Padrões de violência domiciliar associada ao uso de álcool no Brasil

Implications of household tobacco and alcohol use on child health and women's welfare in six low and middle-income countries: An analysis from a gender perspective

OBJECTIVE

To study the implications of household tobacco and alcohol use on child health and women's welfare using a gender lens in Ethiopia, India, Indonesia, Jordan, Kenya, and Nigeria with varied geographical and cultural characteristics in the pattern of tobacco and alcohol use.

METHODS

We identified child health and women's welfare outcomes that may be impacted by tobacco and alcohol use, with a focus on the crowding-out effects on household resource allocation. For child health indicators, we focussed on engagement in preventative care, nutrition, and responses to acute illness. For women, we focused on access to resources for health-seeking and intimate partner violence (IPV). We used logistic regression to determine the association between household gender tobacco and/or alcohol use on child health and women's welfare, using data from six nationally-representative Demographic and Health Surveys, with each having a sample size of 5000-30,000 households and conducted after 2010.

RESULTS

Children in households where men and women use tobacco are significantly less likely to receive the full schedule of Diphtheria-Pertussis-Tetanus (DPT) vaccine in India, Indonesia, and Jordan (Odds ratio or OR; ORIndia = 0.67, p < 0.001; ORIndonesia = 0.55, p = 0.028; ORJordan = 0.45, p = 0.048), and all basic vaccinations as well as receive appropriate treatment for fever/diarrhoea in India and Indonesia (all basic vaccinations: ORIndia = 0.78, p < 0.001, ORIndonesia = 0.43, p = 0.009; treatment for fever/diarrhoea: ORIndia = 0.65, p < 0.001; ORIndonesia = 0.50, p = 0.038). In most countries, women are significantly more likely to experience IPV when their husband/partner uses tobacco and/or alcohol.

CONCLUSIONS

Across a diverse set of countries with varied cultural characteristics which affect the uptake and use of tobacco and alcohol, tobacco and alcohol use are associated with crowding-out of acute and preventative health-related behaviours and crowding-in of harmful behaviours. This has significant implications for tobacco and alcohol control programmes, and positions tobacco and alcohol control as central to human capital initiatives and in achieving health for all.

Intimate Partner Violence, Anxiety, and Depression in Women with Sexually Transmitted Infections—A Hospital-based Case Control Study

Background:

Sexually transmitted infections (STIs) have complex relationship with mental health and intimate partner violence (IPV) causing community health concern among adolescents and young adults. Women encounter behavioral, psychological, and reproductive health consequences of violence affecting across their lifespan.

Aim:

To determine IPV anxiety and depression in women with STIs.

Methods and materials:

It is a hospital-based cross-sectional study. A total of 115 consecutive females between 18 and 45 years of age who attended STI clinic were enrolled. Sociodemographic details were collected by semi-structured pro forma. IPV was assessed by World Health Organization violence against women instrument; Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale were applied to assess severity of anxiety and depression.

Results:

Mean age of subjects was 31.21 ± 9.08 years. About 55% of the patients had history of IPV. Psychiatric comorbidities noted in 66% of patients. The odds of IPV were more with history of child abuse, suicidal ideation, and substance abuse in husband.

Conclusion:

IPV, anxiety, and depression in STI are in the primitive stage of validation due to associated stigma and lack of awareness. It is high time to divulge dormant triggering factors to protect vulnerable population. Current research should focus on education and women empowerment to prevent STI and mental health issues.

Health behaviour changes during COVID-19 and the potential consequences: A mini-review

The COVID-19 pandemic has brought about profound changes to social behaviour. While calls to identify mental health effects that may stem from these changes should be heeded, there is also a need to examine potential changes with respect to health behaviours. Media reports have signalled dramatic shifts in sleep, substance use, physical activity and diet, which may have subsequent downstream mental health consequences. We briefly discuss the interplay between health behaviours and mental health, and the possible changes in these areas resulting from anti-pandemic measures. We also highlight a call for greater research efforts to address the short and long-term consequences of changes to health behaviours.

Percepções dos Usuários de Crack sobre as suas Relações Familiares na Infância e Adolescência

Resumo O objetivo principal deste estudo foi compreender a percepção dos usuários de crack sobre suas famílias de origem durante a infância e a adolescência. Realizou-se uma pesquisa qualitativa, da qual participaram 29 usuários de crack de ambos os sexos. Os dados oriundos das entrevistas semiestruturadas foram analisados de acordo com o conteúdo temático e organizados em categorias. Os resultados revelaram que os usuários de crack percebem os vínculos familiares como frágeis. Além disso, mencionaram a vivência de situações de violência e consumo de drogas entre os membros da família. Os dados indicam a necessidade de cuidado dos familiares, os quais, muitas vezes, também enfrentam problemas com o uso de substâncias, e o desenvolvimento de ações educativas preventivas na infância e na adolescência.

[Tobacco: the construction of policies for control of its consumption in Brazil]

Brazil is a country that stands out worldwide in the reduction of smoking due to its effective control policies. By means of a narrative review, the article analyzes the nature of the scientific discussions that underpin these public policies from historical, social, health and economic perspectives. The fact that the measures associated with these issues have been marked by conflicts of interest between the tobacco industry and health organizations is highlighted. Themes related to advertising, harm reduction, tax policies and actions to protect nonsmokers are scrutinized. New stipulations on tobacco advertising are examined and, by comparative analysis, a veto on the advertising of alcoholic beverages in the country is suggested.

Cost of a community mental health service: a retrospective study on a psychosocial care center for alcohol and drug users in São Paulo

BACKGROUND

Psychosocial care centers for alcohol and drug users (CAPS-ad) are reference services for treatment of drug users within the Brazilian National Health System. Knowledge of their total costs within the evidence-based decision-making process for public-resource allocation is essential. The aims here were to estimate the total costs of a CAPS-ad and the costs of packages of care (according to intensity of care); to ascertain the ratio between total CAPS-ad costs and the federal funding allocated; and to describe the methods for estimating unit costs for each CAPS-ad cost component.

DESIGN AND SETTING

Retrospective study conducted in a public community mental health service.

METHODS

This was a retrospective cost description study on a CAPS-ad located in a city in the state of São Paulo, using a public healthcare provider perspective and a top-down approach, conducted over a 180-day period from March 1 to August 30, 2015.

RESULTS

The total mean monthly costs of the CAPS-ad were BRL 64,017.54. Healthcare staff accounted for 56.5% of total costs. The mean costs per capita and per month for intensive and non-intensive care packages were, respectively, BRL 668.34 and BRL 37.12.

CONCLUSIONS

The federal budget allocation covered 62.1% of the CAPS-ad costs and the remaining 37.9% end up funded by the municipal government. The cost of the intensive package of care was 18 times greater than the non-intensive package. Developing criteria for using services and different packages of care based on patients' needs, and optimizing human resources according to specific actions, may improve people's mental health and avoid wasted resources.

Epidemiological profile of care for violence in public urgency and emergency services in Brazilian capital, Viva 2014

Injuries and deaths resulting from violence constitute a major public health problem in Brazil. The article aims to describe the profile of calls for violence in emergency departments and emergency Brazilian capitals. This is a descriptive study of Violence and Accident Surveillance System (VIVA), carried out in public emergencies Brazilian cities, from September to November 2014, a total of 4406 calls for aggression. We considered the following categories of analysis: 1) sociodemographic characteristics (gender, age, race / skin color, education, place of residence, vulnerability, alcohol intake); 2) Event feature (probable author, nature and means of aggression); and characteristics of care (getting to the hospital, prior service, evolution). Of the total calls for violence (n = 4406), the highest prevalence was among young people 20-39 years (50.2%), male, black and low education. As for the event characteristics it stands out that 87.8% were physical assaults; 46.3% cut/laceration and 13.7% involved a firearm. The results point to the need to strengthen intersectoral actions to expand the network of care and protection.

[Prevalence of intimate partner violence and associated factors after disclosing the diagnosis of a sexually transmissible disease]

The objective of this study was to investigate factors associated with intimate partner violence after disclosing the diagnosis of sexually transmissible diseases (STDs) in Fortaleza, Ceará State, Brazil. This cross-sectional study enrolled 221 individuals treated at STD clinics. Multivariate logistic regression was performed. A total of 28.1% of individuals committed some type of intimate partner violence after disclosure of the diagnosis. Committing intimate partner violence was associated with alcohol use (OR = 2.79; 95%CI: 1.25-6.22; p = 0.012), the partner having relations with someone else during the current relationship (OR = 4.71; 95%CI: 2.24-9.91; p = 0.000), a history of violence prior to the STD (OR = 2.87; 95%CI: 1.22-6.73; p = 0.015), and having suffered violence after diagnosis of the STD (OR = 6.53; 95%CI: 3.06-13.93; p = 0.000). Intimate partner violence following disclosure of the STD signals that health professionals should identify patients' difficulties in revealing an STD diagnosis to their partners.

[Sexual violence against adolescents in Campo Grande, Mato Grosso do Sul, Brazil]

OBJECTIVE

To analyze the situation of sexual violence against adolescents.

METHODS

Cross-sectional study with spatial analysis, covering 172 reporting forms, from January 2009 to January 2013, in Campo Grande, Mato Grosso do Sul. Data were grouped by neighborhood for spatial analysis. The statistical analysis was descriptive.

RESULTS

Adolescents in situations of violence were mostly girls (94.8%) and white (37.8%). Domestic violence prevailed (51.7%) and with one perpetrator (66.9%). Pregnancy (8.7%) was one of the consequences. The cases were evenly distributed in the city without a preferential spatial pattern and regardless of social background.

CONCLUSIONS

Despite the underreporting of sexual violence cases, the frequency and the individual and collective consequences of this are serious enough to make it a public health issue.

Violência doméstica e a Lei Maria da Penha: perfil das agressões sofridas por mulheres abrigadas em unidade social de proteção

Resumo: A violência baseada no gênero tem se constituído em um fenômeno social que influencia sobremaneira o modo de viver, adoecer e morrer das mulheres. Este estudo visa conhecer as diferenças antes e após a criação da Lei Maria da Penha (LMP) nas agressões sofridas pelas mulheres que foram atendidas na Unidade de Proteção Especial do Estado do Ceará. Trata-se de um estudo seccional, exploratório-descritivo e documental. A amostra foi composta por 197 prontuários das mulheres atendidas em uma Unidade de Proteção Especial do Estado do Ceará entre os anos de 2001 e 2012. Os dados foram analisados através do SPSS(r) versão 20. As questões éticas deste estudo foram alicerçadas na Resolução n.º 466/12. O projeto foi aprovado pelo Comitê de Ética em Pesquisa (COMEPE) da Universidade Federal do Ceará, por meio do protocolo nº 369.332. Os resultados apontam que as mulheres agredidas são jovens (53,5%), pardas (47,2%), sem união estável (68,0%), com baixa escolaridade (91,4%), sem renda mensal fixa (30,5%), que residem em casa própria (35,5%) com familiares (13,7%), são beneficiárias de algum programa de transferência de renda (26,9%) e não possuem trabalhos formais (69,1%). Os agressores são jovens (71,7%, p=0,862), desenvolvem trabalho manual (41,5%, p=0,976), consomem álcool (86,8%, p=0,814), drogas ilícitas (54,7%, p=0,249) e cigarro (54,7%, p=0,931). Após a implantação da LMP, os agressores possuem mais antecedentes criminais (58,5%, p=0,000); a agressão tem ocorrido mais de uma vez, com maior número de denúncias e número de boletim de ocorrência, sendo o uso de substâncias psicoativas (22,6%, p=0,032) ou ciúme (18,9%, p=0,032) o fator desencadeante através de força física (45,3%, p=0,619), representada em hematomas (13,2%, p=0,726) ou não deixando marcas perceptíveis (22,6%, p=0,726) localizadas na cabeça, rosto e pescoço (28,3%, p=0,031). O perfil da violência doméstica se modificou com a promulgação da Lei Maria da Penha e este cenário demanda o desenvolvimento de ações sociais e de saúde voltadas para erradicação/controle e assistência efetiva deste grave problema social e de saúde pública.

Patterns of domestic violence and alcohol consumption among women and the effectiveness of a brief intervention in a household setting: a protocol study

BACKGROUND

Domestic violence and harmful alcohol consumption are considered major public health problems worldwide. These phenomena often co-occur, and they share several risk factors. Nevertheless, few in-depth studies have supported integrated interventions for both phenomena, in particular among Latin American women. This project will study the consumption of alcoholic beverages among women and its relationship with patterns of domestic violence; furthermore, it will assess the effect of a brief intervention (BI) aimed at modifying these behaviors using a community household sample.

METHODS/DESIGN

This project is divided into two studies. Study 1 will employ a cross-sectional observational design and will be conducted using a household sample of adult women (approximate sample size = 1600) to assess harmful alcohol consumption and domestic violence patterns. Study 2, will be a randomized clinical trial based on specific cases from Study 1, assessing the effect of a brief intervention on women who exhibit harmful levels of alcohol consumption (AUDIT ≥ 8). Approximately 73 women will be assigned to one of two groups, either a treated group (TG) or a control group (CG). A sociodemographic questionnaire, a questionnaire concerning general health and substance use, and four other standardized instruments (i.e., the Alcohol Use Disorder Identification Test [AUDIT; used to investigate problems related to alcohol consumption], the Center for Epidemiologic Studies Depression Scale [CES-D; used to measure depressive symptoms], and the Revised Conflict Tactics Scales and Parent-child Conflict Tactics Scales [CTS2 and CTSPC; used to obtain information on violence among couples and between parents and children, respectively]) will be used to collect data.

DISCUSSION

The study protocol will employ a household survey of a representative sample from a neighborhood in a middle income country, where well-conducted household surveys remain rare. The present work represents a step toward a better understanding of violence in women's lives and its interaction with alcohol consumption and expands the discussion on the potential strategies for public health actions seeking to prevent both domestic violence and harmful alcohol consumption.

TRIAL REGISTRATION

Brazilian Clinical Trials Registry: RBR-7rjt4t. Registered 17 October 2013.

Valores, Atitudes e Uso de Bebidas Alcoólicas: Proposta de um Modelo Hierárquico

O presente artigo objetivou conhecer a base axiológica das atitudes frente o uso de álcool, testando o modelo hierárquico valores→atitudes→comportamento. Contou-se com a participação de 149 estudantes de duas IES da cidade de Parnaíba (PI), com idade média de 22,8 anos e maioria homens (57,4%) que responderam oQuestionário dos Valores Básicos, a Escala de Atitudes Frente o Uso de Álcool e perguntas sobre dados demográficos. Os resultados indicam que valores de experimentação se correlacionam positivamente com atitudes favoráveis ao consumo de álcool, ao passo que valores normativos o fizeram negativamente. Confirmou-se, ainda, o papel mediador das atitudes. Esta pesquisa buscou dar suporte ao modelo hierárquico supracitado, favorecendo o entendimento do uso de bebidas alcóolicas e delineamento de políticas públicas para combater o padrão disfuncional de consumo.

Intimate partner violence after the diagnosis of sexually transmitted diseases

OBJECTIVE To assess the prevalence and factors associated with intimate partner violence after the diagnosis of sexually transmitted diseases. METHODS This cross-sectional study was conducted in Fortaleza, CE, Northeastern Brazil, in 2012 and involved 221 individuals (40.3% male and 59.7% female) attended to at reference health care units for the treatment of sexually transmitted diseases. Data were collected using a questionnaire applied during interviews with each participant. A multivariate analysis with a logistic regression model was conducted using the stepwise technique. Only the variables with a p value < 0.05 were included in the adjusted analysis. The odds ratio (OR) with 95% confidence interval (CI) was used as the measure of effect. RESULTS A total of 30.3% of the participants reported experiencing some type of violence (27.6%, psychological; 5.9%, physical; and 7.2%, sexual) after the diagnosis of sexually transmitted disease. In the multivariate analysis adjusted to assess intimate partner violence after the revelation of the diagnosis of sexually transmitted diseases, the following variables remained statistically significant: extramarital relations (OR = 3.72; 95%CI 1.91;7.26; p = 0.000), alcohol consumption by the partner (OR = 2.16; 95%CI 1.08;4.33; p = 0.026), history of violence prior to diagnosis (OR = 2.87; 95%CI 1.44;5.69; p = 0.003), and fear of disclosing the diagnosis to the partner (OR = 2.66; 95%CI 1.32;5.32; p = 0.006). CONCLUSIONS Individuals who had extramarital relations, experienced violence prior to the diagnosis of sexually transmitted disease, feared disclosing the diagnosis to the partner, and those whose partner consumed alcohol had an increased likelihood of suffering violence. The high prevalence of intimate partner violence suggests that this population is vulnerable and therefore intervention efforts should be directed to them. Referral health care services for the treatment of sexually transmitted diseases can be strategic places to identify and prevent intimate partner violence.

Padrão de consumo de bebidas alcoólicas entre os trabalhadores e perfil socioeconômico

Objetivo: Estimar o padrão de consumo de bebidas alcoólicas e o perfil socioeconômico dos trabalhadores de um Serviço Público. Métodos: Estudo transversal realizado com 322 sujeitos que responderam ao Alcohol Use Disorders Identification Test (AUDIT) e às perguntas referentes às variáveis sociodemográficas. Os dados foram processados e analisados por meio do Epi-Info. Resultados: Observou-se que 12,7% fizeram consumo de risco, nocivo e provável dependência. O consumo pesado episódico foi de 32,5%, e 5,3% já causaram problemas a si mesmos ou a outros. A maioria não consumiu álcool nos últimos 12 meses, porém aqueles que consumiram o fizeram em quantidade e frequência elevada. Conclusão: Os resultados mostraram elevada prevalência do padrão de consumo de risco, nocivo e provável dependência associada aos trabalhadores do sexo masculino e ao baixo nível de escolaridade.

The Brazilian smoker: a survey in the largest cities of Brazil

OBJECTIVE

To understand the sociodemographic factors associated with daily consumption of cigarettes and pattern of cigarette use among Brazilian smokers.

METHOD

A cross-sectional study was performed in 2005 involving the 108 largest Brazilian cities. Data were collected through interviews with subjects aged 12 to 65 years in randomly selected households. Based on a questionnaire adapted to the Brazilian context, a logistic regression model was used to investigate the association between the sociodemographic characteristics of the sample and smoking.

RESULTS

Of the 7,921 subjects interviewed, 16.4% reported daily use of cigarettes. The smoking prevalence was similar between genders, although women reported to start smoking at a later age and smoke fewer cigarettes per day. Almost 65% of the smokers were interested in quitting or reducing their smoking habit. The main sociodemographic characteristics associated with smoking were as follows: adult age (30-59 years old), unemployment, low education level, and low socioeconomic level. Alcohol abuse was also shown to be associated with smoking.

CONCLUSIONS

Our findings suggest that adverse socioeconomic characteristics are implicated in increased susceptibility to smoking in Brazil. In our sample, a high proportion of smokers reported interest to quit or reduce smoking. These data suggest that sociodemographic factors should be considered in the elaboration of smoking prevention and treatment policies.

Patterns of injuries in domestic violence in a Romanian population

In Romania, the quantification of traumatic injuries is achieved in medical- legal services; therefore, each domestic violence (DV) victim needs a medical-legal certificate to prove in a court of law the presence of traumatic injuries. In this study, we aimed to determine the pattern of traumatic injuries in DV. A total of 219 consecutive DV cases were included. For each victim, a detailed medical-legal examination was performed, including specialized consults, if needed. Results were analyzed statistically using the SPSS software. Traumatic injuries in DV cases were usually located in the head, face, and neck areas and had a low severity index. Severe lesions were found in less than 10% and no sexual aggression was found. The severity increases with age and is higher for males than females. The pattern of DV-associated injuries we have encountered is similar to the one found in other similar studies. Knowing this pattern may be useful in clinical practice to detect cases of DV.