RESUMO
Introduction. Sexual violence against adolescents is a global problem that affects young people around the world. The ecological model examines its forms and determinants through interconnected levels. Objective. To determine the frequency, characteristics, and predictors of sexual violence in adolescents attending school in Perú. Materials and methods. This was a cross-sectional study that secondarily analyzed data from the Encuesta Nacional de Relaciones Sociales (2019). A stratified probabilistic sample involved 1,579 youth aged 12-17 from 93 schools. The questionnaire evaluated physical, psychological, and sexual violence in the family and at school. Models were estimated using logistic regression analysis, calculating odds ratio (OR). Results. Eighteen point sixty eight per cent (95% CI: 16.80-20.60) suffered some type of sexual assault. In addition, 9.75% (95% CI: 8.28-11.21) reported having been touched in some part of the body and 1.84% (95% CI: 1.17-2.50) reported that was a victim of rape. Age was identified as a risk factor in the microsystem (OR = 1.48) (95% CI: 1.26-1.74), while the age of the first experienced sexual violence acted as a protective factor (OR = 0.61) (95% CI: 0.54-0.69). In addition, in the macrosystem, the perception that violence occurs mainly outside the home increased the risk (OR = 2.06) (95% CI: 1.01-4.19). Conclusions. Approximately two out of ten respondents reported having experienced some type of sexual violence, with verbal harassment and invasive personal contact being the most common. No single level or factor can fully explain adolescent sexual violence without considering its ecological interconnectedness.
Introducción. La violencia sexual contra los adolescentes es un problema global que afecta a jóvenes de todo el mundo. El modelo ecológico examina sus formas y factores determinantes a través de niveles interconectados. Objetivo. Determinar la frecuencia, las características y los predictores de la violencia sexual contra adolescentes escolarizados en Perú. Materiales y métodos. Se llevó a cabo un estudio transversal en el cual se analizaron de manera secundaria los datos de la Encuesta Nacional de Relaciones Sociales (2019). Una muestra probabilística estratificada incluyó a 1.579 jóvenes de 12 a 17 años de 93 escuelas. Con el cuestionario se evaluó la violencia sexual en la familia y en la escuela. Se estimaron modelos mediante análisis de regresión logística, calculando la razón de momios (odds ratio, OR). Resultados. El 18,68 % (IC95%: 16,80-20,60) sufrió algún tipo de agresión sexual. Además, el 9,75 % (IC95%: 8,28-11,21) informó haber sido tocado en alguna parte del cuerpo y el 1,84 % (IC95%: 1,17-2,50) informó que fue víctima de violación. La edad se identificó como factor de riesgo en el microsistema (OR=1,48) (IC95%: 1,26-1,74), mientras que la edad de la primera violencia sexual actuó como factor protector (OR=0,61) (IC95%: 0,54-0,69). Además, en el macrosistema, la percepción de que la violencia ocurre principalmente fuera del hogar incrementó el riesgo (OR=2,06) (IC95%: 1,01-4,19). Conclusión. Aproximadamente, dos de cada diez encuestados informaron haber experimentado algún tipo de violencia sexual, siendo el acoso verbal y el contacto personal invasivo los más comunes. Ningún nivel del modelo ecológico o factor único puede explicar completamente la violencia sexual contra los adolescentes sin considerar su interconexión ecológica.
Assuntos
Delitos Sexuais , Humanos , Adolescente , Peru/epidemiologia , Estudos Transversais , Feminino , Masculino , Delitos Sexuais/estatística & dados numéricos , Criança , Fatores de Risco , Estupro/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
This study estimated the effects of the COVID-19 pandemic on maternal mortality in Chile between 2020 and 2021. A natural experiment was conducted using official data on maternal deaths and live births (LBs) between 1997 and 2021. The effects of the SARS-CoV-2 outbreak were evaluated using interrupted time series (ITS) and an autoregressive integrated moving average (ARIMA) model to forecast the expected rates on MMR and 95% confidence intervals (95% CI). In Chile, following World Health Organization suggestions, maternal deaths aggravated by SARS-CoV-2 are assigned to code O98.5 (non-respiratory infectious indirect) accompanied by code U07.1 or U07.2, depending on confirmation of the presence or absence of the virus. ITS analysis revealed that the SARS-CoV-2 outbreak impacted the MMR due to indirect causes, with a greater increase in indirect nonrespiratory causes than respiratory causes. The ARIMA forecast was consistent with ITS, showing that the expected MMR for indirect causes (3.44 in 2020 and 1.55 in 2021) was substantially lower than the observed rates (9.65 in 2020 and 7.46/100.000 LBs in 2021). For nonrespiratory indirect causes, the observed values of the MMR for 2020 (8.77/100.000 LBs) and 2021 (7.46/100.000 LBs) were double the predicted values of 4.02 (95% CI: 0.44-7.61) and 3.83 (95% CI: -0.12-7.79), respectively. A lower effect was observed on direct obstetrical deaths. During 2020-2021, there was a rise in the MMR in Chile attributable to SARS-CoV-2. The pandemic contributed to an escalation in the MMR due to indirect causes, particularly nonrespiratory and infectious causes. MMR due to direct obstetric causes were less affected. This suggests that the pandemic disproportionately affected maternal health by exacerbating conditions unrelated to pregnancy, childbirth, or postpartum, more than those directly linked to obstetric complications.
RESUMO
Background: Emerging pandemic viruses may have multiple deleterious effects on maternal health. This study examines the effects of a pandemic influenza virus on cause-specific maternal mortality time series, using Argentinian vital statistics. Methods: We conducted a population-based natural experiment from national vital records of maternal deaths between 1980 and 2017. Joinpoint regression models were used to model time series of the maternal mortality ratio (MMR). The sensitivity of the registry to detect the effects of the pandemic H1N1 2009 influenza virus on cause-specific MMR was analysed using a panel of parallel interrupted time series (ITS). Findings: Over this 38-year study, the MMR decreased by 58·6% (69·5 to 28·8 deaths/100,000 live births), transitioning from direct obstetric causes (67·0 to 21·1/100,000 live births; 68·4% decrease) to indirect causes (2·6 to 7·7/100,000 live births; 196·2% increase). The regression analysis showed an average reduction of -2·2%/year (95% CI: -2·9 to -1·4) with 2 join points in the total trend (1998 and 2009). Parallel ITS analyses revealed the pandemic H1N1 virus had an increasing effect on mortality from the respiratory system- and sepsis-related complications (level change 4·7 and 1·6/100,000 live births respectively), reversing after the outbreak. No effect was found on MMR from hypertensive disorders, haemorrhage, abortive outcomes, other direct obstetric causes, and indirect non-respiratory comorbidities. Interpretation: The Argentinian maternal death registry appears sensitive to detect different effects of emerging infectious epidemics on maternal health. In a population-based natural experiment, pandemic H1N1 virus impacted maternal mortality almost exclusively from the respiratory system- and sepsis-related complications. Funding: Supported by FISAR www.fisarchile.org.