Resumo A violência por parceiro íntimo (VPI) é uma violação dos direitos humanos e um grave problema de saúde pública global. Este estudo investigou fatores associados à VPI em mulheres sobreviventes na Colômbia. Quatro discussões de grupos focais com mulheres sobreviventes de VPI e 15 entrevistas com informantes-chave com profissionais de serviços sócio-médico-legais foram realizadas usando amostragem intencional nas cidades de Cali e Tuluá. As transcrições foram analisadas manualmente, sob um ponto de vista construtivista social e uma abordagem de análise de conteúdo. Os fatores associados à VPI foram divididos em 4 temas: crenças culturais, ciúmes, abuso de álcool e história pessoal da VPI. O primeiro tema foi dividido em: patriarcado, papéis de gênero, normalização da violência, desconhecimento de direitos, dependência econômica e ‘homens possuem mulheres’. VPI foi descrita como uma construção sociocultural formada por valores patriarcais e processos individuais. A VPI é causada por uma complexa interação de diferentes fatores nos níveis do indivíduo, relacionamentos, comunidade e social. Os órgãos governamentais e não governamentais e a sociedade são instados a criar juntos estratégias preventivas e específicas no contexto.

Abstract Intimate partner violence (IPV) is a human rights violation and a serious global public health problem. This study investigated factors associated with IPV in female survivors in Colombia. Four focus group discussions with female survivors of IPV and 15 key informant interviews with professionals from psychological, social and legal services and community leaders were conducted in Cali and Tuluá. Participant recruitment was via purposive sampling. Transcripts were analysed manually taking a social constructivist standpoint and a content analysis approach. Factors associated with IPV were divided into four themes: cultural beliefs, jealousy, alcohol abuse, and personal history of IPV. The first theme was divided into: patriarchy, gender roles, normalisation of violence, and unawareness of rights, economic dependence, and ‘men own women’. The sub-themes were all inter-related and underpinned by patriarchal values. IPV was described as a sociocultural construction formed by patriarchal values ingrained in community and societal norms and individual processes. Therefore, academia, governmental and non-governmental bodies and society are urged to together, create preventative, context specific strategies for individuals, communities and societies.

Resumo A violência por parceiro íntimo (VPI) é uma violação dos direitos humanos e um grave problema de saúde pública global. Este estudo investigou fatores associados à VPI em mulheres sobreviventes na Colômbia. Quatro discussões de grupos focais com mulheres sobreviventes de VPI e 15 entrevistas com informantes-chave com profissionais de serviços sócio-médico-legais foram realizadas usando amostragem intencional nas cidades de Cali e Tuluá. As transcrições foram analisadas manualmente, sob um ponto de vista construtivista social e uma abordagem de análise de conteúdo. Os fatores associados à VPI foram divididos em 4 temas: crenças culturais, ciúmes, abuso de álcool e história pessoal da VPI. O primeiro tema foi dividido em: patriarcado, papéis de gênero, normalização da violência, desconhecimento de direitos, dependência econômica e ‘homens possuem mulheres’. VPI foi descrita como uma construção sociocultural formada por valores patriarcais e processos individuais. A VPI é causada por uma complexa interação de diferentes fatores nos níveis do indivíduo, relacionamentos, comunidade e social. Os órgãos governamentais e não governamentais e a sociedade são instados a criar juntos estratégias preventivas e específicas no contexto.

Abstract Intimate partner violence (IPV) is a human rights violation and a serious global public health problem. This study investigated factors associated with IPV in female survivors in Colombia. Four focus group discussions with female survivors of IPV and 15 key informant interviews with professionals from psychological, social and legal services and community leaders were conducted in Cali and Tuluá. Participant recruitment was via purposive sampling. Transcripts were analysed manually taking a social constructivist standpoint and a content analysis approach. Factors associated with IPV were divided into four themes: cultural beliefs, jealousy, alcohol abuse, and personal history of IPV. The first theme was divided into: patriarchy, gender roles, normalisation of violence, and unawareness of rights, economic dependence, and ‘men own women’. The sub-themes were all inter-related and underpinned by patriarchal values. IPV was described as a sociocultural construction formed by patriarchal values ingrained in community and societal norms and individual processes. Therefore, academia, governmental and non-governmental bodies and society are urged to together, create preventative, context specific strategies for individuals, communities and societies.

Resumo Devido à carência de serviços em saúde mental destinados aos Afro-colombianos vítimas de violência, a intervenção CETA (Common Elements Treatment Approach) foi implementada no pacífico da Colômbia. Dada a importância em melhorar essas intervenções, é necessário caracterizar o seu processo de execução. O objetivo deste artigo é descrever a realização da intervenção CETA para Afro-colombianos vítimas de violência em Buenaventura e Quibdó, Colômbia. Trata-se de estudo de caso com elaboração de entrevistas aprofundadas a Trabalhadores Comunitários Psicossociais (TCP), supervisores e coordenadores responsáveis pela execução CETA. Obtiveram-se seis categorias Núcleo: 1. Efeito do conflito armado e pobreza; 2. Severidade do trauma; 3. Mudanças percebidas com a intervenção CETA; 4. Características e desempenho dos TCP; 5. Enfoque na cultura Afro-colombiana; e 6. Estratégias para promover bem estar dos usuários. O contexto do pacífico colombiano está relacionado a múltiplos fatores, como o conflito armado ativo, crise econômica, e carência de serviços em saúde mental, afetando o processo de implementação e seus efeitos. Isto gera a necessidade de fortalecimento e estabelecimento de alianças institucionais, visando garantir a saúde mental das vítimas dessa região.

Abstract Due to the limited supply of mental health services for Afro-Colombian victims of violence, a Common Elements Treatment Approach (CETA) intervention has been implemented in the Colombian Pacific. Given the importance of improvement in mental health interventions for this population, it is necessary to characterize this process. This article seeks to describe the implementation of CETA for Afro-Colombian victims of violence in Buenaventura and Quibdó, Colombia through case studieswith individual in-depth interviews with Lay Psychosocial Community Workers (LPCW), supervisors, and coordinators responsible for implementing CETA. From this six core categories were obtained: 1. Effect of armed conflict and poverty 2. Trauma severity 3. Perceived changes with CETA 4. Characteristics and LPCW’s performance 5. Afro-Colombian culturalapproach and 6. Strategies to promote users’ well-being.Colombian Pacific’s scenario implies several factors, such as the active armed conflict, economic crisis, and lack of mental health care resources, affecting the implementation process and the intervention effects. This implies the need to establish and strengthen partnerships between institutions in order to administer necessary mental health care for victims of violence in the Colombian Pacific.

Resumo Devido à carência de serviços em saúde mental destinados aos Afro-colombianos vítimas de violência, a intervenção CETA (Common Elements Treatment Approach) foi implementada no pacífico da Colômbia. Dada a importância em melhorar essas intervenções, é necessário caracterizar o seu processo de execução. O objetivo deste artigo é descrever a realização da intervenção CETA para Afro-colombianos vítimas de violência em Buenaventura e Quibdó, Colômbia. Trata-se de estudo de caso com elaboração de entrevistas aprofundadas a Trabalhadores Comunitários Psicossociais (TCP), supervisores e coordenadores responsáveis pela execução CETA. Obtiveram-se seis categorias Núcleo: 1. Efeito do conflito armado e pobreza; 2. Severidade do trauma; 3. Mudanças percebidas com a intervenção CETA; 4. Características e desempenho dos TCP; 5. Enfoque na cultura Afro-colombiana; e 6. Estratégias para promover bem estar dos usuários. O contexto do pacífico colombiano está relacionado a múltiplos fatores, como o conflito armado ativo, crise econômica, e carência de serviços em saúde mental, afetando o processo de implementação e seus efeitos. Isto gera a necessidade de fortalecimento e estabelecimento de alianças institucionais, visando garantir a saúde mental das vítimas dessa região.

Abstract Due to the limited supply of mental health services for Afro-Colombian victims of violence, a Common Elements Treatment Approach (CETA) intervention has been implemented in the Colombian Pacific. Given the importance of improvement in mental health interventions for this population, it is necessary to characterize this process. This article seeks to describe the implementation of CETA for Afro-Colombian victims of violence in Buenaventura and Quibdó, Colombia through case studieswith individual in-depth interviews with Lay Psychosocial Community Workers (LPCW), supervisors, and coordinators responsible for implementing CETA. From this six core categories were obtained: 1. Effect of armed conflict and poverty 2. Trauma severity 3. Perceived changes with CETA 4. Characteristics and LPCW’s performance 5. Afro-Colombian culturalapproach and 6. Strategies to promote users’ well-being.Colombian Pacific’s scenario implies several factors, such as the active armed conflict, economic crisis, and lack of mental health care resources, affecting the implementation process and the intervention effects. This implies the need to establish and strengthen partnerships between institutions in order to administer necessary mental health care for victims of violence in the Colombian Pacific.

Resumen Objetivo: Determinar la asociación relación familiar-social con la intimidación escolar (IE) entre pares en instituciones educativas públicas de cuatro municipios del Departamento del Valle del Cauca en 2009. Métodos: Estudio de casos y controles apareados por sexo e institución educativa. La población de estudio provino de una base de datos secundaria aportada por la Secretaría Departamental de Salud, la cual estaba constituida por escolares matriculados en grados de 6.° a 11.°. Se aplicó la escala de CISNEROS y el APGAR familiar. Mediante regresión logística condicionada, se obtuvo un modelo explicativo de la IE. Resultados: Se encontró que los escolares que viven en un entorno familiar donde prevalece la violencia verbal y física y además tienen un vecindario hostil son más vulnerables a la IE. El riesgo de ser víctima de intimidación escolar se explicó por: la disfunción familiar (odds ratio [OR] = 2,67; intervalo de confianza del 95% [IC95%], 1,05-6,82), la agresión verbal en el hogar (OR = 2,81; IC95%, 1,45-5,46), padres castigadores (OR = 2,53; IC95%, 1,12-5,75) y vecinos que se agreden físicamente (OR = 1,87; IC95%, 1,00-3,56). Conclusiones: Se ratifica lo mencionado por López, quien plantea que la victimización y el rechazo escolar en la adolescencia se relacionan con factores externos al aula, como la calidad de la comunicación entre padres e hijos. Respecto a la influencia familiar en la IE, Bowes indica que la atmósfera positiva familiar se asocia significativamente con la resiliencia de los escolares a la victimización. Por otra parte, ser castigado de forma física genera al escolar problemas de autoestima que llevan a la carencia de actitudes de protección ante las agresiones que se presentan en la escuela.

Abstract Objective: To determine the association between family and social relationships and School Bullying (SB) among peers in public education institutions in four municipalities of the department of Valle del Cauca, Colombia, during 2009. Methods: A case-control study matched by sex and educational institution was carried out. The study population came from a secondary database provided by the Departof Health Secretaryhealth, which consisted of data gathered in a survey of schoolchildren enrolled in grades 6 to 11. The CISNEROS scale and the Family APGAR test were applied to measure outcome and exposure variables. A conditional logistic regression model was obtained to explain SB. Results: It was found that schoolchildren living with a family where verbal and physical violence prevails, as well as in a hostile neighborhood, are more vulnerable to SB. The probability of being an SB victim is explained by: family dysfunction (OR=2.67; 95%CI, 1.05-6.82), verbal aggression at home (OR=2.81; 95%CI, 1.45-5.46), physical punishing parents (OR=2.53; 95%CI, 1.12-5.75), and neighbors who are physically aggressive to each other (OR=1.87; 95% CI, 1.00-3.56). Conclusions: The study confirmed that reported by Lopez, who suggested that victimization and school rejection in adolescence is related to factors outside the classroom, such as the quality of communication between parents and children. As regards family influence in the SB, Bowes indicates that a positive family atmosphere is significantly associated with the resilience of school victimization. Furthermore, being physically punished by parents generates low self-esteem in the schoolchild that leads to lack of self-protective attitudes to the attacks that occur within the school.

The Region of the Americas, with a homicide rate of 16.4 per 100,000 population (2004), is the second most violent region in the world, but public policy-making for the prevention of violence and crime is hampered by the absence of reliable and comparable data on the problem's various manifestations. This paper describes a 14-country initiative, sponsored by the Inter-American Development Bank in part-nership with other regional agencies, to develop-collectively and by consensus- indicators for peaceful coexistence and citizen security that permit comparisons among countries, systematization of methods for the production and collection of pertinent data, the development of regional policies, and the dissemination and sharing of good practices. The selected indicators were homicide, death from road traffic injuries, suicide, death by firearm, sexual crime, family violence, child abuse, robbery, theft, vehicle theft and robbery, abduction, traffic offenses committed while under the influence of alcohol, general victimization, victimization by theft, victimization by robbery, perception of insecurity, perception of fear, confidence in institutions, and justification of the use of violence. For each indicator, agreement was reached on the type of measurement and the minimum variables that should be taken into account to have appropriate criteria for comparison.

La región de las Américas, con una tasa de homicidios de 16,4 por 100 000 habitantes (2004), es la segunda más violenta del mundo, pero la formulación de políticas públicas de prevención de violencia y delincuencia se ve obstaculizada por la ausencia de datos confiables y comparables sobre las diferentes manifestaciones del problema. El presente trabajo detalla un esfuerzo realizado por 14 países, patrocinado por el Banco Interamericano de Desarrollo y en asocio con otros organismos regionales, para desarrollar -de manera colectiva y consensuada- indicadores de convivencia y seguridad ciudadana que permitan comparaciones entre países, sistematizar métodos de producción y recolección de los datos pertinentes, generar políticas regionales y difundir e intercambiar buenas prácticas identificadas. Los indicadores escogidos fueron homicidio, muerte por lesiones de tránsito, suicidio, muerte por arma de fuego, delito sexual, violencia intrafamiliar, maltrato infantil, hurto, robo, hurto/robo de vehículos, secuestro, infracción de tránsito bajo efectos del alcohol, victimización general, victimización por robo, victimización por hurto, percepción de inseguridad, percepción de miedo, confianza en las instituciones y justificación del uso de violencia. Para cada indicador se acordó la forma de medición y las variables mínimas que deben tenerse en cuenta para contar con criterios de comparación apropiados.

Introducción: Según la OMS, en el 2020 aproximadamente 1,53 millones de personas se suicidarán y de 10 a 20 veces más lo intentarán. En el Departamento de Nariño (Colombia) se han venido presentado tasas sostenidas que superan el promedio nacional, y de estas muertes el 55% ha ocurrido en jóvenes entre los 15 y 24 años de edad, un patrón de comportamiento que difiere del descrito en otras partes del mundo, donde predominan los suicidios de adultos mayores. Objetivo: Determinar los factores individuales, familiares y sociales asociados en la ocurrencia del suicidio en el Departamento de Nariño. Metodología: Estudio de casos y controles entre 101 individuos, quienes se suicidaron (casos), y 112 muertos por lesiones no intencionales (controles), apareando por edad, municipio de residencia y fecha del suicidio. La información se tomó del familiar más cercano, mediante un cuestionario estructurado -con técnica de autopsia psicológica y recolección de los síndromes psiquiátricos más importantes (depresión, ansiedad, psicosis y consumo de sustancias psicoactivas)-. Resultados: En la muestra, el 70% de casos y controles corresponden a los hombres. En el modelo de regresión logística condicionada permanecieron los siguientes predictores como efecto independiente en el riesgo de suicidio: falta de práctica religiosa activa, escolaridad menor de 11 años, diagnóstico psiquiátrico previo, intento de suicidio previo, presencia de estrés agudo y depresión. Conclusiones y recomendaciones: Este estudio es uno de los pocos estudios analíticos realizados en Colombia. Además, con sus hallazgos es posible desarrollar un programa municipal de prevención de suicido en jóvenes de Pasto, Nariño.

Introduction: The WHO has estimated that approximately 1,53 millions of suicidal events and more than 10 to 20 times of suicide attempts will occurred by 2020 worldwide. Sustained rates of suicide exceeding the national average of 55% of these deaths mainly occurred in young people between 15 and 24 years, in the Department of Narino. This differs from the international pattern where suicide is predominantly in older adults. Objective: To determine individual, family related and social factors associated with the occurrence of suicide in the Department of Narino. Methods: A matched case-control study. A sample of 101 individuals, who committed suicide (cases), and 112 deaths from unintentional injury (controls), were matched for age, municipality of residence and date of suicide. The information for both (cases and controls) was collected from the nearest relative. A structured questionnaire -includes the psychological autopsy technique and screening of major psychiatric syndromes (depression, anxiety, psychosis, and psychoactive substance was used). Results: In the study sample, 70% of both cases and controls were male. When examine the conditional logistic regression model, Lack of religious practice, under 11 years of formal education, previous mental disease diagnosis, previous suicide attempt, presence of acute stress, and depression, are remained independent significant predictors to the effect on risk of suicide. Conclusions and Recommendations: This analytical study is one of the kind developed in Colombia. This study provided evidence to develop a municipal youth suicide prevention program in Pasto, Nariño.

OBJECTIVE: Describe the impact of interventions focused on decreasing deaths by motorcycle crash. MATERIAL AND METHODS: We analyzed variations in deaths by motorcycle crash in Cali when the interventions were implemented and the statistical significance of changes between 1993 and 2001. RESULTS: The rate of motorcyclist deaths per 100 000 inhabitants decreased from 9.7 in 1995 to 3.6 in 2001. The greatest reduction was observed after the introduction of the helmet law for motorcycle drivers in 1996 (12.3%). Other interventions-such as a helmet law for passengers, a reflective safety vest, a circulation ban for motorcyclists in December, and compulsory courses for all motorcyclists-produced a greater decrease in mortality; meanwhile, a lack of law enforcement increased it. CONCLUSIONS: The establishment and implementation of a combination of prevention strategies was more effective than a single or non-articulated strategy.

OBJETIVO: Este estudio se ideó para describir el efecto de las intervenciones dirigidas a disminuir las muertes de los motociclistas. MATERIAL Y MÉTODOS: Se analizaron las variaciones en la mortalidad de motociclistas en Cali, al momento de aplicarse las intervenciones, y el significado estadístico de dichos cambios, entre 1993 y 2001. RESULTADOS: La tasa de muerte de motociclistas por cada 100 000 habitantes se redujo de 9.7 en 1995 a 3.6 en 2001. La mayor reducción se observó después de la introducción del uso del casco protector en 1996 (12.3%). Otras medidas como la obligatoriedad del casco para los pasajeros, el uso del chaleco reflectivo, la prohibición de usar motocicletas en días de diciembre y la exigencia de cursos para infractores redujeron en su conjunto aún más la mortalidad, mientras que el debilitamiento de la vigilancia la incrementó. CONCLUSIONES: La implantación y ejecución de medidas combinadas de prevención resultan más efectivas que las medidas individuales o desarticuladas.

OBJECTIVE: Describe the impact of interventions focused on decreasing deaths by motorcycle crash. MATERIAL AND METHODS: We analyzed variations in deaths by motorcycle crash in Cali when the interventions were implemented and the statistical significance of changes between 1993 and 2001. RESULTS: The rate of motorcyclist deaths per 100 000 inhabitants decreased from 9.7 in 1995 to 3.6 in 2001. The greatest reduction was observed after the introduction of the helmet law for motorcycle drivers in 1996 (12.3%). Other interventions-such as a helmet law for passengers, a reflective safety vest, a circulation ban for motorcyclists in December, and compulsory courses for all motorcyclists-produced a greater decrease in mortality; meanwhile, a lack of law enforcement increased it. CONCLUSIONS: The establishment and implementation of a combination of prevention strategies was more effective than a single or non-articulated strategy.

OBJETIVO: Este estudio se ideó para describir el efecto de las intervenciones dirigidas a disminuir las muertes de los motociclistas. MATERIAL Y MÉTODOS: Se analizaron las variaciones en la mortalidad de motociclistas en Cali, al momento de aplicarse las intervenciones, y el significado estadístico de dichos cambios, entre 1993 y 2001. RESULTADOS: La tasa de muerte de motociclistas por cada 100 000 habitantes se redujo de 9.7 en 1995 a 3.6 en 2001. La mayor reducción se observó después de la introducción del uso del casco protector en 1996 (12.3%). Otras medidas como la obligatoriedad del casco para los pasajeros, el uso del chaleco reflectivo, la prohibición de usar motocicletas en días de diciembre y la exigencia de cursos para infractores redujeron en su conjunto aún más la mortalidad, mientras que el debilitamiento de la vigilancia la incrementó. CONCLUSIONES: La implantación y ejecución de medidas combinadas de prevención resultan más efectivas que las medidas individuales o desarticuladas.