Comprehensive health (care) services to women in gender violence situation: an alternative to primary health care

Este artigo trata das possibilidades de atuação do campo da saúde na abordagem da violência contra a mulher desde suas práticas assistenciais nos serviços e baseadas na perspectiva de gênero. Apresenta-se uma dada compreensão teórico conceitual da violência de gênero contra as mulheres articulada a uma proposta de cuidado, pois a forma como o problema é delimitado é essencial para a intervenção, respondendo a finalidades sociais diversas. Trata-se, portanto, de pensar quais os objetivos da ação em saúde e qual o seu lugar na produção e reprodução de modos de viver e adoecer. Defende-se a possibilidade de atendimento integral, para que também a violência, e não apenas suas repercussões, seja considerada no trabalho em saúde. Recupera-se a proposta de atenção dirigida à violência sexual no Brasil e debate-se uma possibilidade de atuação na atenção primária tal como implantada no Centro de Saúde Escola Samuel B. Pessoa. As ações propostas e integradas ao Programa de Atenção Integral à Saúde da Mulher (PAISM) da Unidade constituem uma atividade de atendimentos a conflitos familiares difíceis (CONFAD), conceituada como uma técnica específica de detecção, escuta e orientação qualificadas, que caracterizam uma “técnica de conversa” como agir profissional. Por fim, discutem-se aspectos relativos à conexão do setor saúde com a rede intersetorial de atenção e suas principais dificuldades.This paper deals with the possibilities of the health sector to approach violence against women in its practices as a gender issue. It is presented a conceptual and theoretical comprehension of gender violence linked to a care proposal, as the definition of the problem is essential to the intervention, answering to different social ends. To do that, is necessary to think what the objectives of the work in health are and where it is placed within the production and reproduction of the ways of living and falling ill. It is argued the possibility of full assistance, in order that violence itself, and not only its repercussions, are considered in the health work. The proposal of care for sexual violence in Brazil is recovered, and a model of primary health care implemented at Samuel B. Pessoa Health School Center is presented. This model is integrated in the Women’s Integral Health Care Program (PAISM) and attends women in severe domestic conflicts (CONFAD) conceptualized as a specific technique of detection, listening and counseling, featuring a “chat technique” as a professional action. To conclude, aspects related to the connections of the health sector with the intersectorial network are discussed presenting its principal difficulties

Repercussão da exposição à violência por parceiro íntimo no comportamento dos filhos

OBJETIVO: Analizar la asociación entre la exposición a la violencia por pareja íntima (VPI) contra la mujer con desajustes de comportamiento y problemas escolares entre los hijos. MÉTODOS: Pesquisa poblacional participante del WHO Multicountry Study on Violence Against Women, con 790 mujeres que cohabitan con hijos de cinco a 12 años, residentes en el Municipio de Sao Paulo, Sureste de Brasil, y en la Zona de la Mata de Pernambuco, Noreste de Brasil. Se realizaron tres modelos múltiples para estimar la fuerza de la asociación entre variables explicativas de apoyo social y comunitario, eventos de vida estresantes, factores sociodemográficos y gravedad de la VPI, entre otras. Los modelos incluyeron tres aspectos respectivos: número de problemas de comportamiento, agresividad e interrupción, abandono o repetición escolar. RESULTADOS: La exposición a la VPI física y/o sexual grave estuvo asociada a la ocurrencia de problemas escolares, de problemas de comportamiento en general, y de comportamientos agresivos en el análisis de regresión logística univariada. La exposición a la VPI grave se mantuvo asociada a la ocurrencia de tres o más problemas de comportamiento entre sus hijos, independientemente del trastorno mental común, de la baja escolaridad, de la madre (abuela) haber sido víctima de VPI física y del apoyo social y comunitario en los modelos de regresión logística múltiples. La VPI grave estuvo asociada al comportamiento agresivo y a los problemas escolares, después del ajuste por otras variables sociodemográficas, entre otras. El estado de salud mental materno constituye un factor mediador de la relación entre la exposición a la VPI y los problemas de comportamiento, sobretodo la agresividad. CONCLUSIONES: La VPI grave afecta el comportamiento de los hijos y debe ser incluida en la asistencia a la salud de los niños en edad escolar, por medio de intervenciones conjuntas entre niños y madres.OBJETIVO: Analisar a associação entre a exposição à violência por parceiro íntimo (VPI) contra a mulher com desajustes comportamentais e problemas escolares entre os filhos. MÉTODOS: Inquérito populacional participante do WHO Multicountry Study on Violence Against Women, com 790 mulheres que coabitam com filhos de cinco a 12 anos, residentes no Município de São Paulo, SP, e na Zona da Mata de Pernambuco. Foram realizados três modelos múltiplos para estimar a força da associação entre variáveis explanatórias de apoio social e comunitário, eventos de vida estressantes, fatores sociodemográficos e gravidade da VPI, entre outras. Os modelos incluíram três respectivos desfechos: número de problemas de comportamento; agressividade; e interrupção abandono ou repetência escolar. RESULTADOS: A exposição à VPI física e/ou sexual grave esteve associada à ocorrência de problemas escolares, de problemas de comportamento em geral e de comportamentos agressivos na análise de regressão logística univariada. A exposição à VPI grave manteve-se associada à ocorrência de três ou mais problemas de comportamento entre seus filhos, independentemente do transtorno mental comum, da baixa escolaridade, de a mãe (avó) ter sido vítima de VPI física e do apoio social e comunitário nos modelos de regressão logística múltiplos. A VPI grave esteve associada ao comportamento agressivo e aos problemas escolares, depois do ajuste por outras variáveis sociodemográficas, entre outras. O estado de saúde mental materna constituiu-se em fator mediador da relação entre a exposição à VPI e os problemas de comportamento, sobretudo agressividade. CONCLUSÕES: A VPI grave afeta o comportamento dos filhos e deve ser incluída na assistência à saúde das crianças em idade escolar, por meio de intervenções conjuntas entre crianças e mães.OBJECTIVE: To analyze the relationship between intimate partner violence (IPV) against women and children's dysfunctional behaviors and school problems. METHODS: Population-based study part of the WHO Multicountry Study on Domestic Violence Against Women including 790 women living with their children aged five to 12 years in two different regions of Brazil: the city of São Paulo, Southeastern Brazil, and Zona da Mata area in the state of Pernambuco, Northeastern Brazil. Three multivariate models were developed to estimate the strength of the relationship between explanatory variables such as social and community support, stressful events of life, sociodemographic factors and "IPV severity," among others, and three outcomes: number of dysfunctional behaviors; aggressive behavior; and school problems (interruption, drop out or failure). RESULTS: Exposure to severe physical and/or sexual IPV was associated to school problems, behavioral dysfunctions in general and aggressive behaviors in the univariate analysis. Exposure to severe IPV against women was associated to the occurrence of three or more dysfunctional behaviors in their children, regardless of common mental disorder, low schooling, physical IPV against maternal grandmother, social and community support in the multivariate models. Severe IPV remained associated to aggressive behavior and school problems after adjustment for other sociodemographic variables, among others. Maternal mental health status was identified as a mediating factor between IPV exposure and dysfunctional behaviors, especially aggressive behaviors. CONCLUSIONS: Severe IPV affects children's behaviors and should be addressed in health policies for school-aged children through the development of common interventions for mothers and children

Percepciones de los estudiantes de ciencias de la salud sobre el aprendizaje cooperativo en la modalidad virtual

Objective: To identify the perceptions of implementing online cooperative learning during the 2021 II academic semesterby first-year students of Universidad Nacional Mayor de San Marcos (UNMSM) School of Medicine. Materials and methods: A descriptive and cross-sectional research design was used in this study. The population consisted of 592 students from the professional schools of Human Medicine, Nursing, Obstetrics, Nutrition and Medical Technology. A random probability sampling was carried out and a sample of 429 students was obtained. The Cooperative Learning Questionnaire with an 8-point Likert scale response format developed by McLeish was used as an instrument for data collection. It is a reliable and valid instrument that was administered online to the sample of students at the end of the course using Google Forms. The quantitative data were analyzed descriptively using IBM SPSS Statistics V22. The descriptive statistics included frequencies, averages and standard deviation. Results: Out of the students in the sample, 65.9 % were females and 34.1 % were males. Most participants had favorableperceptions of online cooperative learning, with averages between 3.77 and 4.53. Favorable perceptions of this methodologywere mainly identified in the dimensions quality of the group interaction process, teaching of interpersonal skills in smallgroups and positive interdependence. Conclusions: The students had favorable perceptions of online cooperative learning because it helped them to improve their social skills, favored their attitude toward group work, allowed them to participate in the sessions with enthusiasm,helped them to improve peer interaction, and promoted the development of their creativity and interpersonal skills. Therefore, its implementation and analysis of achievements in online environments are recommended.Objetivo: Identificar las percepciones de los estudiantes de primer año de estudios de la Facultad de Medicina de la Universidad Nacional Mayor de San Marcos (UNMSM) sobre la aplicación del aprendizaje cooperativo en la modalidad virtual durante el semestre académico 2021-II. Materiales y métodos: El diseño de investigación aplicado en este estudio fue descriptivo y transversal. La población estuvo conformada por 592 estudiantes pertenecientes a las escuelas profesionales de Medicina Humana, Enfermería, Obstetricia, Nutrición y Tecnología Médica. Se realizó un muestreo probabilístico aleatorio y se obtuvo una muestra de 429 estudiantes. Para la recolección de datos, se empleó como instrumento el Cuestionario de Aprendizaje Cooperativo, con un formato de respuesta en escala Likert, que consta de 8 indicadores y fue elaborado por McLeish. El instrumento es confiable y válido; fue aplicado a lamuestra de estudiantes al finalizar la asignatura de manera virtual mediante Google Forms. Los datos cuantitativos se analizaron descriptivamente con el programa SPSS 22. La estadística descriptiva que se aplicó incluye frecuencias, promedios y desviaciónestándar. Resultados: De los estudiantes que conformaron la muestra, el 65,9 % fueron mujeres y el 34,1 %, hombres. La mayor parte de los participantes tuvo percepciones favorables hacia el aprendizaje cooperativo en la modalidad virtual, y se obtuvieron promediosentre 3,77 y 4,53. Se identificaron percepciones favorables hacia esta metodología, principalmente en las dimensiones calidad delproceso de interacción del grupo, enseñanza de habilidades interpersonales en grupos pequeños e interdependencia positiva. Conclusiones: Los estudiantes tuvieron percepciones favorables hacia el aprendizaje cooperativo en la modalidad virtual, ya que contribuyó a mejorar su socialización, favoreció su actitud hacia el trabajo en grupo, permitió su participación en las sesiones con agrado, ayudó a mejorar sus interacciones con sus pares, desarrolló su creatividad y habilidades interpersonales, por lo cual se recomienda su aplicación y análisis de los logros en los entornos virtuales

A three-talk model for shared decision making: multistage consultation process

© 2017 The Authors. Published by BMJ. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1136/bmj.j4891Objectives To revise an existing three-talk model for learning how to achieve shared decision making, and to consult with relevant stakeholders to update and obtain wider engagement. Design Multistage consultation process. Setting Key informant group, communities of interest, and survey of clinical specialties. Participants 19 key informants, 153 member responses from multiple communities of interest, and 316 responses to an online survey from medically qualified clinicians from six specialties. Results After extended consultation over three iterations, we revised the three-talk model by making changes to one talk category, adding the need to elicit patient goals, providing a clear set of tasks for each talk category, and adding suggested scripts to illustrate each step. A new three-talk model of shared decision making is proposed, based on “team talk,” “option talk,” and “decision talk,” to depict a process of collaboration and deliberation. Team talk places emphasis on the need to provide support to patients when they are made aware of choices, and to elicit their goals as a means of guiding decision making processes. Option talk refers to the task of comparing alternatives, using risk communication principles. Decision talk refers to the task of arriving at decisions that reflect the informed preferences of patients, guided by the experience and expertise of health professionals. Conclusions The revised three-talk model of shared decision making depicts conversational steps, initiated by providing support when introducing options, followed by strategies to compare and discuss trade-offs, before deliberation based on informed preferences

P-wave excited baryons from pion- and photo-induced hyperon production

We report evidence for $N(1710)P_{11}$, $N(1875)P_{11}$, $N(1900)P_{13}$, $\Delta(1600)P_{33}$, $\Delta(1910)P_{31}$, and $\Delta(1920)P_{33}$, and find indications that $N(1900)P_{13}$ might have a companion state at 1970\,MeV. The controversial $\Delta(1750)P_{31}$ is not seen. The evidence is derived from a study of data on pion- and photo-induced hyperon production, but other data are included as well. Most of the resonances reported here were found in the Karlsruhe-Helsinki (KH84) and the Carnegie-Mellon (CM) analyses but were challenged recently by the Data Analysis Center at GWU. Our analysis is constrained by the energy independent $\pi N$ scattering amplitudes from either KH84 or GWU. The two $\pi N$ amplitudes from KH84 or GWU, respectively, lead to slightly different $\pi N$ branching ratios of contributing resonances but the debated resonances are required in both series of fits.Comment: 22 pages, 28 figures. Some additional sets of data are adde

The CLIF Consortium Acute Decompensation score (CLIF-C ADs) for prognosis of hospitalised cirrhotic patients without acute-on-chronic liver failure

BACKGROUND & AIMS: Cirrhotic patients with acute decompensation frequently develop acute-on-chronic liver failure (ACLF), which is associated with high mortality rates. Recently, a specific score for these patients has been developed using the CANONIC study database. The aims of this study were to develop and validate the CLIF-C AD score, a specific prognostic score for hospitalised cirrhotic patients with acute decompensation (AD), but without ACLF, and to compare this with the Child-Pugh, MELD, and MELD-Na scores. METHODS: The derivation set included 1016 CANONIC study patients without ACLF. Proportional hazards models considering liver transplantation as a competing risk were used to identify score parameters. Estimated coefficients were used as relative weights to compute the CLIF-C ADs. External validation was performed in 225 cirrhotic AD patients. CLIF-C ADs was also tested for sequential use. RESULTS: Age, serum sodium, white-cell count, creatinine and INR were selected as the best predictors of mortality. The C-index for prediction of mortality was better for CLIF-C ADs compared with Child-Pugh, MELD, and MELD-Nas at predicting 3- and 12-month mortality in the derivation, internal validation and the external dataset. CLIF-C ADs improved in its ability to predict 3-month mortality using data from days 2, 3-7, and 8-15 (C-index: 0.72, 0.75, and 0.77 respectively). CONCLUSIONS: The new CLIF-C ADs is more accurate than other liver scores in predicting prognosis in hospitalised cirrhotic patients without ACLF. CLIF-C ADs therefore may be used to identify a high-risk cohort for intensive management and a low-risk group that may be discharged early

Results of the third Marine Ice Sheet Model Intercomparison Project (MISMIP+)

We present the result of the third Marine Ice Sheet Model Intercomparison Project, MISMIP+. MISMIP+ is intended to be a benchmark for ice-flow models which include fast sliding marine ice streams and floating ice shelves and in particular a treatment of viscous stress that is sufficient to model buttressing, where upstream ice flow is restrained by a downstream ice shelf. A set of idealized experiments first tests that models are able to maintain a steady state with the grounding line located on a retrograde slope due to buttressing and then explore scenarios where a reduction in that buttressing causes ice stream acceleration, thinning, and grounding line retreat. The majority of participating models passed the first test and then produced similar responses to the loss of buttressing. We find that the most important distinction between models in this particular type of simulation is in the treatment of sliding at the bed, with other distinctions - notably the difference between the simpler and more complete treatments of englacial stress but also the differences between numerical methods - taking a secondary role. © 2020 Wolters Kluwer Medknow Publications. All rights reserved

Results of the third Marine Ice Sheet Model Intercomparison Project (MISMIP+)

We present the result of the third Marine Ice Sheet Model Intercomparison Project, MISMIP+. MISMIP+ is intended to be a benchmark for ice-flow models which include fast sliding marine ice streams and floating ice shelves and in particular a treatment of viscous stress that is sufficient to model buttressing, where upstream ice flow is restrained by a downstream ice shelf. A set of idealized experiments first tests that models are able to maintain a steady state with the grounding line located on a retrograde slope due to buttressing and then explore scenarios where a reduction in that buttressing causes ice stream acceleration, thinning, and grounding line retreat. The majority of participating models passed the first test and then produced similar responses to the loss of buttressing. We find that the most important distinction between models in this particular type of simulation is in the treatment of sliding at the bed, with other distinctions – notably the difference between the simpler and more complete treatments of englacial stress but also the differences between numerical methods – taking a secondary role

Violência contra mulheres entre usuárias de serviços públicos de saúde da Grande São Paulo

OBJECTIVE: To estimate the prevalence of (physical, psychological, and sexual) violence against women by an intimate partner and non-partner perpetrators among users of public health services and to compare these women's perception of having ever experienced violence with reports of violence in their medical records in the different services studied. METHODS: The study was conducted in 19 health services, selected as a convenience sample and grouped into nine research sites, in metropolitan area of São Paulo from 2001 to 2002. Questionnaires on having ever experienced violence in their lifetime and in the last 12 months and perpetrators were applied to a sample of 3,193 users aged 15 to 49. A total of 3,051 medical records were reviewed to verify the notification of violence. Comparative analyses were performed by Anova with multiple comparisons and Chi-square test followed by its partition. RESULTS: The following prevalences were found: any type of violence 76% (95% CI: 74.2;77.8); psychological 68.9% (95% CI: 66.4;71.4); physical 49.6% (95% CI: 47.7;51.4); physical and/or sexual 54.8% (95% CI: 53.1;56.6), and sexual 26% (95% CI: 24.4;28.0). The prevalence of physical and/or sexual violence by an intimate partner in their lifetime was 45.3% (95% CI: 43.5;47.1), and by non-partners was 25.7% (95% CI: 25.0;26.5). Only 39.1% of women reporting any episode of violence perceived they had ever experienced violence in their lifetime and 3.8% of them had any reports of violence in their medical records. The prevalences were significantly different between sites as well as the proportion of perception and reports of violence in medical records. CONCLUSIONS: The expected high magnitude of the event and its invisibility was confirmed by low rate of reports in the medical records. Few perceived abuses as violence. Further studies are recommended taking into account the diversity of service users.OBJETIVO: Estimar a prevalência de violência contra mulheres (física, psicológica e sexual), por parceiro íntimo ou outro agressor, entre usuárias de serviços públicos de saúde e contrastá-la com a percepção de ter sofrido violência e com o registro das ocorrências nos serviços estudados. MÉTODOS: Estudo realizado em 19 serviços de saúde, selecionados por conveniência e agrupados em nove sítios de pesquisa na Grande São Paulo, entre 2001-2002. Questionários sobre violência sofrida alguma vez na vida, no último ano e agressor foram aplicados à amostra de 3.193 usuárias de 15 a 49 anos. Foram examinados 3.051 prontuários dessas mulheres para verificação do registro dos casos de violência. Realizaram-se análises comparativas pelos testes Anova, com comparações múltiplas e qui-quadrado, seguido de sua partição. RESULTADOS: As prevalências observadas foram: qualquer violência 76% (IC 95%: 74,2;77,8); psicológica 68,9% (IC 95%: 66,4;71,4); física 49,6% (IC 95%: 47,7;51,4); física e/ou sexual 54,8% (IC 95%: 53,1;56,6) e sexual 26% (IC 95%: 24,4;28,0). A violência física e/ou sexual por parceiro íntimo na vida foi de 45,3% (IC 95%: 43,5;47,1) e por outros que não o parceiro foi de 25,7% (IC 95%: 25,0;26,5). Apenas 39,1% das que relataram qualquer episódio consideraram ter vivido violência na vida, observando-se registro em 3,8% dos prontuários. As prevalências diferiram entre os sítios de pesquisa, bem como a percepção e registro das violências. CONCLUSÕES: A esperada alta magnitude do evento e sua invisibilidade foram confirmadas pelas baixas taxas de registro em prontuário. Constatou-se ser baixa a percepção das situações vividas como violência. Sugerem-se estudos ulteriores que avaliem a heterogeneidade das usuárias dos serviços