[Challenges facing health professionals in the notification of violence: mandatory implementation and follow-up procedures]

Analysis of reported cases of repeated violence in Espírito Santo

OBJECTIVES

Identify the frequency of recurrent violence in cases reported in Espírito Santo and the associated factors.

METHODS

Cross-sectional study. Which included data on violence in Espírito Santo from 2011 to 2018, from the Notifiable Diseases Information System, and, Statistical analyzes were performed using the chi-square test and Poisson regression.

RESULTS

54.2% (N:14.966) of reported cases of violence are repeated, and higher prevalences were associated with female sex (PR:1.54), child (PR: 1.29) or elderly victims (PR: 1.25), the presence of disabilities/disorders (PR:1.42) and occurrence in urban/peri-urban areas (PR: 1.10). Furthermore, there is a greater frequency of injuries caused by a single aggressor (PR: 1.20), man (PR: 1.28), aged 25 or over (PR: 1.09), known to the victim (PR: 2.81) and at home (PR: 1.69).

CONCLUSION

The reported cases of violence showed a high frequency of recurrence, and were associated with the studied characteristics of the victim, the aggressor and the event.

"Everything That Is Here, I Have Lived": A Triangulated Analysis of an Intimate Partner Violence Assessment Tool in Curitiba, Brazil

Using a mixed-methods triangulation approach we piloted the Composite Abuse Scale-Brazilian version (CAS-Brazil) at the House of the Brazilian Woman of Curitiba among 62 survivors of intimate partner violence and four professionals serving survivors to assess its feasibility for use. Quantitative data were tabulated using descriptive statistics while qualitative data were recorded, coded, and thematically analyzed. Four qualitative domains emerged: (a) conceptual understanding; (b) item definitions; (c) women's experiences; and (d) professionals' perspectives. Comprehension of the CAS-Brazil appeared high across participants from diverse backgrounds. Professionals viewed it as highly feasible for use in Brazilian cross-sectoral services to support survivor decision-making.

The Evaluation of a Domestic Abuse Response Team Program in an Emergency Department

Purpose

Domestic abuse (e.g., family violence) occurs globally and increases the risk for lifelong adverse health outcomes for all members involved. Although victims of domestic abuse often refrain from seeking support due to various reasons (e.g., fear), health centers such as emergency departments (EDs) can serve as outlets for assistance. The Domestic Abuse Response Team (DART) is a program working collaboratively with a regional hospital center in Alberta, Canada, uniquely providing immediate, expert, and patient-oriented services (e.g., safety plans) to domestic abuse victims within the ED. This study aimed to evaluate the DART program by: (1) using administrative data to characterize ED and DART patient characteristics and (2) examining staff perceptions about DART's operations, effectiveness, challenges, and improvements.

Methods

A mixed-methods approach was used to collect data from April 1st, 2019 to March 31st, 2020. Quantitative data consisted of descriptive statistics on patient and staff characteristics and qualitative data was collected through two surveys to determine perceptions of the DART program.

Results

Approximately 60% of ED patients were screened for domestic abuse and 1% were referred to DART, of which 86% were female. All referrals received support within an hour and were provided patient-oriented assistance. Qualitative data revealed that the DART program offers important support to patient victims, increases comfort around dealing with domestic abuse, and decreases ED staff workloads.

Conclusions

The DART program offers valuable support to domestic abuse victims. Staff reported that DART is effective in providing victims with immediate care and services while also supporting ED staff.

Physical violence against children in Espírito Santo, Brazil: prevalence and associated factors

OBJECTIVE

To verify the prevalence of reported cases and the factors associated with physical violence against the child.

METHODS

Cross-sectional study with data from reported cases of physical violence against children from 2011 to 2018 in the state of Espírito Santo, Brazil. The characteristics of the victim, author and aggression were studied, and the associations were analyzed using Poisson regression.

RESULTS

In the period, were notified of 3,127 cases of violence against children. The frequency of physical violence was 23.6% (CI95%: 22.2-25.2), more prevalent in males; for the age group of 6 to 9 years; in rural areas; among aggressors over 20 years of age; outside the residence, and night/dawn shift.

CONCLUSIONS

Physical violence affects an expressive number of children, mainly committed by adult individuals, probably being the result of an asymmetric relationship of power. Thus, it is important to highlight the need for child protection actions together with cultural and structural changes in our society.

Sexual Violence against Adolescents in the State of Espírito Santo, Brazil: An Analysis of Reported Cases

OBJECTIVE

We describe the prevalence of the reported cases of sexual violence against adolescents and analyze their associated factors.

METHODS

A cross-sectional analytical study (n = 561) was conducted with reported data on sexual violence against adolescents in the state of Espírito Santo registered in SINAN between 2011 and 2018 to understand the prevalence and predictors of sexual violence against adolescent victims, as well as to describe the perpetrators and the nature of the aggression. Variables to characterize the victim, aggression, and perpetrator were used. Bivariate analyses were performed using chi-square (χ²) and Fisher's exact tests, and multivariate analyses were conducted using log-binomial models; the results were presented with prevalence ratios. All analyses were stratified by sex.

RESULTS

The prevalence of sexual violence was 32.6%, and 93% of the victims were female. In both males and females, the reported sexual violence was associated with a younger age (10-12 years old), living at home, being related to the perpetrator, and a history of sexual violence. In females, the reported sexual violence was also associated with the number of perpetrators, and in males, with the perpetrator's age.

CONCLUSIONS

Our findings show the high frequency of reporting of sexual violence and the characteristics of the victim, the aggression, and the aggressor as factors associated with its occurrence in both sexes. The importance of health information systems for disseminating data and the need for measures to prevent and treat the violence among adolescents is urgent.

Completeness, consistency and non-duplicity of records of child sexual abuse on the Notifiable Health Conditions Information System in the state of Santa Catarina, Brazil, 2009-2019

OBJECTIVE

To evaluate the completeness, consistency and duplicity of records of child sexual abuse on the Notifiable Health Conditions Information System (SINAN) in Santa Catarina, Brazil, between 2009 and 2019.

METHODS

This was a descriptive and analytical cross-sectional study aimed to assess the quality of SINAN data regarding completeness, consistency and non-duplicity.

RESULTS

3,489 cases of violence were reported, with a 662.5% increase in the number of notifications in the period studied, with the increase in the number of referral centers for the care of people in situations of sexual violence in the state, explaining 46.7% of the variation in the number of cases, between the years studied. Consistency was excellent in 90.0% of the records; and completeness ranged between excellent and good in 92.3% of them. There was an increased trend in completeness for 14 variables in the period. There were no duplicate records.

CONCLUSION

Data from the sexual violence against children surveillance system were considered adequate regarding the questions that were assessed in the study.

Violence against children and adolescents: nurse’s actions in primary health care

ABSTRACT Objectives: to analyze the role of nurses in suspected or confirmed cases of violence against children and adolescents in Primary Health Care. Methods: an analytical research, with a qualitative approach. Thirty nurses participated in the study, and data were collected by means of an individual form and a semi-structured interview. The data received lexicographic analysis by the software IRaMuTeQ (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires) organized by Bardin’s content analysis. Results: five categories emerged, in which it was possible to consider that the nurses’ approach in cases of violence was based on the identification of violence through physical examination during nursing consultations, health promotion actions in the school environment, request for support from the multi-professional team, and transfer of responsibilities. Final Considerations: it is inferred that the fragility in the professional training of nurses to address situations of violence against children and adolescents produces deficits in comprehensive care for victims.

The care for the persistent family aggressor in the perception of nursing students

OBJECTIVE

to analyze the perception of nursing students about the care given to the persistent family aggressor.

METHOD

a descriptive study, with a qualitative approach. Madeleine Leininger's Theory of Diversity and Universality of Care was used as a theoretical reference. The data collection took place with 37 in the last year of at a public university in Southeast Brazil. We used the technique of Projective Design with a Topic and semi-structured interview. The data were analyzed with the content analysis.

RESULTS

the examination of the narratives underpinned the construction of four categories: The care of the aggressor with the family, Recognition of family values and culture, The search for knowledge to care for the aggressor and family, Multidisciplinary and intersectoral care to confront violence.

CONCLUSION

there is an acknowledgment that the care for the aggressor should not only be individual but should involve all those affected. For this, multidisciplinary work is important, and the search for knowledge on the subject is essential for culturally significant care.

Presumption of sexual abuse in children and adolescents: vulnerability of pregnancy before 14 years

OBJECTIVES

to investigate the presumption of sexual abuse through the records of live births with mothers up to 13 years of age.

METHODS

this is a quantitative study, with an ecological design, carried out in Maceió, with data from the Brazilian Live Birth Information System from 2009 to 2017, based on Law 12,015/2009, on sexual crimes against the vulnerable, applying the presumption of violence in children under 14 years old.

RESULTS

nine hundred fifty-three births of children with mothers aged 10 to 13 years were recorded; 1.3% were reported as victims of sexual abuse; 20.3% declared to be married or living in a stable relationship. Records were concentrated in 04 neighborhoods, Guaxuma, Benedito Bentes, Tabuleiro do Martins, and Jacintinho.

CONCLUSIONS

there was a prevalence of pregnancy and marriage in girls under 14 years of age and scarcity of reporting presumed sexual abuse by health professionals.

Violence against women in life: study among Primary Care users

This article aims to estimate the prevalence and factors associated with intimate partner violence among primary care users. Cross-sectional study with women aged 20 to 59 years. Physical, sexual and psychological violence was screened by the World Health Organization instrument. Poisson regression was used for crude and adjusted analysis. Nine hundred ninety-one women participated in the study. The prevalence of violence throughout the lifespan was: psychological 57.6% (95%CI 54.6-60.7); physical 39.3% (95%CI 36.2-42.3) and sexual 18.0% (95%CI 15.7-20.5). Women with up to eight years of schooling, divorced or separated, whose mothers suffered intimate partner violence, who reported drug use and experienced sexual violence in childhood showed a higher prevalence of the three types of violence. Religion was associated with psychological and sexual violence and the use of cigarettes to physical and psychological violence. Participants with lower household income had a higher prevalence of physical violence. A high prevalence of intimate partner violence was identified among users. Worse socioeconomic conditions, risk behaviors and a history of assault are associated with greater occurrence of this problem.

Challenges for the implementation of the chain of custody for rape victims in the Federal District

Abstract Chain of Custody implies adequate collection, recording, and storage of the vestige of sexual violence, guaranteeing the reliability of the material that will be forwarded as expert evidence. Its implementation in the Unified Health System has faced challenges. Objective: To know the attendance to victims of sexual violence in the public maternity of Federal District and evaluate the knowledge of the team about the legislation on a chain of custody. Method: Cross-sectional, quantitative, and descriptive study with 134 medical and nursing professionals working in the obstetric emergency, who answered a questionnaire, submitted to descriptive statistical analysis and the Qui-Square Test. Results: Of the 78.95% of professionals who reported attending to victims of sexual violence, 25.71% consulted in 10 minutes, and 14.18% received specific training. The situational diagnosis reveals that the care is superficial, centered on medical issues, and the collection of vestiges is non-existent. Conclusion and implications to nursing practice: A generalized change of posture is necessary so that it is possible to implant the chain of custody in the maternity studied. It is essential to develop care beyond medical issues, and which includes forensics. It is suggested a collaborative action between physicians and nurses, with nursing as the epicenter of this process.

PROTOTYPE FOR MONITORING INCIDENTS IN THE HEALTH SERVICES: INNOVATION FOR PATIENT SAFETY

ABSTRACT Objective: to describe the participatory process of building a prototype to support the development of an information management system for notification, investigation and monitoring of health incidents. Method: a methodological research study on technology development, carried out in two stages: 1) documentary analysis of primary and secondary sources related to forms and legislation on incident notification systems, from September to October 2018; 2) deliberative dialog in two sessions, with 12 managers and coordinators of the Quality and Patient Safety Center of public hospitals in the Federal District, held in November 2018. In the deliberative session there was a presentation of the prototype and discussion of its applicability and functionality for the development of an information system for risk management in the health services. Results: creation and prototyping of a tool with 4 (four) screens representing the systematic flow of data. Screen 1: Simplified notification for patients and companions. Screen 2: Notification for the health professional. Screen 3: Investigation of the event and action plan. Screen 4: Intervention and monitoring by means of indicators. Conclusion: this is a tool capable of integrating actions to reduce the occurrence of incidents based on the identification and timely intervention on the risk factors. It can be used as a facilitating basis for the development or improvement of new instruments for risk management in the health services.

Validação da Escala de Crenças sobre Abuso Sexual (ECAS) no Contexto Brasileiro

Resumo O presente artigo objetiva adaptar e validar para o contexto brasileiro a Escala de Crenças sobre Abuso Sexual (ECAS) de origem portuguesa, composta por 17 itens e três fatores. Para tanto foram realizados dois estudos, no primeiro foi feita uma análise fatorial exploratória com amostra de 208 estudantes universitários, obtendo-se uma estrutura unifatorial, divergindo da escala original, com alfa de Cronbach de 0,88. Diante da discordância, foi realizado um segundo estudo, visando confirmar a estrutura fatorial da escala, com amostra de 209 estudantes universitários. Portanto, o resultado confirmou como melhor modelo a estrutura unifatorial da escala, com redução de 17 para 11 itens, obtendo-se alfa de Cronbach de 0,84. Sendo assim, a adaptação e validação da ECAS contribui para preencher uma carência existente no Brasil em relação a instrumentos voltados a mensurar as crenças sobre o abuso sexual infantojuvenil, podendo colaborar com estudos e intervenções na área.

Notificações de violência relacionadas ao trabalho e vigilância em saúde do trabalhador: rompendo a invisibilidade

Resumo Introdução: a Política Nacional de Saúde do Trabalhador e da Trabalhadora prevê o replanejamento de ações em saúde do trabalhador a partir do reconhecimento das violências relacionadas ao trabalho. Objetivos: descrever o processo de notificação de violências relacionadas ao trabalho como ferramenta para investigação e intervenção em saúde do trabalhador e as ações decorrentes, por meio de vigilância em saúde do trabalhador, desenvolvidas pelo Centro de Referência em Saúde do Trabalhador (Cerest) de São Bernardo do Campo/SP, no período de 2009 a 2016. Métodos: relato descritivo da atuação do Cerest com base em revisão documental e dados secundários de notificações de violências relacionadas ao trabalho e apresentação e discussão de três ações de vigilância em saúde do trabalhador centradas em aspectos psicossociais. Resultados: as notificações operaram como ferramentas que possibilitaram transformar dados em informações e conhecimento crítico para ação. As vigilâncias foram motivadas por queixas de assédio moral feitas por trabalhadores acidentados em metalúrgica; denúncia e notificações referentes ao adoecimento de trabalhadores em teleatendimento; denúncias de trabalhadores com deficiências em um supermercado. Conclusão: as informações deram visibilidade aos problemas dos trabalhadores e possibilitaram planejamento, pelo Sistema Único de Saúde (SUS), de ações preventivas de enfrentamento à violência e a aspectos psicossociais relacionados ao trabalho.

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.

Notification of intrafamily violence against elderly women in the city of São Paulo

Abstract Objective: the aim of the present study was to characterize the population of elderly women who have suffered sexual and physical violence and describe the characteristics of this aggression. Method: a cross-sectional study was carried out using secondary data from the Violence and Accident Surveillance Information System, which registers reports of physical and sexual violence against the female population aged 60 and older. Results: in 2013 289 acts of physical violence against elderly women in the city of São Paulo were recorded, and sexual violence was reported in ten cases. Conclusion: physical and sexual violence occurred mainly in the family environment, with the majority of aggressors male and a family member or known to the victim. In their direct and daily dealings with elderly health service users at all levels of complexity, doctors should know how to investigate and identify cases of violence, properly approach patients, act in coordination with other professionals and apply interventions that are effective for each case.

Self-perceived quality of health and satisfaction by elderly seen by the Family Health Strategy team

OBJECTIVE

To verify the profile of elderly followed up by Family Health Strategy teams and the influence of self-reported chronic diseases on demographic variables, describing self-perception and satisfaction with quality of health.

METHODS

This is a cross-sectional population- based study carried out with 301 elderly residents in two areas of a city in southern Brazil. Data were collected through a questionnaire based on the Health, Well-Being, and Aging Study adapted by researchers, and a playful scale to assess satisfaction with health. For the statistical analysis, the χ2 test was used (p<0.05).

RESULTS

Regarding cognitive assessment, the majority was classified as independent (86.4%), not requiring caregiver assistance to answer the questionnaire. The population was predominantly female (55.8%), White (64.8%), married (51.2%), and catholic (82.1%). A total of 47.5% considered their current health status as regular. Regarding satisfaction with health, 72.4% were happy, even reporting having at least one chronic health problem (58.5%).

CONCLUSION

The presence of chronic diseases was reported by most respondents, and the practice of self-medication is significantly more frequent among the aged. Nevertheless, the degree of satisfaction with their health status was predominantly positive, both related to the previous year and compared to others of the same age.

Registros de Notificação Compulsória de Violência Envolvendo Crianças e Adolescentes

Resumo Este estudo objetivou apresentar dados epidemiológicos de notificações compulsórias da violência na faixa etária da infância e da adolescência, no período de 2009 a 2013, ocorridos e notificados em uma cidade do interior do estado do RS, identificando o sexo das vítimas, o tipo de violência sofrida, o local onde ocorreu o fato e o tipo de vínculo com o agressor. Para isso, realizou-se uma pesquisa epidemiológica descritiva e documental com dados secundários do Sistema de Informação de Agravos de Notificação, analisados conforme estatística descritiva. Os resultados indicaram que o sexo feminino predominou no número de vítimas, a violência física foi a mais notificada, a residência foi o local onde mais ocorreram as violências, tendo a mãe e o pai como os principais agressores. Conclui-se, a partir desses resultados, que a notificação compulsória da violência é um desafio ao campo da saúde e que esse procedimento pode ser um instrumento de proteção à infância e a adolescência, quando integrado a outras práticas de cuidado.