Bakgrund: Mäns våld mot kvinnor är ett globalt samhällsproblem och kan resultera i allvarliga konsekvenser för kvinnans hälsa. I enlighet med sjuksköterskors etiska kod bär sjuksköterskor ett ansvar över att säkerställa att patienten erbjuds god vård, vilket bland annat omfattas av att värna om patienters säkerhet och motverka att patienten blir utsatt för hot och fara. Socialstyrelsens föreskrifter fastslår hälso- och sjukvårdens ansvar över att fastställa rutiner kring arbetet med våldsutsatta patienter. Med bakgrund av detta är det av betydelse att sjuksköterskor ställer frågor om våld till kvinnliga patienter för att uppmärksamma och identifiera våldsutsatthet. Syfte: Syftet var att beskriva sjuksköterskors erfarenheter av att ställa frågor om våld till kvinnliga patienter inom hälso- och sjukvården. Metod: En litteraturöversikt med tolv artiklar; fem kvalitativa artiklar, fyra kvantitativa artiklar samt tre artiklar med mixad metod. Artiklarna är hämtade från databaserna PubMed och Cinahl Complete.   Resultat: Utifrån dataanalysen identifierades fyra teman. Arbetsmiljö och arbetsrutiner, brist på kunskap, att bli känslomässigt påverkad och att identifiera tecken på våld.  Slutsats: Sjuksköterskor påverkas känslomässigt av att arbeta med våldsutsatta kvinnor. Till följd av brister i arbetsmiljön upplever även sjuksköterskor att de saknar tid och möjlighet till att ställa frågor om våld. Vidare finns meningsskiljaktigheter i när och hur frågor om våld ska ställas, vilket relateras till otydliga arbetsrutiner. Sjuksköterskor uppgav även att de hindras från att ställa frågor om våld på grund av bristande kunskap och utbildning. Konsekvensen blir att frågor om våld inte ställs och att våldet därmed inte upptäcks i önskvärd utsträckning. / Background: Men's violence against women is a global social problem and can result in serious consequences for women's health. In accordance with the nursing code of ethics, nurses have a responsibility to ensure that patients are offered good care, which includes safeguarding the safety of patients and preventing patients from being exposed to threats and danger. The regulations of the Swedish National Board of Health and Welfare state the responsibility of health care to establish procedures and routines for working with patients who have experienced violence. Based on this, it is important for nurses to ask women patients about violence in order to raise awareness and identify victimization.  Aim: The aim was to describe nurses’ experiences of asking female patients about violence in health care. Method: A literature review with twelve articles; five qualitative articles, four quantitative articles and three articles with a mixed method. The articles are retrieved from the databases PubMed and Cinahl Complete. Results: Based on the data analysis, four themes have been identified. Work environment and work routines, lack of knowledge, being emotionally affected and identifying signs of violence. Conclusions: Nurses are emotionally affected by working with abused women. Due to shortcomings in the work environment, nurses also feel that they lack the time and opportunity to ask questions about violence. Furthermore, there are differences of opinion on when and how questions about violence should be asked, which is related to unclear work routines. Nurses also stated that they are prevented from asking questions about violence due to a lack of knowledge and training. The consequence is that questions about violence are not asked and that violence is not detected to the desired extent.

Violência por parceiro íntimo (VPI) e morbidade materna grave constituem-se em importantes agravos à saúde sexual e reprodutiva feminina e representam formas de expressão das desigualdades de gênero. De acordo com os critérios clínicos, laboratoriais e de manejo relativos à morbidade materna grave, adotados pela Organização Mundial de Saúde (OMS) para a definição de condições potencialmente ameaçadoras da vida materna (CPAV), este estudo teve por objetivo analisar a associação entre VPI na gravidez atual e ocorrência de CPAV entre mulheres atendidas em maternidades públicas da Grande São Paulo. Gestantes e puérperas que constituíram a população de estudo (N=446) foram divididas em dois grupos distintos: 1) que desenvolveram CPAV durante o ciclo gravídico puerperal atual, definidas como casos (n= 109); e 2) que não apresentaram qualquer tipo de intercorrência clínica, laboratorial ou de manejo no mesmo ciclo, definidas como controles (n=337). Respeitando-se os preceitos da ética em pesquisa com seres humanos, os casos e os controles foram selecionados por meio de visitas diárias aos locais de estudo entre novembro de 2010 e junho de 2011; próximo da alta hospitalar, entrevistas estruturadas foram conduzidas para investigação retrospectiva de VPI durante a gravidez atual, por meio de questionário adaptado do Estudo Multipaíses da OMS sobre Saúde da Mulher e Violência Doméstica. A relação entre a variável resposta (CPAV), a variável de exposição (VPI) e demais variáveis independentes, foi avaliada por meio de proporções, testes qui-quadrado ou exato de Fisher e pelo modelo de regressão logística múltiplo. Identificou-se prevalência de \"near miss\" materno de 5,62/1.000NV, ou seja, 0,56% e, Razão de Resultados Maternos Severos de 6,37/1.000NV. Considerando-se a tipificação da violência, observou-se prevalência de 12,7% de violência psicológica; 7,6% de violência física e 1,6% de violência sexual durante a gestação atual entre casos e controles. A despeito da ausência de significância estatística entre a exposição à VPI na gestação atual, relatada por 13% da amostra, e a ocorrência do desfecho CPAV, verificou-se que tanto as gestantes expostas à VPI quanto as mulheres que desenvolveram CPAV, apresentam fatores associados às condições sociodemográficas e reprodutivas desfavoráveis. Concluiu-se sobre a importância do monitoramento de casos CPAV que, assim como o rastreamento rotineiro da VPI entre gestantes, deve ser incluído no processo de trabalho dos enfermeiros. Isto é importante para promover a qualificação da atenção à saúde materna. / Intimate partner violence (IPV) and severe maternal morbidity represents importants women´s sexual and reproductive health issues, as well as an expression means of gender inequalities. According to clinical, laboratory-based and management-based criteria concerning severe acute maternal morbidity adopted by World Health Organization (WHO) to define potentially life-threatening maternal condition, this study aims to analyze the association between IPV in current pregnancy and potentially life-threatening condition among women cared in Great São Paulo public hospitals. Pregnant and postpartum women who constituted the study population (N=446) were categorized into two distinct groups: 1) who developed potentially life- threatening condition during current pregnancy, childbirth or postpartum, called cases (n= 109); and 2) women who did not attended to any clinical, or laboratory- based and management-based criteria, called controls (n=337). According to the ethical standards of human research, cases and controls were selected through daily visits at study settings during November 2010 and June 2011; near discharge from hospital, the structured interviews were conducted to investigate the prospective relationship among IPV during current pregnancy through a questionnaire adapted from Who Multi-country Study on Women\'s Health and Domestic Violence Against Women. The relationship between response variable (potentially life-threatening maternal condition), the exposition variable (IPV) and the others independents variables was assessed by proportions, chi square test or Fisher\'s exact test and multiple regression logistic. The maternal near miss prevalence identified was 5,62/1.000 live births, or 0,56%. The Severe Maternal Outcome Ratio was 6,37/1.000 live births. Considering the violence´s types, the study have found 12,7% of psychological, 7,6% of physical and 1,6% of sexual injuries during current pregnancy among cases and controls. Despite the absence of statistical significance between VPI exposition in current pregnancy, which was related by 13% of the total sample, and the potentially life-threatening maternal outcome, it was verified that both pregnant women exposed to IPV as those who developed potentially life-threatening conditions, showed factors associated with sociodemographic and reproductive unfavorable conditions. In conclusion, it is recommended potentially life-threatening condition continued audit, as well as the IPV routine screening among pregnant women should be included in the nurse´s working process. It`s important to improve the quality of maternal care health system.

Bakgrund: Våld mot kvinnor är ett globalt hälsoproblem, 35% av samtliga kvinnor i världen har någon gång blivit utsatta för våld. Sjuksköterskans ansvar syftar till att identifiera behov och erbjuda god omvårdnad till kvinnan utsatt för våld utifrån rådande situation. En bristande sjukvård leder till sjuksköterskor som tvivlar på sin förmåga och patienter som känner sig otrygga till att avslöja våldet. Identifieras inte kvinnans utsatthet föreligger det en risk att hon kvarblir i en osund relation och i värsta fall dör till följd av våldet. Syfte: Att beskriva hindrande och möjliggörande faktorer för att identifiera kvinnor som utsatts för våld i nära relationer. Metod: En allmän litteraturstudie utifrån tio artiklar med både kvantitativ och kvalitativ ansats. Huvudresultat: Identifierade utmaningar var vårdpersonalens bristande kunskap, känslor och attityder samt organisatoriska brister. Vikten av identifiering och den betydelsefulla vårdrelationen identifierades som möjligheter till upptäckten av kvinnor utsatta för våld. Både utmaningar och möjligheter hade anknytningar till sjuksköterskans kunskap, attityd, identifiering, bemötande och ansvar. Slutsats: Slutsatsen tyder på att bristfällig kunskap, organisatoriska brister såväl som känslor och attityder hos vårdpersonal står till grund för en del svårigheter såsom att inte veta hur de ska förhålla sig, inte veta var de ska vända sig och obehagskänslor. Bättre identifieringsstrategier och en betydelsefull vårdrelation visade påverka sjuksköterskans förhållningssätt till det bättre vilket kunde leda till fler avslöjanden från kvinnor. / Background: Violence against women is a global health problem, of which 35% of all women in the world sometime during their lifetime has experienced. The nurse has a significant part in the encounter with women exposed to violence due to the nurses responsability of identification and providing of a tailor-made nursing. An inadequate healthcare leads to nurses who discredit themselves and patients who feel unsafe to disclose the violence. If the nurse doesn’t identify battered women there is a risk that she stays in the abusing relationship and in worst case, dies. Aim: Was to describe obstructive and enabling factors for identifying women who were exposed to domestic violence. Method: A litterature study was applied based on ten articles that were of both quantitative and qualitative approach. Results: Identified challenges were the lack of knowledge, feelings and attitudes of healthcare professionals and organizational deficiencies. The importance of identification and the important care relationship were identified as opportunities for the discovery of women subjected to violence. Both challenges and opportunities had links to the nurse's knowledge, attitude, identification, treatment and responsibility. Conclusion: The conclusion suggests that insufficient knowledge is the basis for both organizational deficiencies but also feelings and attitudes among healthcare personnel, this was also the area that was most in need of development. Better identification strategies and a meaningful relationship to the patients turned out having positive effects on nurses approach, which could lead to more disclosures from women.

Bakgrund: Våld mot kvinnor är ett känt socialt problem världen över och har under 2000-talet ökat med 30 procent. År 2007 anmäldes i Sverige ca 27 000 brott rubricerade som misshandel mot kvinnor och drygt 2/3 av dessa brott utfördes av en bekant gärningsman. Sjuksköterskan har en potentiellt unik och viktig roll i att identifiera och ta hand om kvinnor som söker hjälp gällande våld i parrelationer. Syfte: Att beskriva vilken roll sjuksköterskan har i mötet med den våldsutsatta kvinnan, samt hur sjuksköterskan upplever mötet. Metod: En deskriptiv litteraturstudie där 13 vetenskapliga artiklar har granskats och sammanställts. Resultat: Sjuksköterskans roll går ut på att skapa en trygg miljö och stödja den våldsutsatta kvinnan. Sjuksköterskan bör använda sig av ett professionellt bemötande och skapa en relation där en god kommunikation är möjlig. Sjuksköterskor upplever ofta frustration i mötet med den våldsutsatta kvinnan då det kan vara svårt att skapa en öppen dialog. Sjuksköterskor beskriver även en känsla av maktlöshet, då kvinnan väljer att gå tillbaka till ett våldsamt förhållande. Det är vanligt att sjuksköterskor i mötet med den våldsutsatta kvinnan blir känslomässigt engagerade. Slutsats: Sjuksköterskor saknar kunskap inom screening, bemötande samt omhändertagande av våldsutsatta kvinnor och är i behov av mer utbildning inom ämnet. / Background: Violence against women is a known social problem worldwide and increased by 30 percent in the 2000s'. In 2007, about 27 000 crimes captioned as abuse against women were reported in Sweden and just over 2/3 of these crimes were carried out by a known perpetrator. As a nurse you have a potentially unique and important role in identifying and taking care of women seeking help regarding intimate partner violence. Aim: To describe the role nurses have in the meeting with the abused woman, and how nurses perceive meeting. Method: A descriptive literature review in which 13 scientific papers have been reviewed and compiled. Results: Nursing role is to create a safe environment and support the abused woman. Nurses should use a professional approach and create a relationship where good communication is possible. The nurse often experience frustration in the meeting with the abused woman as it can be difficult to create an open dialogue. Nurses also describe a sense of powerlessness, when the woman chooses to go back to a violent relationship. It is common for nurses, in the meeting with the abused woman, to become emotionally involved. Conclusion: Nurses lack training in screening, treat and care for abused women and need more education in the subject.

Violence against women is a problem in all countries in the world, including the small autonomy of the Åland Islands. The violence ranges from psychological threats to femicide. In the Åland Islands the issue has been placed on the agenda of politicians and the authorities, while reports about severe violence against women have been brought to the public. In Åland no scientific research on violence against women has been performed. The overall aim of this dissertation is to gain a deeper insight into how battered women in Åland are cared for by nurses, and how the official organizations have responded to the government policy directives. In this thesis, the first study, a descriptive survey, describes how nurses identify and support battered women. In the second and third studies, the method of grounded theory was used to explore the experiences and perceptions of nurses and battered women of violence against women. In the fourth study a case study approach was used to explore government policies for intimate partner violence. The main findings in this thesis are that battered women used health services to receive help. We found that nurses identified and supported abused women, even though services for these women were inadequate. Nurses were willing to help the women, but they often lacked support. Battered women reported that they received ad hoc help. They were often left alone, dependent on a nearby person to escape, survive, and recover. Another finding was that the Government of the Åland Islands demanded that the official organizations should allocate services to battered women, but the organizations’ response to the directives had some limitations. From a public health perspective, the phenomenon presents an urgent challenge. Overall, the public health community can and should contribute greatly towards the understanding, prevention, and control of violence by applying and adapting already constructed principles, and by implementing strategies. / Våld mot kvinnor är ett problem som förekommer i alla länder I världen inkluderat det lilla autonoma området Åland. Fenomenet kan jämföras med terror. Våld mot kvinnor utövas i former från hot till mord. På Åland har problemet lyfts fram både genom politikers som tjänstemäns agendor, samtidigt som rapporter om allvarligt förekommande våld mot kvinnor rapporterats till allmänhetens kännedom. Våld mot kvinnor har inte studerats genom vetenskaplig forskning på Åland. Huvudsyftet med denna avhandling är att uppnå fördjupade insikter angående hur våldsutsatta kvinnor bemöts av sjukskötare och hur de offentliga organisationerna agerat utifrån regeringens direktiv. I denna avhandling är den första studien en beskrivande undersökning som beskriver hur sjukskötare identifierar och hjälper våldsutsatta kvinnor. Den andra och tredje studien har använtgrounded theory för att studera sjukskötare och våldsutsatta kvinnors erfarenheter och uppfattningar angående våld mot kvinnor. Den fjärde studien en case study studie har undersökt regeringens riktlinjer angående våld mot kvinnor. Huvudfynden i denna avhandling visar att våldsutsatta kvinnor söker hjälp från hälsovården. Vi fann att sjukskötare identifierar och stöder våldsutsatta kvinnor även då servicen var otillräcklig. Sjukskötare var villiga att hjälpa kvinnorna men de saknade ofta själva stöd. Våldsutsatta kvinnor rapporterade att de erbjöds en hjälp som de uppfattade som ad hoc. De var ofta lämnade ensamma helt beroende av en närstående person för att kunna fly, överleva, och återhämta sig. Ett annat fynd var att Ålands landskapsregering hade uppmanat de offentliga organisationerna att erbjuda service till våldsutsatta kvinnor, men organisationernas respons var begränsade. Fenomenet utgör en akut utmaning sett utifrån ett folkhälsoperspektiv. Slutligen, de ansvariga för folkhälsan i samhället kan och borde bidra med förståelse, prevention, och kontroll av våldet genom att tillämpa och anpassa redan konstruerade principer, och genom en implementering av åtgärder.

Diss. (sammanfattning) Umeå : Umeå universitet, 2010.

p. 1-101 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-04-29T17:45:04Z No. of bitstreams: 1 11111s.pdf: 722272 bytes, checksum: 5a420e49e0b2d65bd54bbaa8e6b38593 (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-04T17:26:50Z (GMT) No. of bitstreams: 1 11111s.pdf: 722272 bytes, checksum: 5a420e49e0b2d65bd54bbaa8e6b38593 (MD5) / Made available in DSpace on 2013-05-04T17:26:50Z (GMT). No. of bitstreams: 1 11111s.pdf: 722272 bytes, checksum: 5a420e49e0b2d65bd54bbaa8e6b38593 (MD5) Previous issue date: 2006 / Este estudo de corte transversal teve como objetivo descrever o padrão de ocorrência de distúrbios psíquicos menores entre mulheres de 15 a 49 anos, atendidas em um hospital de emergência de Salvador e que sofreram diferentes tipos de violência. As mulheres foram identificadas a partir de entrevistas face a face, utilizando-se o ?Abuse Assesment Screen?. Para avaliar o estado mental, utilizou-se uma versão do ?Self-Reporting Questionnaire? (SRQ-20). Do total de 273 mulheres, 77, 3 % (Intervalo de Confiança - IC 95 % = 78% - 82 %) apresentaram escore igual ou acima de sete no SRQ- 20, sugerindo provável morbidade psiquiátrica. Mulheres que sofreram mais de um tipo de violência (Razão de Prevalência ? RP= 1,31; IC 95% = 1,11 ? 1,56) e foram agredidas nos últimos doze meses (RP= 1,30; IC 95% = 1,08 ? 1,58) apresentaram maior prevalência de distúrbios psíquicos menores. Os resultados sugerem uma associação positiva entre violência e doença mental, o que requer medidas mais eficazes de atenção às vítimas, como a criação de redes institucionais que garantam a integralidade da assistência às mulheres. / Salvador

Violência por parceiro íntimo (VPI) e morbidade materna grave constituem-se em importantes agravos à saúde sexual e reprodutiva feminina e representam formas de expressão das desigualdades de gênero. De acordo com os critérios clínicos, laboratoriais e de manejo relativos à morbidade materna grave, adotados pela Organização Mundial de Saúde (OMS) para a definição de condições potencialmente ameaçadoras da vida materna (CPAV), este estudo teve por objetivo analisar a associação entre VPI na gravidez atual e ocorrência de CPAV entre mulheres atendidas em maternidades públicas da Grande São Paulo. Gestantes e puérperas que constituíram a população de estudo (N=446) foram divididas em dois grupos distintos: 1) que desenvolveram CPAV durante o ciclo gravídico puerperal atual, definidas como casos (n= 109); e 2) que não apresentaram qualquer tipo de intercorrência clínica, laboratorial ou de manejo no mesmo ciclo, definidas como controles (n=337). Respeitando-se os preceitos da ética em pesquisa com seres humanos, os casos e os controles foram selecionados por meio de visitas diárias aos locais de estudo entre novembro de 2010 e junho de 2011; próximo da alta hospitalar, entrevistas estruturadas foram conduzidas para investigação retrospectiva de VPI durante a gravidez atual, por meio de questionário adaptado do Estudo Multipaíses da OMS sobre Saúde da Mulher e Violência Doméstica. A relação entre a variável resposta (CPAV), a variável de exposição (VPI) e demais variáveis independentes, foi avaliada por meio de proporções, testes qui-quadrado ou exato de Fisher e pelo modelo de regressão logística múltiplo. Identificou-se prevalência de \"near miss\" materno de 5,62/1.000NV, ou seja, 0,56% e, Razão de Resultados Maternos Severos de 6,37/1.000NV. Considerando-se a tipificação da violência, observou-se prevalência de 12,7% de violência psicológica; 7,6% de violência física e 1,6% de violência sexual durante a gestação atual entre casos e controles. A despeito da ausência de significância estatística entre a exposição à VPI na gestação atual, relatada por 13% da amostra, e a ocorrência do desfecho CPAV, verificou-se que tanto as gestantes expostas à VPI quanto as mulheres que desenvolveram CPAV, apresentam fatores associados às condições sociodemográficas e reprodutivas desfavoráveis. Concluiu-se sobre a importância do monitoramento de casos CPAV que, assim como o rastreamento rotineiro da VPI entre gestantes, deve ser incluído no processo de trabalho dos enfermeiros. Isto é importante para promover a qualificação da atenção à saúde materna. / Intimate partner violence (IPV) and severe maternal morbidity represents importants women´s sexual and reproductive health issues, as well as an expression means of gender inequalities. According to clinical, laboratory-based and management-based criteria concerning severe acute maternal morbidity adopted by World Health Organization (WHO) to define potentially life-threatening maternal condition, this study aims to analyze the association between IPV in current pregnancy and potentially life-threatening condition among women cared in Great São Paulo public hospitals. Pregnant and postpartum women who constituted the study population (N=446) were categorized into two distinct groups: 1) who developed potentially life- threatening condition during current pregnancy, childbirth or postpartum, called cases (n= 109); and 2) women who did not attended to any clinical, or laboratory- based and management-based criteria, called controls (n=337). According to the ethical standards of human research, cases and controls were selected through daily visits at study settings during November 2010 and June 2011; near discharge from hospital, the structured interviews were conducted to investigate the prospective relationship among IPV during current pregnancy through a questionnaire adapted from Who Multi-country Study on Women\'s Health and Domestic Violence Against Women. The relationship between response variable (potentially life-threatening maternal condition), the exposition variable (IPV) and the others independents variables was assessed by proportions, chi square test or Fisher\'s exact test and multiple regression logistic. The maternal near miss prevalence identified was 5,62/1.000 live births, or 0,56%. The Severe Maternal Outcome Ratio was 6,37/1.000 live births. Considering the violence´s types, the study have found 12,7% of psychological, 7,6% of physical and 1,6% of sexual injuries during current pregnancy among cases and controls. Despite the absence of statistical significance between VPI exposition in current pregnancy, which was related by 13% of the total sample, and the potentially life-threatening maternal outcome, it was verified that both pregnant women exposed to IPV as those who developed potentially life-threatening conditions, showed factors associated with sociodemographic and reproductive unfavorable conditions. In conclusion, it is recommended potentially life-threatening condition continued audit, as well as the IPV routine screening among pregnant women should be included in the nurse´s working process. It`s important to improve the quality of maternal care health system.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2016-04-07T14:41:13Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DISSERTAÇÃO JOSIANNE MATTOS.pdf: 1147221 bytes, checksum: 26a5d5a2976ac258b491cc24dc6aa6c8 (MD5) / Made available in DSpace on 2016-04-07T14:41:13Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DISSERTAÇÃO JOSIANNE MATTOS.pdf: 1147221 bytes, checksum: 26a5d5a2976ac258b491cc24dc6aa6c8 (MD5) Previous issue date: 2015-08-21 / CAPEs / A violência é uma questão complexa que se reproduz no cotidiano. Ela pode se naturalizar nas relações parentais - sob a justificativa de atos disciplinares - e, numa outra perspectiva, na relação com parceiros íntimos. O objetivo da pesquisa foi estimar a prevalência e analisar a associação entre a violência cometida contra mulheres por parceiro íntimo (VPI) e a prática educativa materna (PEM) com crianças no início da escolaridade formal. Estudo transversal, realizado entre 2013 e 2014 com 631 mulheres, entre 24 e 58 anos, cadastradas na Estratégia de Saúde da Família do Distrito Sanitário II da cidade do Recife, Pernambuco. A PEM foi avaliada pela escala de conflitos Parent-Child Conflict Tactics Scale. VPI foi definida por atos concretos de violência psicológica, física e sexual infligidos à mulher pelo parceiro. A associação da VPI com a PEM foi estimadvoa pelos odds ratios brutos e ajustados, utilizando-se análise de regressão logística multivariada. As prevalências foram, VPI: 24,4% e PEM violenta: 93,8% (82,4% de agressão física e 91,4% de agressão psicológica). Disciplina não violenta (DNV) foi referida por 97,6% das mulheres como estratégia educativa, coexistindo com estratégias violentas de disciplinamento. Houve associação entre VPI e PEM; ter relatado VPI aumentou as chances em 2,2 vezes da criança sofrer agressão psicológica (IC95%: 1,0 - 5,0). Embora a DNV tenha sido referida, os achados demonstram alta prevalência de prática educativa materna que perpassa pela violência, o que aponta para a necessidade de intervenções que minimizem os prejuízos da violência na mulher e na criança. / Violence is a complex issue that happens every day. It can become natural in parental relationships – justified as disciplinary actions – and, on another perspective, on the relationship with intimate partners. This research aimed to estimate the prevalence and to analyze the association between the intimate partner violence against women (IPV) and the maternal educational practice (MEP) against to children at the start of formal education. This is a Cross-sectional study, carried out from 2013 to 2014 with 631women in the age group 24 and 58 years old, registered at the Sanitary Distric II Family Health Strategy of Recife, Pernambuco. The MEP was evaluated with the Parent-Child Conflict Tactics Scale. IPV was defined by the concrete psychological, physical and sexual violence acts inflicted to the woman by her partner. The association of IPV and MEP was estimated by the crude and adjusted odds ratio, using the logistic regression analysis. The prevalences of, IPV was (24.4% and for violent MEP 93.8%; 82.4 % for physical aggression and 91.4% psychological aggression). Non-violent discipline (NVD) was referred by 92.6% of women as educational strategy, coexisting with violent disciplining strategies. There was an association between IPV and MEP: have reported IPV increased 2,2 times the chances of a child to suffer psychological aggression (CI95%: 1.0 – 5.0). Although the NVD has been referred, the finding demonstrate high prevalence of violent maternal educational practice, what points out to the necessity of interventions that minimize the harms on the woman and the child.

Orientadores: Ana Maria Segall Correa, Silvia Maria Santiago / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T03:20:09Z (GMT). No. of bitstreams: 1 Audi_CeleneAparecidaFerrari_D.pdf: 4215220 bytes, checksum: 127ca6e6ad40b4ce8643dc88d2cf647e (MD5) Previous issue date: 2007 / Resumo: A violência contra as mulheres, em suas diversas formas, é endêmica em todos os países do mundo, independente da classe social, raça ou idade. Estudos têm mostrado que a gestante não está livre de sofrer as diversas manifestações de violência doméstica. O objetivo deste trabalho foi investigar a associação entre violência doméstica contra as gestantes, residentes na região Sudoeste de Campinas-SP e os fatores associados à violência perpetrada pelo parceiro íntimo, assim como, verificar o impacto dessa violência no peso ao nascer ou na prematuridade. Inicialmente, foram realizados grupos focais para subsidiar o estudo de coorte. Neste, numa etapa retrospectiva foram coletadas informações sobre experiência de violência doméstica vivida pelas gestantes selecionadas, no ano anterior a gestação. Numa etapa prospectiva, coletamos dados sobre nova exposição à violência doméstica durante e após período gestacional. Informações sobre, características sócio demográficas das gestantes, do parceiro íntimo, sobre o parto e pós-parto imediato, também foram pesquisadas. Participaram do estudo 1379 gestantes usuárias do SUS. Do total da amostra, 19,1 % (262) referiram ter sido vítima de violência psicológica, 5,9% (81) de violência física e 1,3% (18) de violência sexual. A prevalência de violência física ou sexual foi de 6,5% (81) gestantes. Através de analise de regressão logística, permaneceram associados: 1) à violência psicológica: gestante com escolaridade fundamental ou menor (p<0,013), gestante ser responsável pela família (p<0,001), sentimento de rejeição (p<0,001), gestante presenciou agressão física na infância (p<0,001), gestante sofreu agressão física na infância (p<0,032), parceiro íntimo adolescente (p<0,011) e consumir bebida alcoólica com freqüência superior a uma vez por semana (p<0,001); 2) à violência física/sexual: a gestante ter relatado dificuldade em fazer as consultas de pré-natal (p<0,011 ), gestante com escolaridade fundamental ou menor (p<0,002), sentimento de rejeição (p<0,001), gestante sofreu agressão física na infância (p<0,021), parceiro íntimo não trabalhar (p<0,039) e o parceiro fazer uso de drogas e consumir álcool com freqüência superior a uma vez por semana (p<0,001). Para analisar o peso ao nascer ou prematuridade, 1220 mulheres foram acompanhadas durante o período de pré-natal e pós-natal (88,5% das gestantes inicialmente selecionadas). Essa diferença refere-se a 11,5% das perdas de acompanhamento, basicamente por mudança de endereço. O peso médio ao nascer foi de 3,233 gramas e a idade gestacional foi em média 38,56 semanas. Apresentaram BPN ou PM 13,8% RN. Condições de risco para BPN ou PM foram: gestante ter tido RN PM em outra gestação (p<0,003), ser tabagista (p<0,001), ter tido parto por cesárea (p<0,001) e ser baixa a escolaridade do parceiro (p<0,005). Os eventos adversos, manifestados durante a gestação associados à violência psicológica e violência física/sexual foram, respectivamente: infecção urinária (p<0,007; p<0,027), falta de desejo sexual (p<0,018; p<0,001), afecções ginecológicas (p<0,009), enxaqueca (p<0,014), sentimento de rejeição e distúrbios neuróticos (p<0,001). Conclusões: este estudo conseguiu identificar que a prevalência de qualquer forma de violência contra a gestante pode acometer aproximadamente uma em cada seis delas. O perpetrador mais provável é o que consome drogas licitas ou ilícitas; mostraram-se de maior risco as mulheres de baixa escolaridade, dificuldades de comparecer ao pré-natal e que são responsáveis pela família. Não foi observada associação estatisticamente significativa entre violência doméstica e baixo peso ao nascer ou prematuridade. Os eventos adversos manifestados durante a gestação foram: infecção urinária, falta de desejo sexual, afecções ginecológicas, enxaqueca, sentimento de rejeição e distúrbios neuróticos. As prevalências de violências observadas e os fatores a elas associados evidenciam a magnitude e complexidade do problema. Sugere-se rever os mecanismos que permitam sua identificação e orientem abordagem inter e multidisciplinar, especialmente no âmbito da Saúde Pública, com ênfase na atenção primária / Abstract: Violence against women, in its various forms, is endemic in every country in the world, regardless of social class, race, or age. Studies have shown that pregnant women also suffer from the various manifestations of domestic violence. The objective of this study was to investigate the association between domestic violence against pregnant women residing in the southeastern region of Campinas-SP and the factors associated with violence perpetrated by their partners, as well as examine the impact of this violence on birth weight and premature birth. Focus groups were initially conducted to complement the cohort study. In the latter, in a retrospective phase, information was collected regarding the domestic violence experienced by the pregnant women during the year preceding their pregnancy. In a prospective phase, data was collected on exposure to domestic violence during and after pregnancy. Information on the socio-demographic characteristics of the pregnant women, of their partners, and about the birth and immediate post-partum period was also collected. The total number of pregnant women who participated in the study was 1379, all users of the Brazilian Unified Health System (SUS). Of these, 19,1% (263) claimed to have been victims of psychological violence, 5,9% (81) of physical violence, and 1,3% (18) of sexual violence. The prevalence of physical or sexual violence was 6,5% (81). Logistic regression analysis showed associations between: 1) psychological violence 8th grade education or less (p<0,013), pregnant woman describing herself as being responsible for the family (p<0,001), rejection feeling (p<0,001), pregnant woman witnessed physical aggression in the childhood (p<0,001), pregnant woman suffered physical aggression in the childhood (p0, <032), adolescent father (p0<,011) and alcohol consumption by partner more often than once a week (p<0,001); 2) physical/sexual violence and: difficulty in doing prenatal consultations (p<0,011), 8th grade education or less (p<0,002), and drug and alcohol consumption by partner more often than once a week (p<0,001), rejection feeling (p<0,001), pregnant woman suffered physical aggression in the childhood (p<0,021), partner intimate doesn't work. To analyze birth weight or premature birth, 1220 women were followed during the pre- and post-natal period (88,5% of the pregnant women initially selected). This represents a 11,5% loss basically due to address changes. Mean birth weight was 3,233 grams and mean gestational age was 38,56 weeks. Of the newborns, 13,8% were low birth weight or premature. Risk conditions for low birth weight or prematurity included: history of previous premature births (p<0,003), tobacco use (p<0,001), cesarean birth (p<0,001), and low educational level of the partner (p<0,005). The event¿s adverse manifested during pregnancy association¿s violência psychological violence and physical/sexual violence were, respectively urinary infection (p <0,007; p <0,027), lacks of sexual want (p<0,018; p<0,001), gynecological problem (p<0,009), headache (p <0,014), rejection feeling and neurotic disturbances (p <0,001). Conclusions: In this study, it was found that the prevalence of some form of violence against pregnant women can be as high as one in six. The most likely perpetrators are consumers of illicit or licit drugs. Women at higher risk included those with fewer years of schooling, those who had difficulties in keeping their prenatal care appointments, and those who described themselves as being responsible for the family. No statistically significant associations were observed between domestic violence and low birth weight or premature birth. The adverse events manifested during the gestation were: urinary infection lacks of sexual want, gynecological problem, headache, rejection feeling and neurotic disturbances. The prevalence¿s of the different types of violence observed and their associated factors suggest the magnitude and complexity of the problem. It is recommended that mechanisms to identify the problem and provide inter- and muti-disciplinary guidance be reviewed, especially in the sphere of public health, with emphasis in primary health care / Doutorado / Epidemiologia / Doutor em Saude Coletiva