Health needs: the interface between the discourse of health professionals and victimized women

Objective:

to understand the limits and the evaluative possibilities of the Family Health Strategy regarding the recognition of the health needs of women who experience violence.

Method:

a study with a qualitative approach, grounded in the perspective of gender, and which adopted health needs as the analytical category. The data were collected through interviews with health professionals and women who made use of a health service, and were analyzed using the method of discourse analysis.

Results:

the meeting between the discourses of women who use the services and the professionals of the health service revealed, as the interface, human needs, as in the example of autonomy and of bonds. The understanding regarding the needs was limited to the recognition of health problems of physical and psychological natures, just as the predominance of the recognition of needs for maintaining life in the light of essentially human needs was revealed in the professionals'' discourses as an important limitation of the practices.

Conclusion:

emphasis is placed on the perspective of gender as a tool which must be aggregated to the routine of the professional practices in health so as to confirm or deny the transformative character of the care in place regarding the recognition and confronting of the women''s health needs.     

Conjugal violence in the perspective of "Family Health Strategy" professionals: a public health problem and the need to provide care for the women

Objective

to construct a theoretical matrix based on the meanings of the interactions and actions experienced by the professionals regarding the nursing care practices and the health of women in situations of conjugal violence in the ambit of the Family Health Strategy.

Methods

research based in Grounded Theory. Following approval by the Research Ethics Committee, 52 professionals were interviewed in Santa Catarina, Brazil. The analysis was based on open, axial and selective codifications.

Results

the theoretical model was delimited based on the phenomenon "Recognizing conjugal violence as a public health problem, and the need for management of the care for the woman", which reflects the experience of the professionals in relation to care for the woman, as well as the meanings attributed to this care.

Conclusions

the phenomenon allows one to understand the movement of action and interaction regarding the care for the woman in a situation of conjugal violence.     

Support to women who denounce experiences of violence based on her social network

Objective:

to analyze the possibilities of help/support through the mapping and acknowledgement of the social network of women who denounce experiences of violence at a Police Precinct for Women.

Method:

qualitative study based on the theoretical-methodological framework of Lia Sanicola''s Social Network, through interviews with 19 women.

Results:

the analysis of the network maps evidenced that the primary social network was more present than the secondary on and, despite consisting of significant relations, it demonstrates limitations. The women access the secondary network occasionally in the violence problem and/or its repercussions in their life and health. The discrete presence of the health network in the composition of the social network was revealed and, when mentioned, the relation between the health professional and the woman was characterized as fragile.

Conclusion:

the importance of the social network relates to the creation of spaces of help/support for the women beyond the moment of the aggression, which accompany them throughout their process of emancipation from an experience annulled by violence, considering that each woman acts and makes decisions in the relational context when she is ready for it.     

Reports of violence against women in different life cycles

Objective

to analyze the reports and factors associated with violence against women.

Method

this was a cross-sectional, exploratory and analytical study with information about the cases of reported violence, extracted from the Civil Police Report Bulletin, in a mid-sized city in Minas Gerais, Brazil.

Results

out of the 7,487 reports of violence against women, it was found that 44.6% of the cases were threats, 28.5% aggression, 25.1% bodily injury, 1.1% rape, and 0.7% some other type of injury. In the bivariate analysis, a higher number of cases (p=0.000) committed by partners was evidenced, for all kinds of violence except for rape. Children, adolescents and adults experienced violence by partners, followed by family members. Regarding older women, violence was committed by family members.

Conclusion

there is the need for programs to be established to prevent violence against women in various sectors of society, permeating the life cycle.     

Common mental disorders and intimate partner violence in pregnancy

OBJECTIVE

To investigate the association between common mental disorders and intimate partner violence during pregnancy.

METHODS

A cross sectional study was carried out with 1,120 pregnant women aged 18-49 years old, who were registered in the Family Health Program in the city of Recife, Northeastern Brazil, between 2005 and 2006. Common mental disorders were assessed using the Self-Reporting Questionnaire (SRQ-20). Intimate partner violence was defined as psychologically, physically and sexually abusive acts committed against women by their partners. Crude and adjusted odds ratios were estimated for the association studied utilizing logistic regression analysis.

RESULTS

The most common form of partner violence was psychological. The prevalence of common mental disorders was 71.0% among women who reported all form of violence in pregnancy and 33.8% among those who did not report intimate partner violence. Common mental disorders were associated with psychological violence (OR 2.49, 95%CI 1.8;3.5), even without physical or sexual violence. When psychological violence was combined with physical or sexual violence, the risk of common mental disorders was even higher (OR 3.45; 95%CI 2.3;5.2).

CONCLUSIONS

Being assaulted by someone with whom you are emotionally involved can trigger feelings of helplessness, low self-esteem and depression. The pregnancy probably increased women`s vulnerability to common mental disorders     

家庭暴力对妇女生殖健康的影响

妇女遭受家庭暴力已日益成为一个重要的公共健康和社会问题.无论在发达国家还是发展中国家,针对妇女的暴力事件都不同程度地存在.产生家庭暴力的因素可以分为受害者因素、施暴者因素和社会文化因素.家庭暴力不仅会使妇女更容易罹患各种妇科疾病和生殖道感染,而且会使妇女更容易发生意外妊娠、流产、妊娠期并发症甚至死亡,从而对妇女生殖健康...     

The health-disease process and the family health strategy: the user's perspective

OBJECTIVE:

to analyze the meanings Primary Health Care users attribute to their health-disease process and the services used.

METHODS:

this qualitative research uses the focus group technique to interview two groups of users the service monitors. The first is a group of elderly people and the second of pregnant women. To analyze the meanings, the discourse analysis technique and the reference framework of health promotion are used.

RESULTS:

the group of elderly, being mostly female arterial hypertension and diabetes mellitus patients, visualizes the health-disease process as the evolution of human existence controlled by divine power, signifying the health service as a blessing in the control of the disease. The Group of young pregnant women signified health as the ability for self-care and disease as the disability for that purposes, considering the Primary Health Care service as responsible for the recovery of individual and family health.

FINAL CONSIDERATIONS:

the users demonstrated dissatisfaction with bureaucratic and vertical relations present at the health services. In each group, it was observed that the meanings for health and disease and meanings of the health service the users elaborated can be related.     

Primary Health Care Evaluation: the view of clients and professionals about the Family Health Strategy

Objective:

to evaluate the attributes of primary health care as for access; longitudinality; comprehensiveness; coordination; family counseling and community counseling in the Family Health Strategy, triangulating and comparing the views of stakeholders involved in the care process.

Method:

evaluative research with a quantitative approach and cross-sectional design. Data collected using the Primary Care Assessment Tool for interviews with 527 adult clients, 34 health professionals, and 330 parents of children up to two years old, related to 33 family health teams, in eleven municipalities. Analysis conducted in the Statistical Package for Social Sciences software, with a confidence interval of 95% and error of 0.1.

Results:

the three groups assessed the first contact access - accessibility with low scores. Professionals evaluated with a high score the other attributes. Clients assigned low score evaluations for the attributes: community counseling; family counseling; comprehensiveness - services rendered; comprehensiveness - available services.

Conclusions:

the quality of performance self-reported by the professionals of the Family Health Strategy is not perceived or valued by clients, and the actions and services may have been developed inappropriately or insufficiently to be apprehended by the experience of clients.     

Adolescents with attention deficit hyperactivity disorder and exposure to violence: parents' opinion

Objective:

to identify the opinion of parents or guardians of adolescents diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) about their children''s exposure as perpetrators or victims of violence situations in family life or outside.

Method:

qualitative study with use of thematic oral history. Nine parents of 07 adolescents with ADHD participated. Data were collected from April to September of 2013 using thematic interview. The interviews were recorded at scheduled times at the participants'' home, with an average duration of 30 minutes. The findings were submitted to inductive thematic analysis.

Results:

data analysis allowed the identification of the occurrence of "Conflicts in family life" and "Conflicts in the context of school and community". Parents reported the involvement of their children as victims, perpetrators and witnesses of physical and psychological violence, and the difficulty of them and the school to understand and handle these situations.

Conclusion:

violence occurs in ADHD adolescents'' interpersonal relationships. Communication between health professionals, school and families is precarious. Through the systematization of nursing care, nurses can plan strategies that articulate support networks and interpersonal relationships of adolescents with the disorder (family and school).     

Unfortunate Moms and Unfortunate Children: Impact of the Nepali Civil War on Women's Stature and Intergenerational Health

I analyze the long-term health impacts of Nepal's 1996-2006 civil conflict. I use information on monthly conflict incidents at the village level, which allows me to identify the effects of exposure to conflict more accurately than prior studies. I exploit the heterogeneity in conflict intensity across villages and birth cohorts to document the impacts on adult stature and intergenerational health. I find that childhood exposure to conflict and, in particular, exposure starting in infancy, negatively impacts attained adult height. Each additional month of exposure decreases a women's adult height by 1.36 millimeters. The impacts are not limited to first-generation - I find that a mother's exposure to conflict in her childhood is also detrimental to her child's health. Mothers exposed to conflict during their childhood have more children and live in less wealthy households, likely reducing their ability to invest during their children's critical period of physical development.     

家庭环境对中学生心理健康影响的研究

目的探讨家庭环境对中学生心理健康的影响。方法采用症状自评量表（ScL-90）和父母养育方式评价量表（EMBu）对安徽省宣城市某普通中学八年级116名学生进行心理健康测量。结果核心家庭的中学生心理健康水平高于单亲家庭和主干家庭的学生;父母采用情感温暖、理解的教育方式时,中学生出现心理健康方面的症状较少;而采用惩罚严厉、过分干涉、拒绝否认和过度保护的教育方式时,易出现如焦虑、抑郁、敌对情绪及人际冲突等诸多心理健康方面的症状;中学生家庭经济状况与心理健康量表的各个因子之间存在显著相关。结论不同的家庭结构、父母教养方式和家庭经济情况对中学生心理健康状况具有重要的影响。     

Participation of adolescents in the Family Health Strategy from the theoretical-methodological structure of an enabler to participation

Objective

to evaluate the participation of adolescents in the Family Health Strategy, from the theoretical-methodological structure of an enabler to participation.

Method

a quantitative study, conducted from December of 2010 to March of 2011, with 213 professionals in the FHS in the region of Cariri-Ceará-Brazil. Data were collected through a questionnaire and organized in SPSS 18.0.

Results

the level of normative participation becomes manifest beginning with the adolescent search for health services, motivated by disease (77.9%). Normative participation + independence appear when they seek prenatal care and family planning. Emancipatory participation was identified by the frequency of adolescents in group activities, in the schools, and a move in the direction of the level of transformative participation was observed.

Conclusion

in this context, it is understood that there exists a need to stimulate the participatory process of the adolescents for a change in health promotion in this group.     

The role of intimate partner violence, race, and ethnicity in help-seeking behaviors

Objective . Women experiencing intimate partner violence (IPV) have multiple health and social service needs but many, especially Hispanic, women may not access these resources. This research sought to examine the relationship between IPV and health and social services utilization (help-seeking behaviors), with a focus on racial and ethnic disparities.

Design . Case-control study from an urban US emergency department population in which cases (women with IPV) and controls (women without IPV) were frequency matched by age group and race/ethnicity. Logistic regression analyses were performed to examine the relationship between IPV and help-seeking behaviors and between help-seeking behaviors and race/ethnicity among abused women. In addition, a stratified analysis was conducted to examine the relationship between acculturation and help-seeking behaviors among Hispanic women.

Results . The sample included 182 cases and 147 controls. Among the health services, alcohol program, emergency department, and hospital utilization were significantly increased among IPV victims compared to non-victims after taking demographic and substance use factors into account. Similarly, IPV victims were more likely to access social/case worker services and housing assistance compared to non-victims. Specific help-seeking behaviors were significantly associated with race and ethnicity among IPV victims, with non-Hispanic white and black women more likely to use housing assistance and emergency department services and black women more likely to use police assistance compared to Hispanic women. Among all Hispanic women, low acculturation was associated with decreased utilization of social services overall and with any healthcare utilization, particularly among abused women.

Conclusions . Social service and healthcare workers should be alerted to and screen for IPV among all clients. The need for increased outreach and accessibility of services for abused women in Hispanic communities in the USA should be addressed, with cultural and language relevance a key component of these efforts.     

The causes of bullying: results from the National Survey of School Health (PeNSE)

Objective:

to identify the characteristics and reasons reported by Brazilian students for school bullying.

Method:

this cross-sectional study uses data from an epidemiological survey (National Survey of School Health) conducted in 2012. A total of 109,104 9th grade students from private and public schools participated. Data were collected through a self-applied questionnaire and the analysis was performed using SPSS, version 20, Complex Samples Module.

Results:

the prevalence of bullying was 7.2%, most frequently affecting Afro-descendant or indigenous younger boys, whose mothers were characterized by low levels of education. In regard to the reasons/causes of bullying, 51.2% did not specify; the second highest frequency of victimization was related to body appearance (18.6%); followed by facial appearance (16.2%); race/color (6.8%); sexual orientation 2.9%; religion 2.5%; and region of origin 1.7%. The results are similar to those found in other sociocultural contexts.

Conclusion:

the problem belongs to the health field because it gathers aspects that determine the students'' health-disease-care continuum.     

Child development surveillance: intervention study with nurses of the Family Health Strategy

Objective:

to evaluate the effectiveness of an educational action in child development surveillance performed by nurses working in primary health care.

Methods:

interventional study with a before-and-after type of design, carried out with 45 nurses and 450 mothers of children under 2 years of age. Initially, it was evaluated the practices and knowledge of nurses on child development surveillance and the mothers were interviewed about these practices. Subsequently, workshops were carried out with nurses and four months later, the knowledge of nurses and the maternal information were reevaluated.

Results:

after intervention there was significant increase in the frequency of the following aspects: from 73% to 100%, in relation to the practice of nurses of asking the opinion of mothers about their children''s development; from 42% to 91%, regarding the use of the systematized instrument of evaluation; from 91% to 100% with respect to guidance to mothers on how to stimulate child development.

Conclusions:

the intervention contributed to the increase of knowledge of nurses and implementation of child development surveillance, showing the importance of this initiative to improve the quality of child health care.     

Factors associated with reporting of abuse against children and adolescents by nurses within Primary Health Care

OBJECTIVE:

to analyze the factors associated with the underreporting on the part of nurses within Primary Health Care of abuse against children and adolescents.

METHOD:

cross-sectional study with 616 nurses. A questionnaire addressed socio-demographic data, profession, instrumentation and knowledge on the topic, identification and reporting of abuse cases. Bivariate and multivariate logistic regression was used.

RESULTS:

female nurses, aged between 21 and 32 years old, not married, with five or more years since graduation, with graduate studies, and working for five or more years in PHC predominated. The final regression model showed that factors such as working for five or more years, having a reporting form within the PHC unit, and believing that reporting within Primary Health Care is an advantage, facilitate reporting.

CONCLUSION:

the study''s results may, in addition to sensitizing nurses, support management professionals in establishing strategies intended to produce compliance with reporting as a legal device that ensures the rights of children and adolescents.     

南京市流动妇女的避孕方法现状及影响因素研究

基于"南京市建邺区流动妇女计划生育/生殖健康状况研究"的问卷调查数据,对流动妇女的避孕方法现状及影响因素进行了分析。研究表明:流动妇女避孕措施的选择依次是宫内节育器(48.0%)、绝育术(32.9%)和避孕套(16.3%);65.4%的流动妇女没听说过紧急避孕;46.0%的流动妇女不知道目前自己使用的避孕方法的副作用。据此提出,应建立流动人口计划生育/生殖健康服务管理和测评体系,以保证基层流动人口的计划生育/生殖健康服务工作落到实处。