Ivan França-Junior

Violence against women: a study in a primary healthcare unit

OBJECTIVES There is scarce information on violence against women in the Brazilian society. This fact is rarely reported in medical records as part of the diagnosis and case management, despite evidence showing the significant impact of violence on the populations health. The study aim was to estimate the occurrence of violence against women, and to determine the nature and magnitude of the violent action and the relationship between women and her aggressors. METHODS The study was conducted among women seen in a primary care unit of the city of São Paulo, Brazil, in a two-month period in 1998. The occurrence of violence cases was ascertained using standardized interviews to all women aged 15 to 49 years who sought health care during the study. Three-hundred and twenty-two women were interviewed. RESULTS Of the participants, 143 (44.4%; IC95%=38.9-49.8%) reported at least one episode of physical violence in their adult life, 110 of those perpetrated by their partners or family members (34.1%; IC95%=28.9-39.3%). Thirty-seven women (11.5%; IC95%=8.0-14.9%) reported at least one episode of sexual violence in their adult life, 23 of those perpetrated by their partners or family members (7.1%; IC95%=4.3-9.9%). CONCLUSIONS As reported in other countries, physical and sexual violence is highly frequent among women seen in primary care services. In most cases their partners and family members are the perpetrators and the episodes are mostly serious and recurrent.

Violence against women by their intimate partner and common mental disorders.

The World Health Organization considers gender violence a cause of anxiety, depression and suicidal thoughts among women. This study investigated the association between violence committed against women by their intimate partners, defined by psychologically, physically and sexually abusive acts, and common mental disorders, assessed by using the Self Reporting Questionnaire (SRQ-20). A population-based household survey was carried out among women aged 15-49 years in two sites: São Paulo, the largest Brazilian city, and Zona da Mata of Pernambuco, a region with both urban and rural areas in the Northeast of the country. A large proportion of women reported violence (50.7%). The most frequent forms were psychological violence alone (18.8%) or accompanied by physical violence (16.0%). The prevalence of mental disorders was 49.0% among women who reported any type of violence and 19.6% among those who did not report violence (p<0.0001). After adjustment for demographic and socioeconomic characteristics, the nature of the relationship, stressful life events and social support, all the forms of violence studied, with the exception of sexual violence alone or accompanied by either physical or psychological violence (p=0.09), were significantly associated with mental disorders: physical violence alone (OR1.91; CI 95%1.2-3.0), psychological violence alone (OR 2.00; CI 95% 1.5-2.6), sexual violence alone or accompanied by either physical or psychological violence (OR1.80; CI95% 0.9-3.6), both psychological and physical violence (OR 2.56; CI 95% 1.9-3.5) and all three forms of violence (OR 2.68; CI 95% 1.8-4.0). This is the first population-based study on the association between intimate partner violence and mental health in Brazil. It contributes to the existing body of research and confirms that violence, frequently experienced by women in the country, is associated with mental disorders. Policies and strategies aimed at reducing gender-based violence are necessary for preventing and reducing anxiety and depression among women.

Fatores associados à violência por parceiro íntimo em mulheres brasileiras

OBJETIVO: Estimar a prevalencia e os fatores associados a violencia fisica e/ou sexual por parceiro intimo em diferentes contextos socioculturais. METODOS: Estudo transversal, participante do WHO Multi-country Study on Womens Health and Domestic Violence against women, com amostra representativa de mulheres no municipio de Sao Paulo e Zona da Mata de Pernambuco, regiao com normas mais tradicionais de genero. Foram entrevistadas no domicilio 940 mulheres de Sao Paulo e 1.188 da Zona da Mata, entre 2000-1, com idade entre 15 a 49 anos que tiveram parceria afetivo-sexual com homens alguma vez na vida. Foram construidos tres conjuntos de fatores, correspondentes a blocos hierarquicamente ordenados: caracteristicas sociodemograficas, familiares e aspectos referentes a autonomia/submissao feminina. Utilizou-se regressao logistica hierarquica na analise dos fatores associados a violencia por parceiro intimo em cada local. RESULTADOS: Encontrou-se prevalencia de 28,9% em Sao Paulo (IC 95% 26,0;31,8) e 36,9% (IC 95% 34,1;39,6) na Zona da Mata. Escolaridade ate oito anos, violencia fisica conjugal entre os pais da mulher, abuso sexual na infância, cinco ou mais gestacoes e problemas com a bebida mostraram-se associados a violencia por parceiro intimo em ambos locais. Autonomia financeira da mulher, uniao informal, idade e consentimento na primeira relacao sexual mostraram-se associadas a maiores taxas apenas na Zona da Mata. As caracteristicas socioeconomicas associadas no primeiro bloco foram mediadas por outros fatores no modelo final. CONCLUSOES: Os achados mostram a relativizacao dos fatores socioeconomicos diante de outros, em especial os representantes de atributos de genero. Nas duas localidades estudadas foram encontradas diferencas socioculturais que se refletiram nos fatores associados.

Prevenção do câncer de colo do útero: um modelo teórico para analisar o acesso e a utilização do teste de Papanicolaou

Several studies have indicated that the prevailing high incidence and mortality rates of cervical cancer, mainly in developing countries, are due to the low quality and coverage of the cervical smear or Papanicolaou (Pap) test. This article intends to analise some aspects related to measures of control and prevention of cervical cancer, such as the effectiveness of the Pap test, the operational and scientific rationale of public health policies for the prevention of cervical cancer and coverage of the Papanicolaou test in many countries. It also intends to review the explanatory models that have been proposed to analyze access to this service. For this latter objective, we investigated the factors associated to the use of the Pap test described within the epidemiological literature and we proposed a new approach in the investigation of these factors, incorporating social, cultural and organizational aspects in the analysis of access to and use of this practice so that measures of prevention and control may be more coherent with the needs and the rights of women.

Factors associated with intimate partner violence against Brazilian women

OBJETIVO: Estimar a prevalencia e os fatores associados a violencia fisica e/ou sexual por parceiro intimo em diferentes contextos socioculturais. METODOS: Estudo transversal, participante do WHO Multi-country Study on Womens Health and Domestic Violence against women, com amostra representativa de mulheres no municipio de Sao Paulo e Zona da Mata de Pernambuco, regiao com normas mais tradicionais de genero. Foram entrevistadas no domicilio 940 mulheres de Sao Paulo e 1.188 da Zona da Mata, entre 2000-1, com idade entre 15 a 49 anos que tiveram parceria afetivo-sexual com homens alguma vez na vida. Foram construidos tres conjuntos de fatores, correspondentes a blocos hierarquicamente ordenados: caracteristicas sociodemograficas, familiares e aspectos referentes a autonomia/submissao feminina. Utilizou-se regressao logistica hierarquica na analise dos fatores associados a violencia por parceiro intimo em cada local. RESULTADOS: Encontrou-se prevalencia de 28,9% em Sao Paulo (IC 95% 26,0;31,8) e 36,9% (IC 95% 34,1;39,6) na Zona da Mata. Escolaridade ate oito anos, violencia fisica conjugal entre os pais da mulher, abuso sexual na infância, cinco ou mais gestacoes e problemas com a bebida mostraram-se associados a violencia por parceiro intimo em ambos locais. Autonomia financeira da mulher, uniao informal, idade e consentimento na primeira relacao sexual mostraram-se associadas a maiores taxas apenas na Zona da Mata. As caracteristicas socioeconomicas associadas no primeiro bloco foram mediadas por outros fatores no modelo final. CONCLUSOES: Os achados mostram a relativizacao dos fatores socioeconomicos diante de outros, em especial os representantes de atributos de genero. Nas duas localidades estudadas foram encontradas diferencas socioculturais que se refletiram nos fatores associados.

Repercussão da exposição à violência por parceiro íntimo no comportamento dos filhos

OBJETIVO: Analisar a associacao entre a exposicao a violencia por parceiro intimo (VPI) contra a mulher com desajustes comportamentais e problemas escolares entre os filhos. METODOS: Inquerito populacional participante do WHO Multicountry Study on Violence Against Women, com 790 mulheres que coabitam com filhos de cinco a 12 anos, residentes no Municipio de Sao Paulo, SP, e na Zona da Mata de Pernambuco. Foram realizados tres modelos multiplos para estimar a forca da associacao entre variaveis explanatorias de apoio social e comunitario, eventos de vida estressantes, fatores sociodemograficos e gravidade da VPI, entre outras. Os modelos incluiram tres respectivos desfechos: numero de problemas de comportamento; agressividade; e interrupcao abandono ou repetencia escolar. RESULTADOS: A exposicao a VPI fisica e/ou sexual grave esteve associada a ocorrencia de problemas escolares, de problemas de comportamento em geral e de comportamentos agressivos na analise de regressao logistica univariada. A exposicao a VPI grave manteve-se associada a ocorrencia de tres ou mais problemas de comportamento entre seus filhos, independentemente do transtorno mental comum, da baixa escolaridade, de a mae (avo) ter sido vitima de VPI fisica e do apoio social e comunitario nos modelos de regressao logistica multiplos. A VPI grave esteve associada ao comportamento agressivo e aos problemas escolares, depois do ajuste por outras variaveis sociodemograficas, entre outras. O estado de saude mental materna constituiu-se em fator mediador da relacao entre a exposicao a VPI e os problemas de comportamento, sobretudo agressividade. CONCLUSOES: A VPI grave afeta o comportamento dos filhos e deve ser incluida na assistencia a saude das criancas em idade escolar, por meio de intervencoes conjuntas entre criancas e maes.

Crianças órfãs e vulneráveis pelo HIV no Brasil: onde estamos e para onde vamos?

O objetivo do artigo foi identificar a magnitude e a situacao de alguns direitos humanos, conforme expressos na United Nations General Assembly Special Session on HIV/AIDS, de criancas e adolescentes portadores de HIV/Aids, afetados nao-orfaos e orfaos por Aids, com base em pesquisa sobre o tema na literatura cientifica nacional e internacional. Os principais achados nao permitiram indicar com seguranca quantos seriam as criancas e os adolescentes portadores do HIV e afetados nao-orfaos. Ha informacoes sobre o numero de portadores de Aids e de orfaos. Estas estimativas, sejam elas oriundas do sistema de vigilância, modelos matematicos ou inqueritos, sao discutidas em suas limitacoes e possibilidades. Apesar da literatura ainda ser relativamente pequena, ha indicios de comprometimento de varios direitos como saude, educacao, moradia, alimentacao, nao discriminacao, integridade fisica e mental. Verificou-se que o Brasil ainda precisa avancar para responder as necessidades adicionais dos orfaos e outras criancas vulneraveis. A resposta brasileira, ate o momento, e limitada a assistencia medica para criancas e adolescentes portadores do HIV/Aids, ao combate a transmissao vertical do HIV e ao financiamento da instalacao e manutencao de casas de apoio (abrigos pelo Estatuto da Crianca e do Adolescente) para infectados afetados, orfaos ou nao. Essas medidas sao insuficientes para garantir um ambiente de apoio para orfaos, criancas e adolescentes infectados ou afetados pelo HIV/Aids. Propoem-se formas do Brasil criar e aprimorar bases de dados para responder a esses desafios.

Impact of exposure to intimate partner violence on children's behavior

OBJETIVO: Analisar a associacao entre a exposicao a violencia por parceiro intimo (VPI) contra a mulher com desajustes comportamentais e problemas escolares entre os filhos. METODOS: Inquerito populacional participante do WHO Multicountry Study on Violence Against Women, com 790 mulheres que coabitam com filhos de cinco a 12 anos, residentes no Municipio de Sao Paulo, SP, e na Zona da Mata de Pernambuco. Foram realizados tres modelos multiplos para estimar a forca da associacao entre variaveis explanatorias de apoio social e comunitario, eventos de vida estressantes, fatores sociodemograficos e gravidade da VPI, entre outras. Os modelos incluiram tres respectivos desfechos: numero de problemas de comportamento; agressividade; e interrupcao abandono ou repetencia escolar. RESULTADOS: A exposicao a VPI fisica e/ou sexual grave esteve associada a ocorrencia de problemas escolares, de problemas de comportamento em geral e de comportamentos agressivos na analise de regressao logistica univariada. A exposicao a VPI grave manteve-se associada a ocorrencia de tres ou mais problemas de comportamento entre seus filhos, independentemente do transtorno mental comum, da baixa escolaridade, de a mae (avo) ter sido vitima de VPI fisica e do apoio social e comunitario nos modelos de regressao logistica multiplos. A VPI grave esteve associada ao comportamento agressivo e aos problemas escolares, depois do ajuste por outras variaveis sociodemograficas, entre outras. O estado de saude mental materna constituiu-se em fator mediador da relacao entre a exposicao a VPI e os problemas de comportamento, sobretudo agressividade. CONCLUSOES: A VPI grave afeta o comportamento dos filhos e deve ser incluida na assistencia a saude das criancas em idade escolar, por meio de intervencoes conjuntas entre criancas e maes.

The Role of School Environment in Physical Activity among Brazilian Adolescents

Objective To analyze the association of physical activity facilities and extracurricular sports activities in schools with physical activity among adolescents. Methodology/Principal Findings We used data collected for the National Survey of School Health in 2012. The national representative sample comprised 109,104 Brazilian students from 2,842 schools. We calculated the prevalence of participation in physical education classes, leisure-time physical activity, and total physical activity level. We also evaluated the following physical activity facilities: sports courts, running/athletics tracks, schoolyard with teacher-directed physical activities, swimming pools, locker rooms; and the offer of extracurricular sports activities. Schools with at least one physical activity facility had increased odds of participation in physical education (OR 1.59; 95% CI 1.20 to 2.10). However, in order to increase leisure-time physical activity (OR1.14; 95% CI 1.03 to 1.26) and total physical activity level (OR 1.15; 95% CI 1.06 to 1.24) at least four and two facilities, respectively, were necessary. Extracurricular sports activities in schools were positively associated with leisure-time physical activity and physical activity level. The number of sports courts and swimming pool in a school were associated with participation in physical education classes. Availability of sports courts, running/athletics tracks, and swimming pool in schools were associated with leisure-time physical activity. Total physical activity was associated with schools with sports courts, schoolyard with teacher-directed physical activities, and swimming pool. Conclusions School-level characteristics have important potential to increase the possibility of engagement in physical activity in and out of school, and therefore have a fundamental role in promoting these practices.

Antiretroviral treatment adherence in childhood and adolescence: Multidisciplinary team as an associated factor in Brazil

Our aim was to analyze factors associated with non-adherence to antiretroviral (ARV) treatment among children and adolescents. A cross-sectional study was carried out involving non-institutionalized children and adolescents between 2 and 20 years of age, addressing non-adherence to ARV treatment, which was defined as taking ≤89% of the medications on the day of the interview and the three previous days. The investigation into the association between non-compliance and the variables of interest was performed using unconditional logistic regression. The independent factors associated with non-adherence were forgetfulness (OR = 3.22; 95%CI = 1.75–5.92), difficulties coping with treatment (OR = 2.65; 95%CI = 1.03–6.79), and living with grandparents (OR = 2.28; 95%CI = 1.08–4.83), whereas a protective effect was found with participation in multidisciplinary activities (OR = 0.49; 95%CI = 0.25–0.96), i.e., this factor indicates that the exposure to the variable is beneficial, promoting adherence. We concluded that forgetting to take the medications and reporting having difficulty coping with ARV treatment are potentially modifiable factors through educational and programmatic actions. Residing with ones grandparents may strongly impact adherence to ARV treatment, indicating the need for the systematic support of these family members. Participation in multidisciplinary activities should be stimulated at health-care services.