Maria Fernanda Tourinho Peres

Mortalidade por homicídios no Brasil na década de 90: o papel das armas de fogo

OBJECTIVE: To describe the growth of homicide death in Brazil and to investigate the contribution of firearms to homicide death growth in the 90s. METHODS: An ecological descriptive time series was carried out for the period 1991 to 2000. External cause mortality data were obtained according to place of residence for the overall population and by gender from the Ministry of Health Mortality Information System. Homicides were classified as firearm, non-firearm and unknown (weapon) deaths. Proportional mortality and mortality rates (by 100,000) were calculated. RESULTS: Homicides accounted for 33% of all external cause deaths in the 90s. Firearms were used in more than 50% of deaths in 1991 and in almost 70% in 2000. This growth was seen for both genders and in all state capitals. Homicide mortality rate grew 27.5% in the whole country, and firearm homicide mortality rate grew 72.5%. During the same period there was a drop in deaths classified as unknown weapon homicide, which could partially explain the growth seen in firearm homicide rates. CONCLUSIONS: Data suggest the magnitude of firearm contribution for the growing tendency of homicide deaths in Brazil in the 90s. Data quality regarding intentionality and type of weapon used has hindered data analysis.OBJECTIVE To describe the growth of homicide death in Brazil and to investigate the contribution of firearms to homicide death growth in the 90s. METHODS An ecological descriptive time series was carried out for the period 1991 to 2000. External cause mortality data were obtained according to place of residence for the overall population and by gender from the Ministry of Health Mortality Information System. Homicides were classified as firearm, non-firearm and unknown (weapon) deaths. Proportional mortality and mortality rates (by 100,000) were calculated. RESULTS Homicides accounted for 33% of all external cause deaths in the 90s. Firearms were used in more than 50% of deaths in 1991 and in almost 70% in 2000. This growth was seen for both genders and in all state capitals. Homicide mortality rate grew 27.5% in the whole country, and firearm homicide mortality rate grew 72.5%. During the same period there was a drop in deaths classified as unknown weapon homicide, which could partially explain the growth seen in firearm homicide rates. CONCLUSIONS Data suggest the magnitude of firearm contribution for the growing tendency of homicide deaths in Brazil in the 90s. Data quality regarding intentionality and type of weapon used has hindered data analysis.

[Decline in homicide rates in Sao Paulo, Brasil: a descriptive analysis].

OBJECTIVE To describe homicide mortality in the municipality of São Paulo according to type of weapon, sex, race or skin color, age, and areas of socioeconomic inequalities, between 1996 and 2008. METHOD For this ecological time-series study, data about deaths in the municipality of São Paulo were collected from the municipal program for improvement of mortality information, using International Classification of Diseases, 10th revision (ICD-10) codes. Homicide mortality rates (HMR) were calculated for the overall population and specifically for each sex, race or skin color, age range, type of weapon, and occurrence in social deprivation/affluence areas. HMR were adjusted for age using the direct method. The percentage age of variation in HMR was calculated for the study period. For areas of socioeconomic inequalities, the relative risk of death from homicide was calculated. RESULTS HMR fell 73.7% between 2001 and 2008. A reduction in HMR was observed in all groups, especially males (-74.5%), young men between 15 and 24 years of age (-78.0%), and residents in areas of extreme socioeconomic deprivation (-79.3%). The reduction occurred mostly in firearm homicide rates (-74.1%). The relative risk of death from homicide in areas of extreme socioeconomic deprivation, as compared to areas with some degree of socioeconomic deprivation, was 2.77 in 1996, 3.9 in 2001, and 2.13 in 2008. In areas of high socioeconomic deprivation, the relative risk was 2.07 in 1996 and 1.96 in 2008. CONCLUSIONS To understand the reduction in homicide rates in the municipality of São Paulo, it is important to take into consideration macrodeterminants that affect the entire municipality and all population subgroups, as well as micro/local determinants that have special impact on homicides committed with firearms and on subgroups such as the young, males, and residents of areas of high socioeconomic deprivation.

Homicídios, desenvolvimento socioeconômico e violência policial no Município de São Paulo, Brasil

OBJECTIVE To analyze the association between police violence and homicide mortality rates taking into consideration the effect of contextual variables. METHODS This was an environmental, cross-sectional study that included the 96 census districts in the City of São Paulo. The association between the variables was analyzed using Spearmans rank correlation and simple and multiple regression analysis. RESULTS Univariate analysis revealed a strong and significant association between homicide mortality coefficients and all the indicators of socioeconomic development and police violence. After controlling for potential confounding factors, the association between police violence and homicide mortality coefficients remained strong and significant. This significance was lost only after control for the size of the resident population. CONCLUSION The results indicate that police action that violates basic human rights is not the right answer to urban violence. The combination of homicides from interpersonal violence and deaths from police violence results in negative socialization and promotes further violence.OBJETIVO: Analisar a associacao entre violencia policial e coeficientes de mortalidade por homicidio, considerando o efeito de variaveis contextuais. METODOS: Estudo ecologico de corte transversal considerando os 96 distritos censitarios do Municipio de Sao Paulo. A associacao entre as variaveis foi determinada atraves de correlacao de Spearman e de analise de regressao linear simples e multipla. RESULTADOS: Nas analises univariadas, encontramos associacao forte e significativa entre os coeficientes de mortalidade por homicidio e todos os indicadores de desenvolvimento socioeconomico e violencia policial. Apos controle dos potenciais confundidores, a associacao entre a violencia policial e os coeficientes de mortalidade por homicidio manteve-se forte e significativa. Apenas com o controle para o tamanho da populacao residente a associacao perdeu a significância estatistica. CONCLUSAO: Os resultados indicam que uma acao policial centrada na violacao de direitos humanos basicos nao parece ser a resposta correta para o enfrentamento da violencia urbana. A combinacao de homicidios que resultam de violencia interpessoal com mortes por violencia policial representa uma situacao de socializacao negativa, favorecendo ainda mais violencia.

Evolução dos homicídios e indicadores de segurança pública no Município de São Paulo entre 1996 a 2008: um estudo ecológico de séries temporais

The scope of this paper was to analyze the association between homicides and public security indicators in Sao Paulo between 1996 and 2008, after monitoring the unemployment rate and the proportion of youths in the population. A time-series ecological study for 1996 and 2008 was conducted with Sao Paulo as the unit of analysis. Dependent variable: number of deaths by homicide per year. Main independent variables: arrest-incarceration rate, access to firearms, police activity. Data analysis was conducted using Stata.IC 10.0 software. Simple and multivariate negative binomial regression models were created. Deaths by homicide and arrest-incarceration, as well as police activity were significantly associated in simple regression analysis. Access to firearms was not significantly associated to the reduction in the number of deaths by homicide (p>0,05). After adjustment, the associations with both the public security indicators were not significant. In Sao Paulo the role of public security indicators are less important as explanatory factors for a reduction in homicide rates, after adjustment for unemployment rate and a reduction in the proportion of youths. The results reinforce the importance of socioeconomic and demographic factors for a change in the public security scenario in Sao Paulo .

Fall in homicides in the city of São Paulo: an exploratory analysis of possible determinants

Throughout the first decade of the 2000s the homicide mortality rate (HMR) showed a significant reduction in the state and the city of São Paulo (MSP). The aim of this study is to describe the trend of HMR, socio-demographic indicators, and the investment in social and public security, and to analyze the correlation between HMR and independent variables in the MSP between 1996 and 2008. An exploratory time series ecological study was conducted. The following variables were included: HMR per 100,000 inhabitants, socio-demographic indicators, and investments in social and public security. The moving-averages for all variables were calculated and trends were analyzed through Simple Linear Regression models. Annual percentage changes, the average annual change and periodic percentage changes were calculated for all variables, and the associations between annual percentage changes were tested by Spearmans correlation analysis. Correlations were found for the proportion of youth in the population (r = 0.69), unemployment rate (r = 0.60), State budget for education and culture (r = 0.87) and health and sanitation (r = 0.56), municipal (r = 0.68) and State (r = 0.53) budget for Public Security, firearms seized (r = 0.69) and the incarceration rate (r = 0.71). The results allow us to support the hypothesis that demographic changes, acceleration of the economy, in particular the fall in unemployment, investment in social policies and changes in public security policies act synergistically to reduce HMR in São Paulo. Complex models of analysis, incorporating the joint action of different potential explanatory variables, should be developed.

Vulnerabilidade e violência: uma nova concepção de risco para o estudo dos homicídios de jovens

No campo da saude publica, a violencia tem sido estudada em consonância com a classica abordagem de risco. Em geral, as analises desenvolvidas dentro desta perspectiva permitem evidenciar as tendencias populacionais de morbimortalidade, alem de identificarem fatores de risco relacionados na rede de causalidades. No entanto, embora importantes como fontes de informacao e hipoteses, isoladas essas analises nao sao capazes de dar conta da complexidade envolvida no fenomeno. Este artigo tem como objetivo iniciar uma reflexao sobre as possibilidades de uso do conceito de vulnerabilidade no estudo da violencia, especificamente no entendimento das situacoes que tornam os jovens as principais vitimas de homicidios. Propoe-se, assim, uma nova concepcao de risco que leva em consideracao os processos sociais e culturais presentes na vulnerabilidade desse grupo a violencia letal, por meio de uma perspectiva que apresente as especificidades inerentes a condicao juvenil e aos desafios representados pela conformacao social contemporânea.No campo da saude publica, a violencia tem sido estudada em consonância com a classica abordagem de risco. Em geral, as analises desenvolvidas dentro desta perspectiva permitem evidenciar as tendencias populacionais de morbimortalidade, alem de identificarem fatores de risco relacionados na rede de causalidades. No entanto, embora importantes como fontes de informacao e hipoteses, isoladas essas analises nao sao capazes de dar conta da complexidade envolvida no fenomeno. Este artigo tem como objetivo iniciar uma reflexao sobre as possibilidades de uso do conceito de vulnerabilidade no estudo da violencia, especificamente no entendimento das situacoes que tornam os jovens as principais vitimas de homicidios. Propoe-se, assim, uma nova concepcao de risco que leva em consideracao os processos sociais e culturais presentes na vulnerabilidade desse grupo a violencia letal, por meio de uma perspectiva que apresente as especificidades inerentes a condicao juvenil e aos desafios representados pela conformacao social contemporânea.

Patterns of health-related behaviours among adolescents: a cross-sectional study based on the National Survey of School Health Brazil 2012

Objectives The aim of this study was to analyse the clustering of multiple health-related behaviours among adolescents and describe which socio-demographic characteristics are associated with these patterns. Design Cross-sectional study. Setting Brazilian schools assessed by the National Survey of School Health (PeNSE, 2012). Participants 104 109 Brazilian ninth-grade students from public and private schools (response rate=82.7%). Methods Exploratory and confirmatory factor analyses were performed to identify behaviour clustering and linear regression models were used to identify socio-demographic characteristics associated with each one of these behaviour patterns. Results We identified a good fit model with three behaviour patterns. The first was labelled ‘problem-behaviour’ and included aggressive behaviour, alcohol consumption, smoking, drug use and unsafe sex; the second was labelled ‘health-compromising diet and sedentary behaviours’ and included unhealthy food indicators and sedentary behaviour; and the third was labelled ‘health-promoting diet and physical activity’ and included healthy food indicators and physical activity. No differences in behaviour patterns were found between genders. The problem-behaviour pattern was associated with male gender, older age, more developed region (socially and economically) and public schools (compared with private). The ‘health-compromising diet and sedentary behaviours’ pattern was associated with female gender, older age, mothers with higher education level and more developed region. The ‘health-promoting diet and physical activity’ pattern was associated with male gender and mothers with higher education level. Conclusions Three health-related behaviour patterns were found among Brazilian adolescents. Interventions to decrease those negative patterns should take into account how these behaviours cluster together and the individuals most at risk.

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.

Graves violações de direitos humanos e desigualdade no município de São Paulo

OBJETIVO: Analisar o perfil de graves violacoes de direitos humanos e sua associacao com aspectos socioeconomicos e demograficos. METODOS: Estudo ecologico, de corte transversal, tendo como unidade de analise os 96 distritos censitarios do municipio de Sao Paulo (SP) para o ano de 2000. Foi utilizado o banco de dados sobre graves violacoes de direitos humanos, do Nucleo de Estudos da Violencia da Universidade de Sao Paulo, que contem informacoes sobre todos os casos de execucoes sumarias, linchamento e violencia policial noticiados na imprensa escrita. Dados socioeconomicos e demograficos foram obtidos do Censo 2000 da Fundacao Instituto Brasileiro de Geografia e Estatistica. Foi testada a associacao entre a variavel dependente - graves violacoes de direitos humanos (composta pelo numero de vitimas de violencia policial, linchamentos e execucoes sumarias) - e variaveis socioeconomicas e demograficas por meio do teste de correlacao de Spearman. RESULTADOS: As correlacoes entre as violacoes de direitos e os indicadores socioeconomicos e demograficos foram estatisticamente significantes, exceto em relacao a taxa de urbanizacao e relacao de leito hospitalar por 1000 habitantes. As correlacoes mais fortes foram encontradas entre graves violacoes de direitos e tamanho populacao residente (r=0,693), proporcao de jovens de 15 a 24 anos na populacao (r=0,621) e proporcao de chefes de familia sem instrucao ou com ate tres anos de escolaridade (r=0,590). CONCLUSOES: Graves violacoes de direitos humanos atingem mais incisivamente a populacao que apresenta piores condicoes de vida. Desse modo, perpetua-se um quadro em que a desigualdade na efetivacao dos direitos sociais e economicos se sobrepoe diretamente a violacao dos direitos civis, intensificando um ciclo de violencia.OBJECTIVE To analyze the profile of gross human rights violations, and the relationship between these violations and socioeconomic and demographic indicators. METHODS Cross-sectional ecological study of 96 census districts of the city of São Paulo (Southeastern Brazil) in the year 2000. The data used came from the gross human rights violations database maintained by the Núcleo de Estudos de Violência (Center for the Study of Violence) at the Universidade de São Paulo. This database contains information on all the cases of summary executions, lynching and police violence reported on the written press. Socioeconomic and demographic data were obtained from the 2000 Census carried out by the Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics). A descriptive analysis of the data was carried out, and the association between the dependent variable - gross human rights violations (number of police violence victims, lynching episodes and summary executions) -, and different socioeconomic and demographic variables was tested. In order to test this association the Spearmans correlation test was used. RESULTS The correlations between gross human rights violations and the socioeconomic and demographic indicators were statistically significant, except for the urbanization rate and the hospital beds per 1000 inhabitants. The strongest correlations were found between the dependent variable and the following variables: size of the resident population (r=0,693), proportion of youths aged from 15 to 24 years (r=0,621), and proportion of household heads with no education or with up to three years of schooling (r=0,590). CONCLUSIONS Gross human rights violations more markedly occur in the population with the worst living conditions. Therefore, in a scenario in which inequality in attaining social and economic rights is directly superposed to the violation of civil rights, the violence cycle is intensified and perpetuated.

Pre-exposure and postexposure prophylaxes and the combination HIV prevention methods (The Combine! Study): protocol for a pragmatic clinical trial at public healthcare clinics in Brazil.

Introduction Few results from programmes based on combination prevention methods are available. We propose to analyse the degree of protection provided by postexposure prophylaxis (PEP) for consensual sexual activity at healthcare clinics, its compensatory effects on sexual behaviour; and the effectiveness of combination prevention methods and pre-exposure prophylaxis (PrEP), compared with exclusively using traditional methods. Methods and analysis A total of 3200 individuals aged 16 years or older presenting for PEP at 5 sexually transmitted disease (STD)/HIV clinics in 3 regions of Brazil will be allocated to one of two groups: the PEP group—individuals who come to the clinic within 72 h after a sexual exposure and start PEP; and the non-PEP group—individuals who come after 72 h but within 30 days of exposure and do not start PEP. Clinical follow-up will be conducted initially for 6 months and comprise educational interventions based on information and counselling for using prevention methods, including PrEP. In the second study phase, individuals who remain HIV negative will be regrouped according to the reported use of prevention methods and observed for 18 months: only traditional methods; combined methods; and PrEP. Effectiveness will be analysed according to the incidence of HIV, syphilis and hepatitis B and C and protected sexual behaviour. A structured questionnaire will be administered to participants at baseline and every 6 months thereafter. Qualitative methods will be employed to provide a comprehensive understanding of PEP-seeking behaviour, preventive choices and exposure to HIV. Ethics and dissemination This study will be conducted in accordance with the resolution of the School of Medicine Research Ethics Commission of Universidade de São Paulo (protocol no. 251/14). The databases will be available for specific studies, after management committee approval. Findings will be presented to researchers, health managers and civil society members by means of newspapers, electronic media and scientific journals and meetings.