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Objetivo: analisar as percepções de profissionais da atenção primária à saúde de Paranaguá/PR sobre as relações entre a pandemia de COVID-19 e casos de violência doméstica em seus territórios adscritos, identificando desafios na abordagem, impactos nas famílias e manejo dos casos. Metodologia: pesquisa qualitativa com entrevistas semiestruturadas e grupos focais com 36 profissionais de duas unidades básicas de saúde de Paranaguá, litoral paranaense. Resultados: profissionais da atenção primária à saúde foram unânimes em relatar o aumento no número de casos de violência doméstica naquelas comunidades, com impactos tanto para mulheres, quanto para crianças e adolescentes, sendo o fechamento das escolas um fator agravante. Como principais desafios, foram reportados: a desestruturação da atenção primária à saúde durante o auge da pandemia com deslocamento de profissionais e recursos; desinformação sobre fluxos de encaminhamento nos casos de violência doméstica na rede intersetorial; medo dos profissionais, tanto da pandemia, quanto de denunciar casos de violência doméstica; e rotatividade de profissionais. Conclusão: o período de isolamento social causado pela pandemia intensificou os casos de violência doméstica segundo as percepções de profissionais da atenção primária à saúde de Paranaguá. O desmonte da rede intersetorial prejudicou ainda mais o cuidado de pessoas em situação de vulnerabilidade e/ou violência. A ausência de diretrizes nacionais do governo federal deixou municípios e profissionais da atenção primária à saúde à própria sorte para lidar com o problema.

Objective: to analyze the perceptions of primary health care professionals in Paranaguá/PR about the relationship between the COVID-19 pandemic and cases of domestic violence in their assigned territories, identifying challenges in the approach, impacts on families and case management. Methodology: qualitative research was conducted using semi-structured interviews and focus groups with 36 professionals from two primary health care units in Paranaguá, on the Paraná coast. Results: primary health care professionals unanimously reported an increase in the number of domestic violence cases in those communities, affecting women, children, and adolescents, with the closure of schools identified as an aggravating factor. The main challenges highlighted were the disruption of primary health care services during the peak of the pandemic due to the reallocation of professionals and resources; misinformation about referral processes for domestic violence cases within the intersectoral network; fear among professionals regarding the pandemic and reporting domestic violence cases; and high staff turnover. Conclusion: the period of social isolation caused by the pandemic intensified domestic violence cases, according to the perceptions of primary health care professionals in Paranaguá. The dismantling of the intersectoral network further compromised the care of individuals in situations of vulnerability and/or violence. The absence of national guidelines from the federal government left municipalities and primary health care professionals on their own to deal with the issue.

Objetivo: analizar las percepciones de los profesionales de la atención primaria de salud de Paranaguá/PR sobre las relaciones entre la pandemia de COVID-19 y los casos de violencia doméstica en sus territorios asignados, identificando desafíos en el abordaje, impactos en las familias y gestión de casos. Metodología: investigación cualitativa con entrevistas semiestructuradas y grupos focales con 36 profesionales de dos unidades básicas de salud de Paranaguá, en la costa de Paraná. Resultados: los profesionales de la atención primaria de salud fueron unánimes al reportar el aumento del número de casos de violencia doméstica en esas comunidades, con afectaciones tanto a mujeres, niños y adolescentes, siendo el cierre de escuelas un agravante. Se informaron los principales desafíos: la interrupción de la atención primaria de salud durante el apogeo de la pandemia con el desplazamiento de profesionales y recursos; desinformación sobre los flujos de derivación de casos de violencia doméstica en la red intersectorial; miedo entre los profesionales, tanto a la pandemia como a denunciar casos de violencia doméstica; y rotación profesional. Conclusión: el período de aislamiento social provocado por la pandemia intensificó los casos de violencia doméstica según la percepción de los profesionales de la atención primaria de salud en Paranaguá. El desmantelamiento de la red intersectorial perjudicó aún más la atención a personas en situación de vulnerabilidad y/o violencia. La ausencia de directrices nacionales por parte del gobierno federal dejó a los municipios y a los profesionales de atención primaria de salud a su suerte a la hora de abordar el problema.

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

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O objetivo deste estudo foi caracterizar as notificações de violência interpessoal (VIP) contra lésbicas, gays, bissexuais e transgêneros (LGBT) registradas no Sistema de Informação de Agravos de Notificação (SINAN) no estado do Paraná, durante o período de 2015 a 2017. A abordagem adotada foi de cunho epidemiológico, ecológico e descritivo. Um total de 1.035 notificações de VIP direcionadas à comunidade LGBT foi identificado, prevalecendo principalmente entre pessoas com idades compreendidas entre 30 e 59 anos (33,8%), de cor branca (66,7%), e com nível educacional de ensino fundamental incompleto (35%). A residência se destacou como o principal local de ocorrência, compreendendo 54,6% dos casos, sendo que 55,6% das notificações descreviam violência de natureza física. A maioria dos supostos agressores era do sexo masculino (72,3%) e, em 30,4% das notificações, foram identificados parceiros íntimos como autores prováveis. Geograficamente, a Segunda Regional de Saúde do Paraná contribuiu com 24,7% das notificações, enquanto o município de Curitiba representou 14% delas. Dessa maneira, o estudo em questão desempenha um papel significativo no fortalecimento da vigilância e monitoramento das ocorrências de violência dirigida à população LGBT no estado do Paraná.

This study aimed to characterize the notifications of interpersonal violence (IPV) against lesbians, gays, bisexuals, and transgender people (LGBT) recorded in the Notifiable Diseases Information System (SINAN) in the state of Paraná between 2015 and 2017. The adopted approach was epidemiological, ecological, and descriptive. A total of 1.035 notifications of IPV targeting the LGBT community were identified, mainly prevalent among people aged between 30 and 59 years old (33,8%), white (66,7%), and with incomplete primary education (35%). The victims' home stood out as the place with the most occurrences (54,6%), and 55,6% of the cases were physical violence. Most alleged aggressors were male (72,3%), and in 30,4% of the events, intimate partners were identified as the likely perpetrators. Geographically, the Secondary Health Region of Paraná contributed to 24,7% of the notifications, while the municipality of Curitiba accounted for 14%. Thus, the study in question plays a significant role in strengthening the surveillance and monitoring of incidents of violence against the LGBT population in Paraná.

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Transgender people often live with social vulnerability, largely promoted by gender-based prejudice. Our aim in this article was to raise preliminary data on how the COVID-19 pandemic and perceived prejudice have contributed to the problem of food and food insecurity in the transgender communities in Brazil. We conducted a web-based cross-sectional study, in which 109 transgender people from all regions of Brazil participated. We used the Chi-Square test and Poisson regression modeling with robust variance to estimate the association between food insecurity and the investigated factors. In our sample, 68.8% of transgender people experienced food insecurity, of these, 20.2% experienced severe food insecurity. Our results showed that the difficulties in purchasing food in the transgender community predate the COVID-19 pandemic, yet that the restrictive measures adopted have also impacted overall access to quality food. However, the main explanations for food insecurity were income and employment. In predicting food insecurity, the experiences of prejudice must be considered, and give rise to the hypothesis that specific conditions to which transgender people are exposed explain, to some degree, their vulnerability to food insecurity.

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The COVID-19 pandemic led to family and routine reorganization, triggering social problems. Women were further exposed to domestic violence, especially intimate partner violence (IPV), with consequences to their and their children's health. However, few Brazilian studies address the issue, especially considering the pandemic and its restrictive measures. The objective was to verify the relationship between mothers'/caregivers' IPV and their children's neuropsychomotor development (NPMD) and quality of life (QOL) during the pandemic. Seven hundred one female mothers/caregivers of children (0-12 years old) responded to the online epidemiological inquiry. NPMD was investigated with the Caregiver Reported Early Development Instruments (CREDI-short version); QOL, with the Pediatric Quality of Life Inventory (PedsQL™); and IPV, with the Composite Abuse Scale (CAS). The independence chi-square test was used, with Fisher's exact statistics, in SPSS Statistics 27®. Children whose mothers were exposed to IPV were 2.68 times as likely to have a "low" QOL score (χ2(1) = 13.144, P < .001; φ = 0.137). This indicates a possible environmental influence on the children's QOL, which may have been aggravated by strict social distancing during the COVID-19 pandemic.

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Intimate partner violence (IPV) is a challenge in Brazil. The country holds one of the highest rates of femicide in the world, most of which are preceded by IPV. We conducted a cross-sectional study with 34,334 women, aged 18 to 59 years, from the 2019 Brazilian National Health Survey to analyze the prevalence of IPV and its subtypes among the Brazilian adult women in the last 12 months, encompassing their health consequences and the use of health services resulting from IPV. We also used logistic regression models to estimate the association of sociodemographic characteristics and self-perceived health status with IPV. The prevalence of IPV among Brazilian adult women in the last 12 months was 7.6% (95% confidence interval [CI] [7.0, 8.2]). Women aged 18 to 39 years, not married, and with income of up to 1 minimum wage (MW), had higher odds of suffering IPV. Among those who reported health consequences due to IPV, 69% reported psychological consequences, and 13.9% sought health care, mostly in primary or secondary health care services in the Brazilian Unified Health System (41.9%). Regarding the self-perceived health variables, women who reported eating problems (odds ratio [OR] = 1.29; [1.01, 1.65]), lack of interest/absence of pleasure (OR = 1.41; [1.11, 1.79]), depressive feelings (OR = 1.39; [1.03, 1.88]), feeling of failure (OR = 1.75; [1.36, 2.24]), and suicidal thoughts (OR = 1.73; [1.25, 2.41]) had greater odds of reporting IPV compared to those who did not report these same perceptions. The results show that younger, divorced or single, low-income women with eating problems and mental health disorders were more likely to suffer IPV. IPV often led to health problems, and many abused women sought support from public health services. Health professionals must be trained to identify and care for these women, thereby acting as allies in preventing and reducing IPV.

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Intimate partner violence (IPV) is a challenge in Brazil; the country is ranked 6th globally for femicide and one in four women experience physical and/or sexual IPV in their lifetimes. Safety decision aids (SDA) are tools for women experiencing IPV. Building upon previously developed and tested online SDA tools, we intend to adapt an SDA tool for use in Brazil. The purpose of this study was to examine the feasibility of a technology-based SDA to support Brazilian women living with IPV, tailored for the Brazilian context. Our participatory-action research approach built upon research between 2018 and 2019 at the House of the Brazilian Woman (HBW) of Curitiba, Brazil, a cross-sectoral one-stop center (OSC) providing comprehensive care for IPV survivors. Field research included observation, field notes, and in-depth interviews with twenty-eight (n = 28) participants (HBW staff and survivors). The results were grouped into four main thematic categories: advantages; uncertainties; barriers; and suggestions. The triangulated results showed that the majority of participants considered the SDA feasible, highlighting flexibility and confidentiality; information about IPV; and access to resources for formal help-seeking as advantages of the tool. Participants also expressed uncertainties about SDA's ability to increase women's safety and its accessibility for the most vulnerable. They made suggestions for improvement to meet the unique needs of Brazilian women. This study provided evidence on the potential of an SDA tailored for use within a comprehensive program of women survivors in Brazil. This step was crucial to inform the future implementation and evaluation.

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Resumo Introdução: Pessoas trans pertencem a um grupo marginalizado e vulnerável na sociedade e sofrem com dificuldades no atendimento no sistema de saúde. Este estudo objetivou compreender o processo saúde-doença-cuidado dessas pessoas e seu acesso aos serviços de saúde na cidade de Curitiba-PR, Brasil. Metodologia: Pesquisa qualitativa hermenêutica, por meio de dez entrevistas semiestruturadas com pessoas trans de Curitiba, que foram gravadas, transcritas e codificadas. Apreenderam-se as experiências e percepções sobre a saúde desses sujeitos e suas trajetórias de atendimento no sistema de saúde, analisando-se pela perspectiva hermenêutica. Resultados: As narrativas mostram que ainda há muito despreparo dos profissionais da saúde, e isso gera situações de desconforto à população trans. Essas experiências moldam a conduta dessa população frente aos serviços de saúde, muitas vezes evitando-os. Toda essa dificuldade no acesso à saúde gera questões de saúde mental e sentimentos de ideação suicida. Conclusão: O estudo evidenciou a falta de reconhecimento e de aceitação da forma que pessoas trans se expressam e a existência de uma série de ações discriminatórias por parte dos trabalhadores da saúde. A compreensão dessas dificuldades aponta para o que pode ser modificado para garantir um acesso à saúde de maior qualidade para essa população.

Abstract Introduction: Trans people belong to a marginalized and vulnerable group in society and suffer from difficulties in receiving care in the health system. This study aimed to understand the health-disease-care process of trans people and their access to health services in Curitiba, PR, Brazil. Methodology: Qualitative hermeneutic research, through semi-structured interviews with ten trans persons from Curitiba. The interviews were recorded, transcribed, coded and submitted to hermeneutic analysis. Analysis enabled to understand participants' experiences and perceptions about their health and trajectories of care in the health system. Results: The narratives showed that there is still a lot of unpreparedness of health professionals and this produces discomfortable care for the trans persons. These experiences shape the behavior of the trans population towards health services, often avoiding them. All this difficulty in accessing health care generates mental health issues and feelings of suicidal ideation. Conclusion: The study highlighted the lack of recognition and acceptance of the way trans people express themselves and the existence of several discriminatory actions practiced by health workers. Understanding these challenges points to what need to be improved, such as increasing access and the healthcare quality for this population.

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OBJECTIVE: To perform the translation and cross-cultural adaptation from English into Brazilian Portuguese of the Composite Abuse Scale, an instrument that identifies and quantifies intimate partner violence. METHODS: This study is based on the strict implementation of its previously published protocol, which consists of ten steps: (a) conceptual analysis; (b) double-blind translation; (c) comparison and first reconciled version of the two translations; (d) back-translation; (e) review of the back-translation by the developer and second reconciled version; (f) expert committee review (n = 6); (g) comparison of expert reviews and third reconciled version; (h) cognitive interviews with women from the Casa da Mulher Brasileira in Curitiba (n = 15); (i) assessments of user perceptions and final reconciliation; and (j) submission of the final version of the questionnaire to the developer. RESULTS: The implementation of the 10 steps of the protocol allowed the idiomatic, semantic, conceptual and experiential equivalences of the Composite Abuse Scale, incorporating suggestions and criticisms from the different participants of the process. Participants included the developer, professional translators, researchers specialized on the subject, women in situation of intimate partner violence, and professionals who provide care to them. Experts and cognitive interviews with women were instrumental in ensuring equivalence, and facilitating the understanding, including: (1) adaptation of the term "intimate relation" to "affective or conjugal relation"; (2) substitution of enclisis for proclisis cases in 20 items; (3) adoption of gender-neutral language, allowing its use in heterosexual, bisexual, and same-sex relations; (4) materialization of an instrument of scientific rigor and self-applicable, which may help women to visualize the situations of abuse in their relations. CONCLUSIONS: The translation and cross-cultural adaptation process of the Composite Abuse Scale resulted in the Composite Abuse Scale Brazilian Portuguese Version, a 30-item self-applicable instrument, capable to identify and quantify intimate partner violence, its frequency, severity and typologies (physical, emotional, harassment and severe combined violence).

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The aim was to analyze the relations between homicidal violence, human development, inequality, population size, and urbanization rates in Brazilian municipalities. This is a retrospective ecological study of 5,570 Brazilian municipalities which analyzes the relations between the average rate of homicides registered in the Brazilian Mortality Information System (from 2005 to 2015) and selected indicators: municipal human development indices (HDI-M), Gini index, urbanization rates, and quantitative population. Analysis of the relative effect (%) of the variables on the risk for homicidal violence showed a greater association with more populous municipalities (log 10) (80.8%, 95%CI: 73.0; 88.8), more urbanized ones (8%, 95%CI: 6.7; 9.2), with higher Gini index (6%, 95%CI: 2.6; 9.5); whereas the relation with HDI-M is inverse (-17.1%, 95%CI: -21.4; -12.6). National policies which aim to limit population growth and the urbanization of the most populous Brazilian cities could reduce homicide rates across the country. Reducing inequalities and investing in municipal social education, health, and income policies could also reduce the number of homicides. We estimated that improving the HDI-M of the municipalities by 0.1 would cause a national reduction between 7,560 and 12,834 annual homicides, whereas decreasing income inequality (Gini index) by 0.1 would mean saving between 1,569 to 5,448 lives per year.

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