ANA FLAVIA PIRES LUCAS D OLIVEIRA
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Departamento de Medicina Preventiva, Faculdade de Medicina - Docente
LIM/39 - Laboratório de Processamento de Dados Biomédicos, Hospital das Clínicas, Faculdade de Medicina
LIM/39 - Laboratório de Processamento de Dados Biomédicos, Hospital das Clínicas, Faculdade de Medicina
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article 426 Citação(ões) na Scopus The health-systems response to violence against women(2015) GARCIA-MORENO, Claudia; HEGARTY, Kelsey; D'OLIVEIRA, Ana Flavia Lucas; KOZIOL-MCLAIN, Jane; COLOMBINI, Manuela; FEDER, GeneHealth systems have a crucial role in a multisector response to violence against women. Some countries have guidelines or protocols articulating this role and health-care workers are trained in some settings, but generally system development and implementation have been slow to progress. Substantial system and behavioural barriers exist, especially in low-income and middle-income countries. Violence against women was identified as a health priority in 2013 guidelines published by WHO and the 67th World Health Assembly resolution on strengthening the role of the health system in addressing violence, particularly against women and girls. In this Series paper, we review the evidence for clinical interventions and discuss components of a comprehensive health-system approach that helps health-care providers to identify and support women subjected to intimate partner or sexual violence. Five country case studies show the diversity of contexts and pathways for development of a health system response to violence against women. Although additional research is needed, strengthening of health systems can enable providers to address violence against women, including protocols, capacity building, effective coordination between agencies, and referral networks.- Temporal Relationship Between Intimate Partner Violence and Postpartum Depression in a Sample of Low Income Women(2013) FAISAL-CURY, Alexandre; MENEZES, Paulo Rossi; D'OLIVEIRA, Ana Flavia Pires Lucas; SCHRAIBER, Lilia Blima; LOPES, Claudia S.To estimate whether there is a temporal association between Postpartum Depression (PPD) and intimate partner violence (IPV), and to assess the potential role of social support on this relationship. A cross-sectional study was conducted between January 2006 and March 2007 with 701 low income women who received prenatal and postpartum care in primary health care units of the public sector in So Paulo, Brazil. The Self-Report Questionnaire (SRQ-20) was used to assess the presence of PPD. Structured standardized questionnaires were used to assess IPV and social support. The prevalence of PPD was estimated with a 95 % confidence interval. Crude and adjusted prevalence ratios were calculated using Poisson regression to examine the association between PPD and exposure variables. Values of p < 0.05 were considered statistically significant. The prevalence of PPD was 27.9 % (95 %CI 24.6:31.2). The prevalence of psychological IPV was 38.6 %, physical IPV 23.4 %, and sexual IPV 7.1 %. The multivariate analysis showed that PPD was strongly associated with current psychological and physical/sexual violence, after controlling for confounding factors, and less so with past (prenatal or lifetime) IPV. Presence of social support was an independent protective factor for PPD. Identifying and addressing intimate partner violence, including psychological violence, in the postpartum period should be considered as part of a comprehensive approach to caring for new mothers.
- Factors associated with the severity of IPV perpetrated by substance using men towards current partner(2019) CANFIELD, Martha; RADCLIFFE, Polly; D'OLIVEIRA, Ana Flavia Pires Lucas; GILCHRIST, GailPurpose The purpose of this paper is to examine frequency and correlates of intimate partner violence (IPV) severity perpetrated by heterosexual men receiving treatment for substance use towards a current partner in the past 12 months. Design/methodology/approach A secondary analysis of a self-reported questionnaire (n=162) completed by men receiving treatment for substance use in England and Brazil was conducted. Types of IPV perpetration (emotional, physical and/or sexual IPV) and frequency of occurrence were assessed. A five level ordinal variable for IPV perpetration severity was created: no IPV, minor; moderate, low severe and high severe. Psychological and cultural correlates of perpetration severity were explored using ordinal logistic regression. Findings Approximately four in ten men reported perpetrating IPV towards their partner in the past 12 months, one in ten reported perpetrating severe IPV (including hitting with something, kicking or beating, choking or burning, threatening with/using a weapon, sexual IPV and frequent emotional IPV) during this period. A number of correlates of perpetration severity were identified: experiencing childhood physical abuse, witnessing IPV in childhood, perpetrating IPV in previous relationships, committing violence towards another man, controlling behaviours, technology-facilitated abuse, depressive symptoms, having a substance using partner, receiving treatment for illicit drug use, hazardous drinking and poly-drug use. Originality/value A strength of this study methodology is the use of a specific 12 months time frame for the perpetration of IPV towards current partner. The categorisation of levels of IPV perpetration based on types and frequency of violence occurrence was an additional valuable contribution of this study.
- Accounting for intimate partner violence perpetration. A cross-cultural comparison of English and Brazilian male substance users' explanations(2017) RADCLIFFE, Polly; D'OLIVEIRA, Ana Flavia Pires Lucas; LEA, Susan; FIGUEIREDO, Wagner dos Santos; GILCHRIST, GailIntroduction and AimsThis paper describes how substance use features in the accounts of intimate partner violence (IPV) perpetrators in treatment in England and Brazil. The aim of the research was to better understand cross cultural constructions of IPV perpetration amongst men in treatment for substance use. Design and MethodsSemi-structured interviews were conducted with 40 men in community substance use treatment in Sao Paolo, Brazil and London and the South East of England who had reported IPV perpetration in a questionnaire survey. A thematic, narrative analysis was carried out of men's explanations for IPV perpetration. FindingsThree types of narratives were distinguished: (i) disputes, centred on substance use, that escalate to IPV perpetration; (ii) IPV perpetration that is explained by uncharacteristic loss of control, as a result of intoxication; and (iii) IPV perpetration provoked by a perceived betrayal, in which substance use is incidental. In all types of accounts hegemonic principles of male and female roles and behaviour provided a context for and make IPV perpetration explicable. Discussion and ConclusionsSubstance use and IPV are culturally constructed and contextually defined. Understanding the meaning-making of substance using IPV perpetrators has implications for the treatment of both substance abuse and IPV. [Radcliffe P, d'Oliveira AFPL, Lea S, dos Santos Figueiredo W, Gilchrist G. Accounting for intimate partner violence perpetration. A cross-cultural comparison of English and Brazilian male substance users' explanations. Drug Alcohol Rev 2017;36:64-71]
- Controlling behaviours and technology-facilitated abuse perpetrated by men receiving substance use treatment in England and Brazil: Prevalence and risk factors(2017) GILCHRIST, Gail; CANFIELD, Martha; RADCLIFFE, Polly; D'OLIVEIRA, Ana Flavia Pires LucasIntroduction and AimsControlling behaviours are highly prevalent forms of non-physical intimate partner violence (IPV). The prevalence of perpetrating controlling behaviours and technology-facilitated abuse (TFA) was compared by men receiving substance use treatment in England (n=223) and Brazil (n=280). Factors associated with perpetrating these behaviours towards their current/most recent partner and their association with other types of IPV were explored. Design and MethodsSecondary analysis from two cross-sectional studies was performed. Data on socio-demographic characteristics, infidelity, IPV perpetration and victimisation, adverse childhood experiences (ACE), attitudes towards gender relations and roles, substance use, depressive symptoms and anger expression were collected. ResultsSixty-four percent (143/223) and 33% (73/223) of participants in England and 65% (184/280) and 20% (57/280) in Brazil reported controlling behaviours and TFA, respectively, during their current/most recent relationship. Excluding IPV victimisation from the multivariate models; perpetrating controlling behaviours was associated with a higher number of ACE, higher anger expression (England) and severe physical IPV perpetration (Brazil), and perpetrating TFA was associated with younger age. Including both IPV victimisation and perpetration in the multivariate models; perpetrating controlling behaviour was associated with experiencing a higher number of ACE, higher anger expression (England), emotional IPV victimisation (England) and experiencing controlling behaviour from a partner (England). The perpetration of TFA was associated with younger age and experiencing TFA from a partner. ConclusionsTechnological progress provides opportunities for perpetrators to control and abuse their partners. Controlling behaviours and TFA should be addressed to reduce IPV perpetration by males in substance use treatment. [Gilchrist G, Canfield M,Radcliffe P, d'Oliveira AFPL. Controlling behaviours and technology-facilitated abuse perpetrated by men receiving substance use treatment in England and Brazil: Prevalence and risk factors. Drug Alcohol Rev 2017;36:52-63]
- The prevalence and factors associated with ever perpetrating intimate partner violence by men receiving substance use treatment in Brazil and England: A cross-cultural comparison(2017) GILCHRIST, Gail; RADCLIFFE, Polly; NOTO, Ana Regina; D'OLIVEIRA, Ana Flavia Pires LucasIntroduction and AimsIntimate partner violence (IPV) perpetration is common among men who use substances. Substance use is a contributing factor for IPV perpetration. This cross-sectional study determined lifetime prevalence and factors associated with ever perpetrating IPV by men receiving substance use treatment in Brazil (n=281) and England (n=223). Design and MethodsIPV, adverse childhood experiences, attitudes towards gender relations and roles, current health state, substance use, depressive symptoms and anger expression were assessed. Logistic regression determined factors associated with ever perpetrating any (emotional, physical and/or sexual) IPV. Multinomial logistic regression determined factors associated with ever perpetrating different types of IPV. Results74.6% (373/500) reported ever perpetrating IPV: 16.5% (82/498) emotional IPV only, 46.4% (231/498) physical IPV (with/without emotional IPV) and 11.6% (58/498) sexual IPV (with/without emotional and/or physical IPV). Higher anger expression, higher depressive symptoms, fighting physically with another man in the past year (Brazil only), experiencing a greater number of adverse childhood experiences and a higher hazardous drinking score (England only) predicted ever perpetrating IPV. Compared to never perpetrating any IPV, anger expression was associated with emotional and physical IPV perpetration; fighting physically with another man in the past year was associated with physical IPV perpetration and experiencing a greater number of adverse childhood experiences and a higher hazardous drinking score were associated with both physical and sexual IPV perpetration. Discussion and ConclusionsIntegrated interventions that address IPV and substance use delivered in substance use treatment could improve outcomes for perpetrators and victims.[Gilchrist G, Radcliffe P, Noto AR, d'Oliveira AFPL. The prevalence and factors associated with ever perpetrating intimate partner violence by men receiving substance use treatment in Brazil and England: A cross-cultural comparison. Drug Alcohol Rev 2017;36:34-51]
- Ethical challenges in global research on health system responses to violence against women: a qualitative study of policy and professional perspectives(2024) LEWIS, Natalia V.; KALICHMAN, Beatriz; AZEREDO, Yuri Nishijima; BACCHUS, Loraine J.; D'OLIVEIRA, Ana FlaviaBackgroundStudying global health problems requires international multidisciplinary teams. Such multidisciplinarity and multiculturalism create challenges in adhering to a set of ethical principles across different country contexts. Our group on health system responses to violence against women (VAW) included two universities in a European high-income country (HIC) and four universities in low-and middle-income countries (LMICs). This study aimed to investigate professional and policy perspectives on the types, causes of, and solutions to ethical challenges specific to the ethics approval stage of the global research projects on health system responses to VAW.MethodsWe used the Network of Ethical Relationships model, framework method, and READ approach to analyse qualitative semi-structured interviews (n = 18) and policy documents (n = 27). In March-July 2021, we recruited a purposive sample of researchers and members of Research Ethics Committees (RECs) from the five partner countries. Interviewees signposted policies and guidelines on research ethics, including VAW.ResultsWe developed three themes with eight subthemes summarising ethical challenges across three contextual factors. The global nature of the group contributed towards power and resource imbalance between HIC and LMICs and differing RECs' rules. Location of the primary studies within health services highlighted differing rules between university RECs and health authorities. There were diverse conceptualisations of VAW and vulnerability of research participants between countries and limited methodological and topic expertise in some LMIC RECs. These factors threatened the timely delivery of studies and had a negative impact on researchers and their relationships with RECs and HIC funders. Most researchers felt frustrated and demotivated by the bureaucratised, uncoordinated, and lengthy approval process. Participants suggested redistributing power and resources between HICs and LMICs, involving LMIC representatives in developing funding agendas, better coordination between RECs and health authorities and capacity strengthening on ethics in VAW research.ConclusionsThe process of ethics approval for global research on health system responses to VAW should be more coordinated across partners, with equal power distribution between HICs and LMICs, researchers and RECs. While some of these objectives can be achieved through education for RECs and researchers, the power imbalance and differing rules should be addressed at the institutional, national, and international levels. Three of the authors were also research participants, which had potential to introduce bias into the findings. However, rigorous reflexivity practices mitigated against this. This insider perspective was also a strength, as it allowed us to access and contribute to more nuanced understandings to enhance the credibility of the findings. It also helped to mitigate against unequal power dynamics.