditions to primary care in a university hospital. METHOD This is a sectional study with a sample of 197 subjects hospitalized from March to June 2016 in the medical clinic of a university hospital in Juiz de Fora. The assessment, conducted through interviews, used the Primary Health Care Assessment Tool, reduced version for adults, and the Brazilian list of sensitive conditions, edited by the Ministry of Health. RESULTS The regular frequency of the Primary Care was associated with hospitalizations (OR:2,06), especially related to the low performance of the access attributes (OR:5,3) and the comprehensives (OR:4,7). CONCLUSION The low orientation of the Primary Care attributes suggests that only the coverage at this level may not be sufficient to reduce these hospitalizations, but the way it is organized and effective at the community level.

Profile of intimate partner violence in Family Health Units

OBJECTIVE To estimate the profile of intimate partner violence involving women in a scenario of Family Health Strategy in the municipality of Nova Iguaçu (Rio de Janeiro). METHOD A transversal study was conducted in four units with a sample of 640 women between the ages of 25 to 64. The phenomena of violence was determined using the tool Revised Conflict Tactics Scales, validated for Brazil. Statistical analysis took into consideration an estimation of prevalence in the calculation of the p values. RESULTS The situations of violence and the sociodemographic profiles demonstrated a statistically significant relationship with the variables of educational level and housing conditions. Age, ethnicity and economic class demonstrated an association with certain types of violence, varying in type and severity. CONCLUSION The study investigated the profile of these situations of violence and enabled reflection regarding the approaches adopted by the Family Health Strategy teams.

Ethical considerations about research with women in situations of violence

Este ensaio tem por objetivo refletir sobre os principios etico-metodologicos envolvidos em pesquisas com mulheres em situacao de violencia. O texto discute a aplicacao dos principios da beneficencia e nao maleficencia durante as pesquisas que envolvem esta tematica, apontando para recomendacoes balizadas pela privacidade, autonomia e contribuicoes imediatas para os sujeitos voluntarios. A seguir, tomando como referencial teorico os principios da justica e equidade, os autores propoem um debate sobre os aspectos metodologicos envolvidos na garantia de protecao das entrevistadas, com vistas a melhoria da qualidade dos dados obtidos e possiveis contribuicoes sociais.This essay aims at reflecting on the ethical and methodological principles involved in research with women in situation of violence. The text raises the discussion of the application of the principles of beneficence and non-maleficence during researches involving this issue, pointing to recommendations towards privacy, autonomy and immediate contributions for volunteers. Then, taking as theoretical reference the principles of justice and equity, the authors propose a debate on methodological aspects involved in protection of respondents, with a view at improving the quality of the data obtained and possible social contributions.

Consideraciones éticas sobre investigaciones con mujeres en situación de violencia

Este ensaio tem por objetivo refletir sobre os principios etico-metodologicos envolvidos em pesquisas com mulheres em situacao de violencia. O texto discute a aplicacao dos principios da beneficencia e nao maleficencia durante as pesquisas que envolvem esta tematica, apontando para recomendacoes balizadas pela privacidade, autonomia e contribuicoes imediatas para os sujeitos voluntarios. A seguir, tomando como referencial teorico os principios da justica e equidade, os autores propoem um debate sobre os aspectos metodologicos envolvidos na garantia de protecao das entrevistadas, com vistas a melhoria da qualidade dos dados obtidos e possiveis contribuicoes sociais.This essay aims at reflecting on the ethical and methodological principles involved in research with women in situation of violence. The text raises the discussion of the application of the principles of beneficence and non-maleficence during researches involving this issue, pointing to recommendations towards privacy, autonomy and immediate contributions for volunteers. Then, taking as theoretical reference the principles of justice and equity, the authors propose a debate on methodological aspects involved in protection of respondents, with a view at improving the quality of the data obtained and possible social contributions.